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JUL 7 867
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LANE MEDICAL lOMMMT
SCO PA81EUR MIfE
PALO ALIO. CAUFOBOA 94304
ANSWERS
TO
QUESTIONS PRESCRIBED
BY
MEDICAL STATE BOARDS
BY
ROBERT B.^LIIDY, M.D.,
L&TB ACTINO- ASSISTANT 8URGBON, U. S. A. ; LECTURKR ON PRACTICE OP MKDICINB IN TEMPLE
COLLEGE OF PHILADELrHlA ; AUTHOR OF " ANSWEK8 TO QUESTIONS PREBCBIBED
BY DENTAL STATE BOARDS ;" " ANSWEIU> TO QUESTIONS PBESCKIBltD
BY PHAKHACEUTIOAL STATE BOARDS," ETC.
THIRD EDITION, REWRITTEN AND ENLARGED.
PHILADELPHIA :
JOHN JOS. McVEY.
1907
I
ANE LIBRARY. STANFORD UNlVERbl It
Entered according to the Act of Congifss, in the year 1U07,
By JOHN JOS. McVEY,
In the OfBce of the Librarian at Washington, D. C.
A-^
/
V
tA
PREFACE TO THIRD EDITION.
The large sale of this work has permitted the early prep-
aration of a third revision. The entire text has been care-
fully scrutinized, corrected where necessary, revised and
abbreviated where improvement could be made, and added
to by the incorporation of recent examination questions and
answers. This third edition has been edited throughout by
Charles Piatt, M. D., Ph. D. Robert B. Ludy.
PREFACE TO SECOND EDITION.
The indorsement of the first edition of this book by teach-
ers and students, as shown by numerous expressions of ap-
proval, as well as by its rapid sale, is extremely gratifying to
the author and seems to warrant its continuance.
All new State Board questions which have appeared since
the publication of the first edition have been added. It is
hoped that the careful revision to which the work has been
subjected has eliminated the errors which appeared in the
first edition.
Everything has been sacrificed to brevity and accuracy, so
that students will find the book indispensable in preparing
for college, hospital, army and navy examinations in the
shortest possible time.
(iii)
iv PREFACE TO SECOND EDITION.
Many persons having an adequate knowledge of the sub-
ject in which they are tested, fail because of their inability to
interpret properly the intents and purposes of the questions
to be answered by them. To aid in this, as well as to afford
a convenient manual for the general preparation of medical
students in their work, is the sole object of this book.
Having collected a large number of questions from differ-
ent states, it was found that duplications occurred ranging
from 30% to 80%, varying according to the several subjects.
Thus a comprehensive knowledge of these questions and an-
swers will serve excellently in the preparation of future ex-
aminations before such Boards.
In order to secure a critical interpretation of the questions,
and concise, yet complete, answers to the same, the author has
been favored by the assistance of well-known specialists in
their several lines, whose competence and experience give to
the work a range and value impossible of attainment in the
product of a single author.
To them the author makes grateful acknowledgment. The
high value of their carefully prepared answers is fully appre-
ciated by him, and will be by those into whose hands the work
is committed. Robert B. Ludy.
SPECIAL AUTHORS.
Herbert L. Northrop^ M. D.
Professor of Anatomy, and Associate Professor of Surgery in
the Hahnemann Medical College and Hospital of Philadelphia.
Wm. Hartnar Good^ A. M., M. JD.
Demonstrator in Physiology at the Medico-Chirurgical College
of Philadelphia.
diaries riatt, A. C, M. !>., Th. !>., JP. C S. Lond.
Author of Piatt's Medical Chemistry; Member of the Ameri-
can Chemical Society; Member of the Social ^ Chimique de Paris;
Honorary Fellow of the Society of Biological Chemistry of
London.
W. Wayne Babcock, M. 1>.
Professor of Surgery and Clinical Surgery in Temple College
of Philadelphia; Assistant Pathologist to the Philadelphia Hos-
pital, and Joint Author of Vol. V., Cohen's System of Physio-
logic Therapeutics.
JF» Mersey Thomas^ M. JD.
Lecturer on Surgery, Medico-Chirurgical College; Assistant
Surgeon, Medico-Chirurgical Hospital.
W. A. Neunnan JDortarifl^ M, D.
Associate in Gynecology, Philadelphia Polyclinic; Assistant
Obstetrician, Hospital of the University of Pennsylvania; Au-
thor of ** Modern Obstetrics,'' System of American Medical
Dictionaries, etc.
Thotnas L. Col^y^ M. JD.
Assistant Visiting Physician and Chief of Medical Dispensary,
Methodist Episcopal Hospital; Associate Editor Therapeutic
Monthly.
(V)
CONTENTS.
PAca
I. Anatomy 9
By Ilerbert L. Northrop, M. D.
II. PnYsiOLOOY 73
By Wm. Harmar Good, A. M., M. D.
III. Hygiene 135
By Robert B. Ludy, M. D.
IV. Chemistry 173
By Charles Piatt, M. D., Ph. D.
V. PATnOLOGY AND BACTERIOLOGY 307
By W. Wayne Babcock, M. D.
VI. Surgery 339
By W. Ilersey Thomas, M. D.
VII. Obstetrics and Gynecology 433
By W. A. Newman Borland, M. D.
VIII. Therapeutics and Materia Medica 519
By Thomas L. Coley, M. D.
IX. Practice op Medicine 613
By Robert B. Ludy, M. D.
(vii)
ANATOMY.
What is connective tissue? Where in the body is con-
nective tissue found?
Connective, or areolar, tissue consists of branched cells, or
connective tissue corpuscles, the fibres of which interlace and
form spaces or areolae. It is freely distributed throughout
the body, forms sheaths of muscles, blood vessels, nerves, etc.,
binds parts together and forms a generally evenly spread-out
layer beneath the skin, the superficial fascia.
Into what and how far from the pyloric orifice of the
stomach does the ductus communis choledochus normally
open?
Into the duodenum upon its concave side (descending por-
tion) three or four inches below the pyloric orifice.
Give the course, relations and structure of the ureter.
Begins in the upper expanded portion, the ** pelvis of the
kidney/' passes downward behind the peritoneum upon the
psoas magnus muscle, over the brim of the pelvis into pelvic
cavity, forward to base of bladder, between rectum and blad-
der in male, y^ i^^^^h from cervix in female, then between
vagina and bladder, terminating at posterior angle of trigone.
It consists of three coats, fibrous, nuLscular and mucous.
What constitutes the brachial plexus?
The 5th, 6th, 7th and 8th cervical nerves and 1st thoracic
nerve.
Mention the ligaments, fissures and lobes of the liver
Ligaments are five in number, falcifonn (suspensory),
round, coronary, right and left lateral ; fissures are five in
(9)
10 ANATOMY.
number, fissure for round ligament (obliterated umbilical
vein), for gall-Madder, for ductus venosus, for inferior cava,
and transverse fissure; lobes are five in number, right, left,
quadrate, Spigelian, caudate.
Mention the abdominal muscles. Describe any one of
these muscles.
External and internal oblique, transversalis, recti, pyra-
midales. (Quadratus lumborum, psoas magnus and parvus,
and iliacus might be included.) Internal oblique takes origin
from outer half of Poupart's ligament, from anterior two-
thirds of middle lip of iliac crest, from lumbar aponeurosis,
from last three ribs; is inserted into linea alba and inner
extremity of ilio-pectineal line behind Gimbernat's ligament.
Its aponeurosis divides to form sheath of rectus for its upper
three-fourths, passing in front of rectus for its lower fourth.
The line of this division of internal oblique is called linea
semilunaris ; internal oblique unites with transversalis to form
conjoined tendon. Action is to flex thorax upon pelvis, or
vice versa, to rotate trunk toward same side, and to compress
abdominal viscera.
Locate the principal groups of lymphatic glands.
Inguinal (superior and inferior), axillary and cervical
(supei-ficial and deep).
Give the anatomy of the true vocal cords.
Are two in number, formed by crico-thyroid membrane,
attached to retiring angle of thyroid cartilage anteriorly and
to vocal process of arytenoid cartilage posteriorly; have
thyro-arytenoid muscle along their outer side. They are
covered by mucous membrane, which is closely attached and
thin, and consisting of stratified, squamous epithelial cells.
Give the point of opening of the parotid duct, of the
submaxillary duct and of the sublingual duct.^
Parotid duct in cheek wall opposite middle upper molar
tooth; of submaxillary duct, in fnenum linguae; sublingual
duct, close to fraenum lingute.
ANATOMY. 11
Describe the ischiorectal fossae and their contents.
Are located between the lower part of the rectum and the
ischial tuberosities; are triangular in shape, bounded inter-
nally by sphincter ani, levator ani and coccygeus muscles;
externally by tuberosity of ischium; are filled with adipose
tissue; in outer wall is internal pudic artery; crossing the
space are inferior hemorrhoidal vessels and nerves.
State origin, course, and distribution of sixth cranial
nerve.
Superficial origin, from groove between medulla and pons ;
course, forward through cavernous sinus, exit from cranial
cavity by sphenoidal fissure; distribution to external rectus
of eye.
Give the relations of the right Icidney.
Rests upon quadratus lumborum and psoas magnus muscles,
is in contact with under surface of right lobe of liver, has
duodenum and ascending colon in front.
Describe the right ventricle of the heart.
Is placed mostly upon anterior aspect of heart, does not
extend to apex, is crescentic in cross-section, contains tricuspid
valve, which guards right auriculo-ventricular opening, to
left and front of which is conus arteriosus leading up to pul-
monary orifice, which is guarded by pulmonary semilunar
valves, contains columnse carnese, musculi papillares and
chord© tendineffi.
Describe endothelium.
Irregular, flattened (squamous) cells, attached edge to edge,
resting on basement membrai^e.
Describe the external carotid artery.
One of the two terminal branches of common carotid, given
off at level of upper border of thyroid cartilage, extends up
neck, passes into parotid gland, where it terminates by divid-
ing into superficial temporal and internal maxillary arteries.
Branches are: Ascending pharyngeal, to lateral wall of
12 ANATOMY,
pharynx; superior thyroid, to larynx and thyroid body; lin-
gual, to tongue; facial, to superficial parts of face; occipital,
to post-<5ervical and occipital regions ; posterior auricular, to
external and middle ear; superficial temporal, to scalp; in-
ternal maxillary, to deep parts of face and by middle menin-
geal (through foramen spinosum of sphenoid), to inner skull
wall and dura.
What muscles form the calf of the leg? Describe any
one of these muscles.
Gastrocnemius and soleus. Gnastrocnemius takes origin by
two heads from internal and external condylar ridges of
femur; these heads unite, join the soleus, thus forming the
tendo A chill is, which is inserted into the posterior extremity
of the OS calcis.
Describe the thyroid gland.
It consists of right and left lobes connected by an isthmus
across 2d, 3d and 4th rings of trachea; has a capsule and
trabeculae enclosing closed follicles, which contain colloid
material. "-/U..} ^if>/>>. (r /nt^/ j ; . ' y. '{. ^ - '^
Give a comprehensive description of any one of the
long bones of the body.
The humerus possesses a shaft and two extremities. The
upper end has a head which is hemispherical and articulates
with glenoid cavity of scapula. Just below it is the anatom-
ical neck, to which the capsule of the shoulder-joint is at-
tached. Then come the greater and lesser tuberosities, serving
for the attachment of muscles, while below them is the surgical
neck. The bicipital groove and ridges extend downward
between the two tuberosities, and also serve for the insertion
of muscles. Upon the posterior surface of the shaft is the
musculo-spiral groove. Rough impressions are found upon
the outer and inner aspects of the sh<aft for the deltoid and
coraco-brachialis muscles respectively. The lower end is ex-
panded laterally, to receive the radius and ulna, and supports
the outer and inner condyles. The articular surface is di-
ANATOMY. 13
vided into a capitellum externally for the head of the radius,
and a trochlea internally for the greater sigmoid cavity of
the ulna. A^bove the trochlear surface is the coronoid fossa
anteriorly, and the olecranon fossa posteriorly.
Into what two great classes are muscles divided? Give
a macroscopic and a microscopic description of each.
Voluntary and involuntary. The voluntary muscles num-
ber about 311 in the body. The fibres are bound into bundles
by connective tissue (perimysium), and are attached to bones,
ligaments or integument by bands of white fibrous tissue
called tendons. The involuntary muscular tissue is found
throughout the greater part of the wall of the alimentary
tract, in the walls of the arteries and veins, and in the uterus.
The microscopic appearance of a voluntary fibre is one that
is transversely striated, with a sarcolemma (sheath) inclosing
the sarcous elements. The involuntary fibre is fusiform, is
longitudinally striated, and possesses a centr^ally placed
nucleus.
Describe the right and the left subclavian vein.
The right subclavian vein rests on the first rib in front of
the scalenus anticus muscle, and is a continuation of the
axillary vein; just below and behind the stemo-elavicular
joint it unites with the internal jugular vein to form the right
innominate vein. The left subcl'avian vein does not differ
materially from the right; at the junction oif subclavian and
internal jugular on the left side the thoracic duct terminates.
The subclavian veins receive the blood from the upper ex-
tremities, shoulders, chest wall and superficial area of face
and neck.
Mention the flexor muscles of the forearm and describe
one of them.
Flexor carpi radialis, flexor carpi ulnaris, flexor sublimis
digitorum, flexor profundus digitorum, flexor longus pollicis.
Flexor profundus digitorum takes origin from upper % of
shaft of ulna, from coronoid process and from interosseous
14 ANATOMY.
membrane ; is inserted by 4 tendons into last phalanx of each
finger ; action, to flex last phalanx.
Compare aponeuroses with tendons.
Aponeuroses are broad, flat sheets of flbrous tissue to which
muscular fibres are attached, serving as tendons of insertion
for these fibres. Tendons are rounded- (cord-like) or narrow
(ribbon-like) bundles of fibrous tissue attaching muscles to
bones or forming ligaments of joints (shoulder, hip).
Give the number of the cervical vertebrae and mention
the marked characteristics of such of these vertebrae as
are in any way peculiar.
Seven. The atlas is a ring with two lateral masses sup-
porting a superior and an inferior pair of articular processes ;
it has no spinous process; the axis has an odontoid process
on the upper surface of its body; the 7th vertebra has a long
spine, hence its name, the vertebra prominens.
Name the bones of the head.
Occipital, 2 parietals, frontal, 2 temporals, sphenoid, eth-
moid, 2 nasal, 2 lachrymal, 2 inferior turbinals, vomer, 2
maxillse, 2 palate, 2 malar, mandible.
Describe the acetabulum.
Is formed by union of ilium, ischium and os pubis; has
horseshoe-shaped articular surface and non-articular depres-
sion at bottom; cotyloid notch is below and in front; is deep-
ened by cotyloid ligament in recent state attached to rim.
Name the seven muscles of the orbit.
Levator palpebrie superioris, superior, inferior, external,
internal recti, superior and inferior oblique.
Where is the compressor urethrae muscle?
Between the two layers of triangular ligament and sur-
rounds membranous urethra.
Describe the origin and distribution of the optic nerves.
They arise from the optic commissure, pass out of cranial
ANATOMY, 15
cavity with ophthalmic artery through optic foramen, pierce
sclerotic and choroid. «oats of eyeball to nasal side of posterior
pole and are distributed to retinae.
What is the solar plexus?
A neuro-ganglionic collar of the sympathetic nervous system
surrounding celiac axis, from whdch nerve trunks accompany
arterial branches to supply all abdominal viscera.
Name the foramina at the base of the skull, and the
structures transmitted through each.
Foramen magnum : Spinal cord, meninges, spinal accessory
nerves, vertebral arteries. Posterior condyloid (inconstant) :
Veins. Anterior condyloid (2) : Hypoglossal nerves. Mas-
toid: Emissary vein. Internal auditory meatus: Auditory
and facial nerves, auditory artery. Jugular foramen : Lateral
and inferior petrosal sinuses, glosso-pharyngeal, pneumogas-
tric and spinal accessory nerves. Hiatus Fallopii: Great
superficial petrosal nerve. Middle lacerated foramen: In-
ternal carotid artery, sympathetic plexus. Foramen spino-
sum : Middle meningeal artery. Foramen ovale : Miandibular
division of sensory root of fifth cranial nerve and motor root
of fifth. Foramen rotundum: Maxillary division of fifth.
Vidian canal: Vidian nerve. Optic foramen: Optic nerve
and ophthalmic artery. Sphenoidal fissure: Motor oculi,
trochlear and abducens nerves, ophthalmic division of fifth,
ophthalmic vein. Olfactory foramina: Olfactory nerves.
Describe the female urethra as to (a) location, (b)
dimensions, (c) structure.
Is located anterior to vagina, extending from internal uri-
nary meatus (neck of bladder) to external urinary meatus
in vestibule, close to anterior margin of vaginal orifice. It
is iy2 inches long and quite dilatable. Is lined with mucous
membrane (squamous epithelium, stratified) which is thrown
into longitudinal folds, and is surrounded by an areolar coat
and by muscular layers containing inner longitudinal and
16 ANATOMY.
outer circular fibres, with an abundance of yellow elastic
tissue and many vessels, especially veins.
What is contained in the right hypochondriac region?
Part of right lobe of liver, part of gall-bladder, part of
ascending colon, hepatic flexure, part of right kidney.
What mtiscles form the tendo Achillis, and where is the
tendon inserted?
Gastrocnemius and soleus; inserted into posterior part of
OS calcis.
What forms the internal malleolus of the ankle-joint?
The lower end of the tibia.
Describe the bones of the foot, giving their divisions
and articulations.
Tai-sus consists of os calcis, astragalus, cuboid, scaphoid,
cuneiform bones (internal, middle and external) ; metatarsus
consists of five bones; phalanges number fourteen. Astra-
gulus articulates with tibia, fibula, os calcis, scaphoid. Os
calcis articulates with astragalus, cuboid. Scaphoid articu-
lates with astragalus and three cuneiform bones. Cuneiform
bones articulate with scaphoid behind, with each other lat-
erally, and with first, second, third and fourth metatarsal
bones in front. Metatarsals articulate with three cuneiform
and cuboid behind, with each other, and with first phalanges.
Phalanges articulate with metatarsals and with each other.
Name the articulations of the occipital bone.
Atlas, two pjarietals, two temporals, sphenoid.
What are the special characteristics of the left ven-
tricle of the heart?
It forms the apex of the heart ; its wall is thicker than that
of the right ventricle; its musculi papillares are fewer in
number and larger; auriculo-ventricular valve (mitral) is
made up of two segments.
ANATOMY. 17
Describe the auditory apparatus.
Consists of three divisions, viz., external, middle and in-
ternal ear. Auricle is attached to temporal bone, is made
up of elastic cartilage, leads into external auditory meatus,
at bottom of which is obliquely placed membrana tympani.
^liddle ear is narrow cavity in petrous bone, Eustachian
tube connecting it with the naso-pharynx ; mastoid antrum
is in upper posterior part, leading into mastoid cells; it is
lined with mucous membrane. The internal ear consists of
osseous labyrinth containing membranous labyrinth, and is
made up of vestibule, cochlea and three semicircular canals.
To membranous labyrinth auditory nerve is distributed.
Mention the sutures at the vertex of the skull and state
what bones they unite.
Sagittal suture, uniting the two parietal bones; lambdoid,
uniting occipital with both parietals; coronal, uniting both
parietals behind with frontal anteriorly.
Mention and describe the salivary glands.
Parotid, submaxillary, sublingual. Parotid, largest, placed
in front of ear, behind ramus of mandible; duct (Stcno's)
passes across masseter muscle, perforates buccinator muscle,
terminates in cheek wall opposite upper middle molar. Par-
otid has facial nerve, external carotid artery, temporo-maxil-
lary vein passing through it.
Submaxillary gland. is located upon inner side of body of
mandible posteriorly, is crossed by facial artery; duct (Whar-
ton's) passes forward, terminating close to fraenum lingusB.
Sublingual gland, located in shallow fossa upon inner side
of body of mandible, near symphysis, is covered by mucous
membrane of mouth; ducts (Bartholin's) terminate near
fraenum linguse.
Mention any one muscle which moves the humerus (a)
forward, (b) backward, (c) inward.
(a) Coraco-brachialis ; (b) posterior fibres of deltoid; (c)
latissimus dorsi.
2
'\
18 AXATOMY.
What would be the collateral circulation if the brachial
artery were ligated below its profunda branches?
Superior and inferior profunda above, anastoniotica magna,
radial and ulnar (anterior and posterior) recurrent below.
Describe the Meibomian gilands.
Sebaceous glands einbeddeil ia posterior surfafle of tarsal
plates of eyelids, <wn.sisting of single duct with closely at-
tached acini, orifices of duets tenninating in single row of
apertures along posterior lid- margin.
Give location and a description of the tubercuia quad-
rigemina.
Located upon upper surface of crura cerebri, just behind
third ventricle and beneath posterior part of velum inter-
positum ; nates anterior to testes. They consist of gray mat-
ter externally, white internally, and are connected with bra-
chia of optic tracts.
Describe the renal blood circulation.
Arterial blood cutera sinus through hiUim by means of renal
artery, branches of which pass between Malpighian pyramids
to eortico- medullary junction, where they form transverse
branches which send arterioles into cortical and medullary
portions of kidney, forming glomeruli in the former, and
plexuses around the uriniferous tubules in the latter. The
veins collect the blood from these parts, form corti co-medul-
lary branches and pass through medullary portion between
pyramids, leaving kidney through sinus as renal vein.
Mention the muscles attached to the great trochanter
of the femur.
Gluteus medius and minimus, pyriformis. obturator iuter-
nus, gemellus superior and inferior, obturator externus.
What arteries, muscles and nerves would be severed in
a cross-section at the middle of the humerus?
Brachial, superior and inferior profunda; biceps, triceps.
ANATOMY. 19
insertions of deltoid and coraxjo-brachialis, origin of brachi-
alis anticus; musculo-cutaneous, internal cutaneous, median,
ulnar, musculo-spiral.
Describe the vagina.
Begins at vulvar aperture, extends upward and backward
in axis of outlet of pelvis, surrounds cervix uteri, reaching
higher up on cervix posteriorly than anteriorly, is lined with
laminated squamous cells, has large venous plexuses in sub-
mucosa, contains circular (within) and longitudinal (wiji-
out) involuntary muscle fibres. Bladder and urethra are in
front, rectum is behind. Peritoneum covers upper posterior
Differentiate synarthrosis, amphiarthrosis, and diarth-
rosis, giving an example of each.
Synarthrosis is an immovable joint consisting of two bones
placed edge to edge with little or no fibrous tissue intervening ;
example, lanibdoid suture. Amphiarthrosis is joint permit-
ting of slight motion, made up of two bones with intervening
fibrocartilaginous plate or disk and held together by liga-
ments; example, joints formed by bodies of vertebrae and
intervertebral disks. Diarthrosis is freely movable joint,
consisting of two or more bones with articular surfaces cov-
ered with hyaline cartilage and surrounded by ligaments lined
with synovial membrane ; example, hip- joint.
Describe the shoulder-joint.
Variety, enarthrodial (ball-and-socket) ; bones, glenoid
fossa of scapula, head of humerus; ligament, capsular, which
is intimately blended with tendons of insertion of sub-scapu-
laris, supraspinatus, infraspinatus and teres minor muscles;
tendon of long head of biceps passes within capsule over
humeral head, and is surrounded by synovial membrane;
movements, flexion, extension, abduction, adduction, rotatiou
>^ and circumduction.
y ^ ^ Give the origin, insertion, action and nerve supply of
1
20
ANATOMY.
■^
any one of the following muscles: superior oblique, mas-
seter, trapezius.
Trapezius, origin from external occipital protuberance,
inner third of supefior curved line of occipital bone, iiga-
nientuin nuclne, spine of seventh cervical vertebra, spines of
all thoi-acie verteibne; insertion into posterior border, outer
third of clavicle, inner margin of acromion and entire upper
border of spine of scapula ; action, to retract head, to approxi-
SseapuliP, to elevate point of shoulder, to assist serratuB
us in rotating scapula, as in act of carrying arm to up-
right vertical position; nerves, spinal accessory, third and
fourth cervical.
Give the origin, main branches and relations of any
one of the following arteries: external carotid, axillary,
femoral.
' jVxillary artery is continuatioo of subclavian from outer
border of 1st rib, extends to lower border of axilla (teres
major muscle) in line indicated by coraco-brachialls muscle
(inner border), lying behind and above axillarj' vein; outer
cord of bracliial plexus is above it, inner cord is below it,
posterior cord is behind it, median nerve lies upon it; pecto-
ralis minor muscle crosses it in front, pectoralis major .is ante-
rior to first and third portions; branches are superior tho-
racic, acromial thoracic, long thoracic, alar thoracic, sub-
scapular, anterior and posterior circumflex.
Describe the course of the nerve fibres in the optic
commissure.
Fibres upon its posterior surface (Gudden's commissure)
have nothing to do with sight, and unite posterior quadri-
geminal bodies (testes) ; middle fibres decussate, those from
right optic tract passing to left optic nerve and vice versa,
to terminate in nasal half of retina; outermost fibres of each
tract do not decussate, but pass into optic nerve to be dis-
tributed to temporal half of retina of same side.
ANATOMY. 21
Give the origin, course and distribution of the great
sciatic nerve.
Origin from lower lumbar and upper sacral nerves (sacral
plexus; eourse, through great saero-sciatic foramen below
pyriformis muscle, from beneath lower margin of gluteus
maximus midway between trochanter major and tuber ischii,
rests upon adductor magnus and divides about middle of thigh
into internal and external popliteal nerves; it supplies semi-
tendinosus, semimembranosus, adductor magnus and biceps.
Internal popliteal is continued down leg as posterior tibial,
distributed to back of leg and sole of foot ; external popliteal
curves around below head of fibula to front of leg, becoming
anterior tibial to front of leg and dorsum of foot
Describe the great omentum.
^lade up of double fold of peritoneum, extending from
greater eurvature of stomach downward for variable distance,
then returning, surrounds transverse colon. It contains be-
tween its layers more or less adipose tissue.
Give the gross and the topographic anatomy of the
pancreas.
The '* abdominal salivary gland *' is located in upper pos-
terior part of abdomen, behind stomach, in front of vertebral
column and left kidney, and to right of spleen. Is elongated,
soft in consistency, made up of lobules held together by con-
nective tissue, is pinkish in color, and is divided into tail,
body and head, the latter embraced by curve of duodenum.
Is supplied by branches from splenic artery, which courses
along upper border. Its duct, extending throughout the
length of the gland, terminates with common bile duct in
descending portion of duodenum.
Locate and describe the pericardium.
Fibro-serous sac surrounding heart, pyramidal, with base
attached to central tendon of diaphragm, apex corresponding
to great vessels at base of heart, and connected with deep
22 ANATOMY.
cervical fascia by fibrous prolongations upward. Outer layer
fibrous, lined with parietal serous layer, which is retleeted
upon heart and vessels at its base, constituting the visceral
layer.
Describe and give the anatomical relation of the ap-
pendix vermiform is.
Is 31/^ to iy^ inches long, made up of inner mucous coat,
which is thickly set with simple, tubular glands (crypta of
Lieberkuhn) and covered with columnar epithelium, beneath
which is a thick layer of adenoid tissue, diffused and collected
into closed follicles; oulside of raucous membrane is sub-
mucosa, with plexuses of vessels and nerves; next comes
muscular layer, having thick, inner circular and thinner,
outer longitudinal layer; the peritoneum surrounds the ap-
pendix and forms a meso-appendix, usually extending along
one-half the length of the organ; in this the appendicular
artery (branch of ileo-colic) courses; arterial supply is of the
end-artery variety; the nerves are branches of the superior
mesenteric plexus of the sympathetic system. The appendix
is attached to t!he cecum, Tisually depending from its inner
and posterior aspect, not far from ileo-cecal junctiom; it may
extend in any direction. In the female a fold of peritoneura
is continued from the broad ligament to the meso-appendix
( appendiculo-ovarian ligament), and conveys a branch of the
ovarian artery.
Describe Poupart's ligament, naming its anatomical re-
lations and uses as a surgical guide.
Is formed by aponeurosis of external oblique muscle blend-
ing with fascia lata, and extends, slightly curved downward,
from anterior superior iliac spine to pubic srpine; a reflected
portion, Ginlbernat's ligament, is attached to pubic end of
iliopectineal line, forming inner margin of femoral (crural)
ring (neck of femoral hernia). Beneath Poupart's ligament
external ctrtaneous nerve, iiio-psoas muscle, anterior crural
nerve, femoral artery and vein are locatedi; above and to
ANATOMY. 23
outer side of pubic spine it forms outer pillar of external
inguinal ring.
Describe the femoral artery and its branches.
Begins as continuation of external iliac beneath middle of
Poupart's ligament, extends downward, bisecting Scarpa ^s
triangle, through Hunter's canal, at lower end of which it
becomes the popliteal. Branches are superficial epigastric,
superficial circumflex iliac, superficial and deep external
pudic, profunda, anastomotica magna, muscular.
Name the principal lobes of the brain and the fissures
dividing them.
Frontal, parietal, temporal, occipital, central (island of
Reil). Fissure of Rolando separates frontal from parietal;
fissure of Silvius separates frontal and parietal from tem-
poral; parieto-occipital fissure separates parietal from occip-
ital ; central lobe is found deeply placed in Sylvian fissure.
Name the twelve pairs of cranial nerves.
Olfactory, optic, motor oculi, trochlear, trigeminal, abdu-
cens, facial, auditory, glosso-pharyngeal, pneumogastric, spi-
nal accessory, hypoglossal.
Name the bones articulating with the humerus.
Scapula, radius, ulna.
Describe the Eustachian tubes.
Two tubes connecting middle-ear with naso-pharynx.
Pharyngeal orifice is usually vertical slit just above floor of
nasal chamber, behind posterior naris, and bounded poste-
riorly by * * cushion ' ' of pharynx. Tube is formed by tem-
poral bone in angle between squamous and petrous portions,
and by coiled' plate of cartilage attached to edge of bony part
of tube ; is lined with ciliated columnar epithelium.
Describe the diaphragm, its principal openings and
nerve supply.
Dome-shaped muscle, origin from inner surface of last six
ANATOMY.
costal cartilages, posterior surface of enBiform cartilage, by
two crura from bodies of lumbar vertebriE (2d to 4th), from
ligamenta arcuata, external and internal. Insertion into
aponeurotic centra! tendon, which consists of three leaflets.
Aortic opening is between crura, and transmits aorta, thoracic
duct and vena azygos major; esophageal opening is anterior
and slightJy to left of vertebral column, transmitting eso-
phagus and both pneumogastric nerves; caral opening is in
right leaflet of central tendon, and to its margins the outer
coat of inferior cava is attached. Nen-e siipply, both
phrenics.
Describe the broad ligaments of the uterus and their
anatomical relations.
Double folds of peritoneum attached to floor and lateral
margins of true pelvis, covering uterus anteriorly and pos-
teriorly, reflected from it to bladder in front and to vagina
behind. Between its layers are found Fallopian tubes, round
ligaments, utero-ovarian ligaments, uterine and ovarian
arteries and veins, lymphatics, and ietal relics. The ovaries
are attached to it behind, near the pelvic brim.
Describe the crystalline lens, and state what tissues are
in contact with it, and how.
Is a transparent, biconvex body, convexity being greater
upon posterior surface than upon anterior; is contained in
capsule, which is elastic; it consists of lens-fibres, which are
derived from epithelial cells (ectoderm), arranged in layers,
which are of softer consistency near the surface (cortex),
more compact and dense at the center (nucleus). It is non-
vascular in the adult, its nutrition being maintained by inter-
cellular transmission of nutritive fluids. Its suspensory lig-
ament is formed by hyaloid membrane enclosing the vitreous,
and is attached to lens capsule. The lens rests in patellar
fossa of vitreous, iris (pupillary margin) rests upon its ante-
rior surface. Jind ciliary processes are in relation with its
circular edge.
ANATOMY. 25
Give a brief description of the membranes of the brain.
The dura lines the cranial cavity, is adherent to the vault,
sides and base, and sends processes between cerebral hemis-
pheres (falx cerebri), between eerebrum and cerebellum
( tentorium cerebelli) , and between hemisphere of cerebellum
(falx cerebelli); it splits to form spaces for the intima of
veins, known as venous sinuses. The arachnoid, between dura , \ A
and pia, is thin and delicate, and contains spaces for cerebro- :. /
spinal fluid, best developed at base of brain. The pia closely ' \ \
invests the encephalon, dipping into fissures and sulci, send-
ing arterial branches into cerebral substcinee and receiving
veins from same, and passes through transverse fissure into in-
terior of brain, constituting velum interpositum, and furnish-
ing choroid plexuses of ventrieles.
Describe the gross anatomy of the larynx.
Consists of cartilaginous framework, ligaments, muscles,
and is lined with mucous membrane. Cartilages are thyroid, yl
cricoid, two arytenoids, two comicula laryngis and epiglottis. j/
Thyroid is shield-shaped, projects forward as pomum Adami ;
cricoid is ring-shaped, is placed- below thyroid, is broad pos-
teriorly and supports arytenoids, one on each side of posterior
quadrilateral portion. Epiglottis is attached by stem to angle
of thyroid, and is directed upward over entrance to larynx.
Crico-th^Toid membrane extends from ericoid cartilage up-
ward within thyroid, and by rounded, free edge forms true
vocal bands, whieh extend between thyroid anteriorly and
vocal processes of arytenoids posteriorly. Lateral crico-
arytenoid muscles approximate vocal bands, posterior crico-
arytenoid muscles separate them. Superior laryngeal artery
pierces thyro-hyoid membrane to supply interior of larynx,
superior laryngeal nerve is nerve of sensation to mucous
membrane, and recurrent laryngeal is motor nerve to all mus-
cles but one (crieo-thyroid) supplied by superior laryngeal.
Minutely describe the relations of the peritoneum to
the bladder.
Covers upper surface and sides, reflected on to rectum in
26 ANATOMY.
male and va-gina in female; leaves anterior abdominal wall
just above symphysis to form loose fold between bladder and
symphysis, then passing to summit of bladder without cover-
ing its anterior wall, thus forming prevesical space (space of
Retzius) .
Describe the endocardium.
Is eontimious with the tunica intima of the vessels at the
base of the heiart, lines both auricles and both ventricles, and
forms, strengthened by fibrous tissue, the several valves of
the heart.
What parts of the brain does the Pons Varolii connect?
Cerebellum with posterior quadrigeminal bodies (testes),
one cerebellar hemisphere ^ritli the other, parts below (cord
and medulla) with cerebml hemisphere above.
Name the ganglia connected with the 5th pair of cranial
nerves.
Gasserian, ophthalmic, sphe no- palatine (Meckel's), otic,
submaxillary.
Give an anatomical description of the bronchia) tubes.
Formed by division of trachea-, right and left bronchial
tubes pass into right and left lungs respectively at root of
lung, dividing and subdividing, finally becoming bronchioles.
Each consists of rings or plates of cartilage held together by
an elastic membrane, and are lined by mucous membrane
possessing ciliated columnar epithelial cells in larger tubes
and squamous cells in smallest tubes.
Name the branches of the subclavian artery.
Vertebral, internal maniiHary, thyroid axis (inferior thy-
roid, transverse cervical, suprascapular), superior intercostal.
Describe the inguinal canal.
Is a Hat-sided pastsa^e in the lower part of the inguinal
region, extending between internal and external abdominal
rings; its " floor " is formed by tranaversalis fascia meeting
ANATOMY, 27
Poupart's ligament; its **roof by conjoined tendon (internal
oblique and transversalis muscles) ; interior wall by skin,
superficial fascia, aponeurosis of external oblique, internal
oblique ; posterior wall by transversalis fascia, pre-peritoneal
fat and peritoneum. Is about II/2 inches long in adult, trans-
mitting spermatic cord in male and round ligament in female.
If the femoral artery were obstructed at the apex of
Scarpa's triangle, through what channels would the blood
flow to reach the tibial artery?
Through profunda femoiis and its branches, anastomosing
with articular branches of popliteal.
Name the structures that maintain the bladder in posi-
tion, male and female.
Recto- vesical fascia, folds of peritoneum, in both sexes;
rectum in male, uterus and vagina in female.
Where are the ventricles of the larynx?
Between the true and false vocal cords.
Describe the triangle of the elbow and name the struc-
tures that pass through it.
Base directed upward, formed by line drawn between the
two condyles, outer side bounded by supinator longus, inner
side by pronator radii teres; floor is formed by brachialis
anticus and supinator brevis. It contains brachial artery
and venae comites, radial and ulnar arteries, median and
musculo-spiral nerves, and tendon of biceps.
Name the abdominal viscera partially covered by peri-
toneum.
Right and left suprarenal bodies, right and left kidneys,
pancreas, duodenum, ascending and descending colons, rec-
tum, bladder, uterus.
Describe the arteries and veins passing to and from the
kidneys.
Renal artery, branch of abdominal aorta, enters hilum.
28
ANATOMX.
breatai up into branchea which pass between Malpighian pyra-
mids to eorticD-medullary junction, then sending branches
into cortex and medulla. Veins are similarly arranged, be-
yiinning in interior of kidney ; they leave by passing through
sinus and hiluni, known as renal vein, to join inferior cava.
Give the anatomy of the bladder, including blood and
nerve supply.
A reservoir iu thi? pehis, partially covered by peritoneum,
consisting of involuntary nniacular fibres extending in longi-
tudinal and cireular directions, a submucosa and a mucous
membrane, the latter possessing transitional, squamous epithe-
lial cells. Blood supply is from internal iliac artery, through
superior, middle and inferior vesical branches; nerve supply
is from pelvic plexus of sympathetic and from 3d to 4th
sacral nerves.
Describe the testes.
They are two seminal glands contained vrilhin the scrotal
cavity, suspended by the spermatic cord, and surrounded by
a peritoneal process, the tunica vaginalis testis. Each eland
consists of a fibrous stroma, the tunica albuginea. dividing
the interior into compartments which contain the seminiferous
tnbules, the latter eonverging toward the posterior part of
the gland, and emerging to constitute the epididymis.
Describe the structure of the prostate gland and give
its anatomical relations.
It possesses a capsule of fibrous tissue, enclosing voluntary
and involuntary muscle and branched tubular glands openin»
into prostatic urethra; base is closely applied to "neck" of
bladder, circular muscular fibres of which are continued
around prostatic urethra, which pierces prostate from base
to apes; behind is rectum; in front is pubo-prostatic plexus
of veins separating it from symphysis pubis; ejaculatory
ducts pass through gland between middle and lateral lobes.
With what bones does the clavicle articulate?
Sternum, cartilage of first rib, scapula.
ANATOMY. 29
Give the origin and distribution of the median nerve.
Formed by branch from outer and one from inner cord of
brachial plexus in axillary space, over front of axillary artery,
is in close relation to brachial artery to bend of elbow, when
branches are distributed to all superficial muscles in front of
forearm except flexor carpi ulnaris; a branch known as ante-
rior interosseous supplies outer half of flexor profundus, flexor
longus pollicis and pronator quadratus (deep muscles) ; in
the palm the median is distributed to integument of flexor
surface of thumb, index, middle and middle-finger half of
ring finger and their contiguous sides, and dorsum of distal
segment of thumb and fingers (2i/^), motor branches to ab-
ductor and opponens pollicis, superficial head of flexor brevis
pollicis and two outer lumbricales.
Where is the fissure of Sylvius and what artery does it
contain?
Begins at anterior perforated space, separates frontal and
parietal lobes from temporal lobe, passes upward and back-
ward to terminate in parietal lobe; contains middle cerebral
artery.
Name the branches of the brachial artery.
Superior profunda, nutrient, muscular, inferior profunda,
anastomotica magna, radial and ulnar (terminals).
Name the component parts of the spermatic cord.
Spermatic artery, spermatic veins (pampiniform plexus),
vas deferens, deferential artery and deferential veins, lym-
phatics, nerves (spermatic plexus of sympathetic).
What forms the internal hamstrings?
Tendons of semitendinosus, semimembranosus, gracilis.
Describe the location of the intercostal arteries.
In the intercostal groove near the lower border and inner
surface of the rib; anteriorly it occupies the upper part of
the intercostal space.
I
What bone forms the heel and with what does it artic-
ulate?
Oa calcia; with astragalus and cuboid.
What arteries supply the heart with blood, and where
do they originate?
Coronary (2), springing from arch of aorta just above
sinuses of Valsalva of aortic semilunar valve.
Name the structures located in the inguinal canal and
give their anatomical relations.
ypei-niatic conJ in male, round ligament in female. Are in
relation with walls of inguinal canal, which are, anterior,
external oblique aponeurosis entire length, conjoined tendon
(interna! oblique, transversalis) for outer third; posterior,
transversalis fascia and, at inner end, insertion of conjoined
tendon; floor is formed by Poupart's ligament and trans-
versalis fascia; roof by arched fibres of conjoined tendon.
Describe the thoracic duct.
Begins upon body of second lumbar vertebra in dilated
pouch called receptaculura chyli, passes through aortic open-
ing in diaphragm, then through posterior mediastinum, and
at base of neck arches to left, terminating at junction of left
subclavian and internal jugular veins. It drains the lymph
from all parts of body except right up^ier extremity, right
side of head and necic, right half otf thorax (right lung and
right side of heart) and upper surface of liver.
Describe the pleura.
A closed serous sac lining the thoracic wall (parietal layer),
from which it is retlected to the lung, investing it (visceral
layer), dipping into the fissures and sending process from
root of lung fo diaphragm (ligaimentum latum pulmonis).
Name the seven openings into the pharynx.
Two posterior nares, two Eustachian orifices, mouth, larj'nx,
esophagus.
ANATOMY. 31
Locate and describe the spleen.
Is in the left hypochondriae region, dorsally, to left of
fundus of stomach and to left of tail of pancreas ; is in con-
tact with und^r surface of diaphragm, which separates it
from 8th, 9th, 10th and 11th ribs. It has convex outer sur-
face, antero-internal and postero-internal surfaces, is entirely
covered by peritoneum, at hilum splenic artery breaks
up into branches to enter gland (ductless) and splenic
vein leaves interior. Anterior border is notched; capsule
invests it and sends trabeculce into inlterior at hilum,
dividing it into compartments, or areolae, which contain
splenic pulp. Wall of arteriole becomes thickened with lym-
phoid material, which thickenings are known as Malpighian
corpuscles. Minute arterioles terminate abruptly in areolae,
where blood mixes with splenic pulp. Color of spleen is
purple.
What bones make up the pelvis? Give the gross anat-
omy of the bony pelvis.
Two ossa innominata (ilium, ischium, os pubis), sacrum and
coccyx. Bony pelvis consists of upper expanded portion
called the false pelvis, and lower slightly cordiform cavity
known as the true pelvis. The true pelvis has inlet, cavity
and outlet, conjugaite (antero-posterior), transverse and ob-
lique diameters.
Mention the muscular and the ligamentous attachments
of the patella.
Quadriceps extensor femoris (rectus, vastus internus and
externus, crureus) ; ligamentum patellae.
Describe the wrist-joint.
Is formed by radius and triangular cartilage above, sca-
phoid, semilunar and cuneiform below. (Ulna is separated
from cuneiform by triangular interarticular cartilage, hence
is excluded from wrist-joint). Ligaments are anterior and
posterior, ex^ternal and internal lateral. Movements are
flexion, extension, abduction, adduction, circumduction.
32 ANATOMY.
What muscles assist in mastication? In deglutition?
(a) Teniporal, internal and external pterygoids, masrieter.
(b) Mylo-byoid, digastric, stylo-hyoid (first part of ael) :
ouio-hyoid, slerao-hyoid, sterno-thyroid, thyro-hyoid (second
part of act).
State (a) the nerve supply of the rectum, (b) the blood
supply of the rectum.
(a) Sympathetic branches from inferior mesenteric and
hypogastric; plexuses inferior hemorrhoidal, branch of in-
ternal pudie. (b) Superior and middle hemorrhoidal arter-
ies, branches of inferior mesenteric and anterior trunk
of internal iliac respectively; inferior hemorrhoidal, branch
of internal pudic.
Describe the internal jugular vein.
Is formed just below jujpilar foramen by lateral and infe-
rior petrosal sinuses; .courses down neck beneath anterior
border of sterno-cleido-mastoid muscle, in a common sheath
with the internal carotid (above), oommon carotid (below),
and pneumogastric nerve, the latter behind and between, and
the artery to the inner side of the vein, which partially over-
laps the artery. Behind Ktemal end of clavicle it unites with
subclavian to form innominate vein.
With what bones does the radius articulate?
Humerus, ulna, scaphoid and semilunar.
Name the branches of the abdominal aorta.
Two phrenics, celiac axis (brs. gastric, hepatic, splenic).
superior and inferior mesenteric, suprarenals, renals, lumbar
arteries (4). spermatic or ovarian, middle sacral and right
and left conunon iliacs.
What are the anterior and posterior boundaries of the
axilla, and what arteries and nerves pass through it?
Anterior boundary: Pectoralis major and minor. Poste-
rior boundary: Subscapularis, teres major and latissinnts
ANATOMY. 33
dorsi. Arteries passing through : Axillary and its branches
(superior thoracic, acromial thoracic, long thoracic, alar tho-
racic, subscapular, anterior and 'posterior circumflex).
Nerves passing through : Brachial plexus, consisting of outer,
middle and inner cords, with ^branches as follows: Musculo-
cutaneous, internal and lesser internal cutaneous, circumflex,
ulnar, mu&culo-spiral, median.
Give the origin and distribution of the third division
of the fifth pair of nerves.
Origin : From Gasserian ganglion at apex of petrous bone,
passes through foramen ovale with motor root, with which it
now unites; divided into anterior and posterior divisions,
anterior being mostly motor to xmiscles of mastication (tem-
poral, pterygoids, masseter) , posterior division forming infe-
rior dental, which furnishes mylo-hyoid to muscle of same
name, branches to teeth, incisor and mental branches; auri-
culo-temporal, sensory to ear and temple; lingual, which re-
ceives chorda tympani branch of facial and is distributed to
tongue.
Bound Scarpa's triangle, and mention the vessels and
nerve in it.
Is bounded by Poupart's ligament above, sartorius exter-
nally, adductor longus internally; vessels are common and
superficial femoral, profunda femoris arteries; femoral vein;
nerve is anterior crural.
Give the location and describe the anatomical struc-
ture of the kidneys.
Are placed in loins, relating upon psoas magnus and quad-
ratus lumborum muscles, upper end of left reaching as high
as upper border of 11th rib, upper end of right as high as
lower border of 11th rib. Ecush is capped by suprarenal body,
is surrounded by capsule and |)erirenal connective tissue con-
taining fat, is supplied by renal ai*tery, and drained by renal
vein and lymphatics; nerves from renal plexus of S3rmipar
3
34 ANATOMY.
tfaetic system. 'Hie kidney is bean-shaped, notch upon inner
border is called the hiliun, leading into a depression or
cavity known as the sinus; here the renal duct, or ureter,
begins and the vessels and nerves enter or leave. The interior
of the gland consists of a connective tissue parenchyma sup-
porting vessels and uriniierous tubules, arranged as cortex
and med'ulla: the cortex contains the glomeruli (coiled-up
blood vessels — "little ball of yarn") and some of the tubules;
the medulla consists of pyramids (Malpighian or medullary)
made of parallel collecting tubules, which terminate upon
the apex of the pyramidi, [xdiring urine into the culices of the
"pelvis of the kidney," the upper expanded portion of the
ureter. The uriniferous tubules begin around a glomerulus
as a closed extremity (capsule of Bowman), then pass tor-
tuously through the cortex down into the medulla and back
a^in into the cortex (loop of Ilenle), terminating in one of
the collecting tubules found in the pyramid of Perrein, whose
liase is in apjjosition with the hase of a medullary pyramid.
Describe the mesentery.
Is a double fold of peritoneum attaebed to posterior ab-
dominal wall in an oblique line extending between the left
side of tbe body of the second lumbar vertebra to the right
sacro-iliac joint, a distance of about eight inches. Between
its two layers are found arteries, veins, lymphatics (lacteala).
lymphatic nodes (mesenteric "glands"}, and more or lesi
fat; to its expanded, convoluted edge the small intestine is
attached, the mesenteric layers surrounding it and constitut-
ing its serous covering.
Give the name and location of the various glands found
in the small intestine.
Glands in aiimll intestine: Duodenal ("Bruuer'a"), in
duodenum; intestinal follicles ("crypts of Lieberkulin"), in
whole length of small and large intestine; solitary glands, in
wall of small intestine, collected into colonies in ileum, then
known as Peyer's patches.
ANATOMY, 35
Give a brief yet comprehensive description of the heart.
Base corresponds to upper level of third costal cartilage,
one in-eh to right of srt;ema'l margin and one-half inch to left ;
apex to fifth intercostal space jufift internal to vertical line
drawn through left nipple ; base is directed upward and back-
ward to the right, apex downward, forward and to the left.
Is surrounded by fibro-serous sac called pericardium, consist-
ing of two layers, fibrous externally, serous internally, the
latter lining sac (parietal layer) and covering heart (visceral
layer), it is attached to central tendon of diaphragm.
Right auricle has openings of superior and inferior vence
cavffi and coronary sinus; right ventricle receives blood from
right auricle through right auriculo-ventricular opening
(tricuspid valve), and expels it through conus arteriosus into
pulmonary artery. Which is guarded by pulmonary semilunar
valve; right ventricle contains columnae carnesB, museuli
papillares, chord® tendineae attached to tricuspid valve seg-
ments; left auricle has four openings for pulmonary veins
and left aurieulo-ventricular opening, guarded by mitral
valve; left ventricle has columnae carneae, etc., like right,
its wall is thicker ; it forms apex of heart, and blood leaves it
by passing into aorta, which is guarded by aortic semilunar
valve; coronary arteries (2), branches of aorta above semi-
lunar valve, supply heart muscle. Heart is lined with endo-
cardium. Pneumogastrics and cardiac plexuses of sym'pa-
thetic nervous system supply heart.
What forms the external malleolus?
Lower end of fibula.
Describe one of the vertebrae.
Consists of centrum, or body, projecting anteriorly, with
arch behind, made up of two (lateral) pedicles, converging
laminae to form spinous process, transverse process on each
side, superior and inferior pair of articular processes, inter-
vertebral notch on under side of each pedicle.
36 AJfATOMY.
Describe the position of the palmar arterial arches.
Superficial palmar arch is placed upon tendons of flexor
sublimis digitorum, extending aeross palm at level of line
drawn transversely at angle of web between thumb and index
finger; deep arch lies upon metacarpal bones and interossei
niuseles, one-half inch nearer carpiis than superficial arch.
What bh>o<l vessels pass to and from the liver?
To it, hepatic artery', pnrtal vein; unibitical vein in fretus;
from it, hepatic veins.
Describe the pyloric orifice of the stomach.
Is directed backward and to right, is near neck of gall-
bladder, consists of special thickening of stomach wall pro-
duced by circular muscular fibres, which have sphincter-like
action.
What tissues of the abdominal wall are divided in the
operation for appendicitis?
Skin, superficial fascia, external oblique muscle, internal
oblique and transveraalis muscles, transversalis fascia (pre-
peritoneal fat), peritoueuni. Or, skin, siiperficial fascia, linea
semilunaris, transversalis 'fascia, peritoneum.
With what bones does the frontal articulate?
Both parietal, -both malar, both nasal, 'both lachrymal, both
maxilla? (superior), ethmoid, sphenoid.
Give the course and relations of Stenson's duct.
Is formed in parotid gland, emerges from its anterior bor-
der, resting upon mas.seter muscle a finger's breadth below
zygoma; it then perforates huecinator muscle, runs forward
and pierces mucous membrane of cheek wall opposite upper
middle molar tooth.
Describe the Fallopian tubes and give their relations.
Oviducts are attached to cornua of uterus, extend laterally
to a point near pelvic brim, here expanding into fimbriated
extremity: one of the fimibriie ds attached to ovar>' Ctubo-
ANATOMY. 37
ovarian ligasment). Each tube is lined with mucous mem-
brane thrown into folds, possessing columnar, ciliated epithe-
lium, outside of which is muscular coat of internal circular
and external longitudinal fibres, the whole being covered
by peritoneum of broad ligamen/t. Ovarian and uterine
arteries anastomose along their lower border; fimbriated ex-
tremity is in close relation to ovary; outer part of broad
ligament, extending from tube to pelvic wall, is called inf un-
dibulo-pelvic ligament, and contains ovarian artery and veins.
Describe the dura mater. Mention the processes and
sinuses of the dura mater.
Forms the lindng or endosteum of cranial cavity, and
extends through foramen magnum into neural canal as ex-
ternal layer of theca of cord; is tough and fibrous, forms
projections or shelves in cranial cavity for support of
encephalon. These are falx cerebri, falx cerebelli, tentorium
cerebelli. Dura consists of two layers, endosteal and menin-
geal, which separate at certain places to permit the entrance
of the tunioa intima of a vein, thus forming venous sinuses
of cranium. These are superior and inferior longitudinal,
straight, two lateral, occipital, two superior and inferior
petrosal, transverse, circular, and two cavernous.
Give the macroscopic and the microscopic appearance of
(a) kidney tissue, (b) lung tissue, (c) nerve liber.
(a) Kidney tissue is moderately firm, somewhat granular,
reddish-brown in color. Microscopically it presents glomer-
uli, uriniferous tubules, blood' vessels and interstitial con-
• nective tissue, (b) Lung tissue is of a mottled pink color,
soft and porous. Under the microscope it shows bronchioles
(fibrous wall 6f elafiftic tissue lined with mucous membrane)
and alveoli, dilatations lined with mucous membrane of squa-
mous epithelial cells, outside of whdch are seen capillary blood
vessels, (c) Nerve filbre is cord-like, soft and white. Histo-
logically it consists of axis cylinder surrounded by white
substance of Schwann (medullary substance) (absent in hon-
ANATOMY.
medullated nerves) aud encased in the ueurilemma. Inter-
ruptions in the medullary sutostance occur (nodes of Banvier) ,
What anatomic parts are normally found in the left
hypochondriac region?
Fundus of stomech, spleen and tail of pancreas, spleiiii;
flexure of colon, part of left kidney.
Give in language or by drawing, the normal curvatures
of the spinal columns, and describe a typical cervical ver-
tebra.
Curves are cervical, thoracic, lumbar, saero-coccygeai;
convexity is forward in cervical, backward in thoracic,
forward in lumbar, backward in sacro- coccygeal. The line
of gravity of the trunk p<as8cs through the chords of
these curves. A typical cervi-eal vertefbra consists of a small
body, diverging pedicles, a bifid spinous process, bifid trans-
verse process grooved on upper border, with a costo-trans-
verse foramen for vertebral artery at base of transverse
process; neural foramen is relatively large.
Name the bones and ligaments of the ankle-joint.
Tibia, fibula, astragalus; anterior and posterior, interna!
(deltoid) and externai lateral ligaments.
Name the principal muscles that keep the body erect
on the thigh and give the origin and insertion of any one
of them.
Gluteus maximus, gluteus inediua, gluteus minimus, ham-
strings ; gluteus maximus takes ile origin from outer surface
of ilium ibetween posterior part of creat and superior gluteal
line, frcMu vertebral aponeurosis, two last pieces of sacrum,
posterior surface of great sacro-scifttic ligament, and is in-
serted into gluteal ridge of femur ^nd ilio-tibial band of
fascia lata.
Give the origin, distribution and branches of the middle
meningeal artery.
I."" branch of internal maxillary, passes through foramen
ANATOMY. 39
spinosum of sphenoid, traverses wall of middle cranial fossa,
dividing inix) anterior and posterior branches (meningeal)
supplying dura and bony wall of cranium.
Where does the glosso-pharyngeal nerve rise and what
structures are supplied by this nerve and its branches?
Arises from groove between olivary and Testiform bodies,
passes out of cranial cavity through jugular foramen, divides
into lingual and pharyngeal branches, suppljnng mucous
membrane of posterior part of tongue (circuravallate papillae)
and mucous membrane of pbarynx. A branch (Jacobson's)
is distributed to tympanum.
Describe the pharynx.
Belongs to both respiratory and alimentary tracts, is lined
with mucous membrane possessing ciliated columnar cells
above, and squamous, stratified cells below level of soft palate ;
pharyngeal (aponeurosis is between mucous membrane and
constrictor muscles ; constrictor muscles are three in number,
superior, middle, inferior. Pharynx is flattened antero-pos-
teriorly, is widest opposite greater comua of hyoid bone, and
communicates with posterior nares, with middle ears by
Eustachian tutoes, with mouth, larynx and esophagus. The
pharyngeal tonsil is located upon upper posterior wall, and
consists of a special collection of adenoid tissue, which is
found more or less freely distributed throughout naso-
pharynx.
Name the regions of the abdomen.
Draw transverse line through anterior superior iliac spines ;
also through costal cartilages of 10th ribs; intersect with
vertical lines through center of Poupart's ligament. Nine
regions thus formed are, from aibove downward, right and
left hypochondriac, epigastric, right and left lumbar, umbil-
ical, right and left inguinal, hypogastric.
Locate and describe the cecum.
First part of large intestine, found below ileo-cecal junc-
40 ANATOMY.
tion in right iliac fossa ; lis entirely surrounded by peritoneum,
possesses sacculations, iJiat -upon right side usually larger,
thus throwing original (fetal) apex to left, at which point
appendix vemiiformis is attached. Longitudinal muacular
bands well defined.
Describe the eyeball and give its parts.
Is spherical in sh-ape, embedded in orbital fat, has (wular
muscles attached to it, is perforated by optic nerve and ciliary
arteries and veins, iposterior five-sixths opaque, anterior one-
sixth transparent. Its walls are made up of sclerotic and
cornea, uveal tract (choroid) and retina, eucloaing crystalline
lens and vitreous body. Behind cornea is anterior chamber
eontaining aqueous humor ; in front of crystalline leas is iris.
Give the names of live muscles of the male perineum.
Ischi<)-cavevno8US, compressor itretlirie. buibo-cavernosus,
transversusperinei, sphincter ani ext^rnus.
Name five muscles of the back of the leg.
GastrocnemiuB, plantaris, soleus, tibialis posticus, flexor
longua digitorum.
Name the principal divisions and subdivisions of the
internal carotid artery.
It divides, after passing through cavernous sinus, into ante-
rior and middle cerebral arteries; its subdivisions are oph-
thalmic and posterior communicating.
Locate and describe the ileo-cecal valve.
Is found at junction of ileum with cecum, formed by
ileum passing upward and outward to the right to meet large
bowel obliquely; its orifice is. a horizontal slit projecting into
cecal lumen.
Describe either the ascending or descending vena cava.
Ascending vena cava is formed by union of the two common
iliac veins upon body of fifth lumbar vertebra, passes upward,
resting on bodies of vertebra to right of aorta, pierces dia-
ANATOMY. 41
phragm at caval opening, and almost ianmediately enters right
auricle. Its tributaries are lumbar veins, right spermatic
vein (or ovarian), renal veins, hepatic veins, phrenic veins.
Name the bones that form the ankle-joint and give their
relations.
Tibia and fibula above, with internal and external malleoli,
respectively, forming mortise for astragalus, whose trochlear
surface and sides fill up the space 'between the two bones of
the leg.
What muscles form the quadriceps extensor crureus and
where is its conjoined tendon inserted?
Rectus femoris, vastus ertemtis, vastus internus, crureus;
tendon is inserted into tubercle of tibia.
With what bones does the malar articulate?
Frontal, superior maxilla, temporal, sphenoid.
What arteries supply the bladder in the male, and from
what are they branches?
Superior, middle and inferior vesicle, branches of anterior
trunk of internal iliac.
In an amputation of the forearm, 3 inches above the
wrist, what arteries will it be necessary to tie, and of
what are they branches?
Radial and ulnar arteries, branches of the brachial ; interior
and posterior interosseous arteries, branches of the ulnar.
Locate the 4th ventricle of the brain.
Floor is formed hy medulla and pons, borders by inferior
and superior peduncles of oerelbellum, with middle peduncles
at lateral angles; roof is for^ned by valve of Vieussens, or
superior medullary velum, above, inferior medullary velum
and tela choroidea inferior below.
Locate and briefly describe the gall-bladder.
Is placed upon under surface of right lobe of liver, in so-
IME LIBRARY. STANFORD UNlVtR^VW
42 ANATOMY.
called tiseure for gall-blftdder ; fundus projects beyond ante-
rior border of liver. Is a pear-shaped sac covered by perito-
neum, having a rounded end called the fundus, and a
constricted posterior extremity known as the neck, which is
continued into the cystic duct. Its wall is composed of
filirous and muscuier tissue, and it is lined with mucous
membrane, which is tlirown into corkscrew-like folds at the
neck and beginning of the cystic diict.
Describe the esophagus as to (a) location, (b) dimen-
sions, (c) arterial supply.
Is located behind trachea, and in posterior mediastinum,
extending from lower end of pharynx to cardiac end of stom-
ach at esophageal orifice of diaphragm. It is 10 inches long;
its arterial supply is by branches from the inferior thyroid
(thyroid axis of subclavian), thoracic aorta, gastric (eoeliac
axis), left phrenic.
Describe the rectum as to structure, length and con-
tained g^lands.
Extends from thiM piece of saei-um to amis, curved for-
ward. From third piece of sacrum to tip of coccyx is par-
tially covered' by peritoneum. Its walla consist of peritoneum
or fibrous tissue externally, -within which is muscular coat of
longitudinal and circular fibres; then comes submucosa sup-
porting mucous membrane, llie latter forming fixed, trans-
\Trae folds (plicae recti, or valves of Houston), two or three
in number, extending transversely around portion of rectum.
filands are of mucous variety.
How is the eye supplied with blood?
By the ophthalmic artor?', forming ciliary branches anrt
arteria centralis retina?.
What is the circle of Willis?
An arterial anastomosis at base of brain, formed by internal
carotid arteries as follows: Each internal carotid sends for-
ward the anterior cerebral, which is oonnerted with the oppo-
ANATOMY, 43
mte anterior cerebral toy the anterior communicating; it
furthermore sends backward the posterior communicating
which meets the posterior cerebral, which is a branch of the
basilar.
Name and bound the ventricles of the brain.
The lateral ventricles (first and second) are bounded above
by corpus callosum; below hy intraventricular portion of
corpus striatum, taenia semicircularis, choroid plexus, optic
thalamus, posterior pillar of fornix, corpus fimbritttum; in-
ternally by septum lucidum. Third is bounded above by
velum interpositum ; below by gray matter at base of brain,
i. e,, lamina cinerea, tuber einereum, corpora albicantia, pos-
terior perforated space and tegmenta of crura cerebri ; later-
ally by optic thalami; anteriorly iby lamina cinerea and
anterior pillars of fornix; posteriorly by posterior commis-
sure and pineal gland (epiphysis cerebri). Fourth ventricle
is bounded above by valve of Vieussens (superior medullary
velum), in the middle by epithelial lining and pia; below
by inferior medullary velum; floor is formed above by pons,
below by medulla; sides are formed by superior, middle and
inferior cerebellar peduncles.
Describe the sympathetic nerve, naming and locating
the principal ganglia.
Consisrts of a double chain of ganglia extending along
either side of vertebral column anteriorly, connected by
branches with each other and with spinal nerves (rami com-
raunicantes), furnishing branches to blood vessels (vaso-
motor nerves) and forming plexuses — ^three prevertebral
plexuses and numerous secondary plexuses around arteries.
Principal ganglia are ophthalmic, in back part of orbit;
spheno-patetine, in spheno-maxillary fossa; submaxillary,
upon submaxillary gland; semilunar, upon aorta around
coeliac axis.
Give the origin, insertion and action of any one of the
I.
44 ANATOMY.
following muscles: occipito>frontalis, deltoid, gastrocne-
mius.
Deltoid arises from outer Ihird anterior border of clavicle,
(ititer martriii of acromion, lower border of spine of scapiUa,
entire length, and' is inserted into deltoid impression upon
outer surface of middle of shaft of humeriis. Action, to
abduct arm to horizontal position. Nerve, circumflex.
What arteries unite to form the basilar artery?
The twD vei-tebrals.
Describe the tongue.
Consists of intrinsic and extrinsic muscles. Intrinsic are
ditTerent divisions of lingualis (superior, inferior, transverse
and vertical) ; extrinsic are geniohyi^lossus, hyoglossus,
styloglossus, palatoglossus. Tongue is supported by hyoid
bone, is covered ty mucous membrane thickly set with papillte.
viz., circunivallate at base, fungiform and filiform upon dor-
sum and margin. Nerves: Motor, hypoglossal; sensory and
tniBlfttory, glosso-pharyngeal, lingual, chorda tympani.
Describe the pia mater.
Innermost of three meninges, is closely applied to central
nervous sj'stem, supporting blood vessels, dipping down into
sulci and passing into general ventricular cavity of ence-
phalon to develop choroid plexuses — vascular fringes found
in lateral, third and fourth ventricles.
Describe the bones of the hand with their divisions and
articulations.
Carpus, metacarpus, phalanges. Kipht carpal bones: Sca-
phoid, aemilun-ar. eunelfomi, pisiform, trapezium, trapezoid,
OS magnum, unciform. Five metacarpal bones; fourteen
phalanges. Carpal articulate with each other and with bases
of metacarpals; scaphoid and semilunar articulate ivith ra-
dius; cuneiform with triangular interarticular cartilage be-
tween it and ulna; metacarpals articulate with each other at
their bases and with first phalanges at their heads; phalanges
articulate with each other and with metacarpals.
A
ANATOMY. 45
■
I
Describe the hip-joint«
Enarthrodial, or ball-and-socket joint, formed by acetab-
ulum and head of femur, surrounded by capsule, most im-
portant and strongest part of which is found upon the anterior
aspect of the joint, extending between anterior inferior spine
of ilium and anterior intertrochanteric line (spiral line of
femur), and is known as the *'Y'' ligament (ilio-femoral).
This ligament prevents hyperextension of thigh upon pelvis,
or falling backward of trunk. Capsule is attached to innomin-
ate bone around margin of acetalbulum and to neck of femur ;
ligamentum teres is attached to head of femur and to bottom
of acetabulum. Movements permitted': Flexion, extension,
abduction, adduction, rotation and circumduction.
Name live muscles of the shoulder and arm. Give the
ori^n, insertion and action of any one of the live.
Deltoid, coraco-^brachialis, biceps, triceps, teres major.
Biceps takes origin by two heads, one from ooraooid process
of scapula, the other from upper margin of glenoid fossa, this
tendon passing through shoulder-joint to reach bicipital
groove ; insertion is into deep fascia of forearm by semilunar
(bicipital) fascia, and into bicipital tuberosity of radius;
action is to flex forearm upon arm, and to supinate hand.
Give the origin, course and branches of any one of the
following arteries: brachial, temporal, left common carotid.
Left common carotid arises from arch of aorta, courses
upward and outward' in line drawn from stemo-clavicular
joint to mastoid, dividing at level of upper border of thyroid
cartilage into its only branches, external and internal carotids.
Describe the hemispheres and lobes of the brain.
The cerebral hemispheres are ovoid, convex upon superior
and lateral surfaces, partially separated from each other by
longitudinaj fissure, but connected by corpus callosum.
Frontal lobe occupies anterior fossa of cranial cavity, sepa-
rated from parietal lobe by fissure of Rolando, and from
46 AlfATOAiy.
anterior part of temporal lobe by Sylvian fissure; parietal
lobe is bounded by fissure of Rolando anteriorly, parieto-
oocipital fissure posteriorly, Sylvian fissure inferiorly, great
longitudinal -fissure superiorly; occipital lobe is found behind
parieto-ocdpital fissure; temporal loW is below fissure Sylvius,
and rests in middle cranial fossa.
Where in the topography of the abdomen is the sigmoid
flexure located? The appendix vermiformis?
(a) lu left inguinal and hypogastric regions, (b) In right
iugiiinal region.
Give the surgical anatomy of femoral hernia.
Neck of sac is at femora], or crural, ring formed by Gim-
bernat's liganient on inner side, femoral vein on outer, Pou-
part's ligament in front, and horizontal ramus of pubie bone
behind; is closed by septum crnrale; crural canal is narrow
interval between femoral vein and femoral sheatb on inner
side of vein, and extends from crural ring above to upper
margin of saphenous opening below. Saphenous opening is
Hosed by cribriform fascia.
Describe the esophagus.
Extends from lower margin of cricoid cartilage to stomach.
is ten inches long, situated behind trachea in neck and in
posterior mediastinum in thorax; curves forward to esopha-
geal openiug in diaphragm, throligh which it passes, accom-
panied by pneumogastric nerves; wall consists of external
longitudinal and internal eireular muscle fibres, a submucoaa
and a mucous meml)rane, H'hi'ch is thrown into longitudinal
folds, and is made np of stratified epithelial cells.
Describe the formation of the teeth.
The teeth are composed of three substances — the enamel,
the dentine and. the eemen^ira. The enamel covers the ex-
posed part of the tooth, the crown of the tooth. The ce-
mentuin eovers the part of the tooth within the alveolus of
the jaw. The junction of the enamel with the cementum
ANATOMY, 47
is called the neck of the tooth. The bulk of the tooth is
made up of the dentine, which extends from the root to the
crown. Each tooth contains a cavity, the pulp cavity, which
communicates with the exterior through a small aperture at
the apex of the root, the apical foramen. The cavity con-
tains a soft connective tissue — the pulp, rich in vessels and
nerves. The fang, or root, of the tooth has a fibrous invest-
ment called the peridental membrdne, or periosteum.
Give a brief description of the facial nerve.
The 7th cranial nerve, after passing through facial canal
(aqueductus Fallopii) of temporal bone, emerges at the stylo-
mastoid foramen, and enters substance of parotid gland.
Here it divides into two sets of branches, temporo- facial and
cervico-facial, supplying muscles of expression. Its chorda
tympani branch traverses inner surface of membrana, tym-
pana, after leaving main trunk in facial canal, and emerg-
ing through one end of the Gasserian fissure unites with lin-
gual branch of 5th and accompanies it to subm-axillary gland
and ganglion and anterior % of mucous membrane of tongue.
Describe the elbow-joint.
Is a ginglymus, or hinge- joint, made up of lower end of
humerus and upper ends of radius and ulna ; head of radius
articul-ates with capiteHum, and greater sigmoid cavity of
ulna with trochlear surface of humerus. Its capsule is
divided into anterior and posterior, internal and external
lateral ligaments. It permits of flexion and extension. It
is lubricated by synovial membrane lining its capsule.
Describe the superior vena cava.
Is formed by union of right and left innominate (jugulo-
cephalic) veins^ just below cartilage of 1st rib (close to right
border of sternum) ; is nearly three inches long and terminates
in right auricle ; it receives vena azygos major.
Describe the temporo-maxillary articulation, mentioning
the ligaments.
Bony parts are glenoid fossa and articulating eminence of
48 ANATOMY.
tenjporal bone, and condyle of mandible; ligaments form a
capsule, much stronger estemially and posteriorly; external
lateral ligament extends between tubertle of zygoma and
neck of eondylo; associated ligamentous bauds are spheno-
mandibuiar and stylo-mandibular ; an interarticular cartilage
contained within the joint cavity hos tendon of insertion of
external pterygoid muscle attached to it. Movements per-
mitted are depreesion and elevation of jaw around a trans-
verse axis, and a sliding forward of both sides, protruding
chin, or of one side at a time, producing a triturating
movement.
Describe the maxillary sinus (or antrum of Highmore).
Is a triangular cavity contaaned in body of maxilla, lined
with mucous membrane and communicating with middle
meatus of nose through one or two small openings; apex of
cavity is formed by malar iprocess of maxilla; base is formed
by outer wall of nose; in its posterior wall are posterior
dental canals for pasterior dental vessels and nerves to the
teeth; in floor are usually seen several elevations, correspond-
ing to roots of 1st and 2d moilar tfeth.
Describe the aorta.
Springs from left ventricle, anieriorly, extends upward
t» upT>er border of right 2d costal cartilage, then arches
backward to left and descends through thorax, reeling upon
vertebral ibodies, passes through aortic opening in diaphragm
and courses through aibdominal cavity as far as body of 4th
lumbar vertebra.
Branches are: Two coronary from ascending portion; in-
nominate, left common carotid and left subclavian from arch ;
bronchial, intercostal, pericardiac, esophageal and posterior
mediastinal from thoracic portion; 2 phrenic, lumbar, sacra
media (parietal branches), celiac axis (gastric, hepatic,
aplenic), superior mesenteric, inferior mesenteric (single
branches from front), suprarenal, renal, spermatic (or
ovarian) (lateral paired branches) fromebdominal portion.
ANATOMY. 49
Describe the trachea and give its anatomical relations.
It extends f rom the larynx to the bronchi, and consists of
a series af transversely directed, incomplete rings of cartilage
united by an elastic membrane which contains involuntary
musde-fibre posteriorly, where the cartilaginous ring is de-
ficient ; it is lined with a mucous membrane which is covered
with ciliated columnar epithelial cells.
The trachea rests upon the esophagus, being flattened pos-
teriorly; in the groove between these two structures is the
recurrent laryngeal nerve, upon each side ; the common caro-
tid artery, internal jugular vein and pneumogastric nerve
are close to it at its lower portl-^n, while the isthmus of the
thyroid body crosses it upon its second and third rings, and
the lobes of the saraie rest upon it laterally.
Describe the pulmonary veins.
They are four in number, usually, 2 for each lung, and
return arterial blood from lungs to left auricle of heart.
Describe the spinal column.
It consists of 33 separate vertebrae, distributed as follows :
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal. Sacral
and coccygeal coalesce early in life by ossification of inter-
vertebral substances; cervical segment possesses curve with
convexity forward, thoracic with convexity backward, lum-
bar with convexity forward, sacral with convexity backward ;
line of gravity passes through chords of these curves.
Special or peculiar vertebrse are: Atlas, axis, 7th cervical
(vertebra prominens) ; ribs articulate with thoracic series;
ilia articulate with sacrum. Spinal column contains neural
canal for spinal cord.
Give the minute anatomy of the skin.
The skin consists of the cutis vera, formed of fibrous tissue,
the superficial layer being raised into numerous papillsB.
This is the vascular layer of the skin. The end bulbs of the
sensory nerves are found here also. Ck)verin'g the cutis vera
is the epidermis, formed of numerous layers of epithelium.
4
50 ANATOMY.
There are four strata of the epibhdium : The outer, horny, or
Btratura eorueiuia; the sftratum lucidam; the stratum granu-
losum, and the inner or stratum mucosum.
Give a general description of the alimentary canal, nam-
ing its successive divisions.
Its parts, in order, are: Mouth, pharynx, esophagus,
stomach, sinaJl intestine (duodenum, jejuno-ileum), large in-
testine (cecum, ascending, ti-ansverse, descending and sigmoid
eolons, rectum and amal canal).
Slouth is composed of upper and lower jaws covered by
cheek walls, with buccal ori-fice directed transversely; con-
tains tongue, at base of which are fauces with anterior and
posterior pillars and tonsils.
Pharynx joins esophagus at lower border of cricoid carti-
lage ; esophagus is 10 inches long and passes through dia-
phragm to be continued into stomach.
Stomach occupies epigastric and left hypochondriac regions
and 'presents a cardiac and a pyloric extremity and a greater
and lesser curvature. Its wall consists of 4 coats, viz., serous,
muscular, areolar and mucous.
Duodenum is fixed and curved around head of pancreas;
common bile and pancreatic duels open into it; jejuno-ileum,
attached to posterior abdominal waM by mesentery, extends
for 20 feet, or more, to ileo^jecal junction, where it joins large
intestine; vermiform appendix is attached to cecum (usually
inner side), below ileo-cecal "valve; ascending colon passes to
liver, forms hepatic flexure; transverse colon, with gi-eat
omentum attached, crosses to spleen and forms splenic flexure ;
descending colon reaches left iliac fossa and is continued into
sigmoid which curves around into pelvis, restinig on sacnim ;
rectU'm curves forward and anal canal, guai-ded by internal
(involuntary) and external (voluntary) sphincters, opens
downward and slightly backward.
State .the origin and exit of the pneumogastric nerve.
Superficiai origin, from side of medulla in groove between
olivary and reetiform bodies; exit, through jugular foramen.
ANATOMY. 51
Describe the mastoid portion of the temporal bone.
Masrtoid bone is placed behind, is rough and convex exter-
nally and projects downward and forward as mastoid process ;
beneath are digastric fossa for posterior belly of digastric
muscle, and occipital groove for occipital artery ; within sub-
stance of mastoid are mastoid cells, the largest of which
is called mastoid antrum, which communicates with middle
ear; upon cerebral surface of mastoid is sigmoid groove for
lateral sinus.
Describe the lateral sinuses.
Right and left lateral sinuses commence at internal occi-
pital protuberance, right being formed by superior longitu-
dinal sinus, left by straight sinus; are located in attached
margin of tentorium, grooving occipital, parietal, mastoid and
occipital bone again, leaving cranial cavity through jugular
foramen, jusrt; outside of which they unite with inferior pe-
trosal sinus to form internal jugular vein.
Give the origin and insertion of the muscles which form
the anterior triangles of the neck.
The anterior common triangle is bounded above by the
lower border of the mandible and a line extending backward
from the angle of the mandible to the mastoid process of the
temporal bone; in front, by the median line of the neck;
behind, by the anterior border of the stemo-mastoid muscle.
This ooonmon triangle is divided into the submaxillary, su-
perior carotid and inferior carotid triangles, by the posterior
belly of the digaaftric muscle above and the anterior belly of
the omo-'hyoid below.
Stemo-mastoid muscle : Origin, from anterior surface of up-
per part of manubrium stemi and inner third of anterior
border of clavicle ; insertion, into mastoid process of tenuporal
and outer half of superior curved line of occipital bone.
Omo-hyoid muscle: Origin, from upper border of 'scapula
to inner side oif suprascapular noteh; insertion, into body
of hyoid bone.
52 ANATOMY.
Digastric muscle : Origin of posterior belly is from digastric
fossa of mastoid portion of temporal bone, and of anterior
belly from lower border of mandible close to symphysis; in-
sertion, into central tendon, which as attached to body and
greater cornu of hj-oid bone.
Name and describe the course of the arteries supplying
the hand.
Rfldiad and ulnar arteries. Course of radial artery is from
just below bend of elbow down radial boi-der of forearm to
outer side of wriBt, where it turns over on to dorsum of hand,
passes down through proximal end of first interosseous spa«e
to reach palm, now passing transversely across deep part of
palm to anastomose with deep communicating branch of
ulnar artery.
Course of ulnar artery is from near head of radius in a
curve over to ulnar border of forearm, thence along ulnar
border to radial side of pisiform bone, where it divides into a
superficial branch, to form superficial palmar arch and a deep
branch to eomplete deep areli.
Locate and describe the ovaries.
The ovaries are located ordinarily close to lateral part of
ti'ue pelvic brim, attached to posterior layer of broad ligament.
They somewhat resemble a broad almond, are 1^4 inches in
length, whitish in color, with an uneven, puckered surface,
and consist of a covering of germinal epithelium, and a stroma
which encloses ovisacs, vessels and nerves.
Locate and describe the principal convolutions of the
brain.
Ascending frontal convolution bounds the fissure of Rolando
anteriorly, and belongs to the frontal lobe ; ascending parietal
convolution bounds the fissure of Rolando posteriorly, and is
a pari: of the parietal lobe. In these convolutions are located
important motor nerve -centers, controlling nei-ves which are
distributed to the opposite side of the body.
The cunens is a convolution belonging to the mesial surface
ANATOMY. 53
of the occipital lobe, between the iMemal parieto-oceipital
and caleardne fissures; in it are located the cortical centers
of sight.
Describe the palmar fascia.
It consists of a central and two lateral portions. Central
portion is /thick and binds d^own tendons and protects vessels
and nerves; it is narrow above where it is attached to an-
terior annular ligament ; below it is broad and divides into 4
slips for the four fingers, these being attached to under
surface of skin at base of fingers, to sides of metacarpo-phalan-
geal joints and to sides of metacarpal bones near their distal
ends.
Give the origin and insertion of the muscles of the
scapulo-humeral joint.
Supraspinatus, infraspinatus, teres minor, subscapnlaris,
deltoid, bicei)s and triceps.
Supraspinatus : Origin, from inner % of sujpraBpinous fossa ;
insertion, into highest facet of greater tuberosity of humerus,
and blending intimately with capsular ligament of shoulder
joinjt.
Inf raspdnatus : Origin, from inner % of inf raspinous fossa ;
insertion, into middle facet of greater tuberosity, also blend-
ing with capsular ligament.
Teres minor: Origin, from upper % of axillary border of
scapula; insertion, inrt;o lowest facet of greater tuberosity,
also blending with capsular ligament.
Su/bscapularis : Origin, from greater part of subscapular
fossa; insertion, into lesser tuberosity of humerus, its tendon
of insertion also blending closely with capsular ligament.
Deltoid : Origin, from outer % of an/terior border of clavicle,
from outer margin of acromion and lower border of spine of
scapula; insertion, into rough, triangular area on outer side
of shaft of humerus near its middle.
Biceps : Origin, from coracoid process and from upper mar-
gin of glenoid cavity (short and long heads, respectively) ;
54
ANATOMY.
insertion, into bicipi^tal tuberosity of radius and by bidipital
(or eemilTitmr) fascia, into deep fascia of forearm.
Trioeps; Origin, from axillary border of scapula just be-
low glenoid cavity (long or sca,pular head), and from pos-
terior surface of humerus, one head above, the other below,
the musculo-sjpiral groove (2 short or humerajl heads) ; inser-
tion, into olecranon process of ulna.
Describe the nasal fossae.
Are 2 irre^ar oavitiea in middle of fa«e, on either side
oOE median line, separated from each other by mesially placed
nasal septum ; they extend upward to anterior floor of cranial
cavity, and downward to roof of mouth ; they open anteriorly
by 2 large apertures, the ajiterior nares, and communicate
with nasonpharynx by posterior nares.
Roof is narrx)w, and formal in center by cribriform plate
of ethmoid, anteriorly thy nasal bones and nasal spine of
frontal, posteriorly by under surface of body of sphenoid.
Roof contains aipertures in oribriform plate for olfactory
nerves; behind are opening leading into sphenoidal sinuses.
Floor is smooth, wider in middle than at either end, and
is formed 'by p^ate process of masdila. anteriorly, and by
palate process of palate bone posteriorly.
Inner waJl consists of septum, which is made up of crest
of nasal bones and spine of frontal, by perpendicular plate
of ethmoid, by vomer and by rostrum of sphenoid, and below
by crests of maxillary and palate bones. A large notch at an-
terior estre<mity of bony septum receives the septal cartilage.
Outer wall is formed, in front, by lachrymal bone and nasal
process of maxilla; in the middle, by ethmoid, inner surface
of maxilla, and inferior turbinated; Ijcbind, by vertical plate
of palate bone and internal pterygoid plate of sphenoid. The
outer wall conitains 3 irregtilar. longitudinal passages, viz.,
superior, middle and inferior meati; the superior meatus
(smallest) is located at upper and hnek part of nasal fossa,
is between superior and middle turtrieated bones, and com-
municates with spheno-maxillary fossa by spheno- palatine
ANATOMY. 55
foramen, and with posterior ethmoidal cells by an opening
in its outer wall. (Opening for srphenoidal sinus is above and
behind superior turbinated bone). Mddle meatus is situ-
ated between middle and inferior turbinated bones. It con-
tains, anteriorly, the orifice oif the infundibulum, by which
the middle meatus is placed in communication with the an-
terior ethmoidul cells and the frontal sinuses; the middle
ethmoidal cells and maxillary antrum also open into middle
meatus. Inferior meatus is the largest, is formed by inferior
turbinaited above and floor of nasal fossa below ; it contains,
under cover of «the inferior turbinated, anteriorly, the termin-
ation of the naso-laehrymal duct.
Name and locate the accessory sinuses of the face and
describe their outlets.
Frontal sinuses, contained between outer and inner ta;bl€s
of frontal bone above supraorbital arc^h, communicate through
infundibulum with anterior ethmoidal cells and middle nasal
meatus.
Ethmoidal cells, comprising greater part of lateral mass
of ethmoid bone, and divided into anterior, middle and pos-
terior. Anterior and middle ethmoidal cells open into middle
nasal meaitus; posterior ethmoidal cells open into superior
nasal meatus.
Sphenoidal cells (or sinuses) are contained within body of
sphenoid bone and communicate with upper, back part of
nasal fossa.
Maxillary sinus (antrum of Ilighmore) is situated in body
of maxilla; its outlet is an aperture communicating with
middle meatus of nose.
Describe the iris, giving relations, nerve and blood
supply.
It is an elastic, contractile diaphragm, forming the anterior
extremity of the middle, pigmented and vascular tunic of the
eyeball. By its x>eripheral attached border it is directly
continuous with the ciliary body ; it is placed in front of ithe
56 ANATOMY.
crystalline lens, and incompletely divides the anterior cham-
ber iatx) two compartanents. Near its center is a circular
opening, the pupil, which varies greatly in size. In structure
the iris consists of a stroma of delicate fibrous and elastic
tissue, with perhaps some involuntary miiwjie fibres. It is
supplied by the ciliary uer\'es. The long and anterior ciliary
arteriea anastomose and form a vascular circle around the
attached margin of the iris, sending branches in towai-d the
pupillarj- margin.
Describe the course and distribution of the nerves of
the palm of the hand.
Median, from outer and' inner cords of brachial plexus, ac-
companies brachial artery, rests upon flexor pi-ofundus digi-
torum in forearm, passes beneath annular ligament into palm.
It supplies all anterior foreann muscles except flexor carpi
uJnaris and ulnar half of tiexor profundus digitorum-, cuta-
neous branches supply palm, thumb, index, middle and half
of ring fingers on their palmar aspect and nail-beds, and outer
two lumbrieales.
Ulnar, from inner cord, descends along inner border of
arm, behind inner condyle oif humerus, then between flexor
carpi ulnari^ and flexor profundus, both of which it supplies;
it crosses anterior annular ligament with ulnar artery and
divides to supply short muscles of little finger, all interossei.
inner two lumbrieales and flexor brevis and adductor polticis;
cutaneous distribution is to dorsum and palm of hand on
ulnar side, and to little finger and ulnar ha^f of ring finger.
Give the origin, insertion and action of any one of the
following muscles: digastric, sacrolumbaiis, rectus ab-
dominis.
Rectus abdominis takes its origin from 'body of pubic bone
and from anterior ligaments of puhic symphysis of opposite
side, is inserted into costal oartilages of 5th, 6th and 7th ribs ;
eODitains three transverse lines (linete transversse), which
extend in zigzag style across the musole in its upper part;
ANATOMY. 57
action is to flex thorax upon pelvis, or vice versa, and to
compress abdominal viscera.
Give four principal points of distribution of the pneu-
mos:a8tric or par vas:um nerve.
Pharynx (motor), larynx (motor and sensory), heart
(superficial and deep cardiac plexuses), stomach (uniting
\%4th sympathetic system) .
Wliat is contained in tlie middle mediastinum?
Heart and pericardium, ascending aorta, lower part of
superior cava, vena azygos major, both bronchi, pulmonary
artery and veins, phrenic nerves.
What anatomical parts are involved in the descent of
the testes?
Gubemaculum testes, visceral and parietal layers of peri-
toneum, transversalis fascia, inguinal canal and rings, internal
oblique muscle (cremaster muscle and cremasteric fascia),
intercolumnar fascia.
Describe the bones forming: the ossa innominata.
Ilium has curved crest extending from aniterior superior to
posterior spine; internally is iliac fossa (fialse pelvis, limited
below by ileo-pectineal line) ; externally are superior, middle
and inferior gluteal lines; greater sdatic notch is behind,
partly formed by ischium; anterior inferior spine for rectus
femoris and ilio- femoral (Y) ligament is below anterior supe-
rior spine; ilium forms part of true pelvis and two-fifths of
acetaibulum ; fuses with os pubis and ischium at 18th to 20th
year ; articulates with sacrum by auricular surface.
Ischium has a body above, with spine of ischium projecting
backward and inward, and separating greater from lesser
sciatic notches ; lesser sciatic no^h is on ischium below spine ;
tuberosity of i«;hium is lowest part, from which ramus as-
cends to¥rard pulbic bone and i>artially bounds obturator
foramen; ischium forms two-fifths of acetabulum and part
of true pelvis. ,
58 ANATOMY.
Os pubis has body (articulates with opposite bon«, formiBg
symphysis puljis) ; horizontal and descending ramus, bound-
ing obtumtor foramen; pubifl spine for Poupart's ligament;
ilio-pectineal line exteiidiing fixim body along horizontal
ramus; on under surface of latter is groove for obturator
vessels and nerve.
Describe the sternum, its articulations and the import-
ant muscles attached to it.
Consists of manubrium, gladiolus and ensiform appendix;
suprasternal notch is above, between clavicles; notches are
■found along latenal borders for articulation of first seven
pairs of nibs (costal cartilages), and at upper outer angles
of manubrium for clavicles; transverse ridge (subcutaneous
landmark) exists at line of junction of manubrium and gladi-
olus, marking level of third rib; ensiform varies in size and
shape. Important muscles attached are sterno-deido- mastoid
and pectoraJis major; rectus abdominis and diaphragm an?
attached to ensiform.
What portion of the bladder is uncovered by perito-
neum?
The anterior wall, which is separated from symphysis pubis
by prevesical space (cavum Retzii).
Describe the spinal cord.
Is contained in neural canal, and extends from lower mar-
gin of foramen magnum to body of second lumbar vertebra;
constitutes 2 per cent, of cerebro-spiua! axis; is surrounded
by dura, arachnoid and pia: has two enlargements, cervical
and lunnbar, which mark points of orifrin of large nerve trunks
for upper and lower extremities respectiveily (brachial and
sacral plexuses) ; white nerve matter surrotinds gray, which
is amanged like two inverted eoimnaa (or eapitaJ "H"),
connected by .transverse 'barnd (gray commissure) ; anterior
horn of gray matter conitains large multipolar cells continuous
with motor nerves, which a.ppear upon surface of cord at
antero-lateral aspect; posterior gray horn is continuous with
L
ANATOMY, 59
sensory nerves, which aippear upon postero-lateral aspect of
cord.
Describe the hyoid bone.
Is U-shaiped, placed, with convexity forward, ajbove thyroid
cartiliage ; consists of centmlly located body, two greater cor-
nua directed 'backward and two lesser comua projecting up-
ward at point of junction of body and greater oomua. Hyoid
bone eserves for attachment of thyro-hyoid) membrane and
ligament and stylo-hyoid ligament; of stemo-hyoid, thyro-
hyoid, omo-hyoid, genio-hyoid, genio-hyoglossus, hyoglossus,
mylo-'hyoid, stylo-hyoid and digastric muscles.
Name the articulations of the superior maxillary bone.
Frontal, lachrymal, nasal, malar, palate, ethmoid, inferior
turbinai, vomer and opposite maxiila.
Give the oris:in and distribution of the olfactory nerve.
Olfactory tnact appears upon surface of cerebrum at ante-
rior perforated space, extends forward, terminating in olfac-
tory bulb, which rests upon cribriform plate of ethmoid ; from
under surface of bulto 20 to 30 nerves descend, enter superior
nasal meatus, grooving perpendicular pl*ate and superior and
middle turibinal processes of ethmoid, and are distributed to
nasal mucous membrane covering these parts.
Describe the mammary s^l^nds.
Two hemispherical, lobulaited glands placed upon anterior
thoracic wall over peotoralis major muscle, coverin-g a space
from the second to the sixth rib, and from margin of sternum
to anterior margin of axilla. Nipple, sensitive and pigmented,
projects from center, and contains orifices of lactiferous ducts ;
areola, also pigmented, surrounds nipple ; gland su'bstance is
arranged in lobules (10 to 20), each of which is a compound,
racemose gland, and all are surrounded and supported by
fibrous tissue, forming a capsule.
Describe each of the tunics of the eye and the different
parts of each.
Sclerotic is outermost, consisting of bundles of fibrous
ANATOMY.
tifiBTie cloeely interlaced, is perforated to nasal side of pos-
terior pole by optic nerve, and is continuous with cornea
anteriorly. Six ocular muscles are inserted into it. Cornea
is trauspttreut, consists of bundles of tibrous tissue enclosing
corneal spaces, in which are lodged corneal corpuscles; is
covered by conjunctival epLthellum and lined by Descemet's
membrane; is richly supplied iby sensory nerve fibres, but is
n on- vascular. Uveal tract consists of choroid, ciliary body
and iris, is vascular and pigmented ; choroid is perforated by
optic nerve behind; ciliary body is made up of ciliary pro-
cesses and ciliary muscle; iris is placed in front of lens in
anterior chaimber, and is perforated at its center (pupil).
Betina is imiemiost tunic, made up of nerve -oells and fibres,
representing an expansion of the optic nerve; macula lutea
is point of most acute vision, and is located to temporal side
of optic disk, or .point of entrance of optic nerve; retina is
supplied by arterift centralis retinse, branch of ophthalmic
artery, and drained by central vein oif retina into ophthalmic
vein.
What are the vesiculae seminales?
Two dilated pouches placed betiveen bladder and rectum,
uniting with vasa deferenrtia to form ejacidatory ducts.
Qive the course of the posterior tibial artery.
Extends fi-om lower border of popliteus muscle down leg
between superficial and dee^p layers of muscles to inner side
i>f ankle, where it divides into internal amd external plantar
blanches.
Which of the cranial nerves has the widest distribution?
Pneumofrastric (10th).
Describe the origin and distribution of the ninth pair of
cranial nerves.
Ninth, or flos.so-pharjiigaal, nerve has superficial ori^n
from groove between olivary and restifonn bodies of meduHa;
is diatriturted to pharynx (sensory) and to posterior third
of tongue, especially tw eircumvallate papillEe.
ANATOMY. 61
Give the distribution of tlie radial nerve below the
wrist.
To radial half of dorsum of hand, and dorsum of thum'b,
index, middle and middle-finger half of ring finger, except
distal segments of digits, which are supplied by median nerve.
What is the tinea alba and how is it formed?
•
Is the line of fusion of aponeuroses of external and in-
ternal oblique and transversal'is muscles, extending from en-
edform aJbove to symphysis below; ju^ below its center is
umbilicus.
Describe the sphincter ani.
Are two in number, internal, or involuntary, and external,
or voluntary. Internal is formed by circular fibres of rectal
wall; extemal is attached to tip of coccyx, surrounds anal
opening, and is inserted into median line of perineum.
Describe the periosteum.
Is closely adherent to oulter surface of bone and consists
of two layers, an outer, fibrous layer, and an inner, vascular
layer. In young and growing bones the inner is called the
osteogenetic layer. Nerves and lymip^hatics are also present
in periosteum.
Give the origin, insertion and action of any one of the
following muscles: tibialis anticus, pronator radii teres,
gracilis.
Tibialis anticus arises from upper % of outer surface of
shaft and under surface of outer tuberosity of tibia, from
interosseous membrane; is inserted into internal cuneiform
and first metatarsal bones; action, to flex and invert foot;
to strengthen and help maintain antero-posterior arch of foot.
Give a general description of the cerebral veins.
Remarkable for thinness of <their walls due to lack of muscu-
lar tissue; they have no valves; supei^eial cerebral veins are
lodged in sulci between convolutions, receive blood from sub-
stance of brain and terminate in the sinuses, opening into
I
62 ANATOMY.
them in th« opposite direction to which blood is flowing; deep
cerebral veins diain the iv-enitrides into straight sinus i at
base basilar vein drains interpeduncular space and basal
ganglia.
Relate the differences between a virgin uterus and the
uterus of a multipara.
Uterus of nmltnpara'is larger (especially body), ar-bor vitte
uterina; of cervix is more or lesB effaced, external os is
irregular, or perhaps stellate, in^ead of being a smoothly
outlined, trans\'«rse!y directed slit.
Describe a hair follicle in its relations to the skin.
A hair follicle is an involution of epidermis, forming a
funuel-sluiped depression soiireitimes extending into subcu-
taneous cellular tissue; is usually placed obliquely and be-
comes enlarged at 'bottom to accommodate hair bulb, part of
which is vasciiJar papilla derived from dermal lining of
follicle; opening into follicle are ducts of one or more se-
baceous glands.
What are the Wormian bonea?
Bones developed from separate centers of ossification to
fill in gaps 'between certain of the cranial boues; they are
found most frequently in lambdoid suTure, occasionally oc-
ciijpj'ing position of fontanelles, especially posterior.
Give a general description of the peritoneum. Name
the principal organs covered by it.
Is a closed sac (except in female, at orifices of Fallopian
tubes) which lines abdunninal wall (parietal laj'^r) and
partially or completely surrounds viscera (visceral layer),
constituting their sei-ous ooat; it forms omenta — Gastro-oolic,
or great omentum, gastro-hepatle, or lesser omentum, and
gastro-splenic; it forms mesenteries— Mesentery (proper), of
small intestine, mesocolon (ascending, transverse, descending,
signnwd, me«oappendix : principal oi^ans covered by peri-
toneum are; liver, storaaOh, spleen, small intestine, large
intestine, Fallopian tubes, uterus, bladder.
ANATOMY. 6a
Describe the thymus s:land.
Is first found during second month of intrauterine life,
is largest when child is two or three years old, and usually
disappears before puterty ; is located in anterior mediastinum
and lower part of neck, between lungs, in front of heart
and great vessels and trachea ; consists of two lobes made up
of lobules, which are essentiially lymphatic in character.
What are the suprarenal capsules and what are their
relations to adjacent organs and parts?
Are two in number, one placed upon the upper pole of
each kidney ; each consists of cortex and medulla with vessels
entering and leaving at a hilum ; cortex is yellowish in color
and contains granular, polyhedral cells arranged in columns ;
medulla is darker in color, from presence of bloodvessels
which are closely related to groups of large cells. Suprarenal
bodies are partially covered by peritoneum and are in rela-
tion, right with under surface of liver, left with spleen,
stomach and pancreas.
Describe the medulla oblongata.
Is a pant of eneephalon, continuous with spinal cord be-
low and with pons a/bove; it rests upon 'basilar process of
occipital bone, consists of white nerve matter externally
and gray matter arranged irregularly internally, the latter
appearing upon the surface in floor of fourtlh ventricle, the
lower half of which is formed by upper surface of medulla ;
upon ventral surface is an'terior median fissure, partially
obliterated below by diecussation of crossed pyramidal tracts;
near anterior part of inferior surface are olivary bodies;
posfterior columns diverge to form calamus scriptorius and to
bound fourth ventricle laterally for its lower half; postero-
laterally are restiform bodies which can be traced* upward
into cerebellum, forming inferior peduncles of latter.
Cranial nerves from seventh to eleventh inclusive arise from
side of medulla, while twelfth appears upon surface ip. groove
between olivary body and anterior pyramid.
64 A^'ATOMy.
Locate and describe the lachrymal gland.
Is looat«d in upper, outer and anterior part of orbit, to
inner side of external angular process ; is made up of lobiUea,
or clusters of acini, arranged around the ducts, six to tsvelve
in number, whioh empty into outer part of superior con-
junctival fornix.
Describe the lungs.
Each ia pyramidal in »hape, base reatin-g upon diaphragm,
apex extending into superior aperture of Dliorax, lateral, con-
vex surface -being applied to thoracic wall and inner, niesia
and irregularly concave surface looking toward mediastinum
each possesses a root, placed upon inner surface, near pos-
terior, thickened margin, and consisting of ibnonchus, pull
ary artery and vein, ibronehial artery, ner\'e8 and lymphatics
right lung has three loibes, left has two ; each is made up of
IcJbules consisting of a tenninal bronchiole, around which are
arranged clusters of air cells; each lung is invested by vieceral
layer of pleura, whose parietal layer lines thoracic wall.
Describe the structure of the knee-joint.
Bones: Femur, tibia, patella; ligaments r Internal and ex-
ternal lateral, ligamentum patella;, posterior; these are
strenjtlhened and supported by aponeuroses of vastus extemus
and internal antero-lateral ly. semi'i enitranosus posteriorly;
chief internal ligaments are crudii', anterior and posterior;
joint contains two semilunar cartilages which are attached to
non-articular area upon upper surface of tibia ; synovial mem-
brane is extensive and complicated; movements: Flexion, ex-
tension, slight rotation.
Bound the popliteal space. Mention Its contents.
Above by outer and inner hamstrings, below by outer and
inner heads of gasrtrocnemiua muscle, with plantaris upon
outer side; contents are: Internal and external popliteal
nerves, popliteal vein and popliiteal artery, termination of
short saphenous vein and small lymphatic glands.
ANATOMY. 65
Mention the principal brandies of tlie celiac axis.
Gastric, hepatic and splenic arteries.
What are the nerves of the eyeball?
Optic, motor oculi and ophthalmic division of fifth (both
through ofphthalmic ganglion) and sympathetic fibres from
cavernous plexus (also to ganglion) .
Describe the aural labyrinth.
Osseous labyrinth, whose divisions are three semicircular
canals posteriorly placed, a vestibule in middle, and cochlea
anteriorly, all containing membranous lalbyrinth upon which
terminal filaments of auditory nerve and its special neuro-
epithelium are found.
Describe the popliteal artery and give its branches.
Is a continuation downward of femoral from opening in ad-
ductor magnus and divides at lower border of popliiteus
muscle into anterior and posterior tibial arteries; it lies upon
femur, posterior ligament of knee-joint, tibia, and fascia cov-
ering popliiteus muscle; it enters popliteal space at upper
inner margin, and bisects it longitudinally; popliteal vein
is superficial to it ; branches are superior and inferior internal
and external articular, azygos articular, sural (muscular to
calf) , and anterior and posterior tibial.
What are the blood-vessels which supply the arteries
called? Whence are the nerves of the arteries derived?
(a) Vasa vasorum. (b) Vasomotor, from sympathetic
system.
Mention the varieties of epithelium.
Squamous, columnar, ciliated, glandular, transitional, pig-
mented, and neuro-epithelium. The first three may occur in
a single layer, when it is named ** simple;" or, in several
layers, when it is called ** stratified."
Describe the muscular tissue.
Muscular l^issue is of mesodermic origin and consists prin-
5
66 ANATOMY.
cipally of elongated eells (fibrous cells) whieh have the in-
herent power of contracting. The muscle fibres contain
nuclei and, sometimes, that which corresponds to a cell wall,
the sarcolemma. Voluntary and cardiac muscles are striated,
due to the arrangement of al'teruate light and dark disea.
Non-striated muscle is involuntary. Microscopically, they
may 'be differentiated as follows :
Striated.
Non. Striated.
Cardiac.
Fibent striated trans-
No Htriiitiona
.Siriolc-d longitudinally
vemely.
and transversely.
Haa HaivolGmma.
Hvnline sheath.
Nuok'us benealb sarot'-
Nucleoli in center.
Nucleus oval and in
lemma.
center.
FjbcTS do not braneli,
Fibers short
except in the tongue.
Fibers branch freely.
Describe a Haversian system.
A Haversian system occurs in eonipaet bone and consists
of a system of channels through Which the nutrient fluids
pass. It consists of the following: A centrally placed eanal,
the Haversian eanal, which is surrounded by concentric lay-
ers or plates of bone, the kmellie. Between the plates of
bone are irregular clefts, the laeunic, which cominumcate with
each o*her and with the Haversian canal by means of radially
pliiced canals — the canaliculi.
Name the humors of the eyeball.
Aqueous humor, contained in anterdor eham-ber, consists of
98.6% water, and small quantities of extractives and pro-
teids; vitreous humor, occupying the lar^ postci-ior chamber,
lias about the same composition as aqueous humor.
State the origin of the sensory division of the lifth pair
of cranial nerves.
Superfioial origin is from under surface of pons, close to
anterior border.
What is the function of the third cranial nerve?
To supply with motor inifluenee all ocular muscles except
ANATOMY. 67
superior oblique and external rectus, and to furnish motor
root to ophthalmic ganglion.
Describe the ramus of the jaw. Mention the muscles
and ligaments attached to the ramus of the jaw.
Ramus extends upward and slightly backward, forming
angle of jaw by its junction with the body; is surmounted
by coronoid process anteriorly and condyle posteriorly, be-
tween whidh is sigmoid notch ; upon inner surface is inferior
dental foramen.
Muscles and ligaments attached are : Temporal, external and
internal pterygoids, masseter; capsular and internal lateral
Mgament of temporo^mandibular articulation, stylo-mandibu-
lar ligament.
Describe the arytenoid cartilages.
Are pyramidal in shape, rest upon upi)er, posterior part of
cricodd cartilage by their bases, have true Yocal cord (thyro-
arytenoid ligaments) attached to vocal process anteriorly;
lateral crico-arytenoid, posterior crico-arytenoid, arytenoid
and thyro-arytenodd muscles are also attached. The arytenoid
cartilages are covered with mucous membrane and between
them is the intenarytenodd space.
Give the course and relations of the external jugular
vein.
Is formed near angle of jaw by union of temporo-maxillary
and posterior auricular veins, runs downward and outward
upon stemomastoid muscle and under platysma myoides, to
empty inito subclavian vein at middle of clavicle.
Mention the branches of the internal iliac artery.
Anterior trunk : Superior, middle and inferior vesical, ob-
turator, middle hemorrhoidal, uterine, vaginal, internal pudic
and sciatic. Prom posterior trunk: Ilio-lumbar, gluteal,
lateral sacral.
Give the course of the female ureters.
'Rest uipon psoas magnus muscles, pass over brim of pelvis
into cavity of same to base of 'broad ligaments, then
y^ incli from cervix uteri, laterally, obliquely forward and
inward ia anterior vafjinal wall to 'base of bladder.
What nerves form the pharyngeal plexus?
Glosso-pharyugeal, pneumogaslric and cen'ical sympathetic.
What structures are severed in tracheotomy?
Skin, superficial and deep cervical fascia and trachea; per-
haps anterior jugular vein, or branches, and thyroid isthmus.
Describe the phrenic nerve.
Is formed by the fourth cervical nerve, chiefly, passes down-
ward upon anterior surface of scalenus anticus muscle, enters
superior, then middle mediastinum and perforates diaphragm
to supply its under surface.
Describe the ulnar artery as to (a) origin, (b) course,
(c) distribution.
(a) Is one of terminal branches of brachial; (b) is beneath
supei-fieial flexors of forearm, passes obliquely to ulnar border,
having ulnar nerve to ulnar side of it for lower % of its
extent, then 'curves across palm near lower border of anterior
annular ligament (superficial palmar arch), first sending
communicating branch to deep arch, (c) Is distributed to
Htruetures around internel aspect of elbow, to ulnar side of
'forearm, to interosseous membrane, anteriorly and posteriorly,
and adjacent musclea, and to palm and flexor surface of
fingers.
How are the saphenous veins formed? Where do the
saphenous veins empty?
Internal saphenous is formed upon dorsal surface of foot
and inner border; external saphenous is formed upon dorsum
and outer 'border of foot. Internal saphenous vein empties
ijAa femoral at saphenous opening in fascia lata; external
saplienous terminates in popliteal vein.
ANATOMY, 69
Give the situatioii of the lymphatic glatkis of the thorax.
Intercostal spaces posteriorly, anterior and posterior medi-
astina, around broniehial tubes.
Give the boundaries and mention the contents of the
posterior mediastinum.
Is bounded in front by x>erieardium and roots of lungs,
behind by vertelbral column and on edther side by pleura. It
contains descendimg thoracic aiorta, greaiter and lesser azygos
veins, pneumogastric and splanchnic nerves, esapha-gus, thor-
acic duet and lymphatic glands.
Describe the internal abdominal ring.
Is oval in shape, long axis directed vertically, located in
transveraalis fascia Vg inch above Poupart's Hgament and
midway between anterior superior iliac and pubic spines.
Structures of 6perma;tnc cord pass through it in male; round
ligament in female. Infundiibuliform fascia is attached to
its margin ; deep epigastric artery courses along inner margin.
Give a method by which the fissures of Sylvius and
Rolando may be approximately mapped out on the sur-
face of the skull.
Fissure of Sylvius : Draw la line from a point one inch and
a quarter horizontally behind external angular process of
frontal bone to a point % of an inch below parietal eminence.
Fissure of Rolando : From a poinrt; % inch behind mid-point
of line between glabella and external occipital protuberance,
draw a line for 3% inches over side of head at angle of 67°
with median line.
Locate and describe Peyer's glands.
Are located in wall of ibum, more numerous at lower
part; are more or less oval bodies collected together; con-
sist of adenoid (lymphoid) tissue.
Describe the tonsils and name some of the arteries
which supply them with blood.
Are placed between aniterior and posterior palatine arches,
70 ANATOMY.
iu toQBiUar recess, close to base of tongue, vary greatly in
wize and shape, surface is irregular and marked by uumerous
<i<Tirc8sioiis leading into crypts in substaniie of tonsil, and are
MiirnMinded by closed follicles of lymphoid tissue. Arteries:
Oorsalis lingiife, ascending palatine and tonsillar of facia!,
deMN^iidin^' palatine of internal maxillary, ascending pharyn-
Describe the male urethra and state its divisions.
Dividcfl into piMstatic, menvbrauoiis and spongy portions;
proHlivtic pii»ips through prostate gland, has veru montanum
iind ordlioes of ejaculatoiy diicts in its floor, upon either
diiU* i»f whwh are prostatic sinuses with orifices of prostatic
ItlHiidH 1 iriembrunous portion is ^ortest of the three, is eon-
tftinnl Iwlween the two layers of triangular ligament, and
tmrrfHindttl 'by compressor urethrie muscle; spongj' portion is
iMtiitaimul in corpus spongiosum, terminates <aX, meatus urin-
iiHim t'St^M'iiUH (least dilatable part of urethra) and has
nHVrTiil dopifmions in mucous membrane of roof, largest
111" wlilch, just I>ehind fossa na^'icnlaris, which is close to
iiiKiiliiH, jti named lacuna magna.
What !■ the origin and course of the pulmonary artery?
Oi^irlii in fitmi right ventricle; course is upward and
•lltftilly U> hfl lo under surface of transverse portion of
Iliti'I'lo iiri'h, wlit-n- it. divides into right and left pulmonary
iu'Um'Idh fur I'itfbl and Icfl lungs respecliively.
<)lv« Ihtf nnriten of the principal muscles of the back.
TrHlxiHliiii, liitiNMituiH doiiii. rbomboideiis major and minor,
iMimUi)' •pliiiH.
l.liVNl* Mnil dvicrlbe the rectum.
KihUMla riMiii \)\\ti\ plivH' of saerum to anus, with forward
(ilti'VDi U I'uvoivd by iK'HlonPiim in front and on the sides
tiUl,Vt litlnrillMlJliiil Hiiil t'irculnr muscular fibres pronounced;
UlMOdiM im«liilii'Hiiii thli'k, pnwnitanig several permanent, trans-
VVMW ^>^ll•, |i||iwi iwri, iir \filves of flouston; is supplied by
ANATOMY. 71
superior, middde and inferior hemorrhoidal arteries; is be-
hind bladder and prostate in male and vagina in female.
Where does the abdominal aorta commence and where
does k terminate?
Commences at aortic opening in diaphragm upon body of
twelfth thoracic vertebra; terminates upon body of fourth
lumbar vertebra, just to left of median line.
Where is the foramen ovale of the heart and what
purpose does it serve?
In the wall 'between the auricles ; permits passage of blood
in the foetus from right to left auricle, deflecting its course
from right ventricle and pulmonary circulation into general
circulation.
What are the lymphatic glands?
Parts of lymphatic system consisting of adenoid tissue,
enclosed in capcgule, having afferent and efferent lymphatic
vessels; lymph passes through them.
Describe the changes in the vascular system at birth.
Blood ceases to flow through umbilical vein and ductus
venosus into inferior cava; hypogastric arteries become ob-
literated; foramen ovale closes and blood then does not pass
from right to left auricle; ductus arteriosus, connecting pul-
monary artery with arch of aorta 'becomes impervious and
pulmonary circulation is actively established.
In the anatomy of the brain what is the corpus callo-
sum? Describe its connections.
The great transverse commissure consisting of fibres which
pass from one hemisphere to the other, connecting different
parts of the cortex of one with that of lihe other, is located
nearer the base than the top and forms the roof of the lateral
ventricles.
Mention a ntuscle (a) which moves the thumb outward,
ANATOMY.
(b) which moves the head forward, (c) which moves the
foot inward.
(a) Abductor pollicis; ('b) stei-no-eleido- mastoid (rectus
t^apitis antdcus major) ; (c) tibialis anticus.
What is the composition of intervertebral substance?
How much of the spinal column does this substance form?
Is made up of fibro-cartilage; eonstitiites about V4 of the
spinal column.
Give the boundaries of the anterior mediastinum.
In front by the steruum, "behind by the pericardium, later-
ally by the pleune.
What are the ciliary processes in the eye? Where are
they placed and what is their average number?
- Folds of mididle tunic (uveal tract) consisting of con-
nective tisBiie, blood vessels and pigment; are placed around
periphery of lens close to ed'ge, posteriorly, and number about
seventy.
State the action of each of the following musclers: mas-
seter, tibialis anticus, gluteus maximus.
Masseter, to bring lower jaw up against upper jaw ; tibialis
antSeus, to flex foot upon leg and elevate and adduct inner
border of foot; gluteus maximus, to extend trunk upon thigh,
or thigh upon trunk.
PHYSIOLOGY.
Describe the bile-producing and the glycogenic function
of the liven
Bile is prodTiced by the activity of the liver cells chiefly
from the blood from the portal vein. It is collected in little
canals hollowed' between the cells and emptied into the bile
capillaries. Through these it is forced on into the bile duct
and either passed on into the duodenum during the act of
digestion, or stored in the gall bladder until needed.
Glycogen or animal starch is formed by the protoplasmic
activity of the liver cells from proteids and carbohydrates.
It is deposited in the liver cells and when needed is changed
into dextroBe by a diastatic ferment found in the blood of
the liver. This dextrose is carried out in the blood of the
hepatic vein into the general circulation.
Give a dietary for people beyond the age of sixty years.
Food for the aged should be readily dige^ible and capable
of being easily burned up for the maintenance of the heat
of the body. Among suitable articles are eggs, milk, rice,
properly cooked beef, butter and bread.
What is the function of the cerebellum?
The function of the cerebellum is the co-ordination of
muscular movements.
Describe ciliated epithelium and state where it is found
most abundantly.
The cells of ciliated epStheHum are generally columnar in
shape with numerous fine filaments projecting from their free
srurface. Cilia/ted epithelium is found most abundantly in the
(73)
74 PHYSIOLOGY.
trachea and bronchi and here sweeps the tinieus and small
dirt particles toward the mouth.
Give a description of the act of deglutition and mention
the muscles brought into action in swallowing.
The swallowing of solids is divided into three stage* —
buceal, pharj-ngeal and esophageal. The first is voluntai
the others involuntary. The food' is formed into a bolus a
pressed backward by the tongue into the pharynx; the nasal
cavitSes being closed, the pharyngeal muscles contract and
force it on down to the esophagus. This in turn contracts
and by a peristaltic movement forces the bolus into the
stomach.
Liquids ai-e not swallowed in this way. but are squirted
down the esopha^s, with a bulb syringe effect, by the
n^^Iohyoid muscle. The muscles involved iu deglutition are
the mylohyoid, muscles of the tongue, pharyngeal muscles,
especially the constrictors and the involuntary muscular
fibers of the i-sophagus.
How is asphyxia produced? What are the causes of
death from asphyxia?
It is protliiee(l by' anything causing a deficiency in the
supply of oxygen to the tissues, as edema of lungs, membran-
ous laryngitis, constriction of the trachea.
Death is caused by a deficiency in the amount of oxygen
and the accumulation of carbon dioxide in the blood. The
respiratory center is probaibly the first one to be cli.'MUbled.
Describe (a) chyme, (b) chyle.
Chyme is the acid semi-fluid ma-s-s of partially digested food
passing from the stomach into the duodenum.
Chyle is the lymph found in the lacteals of the intestines
containinig tlie ahiwrbed fat. It is a milky white, alkaline
fluid.
Give the process of coagulation of blood.
The fibrin ferment formed by the disintegnition of the
PHYSIOLOGY. 75
white corpuscles acts upon the fibrinogen and converts it, if
calcium salts are present, into the insoluble fibrin. The
fibrin is formed in little filaments all through the blood
and immeshes the blood corpuscles. This forms the clot
whdch gradually begins to contract. A liquid called serum
soon exudes and collects over the clot.
Name the functions of the chorda tympani, sufficiently
detailing each to clearly define its character.
The chorda tympani contains the vasodilator fibers, but
no vasoconstrictor fibers, for the anterior tongue and suJb-
maxillary gland. It contains the secretory fibers to the sub-
maxillary gland, and also the taste fibera for the anterior
two-thirds of the tongue.
Name the groups of food stuffs consfituting the source
of muscular energy. Designate the most important and
state what stored product is utilized.
Carbohydrates are the most important, but fats and pro-
tedds may be used in the production of muscular energy.
Glycogen is the stored product that is utilized.
State the function of the nervus opticus, and explain by
description or diagram the distribution of the fibers com-
posing the chiasma and the effect thereof upon vision.
The nervus opticus is the nerve of the special sense, sight.
At the chiasma, the inner half of each optic nerve crosses
to the opposite side ; therefore, in loss of function of one optic
nerve from injury or pressure back of the chiasma, there is
blindness of the temporal side of retina of the same eye and
of the nasal side of opposite eye. Stimulation of one retina
by light causes a reflex contraction of both pupils.
Describe metabolism.
Metabolism is the cheanical change going on in organized
tissue. There are two divisions — anabolism or building up,
and katajbolism or tearing down. This chemical change is
usually a hydration, dehydration, reduction or oxidation.
76
PHYSIOLOGY.
In the metabolism of proteids of the tissue, pi-oleitl food
must be used to repair the loss.
The carbohydrates are the substanees toost readily broken
up to supply heat and energj', the fats being next in order.
The salts are needed in the various processus, but especially
to combine with the acids, sulphuric and phosphoric, formed
in, proteid kataboiism.
What is the normal proportion of blood in the human
body and how is it renewed after hemorrhage?
About one thirteenth of the body weight is blood. The
water and other constituents of plasma are i-enewed from the
ingested food. The corpuscles are renewed by the -bone mar-
row, spleen and lymphatic tissues.
State the effects of battery currents on the normal
human nerves.
The faradic current stimulates ttiem.
A nerve during the paesa-ge of a constant current through
it, is said to be in a state of electrotoniis. There is an in-
crease of exicitaibility at the negative pole or kathode, and
decrease of excitalbility at the positive or anode.
Qive the relative food value and ease of digestion of
meat, milk, eggs, leguminous fruits.
According to relative food value the order is — meat, eggs,
nulk and leguminous fruits.
According to relative ease of digestion the oi-der is milk,
eggs, meat and leguminous fruits.
What are the effects of removal of the cerebrum in the
lower animals?
A decei-ebrated anima.1 loses all power of voluntarj' niove-
ment, remaining quiescent until some external atimulus brings
out a reflex movement. Thus, food may be placed before
him, but he will not take it; if it is placed in his mouth, he
will swallow it. If turned on bis back, he will right him-
self. He shows no fear.
PHYSIOLOGY. 77
What conditions are necessary for properly exercising
the sense of smell?
For the proper exercise of the sense of smell, the sub-
stance must be volatile, the air in the nasal cavity must be
in motion, and the olfactory apparatus must be in normal
condition.
How would digestion be affected were the ductus com-
munis choledochus obstructed?
In obstruction of the ductus communis choledochus the
feces contain large quantities of undigested fats, the stools
become hard and fetid, and finally death ensues from ab-
sorption of putrefactive products from the intestines.
Give the mechanism of the diaphragm in (a) respiration,
(b) hiccough.
Durin-g rest or relaxation the diap^hragm is domed upward.
Durinjg inspiration, the muscle contracts, the central tendon is
pulled down and thus the vertical diameter of the thorax is
increased. During expiration, the muscle relaxes and the
ddaphragm resumes its domed position.
Hiccough is caused by a sudden spasmodic contraction of
the diaphragm, the inspiration thus caused being arrested
by a sudden closure of the glottis.
How does the nervous system influence gastric diges-
tion?
Through the vagus the secretion of the stomach is con-
trolled from the central nervous system. The vasomotor
nerves of the stomach also influence secretion by controlling
the mount of blood to the stomach.
Oive the physiology of (a) hunger, (b) thirst.
Hunger is the constitutional need of the body for food
with the eccentric symptoms in *the epigastrium. The im-
poverishment and dianges in the blood so aflfect the central
nervous system as to cause the sensation.
Thirst is the constitutional need of the body for water
I
78 PHYSIOLOGY.
with the eccentric syiuptoin in the pharyns. The lack of
water ia the blood so affects the nervous system as to cause
this dryness of the throat.
Give the foramen of exit, the distribution and the func-
tion of the pathetic (fourth cranial) nerve.
The pathetic or trochlear nerve passes out through the
sphenoidal fissure and is the motor neire of the siiperior
oblique.
Give the process of development of the parietal bone.
The parietal bone is fonned between membranes and is not
preceded by temporary cartilage.
The membrane is formed of an external fibrous layer and
aji internal layer, which becomes the periosteum and consists
of a layer of osteoblasts.
Starting? from a point called the center of ossification, little
-spicules of bone are depoBLted in all directions in the inter-
cellular substances. As they become more numerous, they
completely enclose the osteoblasts, which remain permanently
in the hone. This process spreads in all directions and thus
the bone is fonned.
Explain the physiological circuit essential to a reflex
action.
The essentials are an afferent nerve, a nerve center, an
efferent nerve and the peripheral organ whieh it supplies.
Mechanical irritation of the sensory fibers of the vagus in
the mucous membrane of the stomach causes an increased
How of saliva by irritation of the salivary center in the
medulla and consequent passage of efferent impulses to thu
salivarj' glands.
What is the function of the sixth (abducens) nerve?
The abducens is the motor nerve of the external rectus.
Describe the respiratory function of the red blood cor-
puscles.
When the venous blood reaches the capillaries sur-
PHYSIOLOGY, 79
rounding the air vesdcles of the lung, the hemoglobin found
in the red corpuscles rapidly combines with the absorbed
oxygen to form oxyhemoglobin. This is carried back to the
heart and then into the systemic circulation, finally reaching
the capillaries. Here the tissues take the oxygen from the
loosely combined oxyhemogloibin. The hemoglobin is then
carried back to the lungs to be reoxygenated. The cor-
puscles also carry small amounts of carbon dioxide from the
tissues to the lungs.
Describe the normal pulse; state the factors active in
its maintenance, and give the average rate during Infancy,
youth and adult age.
The pulse is the transmission of the cardiac impulse through-
out the arterial system. A normal pulse should be full, of
moderate tension, regular and of the right frequency. It is
ordinarily examined over the radial artery at the wrist,
because in this position there is a hard surface against which
we can press the artery.
The factors active in its maintenance are the normal action
of the heart and of the vasomotor system.
The average rate during infancy is 130 to 140; during
yK)uth 80 to 90 ; during adult life 70 to 75.
Name the active principles of the digestive secretions
and state how each affects the food.
Ptyalin of saliva changes starch into maltose.
Pepsin, when hydrochloric acid is present, changes proteids
into proteoses and peptones.
Rennin changes caseinogen into casein.
Amylopain changes starch into maltose, dextrose, and dex-
trin.
Steapsin splits up fat into fatty acid and glycerin.
Trypsin, in an alkaline medium, changes proteids into
proteoses and peptones.
Invertin changes maltose into dextrose, and saccharose
into equal parts of dex?trose and levulose.
Bile contains no ferment, but aids the pancreatic secretion
in the emulsification of fats.
80 PHYSIOLOGY.
From what portions of the cortex cerebri do the arm,
face and leg receive their motor impulses?
The motor area is along the fissure of Rolando in the as-
cending frontal, ascending parietal and paracentral convolu-
tions. The leg center is the uppermost, the arm center nesl,
and the face center the lowermost.
Describe the position of the vocal chords during phona-
tion and name the factors concerned.
The chink of the glottis during phouation is narrowed,
the arytenoid cartilages are approximated and the voeal cords
are stretclied. The arytenoid muscle approximates the ary
tenoid cartilages, and with the help of the lateral crico-ary-
tenoids and the interna! part of the thyro-arytenoids closes
the glottis. The vocal cords are made tense by the crico-
thyroids and external part of the thyro-arytenoids.
Give the origin of normal fat in the human body and
name e:«amples of the types of food from which it is
elaborated.
The normal fat of tie body is derived from food ingested.
Any excess of food is stored up as fat. Fat may be elabor-
ated from fata ingested' as olein, from carbohydrates as starch,
or from proteids as casein.
Describe a con>pleite physiolosica) revolution of the
heart.
During diastole the blood from the auricles passes into
the ventricles. Toward the end of diastole the auricles
contract, forcing the blood remaining in them into their
respective ventricles ; the ventricles now contract, the auriculo-
v«ntricular valves are closed and the blood is forced into the
pulmonary artery and aorta through the open scmihiaar
valves; the ventricles now relax, the semilunar valves clos-
ing with a snap and the auriculo- ventricular valves being
opened toy the force of blood in the auricles and by the nega-
tive pressure in the ventricles.
.^ ^ PHYSIOLOGY, 81
If the canliac revolution were divided into tenths, the first
or systolic sound would occupy four-tenthis^ the short silence
one-tenth, the second or diastolic sound two-tenths, and the
long silence three-tenths.
Describe the process of respiration.
Respiration is the function of taking in oxygen and the
throwing off carbon dioxide. This exchange of gases takes
place in the air vesicles where the blood and atmospheric air
are separated by but a single layer of squamous epithelium.
Three factors are concerned in this exchange — the law of
pressure of gases, chemical affinity, and the vital activity
of the epithelium.
In tissue respiration the oxygen passes through the endo-
thelium forming the capillary wall, into the tissue, where it is
used up. The carbon dioxide there formed passes from the
(tissues into the capillaries and thence to the lungs.
What are the functions of the blood-vessels?
Through the blood-vessels the blood is forced to the various
parts of the body, carrying nutritive products to the tissues
and waste from the tissues to the organs that excrete it. By
their muscular wall they regulate the amount of blood going
to various portions of the body, and together with the elastic
tissue they contain also reduce the amount of work thrown on
the heart. Through the capillary wall osmosis and diape-
desis take place.
Name and describe the normal respiratory sounds of the
lungs and bronchi.
The vesicular sound is a distant, soft, breezy sound, of
low pitch, with the inspiration three or four times longer
than expiration. It is caused- by air passing through the
bronchi, the sound being modified by the air vesicles. The
bronchial sound is caused by the air rushing in and out of
the bronchi. It is high pitched, loud, tubular in quality, the
expiration being to inspiration as seven is to six.
6
82
PHYSIOLOGY.
I
Of the functions of vision, what is understood by ac-
commodation?
By accommodation is meant the inereaaing of the curvature
of the anterior surfaee of tie crystalline lens to focus near
objects on the retina.
Describe the action of the kidneys, and give the normal
constituents of the urine.
The kidnt'ys are compound tubular glands that pick out
from blood certain waste material which passes down the
tubules into the pelvis of the kidneys and then into the
bladder.
But one constituent of the urine is formed in the kidney
and' that is hippurie acid.
The water filters through the glomeruli principally, while
the urea is picked out by the rodded epithelium of the con-
voluted tubules. No proper secretory nerves have as yet been
found for the kidneys, which seem rather to be controlled by
the vasomotor system. The kidneys have possibly an in-
ternal secretion also.
The normal oonstituenls of the urine are — water, urea,
uric acid, hippnric acid, aodium chloride, potassium and
sodium sul'phates, conjugate sulphate as indican, earthy and
alkaline phosphates, soiiietirues carbonates and oxalates, and
the (■oloring matters urochronie, urobilin and uroerj'thrin.
Describe gastric digestion, with special reference to the
changes effected upon the types of food.
When the food reaches the Stomach the two openings close
and the involuntary muscle contracts down on the mass and
starts up a churning-like movement, by which fresh portions
of food are constantly brought to the surface. At the end
of an hour the pyloric orifice graduaUy relaxes, allowing some
of the more liquid chjTne to pass into the duodenum, and by
the end of three or four hours even the larger pieces of un-
digested' food are forced into the duodenum. During this
time the gastric juice is being poured out from the mucous
niemibrane. The act of mastication and deglutition and the>
PHYSIOLOGY. 83
irritation of sensory vagus endings in the stomach by the food
act as powerful reflex excitants to this secretion.
The ptyalin of the saliva continues to change starch into
maltose until the increasing acidity of the gastric juice stops
its action.
The fats are liquified, but it is upon the proteids that the
chief action takes place. The rennin changes caseinogen
into casein. The pepsin in the presence of the hydrochloric
acid changes the proteids into proteoses and peptones.
Describe the process of segmentaition of the ovum.
The impregnated ovum first divides into two cells by in-
direct division or karyokinesis, these again subdivide, con-
tinning until finally a single layer of cells surrounding a
central cavity is formed. One group of cells proliferates
more rapidly than the other and as a result they become sur-
rounded by the other layer; thus two leaves are formed.
Between these a third layer or mesoblast is formed. From
this blastoderm the animal is now developed.
What is the relation of the capillaries to the circulation?
The capillaries connect the small arterioles with the small-
est veins. They are situated at the periphery.
What precautions should be taken in the ingestion of
vegetable foods? Give the reasons for taking these pre-
cautions.
Vegetable foods should be wedl cooked so as to burst the
cellulose covering of the starch granules; they should be
well chewed' so as to break up the cellulose covering. Some
fatty food should be taken with them as they are deficient
in fats. As some of them contain but littile nutritive ma-
terial, they should be taken in large quantities for obvious
reasons.
Describe the process of osmosis and give examples in
the human economy.
Osmosis is the diflfusion of liquids through a porous mem-
brane.
84 PHYSIOLOGY.
For osmosis to take place the liquids miiBt be miscilile, of
different natures, capable of wetting the memtrane without
acting on it chemically, and the substance must be able to
pass through the membrane, that is, be crystal loidal in nature.
Heat, increase of pressure and electricity aid osmosis.
The following are examples of osmosis: (1) The passage
of some of tte plasma through the capillary wall into the
tissues. (2) The passage of glucose from the intestine into
the poral circulation.
Name the secretions of the alimentary canal and give
the functions of each.
Saliva changes starch into maltose and dextrin, dissolves
soluble substances, thus allowing them to be tasted, lubricates
the bolus of food and aids in speech.
Gastric juice changes caseinogen into oasein, and proteids
into proteoses and peptones. It also destroys many micro-
organisms swallowed in the food.
Pancreatic secretion changes proteids into proteoses and
peptones, stareb into maltose, dextrose, and dextrin, casein-
ogen into casein, and splits up, sai>onifies and emulsifies fats.
Bile neutralizes the acid cbyme precipitating the pepsin,
aids in the emulsificatiou and absorption of fats, increases
peristalsis, and carries off some of the waste thrown out by
the liver.
Stiocus entericus changes maltose into glucose, and sac-
charose into invert sugar.
The alimentary canal has also the usual protecting and
lubricating secretion of mucus.
Describe urea, its occurrence, variations in the quantity
excreted and recognition in the voided urine.
Urea, CO(NH„)j, the great nitrogenous waste, is a crystal-
lizahle substance soluble in water, less soluble in alcohol, neu- ,
trat in reaction and fomiing with nitric acid urea nitrate.
About 51K) grains daily are thrown off in the urine by the
kidneys. It is formed in the Iiver''(|) and in the intestines
PHYSIOLOGY, 85
(I). It varies principally with the amount of nitrogenous
food in the diet. Muscular exercise does not increase it
to any marked extent. It is recognized hy adding nitric acid
to a concentrated urine, when urea nitrate separates out in
a crystalline mass, also by the hypobromite test.
What is rig^or mortis? Whoit is tetanus?
Rigor mortis is the post-mortem rigidity of the muscles due
to the coagulation of the myosinogen.
Tetanus is a state of continued contraction of a living
muscde.
Give the varied functions of the sympathetic nerve.
The function of the sympathetic system is mainly vaso-
motor. It also supplies the heart with accelerating fibers,
the intestines with inhibitory and some motor fibers; dilates
the pupil, and causes a bulging of the eyeball. It also has
an influence on the saJivary secretion.
How are the phenomena of ventriloquism produced?
Instead of the usual expiratory blast, an inspiratory blast
is used in producing the vocal sounds. At the same time
the operator directs the attention of the onlookers to some
object.
Describe the mechanism of micturition.
Usually it is a mixture of a voluntary and involuntary re-
flex act. The reflex center is situated in the lumbar cord.
Stimulation of this center is ordinarily caused by a full
bladder or by the escape of a drop of urine into the urethra,
but may be excited by irritation of sensory nerves of other
surfaces, as the inte^inal mucous membrane by worms.
Ordinarily the sphincter of the bladder is inhibited, the
muscular wall contracts, and aided by the abdominal and
other expiratory muscles forces the urine out tfhrough the
urethra. There are higher centers that have control over
the lower reflex centers.
PHYSIOLOGY.
Name the ferments that are the essential constituents
of each digestive fluid.
Ptj'alin is found in saliva; pepsin and rennin in gastric
juice; auiylopsin, steapsin, trypsin and a rnilk-curdling fer-
ment in the pancreatic juiee ; inivertin in the succus entericus ;
and the micro-organisms or organized ferments in the in-
testines. Bile contains no ferment.
What are the functions of the spinal cord?
The spiiml cord is the great motor and sensory pathway
to and from the peripherj'. In ttie anterior horns are found
the cells concerned in the muscular reflexes, and also the
trophic centers for the muscles. Beside the muscular reflex-
centers, the cord contains the following centers: Anoapinal,
vesicospinal, genitospinal, nterospinaJ, sweat, minor vaso-
motor and possibly ciliospinai.
What post-mortem tests should be applied to prove that
air has entered the lungs of a supposedly still-born child?
Tie the trachea, take out the lungs and place the'm in
water. If they float, air has entered the lungs. The thorax
is not as flat after respiration has started and the diaphragm
is displaced further downward. The lungs are hrighter in
color and are crepitant after air has once entereil.
Wherein does the temperature of the body in advanced
age differ from its temperature in middle life?
In advanced age the temperature has a tendency to be-
come subnoraial from the slightest cause.
Give in language or by drawing the sphygmographic
tracing in aortic insufficiency.
In aortic iusufBcieuL-y there ia the .so-called "trip hammer
pulse." In tie sphygmogram there is a very high, quick up
stroke and an almost as quick downstroke due to the rapid
decrease in pressure caused by the regurgitation. On the
downstroke a small dicrotic wave is seen.
1
PHYSIOLOGY. 87
What are amyloid foods, proteid foods? Give three ex-
amples of each.
The amyloid foods are the -carbohydrates in the molecule
of which are six or multiple of six atoms of carbon, and
hydrogen and oxygen in the proportion to form water.
Starch, cane sugar and glycogen and amyloids.
Proteids are highly complex bodies containing carbon,
ihydrogen, oxygen, nitrogen, sulphur and sometimes phos-
phorus. Egg albumen, casein and gluten are proteids.
How is cartilage (a) developed, (b) nourished?
Cartilage is developed from fhe mesoblast. The cells are
not branched. By karyokinetic changes they divide and
su'bdivide. Each cell is surrounded by a capsule which helps
4o form a portion of the matrix. But beside this, other
material is deposited in the intercellular spaces.
Cartilage is nourished by the perichondrium except arti-
cular cartilage, which is nourished from the underlying bone.
Describe nerve cells and nerve fibers.
The nerve cells are nucleated masses of granular proto-
plasm with one or more protoplasmic prolongations called
dendrons. Passing off from most nerve cells is a long fiber
or axis cylinder.
The nerve fibers are either medullated or non-medullated.
The medullated fibers consist of an axis cylinder or neur-
axon, surrounded by the myelin or white substance of
Schwann, which in turn is covered with the neurilemma or
rfieath of Schwann. An internal layer of protoplasm sepa-
rates the myelin from the neuraxon, and an external layer
separates the myelin from the neurilemma. Here and fhere
along the course of the nerve are found the nodes of Ranvier.
The non-medullated fibers contain no myelin.
What experiments have been made to prove the glyco-
genic function of the liver?
The blood of the portal vein during active digestion of a
p
88 PHYSIOLOGY.
carbohydrate meal contains more sugar than the hepatic
vein, showing the arrest of dextrose in the liver. The hepatic
vein in the inter\'als of digestion contains twice as much
dextrose as that in the bQood entering the liver.
If a rabbit that bas been fed on carrots is killed and the
liver rapidly removed, cut into small pieces and thrown into
boiling water, it yields an estract rich in glycc^en and al-
most free of dextrose.
If ainother animal is treated the same but the liver al-
lowed to stand for some time 'before making an extract, the
extract will contain much dextrose and but little glyct^fen.
The carbohydrate of blood is dextrose and not glycogen.
Under the microscope, glycogen granules are found in the
jirotoplasm of the liver cells.
Qive the function cvf the epiglottis.
The epiglotitis is used in vocalization, especially of the
lower-pitched tones.
What differences of function exist between the white
and gray matter of the encephalon?
The gray matter is composed of cells, which are the ter-
minals that receive sensations, classify the knowledige thus
recedved, and send out impulses.
The white matter is made up of fibers that transmit I3ie
impulses, connecting the cells with each other and with the
periphery.
Describe the ileocecal function.
The ileocecal valve is composed of two semilunar folds
of mucous membrane, containing the cireular fibers. When
the cecum is distended this valve is closed, and thus re-
gur^tation info the small intesline is prevented.
State the approximate time of eruption of the tempo-
rary teelh.
The lower central incisors erupt about the 5tb or 6th
month, followed rapidly by the other six incisors. About
PHYSIOLOGY. 89
the 11th or 12th month the first molars appear. Prom the
18th to 20th month the canines erupt, followed from the
24th to 30th month by the second molars.
State what are, under normal conditions, the (a) adult
number of respirations per minute; (b) body tempera-
ture; (c) average respiratory capacity.
Respiratory rate is eighteen per minute; the body tem-
perature is 98.4° Fahr. ; the average respiratory capacity is
230 cubic inches.
Name two circumstances influencing secretion.
Among circumstances influencing secretion are the supply
of blood to the gland and the proper action of the normal
reflex excitants.
What is the function of (a) sudoriferous glands; (b)
the sebaceous glands?
The function of the sudoriferous glands is to excrete
sweat; that of the sebaceous glands to secrete sebum.
Name the principal centers of organic function in the
medulla oblongata.
The principal centers in the medulla are the respiratory,
cardio-inhibitory, cardio-accelerator, vasomotor, salivation,
mastication, deglutition, vomiting and diabetic.
Account for the contraction and dilatation of the pupil.
The contraction and dilatation of the pupil is a reflex
phenomenon regulating the amount of light and sharpening
tiie image for near objects.
There are two sets of muscular fibers in the iris — circular or
contracting and radiating or dilating.
Give the composition of normal feces.
The feces contain 70 to 80% of water. Of the solid mat-
ter there are indigestible substances as cellulose, mucin and
keratin; some nndigested matter as uncooked starch and
elastin; products of microbic digestion as indol, skatol,
PHYSIOLOGY.
phenol, fatty aeids and leiiein; bacteria: cholesterin; color-
ing matters, stercobiliu; and intestinal debris as cells and
mucus. They are alkaline in reaction, quantity, 6 to 8 ounces
in 24 hours.
Describe the disturbances of function produced by the
excessive imbibition of alcohol.
Esceasive imbibition of alcohol causes congestion of the
stomach witb altered gastric secretion, precipitation of pepsin
during gastric digestion, congestion of liver and finally de-
struction of many of the liver cells. Ou entering the cir-
culation it acts as an irritant to the whole vascular system
and to tihe kidneys. It ul&o causes subnormal temperature.
How are ceils connected?
Cells are connected by the intercellular
ubstancea.
I
What changes take place in the composition of blood as
it passes through the kidneys?
During the passage of the blood through the kidneys, these
organs pick out of it large quantities of urea, uric add,
sodium chloride, alkaline and earthy phosphates, sodium and
potassium sulphates, indican, extractives and water. The
blood also becomes venous, losing oxygen and adding more
carbon dioxide.
How are the vocal sounds producedV
The vocal sounds are produced hy vibrations of the vocal
cords, modified in the case of vowels by peculiarities in the
shape of Che resonating cavities above, mouth, pharynx and
nasal cavities. In the case of consonants the vibrations are
modified 'by a more or less complete interference with the
outgoing flow of air.
What would be the effect on the saliva and on digestion
if Stenson's duct should be divided?
If Stenson's duct should be divldei]. the other parotid
would probably hypertrophy somewhnt to nuike up for the
PHYSIOLOGY. 91
loss of secretion. There would be comparatively little effect
on the saliva or digestion. At first mixed saliva would possi-
bly be less watery and the digestion of starch somewhat
retarded.
Describe the physiologic aspect of atavism.
Atavism is the peculiarity of the offspring of taking on
the characteristics of the parent.
Certain characteristics, inherent in the ovum and spermato-
zoon and derived from the parents, <;ause special develop-
ment in the certain lines, thus causing the offspring to take
on peculiarities of the parents.
Give the extremes of slowness and rapidity of the heart's
action which are consistent with physiical vigor, and with
ability to perform manual labor.
The extremes would probably be from fifty to a hundred
beats per minute; nevertheless, no definite extremes can
be given.
Give the process of regeneration of uterine mucous
membrane following pregnancy.
Following pregnancy the mucous membrane of the uterus
is regenerated from the epitlhelium of the deep glandular
layer. Around the moutih of the glands proliferation goes on
rapidly, the groups of new cells spreading out and finally
coalescing with each otber. About the end of the fifth week
this new membrane is complete. All cells and shreds of
decidual tissue not concerned undergo fatty degeneration
and are thrown off through the lochial discharge.
•
In what manner, physiologically, does a largely dis-
tended stomach produce death?
A largely distended stomach may cause death by interfer-
ence with normal digestion, causing excessive fermentation
and auto-intoxication. Or, pressure on the surrounding or-
gans causes interference with the circulation and the func-
tions of the organs. The venous stasis causes hypertrophy
92 PHYSIOLOGY.
and dilatation of the heart, n-hich finally gives out, death
ensuing.
Give the physiologicBl properties of the facial nerve.
The facial nerve is the motor nerve for the muscles of
expression of the face.
Describe hemogiot>in and mention its derivatives.
Hemoglobin is a proteid-liie body, readily crystallizable and
containing iron. It readily unites with oxygen and other
gases and has a peculiar spectrum. On the addition of an
Bicid or alkali, it is broken up into hematin and globin, a pro-
teid of the globulin group.
Ilematin, heniatoidin, hennin, heraatoporphyrin and methe-
moglobin are derivatives of hemoglobin.
Define and give the physiologic significance of (a) dys-
pnoea, (b) dysphagia, (c) apnoea.
Dyspnoea, or difficult rapid breathing, is cnusfd by a de-
ficient supply of oxygen to the tissues.
Dysphagia, or difficult or painful deglutition, may be
caused by obstruction in the esophagus, reflex spasm, or by
painful affections of the pharynx.
Apnoea, or cessation of breathing, is caused by the 'blood
being overcharged with oxygen, or by a reflex inhibition of
the respiratory center.
What prevents digestion of the stomach by its own
juices?
The reason that the stomach is not digested by its own
juices is not known, so it is said to be due to a vital act
Neither the alkalinity of the mucous membrane, nor the
alkalinity of the blood will explain it.
Give the physiology of (a) blushing, (b) pallor, (c) tear
shedding.
Blushing is a reflex dilatation of tihe bloodvessels of the
skin. Some emotional disturbance so stimulates the vasodi-
PHYSIOLOGY. 93
later center in the medulla as to cause a vasodilatation of the
skin vessels.
Pallor is a reflex vasoconstriction of the bloodvessels of
the skin. It is caused by a reflex excitation of the vaso-
constrictor center in the medulla.
Certain emotions so reflexly stimulate the lachrymal glands
through the central nervous system as to cause tihe glands
to secrete more fluid than can be carried off through the
nasal duct. The excess runs over the cheeks and is called
tears.
What causes (a) circulation of the blood, (b) the beat-
ing of the pulse?
The circulation of the blood is caused by the action of the
heart, aided by the vasomotor system.
The beating of the pulse is caused by tlhe transmission of
the cardiac impulse through the elastic arterial system.
What are the functions of the pancreas?
The pancreas secretes the pancreatic juice. In addition
to this, it has an internal secretion, because extirpation of
the pancreas causes diaibetes.
What substances are absorbed principally in (a) the
stomach, (b) the duodenum?
Alcohol, water and soluble salts are absorbed in large
quantities by the stomach. The fats, proteids and glucose
are absorbed in the duodenum and in the rest of the small
intestines.
Describe the conditions within normal physiological
limits which increase arterral blood pressure.
Anything that will directly or indirectly cause stimulation
of the vasomotor center will cause an increase in arterial
pressure.
Among these causes we have digestion, muscular exercise,
various emotions, as fear and joy, increased resistance in the
capillary system, dyspnoea and asphyxia.
I
94 PHYSIOLOGY.
Name the inorganic proximate principles that enter intO'
the formation of the human body.
The inoi^anic proximate prineiples entering into the for-
mation of the human body are water and the various salts,
as sodium chloride, potassium sulphate, calcium fluoride and
magnesium phosphatL'.
What do you understand by the term nutrition, and
what processes are comprised under it?
By nutrition is meant tlie taking-in of nutrient materialK
its conversion into living protoplasm, and the throwing-ofl?
of waste matter from the cell.
It includes di^stion, absorption, m(!laboliBm and excretion.
What are the Wolffian bodies? When do they appear
and into what organs do they ultimately develop?
The Wolffian iKKlies are the lemporaiy kidn*?ys of early
iuli-a-uterine life, appearing about the third week. In the
female they become tJie parovarium; and in the male, form
the globus major, vas efferentia and coni vasculosi.
What is the composition of human milk?
Milk contains 112 parts of solid matter to the thousand.
Of these, sixty parts are the carbohydrate, lactose; thirty
are fats, olein. palmitin, stearin and butyrin; twenty are
proteids, easeinogen, lactalbumin and lacglobulin; and two
parts are salts, especially sixlium chloride and calcium phos-
phate.
What are the uses of perspiration?
Through the perspiration we get rid of certain waste pro-
ducts, supplementing somewhat the action of the kidneys.
Through it we also throw off large quantities of heat. It also
keeps the skin moist.
What conditions increase the amount of solids in the
urine?
Increased ingestion of salts will increase the amount of
salts excreted.
PHYSIOLOGY. 95.
Diarrhoea, free perepiration and limiting the ingestion of
fluids, will cause a relative increase of solids. Excessive
muscular exercise will also cause a small increase in the
amount of solids.
What are the functions of the pneumogastric nerve?
Among its many functions the pneumogastric is motor and
sensory to the larynx, motor to the pharynx and oesophagus,
motor, sensory and secretory to the stomach, inhibitory of tJie
heart, motor and sensory to the lungs, and sends more fila-
ments through the sympathetic system to the pancreas, liver -
and intestines.
How are the sensations of color produced?
According to the Yung-Helmholtz theory there are three -
sets of retinal filbers, each responding to the stimulation of
one of the primary colors, green, red and violet. Stimula-
tion of these in different degrees causes the various shades.
According to the Hering theory there is one set of fibers,
while there are three chemical substances found in visual
purple. The anabolism of these causes white, red and yellow;
katabolism, black, green and blue. Various combinations,
cause various shades.
Describe the portal circulation; the renal circulation.
The blood collected from the capillaries of the spleen,
stomach and intestines by the splenic, gastric, inferior and
superior mesenteric veins is carried by the portal vein to
the liver. Here this vein breaks up into smaller vessels
running between the lobules, called the interlcbular vessels.
These break into a set of capillaries, called the lobular capil-
laries, which coalesce to form the intralobular veins. These
empty into the sublofbular veins, which in turn form the
hepatic vein which carries the blood into the inferior vena
cava. The hepatic artery supplies especially the capsule of
Hie liver.
In the kidneys we find three sets of capillaries. One-
96
PHYSIOLOGY.
r
set is that of the vasa recta, short vessels given off from the
arterial trunkB and supplying the medullary portioa. Then
we have the arteries of the cortex forming the set of capil-
laries of the glomeruli. The vessels passing out from the
glomeruli are called the eiferent vessels, and again break
up into a set of eapillaries around the eonvohited portion of
the tubules. The blood is then collected by the renal venules
and passes out through the renal vein.
What circumstances and conditions favor i^astric diges-
tion?
Among the many circumstauces favoring gastric digestion
are thorough mastication, slow eating, pleasant taste to the
food, swallowing in small mouthfuls, normal amount of con-
diments, muscular and mental quietude, and a general heaJthy
condition of the various parts of the body.
Describe the physiology of vomiting.
Vomiting is the spasmodic rejection of the contents of the
stomach. It may occur from an aibnormal condition of the
vomiting center in the medulla, or reflexly from the irrita-
tion of many nerves, as the glossopharyngeal in the posterior
surface of the larynx, or the pneumogastric in the stomach,
or from the sight of disgusting oljjeets. di^usting tastes or
smells, or from irritation of other mucous membranes, as the
uterus.
During the act of vomiting the diaphragm is fixed, the
cardiac orifice of the stomach is opened by the longitudinal
fibers and the abdominal muscles contract, causing the eon-
tents of stomach to be forced into the mouth.
What would be the effect on digestion if the pancreatic
duct were obstructed?
As the pancreatic secretion acts on all classes of food, there
would be a marked decrease in the wliole digestive function,
especially on the fats and proteids.
PHYSIOLOGY. 97
Discuss bacteria in the intestines.
The bacteria found in the intestines may be divided into
three ^oups, — fermentative, ehromogenie and pathogenic.
The first class is very useful, forming peptones, dextrose
and fatty acids, and breaking up some poisonous principles,
as choline, into simpler bodies. Unless putrefaction becomes
excessive, it is perfectly normal.
Among other substances formed during microbic diges-
tion are indol, sfcatol, phenol, caribou dioxide, leucin, tyrosin,
hydrogen sulphide and ammonia.
Give the relative activity of absorption in the alimen-
tary canal, the skin and the lungs.
The relative activity of a:bsorption is first through the
lungs, then through the alimentary canal, and third through
the skin.
Give the process of replacement of temporary by per-
manent teeth.
As the jaws grow and can accommodate the larger per-
manent teeth, the little immature permanent teeth budded
off from the temporary set begin to grow upward. As they
grow, the fangs of the temporary teeth are gradually ab-
sorbed, the crown falls off, and then the permanent erupt.
What conditions retard, suspend or prevent the coagu-
lation of blood?
The conditions retarding, suspending or preventing coagu-
lation are — addition of oxalates, proteoses,, peptones or leech
extract ; low temperature ; contact with living vascular walls ;
the covering of the surface with oil; addition of large quan-
tities of neutral salts; excess of carbon dioxide; death by
lightning; and the diseased condition, hemophilia.
What is the function of the superior laryngeal nerves?
The superior laryngeal nerves are the motor for the crico-
thyroid muscles and the sensory for the larynx.
7
98 pnY.VOLOGY.
Discuss the effect of the cooking of food as a means of
rendering it more digestible.
It is especially on the starchy foods that cooking has a
good effect by breaking up the cellulose covering of the starch
granules and changing some of the starch into dextrin.
The fats in the cells are also liberated.
Upon the proteids cooking has rather a detrimental effect,
especially if the temperature is raised very high. For in-
stance, the uncooked egg alhurain is more readily digested
than the coagulated cooked albumin.
What agencies induce the flow of lymph to the point
of discharge in the veins?
The flow of lymph is initnced by the vis a tergo or pressure
in the tissues, by muscular action and the play of the numer-
ous lymphatic valves, by niiiscular tissue in the lymphatic
vessels, and by thoracic suction.
Name some of the involuntary muscles and the function
with which each is concerned.
The litems is the organ for the carrying of the developing
ejnhryo and foetus. The muscle is used for the expulsion of
the foetus at the end of intra-uterine life.
The muscular wall of the intestine is used for mixing and
passing on downwai-d the food received from the stomach.
The tunica media of the arteries contains many muscular
libers that control the supply of blood to the various partt
of the body.
What do you understand by blood pressure?
Blood pressure is the pressure to which the blood is sub-
jected in the circulatory system. In man it is aibout 110
millimeters of mercury.
What effect does an excessive starchy diet produce?
It produces excessive flatulency and may lead to an ali-
mentary glycosuria.
PHYSIOLOGY. 99
Give the mechanism of the organs of hearing.
The sound waves are converged by the auricle, pass through
the external auditory meatus, striking then against the mem-
brana tympani, which sets into movement the ossicles, malleus,
incus and stapes. The base of the stapes fits into the oval
window. Thus the sound waves cause a movement of the
ossicles, which in turn, through the base of the stapes, cause
vibrations to be set up in the perilymph of the vestibule ; then
they are conveyed through the scala vestibuli and through
the helicotrema to the perilymph of the scala tympani, and
out through the round window to be dispersed.
The vibration of the perilymph in the cochlea sets up
vibration in the scala media costaining the organs of Corti,
which are the special receptive apparatus of hearing.
The impressions received here are carried by the cochlear
branch of the auditory nerve to the cerebrum.
What is meant by digestion?
The nutrient material or food ingested has to be so rihanged
that it can be absorbed. This dhanging of the food is called
digestion.
What influence has the nervous system on the process
of secretion?
The nervous system controls the process of secretion by
the various secretory centers and nerves, and by controlling
the amount of blood to the various organs of the body.
Name the refracting media of the eye and the effect that
each has on the rays of light.
The refracting media of the eye are the cornea, aqueous
humor, crystalline lens, and the vitreous humor.
They all converge the rays of light, the cornea being the
most potent, the crystalline lens coming next, then the vitreous
and finally the aqueous humor.
What is the location of the center for articulate speech?
The center for articulate speech is in Broca's convolution,
the left lower frontal in right-handed people.
r
PHYSIOLOOY.
How is the sensation of pain produced?
Stimulation of the spp.cial endings of the pain nerves in
the skin, or stimulation of the trunk of the nerve, causes an
impression to be sent to the special area of the brain pre-
siding over pain sensations. When this center is so stimu-
lated we feel pain.
What kinds of food would you recommend in cases of
obesity?
The whole diet including water should be restricted and
the relative amount of proteids greatly increased in cases
of obesity.
Give the reactions of the following fluids and state the
cause of the reaction in each case: blood, gastric juice
and pancreatic juice.
Biood is alkaline from ils contained alkaline phosphates
and cartjonates.
tiaatric juice is acid from the hydrochloric acid in it.
Pancreatic juice is alkaline froui the sodium carbonate it
contains.
Do variations in the rate and force of respiration affect
the heart, and if so, in what manner?
Increase in the rate and force of respiration increases the
number and force of the heart-beats. A deep inspiration
held for some time will reduce the rate of a rapid heart.
Name the organs of the special senses.
The organs of siJccial sense are the eye, ear, upper por-
tion of nasal eavity, the taste bulbs on the tongue, end the
tactile end organs.
Describe the functions of spinal nerves.
The spinal nerves carry the afferent and efferent impulses
of the body and of the bock of head to and from the central
nervous system.
Among tJie afferent impulses we have those of pain, tem-
perature. Uetile, pressure and muscular sense.
PHYSIOLOOY. 101
Among the efferent, we have the motor, trophic, secretory
and vasomotor.
Describe the effect of a transverse section of the spinal
cord in the mid-dorsal region.
A transverse dorsal section would cause paralysis of mo-
tion and of sensation of the parts below the section, paralysis
of bladder and rectum, and exaggerated reflexes of the legs.
What is meant by the condition of tetanus in a muscle?
When a muscle goes into a state of continued contraction,
it is said to be tetanized.
Describe the digestion in the stomach of a meal of bread
and milk.
The ptyalin of saliva continues for some time in the stomaeh
to change the stareh of the bread into maltose. The hydro-
chloric acid also has some action on the stareh. The gluten
of the bread is changed by pepsin into gluten peptone. The
caseinogen is changed into casein by the rennin, and then
the pepsin changes it into casein proteose and peptone.
The laetalbumin and globulin are also changed into pro-
teoses and peptones. The soluble salts are dissolved and the
fats melted.
What variations of temperature are found in the differ-
ent parts of the body? Mention the reasons for such
variations.
The highest temperature is found in the blood leaving the
liver, and is due to the amount of heat formed in tftiis large
gland.
The tip of the nose is said to be the coldest part of the
body, due to its exposed position and to the thinness of its
walls.
The skin surface is always cooler than the internal or-
gans, due to the radiation of the heat of the blood from the
skin, the evaporation of sweat from the skin and the in-
creased amount of heat produced in the internal organs.
102
I'HYSWLOGY.
P
Describe the mechanism in the opening and closing of
the aortic valve.
The three leaflets of tiie aortk valve are placed with their
concavity toward the aorta. During systole the pressure in
the ventricles forces the blood past the aortic valve into the
aorta. As the ventricle begins to dilate in diastole the pres-
sure of the blood in the aorta tends to force the blood hack
into the ventricle. This foi-ce fills up the pockets of the
aortic leaflets and forces their free edges tt^ether, thus
cilosiug the orifice.
Define life and death.
"Life is that obscure principle whereby organized beings
are peculiarly endowed with certain powers and functions
jociated with inorganic matter,"
»Bth is the cessation of life." (Dorland).
Describe the physiology of rectal feeding.
Small quantities of fiwd, especially if predigested, when
placed in the rectum are readily absorbed and wiH sustain
life as long as the rectum does not become so irritable as not
to retain tihe food. The food should preferably be predi-
gested. but e\'en egg albumin can be absorbed.
What tests should be applied to ascertain the integrity
of (a) the superficial reflexes, (b) tlie deep reflexes?
To ascertain the integrity of superficial reflexes we have
the plantar reflex or movement of the toes on stroking the
sole of the foot ; the cremasteric, the retraction of testicle on
gently stroking the inside of the thigh; the epigastric, eon-
traction of abdominal muscles on stroking the side of the
abdomen; the eiliospinal, dilatation of the pupil on pinchinn
the skin ; and many others.
Of the deep reflexes, the knee jerk is the one usually sought
after. On tapping the tendon below the patella the quadri-
ceps is thrown into action. We also have a bicipital reflex
r contraction of biceps on tapping the tendon at the elbow.
PHYSIOLOGY. 103
What would be the effect of a transverse section of
(a) the anterior root of a spinal nerve, (b) the posterior
root of a spinal nerve?
Transverse section of the anterior root would cause motor
paralysis of the muscles it supplied, and finally atrophy of
the muscles.
Transverse section of the posterior root would cause loss
of sensation of the part it supplied.
Describe the physical properties of (a) lymph, (b) chyle.
Lymph is <a yellowish, salty, albuminous liquid, with a
specific gravity of 1015. On exposure to air it clots and
coagulates on heating.
Chyle is simply lymph plus the minute globules of absorbed
fat, and is milky white in color.
How does inipairment of the function of one of the fol-
lowing affect the other two: (a) the skin, (b) the lungs,
(c) the kidneys.
Impairment of the function of the kidneys causes increased
activity of the skin; and at times dyspnoea, asthmatic at-
tacks, urinous breath, Cheyne-Stokes breathing, and con-
gestion of lungs.
Describe an epithelial secreting surface.
The mucous membrane of the stomach consists of a layer
of columnar epithelium resting on a layer of loose connective
tissue, containing some involuntary muscular fibers and many
small blood vessels and lymphatics. Dipping down from
tftie epithelial layer are numerous small glands. These glands
are lined with cubical epithelium and secrete the gastric juice.
In the glands of the cardiac end and of the fundus, beside
the cubical cells, we also find along the sides a number of
spheroidal cells. These are the cells that form the hydro-
chloric acid.
PHYSIOLOGY.
Dtscuss the action of the gastric juice on carbohydrates
and fats.
The gastric juice has no effect on fata, except to melt some
of them because of its temperature.
As to the carbohydrates starch Is unaffected, but the hy-
drochloric acid possibly inverts some of the cane sugar
present in the food.
Give the composition and uses of blood.
The blood is composed of 60 parts plasma and 40 parts
uorpiisdes.
In a thousand parts of plasma ninety-eight are solid. The
bulk of the solid matter is composed of the proteids, serum
albumin, serum globulin and fibrinogen. Besides these we
have various salts, especially compounds of sodium, oalcium,
potassium and magnesium in eombination with chlorine, phos-
phorus and carbon dioxide. There are also fats, urea, uric
acidi, dextrose and eholesterin.
The red corpuscles are composed of water 69%, hemogl(rf)in
29%, and smaJl quantities of other proteids, salts and ex-
tractives.
The white corpuscles contain globulin, albumin, nuclein,
various salts and the mother body of fibrin ferment.
The bloodi carries the absorbed food and oxygen to the
tissues and carries away waste to the organs excreting them.
It also equalizes the temperature of the various parts of the
body.
Describe the process of absorption by (a) the blood-
vessels, (b) the lymphatics.
The digested food is carried through the columnar epithe-
lium of the intestinal villi by the force of osmosis and the
vital activity of the cells, the peptones being changed during
their passage into albumins and globulins. The carhohy-
drates, soluble salts and proteids pass into the capillaries
and then on into the porta.1 vein, \vbieb carries them to the
liver. Prom here they pa.s.s ont through the hepatic vein into
PHYSIOLOGY. 105
the general circulation. The fats are taken up by the lacteals
and carried to the receptaculum chyM and then up through
the thoracic duct into the left subclavian vein.
Describe the red blood corpuscles. Give the best known
and most important function of the red blood corpuscles.
The red corpuscles are non-nucleated, elastic, biconcave
discs about one thirty-two hundredth of an inch in diameter.
They are yellowish-green when seen under the microscope.
In large masses they are red. They carry the oxygen to the
tissues. They consist of a stroma in which is imbedded' the
hemoglobin.
Describe the structure of the arteries. How do arteries
exercise their function?
The arteries have three coats — tunica intima, media and
adventitia. The intima or internal coat consists of a lining
of a single layer of endothelial cells and a layer of yellow
elastic tissue. The media or middle coat is composed es-
pecially of involuntary muscular fibers arranged transversely
to the long axis, but it also contains many elastic fibers. The
adventitia or outer coat is made up of a supporting layer of
areolar tissue in which are many yellow elastic fibers.
In the media we ^nd many little ganglionic masses, the
local vasomotor system. In these the vasomotor nerves end.
The arteries exercise their function on account of being
closed tubes, by reason of their contained elastic tissue, and
by the action of the vasomotor influence of the nervous sys-
tem on the muscular fibers.
Describe the fetal circulation.
The blood coming from the placenta through the umbilical
vein passes into the inferior vena cava, some of it passing
first into .the liver by the ductus venosus and then into the
inferior vena cava. It is then carried into the right auricle,
where it meets the blood returning by the superior vena cava
from the head and upper extremities.
The currents do not mix to any extent, but by means of the
p
106
Eustachian valve the blood from the inferior vena cava flows
throu^ the foramen ovale into tiie left auricle, where il
nieeta tie small amount of blood coniing from the lungs and
is passed on iuto the left ventricle and out through the aorta
to supply especially the head and arms.
The blood from the superior vena cava passes through the
right auricle into the right venlricle and then out through
tlie pulmonary artery. Some of this blood passes to the
Iiings, but most of it passes through the ductus arteriosus into
the des(!0ndiug aorta, where it mixes with the blood from tlie
left v«]tricle and supplies the lower extremities, a portion
passing through tlie umbilical arteries to the placenta.
Mention the erectile tissues of the body and explain
thttr function.
"Ow ppwrtile tissues of the body are the penis, clitoris.
aipplm, end according to some, the mucous memtraae of
iMWi. Tiiey are coneeroed in the genital sense, increasing th-i
vMLWkl <>xoilenient and helping complete orgasm.
Vk1l«t tllitotive changes talce place in (a) the small in-
MMtMS. <b> the large intestines?
In llw small intestines proteids are changed into peptones
mm) «wn h>wer btHlies, as argintn and leiicin; fats are split
UK •«ny«»tfi«l and emulsified; undigested starch is changed
tHh» ViMlt>*>v. which in turn is changed into dextrose, and cane
m^r m iinirtctl.
U rt* iowor part of Ihe small intestine and in the large
iWwIiiiv itii\'ii»bif <Iigcstion is carried on with the forma-
Muu vl inUr\'f«cIion products. earl)on dioxide, methane.
lt.\iM*«>Nt nuli'hHlp. ly'<li"*>Se'>, indol, skatol, phenol, butyric
«Mutt »«U-f>«Hic acitl. leucin. tyrosin. trimethylaniine. and
i)WlK,v ^iIIm'i- iiixhIui'In.
IWMVt^ the Mrutture of (a) striated muscle, (b) non-
«(l-4«W4 MWW**' Which of these is called voluntary, and
Hti>(«M liiw*'!'' » conii>.»sed of fibers transversely stnated.
PHYSIOLOGY. 107
Each fiber is about one inch long and one five-hundredth of
an inch in diameter.
The fibers consist of an outside sheath or sarcolemma, which
is filled with a liquid, the sarcoplasm. Imbedded in this we
find the muscle columns or sarcostyles. These are divided by
a Kraus membrane into sarcomeres, each of which is com-
posed of a central dark portion, the sarcous element, and on
either side a lighter portion.
Non-striated muscle is formed of small spindle-shaped
nucleated cells, not transversely striated. It has some faint
longitudinal striations.
Striated muscle is voluntary, that is, under the control of
the will.
Define reflex nervous action. Give examples.
A reflex action is an afferent impulse followed by an ef-
ferent impulse independent of the higher cerebral centers.
A blow in the solar plexus causes an inhibition of the heart.
The testicle retracts when the inner surface of thigh is stroked.
Describe the rods and cones of the retina.
The layer of rods and eones of the retina is the ninth and
is separated from the choroid by the tenth or pigment layer.
The rods are more abundant than the cones, about five to one,
but are absent in the fovea centralis, the cones only being
present. In the outer end of the rods the visual purple is
found. The oones are i^horter than the rods and contain
no visual purple. The optic nerve ends in these rods and
oones, which are the active receptive organs of sight.
Describe the sphygmograph and state its use.
The sphygmograph or pulse recorder essentially consists of
a spring fastened at one end, with a button on the other
end to press on the artery, and a system of fine levers so ad-
justed as to write the movements of the spring on strips of
glazed, blackened paper.
108 PHYSIOLOGY.
How is accommodation in the eye accomplished?
Accommodation is accomplished by the contraclion of the
ciliarj- muscle relaxing the suspensory ligament and thus al-
lowing tlie ei-ystalline lens to become more convex, ipliieh it
then does on account of its elastic eapsule.
How do veins, arteries and capillaries differ as to (a)
structure, (b) function?
The arteries have three coats, whi<;h contain more muscular
and elastic tissue than the veins. The arteries have no
valves, while many of the veins have. The capillaries are
formed of a single layer of lance-shaped endothelial cells.
The arteries carry t-he blood from the Iieart to the capil-
laries. The veins carry it back to the heart. Through the
eapillarj' wall osmosis and diapedesis occur; thus Hie tissues
are nourished and the waste matter is carried off.
What is the function of each class of foods in the nutri-
tive process?
The proteids repair the tissue; the carbohydrates are the
body fuel, being easily oxidized; the fats arc not so readily
oxidized but are used up to form heat, the excess being stored
in the adipose tissue; the salts are necessary to keep some
of the proteids in solution, to regulate osmosis, to neutralize
the acid produced by katabolism. to form bone, and are s
necessary ingredient in most of the secretions.
State the origin and the uses of (a) lymph, (b) the bile.
Lymph is the diluted blood plasma that has osmosed through
the capiUary wall, to which is added I>inphocytes formed in
the lymphatic glands. It bathes and nourishes the tissues,
carries away wa.ste and adds Ij-mphocjtes to the blood. The
products of some of the ductless glands are emptied into it.
The bile is formed in the liver. Bile neutralizes the acid
eliyme, precipitating the pepsin, aids in Che emulsification and
absorption of fats, increases peristalsis, and contains some
waste products.
PHYSIOLOGY, 109
In what manner is the heart-beat influenced by the
pneumagastric nerve? What is the average number of
heart-^beats per minute in (a) a child aged one year, (b)
an adult aged seventy years?
Stimulation of the pneumogastric nerve causes a slowing
of tihe heart.
The average niiniber of heart-'beats at one year of age is
about 115; at seventy years of age, about 70.
Define emulsification, saponification. Illustrate.
Emulsification is the breaking up of a fat into very small
particles and holding them in suspension in a liquid in which
they will not dissolve, as shaking together bile, water, and
olive oil.
Saponification is the replacing of the glycerin of a fat by
an alkali, as by the heating together of olein and sodium
hydrate to form sodium oleate and glycerin.
What causes an increased flow of bile into the duo-
denum? What pathologic effects may ensue because of
occlusion of the ductus comniunis choledochus?
The act of digestion causes an increased flow of bile into
the duodenum, as will also certain drugs, as calomel and
podophyllin, and irritation of the intestinal mucous mem-
brane.
Occlusion of lihe ductus communis choledochus is followed
by jaundice with its tendency to malaise, headaches, anaemia
and slowing of the heart's action. It also interferes with the
digestion and absorption of fats, allows of an excess of putre-
factive substances being formed in the intestines, and also
causes constipation.
State the function of the third cranial nerve. What is
the effect of division of the third cranial nerve?
The third nerve is the motor nerve for the internal rectus,
superior rectus, inferior rectus, inferior oblique, levator palpe-
brarum, ciliary muscle and the constrictor of the pupil. Sec-
110
PHYSIOLOGY.
r
tioD of this uerv-e causes loss of accommodation, ptosis, es-
ternat or divergent squint and diplopia.
What are the movements of the eyeball? Mention the
muscles concerned in each of the movements.
Protrusion- — caused by the muscular fibers in the capsule
of Tenon.
Retraction — caused by the tigiit closing of the lids or para-
lysis of the muscular fibers in the capsule of Tenon.
Upward movement — caused by contraction of superior rec-
tus and inferior oblique.
Downward movement— caused by contraction of inferior
rectus and superior oblique.
Inward movement — caused by contraction of internal
rectus.
Oubivard movement- — caused by contraction of external
rectus.
Rotary movement — cause<l by contraction of either of the
two oblique muscles.
What are the accepted theories as to the origin of (a)
the red blood corpuscles, (b) the white corpuscles?
The red corpuscli>s are formed Jn the red marrow of bones
and in the spleen.
The white corpuscles are formed in the lymphatic system,
the spleen and the marrow of bones.
How is the diaphragm affected in expiration? State
cause.
The central tendon of the diaphragm is drawn upward into
the thorax during expiration by elastic recoil of the lungs,
tending to produce a vacuum in the pleural cavity.
Define secretion, excretion, protoplasm, assimilation.
A secretion is that product of glandular activity needed
in the various processes of the living organism.
An exeretion is that pro<kiet of glandular activity con-
taining waste of no further iise to the organism.
PHYSIOLOGY. Ill
Protoplasm is the living substance surrounding a specially
formed element called the nucleus.
Assimilation is the conversion into protoplasm of nutrient
material or food ingested.
What are the causes of the apex beat of the heart?
The apex being free it is brought forward to strike against
the chest wall by the contraction of the ventricle. The shock
of the contracting muscle also contributes to it.
What special use does each of the following serve in the
body after ingestion: proteids, fats, carbohydrates, alco-
hol, tea, and coffee?
Proteids repair the tissues, fats are used for body fuel and
as a reserve, carbohydrates are the body fuel, alcohol in
small doses is a general stimulant and by irritating the
mucous membrane causes an increased flow of gastric juice.
Tea and coffee are stimulants, increasing the flow of the
various secretions and stimulating peristalsis.
State the functions of the fifth cranial nerve.
The fifth nerve is the sensory nerve of the face, mouth
and nasal cavities, and the motor nerve of the muscles of
mastication.
What effect, if any, results from the division of (a) a
vasoconstrictor nerve, (b) a vasodilator nerve?
Division of a vasoconstrictor nerve causes a vasodilation
in the part it supplies.
Division of a vasodilator nerve usually has no effect. If
it be in action at the time, a vasoconstriction would follow.
Describe the vermicular movement of the stomach and
intestines. What purpose does this movement serve?
The movement of the stomach causes the food there to be
thoroughly mixed, the peculiar contraction causing a current
down along the fundus to the pylorus and back again along
the lesser curvative.
PHYSIOLOGY.
The movement of the intestine is a true peristaltic one, that
is, one segment of the intestinal walls eontraofs after the
preceding segments; thus a wave of contraction passes down,
niixing and pressing the food on downward.
DifferentHite white fibrous tissue and yellow elastic
tissue as to (a) structure, <b) distribution.
White fi'brous tissue consists of white fibers arranged in
parallel bundles, the connective tissue cells also being ar-
ranged in this way. Yellow elastic tissue is a connective
tisane in which the yellow fibers predominate. These fibers
are larger than the white and are bound together with areolar
tissue. The white fibrous tissue is found (Aere strength and
inelasticity is needed, as in the ligaments and tendons.
The yellow fibrous tissue is found where elasticity is
needed, as in the coats of the blood vessels, in the lungs, and
vocal cords.
Explain the action of the anospinal center in defecation.
The anospinal center is the reHex center for defecation.
Irritation of tbe nuicous membrane of tbe rectum sends an
impression to the anbspinal center, which then causes a re-
laxation of the sphincter muscles and nn (increase in peris-
talsis. This center is under the control of the will to a great
extent.
How is the venous blood current maintained? What
arteries carry venous blood?
The venous fiow is maintained' by the via a tergo, or force
of the heart carried throuKh the capillaries, by tbe play of
the valves in the veins during muscular movements, and by
thoracic and initracardiae action. The pulmonary arteries
earrj' venous blood.
What causes the difference in pitch between male and
female voices? What causes the voice of the youth at
the period of puberty to " crack "?
The male vocbI conls are longer, lience the lower pitched
PHYSIOLOGY. 113
The cause of the tracking of voice at puberty is the change
from the childish treble to the lower adult voice, causing
now and then a treble tone to be put in.
What is the function of connective tissue?
The connective tissue acts as a binding, supporting, con-
necting and protecting tissue for the more delicate tissues
and organs.
What is (a) an efferent nerve, (b) an afferent nerve?
Illustrate.
An efferent nerve is one carrying impulses from the cen-
tral nervous system to the various parts of the body. The
facial nerve carries motor impulses from the central nervous
system to the muscles of expression.
An afferent nerve is one carrying impulses to the central
nervous system from the various parts of the body. The
optie nerve carries impressions received on the retina to the
brain.
Describe the glands and villi of the intestines.
In the intestines we find two sets of glands, Brunner's
and Lieberkuhn 's.
The glands of Brunner are branched convoluted tubular
glands found dipping down in the mucous membrane of the
duodenum only.
The crypts of Lieberkuhn are little tubular depressions in
the mucous membrane of both the small and large intestines.
They are larger in the large intestine. They consist of a
basement membrane lined with columnar and goblet-shaped
epithelial cells.
The villi are small nipple-like projections from the mucous
membrane of the small intestines about one-thirtieth of an
inch long.
A villus consists of a mass of adenoid tissue covered with
a layer of columnar epithelium resting on a basement mem-
brane. In the center of this adenoid tissue we find a little
8
r
114 PHYSIOLOGY.
lymphatic called a lacteal. We also find in the adenoid tissue
many capillaries which coalesce to form the venules of the
meNeuleric veins.
Describe the movements of the blood corpuscles in the
capillaries and explain the phenomena of diapedesis.
The capillaries are on an average just large enough to al-
low the red corpuscles to pass through. In passing through
some of the cajrillaries they are altered somewhat in siiape,
hut on account of their elastic stroma immediately resume
their shape when the pressure is removed. As they have to
How nlong in single file at juncture of two capillaries to form
one. they take alternate turns in passing info it.
The wliite corpuscles tend to adhere to the wall and do
not move as rapidly as the red ones.
In diapedesis the white corpuscle pushes one of its pseu-
ilofHKlia through the cement substance of the cells of the
cHpitlnry wall, and then pulls the rest of the hody through
after it,
Mention three varieties of cells according to situation
in the body.
Kpithelial cells are found in the skin.
Wliite hlood corpuscles are found in the hlood.
Nerve cells are foiimi in the central nervous system.
What is the mode of production of heat in the body?
Heat is produced by the cheniical action going on in the
lijwnesi, specially iu the muscular and glandular tis-suea.
Describe cholesterin, giving its origin and function.
Choletrt«rin is a monatomic alcohol found especially in the
nervoiu tissue, and thrown off in small quantities from the
body in bile. It is possibly a waste product of the nervous
timtie.
Mention and describe three varieties of cells according
to shape.
Involuntary muscular fibers are small spindle-shaped cells.
PHYSIOLOGY. 115
contaming about their center an oval nucleus. They are
faanlily longitudinally striated.
Squamous epithelial cells are flat scale-like cells, having
a small nucleus near their center.
White blood corpuscles are nucleated' granular masses of
protoplasm, about one twenty-five-hundredth of an inch in
diameter. At rest they are globular, but during amebodd
movement are irregular in shape.
Mention the ductless glands and give the theory as to
the function of any one of them.
The ductless glands are the thyroid, thymus, adrenals,
spleen, pituitary body, coccygeal and carotid. Many other
organs have also internal secretion.
The adrenal secretion has a marked influence over vaso-
motor and general muscular tone.
How is the sensation of sound conveyed to the brain?
It is conveyed from the cochlea by the auditory nerve to
the medulla, then to the superior oilive, through lateral fillet
to the posterior quadrigeminal bodies to the cerebral cortex.
What matters are excreted by the skin? How may the
function of the skin be affected as to the amount of ex-
cretion?
The sweat contains one per cent, of solid matter, in which
we find sodium chloride and other inorganic salts, urea, fatty
acids and coloring matter.
The function of the skin may be affected physiologically
by increased urination and diarrhoea, by reflex irritation of
sweat centers, by the emotions, by increase of body tempera-
ture calling for more heat dissipation, and by the accumula-
tion of carbon dioxide in the blood. Ingestion of many drugs
also affects the excretion.
Mention some of the exercises that injuriously affect
the heart. State the reasons for your conclusion.
Among exercises that injuriously affect the heart are
PHYSIOLOGY.
wrestling, long-distauce racing, bicycle racing and rowing
matches, the bad effect being due to the sudden strain which
causes dilatation and hypertr(n)'hy of the heart.
State the function of the retina.
Tlie retina is tlie receptive ner\'ous organ of sight.
What are the physiologic characteristics of protoplasm?
Protoplasm has the power of nutrition, growth, reproduc-
tiou, movement and respouse to stimuli.
What is the usual difference in shape between the red
corpuscles of the blood in the mammaHa and those in
the ovipara?
With the exception of the camels, mammalian red cor-
puscles arc n on- nucleated, biconcave, circular discs. In the
ovipara they ai"e nucleated, oval and biconvex.
State the changes in the diameter of the chest in in-
spiration and expiration.
In inspiration the vertical diameter is increased by the
descent of the diaphragm; the anteroposterior and trans-
verse diameters are increased by the, raising and rotation of
t3he ribs anteriority and laterally.
The reverse occurs during expiration.
The circumference of th-e chest is increased in forced in-
spiration from 2 to 5 or 6 inches over forced expiration.
Explain the anatomic and physiologic difference between
mucous, serous, and synovial membrane.
Mucous membranes are secreting membranes lining cavities
opening into the air and composed of one or more layers of
epithelial cells.
Serous membranes are tiioee lining closed sacs belonging
to the lymphatic system and composed of a single layer of
fiat endothelial celLs on a basement membrane.
iSynovial membranes are those lining closed sacs or bursffi
in joints or over tendons. They secrete synovia, which al-
lows free motion by preventing friction.
PHYSIOLOGY. 117
Describe the physical properties of healthy urine.
Healthy urine is a straw yellow, acid, clear liquid, with
a specific gravity of 1015 to 1026, and with a peculiar odor.
On standing, a slight sediment collects in the lower part of
the liquid.
Describe the changes in form and volume, and in physi-
cal and chemical properties, occurring in the contraction
of a muscle.
The muscle 'becomes shorter, but the volume remains the
same. It becomes acid in reaction, more oxygen is used up
and more carbon dioxide given oflf, sarcolactic acid is gen-
erated, glycogen is used up, and the muscle substances soluble
in. water are diminished in amount, while thcpe soluble in
alcohol are increased.
Locate in the brain, the seat of the special sense of
sight, hearing and smell.
Sight has its seat in the gyrus angularis, cuneus, and in
the occipital lobes; hearing in the superior temporal; smell
in the uncus.
Explain the phenomena and causation of auditory ver-
tigo or Meniere's disease.
It is due to some disturbance or abnormal irritation of the
endings of the vestibular branch of the auditory nerve. This
branch normally sends impressions to the nucleus fastigii in
the cerebellum wliioh help to control the balancing and co-
ordination of the muscles of the body.
How do the striped and unstriped muscular fibers differ
in response to stimuli?
The unstriped muscular fibers are much slower in response.
What is the order of occurrence of rigor mortis In the
different parts of the body?
Rigor mortis usually begins in the muscles of the eye,
118 PHYSIOLOGY.
passing to the jaw and neck muscles, and in turn to the
chest, arms, abdomen and lower extremities.
What relation does the nervous system bear to the ex-
cretion of perspiration?
The nei*vous systoiii through the sweat centers regulates the
excretion of perspiration.
What portion of the cerebrum comprises the motor area?
The motor area is found along the fissure of Rolando in
the ascending parietal, ascending frontal and paracentral con-
volutions and contiguous parts of the superior frontal.
Give the presumptions of survivorship and reasons
therefor in the following from Casper: A is killed by a
thrus:t of a saber on the head; B by that of a bayonet in
the heart; and C by a shot which has torn open the jug-
ular vein.
If A'a injury involved especially the base of the brain the
shock of the injury would probably caiLse instant death.
B would probably 'be the second to die. probably living at
least a half hour until the giving out of the heart from
pressure of the blood in the pericardium.
C would be the last to die, as lacerated wounds of even
large vessels often stop spontaneously, and his bleeding might
be cheeked by pressure until sui^Ieal help arrived.
Define the function of the mucous membrane of the
respiratory tract.
The mucous menrbrane of the respiratory tract secretes a
protecting mucus, and because of its ciliated epithelial cells
keeps the lungs clear of accumulatioQ of mucus and small
dirt particles entering in tihe inspired air. The vital activity
of the squamous cells lining the air vesicles aids in the ex-
change of the respiratorj- gases.
In what glands of the body is the function undeter-
mined?
With the exception of being able to say that they are all
PHYSIOLOGY. 119
probably connected with general metabolism, the functions
of the following glands are undetermined: Pituitary body,
thymus, coccygeal gland. But little is known about the
adrenals and thyroids.
What is the normal ratio of respirations to heart pul-
sation?
In a healthy adult there are four pulse 'beats to one re-
spiration.
Give the foramen of exit, the distribution and the func-
tion of the oculomotor nerve.
The oculomotor nerve leaves the skull through sphenoidal
fissure. It supplies motor filaments to the superior, in-
ternal and inferior recti, the inferior oblique, the levator
palpebrae, the ciliary muscle and the constricting fibers of
the iris.
What office does the Eustachian tube perform?
It equalizes the pressure of the air on the membrana-
tympani, thus facilitating hearing.
Define leucontain.
Leucomains are alkaioidal or basic substances formed in
the living tissue by metabolism, waste in nature, some of
them toxic.
Give the present physiologic conclusions in respect to
the presence of the corpus luteum as a sign of pregnancy.
According to Tidy, ''there may be pregnancy without the
presence of a true corpus luteum, and also bodies indis-
tinguishable from true corpora lutea may be found where
there has been no pregnancy/' The presence of the true
corpus luteum nevertheless is usually a sign of pregnancy.
What effects are produced in the system by the removal
of the thyroid gland?
Removal of the thyroid gland is followed by peculiar de-
praved condition of metabolism called cachexia strumipriva.
PEYSIOLOGY.
Give the principal cliaracteri sties of gastric juice in man.
Gastric juiee is an acid limpid secretion with a specific
gravity of about 1005, quantity ten pints daily. It contains
especially pepsin, rennin and hydrochloric acid.
How can fresh blood stains be distinguished from older
blood stains?
Fresh lilood stains are hrighter In color and the clot is
tlesible; the older stain is darker iind tiie clot is fragile.
Describe color blindness and name the colors which the
subject commonly falls to distinguish.
Color blindness is the inability lo perceive certain colors.
The colors commonly indistinguishable are red and green.
What are the functions of the brain membranes?
The dura mater is tough and protecting, and also acts as
internal periosteum to the bonce of the head.
The arachnoid is a fhin spider-like membrane covered
with endothelial cells that secrete cerebrospinal fluid.
The pia mater is a vascular membrane dipping down into
the sidci and carrying blood to the cortex.
Name the solids in the urine and state the approximate
amount of each voided daily by an adult.
Urea 500 grains; chloride of sodium 180 grains; sulphates
(sodium and potassium) 30 grains; phosphate (earthy and
alkaline) 45 grains; uric acid 7 grains; hippuric acid 7
grains; and small quantities of various pigments and other
organic matter.
Describe the factors which cause the heart sounds.
The first, sound is due to muscular contraction and to the
closure of the auriculo- ventricular valves, as the blood tends
to regurgitate into the auricles during ventricular systole.
The second sound is due to the closure of the semilunar
valves, as caused by the blood tending to regurgitate into
the ventricles during diastole.
PHYSIOLOGY. 121
What is the effect of an excessive meat diet?
An excessive meat diet disturbs the general metabolism,
causing diseased conditions associated with an increase in
uric acid, as gout, rheumatism and migraine.
Explain how the seminal fluid is conveyed to the vesi-
culae seminales.
It is conveyed to the vesiculae seminales by the vas deferens,
which is the prolongation of the tulbe forming the epididymis.
The vas deferens passes up from the testicles through the
external and internal abdominal rings and to the vesiculae
seminales on the posterior surface of the bladder.
How and why is hearing affected by rupture of the
membrana tympani?
The membrana tympani, on account of its shape and the
action of the tensor tympani, is capable of responding to
many vibrations, and thus aids in the acuity of hearing.
Describe cell growth.
Cell growth is that peculiarity which living cells have of
taking in new material and incorporating it into themselves,
thus increasing in size.
Describe the phenomena of (a) asphyxia, (b) syncope,
(c) sleep.
Asphyxia is the eondition caused by a deficient supply of
oxygen. In the complete shutting oflf of the supply of
oxygen we have three stages. First, the stage of marked in-
spiratory efforts or dyspnoea, lasting about one minute;
second, the stage of convulsions with marked expiratory
spasms, lasting about one minute; and third, the stage of ex-
haustion and finally death.
During the first stage the blood pressure begins to rise and
heart becomes somewhat slower. During the second stage
this rise in blood pressure is well marked and also the slow-
ing of the heart. Toward the end of this stage as the re-
spiratory movements cease unconsciousness ensues, the blood
122
PEYSIOLOOY.
I
pressure falls and the heart 'becomes still slower, until death
stops everything.
Syncope is that condiition of unconsciousness following a
sudden depression of the vasomotor and cardia« nervous
mechanism, causing anemia of the brain.
Sleep is a physiological condition of unconsciousness, due
to a periodical need of the nervous system of rest. It is
also due in part to the absence of exl:ernal stimuli. It is ac-
companied by an anemia of the brain.
Name, locate, and give the function of each of the vari-
eties of epithelia.
Epithelium seeretfis and protects the underlying tissues.
Squamous epithelium, found in the mouth, protects the under-
lying structures. Columnar epithelium, found in the intes-
tinal mucosa, aids in the absorption of digested food products.
Ciliated epithellium, found in tiie bronchial mucosa, forces
dust and mucus up into the trachea to be coughed out.
Cuboidal epithelium, found in the salivary glands, secretes
saliva. Goblet-shaped epithelium, found in the mucous mem-
branes, forms the miicous secretion. Stratified epithelium is
composed of several layers, the uppermost generally squa-
mous, and lowermost columnar. It forms the epidermis.
Describe the lymphatic system.
The Ij-mphatic system consists of numerous small thin-
walled vessels with many ■valves, commencing in the tissues -
as lympih capillaries and emptying into two large vessels
that carry the contained lymph to the subclavian veins. In
certain places along the course of the lymphatics, as in
ftxila and groin, are found groups of little glands called
lymphatie glands, Tliese consist of a cortical portion and
a medulla whieh is made of lymphoid tissue, in the center of
which are a number of cells rapidly undergoing karyokinesis.
All the lymphatics (including the laeteals of the intestine)
with the exception of right half of the body from the dia-
phragm upward, empty into the thoracic dnct. This vessel.
PHYSIOLOGY. 123
about the diameter of a goose quill, empties into the left
subclavian vein. The lymphatics of the right side of the
body from the diaphragm upward empty through a smaller
vessel into the right subclavian vein.
Describe the olfactory apparatus. What part of the
olfactory apparatus is the seat of smell?
The nasal cavities are divided into a lower or respiratory
portion and an upper or olfactpry portion.
We find in the upper portion some broad supporting epithe-
lial cells, and projecting upward from cells between these
are little hair-like processes. The olfactory nerve ends in
these specialized cells. The olfactory nerve passes from these
cells through the olfactory bulbs and backward through three
tracts to the cerebrum, ending for the most part in the uncus
of the san^ side.
What is the physiology of the so-called rest cure?
The rest cure corrects faulty metabolism and brings the
tissues again to their normal conditions.
How is the descent of the testicle to the scrotum ac-
complished?
The descent of the testicle is now generally thought to be
due simply to the arrangement of the organs due to the
process of development and not to the traction of muscular
cord, as formerly thought.
Describe the growth and the development of the teeth.
The first step in the formation of the teeth is the down-
ward growth of the epithelium covering the rudimentary jaw.
This forms the enamel germ, which develops especially at cer-
tain points. A little vascular papilla now grows upward
into this enamel germ ; thus we have the rudimentary teeth.
The adiamantoblasts of the enamel germ form the enamel, and
the odontoblasts form the dentine which covers in the dental
pulp. The crusta petrosa is formed from the cells forming
the dental periosteum.
124 PHYSIOLOGY.
What is the condition of the eyeball in myopia? How
may it be corrected?
In myopia the eyeball is too deep, causing the rays of
light to be brought to a focus in front of the retina. It is
corrected by a concave lens.
Define physiologically the term cell. How are cells re-
produced?
A cell is a nucleated mass of protoplasm.
Cells are reproduced by direct division, indirect division
or karyokinesia, and endogenous nuclear multiplication.
Describe the physical characteristics of cartilage. What
is temporary cartilage, permanent cartilage? Illustrate.
Cartilayie is a firm, clajitie, white or yellow-white sub-
stance.
Temporary cartilage is that which afterwai-d is formed
into iwne, as the fetal feinur.
Permanent cartilage is that which remains as cartilage dur-
ing life, as articular cartilage.
Describe the while blood corpuscles, giving source, com<
position and properties.
The white blood corpuscles arc nucleated masses of granu-
lar protoplasm, about y^V<T i^'- '^ diameter and capable o:
amoeboid movement and phagocytic action.
As to the varieties, we find the small lymphocyte, the largei
transitional, the poljTnorpho-nuclear, and eosinophile con-
taining large granules staining readily with eosin. Occas-
ionally a 'basophile can be found.
The white cells are de^-eloped from the lympatic tissues,
the spleen and the marrow of bone. Chemically they con-
tjiin niielein, a globulin, fat, glycogen and a nueleoproteid.
What changes are produced in the air and in the blood
by respiration?
The expired air contains less oxygen and more carbon
dioxide, nitrogen, and water than inspired air. It also con-
PHYSIOLOGY. 125
tains certain volatile organic substances and is warmer than
the inspired air.
The blood leaving the lungs contains more oxygen and less
carbon dioxide and nitrogen than that entering the lungs.
Define aphonia, aphasia. Give the cause of one of these
conditions.
Aphonia is the loss of voiee, or the power of phonation.
Aphasia is the inability to give the proper word symbol.
Motor aphasia is due to a lesion of the left lower frontal
convolution or of the fibers coming from it.
Describe the normal heart sounds.
The first sound is twice as long as the second, lower in
pitch and with a prolonged dull, somewhat booming quality.
It is caused by the closure of the auriculo-ventricular valves
and the sound of contracting muscular walls of the ventricles.
It is heard best at the apex, and is systolic in time.
The second sound foMows the first after a short interval.
It is short, snapping in quality and is higher pitched than
the first. It is caused by the closure of the semilunar valves
and is diastolic in time. It is heard 'best at the base of the
heart.
State the physiologic uses of the large intestine.
Into the large intestine the crypts of Lieberkuhn pour in
some secretion and the microbic digestion goes on. Although
no villi are found here part of the food not already absorbed
is taken up. The feces are concentrated and collected in the
lower end of the intestine, to be expelled during the act of
defecation.
Define (a) tonic muscular contraction, (b) clonic mus-
cular contraction. Give an example of each.
Tonic muscular contraction is a continued contraction, as
the action of sphincter ani.
Clonic muscular contraction is an intermittent or remittent
muscular contraction as seen in the jerking movements of a
convulsion.
126
PHYSIOLOGY.
Define reserve air, residual air, complemental air, tidal
air.
Reserve air is the amount of air that can be expired after
ftn ordioarj' expiration, about 100 cubic inches.
Residua] air is the amount of air left in the lungs after
the most forcible expiration, about 100 cubic inches.
Complemental air is the amount of air that can be taken in
aft«r an ordinary inspiration, about 100 cubic inches.
Tidal air is the amount of air taken in with each ordinary
inspiration, about 30 cubic inches.
What are 'the respective functions of the anterior and
of the posterior cornua of the spinal cord?
The anterior cornua are motor in function and are the
trophic centers for the muscles.
The posterior cornua are mostly relay stations on the sen-
sory pathway.
What exphanation may be given for enlargement of the
spleen in leucocythemia?
The spleen is one of the organs in which white corpuscles
are formed.
Give the difference between the temperature of a new-
born child and that of an adult, between the temperature
of a person intoxicated \yy alcoholic drink and his tem-
perature after the first stimulating drink of liquor.
Immediately after birth the temperature is somewhat above
normall, but soon becomes subnormal. At the end of fwenty-
four hours it has again reached normal and remains so. A
small dose of alcohol causes a slight rise in temperature^
large doses, as in one intoxicated, cause a subnormal
temperature.
' In a healthy man, what time is consumed in the diges-
tion of an ordinary meal of meat, vegetables and bread?
The food remains fi-om two to four hours in the stomach
and about six hours in the small intestine. Digestion is.
practically finished before it leaves the small intestine.
PHYSIOLOGY. 12T
Define human physiology.
Human physiology is tihe study of the phenomena of the
living human body.
Give the causes of muscular fatis:ue.
Muscular fatigue is caused by the accumulation of waste
products in the muscles.
The seat of fatigue, as we ordinarily speak of it, is first in
the central nervous system, then in the motor end plates,
then the muscle and finally the nerve trunks.
Whait effect is produced on the heart's action by stimu-
lation of the cardioinhibitory center?
There is a slowing of the heart, or, if the stimulus is great
enough, a stoppage of the heart in diastole.
Why does blood remain fluid in the body in life, and
cooguhite when shed?
The intima has some unknown peculiar action on the blood.
The blood does not clot until the disintegration of the
white corpuscles sets free the fibrin ferment.
What conditions produce variations in the normal tem-
perature of the body?
Anything that will disturb the proper balance of heat pro-
duction and heat dissipation will cause a variation from the
normal temperature.
Normal physiological variations are caused by digestion,
muscular exercise, menstruation, bathing and excitement.
Drugs, as cocain, atropine, alcohol, acetanilid, may cause
variations from the normal; as will also hypodermic in-
jections of proteoses and peptones, shock, toxins of bacteria
and exposure to excessive changes in temperature of at-
mosphere.
Give the nervous mechanism of urination.
The bladder is supplied with nerves from the lower dorsal
and upper lumbar nerves and also with branches from the
PHYSIOLOGY.
sympatlietic system. The aet of urination may be completely
jnvolun'tary, the reflex center being in the lumbar portion
of the spinal cord and set in action by afferent impulses
from a distended bladder or fi-om irritation possibly of the
mucous membranes. Ordinarily the abdominal muscles aid
voluntarily in urination.
There is probably a higher voluntary center and also an
inhibitory one.
Describe the human blood.
Blood is a red, alkabnc fluid, salty and nauseating in taste,
with a peculiar odor. It has a specific gravity of about 1055.
It is compiled of a liquid portion called plasma, and a solid
portion, the red and white corpuscles. In the plasma we
find serum albumin and globulin, fibrinogen, various salts,
especially sodium, potassium and caleiuni, and small quan-
tities of dextrose, fala and extra<;tives. The hemoglobin is
found in the red corpuscles.
What is the purpose of respiration? Give the mechan-
ism of respiration.
During the act of respiration oxygen is absorbed and car-
bon dioxide is thrown off.
During inspiration the diaphrafrm descends, the ribs are
elevated and rotated outwardi; the cavity of the thorax is
thus enlarged and the air rushes m to 611 up the partial
vacuum ; the muscles now relax and the elasticity of the chest
wall and lungs forces a portion of the air out. These move-
ments are controlled by the respiration center in the raedulU.
How is bone nourished?
Bone is nourished by tlie nutrient arteries through the
Haversian system of canals and by the periosteum.
State the function of the anterior spinal nerve roots.
How is the function proved?
The anterior roots are motor.
Section of the anterior roots causes motor paralysis of
PHYSIOLOGY, 129
the parts that they supply. Irritation of the peripheral ends
causes contraction of the muscles they supply. Irritation of
central ends has no eflfect; no sensation is felt.
Give illustrations of morbiil reflex action.
The vomiting of pregnancy is caused reflexly by irrita-
tion of mucous membrane of uterus.
Faulty digestion may cause reflexly palpitation of the
heart.
What is the composition of urine? Give the normal re-
action and specific gravity of urine.
Urine is composed of 96% water and 4% solids, one-half of
which is urea. The other half is made up of phosphates
(earthy and alkaline), sulphates of sodium and potassium,
chloride of sodium, uric acid, hippuric acid, extractives and
the coloring matters — indican, urobilin and urochrome.
The normal reaction of urine is acid and the specific grav-
ity 1020.
Describe the temporary and permanent teeth.
The temporary or milk teeth are twenty in number, ten in
each jaw. From the front backward we have in each side
of the jaw two incisors, one canine and two molars. The
first tooth to erupt is the lower central incisor about the sixth
month. This set is complete about the thirtieth month.
About the sixth year the jaw has enlarged considerably; as
a result there is room for another tooth and the first per-'
manent tooth, the six-year molar, erupts. Then the incisors
are erupted, pushing out in front of them the temporary
teeth. The last permanent tooth to erupt is the third molar
or wisdom tooth, about the twenty-first year.
There are thirty-two permanent teeth, sixteen in each jaw.
Prom the front backward in each side of the jaw we have
two incisors, one canine, two bicuspids and three molars.
The incisors cut the food, the canines tear it and the molars
grind it.
9
i:SO I'llYHlOLOGY.
Through what medium is the blood relieved of effete
matter and provided with new material?
The blood is relieved of effete materials through the sweat,
urine, feces and exchange of respiratory gases in the lungs.
It is provided with new materia!! through the respiratory
exchange of gases, from tbe gasti-ointestinal tract through
the portal vein and lacteals, and from the ductless glands, a^
the thyroid, spleen, adrenals; aJso from marroiv of bones.
How is normal body temperature regulated and sus-
tained?
It is regulated by the thennotasic centers of the nervous
system, and sustained iby metabolism of the tissues, especially
the muscular and glandular.
State where in the human economy the following sub-
stances are found: fibrin, chondrin, leucin, hippuric acid.
Fibrin is found in clotted Uoml, chondrin in cartilage,
leucin in the intestines, hippuric acid in urine.
What stimuli produce muscular contraction? What is
the nervous mechanism of muscular contraction? Illus-
trate.
Stimuli producing muscular contraction are the normal
nervous stimulus, electrical, mechanaeal, chemical, and
thermal.
In the ner\'0us mechanism of muscular contraction, the
motor impulse starts from the motor nerve cell, passing down
the motor neurason to the motor end plates, and here the
muscle cells are stimulated to contract. One stimulus would
simply cause a muscular twitch, but normally in a muscular
act a series of impulses are sent from the nerve centers to
keep the muscles in a voluntary tetanus.
In raising the foot the motor impulse starts in the cere-
bral grey cdls of the Rolandic area, passes down to the cells in
the anterior horn of the opposite side of the lumbar eord, then
out through the sciatic nerve to the motor end pla-tes of the
PHYSIOLOGY, 131
muscles required to lift the foot, which in turn stimulate
the muscular fibers.
Define stammering and state what causes it.
Stammering is a defect of speech due to the spasmodic
action of the diaphragm interrupting the flow of air past the
vocal cords. The larynx and lips are under control.
Define and describe respiratory rhytlim, respiratory
sounds.
Respiratory rhythm is the relation between the time of in-
spiration and expiration. Inspiration is to expiration as five
is to six, the expiration being followed by a short pause.
The respiratory sounds are the sounds heard in auscultating
the lungs. There are two sounds. One is the vesicular
breathing, which is a low-pitched, soft, distant breezy sound,
the inspiration 'being to expiration as three or four is to one,
in fact expiration may be a mere puff.
The second is the bronchial breathing, heard over the
trachea and primary bronchi. It is high-pitched, blowing or
tubular in quality, the expiration "being louder, a little longer
and higher pitched than inspiration.
What are the functions of the skin and its appendages?
The skin and its appendages protect from drying and
other injury the underlying tissues, especially the end or-
gans of the sensory nerves in the skin. The hair prevents
friction and also protects sensitive parts from extremes of
temperature. On account of the large extent of its surface
and also on account of the sweat glands it contains, the skin
is a great heat-dissipating organ.
Define myopia, hypermetropia, astigmatism. State the
cause of each of these conditions.
Myopia or nearsightedness is a defect in vision in which
parallel rays of light are focussed in front of the retina. It
is due usually to an increased length in the anteroposterior
diameter of the eye.
132
PHYSIOLOGY.
Hypermetropia or farsightedness is a defect in vision in
which parallel rays of light are brought to a focus beyond
the retina. It is generally due to a shortening of the an-
teroposterior diameter of the eye.
ABtigmalisni is an error of refraction in which rays of light
in the various planes are u-ot equally refracted, some of the
rays possibly being focussed on the retina, oBhers behind or
in front of it It is generally due to irregularities in the
curvature of the cornea, but sometimes of the lens.
What is the physiologic function of the liver?
The liver secretes bile, forms glycogen, urea, uric acid, con-
jugate sulphates, destroys some of the red corpuscles and in
fetal life forms some red corpuscles. It also desrtroys many
poisons taken into the body. ,
State the manner in which blood circulates through the
heart and the lungs, beginning at the right auricle.
The blood passes from the right auricle through the tri-
cuspid valve into the right ventricle; thence through the
pulmouary valve into the pulmonary artery, which divides
and subdivides, finally ending in the capillaries around the
air cells. The blood is re-collected and emptied Tty the pul-
monary veins into the left auricle; then it passes on through
the mitral valve into the left ventricle; it is then forced out
Bhrough the aortic valve into the aorta.
Compare arteries, veins and capillaries in respect to
rapidity of the blood stream.
The blood flows in the arteries at about the rate of twelve
inches a second, in the veins seven inches a second, and in the
capillaries two inches a minute.
Name the excreiory glands of the body and the function
of each.
The excretory glands are the kidneys, which excrete urine ;
the sweat glands, which excrete sweat and dissipate heat by
sweating; and the liver, wliich throws off through the bile
PHYSIOLOGY. 133
some waste matter. The lungs are also excretory organs,
throwing oflf carbon ddoxdde and nitrogen.
Describe the origin of a itear as the result of pain.
The pain causes reflexly a stimulation of the lachrymal
gland, causing an increased secretion. More secretion is
poured out than can be carried off by the lachrymal canal,
the excess pouring over the cheek as tears.
What is the office of the columnae carneae?
They give strength to the ventricular wall and prevent
tihe auriculo-ventricular valves from being pressed into the
auricles.
Describe the physiologic causes of obesity.
The physiologic causes of oibesity are overfeeding, espec-
ially with carbohydrates, lack of proper exercise, and cer-
tain i)eculiarities of the cells of an individual.
Name some of the bodily states which lessen the allca-
iinity of the blood.
There is a decrease of alkalinity in rheumatism,, gout, mi-
graine, and while living on a diet deficient in the «ilkaline
mineral matters, or livin-g on a proteid diet.
What is the influence of diet on nutrition?
For nutrition to go on properly the diet must contain the
various classes of foods in proper proportion. Proteids and
salts are absolutely necessary. Nothing but proteids can
replace the used-up proteids of tissue. Salts are needed
especially to neutralize the acids formed durin<g proteid
katabolism, and to form a part in the secretions, like the
hydrochloric add of the gastric juice.
Describe ithe physiologic process by which the bite of a
venomous snalce or the hypodermic injection of the virus
causes death.
The poison injected under the skin is carried by the
lymphatics to the right or left subclavian vein. Having thus
PHrsWLOOY.
reacihed the genera] circulation, it is distributed to the vari-
ous Cleans, and so perverts the function of certain ones as
to cause death.
Name the bile salts, and state the physiologic function
of bile.
The bile salts are sodium {jlycocholate and sodium tauro-
cholate.
BJle aids in the emulsdficatioa and absorption of fats, neu-
tralizes the acid chyme, p reoipitating: the pepsin, increases
peristalsis, and contains some waste matter thrown off hy
the liver.
Describe the ofRces and the characteristics of the grav
matter of the brain.
The gray matter of the cerebral cortex is arranged in six
alternate gray and white layers, the most important of which
is the deep gray layer of large pyramidal cells.
The gray matter of the cerebrum is the center of sensa-
tion, volition and ideation; that is, it receives the sensations,
sends out all voluntary impulses and is the part, of the
nervous system in which thought goes on.
Enumerate the physiologic advantage of natural sleep
and slate at what period of life the least sleep is required.
Natural slepji allows the fatigued ner^'ous system to re-
gain its tone, causes a relaxation of the vasomotor system,
thus giving the heart a chance to i-est. In fact, sleep causes
a. relaxation of all the hodil.v functions, thus allowing the
■Ciseue to recuperate and waste matter to he carried off.
During mature adult life the body can stand the lack of
sleep better than at any other "time.
I
HYGIENE.
What principal hygienic direction sh(^uld be given a
patient suffering from tuberculosis?
Always expectorate into or on such appliances as may,
with their contents, be disinfected or 'burned. Avoid kissing.
How can malarial districts be made healthy?
Remove moisture from the locality by surface or subnsoil
draining ; by planting trees like the eucalyptus, which require
much water for their growth ; by preventing the development
of the mosquito larvse, through the action of petroleum on
water surfaces.
Differentiate between endemic and epidemic diseases.
An endemic disease is one constantly present in a com-
munity. An epidemic disease is one which spreads rapidly,
attacking many people a;t the same time.
State the results to animal life of the combustion of
fuel in a room without chimney connection or other
ventilation.
Carbon monoxide poisoning, suffocation due to excessive
quantity of carbon dioxide and diminished amount of oxygen ;
a systematic poisoning due to breathing products which are
the result of partial burning of excretions thrown off in ex-
halations.
What is the best method of disposing of the bodies of
those who have died of yellow fever?
Cremate such bodies.
(135)
136
HYGIENE
What is meant by natural and acquired immunity' from
disease? Give an example of each.
By natural imniuai'ty' we mean " that inherited trait from
immune ancestors which enables an oi^anism to resist the
attacks of bacteria and their toxic secretions." Thus, as a
rule, the negro race do not contract yellow fever. By ac-
quired immunity we understand that through a previous
attack of an infectious disease, or by inoculation with an
attenuated virus of that disease, the blood of the person
undergoes siich changes as to present a non-fertile soil to the
oi-ganism to whose presence the disease is due. Example,
vaccination in 'preventing small-pox.
What are the principal measures which you would
employ for the prevention of the spread of infectious
diseases?
Iisolate the patient and attendants; disinfect all substances
removed from patient's i-ooni before their removal; establish
the purity of water and food supplies; disinfect the room and
contents after patient's removaO, and observe a precautionary
quarantine.
How would you prepare an artiticial food for a new-
born infant?
Render cow's milk as alkaline as human milk. Dilute with
water to reduce the quantity of casein to what it would be
in maternal milk. Pat and sugar are, increased by the addi-
tion of cream and sugar of milk. To one pint of sterilized
water 17% drachms of pure commercial sugar of milk are
added and dissolved. This sugar water must be kept in a
eool place and not be allowed to sour. WTien feeding time
arrives two tablespoon Euls of cream, one of milk, two of lime
water, and three of the milk-sugar water are mixed, and as
soon as this mixture has been warmed to proper temperature
it may be poured into a bottle and the food is ready for use.
(Fisher.)
^^'i^]^ ^■^-■- '°^
'What are the properties of oleomargarin compared with
butter made in the usual way?
Butter fat contains nearly 8% of the volatile fats; specific
gravity never below 909.8 ; insoluble fatty acids form about
88 % of the weight of butter fat; melting-point of fat is
between 86° andi 94° F. ; readily and completely soluble in
ether.
Oleomargarin fat contains about ^2% of the volatile fats;
specific gravity never above 904.5 ; insoluble fatty acids form
about 95% of the total weight; melting-point rarely <a;bove
82° F. ; less soluble in ether and leaves a residue.
State the value of public t>aths to the health of a large
city.
They give facilities to the poor for obtaining personal clean-
liness, exerting a protective influence over the development
and spread of filth diseases. They encourage the young to
learn to swim, and supply an exeellent form of exercise, pro-
moting growth and development. When properly used tiheir
eflfects are both tonic and s?timulating.
What is sewer gas? How does the inhalation of sewer
gtas in large quantities affect the system?
Sewer gas is a mixture of a number of gases, among which
we find carbonic acid gas, light carburetted hydrogen, nitro-
gen, hydrogen sulphide, ammonium sulphide with fetid organic
matter, the volatile and semi-volatile results of animal and
vegetable decompositions.
Sewer gas gaining entrance to house or room may exert a
depressing influence upon the occupants, and may occasion
vomiting, purging, severe headache, prostration, and through
its carriage of germs cause infectious diseases. Yet sewer
gas per se is sometimes almost innocuous. A chronic form
of poisoning from sewer gas gives rise to pallor, langour,
frequent headaches, loss of appetite, diarrhoea, generally im-
paired health and anemia.
HYGIESE.
Is green wall-paper objectionable; if so, why?
Sometimea, because its color may be due to a compound of
copper and ajsenic, which after becoming damp dries, and is
rubbed or blown from the walls, producing acute or, more
often, chronic forms of arsenical poisoniJng as well as me-
chanical irritation of fauces, conjunctiva, etc.
Contrast the incubative stages of variola and measles.
The incubative stage of variola is from six to seven days
by innoculation, and front ten to fonrteen days by infection.
In measles it is from sev^u to ten days by inoculation and
from seven to twenty-one days by infeetiou.
What conditions and diseases in animals render their
flesh unfit for food?
" The flesh of all animals dead of internal diseases, or
which have been killed while suffering from such diseases or
animal killed by overdriving. The fleah of animals with
contagious diseases that may be transmitled to man. The
flesh of animals that have been poisoned. The flesh of ani-
mals (vith severe infectious diseases, as pyemia, etc. Flesh
cniitaining parasites that may be transmitted to men. All
putrid flesh " (Gerlach).
Discuss detached wards versus many-storied buildings
for a public hospital.
Many wards in one building render the maintaining of dis-
cipline and supervision easier. Quicker service, ease of com-
munication, greater economy of administration are favored
by many wards. Many-storied buildings prevent perfect iso-
lation and ventilation, render diminished supply of sunlight,
lead to danger, as in removal, should fire occur; so that the
detached ward system seems preferable.
Give a fair average death rate (a) in rural districts, (b)
in towns of from 5,000 to 10,000, (c) in cities of over
100,000 inhabitants,
(a) 14. (b) 17. (c) 19 to 22 per thousand.
HYGIENE. 189
Mention five preventable diseases.
Tuberculosis, typhoid fever, cholera, yellow fever and
malaria.
Give the special hygiene af factories in which women
and children are employed.
Each child or woman should be allotted sufficient space to
supply 3,000 cu'bdc feet of fresh air an/ hour by a not greater
air movement than that which would change the air three
times each. hour. The temperature should be kept constant
at about 65 degrees Fahr. Means should be employed to
quickly remove dust or offensive and dangerous gases. Per-
sonal cleanliness should be facilitated by properly equipped
wash-rooms. The water-closet fixtures should be ample and
of proper construction. An infirmary should be provided
for immediate treatment of injuries and suddenly occurring
illnesses.
In the selection of a site for a dwelling what is the best
sanitary soil, sub-soil and topography?
A light, dry soil, as of gravel or sand, that contains no
absorbed filth or sewage, with a nearly constant level of
ground water, avoiding clay or impermeable material both in
the soil and in the sub-soil. The location f^hould not be in
low-lying districts, nor in localities which from the geolog-
ical formation act as collectors of underground water. The
house should not be placed on the top of an elevation where
it would be exposed to strong winds. All other conditions
being favorable, the house should 'be built on the side of a
hill so tihat it receives a maximum supply of air and sun-
light, and in cold climates preferably with a southern ex-
posure.
What is the bubonic plague? What steps can be taken
to limit or extinguish such a scourge?
It is an acute contagious and infectious disease favored by
filthy surroundings and at times occurring epidemically. It
140
HYGIENE.
is due to a epeeifie micro-organism and is characterized,
among other symptoms, ty glandular swelling terminating in
abscess. Preven'tion depeads upon isolation of the sick, thor-
ough disinfection of the clothing, etc., and surroundings of
the paitient and the avoidance of overcrowding and fllth, and
the institution of rigid quarantine to prevent its dissemina-
f
Name the principal adulterations of wine.
Water, coloring aj^entu (logwood, red beets, coal-tar prod-
ucts), flavoring agents (prunes, peaches, raisins, dates, dried
apples), preservatives (salicylic acid, formaldehyde), glycer-
ine, alum and decolorizing agents.
Give some of <the requisites for the sanitary construe
tion of house foundations and cellars.
To keep down the level of ground water subdrain if neces-
sai-y to secure dryness. Coat the foundation inside and out
with cement and provide a cement floor for the cellar. Admit
plenty of air and sunlight into the eell-ar.
What is your view concerning the propriety or neces-
sity of inserting vaccine virus in multiple places?
The duration of the protection from small-pos is said to
be directly proportionate to the number and size of vaccine
veaddes; so vaoeinate in at least two different places afld
let the combined area of vesicle resultant measure over half
an inch.
Give the prophylaxis of the filth diseases.
Sanitary inspection of all houses and buildings with im-
mediate abatement of any nuisances. Thorough cleanliness
applied to pei-sons. habitations and the community, and to
bouses of public use. Examination of water and food sup-
plies, with correction of all disease-exciting causes. Sewage
and waste removal systems to 'be placed in perfect operation.
Isodfltion of patients ack with these diseases, and disinfection
of rooms and property of such patients, and the establishment
HYGIENE, 141
of house, nmnieipal, s^te or national quarantine. Prevent
access of flies and other insects to food and drink.
What is the physical training for a wealc heart when
no valvular lesions exist?
Beginning with gentle calisthenics, exercise should be taken,
preferably in the open air, and increased gradually, such
exercise to be supervised by a competent physician. Later
on climbing exercises of a very gradual degree of diflSculty
may be taken.
How many cubic feet or fresh air per hour are required
by an adult?
Three thousand cubic feet
Discuss the«lheory of hereditary tendencies as applied
to tuberculosis.
Children bom of tuberculous parents present less power to
combat and overcome the attacks of the tubercle bacilli than
others of more healthy parents. Some theorists claim that
this deficiency of resistance is in part due to an inherited
small heart, and lessened drculatory power, thus favoring
conditions of passive eongeetion or low grades of inflamma-
tory processes. Such subjects as a rule show lessened lung
expansion, a flattened or a wedge-shaped chest, etc.
Describe the physiological action of alcohol.
Small or therapeutic doses increase the pulse rate and the
arterial pressure by directly stimulating the heart. Over-
doses directly depress and paralyze the heart muscle. Large
doses produce decided lowering of body temperature. It is
probable that the use of alcohol diminishes the elimination of
CO2. Aloohol causes a great lessening in the excretion of the
produets of tissue waste. It is probable that alcohol in not
too large quantity is entirely destroyed in the body. In
smell doses alcohol acts as a cerebral stimulant, while larger
doses greatly depress and abolish nervous activity, and check
142 HYOIEAE.
digestion. The babitua] use of aieohol is accompanied by a
disposition towards fatty degeneration, partiealarly of beart
muscle, liver and kidneys, and in enlarged and dilated con-
dition of the smaller blood-vessels and a degeneration of all
nervous structures.
Does alcohol possess a food action? On what do you
base your answer?
Yes. " In the sense that it is destroyed in the system and
yields force which is utilized by the organism, and is when
in .snffieient quantity a retarder of tissue change, checking
rbe excretion of nitrogen " (H, C, Wood), We see this in
its administration in typhoid and otiier long-cnntinued fevers.
Yet it is not a true food, since it also exerts toxic effects,
ivhich (ood.s do not.
State your views on compulsory vaccination and relate
the safeguard that should be employed in all cases of
vaccination.
The unprotected individual should be vaccinated as a pro-
tection to himself and to those with whom he eomes in contact.
The virus employed must be free from contamination, and
the instruments used should be perfectly sterile, and the
operation should be performed on a clean surface. The
wound should be adequately protected from irritation by
clothing, and from pathogenic germs.
In the pursuit of what trades is there a predisposition
to pulmonary diseases?
Trades carried on in over-crowded, poorly ventilated rooms^
in damp localities. Trades that give rise to much dust, par-
ticularly if such dust be of fine, hard particles, to which file-
makers, stone-cutters, grinders, etc., are subjected. Such
trades as necessitate cramped positions of the workers pre-
venting iproper lung expa.neion. In vocations giving rise to
poisonous or obnosious vapors, and also where the individual
is exposed to sudden changes of temperature.
HYGIENE, 143
Under what condition is tyrotoxicon found in milk,
cheese and other articles?
Where milk, cheese, ice cream, etc., undergo decomposition
in the presence of other organic matter, as ratting wood,
mould, etc.
The excavation of streets in cities is frequently fol-
lowed by the outbreak of disease, such as diphtheria,
'typhoid fever. What is the cause?
Pathogenic bacteria lie dormant in the soil of cities, and
when such soil is exposed to the air, it becomes dried, and
its contained bacteria taking on an active existence are liber-
ated and carried by the air to susceptible individuals.
Describe the agency of the ptomaines in inducing dis-
eases and the disorders produced by them.
Ptomaines are alkaloidal bodies resulting from decomposi-
tion of nitrogenous substanees. When a'bsorbed into the
blood they may give rise to fever, headache, torpor, fetid
breath. They act like chemical poisons very soon after their
introduction into the system. [Many of them occasion dis-
tinctive trains of symptoms.
How long does a diphtheritic patient remain infective?
How may it be proved that this infective period has
ceased?
About three weeks after local symptoms cease. Make fre-
quent cultures of material from the affected site, and when
sucfh fail to show the specific germ, the patient will no longer
be a source of infection.
How may milk be the means of transmitting the germs
of typhoid fever?
Through water containing Ebertb's bacillus gaining access,
to the milk, as tihrough diluting the milk, washing milk re-
ceptacles in x>olluted water.
144
HYGIENE.
State the period of iiicubatjon in (a) vaccinia; (b) paro-
titis; (c) pertussis; (d) varicella; (e) rotheln.
(a) 3 to 7 days; (t) 14 to 22 days; (c) 2 to 8 days; (d)
4 to 14 days; (e) 12 to 20 days.
Mention the effects of working in phosphorus, as in the
manufacture of phosphorus matches. How can the dan-
gers be limited or prevented?
Inhaling phosphorus furaes produces a form of necrosis of
the jaw, particularly in such as have imperfect teeth. To
avoid its deveiopiiient persons with sound teeth and freedom
from abrasion of the interior of the mouth should be em-
ployed. The work-room should 'be large and well ventilated,
with special air-shaft to foree the fumes away from face of
workers, the employees should have short working hours, and
frequently use a mouth wash and gargle of lime water or
carbona-le of sodium. Turpentine and charcoal should be
exposed in the room.
Whirt fruits are preferable in cases of habitual consti-
pation?
Apples, prunes, figs, itamairinds, grapes and melons.
Indicate a proper diet in the case of diabetes mellitus,
obesity and early convalescence in typhoid fever.
The diabetic should use ou!y a small quantaly of carbo-
hydrate foods, with a relatively large quantity of proteid
foods and fats. The patient suffering from obesity should
use but little fluids or food containing much wat«r. Pood
containing starch and sugar should be eaten sparingly, and
alcoholic liquors and fats must- be avoidwl entirely. He
should eat lean meats, mutton, beef, lamb, chicken, eggs, stale
bread or toast sqDaringly, tomatoes, lettuce, celery, asparagus,
onions, ripe fruits of an acid nature but no sugar.
In convialesceniee from typhoid fever the patient should use
easily digestible food of a concentrated', nourishing character,
of small bulk and without hard or irritating properties, aa
HYGIENE, 145
soups, broths, un<xx)ked oysters, eggs, rioe, wine, milk, calves'
foot jelly, etc.
What is 'the chief unsanitary condition of sea-going
vessels?
The presence of 'bilge water and a dirty hold.
Describe the manner in which antitoxin is prepared.
A virulent culture of the specific micro-organism, or a
strong toxin is injected into the cellular tissue of the selected
animal, under due precautions of aseptic operation. After
the animal has recovered from the symptoms thus produced,
another and stronger injection of the specific poison is given.
Injection after injection of increasing strength is given at
proper intervals, until the animal fails to show any further
symptoms of the disease — after an injection. Blood is then
taken from the jugular vein of the animal, the greatest care
being observed to secure aseptic conditions. This blood re-
ceived in sterilized flasks, which are then stoppered, is stored
in refrigerators until separation of clot and serum occurs.
The serum is now tested to determine its value as antitoxin
and then, after the addition of a very small proportion of
carbolic acid, is placed in small vials, which are then her-
metically sealed. Each vial has marked upon it its strength
in normal antitoxin units in each cubic centimeter, and usually
contains one dose.
Mention same of the objections to curbed or driven
wells in streets or houses with respect to the purity of
water coming from these wells.
The curbing rarely affords protection to the well water
from gases and other emanations from sewers, gas-pipes,
drains, etc., and even though a driven piped well may take
its water from far below the surface, yet in the streets of
cities, with the ever-present sewer and gas pipes, the soil
becomes so saturated with deleterious material as to greatly
endanger, through water carriage, the water from all forms
of wells.
10
146
HYOIEXE.
r
From what disease may immunity be acquired in the
case of persons who have once suffered from these dis-
eases? How is Itnowledse of this fact utilized in the
prevention of certain diseases?
Yellow fever. siiiiLll-pox, scarlet fever, chicken-pox, per-
tuseis, typhus fever, cholera. A partial immunity may result
in measles, mumps and in typhoid.
We may prevent some of these diseases by the introduction
into the patient's .systeui of the particular antitoxin of tie
threatened disease.
Describe the effect of a hot and moist climate on the
human system, and state the class of diseases this atmos-
phere is likely ^^ induce.
In hot and moist climates the inhabitants, as a rule, are
of small stature and deficient in muscular development; of
languid disposition and nervous temperament. The diseases
most prevalent are those affecting the liver and gastro-intea-
tdnal tra^t ; also various forms of malarial disease and yellow-
fever.
What occupations are a menace to public health? Why?
Those occupations that emit irritating, poisonous or nox-
ious fumes and gases, from the vitiation of the atmosphere,
as in fertilizing plants, chemical manufactories, bone-boiling
establishments; also dust, especially if this be of sharp, hard
character, as from cement- making, tool-making, the respi-
ratory tract being thereby subjected to irritation.
Mention some of the objections to storage cisterns under
ground. What are the objections to rain water as a drink?
They often receive dust and dirt; sewer gas may gain
entrance to tlie -water when the " standing waste " or over-
flow pipe of such a cistern is connected with the drain or
soil pipe of a 'house. Storage cisterns cannot be properly
ventilated, and are often difficult to clean.
HYGIENE, 147
If the first part of the rain be collected, such water will
contain dust, poUen, gases and other matters washed from
the air.
Mention some of the diseases to which artisans are
especially liable.
Paintera, and those working in lead, copper and zinc, may
suffer from metallic poisoning; match-makers from phos-
phorus poisoning; tool-makers and grinders from phthisis;
miners from aflFections of »bronchi and lungs; smelters from
areenieal poisoning.
Given an opinion as to the sanitary effect of the different
methods of heating houses.
The most desirable method is by hot water heating by
means of a complete plant with circulation of the hot water
through radiators. Next in value to hot water heating is
steam heating by radiators or by indirect radiation. The use
of open fireplaces in the principal rooms is of great value in
securing ventilation, but yields an unequal and insufiSoient
supply of heat Heating a house by hot air from basement
heaters is efficient and gives good results, if the aar supplied
to the heater for distribution is pure and the house is not
too large.
State average weight of feces in 24 hours in a nor-
mal man. What proportion is made up of liquid and
what of solid contents?
Six ounces, 75 per cent, of which is water.
Name eight principal carbohydrates used as food.
Starch, glucose, saccharose, lactose, dextrin, cellulose, mal-
tose and dextrose.
Name the class of foods which should be given to chil-
dren between the first and second years of age.
We should supply foods in about the proportion of 2 parts
proteid, 3 parts fat, 6 parts carbohydrates, the proteid food
preferably milk.
148 EY6IENE.
How do forests benefit public health?
Foi-ests act aa wind barriers, promote humidity of the air
from the widespread surface they offer for evaporation.
They afford shade in summer, and aid in decreasing the rela-
tive quan'tity of earbon dioxide in tie air, exhaling oxygen to
the air.
State in a general way the maximum number of hours
that primary pupils in the public schools should be kept
at their tasks, and how frequently and in what manner
such tasks may be varied and broken.
One-half hour at a given task is sufficient when the char-
acter of the mental work should be changed. When an
hour's mental application has been enforced, then five or ten
minutes should be given to light calisthenics. Am intermis-
sion of fifteen or twenty minutes in the open air should
occur in the course of three hours' study. An intermission
of two hours should then be allowed for luuicheon and recrea-
tion, at the end of which time a similar routine may be fol-
lowed, as stated atiove, for two hours.
What abnormal condition of the eye is most common
in school children?
Myopia.
What are some of the dangers involved in the domestic
use of ice?
Ice may contain i>athogenic bacteria, and may, when re-
moved from a sick-room transmit infectious disease to other
members of the household.
What is the expectation of life of a professional man
in active practice at the age of 45 years?
24.82 years.
Define the term "quarantine;" mention the principal
quarantinable diseases, and give the rules for determining
the length of time each should be quarantined.
" The adoption of restrictive measures to prevent the in-
EYOIENE. 149
tpoduction of diseases from one country or locality into an-
other " (Wyman).
Quarairtinable diseases include cfholera, smaJl-pox, yellow
fever, pla^e, scarlet fever, diptheria, typhus fever, relaps-
ing fever, cerebro-spinal meningitis, leprosy.
In eruptive fevers isolation of the patient (quarantine) is
continued for two weeks after the eruption has disappeared
except in the case of snuall-pox where quarantine lasts 30 days.
The quarantine in diptheritic cases does not cease until
cultures made from the throat of the patient fail to show
the bacilliis of diphtheria.
State the best means of disinfecting sputum.
Sputum fi^hould be burned or be received into vessels con^
taining strong antiseptic solutions.
What is understood by the germ theory of disease?
Mention all diseases whose causes are known to be spe-
cific micro-organisms.
The germ theory of disease contends that the exciting
cause of each infectious or contagious disease is same specific
organism, and that these diseases are communicated only by
the transference to and development of the particular para-
site or germ within or upon the tissues of the infected in-
dividual.
Diseases due to specific micro-organisms are tuberculosis,
dip'htheria, cholera, typhoid fever, dysentery, pneumonia,
glanders, leprosy, anthrax, erysipelas, gonorr'hea, relapsing
fever and tetanus.
What diseases are incident to school life? How may
these diseases be prevented?
The infectious diseases, whicfh should be prevented by early
recognition and prompt removal of sick pupils. The room
should be disinfected. Curvature of the spine should be cor-
rected or prevented by properly constructed school furniture,
and proper admission of light to the room. Myopia should
BYOJENE.
be preren'ted by the use of clear, large print in text-books
and correction of improper positions in reading and writing
and a good supply of light admitted to the school-room to
the left of the pupils.
Contagious conjunctivitis, prevented by cleanliness and
isolation of the patient.
Chorea, prevented by removal of the afflicted and repres-
sion of all the lendencies toward imitatnon.
What is the value of preventive inoculation in cholera
and diphtheria?
Va.lue in cholera not yet fixed. In diphtheria, antitoxin is
both curative and prophylactic.
Outline the construction of a camp hospital, especially
providing for the care (with least danger to other patients,
medical and surgical) of those suffering from contagious
diseases.
Obtain purity of internal atmosphere; abundance of pure
air and sunlight within the building, facility of administra—
tioa and discipline. To abtain these requirements select a
proper site of soil, not clay, and preferably on hillside, look-
ing southward if in winter; use a simple plan of building,
a sufficient number of wards, preferably on the detached or
pavilion plan. In wards each patient should have at least
90 squai-e feet of surface space, and 1,200 cubic feet of air
space; have provisions for burning all infected material, dift-
charges, etc., to leeward of the hospdtal and at a suitable
distance away.
Can it be proved that the diminished death rate from
diphtheria so generally announced is due to the use of
diphtheria antitoxin? Give reasons.
Yes, By oomparing the death rate in hospitals treating
the same class of patients, in the same community, during the
same time, the one hospital using diptlheric antitoxin, the
other depending upon otiier methods of combating the dis-
i4
HYGIENE. 151
ease. Where the antitoxin is used the death rate is much
lower.
Give the comparative nutritive value of sterilized or
unsterilized cows* milk.
The nutritive value of sterilized milk is less than of milk
unsterilized.
What evil consequences frequently result from the ex-
cessive use of tobacco?
Catarrhal inflammation of pharynx, tonsils and mouth.
Nervous disorders of heart as palpitation, and insomnia also
result Derangements of stomach with loss of appetite, and
impairment of vision together with paralysis of optic nerve,
nervous tremors, and muscular twitchings may result. ^'/. v"^*^^ t f t>j
How should a patient who has been rendered uncon-
scious by heat be treated?
- f If the patient has a strong, full pulse and the face is red
and congested, place him in a recumbent p<»ition with the
head reaised and apply ice until the high temperature falls
to about 100 degrees Fahr.
X, . If the patient is pale, with a weak pulse, use stimulants,
/ as ammonia, by inhalation ; apply heat to the body and keep
head, face and neck cool.
Mention some of the advantages of carefully prepared
artificial ice as compared with natural ice.
It may be made from distilled water so as to be absolutely
pure. It may be obtained in any size or shape and its tex-
ture is more uniform.
What precautions as to food and drink should be ob-
served by those forced to work under the direct rays of
the sun in summer weather?
A small quantity of readily digestible food should be ea4;en
before going to work. Liquids of a non-aleoholic character
may be used liberally, provided perspiratory funetion is ac-
152 HYGIENE.
tively performed. Very cold drinks should 'be avoided. Meat
should be largely excluded from tlie diet.
A law to prevent owners of land in the narrow streets
of New York City from erecting buildings more than
twelve stories in height is being agitated. Give sanitary
and hygienic reasons for and against.
Reasons favoriu"^ tjiJl biLildiiij,'s: The persons using the
upper floors are insured uninterrupted sunshine, good light,
a pure sir, eomparatjively free from street dust, and free-
dom from ground air end water.
Reasons against : Tall buildings prevent proper ventilation
of lower buildings, and obscure sunlig-ht from smaller build-
mgs and the street. Fire is difficult to extinguish in tall
buildings- Their lower floors are often damp and generally
dark, requiring the constant use of artificial illuraiimtion.
They are, therefore, a menace to the lives of their occupants.
What are the best methods of ventilating dwellings,
and what sanitary principles are involved?
The |)i-iiiMting action of wind should be utilized at least
once each day for ail rooms. One of the best methods em-
ployed is the open fireplace, provided such fireplaces be sup-
plied with properly constructed chimney exits. In lieu of
this planr fresh air may be admitted through ventilators, or
l)etweeni the upper and lower window-sashes. The object
sought in these devices is to admit cold air above the heads
of the occupants of tlie room so that the fresh air may pass
through the upper portions of the room and become heated
before reaching the occupants. The u.sual outlet for foul air
is the chimney flue, but when this is not present, it may be
replaced by an opening for the exit of air placed near the
floor of each room. When the incoming air is not heated the
outlet should be at the top of the room. During cold weather
the rate of interchan'ge of air should not be greater than
sufficient to change the air of the room three times an hour.
The air which enters should not have a greater velocity than
five feet per second, or aibout '■iA miles per hour.
HYGIENE. 153
What hygienic precautions should be observed in the
care of the new-born child?
The room should be kept at a temperature of about 72°
Pahr. and well ventilated without draught. The child should
be thoroughly cleansed, using a neutral fat to facilitate the
removal of all fatty or sebaceous material before washing
with warm water and oastile soap. The eyes and surround-
ing pajrts should in particular be thoroughly cleansed; if
possible, without the aid of soap. After thopougihly drying
the infant, its navel should be properly dressed. The infant
should then be warmly dad, kept dry and clean, and away
from noise and strong light.
What hygienic precautions are necessary to insure
healthy sleep?
A well- ventilated room, temperature albout 60° F. Room
and bed should be perfecjtly clean, and the covers of the bed
not too heavy. The head of the person should be slightly
elevated. Noise and light sihould be excluded from sleeping
apartments.
What deleterious gases accumulate in improperly ven-
tilated sleeping rooms?
Carbon dioxide ; carbon monoxide, if rooms 'be heated ; hy-
drogen sulphide ; ammonium sulphide, and many gases of an
organic ammoniacal character.
Does change in climate require any change in food; if
80» what?
Yes. In cold climates a greater quantity of food should
be consumed th-an in hot climates. Food that is productive
of the greatest number of heat units, as fats and meats,
should be partaken of in cold climates. In hot climates the
diet should consist almost entirely of well-cooked vegetables
amd ripe fruits, with the avoidance of alcoholic beverages.
What are some of the dangers of the cold bath?
In those of feeble circulation and at the two extremes of
154 • HYGIENE.
life, cbilling of the surface of the body leaddnc to iutemai
congestion that may result in acute inflammation, particu-
larly of the lungs, kidneys, stoinacli and bowels. Shock seri-
ously afTecting the heart ; and the production of a persisten'tly
lowered ■temperature of the body.
What effect has ground air and water on the health?
Ground air is always impure, 'being contaminated -with
bacteria, carbon dioxide and often with more poisonous
gases. It occasions various degrees of ill-health, varying from
slight general malaise ito one of the acute infectious diseases
or tuberculosis. Ground water from near the surface of pol-
luted soils may be noxious. It causes dampness of the walls
of houses, inviting rheumatic diseases and catarrhal inflam-
1 nations.
What hygienic principles should be observed in infant-
feeding?
Peed the child every few houra during the day; and about
three times during the night till several months old; then
less frequently. If possdbie let the child receive its natural
food from the mother, and in such cases take particul-ar pains
to see that the nipples and breasts of tie mother are kept
dry and clean between the times of nursing. If the infant
is to be given artificial feeding, the cow's milk selected must
l)e from a healthy ammal, must be diluted with water to
give a relatively less proportion of casein, must be sweetened
with milk sugar, and have a slight addition of fats in the
form of cream added, when it will approach human milk in
composition. A definite quantity of milk which should be
warmed to the temperature of the body should be given at
each feeding.
Define the word " nuisance " in a broad hygienic sense.
" Something which either actually injures, or is likely to
injure health, and admits of a remedy either by the indi-
vidtial whose aqt or omission causes tlie nuisance, or by the
local authority" (Wynter-Blyth).
HYGIENE. 155
What should be the height, weight and chest measure
of a typical man aged 25 years?
Height 67.8 inches; weight 139 pounds; measurements of
chest 34.5 inches.
What injurious influences, if any, do cemeteries exert
on the health of persons living in their vicinity?
To most persons the mental effect is depressing. Water
passing through the soil of cemeteries may contaminate the
water supply of the neighborhood with organic material and
mdcro-organisms. The constant turning of soil of cemeteries
may set free imprisoned gases from organic decomposition,
and lead to contamination of the surrounding air.
What physical conditions would render the taking of a
Turkish bath inadmissible?
Atheromatous arteries generally, diseases of the lungs, and
diseases of the heart.
What gases and combination of gases are most efficient
as disinfectants?
Formaldehyde, sulphur dioxide, chlorine, ozone.
What care should be employed in exhumations?
The exhumation of those dead of contagious or infectious
diseases should not be allowed. When possible, the exhuma-
tion should be deferred until cold weather. The presence of
all persons except those absolutely needed should be forbidden.
As the workmen approach the coflBn the earth should have
poured upon it a strong watery solution of creolin. The
eoflSn containing the remains should not be opened, but be
placed at once in a zinc-lined box and hermetically sealed.
What are the hygienic requirements and the physio-
logical effects of bathing?
The bath should be taken to obtain personal cleanliness, as
well as for its stimulation of the -peripheral circulation.
Bathing should be postponed until at least two hours after a
HYGIENE.
meal, and should consume only twenty minutes. Never bathe
when very hungry, or when the body is overheated. Unless
experience has shown thai, good effects accrue from a cold
bath, secure a temperature of about 65 to 75 degrees Fahr.
of the water. The bath should be followed by a thorough
drying and brisk rubbing. Effects following a bath are re-
moval of dirt and of dead epithelium from the person, stim-
uliition of the functional aetivities of the skin; a general
improvement of the organs of elimination.
How much fresh air is required for normal respiration
during 24 hours?
3,000 cubic feet per hwur, or 72,000 cubic feet of air in
24 houre.
What is the best sanitary disposition of stable manure
in large cities?
The liquid poi-tion of manure shoidd be carried by prop-
erly eonstrueted trapped drains into the general sewer. The
solid, dried manure, straw, etc., should te placed in well-
oovered pils, from which it ooiild be removed at proper in-
tei-vflls in covered Tvagons, and employed in the country as
fertilizer; or drain tlie liquid manure into the sewer and
cremate the solid manure.
How may a privy in a city or country be kept while in
use from becoming a nuisance?
Have the privy emptied'at frequent intervals. At inter-
vals of five to seven days, pour into the privy vault mdlk of
lime (about 20 grains of lime for each gallon of sewage),
or stiong solution of iron sulphate; or at frequent intervals
add clean, dry earHh to the privy contents, and provide a
ventilating pipe extt-nding high in the air and down into the
privy v.™lt.
What explanation can be furnished for the greater prev-
alence of diphtheria and small-pox in cold than in warm
weather?
During cold weather the houses are less perfectly venti-
HYGIENE. 157
lated than in warm weather. Booms are frequently over-
crowded, lefis a/ttention is paid to personal cleanliness and
there are more sudden changes in temperature. Such condi-
tions lower the vitality of the body and predispose to disease.
What are the principal adulterations of milk?
Addition of water and abstraction of cream; addition of
coloring matter (annatto, caramel) ; preservatives (borax and
boracic acid, salicylic acid, formaldehyde, ehromates) ; gela-
tine as a thickening for cream.
What changes in food are effected by cooking?
Parasites and germs are destroyed ; the food is made more
tender to facilitate mastication. The tough fibrous envelope
of starch cells is softened, albumin is coagulated, the food
is rendered more palatable, and the action of the different
digestive fluids is aided.
Give the sanitary dimensions of a school-room for fifty
pupils.
A room 15 feet high, 25 feet wide and 40 feet long would
allow each pupil 300 cubic feet of space, which is the ade-
quate amount for each child.
Mention eight satisfactory disinfectants and give indi-
cations for their use.
Formaldehyde (1 pound of formaline for every 1000 cu. ft.
of space), sulphur (3 pounds for every 1000 cu. ft. of space)
or bleaching powder (3 pounds for every 5000 cu. ft. of
space) to fumigate a room. If sulphur or bleaching powder
are iraed, it is necessary to steam the room before beginning
to fumigate. Chloride of lime to disinfect excrementitious
matter from typhoid fever, cholera, dysentery, etc. Carbolic
acid (5% solution) or moist heat (steam and boiling water)
to disinfect clothing. Bichloride of mercury or permanga-
nate of potassium and oxalic acid to disinfect the skin.
158
HYGIENE.
r
What are the most common sources of infection in
diphtheria?
By direct contact with the sputum or shreds of membrane
from the patient. By inhaling the air in the vicinity of the
patient. By fomitjes, as clothing, books, drinking-eups, etc.
What conditions are essential to a good water supply?
Purity at its source, and adequate subsequent protection
from contamination.
What hygienic measures should be observed by the
nursing woman?
An abundant diet, avoiding overfeeding; some fonn of
outdoor exercise each day ; monotony of life and overwork
should be guarded agajost. Warm clothing, personal clean-
liness, abundant sleep, freedom from mental cares, fright or
anger are necessarj- precautions. Each time the child is re-
luoved from the breast the nipples should be washed with
rt'anii water and thoroughly dried.
What precautions should a physician observe to avoid
carrying contagious diseases?
A linen duster and a t ightly- fitting linen cap should be-
worn by tlie physician ia the sick-room, and be removed
after learing the room. Immediately after manipulating the
patient the physician should tboroughly wash and disinfect
his hands and face. A bath and change of clothing before
attending other patients are advisable.
Describe the hygiene o1 the mouth and teeth.
The teet^h should be cleansed after each meal and on rising
in the morning, and foreign matter between the teeth should
'l>e removed. Acidity of the saliva may be counteracted by
■weak alkaline mouth washes.
What methods would you suggest for the hygienic care
of the skin?
Simple foods: Hvoiding constipation; daily exercise in the
HYGIENE. 15^
open air; plenty of sleep (at least eight hours daily) ; fre-
quent warm baths and a cold sponge bath on rising each
morning.
What localities should be sought or avoided by rheu-
matic patients?
Warm, dry, equable climate should be sought. A'lkaline or
sulphur thermal springs are recommended. Damp valleys,
shores of rivers, sea coasts and places which are much ex-
posed to winds and sudden changes of temperature should be
avoided.
Name the kinds of food and the quantity of each for the
daily use of the normal man.
4.5 ounces of proteid; 3.5 ounces of faits; 14 ounces of
carbohydrates; 1 ounce of salts (Moleschott). Or 118 graioa^* W*^
proteids; 56 grains fats; 500 grains carbohydrates (Voit). ^
These quantities represent dry foods. If the diet is stated
ss so-called solid-food (not water-free) the above quantities
must 'be doubled. 50 to 80 ounces of water in liquid form
aje also taken into the system.
What is the object of the wet pack, and what unfavor-
able results may occur from its use?
The cold wet pack is used to lower temperature during
fever. The warm wet pack is used to promote elimination
of fluid, to relax muscular spasm, to promote sleep, and raise
lowered vitality.
The dangers to be guarded against are heart failure or
fatigue, or excitement to weak patients. The cold pack may
give the patient a nervous chill.
Describe in detail the process of disinfection by foi*mal-
dehyde (formalin).
Make the room as near air-tight as possible by closing all
openings and cracks before beginning the process of disin-
fection. All mattresses, pillows, clothing, books, etc., should
be exposed as fully as possible to the action of the disin-
160 HYGIENE.
feotant. Place one pound of formalin for eveiy 1000 cu. ft.
of air space in a " Novy " generator. Start the rapid vola-
tilizing of the formaldehyde and aJlow the room to remain
closed for one day.
What hygienic means should be employed by persons
prone to " catch cold?"
A i-old sponge bath followed by brisk rubbing on aridng
in the morning: daily muscular exercise in the open air and
a liberaJ (but not excessive) diet, largely of carbohydrates.
Describe the necessary sanitary precautions during the
prevalence of an epidemic of Asiatic cholera.
Isolate all patients and aCtendants ; observe strict quarantine
of all infected houses or districts; disinfect and remove any
accumulations of filth, excreta, etc, ; cremate those who have
died from this disease. The water supply should be guarded
to prevent its contamination; and insist upon householders
boiling all water or milk before using the same. All gastric
or intestinal diseases s'hould be attended to at once. Restrict
or prohibit the use of all fruits or uncooked foo<ls from the
district; and use all disinfectant precautions where cases
exist, during continuance of ease, and after its termination.
What are the sanitary requirements of house plumbing?
All pipes and connections, traps, etc., should be in view or
easy of access. Each house must be directly connected by
pipe with the common sewer. The pipes iu the house must
be of iron with leaded joints or screwed couplings. The
drainage pipes shoidd be laid with a gradient of at least one
inch fall to every four feet of length; the main house drain
must be provided with a trap after it has been carried beyond
all house connecting pipes. Pipes from water-closet fixtures,
bath-tubs, wash-basins and sinks must have traps close to
each fixture. Soil pipes must, extend open for at least two
feet above the roof and air must lie admitted to the main 'trap
upon its house-side.
HYGIENE. 161
Describe a simple form of ventilating the sick-room.
Place a wooden strip about three inches wide and as long
as the window frame under the lower sash; through the
space between the top of the lower sash and the bottom of the
upper, sufficient air will enter the room without producing a
draught. ^^
What precautions should be taken in school-rooms to
protect the sight of scholars?
Pupils should not sit facing the windows (the light should
come from behind or over left shoulder) ; blackboards j^hould
not have a glossy surface and should not be placed between
windows. The walls of the room should be of a neutral tinit.
Text-books should be printed in clear, large type. Faulty
pofirt:ure in readdng and writing should be corrected by the
teacher. If toilet accessories are supplied, no child suffering
with an inflammatory disease of the eyes should be permitted
the use of the general supply. Any imperfection in vision
of a pupil should be reported to the parents.
What are the chief sources of contamination to drink-
ing water?
The emptying of sewage into the stream from which the
supply is obtained ; surface water in settled districts gaining
entrance to the supply ; sub-soil water, after passing through
a filthy soil ; drainage from places of burial ; and w^ater which
has dissolved poisonous minerals.
Describe the several methods of purifying drinking
water.
'Sedimentation, occurring when collections of water remain
at rest for a considerable time, removing, in part, at least,
suspended matter.
Sand filtration in which the water flows upon and through
prepared' beds of sand, gravel and broken stone, packed in
separate layers, removes from it not only suspended matter,
but also dissolved organic matter and bacteria, through the
11
BYGIENE.
action of uii- (oxygen in the interstices of the filter matorial,
anil t-he action of sapraphylic bacteria.
Boiling water will free it of pathogeiiif baoteria and tem-
porary hardness, but such water, after boiling, should be
aeratpd t<i fit it for nse.
What do you understand by the " dry earth system "
as applied to excrementitious matter?
The container under the privy seat contains the dry earth.
and after the use of the privy fresh earth is aJwaj^s to be
added to the receptacle. From time to time the contents are
removed nnd buried or otherwise dispoised of.
Contrast the incubative stages of measles and scarlet
fever.
The stage of incubation in measles is from one to three
weeks (averaging 12 days) ; in scarlet fever from one to eight
days (nverakre ■I days).
Mention some of the results of tobacco smoking in
growing school boys in respect to the circulation, air
passages, vision and mental application.
It depresses the circulation and pivxluces palpitation of
the heart. It causes low grades of infiaminatory processes
in the upper air paaeagea. catarrhal conjunctivitis, mental
lethartry. with inability to sustained mental application.
What habits of school children tend to produce myopia?
Reading of small imperfect print: faidty positions while
reading or writing in which the eyes are not far enough re-
moved from the paige; reading or writing in insufficient light,
or when fatigued.
What should be the proper temperature for a living
room in winter?
72"F. for old or weak persons; fio' F. for the young and
vigorous.
P
HYGIENE, 163
What should be the diet of a child over two years of age?
The food should consist principally of milk and bread, with
rice, tapioca, some vegetables of easily aigestible character,
and sparingly of fruit, preferably cooked; but little meat
should be allowed, «nd this preferably mutton.
What hygienic precautions should be observed by a
pregnant woman?
Diet should be nutritious; clothing should be loose; mod-
erate outdoor exercise should be taken each day ; the marital
relations should cease; the action of the skin should be
stimulated by warm baths. After the sixth month the urine
should be examined every few weeks. Constipation should
be corrected by hygienic measures when possible. In late
pregnancy the nipples, if necessary, may be developed by
judicious manipulation.
What is the most sanitary way of disposing of dty
garbage?
Bum it, so that all noxious vapors are also consumed.
Describe the effects of a cereal diet.
Many writere assert that, as a rule, such a diet produces a
lessened muscular formation, wnth an increased fat produc-
tion, and that it also causes a deficient production of red
blood corpuscles, with an accompanying loss of oxidation and
tissue removal; but it is probable that such a diet is com-
patible with good health provided it contains enough proteids.
What is the lowest temperature of steam heat at which
pus cocci are destroyed?
At 240 degrees Fahr. such organisms are killed in a few
minutes, while at 212 degrees Fahr. it requires an exposure
to steam of from thirty to forty minutes.
What physical training would you recommend to a per-
son with weak respiration?
Calisthenic exercises without apparatus directed to increas-
164
HYGIENE.
ing the extrinsic and intrinsic muscles of respiration, accom-
panied by deep and slow breathing. This should be followed
by a course of light, well-regulated gj-mnastie work, with
dumb-bells, Indian clubs and wands. After a proper interval
of several months, progresNJvely difficult niountain-clirabing,
then running exercises, and finally general apparatus work
in a gixKl gymiiasium under proper instruction.
Name three te»ts for detecting impurities in water.
Ntssler's test for defecting and estimating ammonia.
Nitrate of silver for dete<?tiug and estimating chlorides.
Barium nitrate for detecting and estimating sulphates.
What is the best sanitary plan for the disposal of
sewage?
Collect the sewage in lar^e tanks and to it add lime, alum
or iron sulphate. Compress the solid materials after their
subsidence or precipitation and cremate them. Allow the
liquid sewage to flow upon specially prepared filter beds
which are subdrained, and the water flowing from the«e sub-
soil pipes may then [wiss into a stream without great danger
of aiUlintr [inisonous njaterial or pathogenic bacteria.
What is the temperature of tepid water, of hot water,
of boiling water?
Tepid water 75 to 85 degrees Fahr.
Hot water 100 to 110 d-egrees Fahr.
Boiling waler 212 degrees Fiilir.
What diseases are propagated by drinking water?
How can their spread be prevented?
Infectious diseases, particularly cholera and typhoid fever;
diseases due to gastric and intestinal irritation, as forms of
dyspepsia, diarrhn'a, dysentery; disease.^* due to animal para-
sit*»; diseases due to metallic poisons.
Prohibit the use of water containing any dissolved metai.
Distil the water, or boil it for at least one-half hour, thus
purifying it
HYGIENE, 165
Describe in detail the sanitary precautions necessary in
typhoid fever.
Expose urine, stools, vomitus and sputum for three hours
to the action of a solution of chlorinated lime, of the strength
of six ounces to a gallon of water, breaking up all solid
masses. Place all towels, napkins and bed linen in a 5 per
cent, solution of carbolic acid until convenient to boil the
same for half an hour. Secure continuous ventilation of the
sickroom. Boil all water and milk before allowing its use
by tJie patient or members of the household. Fumigate the
room and contents after the patient leaves it.
What hygienic precautions should be employed about
diphtheria?
Isolate the patient; refuse admission to the sick-room of
all whose presence is not necessary; attendants should ob-
serve the greatest personal cleanliness; all secretions should
be collected upon cloths and burned. All articles should be
disinfected before being removed from the sick-room. Mem-
bers of the household should be quarantined.
Mention six desirable factors in the location of a resort
for consumptives.
Equable climate, high altitude, dry atmosphere, pure air,
abundamt sunshine and pine forests are climatic factors for
consumptives.
State the accepted belief in respect to the limitation of
protection from vaccination.
Five years, when revaccination should be attempted. Dur-
ing 3 small-pox epidemic it is advisable to revaccinate all
individuals who have not been vaccinated within two years.
Mention some of the adulterations in preparations of
ground coffee for sale in the shops.
Chicory, peas, roasted cereals and legumes, date stones,
acorns, sawdust, etc.
HYGIENE.
What class of foods should predominate for persons
over sixty years of age?
Use eight-tenths the quantity of proteids thai the vigorous
adult requires; seven^cnths the quantity of carbohydrates;
and OHe and two4enths times tlie quantity of fats.
Which in your judgment is to be preferred in vaccina-
tion, animal or humanized lymph, and why?
Aiiinwil lymph, heeause in its preparation greater eare may
be taken to secure its freedom from deleterious additions.
Name some of the nuisances dangerous to health.
(jBses and dust of a poisonous or irritating nature arising
from many manufacturing industries. Collections of stag-
nant water, garbage and enimaJ excreta exposed to air; leak-
ing drains or sewers saturating the soil, or allowing the escape
of gases. Industries giving rise to great noise or- vibration
in thickly settled eommunites.
What is the best means for preventing the access of
sewer gas in duellings?
Place a trap or water s*aJ l>e1ween the house drain and the
sewer and provide an air inlet pipe to open into the drain
pipe between this trap and the house. A ventilation pipe
should esftend from the house drain to a point above the roof.
State the ordinary J«ath rate of each of four cities
having respectively a population of more than fifty thou-
sand (50,000).
Dublin, 39.9; St, Petei-sburg, 31; Berlin, 17; Amsterdam,
17.8 (1897).
Name the diseases the predisposition to which is greatly
increased by the habitual use of alcohol.
Diseases of the heart and vascular system, the kidneys,
brain and liver, and of the respiratory system, particularly
pni^umonia and asthma.
HYGIENE. 167
Mention methods to be employed for preventing epi-
demics of yellow fever in the tropics.
Remove at once to high or new ground should the disease
appear. Cremate all those who have died of the disease;
disinfect and remove all filth and endeavor to destroy all
mosquitoes and their larvai and other insect pests by the
use of petroleum, sub-soil drainage of damp places, and fill-
ing all stagnant pools with clean dirt.
Name four diseases that are communicable to man
through cows' milk.
Typhoid fever, scarlet fever, cholera and tuberculosis.
To what is indigestion from excessive tea drinking
attributable. State a formula for the preparation of
good tea.
The indigestion is caused chiefly by tannin; also by theo-
bromine.
Pour one pint of boiling water over a dram of the dried
tea leaves and allow it to stand without applying further
beat for ^\q minutes.
State the advantages of cremation over earth burial.
Complete destruction of specific disease germs. If crema-
tion be well performed no obnoxious gases are given to the
air, no gases of puti*efaction contaminate the air, and there
is no dajiger of contaminating the water supply through
drainage from cemeteries.
What are the respective merits of cotton, wool and silk
when used as underwear?
In a varia/ble climate wool is preferable because from a
larger amount of air enclosed in its texture it acts as a good
non-conductor of heat, retaining the body temperature. As
wool is hygroscopic it readily absorbs moisture from which
it parts slowly, so preventing surface chill of the individual
by too rapid evaporation. Next in order to retain the heat
168 HYGIENE.
of the body we rank silk, and least valuable for the retention
of body heat ia cotton. If it be our purpose to supply a cool
garment we would of course reverse this order of arrange-
ment.
If a chemical analysis of water revealed the presence
of nitrites and nitrates, would this condemn it for drinking
purposes? If so, why?
Yes. particularly if nitrites be present. Organic matter,
particularly sewage, is comverted fii-st into nitrites, and these
iirto nitraitea thi-ough the action of bacteria in the soil. These
aalta would, therefore, indicate a fonner polhition of the
water with probably some of that polluted material still in
the water. If nitrates only are present, and it can be shown
that the organic matter is of a vegetable oi-igiu only, the water
need not be condemned.
To what diseases are negroes comparatively insuscep-
tible? In the Middle States to what diseases are negroes
n>ore prone than whites?
Dysentery, yellow fever, and diseases incident to exposure
ito summer heat. Negroes are more prone than whites to
contract small-pox. diseases of the respiratory tract, fibroid
tumors, keloid growth.s and veuoreal diseases.
Give a medical and hygienic plan for the inspection of
immigrants who have just arrived at a seaport.
Examine the "' Bill of Health " and clinical records of all
eases treated duriug the voyage and the lists of passengers,
crew and manifests, and, if desicable, the ship's log. Have
crew and passengers mustered and compared witli the lists,
inivesti gating any discrepancies and make a careful examdna-
tion of both crew and passengers. If a case of infectious
disease has occurred during the voyage, disinfect all exposed
baggage and freight and detain such members of the crew
and passengers as have been exposed iiutil the incubation
period of the disease has passed.
HYGIENE, 169
What conditions of ill health make residence in high
altitudes dangerous? Why?
Chronic Bright 's disease, disease of the heart, emphysema,
and old a^e. High altitudes occasion increased respiratory
effort from the rardfied condition of the atmosphere, causing
increased heart action, and a lessened perspiratory function.
State the physical conditions that make the practice of
taking hot baths inadvisable.
Acute inflammatory diseases, tuberculosis, organic diseases
of the heart and brain, aneurism, cancer, and all diseases in
which stimulation of the circulation is to be avoided.
State some of the sequelae of (a) over-strain, (b) over-
exertion, (c) over-training.
(a) Parting of continuity of osseous, ligamentous, muscu-
lar to blood-vessel structure leading to fractures, dislocations,
rupture of muscles, hernia, rupture of heart muscle, disease
of valves of heart or apoplexy.
(b) May produce same conditions as overstrain and in
addition cause general muscular relaxation, dyspnea, syn-
cope, etc.
(c) Loss of appetite and of muscular power, successive
crops of boils appear, individual loses mental power, as of
concentration of thought, and digestive disturbances occur.
What constitutes hard water and soft water?
** Hardness is the capacity a water has for decomposing
soap, and depends on the amount of salts of magnesia and
calcium in solution.'' (Harrington.)
Soft water contains little or no dissolved salts and rapidly
forme a lather with soap.
Mention the dangers of excessive shade about dwellings.
Excessive shade interferes with the free movement of air,
prevents penetration of the sun's rays, promotes dampness
which is given off to the air by evaporation. It exerts a de-
pressing mental action, promotes the growth of fungi and
170
UYOiESE.
bacteria, ami pitveiits tin? Hspirating actiou of hoat from tlie
sun upon air and moisture in the soils.
What is milk sterilization? How is it performed?
Destruction of ini«ro-<»rgamsuis in the milk by lieat. By
continuous heating of the milk, under pi-essure, for two
houi-s at 248 ' F.
State the objections usually advanced against vaccina-
tion as a preventive of small-pox.
It is urged that it fails to pmtect from smiall-pox (which
is false), that it may pi-oduee blood-ixiisoning, that eoiiBtitu-
tionul diseases like syphilis, scrofula, etc., may be introduced
by the vaccine virus, or in the openatiou. Also that tetanus
may result, and that it is not right to deliberately inoculate
a healthy pei-son with tlie Tints of vaccinia or of any disease.
On what generally accepted theory are toxins used for
the prevention and cure of disease?
That (heir presence in the system renders the blood no
longer able to supj-wrt. the lives of ba<rterifl that occasion such
What infectious diseases may be due to impure drink-
ing water?
Typhoid fever, malarial fevers, cholera, relapsing fever,
dysentery, parasitic diseases.
Define humidity of the atmosphere. Why should a
humid atmosphere cause rheumatic persons and persons
suffering with the gout increased sensitiveness?
The term huniiditj' refci-s to vapor of watt-r in the air. An
increased humidity increases sensitiveness of gouty and rheu-
matic patients by decreasing elimination from the akin of
excretory organic matters and unc acid derivatives and thus
leading to retention of such p<HSon8 in the system.
What constitutes a thorough meat inspection? How
should an inspection of milk be conducted?
Meat should l>e inspected within 24 hours after the animal
HYGIENE, 171
is killed. The following points are noted: The quantity of
bone, for which 17 to 20 per cent, is to be allowed. The
qnantity and characted of the fa/t, noting its color, consis-
(tency, and taste. Condition of the flesh. Condition of the
marrow. Examination of the lungs, liver, kidneys for detec-
tion of infectious disease manifestations. A microscopical
examination of the fleerh for detection of bacteria of path-
ogenic character, trichina, tape-worm or other parasites.
Where possible, it is well to investigate the surroundings in
which the animal has lived and the methods employed for
storage and refrigeration.
An inspection of milk takes cognizance of its specific grav-
ity, color, quanrtdty of cream, presence of preservatives, pres-
ence or absence of dilution, or addition of coloring matter,
determination of total solids, of quantity and quality of ash,
of fats, casein, lactose. The microscopical and bacteriological
examinations are i)erf6rmed and finally an examination is
made of the source, storage and distributing methods.
CHEMISTRY.
What is chemical affinity?
Chemical aflBnity, or chemism, is that force which combines
atoms to form molecules.
Mention three fixed monads, two fixed dyads, one fixed
triad and three elements that vary in valency. Illustrate.
Monads; hydrogen, chlorine, and bromine. Hydrogen is
the standard of comparison, chlorine and bromine are shown
to be monads in their compounds, hydrochloric acid, HCl,
hydrobromic acid, HBr, etc. In no known compounds will
these elements combine with more than one hydrogen atom.
Dyads; oxygen and calcium, as shown in the compounds,
water, Hfi, calcium chloride, CaOlj.
Triad; boron, as shown in the oxide, BjOg, two atoms of
boron combining with the three bivalent oxygen atoms.
Three elements varying in valency are: Carbon, dyad in
CO, tetrad in CO2; sulphur, tetrad in SOj, hexad in SO3;
gold, monad in AuCl, triad in AuCl,.
Differentiate mechanical divisibility 'and chemical di-
visibility.
Mechanical divisibility, that obtainable by mechanical or
physical means, permits, theoretically, the division of matter
into its molecules.
Chemical divisibility, that obtainable by chemical means,
permits of the division of matter into its atoms.
What are salts and how are they formed? Define
neutral salt, acid salt, double salt.
Salts are compounds formed from acids by substituting
(173)
CHEMISTRY.
metals or basic radioals for part or all of tlie replaceable
hydrogen of the aeid.
Neutral salts are those formed from acids by substituting
metals or basic radicals for ail of the replaceable hydrogen of
the acid.
Acid salts are those formed from acids by substituting
meitals or basic radicals for part of the replaceable hydrogen
of the acid.
Double salts are those containing two different metals or
basic radicals in their molecule.
Mention five elements found in nature only in combin-
ation. Into what groups are elements divided?
Alumiuum, pot;assium, sodium, chlorine and bromine.
Elements may be classified according to their electro-chem-
ical properties, e. g.. tlie electix)-negative non-metals, the
electro-poaitive metals; they may be classified according to
their analytical properties, e. g., those precipitated by hydro-
chloric acid, those precipitated by hydrosulphuric acid, etc.;
they may be classified according to their atomic weights {the
periodic law), thus brining together in groups elements
similar in properties.
Mention five elementary substances commonly used in
medicine in a pure or uncombined state.
Oxygen, iodine, sulphur, phosphorus, carbon.
Define reaction, water of crystallization, atomic weight,
specific gravity, reagent.
Reaction — the rearrangement of atoms with formation of
new compounds effected in a ciiemieal change. Water of
crystallization— water necessary to the crystal form. Atomic
weight — the relative weight of an atom as compared with
the weight of another atom taken as a standard. Specific
gravity — the relative weight of a substance as compared with
the weight of an equal vohime of another substance taken as
a standard. Reagent^ a substance used to produce a
chemical reaction.
CHEMISTRY, 175
Define isomorphous, amorphous, crystalline, galvanic,
polarization.
Isomorphous — of the same form, relating in chemistry gen-
erally to substances which crystallize dn the same form.
Amorphous — without form, substances having no regularity
of internal structure, not crystalline. Crystalline — substances
having a regularity of internal molecular structure produc-
ing under proper conditions definite geometrical forms. Gal-
vanic— that pertaining to electricity of chemical origin to
current electricity. Polarization — in reference to light, means
the breaking up of the light ray into two parts whose planes
of vibration are at right angles to each other. Polarization
in electrical batteries refers to the accumulation of gas on the
plates, thereby interfering with the further production of
the electric current.
Describe a method of producing an electric current by
chemical action.
In a jar containing water rendered slightly acid with sul-
phuric acid, place a plate of copper and one of zinc; connect
the two plates outside of the liquid by means of a wire and a
current of electricity will be developed, ** flowing" from the
zinc to the copper through the liquid, and from the copper to
the zinc through the wire.
Explain the uses of the spectroscope in chemical analysis.
A solid body at a white heat produces a ** continuous spec-
trum.'' Elementary substances in the state of gas or vapor
when highly heated yield characteristic spectra consisting of
but one or more bright lines, the position of which is posiitively
fixed for each element. If a strong white light be passed
through certain solutions we obtain a continuous spectrum
crossed by dark lines — **an absorption spectrum." These
facts are made use of in the examination of heated vapors
and of certain solutions. In medicine the spectroscope is
especially useful in the identification of blood by its absorp-
tion spectrum.
176
CIIEVISTHY.
r
Define sublimation, distiflation, Static electricity, gal-
vanic cell, organic compound.
Siibliumtion — tlifi vaporization auU condensation of a vola-
till' solid. DistiJIation — th* vaporization and condensation
of a lifjuid. Static L'!ectri<'ily — ^that ^rc-nerated by friction.
A galvanic cell is an arrangement of eleinents and fluid for
the prodiictitiJi of electricity by chemical action. An organic
eompoiind is a hj"drocarboa or a substance ivhich may be re-
parded as derived from a hydrocarbon.
Give the chemical name of each of the following: (a)
common salt, (b) calomel, (c) sal-ammoniac, (d> plaster of
Paris, (e) a principal ingredient of baking powder.
(a) S(Hiium ^ihloride, (b) mercurous chloride, (c) ammo-
nium chloride, (d) calcium sulphate, (e) sodium bicarboniate.
What is lunar caustic? State how lunar caustic is pre*
pared.
Lunar caustic is moulded silver nitrate. To 100 Gm. of
silver nitrate in a porcelain dish add 4 Gra. of hydrochloric
acid, and melt the mislui-e at aa low a lempemture as pos-
sible. Ktir wi'll Hn<i p<mr the melted mass into suitable
moulds.
Write the formulas and the names of five acids, giving
the graphic formula of one of them.
Hydrochloric acid, IK'l; hydrohromic acid, HBr; nitric
acid, UNO;,; sulphuric acid, ILSO,; sulphurous acid, H^SO,.
The graphic formula for nitric acid is
How may ferric hydrate be hurriedly prepared? When
and how should ferric hydrate be used as an antidote?
Ferric hydraite may be prepared by adding ammonia water
to a solution of ferric aulphate. "Wash the precipitate by
decantation «nd ftlter through unbleached mnslin.
CHEMISTRY. 177
Ferric hydrate is used -as an antidote for arsenic. Give
freely mixed with water or with milk.
Give the details of a test for arsenic.
The Reinsch test : Acidify with hydrochloric acid, introduce
a strip of pure, clean copper foil and boil. If a gray coating
form on the copper, remove from the liquid, dry carefully
by pressing between folds of filter paper, place the copper at
the bottom of an ignition tube, and heat. If the deposit upon
the copper be arsenic it will volatilize and will deposit on the
cool portion of the tube in octahedral crystals of arsenious
oxide.
Mention the physical and the chemical properties of
HoS.
Hydrogen sulphide is a colorless transparent gas, slightly
heavier than air, of disagreeable odor, soluble in water. It
is an acid, burns with a blue flame, producing water and sul-
phur dioxide. Used chiefly as a reagent for the precipitation
of certain of the heavy metals from their solutions.
Give the symbol, valence, occurrence in nature, physical
properties and chemical properties of one of the follow-
ing: bromine, silicon, copper, antimony, manganese.
Copper, symbol, Cu; valence II, occurs in nature in the
free state and as the oxide and sulphide. It is a soft, ductile,
red metal with a specific gravity of 8.9 atomic weight 63.1.
It is a good conductor of heat and electricity. In dry air
it undergoes no change, but in moist air it gradually becomes
coated with a film of the basic carbonate. Heated in the air
it oxidizes to CuO. It is soluble in hot mineral acids, and is
Hcted upon by many of the vegetable acids.
Mention the halogens. Why are they so called? Give
the formulas of three compounds each of which shall con-
tain a different halogen.
The halogens are fluorine, chlorine, bromine and iodine.
The name is derived from the Greek, meaning **salt pro-
12
178 CHEMISTRT.
ducer," and wa-s given because of the saline character of
many of the compiMinds of these elements.
NaCl, sotliiini chloride; KI. potassium iodide; KBr, iwtas-
sium bromide.
State the sources of ammonium compounds. Give the
composition, the method of preparation and the properties
of sal-ammoniac.
Auuiionium compounds are derived from the ammoniacal
liquor from gas works.
Sal ammoniac is the chloride of ammonium, made by satu-
rating the ammoniacal liquor with hydrochloric acid, evapo-
rating the solution to dryness, and subliming the salt pro-
duced. It is a white crystalline substance, salty iu taste,
odorless, very soluble in wator.
Qive a test for (a) ferric compounds, (b> ferrous com-
pounds. Write the chemical names and the formulas of
three salts of iron used in medicine.
(a) I'otaiwiuin ferrocyaiiide gives a dark blue precipitate
(Prnsaiau blue), (b) Potaasium ferricyanide gives a dark
blue precipitate (TumbuH's blue).
Perrio chloride, Fe,Ci„ or PeClj; ferrous carbonate,
PeCO,: ferrous sulphate, FeSO,.
Give the history, occurrence, preparation, properties
and medicinal uses of chlorine.
Di.scoveit'd by Scheeli? in 1774. and was long thought to be
a oonipound. The name was |?iveu to it on account of ita
color. Occurs in nature only iu combination, chief com-
pound, sodium chloride or common salt. Prepared by the
action of hydrochloric acid on manganese dioxide. Proper-
ties: a ye Ho wish -green suffocating gas, heavier than air, solo-
ble in water. Chemically it is an element, symbol, CI, atomic
weight :i:i.18. B monad in combining [)nwer, and has strong
affinity for o'her elements, especially for hydrogen. Chlorine
is u?ed !i-s a disinfectant and deodorant; its aqueous solution
CHEMISTRY. 179
has been used locally in scarlet fever, diphtheria, gangrene
of the mouth, etc.
Hydrargyri oxldum flavum may be prepared by pour-
ing a solution of mercuric chloride into a solution of
sodium hydrate; give the chemical equation.
HgClj,+2NaOH=HgO+2NaCl+H20.
Mention the oxides of iron and give the formula of one
of them.
Ferrous oxide, ferric oxide, and ferro-ferric or magnetic
oxide. The formula for ferric oxide is FejOg.
Give the contmon name, formula, properties, prepara-
tion and uses of zinc sulphate.
White vitriol, ZnS04, made by dissolving zinc in sulphuric
acid and then evaporating the solution. A white, crystalline,
freely soluble salt with metallic taste. It is used as an emetic
and for its effect upon ithe nervous system, in chorea, etc.,
in many cutaneous affections in ointment form, as a collyrium
in aqueous solution, and also for injection in gonorrhoea.
Give the formula and method of manufacture of po-
tassium nitrate.
KNO3. Made by decomposition of sodium nitrate by means
of potassium carbonate or chloride.
NaN03+KCl=Na01+KN0,.
Give the symbol, atomic weight and valence of five non-
metals.
Chlorine, CI, 35.2 (35.18), valence I. Oxygen, 0, 16
(15.88), valence II. Sulphur, S, 32 (31.83), valence II.,
IV., VI. Carbon, C, 12 (11.91), valence II., IV. Nitrogen,
N, 14 (13.93), valence III., V.
Define amid, anilid, radical.
An amid may be regarded as a substance formed from am-
monia by substituting one or more acid radicals for one or
more hydrogen atoms.
180
CHEMISTRY.
^
All anilid is a derivjilive of anilin, formed by substituting
acid radieala for hydro^u,
A radical is an a>toui or group of atoms forming the ba^B
of a series of compounds, but incapable of existing in the
free state.
How may lead enter the system and produce chronic
lead poisoning? Oive the diagnosis of lead poisoning and
mention the chemical antidotes for it.
Lead may be introduced into the system by the drinking
of water which has been standing in lead pipes; with food
whieh has teen in contact with the metal (tin-foil containing
lead, lead glaze on pottery, etc.) ; by handling of lead com-
pounds ( nianuf aeture of paants, painters, etc.); by use of
hair dye eomtaining lead, etc. In chronic lead poisoning we
have anemia, colic, obstinate const! paition, blue line on the
gums, "wrist-drop," and palsy. The chemical antidotes are
the sulphates of MHliuni and magnesium, dilute .sulphuric
acid, etc.
Mention the principal products obtained from petroleum
and describe the properties of one of the products men-
tioned.
By fractional distillation we obtain from petroleum the
petroleum ethers, gasoline, benzin. the napthas, kerosene,
lubricating oils and paraffin.
Benzin or beuzinum is a transparent colorless liquid of
ehamcteristic odor, lighter than water, insoIuWe in water,
soluble in ti parts aJcoliol. and freely soluble in ether, ben-
zone ami oils. Boils at 45' to 60° C, and is highly inflam-
niablf.
Describe starch. How may starch be recognized chemi-
cally? What substance is formed when diastase or dilute
acids act on starch?
A line white powder or in irregular, angular masses; in-
odorous and tasteless, insoluble in cold water or almhol,
forming a paste or whitish .jelly when boiled with water. It
CHEMISTRY. 181
is reeognized chemically by the blue color with iodine test
solution.
By the aetiou of diastase starch is converted into maltose
and dextrin ; by the action of dilute acids, into dextrose and
dextrin.
Describe the preparation and uses of gun cotton
(pyroxylin).
Pyroxylin is made by steeping cotton in a mixture of nitric
and sulphuric acids, then i^emoving and washing with cold
water. It is use<l in making collodium.
How is collodion prepared?
Collodion (collodium, U. S. P.) is made by dissolving py-
roxylin in ether and alcohol. Four grams of pyroxylin with
75 Cc. ether are allowed to stand 15 minutes and then 25 Cc.
alcohol are added.
What is vinegar chemically? Describe the chemical
changes in the manufacture of vinegar.
Vinegar is a dilute (atmut 4 per cent.) solution of acetic
acid with traces of various vegetable extractives. It is pro-
duced by the oxidation of alcoholic liquors, wine, eider, etc.,
under the influence of the acetic acid ferment, mycoderma
aeeti.
CJl50II+02=IIC.H302+H20.
What is the chemical treatment of alimentary corrosion,
caused by mineral acids? Why should the stomach pump
be used carefully, if at all, in such cases?
The acid should be neutralized by weak alkalies, preferably
by magnesia, with the precaution that if carbonates are used
they must be given slowly and in dilute solution to avoid a
sudden evolution of gas. The stomach-pump must be used
only with greatest caution on account of danger of mechanic-
ally injuring the corroded membranes.
Give the chemical treatment of phosphorus poisoning.
Copper sulphate is the chemical antidote. An attempt is
182
CIlEMlsriiY.
made, also, to oxidize the phosphorus, using for this purpose
hydrogen dioxide, ozooe, old oil of turpentine, etc.
Give the formula and properties of methane and describe
its preparation.
Jlefhane, CH,, known also sa ni-areli gas, is produced in
nature by the decomposition of vegetable mattei" under water.
It is a light, colorless, odorless, tasteless, inflammable gas.
Burns with a bluish flame and forms an explosive mixture
with air. It may be prepared by heating a mixture of sodium
acetate, sodium hydroxide and lime. Representing the reac-
tion as taking place between the two sodium eouipounds we
have
NaC,H,0,+NaOH= CII,+Na,CO„.
What is an alkaloid? Mention an alkaloid of (a) bella-
donna, (b) cinchona, (c) hyoscyamus.
An alkaloid may be deacrrhed as an ni-ganic, nitragenous
substance, bajsie in clmraoter, capable of combining directly
with acids to form salt*.
(a) Atropine, {'b) quinine, (c) hyoscyamine.
Differentiate chemically cane-sugar and grape-sugar.
Cane sugar, Ci^IIaaOn, does not reduce Pehliug's solution;
with Trommer's test a blue solution is obtained, but there is
no reduction on boiling.
Grape sugar, C^HiaOj, readily reduces both Fehling's and
Trommer's solutions.
Give the symptoms, diagnostic features and treatment
of phosphorus poisoning.
Disagreeable taste, thirst., nausea, vomiting, purging, later
II jaundiced condition and hemorrhages; sometimes neupotic
symptoms, cramps, etc. A fatty degeneration of the organs
is produced. Vomited matter may he luminous in the dark.
Treatment. — Copper sulphate as emetic and chemical anti-
dole, magnesium sulphflt^. animal charcoal, dilute hydrogen
dioxide, old oil of turpentine.
CHEMISTBY, 183
Define alcohol. Give the approximate percentage of
alcohol in (a) light wines, (b) heavy wines, (c) beers, (d)
whisky, (e) brandy.
An alcohol may be defined as a compound of a hydrocarbon
radical with hydroxyl, e. g., ordinary alcohol, C2H5OH.
(a) 6 to 12 per cent., (b) 12 to 25 per cent., (c) average of
4 to 5 per cent., (d) 30 to 60 per cent., (e) 30 to 50 per cent.,
these percentages being all by volume.
In a thousand parts of human urine what will be the
average composition as to (a) water, (b) urea, (c) uric
acid, (d) organic matters, (e) chloride of sodium, (f) phos-
phoric acid, (g) potash and lime.
(a) In 1000 parts by weight of urine there will be about
980 parts water, (b) about 22 parts, (c) 0.4 part, (d) 25
parts, (e) 8 parts, (f) 2 parts (P2O5), (g) potash, 2 parts
(KjO), and lime, 0.2 part.
(The above is a most unusual form of stating urinary com-
position.)
How is chloroform (a) prepared, (b) purified, (c) tested
for impurities?
(a) Chlorofonn may be prepared by the action of bleaching
powder on alcohol, or on acetone, or by the action of an alkali
on chloral, (b) It is i)urified by shaking with water and then
with pure sulphuric acid; it is then agitated with lime and
with dry calcium chloride, and finally redistilled, (c) It should
yield no foreign odor on evaporation. Shaken with water,
the latter sliould be neutral to litmus, and should not be
afifected 'by addition of silver nitrate or of potassium iodide.
Shaken with one-tenth part strong sulphuric acid, the chloro-
form should remain colorless and the acid should not be more
than faintly colored.
What is the range of the specific gravity of normal
urine? State what diseased conditions produce (a) an ab-
184
CHEMIXTKY.
N
normally high specific gravity of the urine, (b) a low
specific gravity of the urine.
The specific gravity varies generally betweeu 1010 and 1030,
with an average of 1020.
(a) Dialjetos mellitiie, acute nephritis, fever, loss of waiter
by other excretions. (b) Interstitia! nephritis, uremia,
chronic parenchymatous nephritis, absorption of exudates, etc.
How is carbolic acid prepared? Give the treatment of
carbolic acid poisoning.
Carbolic acid or phenol is prepared from eoal-tar by frac-
tional distillation with subsequent purification, or it is pre-
pared synthetically from benzene.
Treatment.— Use stomach tube cautiously, chemical anti-
dotes are sodium sulphate, magnesium sulphate, dilute acetic
acid (vinegar), and st.n)ng alcoholic drinks. Keep body warm
and give stimulants.
Mention a secretion of the body that contains <a)
cholesterin, (b) pepsin, (c) trypsin, (d) casein, (e)
bilirubin.
(a) Bile, (b) gastric jtiice, (e) pancreatic juice, (d) milk
(caseinogen), (e) bile.
What reaction takes place when chloral hydrate is
mixed with an alkali? Illustrate.
Chloroform is produced.
Chloral. CCl,COI-I+NaOH^chloroform. CHCI.-j-sodium
formate. NaCOOIT.
Give the chemical reaction of (a) saliva, (b) gastric
Juice, (c) tears, (d) bile, (e) blood.
(a) Alkaline, (b) acid, (c) neutral, (d) alkaline, (e) alka-
line.
Give the chemistry of acetic acid; mention the most im-
portant acetates and give a method of preparing one ol
them.
Acetic acid, HCjHjO;, is prepared by the destructive dis-
CHEMISTHY. 185
tillatiou of wood and alsso bv the oxidation of alcohol. It is
a clear, colorless liquid with characteristic odor.
Important acetates are acetate of ammonium, iron and
ammonium, lead, potassium, sodium and zinc. Potassium
acetate is made by neutralizing acetic acid with potassium
carbonate.
Give the formula of (a) common (ethyl) alcohol, (b)
sulphuric ether, (c) acetic acid.
(a) aH,Oir. (b) (CJIJ^O. (e) IIC^H.A.
State the non-pathologic causes of abnormal deviations
in the urinary specific gravity.
The specific j?i'a\'ity may be increased above the normal
average by sleep, by exercise, by perspiration; it may be de-
creased by drinking of large quantities of liquids, by check-
ing of perspiration, by chilling the surface of the body, etc.
What are (a) albuminoids, (b) proteids? Give ex-
amples of each.
(a) Albuminoids are substances of modified proteid nature
charaeteristic of the supporting tissues of the body, e. g.,
ossein, chondrigen, elastin.
(b) The term pi-oteid is variously used (1) to signify the
entire class of earl)on, nitrogen, hydrogen, oxygen and sul-
phur compounds which on decomposition yield ammonium
compounds, amides, amido acids, etc., including the albumins
and globulins, the derived substances, peptone, etc., the com-
pound protein substances, mucin, hemoglobin, etc., and the
albuminoids. C2) It is sometimes used <to represent the albu-
mins and the derived and compound albumins, excluding the
albuminoids. (3) It is sometimes used to represent the com-
pound albumins alone, mucin, hemoglobin, etc.
Mention four alkaloids of opium.
Morphine, narcotine, papaverine and codeine.
What 18 the source of uric acid in the economy? Give
186 CHEMISri/y.
the formula and properties of urk acid and mention its
chemical tests.
Uric acid is derived in part irom the nueleins of the body
tissues and in part froin similar bodies taken in food. It
has the formula CsIIjNjOj, and, when pure, is a colorless,
crystalline, odorless, tasteless powder, very insoluble in oold
water or in most acids, in alcohol or in ether. Soluble in
sulphuric acid and in sohitiouK of many of tbe alkaline salts.
The mupexid test. — Moisten wi'th nitric acid, evajiorate to
dryness, moisten the residue with ammoninm hydroxide — a
purple-red color is obtained. The silver carbonate test, —
Render the urine alkailin-e with sodium carbonate, moisten a
filter paper wUh the liquid and touch the moist paper with
a glass ixkI caiTjing a di-op of silver nitrate, A gray stain
indicates presence of iiric acid.
How do human milk and cow's milk differ? What
chemical changes take place in milk when it is exposed to
atmospheric influences.
Huimiij milk contains rather less total solids, leas prot«ids,
moi-e sugar, and less salts than cow's milk. The fat is about
the same.
On exposure to air, bacteria are taken up by the milk, and
under the influence of the bacterium lactis lactose is changed
to lactic acid. This produces a separation of a precipitate
of caseinogen (curd). As a i-esult of further decomposition
the lactic acid is changed to butyrii' acid, which may be recog-
nized by its odor.
State the general composition of fats and give the chief
constituents of (a) tallow, <b) butter, (c) olive oil.
Fats are compounds of the radical glyceryl (CaHj) with
the higher acids of the first and second series of hydroearbons ;
most abundantly we find the glyceridee of palmitic, stearic
and oleic acids.
(a) Tallow is characterized chiefly by stearin, the glyoeride
of stearic acid; (b) butter is characterized by a. larger per-
w
CHEMISTRY. 187
centage of the glycerides of the more volatile acids, butyric,
caproic, caprylic, etc.; (c) olive oil is a glyceride of oleic and
palmitic acids with arachnidin and cholesterol.
Give the composition and properties of urea.
Urea, CO(NH2)2, is the chief nitrogenous excrement of
mammals. It is a crystalline substance very soluble in water,
less soluble in alcohol, insoluble in ether.
What is the usual composition of urinary calculi? Give
the test for recognizing the principal ingredient.
Uric acid and urates, calcium, magnesium and ammonium
phosphates, and calcium oxalate. Uric acid is frequently the
nucleus about which a calculus builds itself, and may there-
fore be regarded as **the principal ingredient.^' The test
for uric acid is the iriurexid test: Evaporate with a drop of
nitric acid and moisten the residue with ammonium hydroxide.
A purple- red color indicates uric acid (or urates).
What chemical reaction takes place when HjOs is ap-
plied to sloughing wounds?
It acts as an oxidizing agent, giving off an atom of nascent
oxygen which attaeks dead tissue, pus, etc. The decomposi-
tion of the hydrogen dioxide is accompanied by effervescence.
What is hemoglobin? Name some of its properties and
give a chemical test for it.
Hemoglobin is a compound of an iron-holding radical,
hemochroraogen (hema tin), with an albuminous radical, globin.
To it the blood owes its color. It combines readily with oxy-
gen, forming oxyhemoglobin, by which oxygen is carried to
the tissues. Various derivatives of hemoglobin may be pro-
duced by action of reducing agents, etc., and many of the
body pigments are derived therefrom. Hemoglobin may be
recognized by the guaiacum test : To the fluid add 3-4 drops
of freshly prepared tincture of guaiacum resin; float an
etherial solution of hydrogen dioxide on the surface of the
mixture — in presence of hemoglobin a blue color will develop.
188 CHEMISTRY.
Or the "hemin" test may be used: To a drop of blood on a
glass slide add a minute erj^tal of sodium chloride and two
drops of glacial acetic acid and heat slowly to boiling. Cool
and osamine under tlie microscope for crystals of hematiQ
hydrochloride.
When testing for albumin in urine, how do you deter-
mine between it and other coagulable proteids?
The only pix>teids coagulated by heat Hre albumin and
globulin; of these albumin is soluble in pure water; globulin
is not. Add the urine drop by drop to some clear water in
a test-tube; if globulin be present a cloud will form as each
drop sinks through the water. Globulin may be separated
from albumin by saturation with mairiiesium sulphate; glo-
bulin is precipitated, albumin is not.
When testing for glycosuria with Fehling's solution
how do you determine whether the reaction is that of
sugar or some other reducing agent?
By applying the fermentajtion test with yeast, the glucose
of diabetic urine ferments readily, while glycuponie acid aJid
other reducing substances wliieh may be present do not fer-
ment.
State the conditions favorable to crystallization.
That the molecules shall be free to move, as they ai'e when
the subslanee is in fluid condition. The substance is melted
and slowly cooled, or dissolved in a suitable solvent and then
slowly evaporated.
What temperature Fahrenheit is equivalent to a tem-
perature of 28 degrees centigrade? What temperature
centigrade is equivalent to a temperature of 120 degrees
Fahrenheit?
28 degi'ees C. X % = 50.4 plus 32 equals 82.4 Fahr.
120 degrees Pnbrenheit minus 32 equals 88 X °Ai equals
48.8 C.
CHEMISTRY, 189
Define atom, molecule.
The atom is the snmllest particle into which matter can be
divided.
A molecule is the smallest particle into which matter can
be divided without altering its characteristic properties.
Give the names of two elements or radicals in each of
the following groups:
Univalent. Bivalent. Trivalent. Quadrivalent.
Hydrogen. Cxygen. Boron Carbon.
Chlorine. Sulphate S(\. Aurum. Platinum.
Illustrate the comparative significance of the following
affixes: ous, ic, ite, ate, id.
An oxy-aeid of stable composition, or one of great import-
ance to arts and industries, takes the termination ic, as H.^S04,
sulphuric acid.
If an oxy-aeid of the same elements contains less oxygen in
its molecule it terminates in ous, as H0SO3, sulphurous acid.
The terminations ous and ic may be used also to distinguish
between different combinations (not acid) of the same ele-
ments, the ous indicating the lower valence (real or apparent)
of the positive element, e. g., ferrous sulphate, FoSO^; ferric
sulphate, Pe2( 864)3.
Salts formed' by replacing the hydrogen of an ic acid by a
metal or basic radical have their names terminating in ate,
as ZU8O4, zinc sulphate.
Salts formed by replacing the hydrogen- of an ous aeid have
their names ending in ite, as Na^SOa, sodium sulphite.
Salts of hydracids have the termination id (or ide).
Compare ozone with oxygen as to (a) occurrence, (b)
properties.
(a) Ozone is found in air only under exceptional circum-
stances, or in minute quantities.
Oxygen occurs in all atmospheric air in the proportion of
about 23 per cent, by weight.
(b) Ozone is a veiy energetic oxidizing agent, aeting like
CHEMISTRY.
nascent oxygen, and oxidizing subatancea that resist the action
of ordinary oxygen, as silver.
Ozone will not support respiration, acting as bji irritant to
respiratory memhranes.
Ozone supports coni'buetion more vigorously than oxygen.
State the characteristics of the following mineral
waters: Chalybeate waters, bitter waters, sulphur waters,
effervescent waters, cathartic waters.
A chalybeate water is a niinei-al water containing dissolved
salts of iron, usually basic carbonates. It has a slight tonic
action, but may occasion intestinal and stomach disturbance
from its irritant action.
Bitter waters may owe their bitter properties to Epsom
or Glauber's sails, held in solution, when they exert a laxa-
tive action ; or a natural water may be bitter from its contact
with vegetable substances, acquiring thereby tonic and stom-
achic properties.
Sulphur waters are those containing di^lved aJkaline sul-
phides, or poly-sulphides, or HjS. Such waters exert an
alterative and often slightly laxative effect, and have a certain
value in treating diseases of the skin. The greater value of
sulphur waters is found in their use for bathing, in chronic
cutaneous aifectious, in gout, in rheumatism.
Effervescent waters are such as are strongly charged with
CO. gas. Such waters are useful as sedative and slightly
stimulating beverages, e. g., thft use of plain soda water in
allaying vomiting.
Cathari:ic waters are such as contain cathartic or laxative
salts in solution, e. g.. Epsom salts, magnesium sulphate, and
(ilauber's salts, sodium sulphate. Their effeet is not only
that of a cathartic, they may assist elimination from other
channels, as kidneys, skin, etc.
What is the antidote for nitric acid poisoning?
Oxide of magnesium, commonly called calcined riiagneaia.
Alkaline carbonates, soap, albumin, oils.
CHEMISTRY, 191
Describe the preparation of iodide of potassium. Give
the reaction.
Saturate a strong solution of caustic potash in water with
iodine. Evaporate to dryness — a mixture of iodide and
iodate of potassium is formed, and when this is heated
strongly the iodaite of potassium parts with its oxygen. Dis-
solve the resultant mass in water, and from it will crystal-
lize, on evaporation, cubes of potassium iodide.
6KH0 + 3I2 = 5KI + KIO3 + 3H2O ;
Then 2KI08 + heat = 2KI + 30^.
Describe lithium as to (a) occurrence, (b) salts com-
monly used in medicine, (c) chemistry of its use in so-
called rheumatic affections.
(a) Lithium occurs in the mineral silieates and phosphates,
and as chloride and carbonate in mineral waters, (b) Salts
used in medicine:
Bromide of lithium LiBr Carbonate of lithium LijCOj
Benzoate of lithium LiC^HjO^ Citrate of lithium LisCjH^O,
Salicylate of lithium LiCfHgOj
( c) It is stated that 25 parts of carbonate of lithium will
dissolve one thousand parts uric acid at 100.4"^ Pahr. ; it is
administered, therefore, in gout to diminish deposits of uric
acid, and to dissolve uric acid calculi.
Mention the important physical, physiologic and chem-
ical properties of ptomains.
Ptomains are alkaloidal substances produced by the action
of bacteria on decomposing animal and vegetable matter.
They resemble the vegetable alkaloids in composition, and
in their tests, are bavsic in character, and like alkaloids may be
poisonous or non- poisonous.
In their poisonous action, after a period of incubation of
from two to six hours, there is produced severe gastro-intes-
tinal irritation with great prostration.
192
CHEMISTRY.
P
What are the chemical constituents of normal urine?
Give a test for the recognition of albumin in urine.
Chlorides of ealeiuin, magnesium, sodiumj potassium.
Phosphates of calcium, magnesium, sodium, potassium. Sul-
phates of sodium, potflssium and organic sulphates, indican,
eti!. Coloring mattei-s, int'ludin-g urobilin, urochrome, uro-
erythrin. Urea, urie acid (as urates), creatinine, hippuric
acid.
Boil the urine; if it becomes hazy, or a c-oagulum forms,
add a few drops of nitric acid, when, if the urine does not
become perfectly transparent, albumin is present.
State the principle underlying the use of antitoxins for
the prevention or cure of disease.
Antitoxins are found in the iblood serum of animals that
have recovered from an infectious disease, and when this
serum is injected into other animaJs, or man, it confers, on
its ahsorptiou. immunity from thai disease.
How may water be decomposed? Illustrate.
By passing a current of galvanic electricity through water,
when the hydrogen gas collects in Imhhles at the negative
electrode and the oxygen gas at the positive electrode; or by
passing steam or vaporous water through an inm pipe heated
to redness, when the hydrogen gas issues at the distal end
of the pipe and oxygen is ret^ained in ehemicaJ union with
the iron, coating the pipe with Fe,0,.
Detine and give examples of the three varieties of
attraction.
Attraction of gravitation i» the force operating between
masses of matter, e. g., the attractive force exerted between
sun and earth.
Heterogeneous attraction or adhesion refers to surface at-
traction of unlike substances ; thus water adhei-es to wood.
Homogeneous attraction or cohesion is the force uniting
like substances, and operates in the interior of the mass as
CHEMISTRY, 193
well as at the surface; thus cohesion aggregates the mole-
cules of water into visible drops.
How many grams are there in a hectogram? How
many scruples are contained in one pound?
One hundred grams equal one hectogram.
Two hundred and eighty-eight (288) scruples one pound
troy.
What is the test for the presence of silver, of mercury?
In solution: Silver with hydrochloric acid or Mrith soluble
chlorides yields a white precipitate, soluble in ammonium
hydroxide, insoluble in nitric acid.
Mercury as mercurosum, in solution, gives a white precipi-
tate wnth the same reagents, of mercurous chloride, not dis-
solving, but turned black on addition of ammonium hydroxide.
Mercury as mercuricum, gives no precipitate with hydro-
chloric acid, but gives a white precipitate Mrith ammonium
hydroxide and a scarlet precipitate with potassium iodide.
How much water vapor will be formed by the union of
500 cubic centimeters of hydrogen and 250 cubic centi-
meters of oxygen?
Five hundred cubic centimeters, at standard temperature
and pressure.
What is a graphic formula? Give live illustrations.
A graphic formula is one showing something of the manner
in which the atoms are joined- or arranged within the molecule.
H 0
I /
Acetic acid. H— C— C-O— II
H
H— O—H Water. H— S— H Hydrogen sulphide.
N
H
-H I
— H Ammonia. H C H Marsh gas.
— H I
H
13
CFIEMISTSf
Give the atomic weight, atomic volume, molecular
weight, molecular volume, and density of oxygen.
Atomic weight, 16 (15.88); atomic volume, 1; molecular
weight. 32; molecular volume. 2; specific gravity compared
with air, 1.1056; specific gravity, or density, compared with
hydrogen. 15. 8S.
Describe the preparation of sulphur and name the
oxides of sulphur.
Piepai-ed generally from the native crude sulphur found
in voleaiiie regions, by distilling from the non-volatile im-
purities.
The oxides are the dioxide, SOj. the trioxide, aO„, the ses-
quioxide. S;0,. and the peroxide. S„0,.
What is Marsh's test? Describe the appartus em-
ployed, and give the conduct of the experiment.
Test for detection of arsenic.
Through the stopper of a glass flask pass :
1. A safety funnel, tlie lower end reaching to lH>Itoin of
flask.
2. An outlet tu'be of glass. To this is to be fitted (a) a
tube bent at right angle, lower part dipping into a solution
of AgNO,,. (b) A tulK' bent at right angle so placed that
the far part of the tube, drawn out to a jet, shall point
upwards.
Test: Place chemically pure zinc in flask, cover with dilute
sulphuric acid, C. P., in such quantity as will come above
lower end of safety funnel.
Hydrogen gas is evolved. Allow gas to pass from the out-
let tube, to which attach tube (a), the lower end of which ia
immersed in nitrate of silver solution.
Heat the outlet tube at a point between flask and silver
solution. At expiration of half hour should there be no brown
or grHv-black stain found on outlet tube where heated, or no
precipitate (blackl found in silver solution, and no yellow
precipitate fornu-d wlicii to a little of silver solution is added
CHEMISTRY, 195
ammonium hydroxide, the zinc and acid used are free from
arsenic.
Pour into safety funnel the solution suspected to contain
arsenic, when, should arsenic be present, a black stain forms
on outlet tube, a black precipitate appears in silver solution,
and this solution yields yellow precipitate of arsenite of silver
when to it we add ammonium hydroxide.
Now substitute tube (b) for tube (a) ; ignite the gas, a
whitish flame appears ; if much arsenic, a garlic odor or white
halo surrounds flame.
Hold cold white surface, as piece of porcelain, in flame — a
brown or black stain of metallic character readily dissolvinig
in solution of chlorinated lime or chlorinated soda, indicates
presence of arsenic.
What is defiant gas? Name some of its properties.
defiant gas, or ethylene, CgH^, heavy carburetted hydrogen.
A colorless gas, feeble ethereal, slightly pungent odor, den-
sity 14 compared with hydrogen. Almost insoluble in water.
Can be liquefied, and is then used to produce low tempera-
ture on its evaporation. Is inflammable, burning in air with
brilliant flame, forms an explosive mixture with air or oxygen.
It is largely to the presence of this gas that illuminating gas
yields light.
What is meant by the destructive distillation of wood,
and what are some of the principal products of such a
process?
Heating wood in a retort in absence of air and collecting
and cooling resultant vapors.
Methyl alcohol, pyroligneous acid, acetic acid, creosote,
carbolic acid, etc.
Name and differentiate the three classes of sugars.
Monosaccharids or glucoses, with the formula, CellijOe;
disaccharids or sucroses, C^aHaoO,, ; polysaccharids or amy-
loses, (CoHioO-)". Chemically the glucoses are aldehydes
ire anhydrides of the
CHEMisruy.
and ketones, the anayloses and suci'oses
glucoses.
What is acetous fermentation?
Brought about by presence of the iiiycodeiiiia aceti, it
causes the souring of alcoholic liquors. It practically con-
sisla in the oxidation of alcohol, producing acetic acid.
C,H,OH + 0,, = CJI.O, + 11,0.
How are chlorides chemically recognized in urinalysis?
By their yielding a white precipitate of chloride of silver
on the addition of a solution of silver nitrate to the urine
after acidifying with nitric acid.
Complete the following equation and write the name
of each resulting compound under its formula:
C,HC1,,0 + NaOH =
(yK.UjO + NallO^UHClj + NaL'llO,
Chloral. ( 'lilcirornrni Mxliiim TurniBli!.
Pb(NO,,), + K,CrO.=
Pb(NO.), + K,CrO, = PbCW, + 2KN0,
Lead cliriiiiiatu potaaBium nitralv.
Describe two experiments showing the difference be-
tween chemical and mechanical action.
Mix 32 grains sniphur and 5fi grains iron filings; a magnet
will remove all of the iron, or carbon disnlphide will dis-
solve? all of the sulphur. This mixing of sulphur and iron is a
mechanical act. in which iron and sulphur still preserve their
properties. Apply heat to such a mixture; a temperature
much higher than the degree of heat applied will develop, due
to chemical union of sulphur and iron, and a magnet will no
longer attra<?t the iron, nor will carbon disulphide have solvent
action. This is a chemical action resulting in formation of
a new substance, iron sulphide, in which the properties of iron
and sulphur no longer exist.
Dissolve sugar in water. No heat is evolved ; each drop of
water shows charficteristic sweetness of sugar; has been no
CHEMISTRY, 197
chemical change, but a physical or mechanical one. Dissolve
sugar in sulphuric acid, obtain black liquid containing no
characteristic sweetness ; sugar has entirely disappeared. This
experiment is an illustration of chemical action.
If potassium be thrown on water, what is the name and
formula of the resulting compound?
Potassium hydroxide, KOH.
What are the general methods by which crystals may
be obtained?
Evaporation from solution, solidifidation after fusion, and
by sublimation.
Discuss arsenic and mention its properties, uses and
compounds.
Arsenic, symbol As, atomic weight 74.4, valence III., V.,
found in nature chiefly as sulphide, associated with the sul-
phides of zinc, iron, bismuth, etc. The metal is steel-gray,
generally crystalline, with a metallic lustre. Used in pyro-
techny, in making shot, and in pigments.
Forms a compound with hydrogen, AsHa, a very poisonous
gas. With oxygen it forms the trioxide, AS2O3, and the
pentoxide, AsgOg, the first named being the most important
compound, often receiving the name of arsenic. It occurs in
a heavy white powder, or transparent vitreous, or opaque,
porcelain- like masses slightly soluble in water.
Other compounds recognized by the pharmacopoeia are the
iodide, sodium arsenate, and potassium arsenite, the latter
being a constituent of Fowler's solution.
The arsenical compounds are used as alterative tonics in
phthisis, malarial cachexia, cancer pastes, skin diseases, in
dentistry, etc.
What is an anesthetic?
A substance used to pnxluce partial or complete uncon-
sciousness, and thus allay pain of operative procedures and
produce muscular relaxation.
198
cHsms
How much water would be required to yield loo grams
of hydrogen?
Nine huiiLlrerl grams iii' wat<?r would yield 1(10 grains hy-
drogen.
Compare the physical properties of chlorine, bromine,
iodine and fluorine.
('Idoriii*?, a heavy grt'en gas; bromine, a heavy dark red
volatile liquid; iodine, scaJe-like blue-black volatile solid;
fluorine, a light yellow practically oolorlesa gas.
All dissolve in watec in varying degrees. Bromine yields
orange-colored vajjor; iodine, violet vapor.
Define evaporation, filtration.
Kvaporation is the conversion of a volatile liquid into a
vapor. This proeese takes place at all temperatures.
Filtration is the act of passing a liquid through a porous
material, the soHd suspcmh'd matters being relaiued.
Name the constituents of the atmosphere. Give the
composition by weight and by volume.
Weight. Volume.
Oxygen 23 20.93
Nitrogen 77 79.07
Water vapor, .5 bo 1.4. Carbon dioxide. .04.
Traces of ammondft and other nitrogen compounds.
Several rare gases, argon, etc., of whieh bul little is known.
Name bodily conditions effecting an increase in the
elimination of urine and also those producing a decrease.
In health urine is increased in amount where from any
cause the perspiratory function or alvine discharges are less-
ened, as from chill of tie surfaice, cold bathing, etc. The
ingestion of much fluid, as drink or watery fooila. In health
urine is decreased by escessive perspiration, diarrhwa, etc.
In disease urine ia increased in diabetes mellitus, in chronic
inflamniation of kidneys, etc. Often si crisis of a severe dis-
ease, in hysteria and in other nervous disorders. In disease
CHEMISTRY, 199
urine is decreased when by high fever, in acute inflammation
of kidneys, and in severe infectious diseases.
Name three common kinds of spirituous liquors and de-
scribe their manufacture.
Spirituous liquors are divided into three classes, (a) dis-
tilled, including whisky, brandy, etc.; (b) ferra*?nted, includ-
ing wines; and (c) malt liquors, including the beers.
The distilled spirits are made by distilling fermented
liquors; brandy from wine, whisky from corn or rye or other
grain, rum from molasses, etc. The wines are made by fer-
menting grape and other fruit juices. The beers are made
by fermenting an infusion of malted barley and hops.
Give the chemistry of photography.
A plate is prepared with an emulsion of a silver salt in
gelatine, and on exposure to light this silver salt undergoes
reduction. After exposure the plate is tivated with a **de-
veloper*' by which the reduced silver salt is still further re-
duced, to the metal, and the remaining silver salt is then re-
moved by washing in a solution- of sodium hyposulphite.
From this negative placed upon a paper prepared in much
the same manner as the plate the prints are obtained.
Complete the following equations and write the name
of each resulting compound under its formula:
Ca(()ll), + (X),= CaCOa + 11,0
Calcium carbonate water.
Na(y I,(), + NaOlI = CII, + NaXOa
Marsh gas sodium carbonate.
What is meant by atomic weight?
The atomic weight of an element is the relative weight of
its atom as compared with the weight of an atom of hydrogen.
Explain the difference between a solid and a liquid.
In a solid cohesion binds the molecules so closely together
that they have no freedom of movement; the substance pre-
serves a fixed form.
200 CHEMISTRY.
A Hqnid has its molecules less tightly bound together, so
that they may flow readily. Cohesion and repellent force
are about equal. A liquid has no fixed form, save thait of the
CODtaimng vessel.
What is a gas?
The molecules making up a gas are self- repellent, each
molecule striving to pass as far from its neighbors as possible.
The repellent force of heat has overcome the force of cohesion.
What is water chemically considered?
[ Water is the monoxide of hydrf^en. Its eompoaition by
weight, 18 pounds of water contains 2 pounds of hydrogen
and 16 pounds of oxygen. By volume two quarts of water
vapor contain two quarts of hydrogen and one quart of
oxygen. Water may act as an electro- positive or basic body,
as in its union witi SOj. to form HjSOj. Or it may act as an
electro- negative or acidulous hmly, as in its union with KjO.
to form 2KII0.
How would you determine the specific gravity of a
liquid?
Use a hydrometer: An instrument of glass, cylindrical in
shape, weighted below, and terminating above in an upright
stem, upon which are engraved lines indicating degrees.
Place this instmment an the liquid to be examined, and
note to which mark or degree the instrument sinks. This
degree denotes the specific gravity of the liquid compared
with water.
What is organic chemistry?
The chemistry of the hydrocarbons and their derivatives.
What is the purpose of litmus paper in urinalysis?
For determining if the urine be acid, alkaline or neutral
in reaction, also whether the acidity be marked or slight, and
whether the alkalinity be of fixed or volatile character.
How is excess of uric acid shown in the urine?
By a ring of whitish color forming a1x>ve the point of oon-
^
CHEMISTRY. 201
taot in the urine when urine is floated on nitric acid in a
test-tube; such ring disappeai-s when gently lieated.
What effect is produced in mixing air with a blast flame
as practiced with an ordinary blow-pipe?
The air so dilutes the gas as to bring every particle of the
gas in complete contact with the oxygen of the air, thus occa-
sioning perfect and complete combustion of the gas. The air
also directs the flame to a desired point.
What metaUic element is constantly present in the coN
oring matter of the blood?
Iron.
Explain the process of combustion.
Combustion is chemical union taking place between two or
more substances, accompanied by the evolution of heat and
light.
Name the lightest of all known elements.
Hydrogen.
Give the symbols of antimony, silver, gold, iron and
zinc.
Antimony, Sb ; silver, Ag ; gold, Au ; iron, Fe ; zinc, Zn.
How would you prepare hydrogen?
Place zinc in a flask provided with a safety funnel, the
lower end of which reaches to the 'bottom of the flask.
Through a second opening in the stopper of the flask
pass an exit tube, the lower end of which just enters the
flask. Then pour into the flask through the funnel dilute
sulphuric acid. Hydrogen gas is formed, and escapes through
the exit tube.
What acid contains chlorine as an important element?
Hydrochloric acid, HCl.
How does wine differ chemically from brandy?
Wine contains from 6 per cent, to 25 per cent, of alcohol ;
202 CHEMISTRY.
brandy from 30 per cent, to 50 per ceot. Wine is a product
of fermentation of fruit juices; brandy results from distill-
ing the fermented product of fruit juioes. Wine contains a
mimt)er of compound volatile ethers that are not present in
brandy.
What is the substance (or substances) from which ortfi-
nary alcohol is derived?
Potato starch and L;riiiiis.
What element constitutes four-fifths of the air?
Nitrogen.
Explain the principle of the Bunsen burner.
The Bunsen burner is supplied near its base with aper-
tui'es for the ready admission of air and its mixture with the
gflB. Each particle of gas is thus supplied with sufBcient
air to obtain perfect combustion.
What is the essential element of all acids?
Hydrofjen.
Name three elements in the potassium group.
Pdtnssium, s.Hliuni, lithium.
Is sulphurous acid a solid, a liquid or a gas at ordinary
temperature? / <
It is a liquid i-esulting when SO, is dissolved in water.
What is albumin?
It is a eiimplex, eoUoi'dal, proteid body composed of H, C,
0, N, and S, oceurriug in both vegetable and animal struct-
ures.
Name the principal sources of bromine.
Natural mineral waters containing magnesiuni bromide in
solution, and sea water.
Give the name and formula of a compound of sulphur
and hydrogen.
Ilydrfij^en sulphide, HjS.
CHEMISTRY, 203
What is the meaning of the sesqui in chemical nomen-
clature?
It means one and a half, and refers to the ratio between
combining elements. Example: PejOg, sesqui-oxide of iron.
Where does potassium occur?
In rocks, soil, etc., in form of silicates, and in sea water, etc.,
in form of chlorides and sulphates.
Define and give an example of each of the following:
(a) Binary compound, (b) acid, (c) hydrate, (d) salt.
(a) A eonii)ound containing two elements, as AgCl. (b)
An acid is a salt of hydrojren ; it has a sour taste, turns lit-
mus red, has corrosive action, when concentrated, upon tis-
sues, unites with and neutralizes bases, forming salts and
water. Example, nitric acid, HNO3. (c) A hydrate is a com-
pound of a metal or basic radical with hydroxyl, OH. Ex-
ample, potassium hydrate, KOIl. (d) A salt is a substance
formed by the replacement of all or part of the hydrogen of
an acid by a metal or basic radical. Example, potassium
sulphate, K2SO4.
What are the laws governing combination of elements?
1. All chemical compounds are definite in their composi-
tion ; the ratio of the elements forming them is constant.
2. If one element unites with another in more than one
proportion, such proportions will be multiples or submultiples
of each other.
3. The proportion by weight in which any two elements
will unite with a third element represents that proportion in
which they would unite with each other if they could so
combine.
What is a chemical reagent?
A substance having an active chemical effect upon other
chemical substances. A substance which by its contact with
another substance creates new compounds.
1 the name.
VHEMIi^TRY.
Mention a pentad element and explai
Nitrogen.
A pentad element is one the atom of which requires five
rnouad atoms to fully satisfy its capacity for chemical union.
Explain the terms (a) amorphous, (b) alkali, (c) water
of crystallization, (d) nascent state.
(a) Amorphous means without form, non-erystalliue. (b)
Alkali, a body possessing the strongest of basic or electro-
positive properties, usually referring toosides and hydroxides
of alkali metals or metals of the alkaline earths, (c) Water
of crystallization is water necessary to the crystal form, (d)
Nascent stale, or newly born, refers to matter in its atomic
form, or before the individual atoms freed from a compound
have united to form molecules.
What are the properties and uses of glucose?
A white or yellowish- white, sweetish substance, freely sol-
uble in water, possessing not quite the sweetening power of
CBne-sugar. Glucose is found in fniits, in honey, and in
small amount in the various fluids of the body. It is made
from cornstarch by treatment with dilute aoids. It has food
value and is used as a substitute for cane-sugar.
What is the difference between nitric oxide (NO) and
air?
Nitric oxide is a compound of nilrogen and oxygen, air is
a mixture of the same elements.
Qive equation for the production of ammonia from am«
montum chloride and calcium hydroxide.
2NH,C1 + Ca(0H)„ = 2Nn, + 2H,0 + CaCL.
How was salicylic acid originally derived? How is it
now manufactured? What are its properties?
It was originally obtained from oil of gaultheria. It is now
manufactured by passing CO.j into a heated retort containing
sodium oarbolate, C:,H,0Na+CO5=C„H,(0H)CO.ONa. and
decomposing this sodium salt with HCl.
CHEMISTRY. 205
It occurs in fine white needle-shaped crystals, permanent in
air, of sweetish taste, acid reaction, soluble in 450 parts of
cold water, soluble in 2 parts alcohol; solution produces in-
tense violet color with ferric sal<ts.
Used as a food preservative, is antiseptic and antirheumatic.
Describe the method of preparing H by the action of Na
on H^O. Write the formula for the reaction and find how
many grams of H 82 grams of Na would make by this
process. (The atomic weight of H is i, of O 16, of Na 23.)
Place a piece of clean-scraped sodium in a combustion
spoon and cover it with a cage of gauze wire to hold it in
place. Fill a cylindrical glass jar completely full of water
and invert mouth down in the pneumatic trough.
Plunge combustion spoon containing Na quickly under
water, below the mouth of the glass jar; the Na at once de-
composes water, and bubbles of hydrogen gas rise in the jar.
Na + II2O = NaOH + H
23 + 18 = 40 + 1
23 grams of Na = 1 gram II
23 :1 ::82 :Z = 3.565 + of H.
Give a brief description of three experiments illustrat-
ing the properties of oxygen.
Plunge a smouldering piece of charcoal in a jar of oxygen
and the charcoal kindles, burning brilliantly.
Heat a watch spring at one end until red-hot, then plunge
into jar of oxygen, and the steel spring burns with great
brilliancy.
Place a piece of phosphorus in a test-tube, cover it with
water, warm slightly, and then by means of a long glass tube
direct a jet of oxygen upon the phosphorus; the latter will
catch fire, burning beneath the surface of the water.
What is the source of phenacetin?
It is an anilid, made from anilin, a product of coal-tar.
206 CHEMISTRY.
Give the occurrence in nature of phosphorus; of chlorine.
PliosphoruB ooeurs in nature as phosphate of caleimn in
the mineral apatite, and as phosphate of oaJciiim and of mag-
nesium in bones. Chlorine occurs in nature chemically com-
bined witJi metals, as NaCI, AgCl, etc. As NaCl it is found
in sea water, river waiter, and in most natural waters, in
mineral deposits, as ixick salt, and in the tissues and fluids of
animals and plants.
What are the chemical names of (a) borax. (b> marble,
(c) blue vitriol?
(a) Sodium tetra-borate, or wwiiuni pyi-o-horat-e. (b) Cal-
cium carbonato. Ic) Copper sulphate.
Define positive element, negative element. Illustrate
each.
A positive element is one which, on the decomposition of
a compound by electr'olysis, *vill go to tlie negative electrode,
A negative element ie one which, on the decomposition of
a compound by electrolysis will go to the positive electrode.
Ii-on. gold and hydrogen are podtive elements. Oxygren,
sulphur and ehlorine an' nosative elements.
Mention the halogens and state in what respects they
exhibit marked similarity.
Chlorine, bromine, iodine, fluorine.
All are monads, all electro- negative, all form hydrogen
acids, all possess bleaching or disinfect&nt action, all combine
with metals. Except fluorine, all form oxy-acids and oxy-
salts.
Mention the properties of hydrogen.
Hydrogen, symbol II. ntomic weig;ht 1, valence I, is a color-
less, ndorless, tasteless tias. The lightest of the well-known
elements. Practically insoluble in water, bums with a color-
less flame, yielding more heat in its burning than any equal
weight of any other substance. In its combustion in air it
forms water. Mixtures of hydrogen with oxygen or air ex-
plode when ignited.
CHEMISTRY. 207
Hydrogen is not poisonous, but will not support combus-
tion nor respiration. It is electro-positive. When liquefied
it forms a steel-blue liquid that is opaque to the passage of
light. It is used as a standard for many scientific deter-
minations.
State (a) the normal specific gravity of urine, (b) the
causes of abnormal deviations in the specific gravity of
urine.
(a) From 1018 to 1025. (b) Specific gravity is lowered in
polyuria, as of diabetes insipidus in chronic interstitial neph-
ritis. In certain nervous disorders, as hysteria, chorea, etc.
Specific gravity is a:bove 1025 in diabetes mellitus, in acute
inflammation of kidney, in certain crises in the eoui'se of
chronic nephritis accompanied by partial suppression of urine.
In certain disorders of digestion. In febrile affections.
Mention the principal chemical constituents of bile.
Waiter, nuicus and pigment, glycocholate of sodium, tau-
rocholate of sodium, soaps, fat, lecithin, cholesterin.
State the properties of aluminum and mention its im-
portant salts.
A silvery-white metal, sp. gr. 2.67, hard, ductile, malleable,
only superficially acted upon on exposure to air, soluble in
hydrochloric acid and in alkalies. The official compounds
are the hydix)xide, sulphate and the double sulphate of potas-
sium and aluminum.
Give the properties of two important compounds of zinc
used medicinally.
Zinc sulphate, ZnS04, a white granular crystalline powder,
used as an as-tringent, soluble in water and used in watery
solution for local application. Internally, is used as an
emetic, and in diarrhiea, etc. Zinc oxide, a yellowish- white
powder, insoluble in water, odorless and tameless, used in
dyspepsia, night sweats, epilepsy, chorea, nnd, externally,
in ointment form.
f.AfJELIBR/^'^v STANFORD UWWakCii,;^
208 CHEMISTRY.
Give in detail two tests for ascertaining the presence of
albumin in the urine.
A long test-tube is three-quarters filled with filtered urine,
and the upper portion la heated to boiling. If a cloud or
precipitate appears, add a few dj-ops of nitric aeid — phoe-
pbates will dissolve and aJiy cloudiness remaining will be
due to albumin.
Place a 10 per cent, solution of ferrocyanide of potassium
in a teat4ube and add to it half ita volmne of acetic acid;
mis well. Then run down the side of the tube the suspected
urine so that it floats upon the reagent without mixing. If
albumen is preseut there will be impairment in transparency
of the liquids, or even an evident precipitation if much albu-
min be present.
What are compound ethers? Give an example.
Compound ethers are salts of hydrocarbon radicals, e. g.,
amyl nitrite, C^HnNO,.
What is glycerin?
Glycerin, CjIIjCOH),, a triatomie aloohol obtained by de-
composition of the fats, is a bland, heavy liquid of a charac-
teristic sweetish taste, with a marked attraction for water
and great solvent powers, particularly for oils, and for many
drug substances.
State the preparation, appearance, formula and uses of
acetic acid.
Acetic acid, HCjHjO,, may be obtained by destructive dis-
tillation of wood, being separated and purified from the
impure product, pyroligneous acid.
It is a coiorlesB liquid of strong, characteristic pungent
odor and a sour or corrosive taste and action. In concen-
trated form it crystallizes at about 60 degrees F. It is used
for softening and removing callous tissues, as a diwnfectant,
and in preparations of its salts.
CHEMISTRY, 209
What chemical changes take place in the body after
death?
The fats undergo gradual deoompoeition ; oxidation of
various tissues takes place, sulphuretfted hydrogen is pro-
duced. Phosphorus leaves its chemical combinations in bone
and other tissue to combine with hydrogen, forming PH,.
Nitrogen unites with hydrogen to form NHg. In general
the complex body substances, proteids, etc., split up into
simpler compounds.
Define base, basic radical, isomerism.
A base is the oxide or hydroxide of a metal or basic radical.
It is a substance which in solution will neutralize an acid
to form salt and water.
A basic radical is an atom, or an unsaturated group of
atoms, having an electro- positive condition and an action
similar to that of a base.
Isomerism is that property, due to the atomic arrangement,
by virtue of which chemical compounds may be composed
of the same elements in the same percentage proportion by
weight yet be different and distinct substances having dif-
ferent properties.
State the normal reaction of urine. How is the reaction
noted? To what is it due?
Reaction acid. By use of litmus paper, which should turn
red when moistened with urine. Acidity due chiefly to pres-
ence of acid phosphate of sodium.
Define qualitative analysis, quantitative analysis. Illus-
trate each.
Qualitative analysis seeks to know ivhat substances are
present in a compound or mixture. Quantitative analysis
seeks to know how mivch of a substance is present. We test
qualitatively to see if there is any albumin in a sample of
urine ; we test quantitatively to find out how much albumin
is present.
14
CHEMISTRY.
Describe the chemical process for the preparation of
alcohol. What percentage of alcohol is found in (a) beer,
(b) wine, (c) whiskey, (d) brandy?
8tarch is eoiivertj?d into dextrose, and this is then changed
by the action of yeast into alcohol and carbon dioxide.
20 JI,„0,., + H,0 = C„H.,0, + C,H,„Oj
SWrch Dei t rose Dextrin
C«H,sO„ + yeast = 2C,H,0H + 2C0,.
(a) About 5 per cent., (b) 6-25 per cent., (c) 30-60 per
cent., (d) 30-50 per cent.
Describe two tests for glucose.
Ciliieose in solution, if boiled with an alkaline cupric hy-
drate sohitioD, reduces the copper salt to the red sub-oxide
of copper, forming a precipitate.
Glucose in solution placed in the polarizing saccharimeter
bends the rays of light towards the right.
What are peptones and how are they produced?
Peptones are dialywuble, feebly acid, proteid products
formed by the action of the digestive ferments upon albu-
minous l>odi€s. They are very soluble in water, and are
insoluble in alcohol and ether.
How do globulins differ from albumins?
GlubulinH are insoluble in water, albumins are soluble,
(ilobulins are precipitated 'by saturated solutions of NaCl,
albumins are not.
Complete the equation: NaC,H,0, + NaOH^.
NnrjIJ)^ + XaOn = CH. + \a/'0,.
Explain the nomenclature of binary compounds. Which
element is to be placed first, and how is the termination
of the second to be altered?
Binary com[>oun(ls ace those composed of two elements.
The L-k-L'tro-posilive or metallic element is named first, the
name of the second element terminating in "ide." Exam-
ples: Ag,S, silver sulphide; NaCl, sodium chloride.
CHEMISTRY. 211
Binary acids, HGl, HBr, etc., have the prefix, '* hydro,"
and the suffix, **ic/'
Define anhydride, latent heat, gravitation.
An anhydride is a substance minus water; the name is
applied most frequently to acidulous oxides thart; are capable
of combining chemically with water to form acids, as SOj,
sulphuric anhydride; NjOg, nitric anhydride.
Latent heat is heat not manifesting itself as temperature;
it is the equivalent of the energy used up in overcoming mole-
cular attraction.
Gravitation is the force of attraction 'between masses of
matter.
Describe methods for determining atomic weights.
1. Determine the specific gravity of the element when in
the gaseous state compared with hydrogen.
2. The product of the atomic weight multiplied by the
specific heat being 6.4, divide 6.4 by the ascertained specific
heat of the element.
3. Note the weight of an element required to take the place
of a given weight of hydrogen in forming a replacement or
substitution compound. Thus acetic acid is HCjHgOj, and
practical demonstration shows that one grain of hydrogen in
acetic acid may be replaced by 108 grains of silver to form
silver acetate, AgCgHgOa; hence one equivalent of silver
weighs 108 times that of hydrogen, or one atom of silver
weighs 108 compared to the weight of one atom of hydrogen.
Explain the difference between metals and non-metals.
Metals are electro-positive and combine with oxygen to
form basic oxides. Non-metals are electro-negative and com-
bine with oxygen to form acid oxides.
Explain the process of manufacturing sulphuric acid on
a large scale.
Sulphur or a sulphide is burned in a plentiful supply of
air, and the resulting sulphur dioxide gas, SOg, is carried
212
VlIEMli^TUY.
into a. aeries of leadeu-lined chaiubera along with vapor of
nitric acid and steam. The sulphur dioxide becomes osidized
to sulphur trioxide (SOJ through the action of the nitric
acid vapor and combines chemically with the wat«r (steam)
to form sulphuric acid. lUSO^.
State the symbol, valence anJ atomic weight of phos-
phorus.
Sym'bol. 1'; valeacy, HI. and V, Atomic weight, 31.0
(30.77).
What is glycogsn? From what is it derived?
(riycoi.'en !(-'uH|,iOfl)„i *"■ carbohydrate of the amylose series,
resembles starch, forms opalescent solution In cold water;
derived chiefly from the carbohydrates of the food, formed
in liver and other body cells.
Give and explain (a) an empiric formula, (b) a rational
formula.
(a) Tile simplest possible expi-ession by formula of the com-
position of a compound, giving the kind of elements present
and the proportionate number of atoms, thus CHjO is an
empiric formula for acetic acid.
(b) A rational formnla. shows the manner in which the
different atoms or radicals combine in order to make one
molecule of the body, thus (..'ni,('0,0]I, in a rational formula
for acetic acid.
What is the chemical antidote for poisoning from lead
acetate? Explain the chemical action of this antidote.
A soluble sulphate, as magnesium sulphate (Epsom salts),
which in contact with acetate of lead foi'ms an insoluble sul-
phate of lead.
Pb(CJI,OJ, -t- MgSO, = PbSO, + Mg(C„H,0,),.
CHEMISTRY, 213
Complete the following equations and give the names
of the resulting compounds:
HgS0, + Hg + 2NaCl =
PeS04 + 2NaHC03 =
IlgSO, + Hg + 2NaCl = HgXL (or 2HgCl) + Na^SO^
Calomel Sodium sulphate
FeSO, + 2NaUC03 = FeCOj + HoO + Na^SO^ + CO^
Ferrous water Sodium carbon
carbonate sulphate dioxide
Define chemical action, physical action. Give exantples
of each.
Chemical action takes place in the interior of the mole-
cule. It is accompanied by the development of heat. When
cheniioal action occurs the identity of the bodies entering
into chemical action is lost, and new substances are produced.
Chemical action takes place between definite weights of the
substances.
Physical action takes place outside of the molecule. It is
not necessarily accompanied by the evolution of heat. The
substances do not lose their identity. Any quantities of the
substances may undergo phj'sical action. Examples: Chera-
ical action, add IICl to marble dust, forming a gas, carbon
dioxide, water and chloride of calcium. Physical action, add-
ing water to sugar we do not lose the characteristic properties
of the w^ater or of the sugar.
State the chemical changes produced within a galvanic
cell while in action.
Cell eomposetl of zinc and copper with dilute sulphuric
acid. The aeid dissolves zinc, forming a solution of zinc sul-
phate. The hydrogen of the aeid is given off in bubbles,
from the copper. Thius the strength of acid is constantly
lessened thi-ough its decomixwiticm and the formation of
sulphate of zinc, until finally all acidity will have disap-
peared from the battery fluid.
n
214 CHhMlSTRY.
Define distillation, sublimation, destructive distillation.
Give examples of each process.
Distillation consists in -the passing of a. liquid into a vapor-
ous wjodition when heated to its boiling point-, and the sub-
sequent condensation of this vapor again to the liqtiid form
on cooling the vapor. Example: Distillation of water.
Sublimation is the passage of a solid into a vapor on being
lieated', and the condensation of that vapor again to the solid
form on cooling without the substance having undergone
decomposition. Example: Subliming iodine, thus obtain-
ing it pure. Destructive distillation is a. form of dis-
tillation in which the original substance in the retort is de-
stroyed, and from the vapors arising new substances are col-
lected. Example: By the destructive distillation of wood we
obtain creosot*;, pyroHgneous acid. etc.
What are the constituents of common illuminating gas?
How is it prepared? Why is it poisonous?
Marah gas. CHj, oleliant pas. C'JI,. acetylene gas, OjHj,
carbon monoxide, carbon dioxide, hydrogen, and traces of
nitrogen, and sulphur compounds. It is prepared by the
destruetive distillation of bituminous coal. Its poisonous
effects are largeJy due to carbon monoxide present.
Illununating gas is also made by the water gas process,
passing air and steam over highly heated carbon, and subse-
quently enriching by mixing with naphtha vapors.
Describe the preparation and appearance of flowers of
sulphur, roll sulphur, precipitated sulphur.
Flowers of sulphur, prepared by subliming stilphur and
cooling the vapor. It is yellow in color, and examined by the
microscope shows rounded globular masses.
Roll sulphur, of yellow color, in sticks about two feet in
length and two inches in diameter. Obtained by pouring
melted sulphur into wooden moulds.
Precipitated sulphur, a white or greenish- while powder,
is prepared by boiling together sulphur and lime and then
CHEMISTRY, 215
decomposing the compound produced by the addition of
hydrochloric acid.
Mention the substances used for disinfection after the
prevalence of conta^ous disease and explain their action.
Sulphur burned, forming SO2, which acts as a ddsinfectant
through its dehydrating effect upon germ life.
Chlorinated lime in presence of acid and by action of the
atmospheric carbon dioxide liberates chlorine gas, and this
latter, combining chemically with hydrogen of moisture, sets
oxygen free; the oxygen then acts destructively upon disease
germs.
Formaldehyde, in solution or as gas, acts as a direct germi-
cide, as do also phenol, mercuric chloride, etc.
What percentage of COo exists normally in the atmos-
phere? What percentage CO2 is dangerous to life?
Atmospheric air contains .04 per cent, by volume of CO,.
A greater percentage of COo than 3.0 per cent, by volume
would be dangerous to life if the COj were accompanied by
impurities from animal respiration. Ten per cent, of COj
in air will prove poisonous, although unaccompanied by re-
epira/tory impurities.
State the properties of nitric acid.
Nitric acid, HNO.^, specific gravity of strong acid, 1.4,
colorless liquid, fuming in air, highly corrosive, stains upon
tissues or fabrics, not discharged by the use of ammonium
hydroxide. It turns litmus red, Avill dissolve most of the
metals, parts readily with its oxygen, forming nitrous acid.
Define and describe sugars. How do glucoses differ
from saccharoses? What kind of sugar is found in dia-
betic urine?
Sugars are organic compounds called carbohydrates; all
consist of C, H, and 0, with six, or a multiple of six, atoms
of carbon and twice as many II atoms as 0 atoms. They
occur in vegetable and animal structures. Glucoses are repre-
216
CHEMISTHY.
s
f
eented by the formula C^lit^Q^ ; they reduce cupric hydrate
to the red cuprous oxide. They crystallize with difficulty;
they are less sweet than cane-sugar.
Saeeharoeea, formula Cj^IIijOn, include the true sugars,
cane-sugar. lactose, maltose. They niay be reg^arded as anhy-
drides of the ghicosee. They readily eiystalH/e, and possess
maximum sBceharin effect.
Ghicoee is found in diabetic nrine.
Give the chemical name and properties of (a) calomel,
(b) corrosive sublimate. Mention two easily applied tests
that will distinguish one from the other.
(a) Calomel, mercnrous chJoride Hg^Clj or IlgCI. Is a
laxative, may by continued use cause constitutional poisoninff;
occurs as an impalpable, insoluble powder. Wlien added to
lime water a black mixture results.
(b) Corrosive subiimaite, mercuric chloride. HgClj is an
alterative, anti-syphilitic, antiseptic and highly poisonous
substance. It occurs in heavy white crystals, soluble in 13
parts of water, and in 3 parts of alcohol. When added to
lime-water a yellow mixture results.
Give the chemical nam« of iodoform. How is iodoform
made?
Iodoform is tri-iodometliane, CHIj. It is made by the
action of iodine and potassium hydroxide on ethyl aletrfiol.
State the atomic theory.
All matter is composed of minute particles called molecules,
and each molecule is made up of indivisible parts called
atoms; these latter in their union to form molecules unite
in fixed quantities by weiylit and iu r.beiiience to fixed lawa
Give the properties and uses of bromine.
Bromine, Br, atomic weieht 80.0 {79.36), valence I, is a
heavy red-brown volatile liquid, specific gravity 2.99. It
vapori/es at all temperajturet*, giving rise to reddish-brown
fumes. It is slijililly soluble in water, soluble in alcohol and
CHEMISTRY, 217
in ether, is caustic, and its vapor is irrespirable. It combines
with many metals to form binary salts, called bromides, e. g.
NaBr, KBr, AgBr. Used as a disinfectant, for cleaning foul
wounds, and, in its salts, internally as medicine.
State the valence of the following radicals: (CN), (HO),
(NO,), (CO), (HC).
CN, monad; HO, monad; NOo, monad; CO, dyad; IIC,
triad.
Give the names and formulas of three sodium salts.
Sodium bromide NaBr. Sodium chloride NaOl. Sodium
iodide Nal.
How is ferric chloride made? Give the chemical equa-
tions.
Dissolve iron in aqua regia, or ferric oxide in hydrochloric
acid.
Fe^ + 6IICi + 2HNO3 = Fe^Cle + N^O^ + 4H2O.
Fe^O., + 6HC1 = Fe^Cle + 3HoO.
Give in detail a test for arsenic in a mixture of food
taken from the stomach.
To the stomach contents add an equal weight of a mixture
of HCl (1 part) and water (3 parts). Digest on a wat-er-
bath and add small quantities of potassium chlorate until the
organic matter is destroyed. Then filter, drive off the chlor-
ine by passing COo gas, and reduce the arsenic compound to
the arsenous by passing SOo gas.
Heat to drive off any excess of sulphurous acid, then
through the resulting liquid pass hydrogen sulphide gas for
several hours. Collect this precipitate, and to it add am-
monium hydrate. Test the dissolved portion or filtrate for
arsenic by Marsh's test.
Define allotropism.
Allotropism refers to elements occurring in more than one
form, as, for instance, carbon in charcoal, graphite and dia-
mond.
218 CHEMISTRY.
Give (he average amount and the composition of normal
urine voided by an adult in 24 hours.
AmounI 50 ouDcex
SolidB lOOOgrtins
Urea
Uricitdd
Hippuric Bcid--
Creatinine
Pignietii, niiicns
Mention five alkaloids. Give the derivation of each.
ytryclinine from nux ^-omica-, morphine fi-om opium; qui-
cliioridts (KNa)..--
sulphalei (KCuj
phoHphatottKNa)..
•' (MgCa)..
, cocaine from erythroxylon coca;
P
nine t'mm cinchona bark;
atropine from belladonna.
Complete the following equations:
CII,I + HKS =
CS, + 2H,0+ 6Cu =
CIIJ + HKS = CII,IIS + KI
CS, + 211,0 + 6Cu-=2H,S + CO. + 6Cu.
State the properties of potassium. Mention ten potas-
sium compounds of importance in medicine. Give for-
I'otassium, K, at. wt. 39.0 (38.86), valence I, is a soft
white metal, slight bluish tint, decomposes water at all tem-
peratures. It is one of the strongest electro- positive elemeuls,
is of monad vaJen<!y, is lighter than water, fuses below a red
heat.
Compounds of importance in medicine are: Potassium
iodide, Kl; nitrate, KNO,; carbonate, K,COs; bromide, KBrj
chlorate. KCIO^; chloride, KCl; sulphate, K,SOj; bi-earbon-
ate, KJICO,; cyanide, KCN; and autimonial tartrate, KSbO-
C.H.O,.
Give a method of determining the specific gravity of a
solid substance insoluble in water.
Weigh substance in air, then immerse in water and weigh
again; divide weight in air by loss in weight in water. Ex-
CHEMISTRY, 219
ample: Gold weighs 10 grains in air, in water weighs 9i/^
grains, loss equals half a grain, then 10, weight in air,
divided by one-half, or the loss of weight when in water,
equals 20, the specific gravity (approximate) of gold.
Give the chemical name, properties and uses of tartar
emetic.
Tartar emetic is potassium antimonyl tartrate. Formula:
KSbOC,H,Oe.
It occurs in crystals or as a white soluble powder, chars
when heated. Used as an emetic and as a nauseating and
sedative expectorant, is very poisonous.
In what part of the body is sulphur found?
Sulphur exists in practically all tissues and fluids of the
body in the form of sulphates or in combination in the sub-
stances of albuminoid nature.
What kind of albumin in morbus Brightii? What prop-
erty renders it readily detectable?
Serum albumen.
It is readily detected through its coagulability by heat or
acid.
How is chlorinated lime made? What is the principal
use of chlorinated lime?
By passing chlorine gas over slaked lime.
Ca(OH) 2 + CI2 = CaaOCl + H^O.
Its chief uses are as a bleaching agent and a disinfectant.
Chlorinated lime liberates chlorine when in contact with an
acid or with the atmospheric carbon dioxide.
What is the difference between an alcohol and a phenol?
Illustrate.
Phenols differ from alcohols in :
1st. Not forming aldehydes and acids on oxidation.
2d. In not dividing into water and hydrocarbons under
the influence of dehydrating agents.
I
220 CHEMISTRY.
3d. Ill not reacting with acids to fonu ethers.
Phenols fonii more stable compounds thHn do alcohols with
the metallic elements.
What are carbohydrates? into what three groups are
these compounds usually divided?
Ca,rbohydrates are organ'ic compounds, composed of C, !I,
0, in which the II and O exist in the relative proportions in
wliich they are present in water and the carbon atoms in
groups of six.
Polysaecharids or amyloses, momwaccharids or ghieixses,
disaoeharids or sueroees.
Qive the formula, uses and properties of hydrogen
dioxide.
HjOj. Used as a disinfectant, bleaching and oxidizing
agent.
It is usually sold in a watery solution containing from 10
to 12 volumes of true hydrogen dioxide or about 3 per cent,
by weight. True hydrogen dioxide ia a thick, syrup-like
liquid obtained through the exaporation of its watery solu-
tions over strong sulphuric add in a vacuum. It readily
parts with an atom of oxygen, particularly if brought in
contact with organic matter, and it is this na^ent oxygen
that effects the bleaching, disinfectant action, etc.
Give the formula and properties of each of two oxides
of carbon, explaining the effect of each on animal life.
Carbon monoxide. CO. A gnu almi>st insoluble in water,
no odor, burns with blue flame to form carbon dioxide, is
lighter than air. It acts as a direct poisonous agent to ani-
mals, uniting with the hemoglobin of the blood, and thua
destroying the oxygeu-carrying power of the red corpuscles.
Carbon -dioxide, COj, is a colorless gas, heavier than air,
no odor, soluble in water, a normal constituent of air. It is
not a. dii^et poison when inhaled, unless in qiiantitiefi
comrtituting over 10 per cent, of the inhaled air. It is, how-
CHEMISTRY. 221
ever, not capaible of supporting iife. It does not burn, nor
does it support combustion.
Describe the preparation of nitrous oxide, writing the
reaction. State the properties and use of nitrous oxide.
Nitrous oxide results when ammonium nitrate is heated in
a retort at temperatures between 460° to 490° P.
XH.NOg + heat = N20 + 2Ufi,
It is a colorless gas, slightly sweetish taste, has no odor.
It is soluble in w^ater, heavier than air. It readily supports
com'bustion, owning to its decomposition by the heat of the
burning body. It does not burn. It is used for the produc-
tion of general anesthesia of a short duration.
Describe phosphorus as to (a) derivation, (b) proper-
ties, (c) commercial uses, (d) medicinal uses, (e) medic-
inal preparations.
(a) From the mineral apatite or from bones, the latter
containing tri-calcium phosphate.
(b) In its usual form is a yellow wax-like solid, occurring
also in red, black and white allotropic forms.
Yellow phosphorus is spontaneously inflammable in air,
especially if it be finally divided, has an odor of garlic, is
highly poisonous, is insoluble in water, but dissolves in oils,
in carbon disulphide, slightly soluble in hot alcohol, etc.
It glows in the dark, it melts and will take fire below the
boiling-point of water.
(c) Making matches, insecticides. Is used in certain metal
alloys to give closer grain and prevent oxidation in the alloy,
as in phosphor bronze.
(d) Useil medicinally in doses of 1-lOOth of a grain in
nerve disorders.
(e) Medicinal preparations — phosphorus, phosphoric acid
dilute, the phosphates, hyiyophosphites and phosphides.
Give the names and formulas of the various gaseous
compounds capable of producing general anesthesia.
Nitrous oxide, NjO; chloroform, CllClg; ether, (C2H5)20.
CHEMISTRY.
A few other eubstances are used for the production of
anesthesia, but they have not aa general a use nor are they
g^eneraUy as satisfactory.
Describe a method of detecting the presence of lead
salts in water.
Concentrate the water to small hulk, add a few drops of
ammonium sulphide— -a black or brownish-black precipitate
or coloration insoluble m dilute hydrochloric acid indicates
the presence of lead.
How may the presence and amount of urea be deter-
mined?
Make a fre^ solution of hypobroiiiite of sodium by dis-
solving 100 grams of ■caustic soda in 250 cubic centimeters
of water, and when cold adding 25 grams of bromine.
Place this solution in the closed arm of a Doremns' ureo-
meter. Now add one cubic ceutimoler of urine, so that it
may mix with the hypobromite solution in the long arm of
tbe apparatus. The urea is decomposed, its components are
absorbed with the exception of nitrogen gas, which, passing to
the upper portion of the tube, depresses the column of liquid
downward. The space occupied by the nitrogen gas indi-
cates the quantity of urea in the sample.
.Mention a chemical antidote for sulphuric acid and ex-
plain the action of this antidote.
Ma-giiesium oxide. It cheniicatly combines with sulphuric
acid to form sulphate of magnesium. This action is accom-
panied by the evolution of but little heat and no pas, and all
corrosive properties of the acid entirely disMippenr in the
neutralisation which it undergoes.
What is fermentation and how is it produced? What
are enzymes?
Perraent-ation is the decomposition of a noo -nitrogenous
body by a ferment. For its production we require a ferment,
moisture, presence of air (generally), and a temperature not
exceeding 100° to 110° F.
CHEMISTRY. 223
Enzymes are soluble or unorganized ferments acting like
yeast and other organized ferments. They are of both vege-
table and animal origin. Those of animal origin are found
in digestive fluids, as pepsin in gastric juice, ptyalin in saliva.
Differentiate chemically sucrose, glucose, lactose and
maltose.
Sucrose, CijHajOn, does not reduce alkaline cupric solu-
tions and does not ferment with yeast.
Glucose, CglliaOe, reduces alkaline cupric solutions and
ferments with yeast.
I^actose, C12H22O11.H2O, reduces alkaline cupric solutions
and does not ferment with yeast.
Maltose, CijHjjOu.HjO, does not reduce Barford's reagent
(acetic acid solution of copper acetate), otherwise is similar
to glucose.
Complete the following equations:
FeCl, + 3NH,0H =
MgCi. + NH.Cl + Na.,PO, =.
PeCl, + 3NlI,OII = Fe(OII)3 + 3NII,(M.
MgCi, + NII.Cl + NagPO, = XIl.MgPO, + 3NaCl.
Describe oxygen as to occurrence, preparation, physical
properties, chemical properties, office in the body.
Oxyj^en, 0, atomic weight 16 (15.88) valence II, occurs in
free state, forming alwut one-fifth of the atmosphere. It is
found chemically combined with % of its weight of hydrogen
in water and is pi'esent in many mineral and organic com-
pounds. It is the most widely distributed of elementary
substances.
Prepared by heating a mixture of potassium chlorate and
manganese dioxide. Physically, oxygen is a colorless, taste-
less, odorless gas, slightly heavier than air. It is soluble to
the extent of 3 per cent, in water.
Chemically, oxygen supports combustion, does not bum, is
strongly electro-negative, is of dyad valency, combines chem-
ically with all elements excepting fluorine and argon.
224 CHEMISTRY.
It supports animal life ; it is carried by tlif red
blood corpuscles to every cell of the body, upon which it
acts destructively to allow of regeneration of tissues.
It is used' remedially where from aoy cause respiraition is
impaired or prevented.
What is chlorine? How is it prepared? How is chlor-
ine administered medicinally through the mouth?
A yeUowish-greeu gat* with suH'ocallug odor, about 'ly-i
times the weight of air, soluble in water. Administered med-
icinally in aqueous solution known in pharmacy as liquor
chlori compositus, containing about 0.4 per cent, chlorine.
Prepared by heating a mixture of manganese dioxide and
hydrochloric acid, and collecting the gas evolved by displace-
ment.
MnO, + 4nCl = MnCI, + 211,0 + Ci,.
Define alloy, amalgam. Cive an example of each.
An alloy is a combination of two or more metals. Ex-
ample : Brass, an ailoy of zinc and copper. An amalgam is
an alloy in which one of the metals is mercury. Example:
Tin amalgam, cmnposed' of tin and mercury, used in making
How is hydrogen sulphide formed in nature? How is
hydrogen sulphide prepared in the laboratory?
It i-esiilts. in nature, from the decomposition of organic
matter containing sulphur in the presence of moiatui-e. Ex-
ample; The rotting of an egg gives rise to hydrogen sulphide
from the union of the sulphur in the albumen with the hy-
drogen of water. Also found in certain volcanic gases and in
some mineral waters.
Hydrogen sulphide may be prepared in the laiboi-atory by
adding dilute sulphuric acid to ferrous sidphide, as
FeS 4- ILrtO, = PeSO. + H.S.
Explain the significance of the following prefixes:
Hydro, sub, hyper, nitro, bi.
Hydro as a prefix is usefl in the naming of hydracids. e. g.
Hydrochloric acid, HCl.
CHEMISTRY. 225
Sub as a prefix is the equivalent of the sufifix **oiis,'' sig-
nifying a lower valence (real or apparent) of the positive
element in a binary compound than is indicated by the suffix
'*ic/' It is also used in indicating certain basic salts, e. g,j
subnitrate of bismuth, BiONOg.
Hyper as a prefix is used especially in indicating a greater
relative amount of oxygen than is contained in another com-
pound of the same elements.
Nitro indicates the presence in a compound of the radical
NOj, as CgHgNOz, nitrobenzene.
Bi indicates two atoms of the element so designated in
chemical combination with another element, as CSj, bi-sul-
phide of carbon.
Mention the metals whose salts are often taken as
poisons.
Silver, lead, mercury, arsenicum, antimony, copper, tin,
zinc, barium.
What is common salt? State where and how common
salt is obtained, and give the chentistry of its use for
freezing purposes.
Sodium chloride, NaCl. Obtained by evaporation of sea
water, and from salt deposits.
When salt is mixed with snow or ice it occasions a rapid
melting — heat is rendered latent, such heat being extracted
from neighboring 'bodies.
Explain the formation of a vesical calculus having a uric
acid nucleus.
An aggregation of uric acid crystals, from their sharp
angular character irritate the vesical mucous lining, so
that they become surrounded with mucus, and then, from
inflamimation produced, we may have decomposition of
urine, with accompanying deposition of alkaline urates, or
phosphates, around the original mass.
15
Vnimfiif. '
2-26
Give two tests for morphine.
Toudi the suspected alkaloid with nitric aoid, and if it be
iBorphiLe it dissoJvt^, yielding an orange-red liquid that
soon fades to yellow.
To niorphiui' add in-ii!ral tVrnc chloride solution — a blue
color is produced.
When are substanires said to (a) isomeric, (b) nieta>
meric, (c) polymeric?
Suljstaucew are isomeric when tJiey are made up of the
Game elements in the same perceuta^re proportion.
Two or more bodies are raetameric when composed of the
same elements in the same percentajie composition and when
they have tie same molecular weight.
Polymeric b<xlies are composed of the same elements in the
same percentage compfwition hut «-ith different molecular
weights.
Write a reaction for making barium sulphate from
KOdium sulphate. How many grams of sodium sulphate
are required to yield 3.33 grams of barium sulphate by
this process? (Atomic weight of barium equals 37.)
.\a„SO, + liaCl, = BiiSO, + 2NaCl.
142Nh,MO, make 233 of BaSO,,
If 233 grams of barium sulphate require 142 grams of
Bodium sulphate, then 2.33 : 142 r ; 2.33 : X, or 1.42,
Result. 1.42 grams of sodium snlphate i-equired.
Describe and illustrate (a) monobasic acid, (b) dibasic
acid, (c> tribasic acid.
(a) An «cid containing one atom of hydrogen eapal^e
of being replaced by a metaJ or an elect ro> positive rad-
ical, as HCJIjOa, acetic acid; AgCjH^Oj. argentic acetate.
(hi An acid which contains two replaceable hydrogen
atoms in each molecule, as ILSO,. sulphuric acid; NajSO,.
sodium sulphate.
fc) An Mcid which mnlains three replaecahip hydrogen
CHEMISTRY. 23,1
atoms in each molecule, as H3PO4, phosphoric acid ; Na3P04,
normal sodium phosphate.
Write chemical equations showing two methods of ob-
taining hydrogen.
Zn + H0SO4 = ZnSO, + H^.
Zn + 2K0H = KjZnOj + H^.
What is the meaning of the words monad, tetrad and
pentad? Give an example of each.
Monad refers to an elemen-t or compound radical whoee
power of cambin«ition is the same as that of hydrogen. Thus
chlorine is a monad, one atom of II uniting with one atom of
chlorine.
Tetrad is an element or compound radical exhibiting a
combining power four times that possessed by hydrogen.
Example: Carbon, as in marsh gas, CII4.
A pentad has a combining power equal to five times that
of hydrogen. Example : Phosphorus, in its compound phos-
phorus pentachloride, POI5.
Describe cyanogen and its principal compounds.
Cyanogen, symbol, Cy or CN.
This body is an organic compound radical composed of
equal volumes of carbon and nitrogen vapors. It is a color-
less, inflammable gas, soluble in water. It exists in a divided
form in many vegetable structures, is electro-negative or acid-
ulous, of monad valency, and resembles chlorine in chemical
compounds which it forms.
Important compounds: Ilydi-ocyanic acid, HCN. A very
volatile liquid with characteristic odor used in dilute aqueous
solution. Verj^ poisonous. KCN, potassium cyanide, a
white, deliquescent, poisonous solid. Potassium ferro-
eyanide and pwtassium ferri-cyanide have considerable use
in arts and manufactures and as chemical reagents. Nickel,
silver and gold cyanides are all used for electro-plating: pur-
poses.
228 CHEMISTRY.
What are the source and principal properties of vase-
line?
Vaseline is obtained by purifying the residue, after dis-
tilling the more volatile snabstances from petroleum.
It is a more or leas fluorescent, unctuous solid, melting at
from 104 to 125 degrees Fahr. It is almost odorless and
tasteless.
Give the general characteristics of the aluminum group
of elements.
Melals of aluraiuum group include aluminum, indium, gal-
lium, and others still less common. They form compounds of
the type MCI, or MjO,. Their oxides are weak bases; their
sulphates, with t-he sulphates of alkali metals, form double
salts called alums, which crj'stallize in the regular iBometric
The oxides and hydroxides are insoluble in water, as are
also the phosphates and carbonates.
(live a typical example of each of the following classes
of mineral waters: (a) Saline cathartic, (b) alkaline, (c)
sulphurous.
(a) Epsom spring water (England), containing magnesium
sulphate.
(b) Vichy, containing sodium bicarbonate.
(e) Richfield spring, containing hydrogen sulphide.
Describe one of the processes by which HCl and N may
be prepared.
IK'l is prepared by hearing sulphuric acid with common
salt and passing the evolved gas into water.
N is pi-epared by passing air over incandescent copper, the
metal uniting with the oxygen present.
Explain the difference between the Fahrenheit, centi-
grade and Reaumur thermometers.
The freezing-point of water in the Fahrenheit scale is placed
at 32 degrees, white in the Cenrigrade and Reanmur scales
CHEMISTRY, 229
this point is made zero. The boiling-point in the Fahrenheit
scale is 212 degrees, the Centigrade scale 100 degrees, Reau-
mur 80 degrees. Between the freezing and boiling points of
water in the F. scale we have 180 degrees, in C. scale 100, in
R. 80. Hence each degree F. would correspond to ^/^ of a
degree C. and */o of a degree R.
What is litmus? Explain its uses in urinalysis.
Litmus is a vegetable substance obtained, from a species of
lichen.
In urinalysis we use it generally in the form of litmus
paper (paper impregnated with an aqueous solution of lit-
mus) to determine tlie reaction of urine. Blue litmus is red-
dened by acids; red litmus is turned to a blue by alkalies,
permanently if the alkalies be fixed, transiently (removable
by warming) if the alkali be volatile.
Give the chemical differences between chloral and chlo-
roform.
Chloral is fonned from aldehyde by substituting three
chlorine atoms for three hydrogen atoms; aldehyde, CHgCOII ;
chloral, CC1.,C0I1.
Known chemically as trichloraldehyde.
Chloroform is trichlormethaue, or marsh gas, in which
three hydrogen atoms have been replaced by chlorine atoms;
nmrsh gas, CII^; chloroform, CHCI3.
Complete the following erquations:
CaCl^H- (NHJ,C03 =
CH.N.O + 2HoO =
CaCl. + (NIIJXO., = CaCOa + 2NH,C1.
CII.NoO + 2Ho6= (NHJ0CO3.
Define malleability, endosmosis.
Malleability is that property by virtue of which certain
metals may be hammered or rolled out into thin sheets.
Endosmoens refei-s to the passage of a liquid of a certain
density inward through a porous partition to mix with a
liquid of different density.
230 niKMlSTRY.
Give the general characteristics of rain water, well
water, river water, and lake water.
Kaiii water, a soft water, containing erases dissolved from
the atmosphere but only a small amonnt of solids. Weli
water, character depends upon depth and location of well,
upon surrounding conditionfi, ns'ture of soil, etc. River water
depends upon source aud exposure to ooutami nation — sewage,
manufacturing waste, geolojncal conditions. Lake water is
similar to river water, dependinir upon conditinns for its
purity or eontaniinatdou.
Give the method of preparation and the special cliarac-
teristics of ozone.
It may be prepared by passing electric discharges through
moist air or oxygen or by the slow oxidation of moist phos-
phorus.
Ozone is a bluish gas with irritating effect upon respiratory
raucous surfaces; it is an artive oxidizing agent.
Test: Paper saturated with a mixture of starch mucilage
and potassium iodide solution will be turned blue by contact
with ozone.
What is flourinc and where is it obtained? State the
preparation and the practical uses of hydrofluoric acid.
Fluorine. F., atomic weight 19 (18.9), valence I. a nearly
colorless gas, the first one of the halogen aeries of elements,
occurs in nature in combination with metals an fluorides,
e. g. calcium fluoride or fluorspar, C'aFj.
Hydrofluoric acid is made iby heating calcium fluoride and
sulphuric acid 4n a leaden vessel and passing the evolved gas
into water, in which it readily dissolves. Its chief use ia as
a solvent for glass, used for etching, etc.
What are the constituent parts of boroglycerid and what
is its use in medicine?
Boric acid and glycerin. U. S. P. Glyceritum boroglycer-
ini, 31 per cent, boric nei-d dissolved in glycerin. Il is anti-
septic and detergent.
\
CHEMISTRY. 231
What are the properties af lead? What is litharge?
Give the toxicology of lead.
Lead, Pb, atomic weight 2(>5 (205.33), valence II; a soft,
heavy, bluish-white metal, tarnishes rapidly on exposure to
air. Melts at 325° C. ; sp. gr. 11.37; oxidizes when heated
in air to form yellow oxide of lead or litharge. Soluble in
Ditric acid, in acetic acid, in very strong hot 8<ulphuric acid.
Litharge is monoxide of lead, PbO.
Lead may occasion acute or chronic poisoning. In acute
lead poisoning we have the action of an irritant — vomiting,
abdominal cramps, constipation. Chronic lead poisoning, as
it occurs in painters or in those constantly exposed to the
fumes of lead and its components, is characterized by anemia,
obstinate constipaticm, abdominal oolic, paralysis of extensor
muscles, prodaicing ** wrist-drop ' ' and many obscure nervous
symptoms, paral.y'ses, anesthesias, ete. Antidotes: magnesium
sulphate and sodium sulphate.
Give the preparation, formula and characteristics of
bromide of ammonium.
Ammonium bromide, NII^Br. Place one pound of bromine
in a stone jar, add to it carefully four times its weight of
water, then add half ounce at a time, very slowly, one quart
of ammonia.
6Br + 8NH3 = 6NII,Br + N^.
It is a white- crystalline salt, saline taste, permanent in air,
soluble in water; heated with caustic soda evolves odor of
ammonia. Passing chlorine gas through its water solution
bromine is disengaged.
Ammonium bromide acts upon the system as a depressant
to the motor function of spinal cord. Its chief uses are to
produce sleep and allay nervous irritability.
Give a description of the preparation and mention the
properties of the principal alcoholic beverage obtained
from the fermentation of malted grains.
The brewer ** mashes" the ground malt with water, and
232 VUEMliiTIiY.
heats at about 180 degrees F. for several hours, when such
Btareh has not been already changed by germination of the
grain is now converted inio dextrin and sugar.
The resulting liquid, "wort," is boiled with hops and
the mixture is allowed to stand, yeast is added, and tbe
liquid fermented. Glucose is changed to alcohol, with a fur-
ther formation in the liquid of traces of lactic, sueeinio, car-
bonic and acetic acids, glycerin, etc.
The fermentative process is finally stopped by heating the
liquid.
Ale, porter, stout and beer differ only in the selection and
proportion of the malt, hops and flavoring material. They
vary in alcoholic content from 1 to 10 per cent, with an aver-
age of 4 to 5 per cent., ales and stouts being generally richer
in both estraclives and alcohol than are the beers.
What is the normal amount of uric acid excreted in 24
hours by an adult, and what effect has diet on the quantity
so excreted?
Prom O.U to 0.8 grammes in 24 hours. Increased by a diet
rich in nitrogen, as of meats, peas, beans, eggs, etc., and by
alcoholic beverages.
What is the fever thermometer? How is It made and
graded?
A small glass thermometer of a minute capillary bore, with
a constriction in the lumen immediately above the mercurial
chamber. The mercury, in its expansion, passes up the tube,
but on cooling and contraeting cannot, by its own weight, fall
down past the constricted portion.
The steps of manufaetni'e are calibrating the tube, filling
and curing the tube, and finally graduating the finished m-
stmment. The scale is generally from 90 degrees Pahr. \o
110 degrees Pahr., eaeh degree being divided into five equal
spaces.
CHEMISTRY. 233
What is the relative importance of the element carbon
in organic chemistry?
All organic compounds contain carbon. It is the essential
element whose presence classes the body as organic.
In testing urine by heat in a case of suspected albu-
minuria, what substances might be precipitated and so
make the test deceptive?
Phosphates of calcium and magnesium. .
Describe the chemical process (a) when iron rusts, (b)
when wood burns, (c) when silver is tarnished by coal gas.
(a) The rusting of iron is an oxidation process, the final
product being ferric hydroxide, FejCOH)^.
(b) Wood burns to form carbon dioxide and water.
(c) Silver, in presence of coal gas, becomes coated with
black sulphide of silver, AgS, from the presence in the coal
gas of sulphur compounds.
Describe the manufacture of illuminating gas.
Coal gas process : Bituminous coal is subjected to destruc-
tive distillaition in retorts, the gaseous product being then
successively cooled to remove the less volatile tar, washed
with water to remove ammonia, and passed through lime to
remove the sulphur compounds.
Water gas process : Air and steam, alternately, are passed
over red-hot coke or anthracite coal.
Co + 2H2O = 2C0 + 2H,.
The gas produced is given illuminating value by enriching
with naphtha.
Mention the antidotes applicable in cases of poisoning
from (a) caustic alkalies, (b) carbolic acid.
(a) Vinegar, lemon juice, oils, fats, mucilaginous drinks.
(b) Soluble sulphates, as sodium or magnesium sulphate,
oils, fats, albumin, vinegar, and alcohol.
234
CHEMISTRY.
Where is oxygen found in the human body and what
are its important uses in the animal economy?
It is present in all animal tissues and fluids. Osygen ia
necessary for the oxidation and removal of existing tissues,
witli subsequent replacement by new structures. It is only
through the ingestion of oxygen, in respiration, that animal
life is maintained.
When sulphur is burned in the air, what is the product
and what are its uses?
Sulphnr dioxide or Nuljiluirous anhydride, SO,.
It bleaches organic colora. is a disinfeiJtaut, and stops or
limits fermentation. In the arts it is used for the manufac-
ture of sulphui-ie acid and other chemical bodies.
Write the formulas for (a) sodium sulphate, (b) potas-
sium nitrate, (c) ammonium chloride.
(a) Na.SO., (h) KNO,,. le) Nil, CI.
Describe the method of obtainin;{ H and O by passing
an electric current through H.O, and tell how to deter*
mine which gas is 0.
Seal two platimim wires in the opposite sides of a glass
flask, .solder two upright strips of plaitinum to these entering
horizonlal wires. Connect one of tlie entering wires with the
positive pole of a galvanic batterj' of several cells and the
other wire with the negative pole. Place in flask water ren-
dered faintly acid with sulphuric acid, and invert two test-
tubes, filled with this same acidified water, over the platinum
terminals. Pass the cui-rent and gas will accnraulflte in both
tubes, the cxygen with half the rapidity of the hydrogen.
The gas inay be further identified by plunjnng into it a frag-
ment of glowing wood, which will Tie kindled to a brilliant
flame by the oxygen.
What is effervescence and what is efflorescence?
Eflfervescenee refere to the bubbling off of a ga.s. (. g.. the
escape of carbon dioxide on treating a carbonate wHth an aeid.
CHEMISTRY, 235
Efiloresceiice refers to the loss of water of ery»tallization
which certain crystals undergo when exposed to air. They
dry out, ibeoome powdery and lose their crystalline form.
What changes take place in alcoholic fermentation?
(rlucoee is converted' into alcohol and carbon dioxide gas:
CeHijOe = 2Q ,11^011 + 200^.
What is understood by specific gravity, and what pre-
cautions are advisable in the use of the urinometer?
(a) By specific gravity of a substance we mean the ratio,
or relation by weight, tlie substance bears to the weight of
an equal volume of »some substance used as a standard.
(b) The temperature of the liquid to be examined should
correspond with the temperature for which the instrument is
graduated, otherwise a correction should be made. The in-
strument should be free of any adhering bubbles. The urino-
meter tube should be filled to the brim.
Give the chemical name and formula of (a) water, (b)
common salt, (c) carbonic acid, (d) nitric acid.
(a) Hydrogen monoxide, HjO. (b) Sodium chloride,
NaCl. (c) Carbonic acid or hydrogen carbonate, HjCOj.
(d) Nitric acid or hydrogen nitrate, HNOg.
How does fire-damp explode in mines?
When marsh gas escapes from fissures in coal formations
and mixes with air, it explodes with violence on contact with
a naked flame or spark, the chemical results being carbon
dioxide and water.
If the proportion of air rises to 18 times the volume of
marsh gas no explosion occurs.
Demonstrate the fact that air is a mixture, and not a
compound.
Pass air through water that has been boiled, and 3 per
cent, of the oxygen of the air will be retained dissolved in
the water, while less than 1 per c<»nt. of nitrogen will be re-
tained by the water.
CHEMJiiTHY.
What is the chemical antidote in case of poisoning by
tartar emetic?
Tannic acid.
What is the formula of sulphuretted hydrogen? What
are some of its properties and uses?
y»lphuretled hydrogen, HjS, is a colorless gas, slightly
heavier than air, of a disgusting, characteristic odor. Burns
with a blue flame when ignited, forming sulphur dioxide and
water.
It is used as a group reagent to preeipilate metals of the
so-called seeond analytical group.
Which metal is (a) the least tenacious, (b> the most
infusible, (c> the best for electro- magnets, (d) the best
for electro-conductors, (e) the most rare?
(a) Mercurj'; (b) osninuin ; (e) iran; (d) silver; (e) ra-
dium.
Describe the process for the preparation of nitric acid.
Prepared by the action of sulphuric acid on sodium nitrate
in glass or cast-iron retorts.
NaNO, + H,SO, = NaHSO, + TINO,.
Give the flame test for barium and strontium.
Moisten a clean platinum wire with hydrochloric acid, and
dip it into the powdered barium salt; hold the wire in the
Bunsen flame, a green eoJor will be obtjiined.
Strontium, under like conditions, will give a brilliant red
color.
What is the per cent, of each constituent present in
sulphuric acid, the atomic weight of sulphur berng 32?
The molecular weight of n„SO. is 98. In 98 parts, then,
of TT;RO, there are, hydrogen 2 parts, sulphur 32 parts,
oxygen 64 parts.
In 100 parts there will be, of hydrogen (2-^98) X 100 =
2.04 per cent. ; of sulphur (32 -^ 98) X 100 ^ -12.65 per cent. :
of oxygen (64-^98) X 100 = 65.31 per cent.
\
CHEMISTRY, 237
What are principal constituents of milk?
Water, fats, sugar (lactose), proteids ineluding caseinogen
and milk albumin, and mineral salts, chiefly phosphates and
chlorides of calcium, magnesium, sodium and potassium.
To what impurity is the occasional toxic effect of bis-
muth salts due?
Arsenic.
Give the chemical reason why diabetics should abstain
from starchy foods.
Because of the convereion of starch into glucose through
the action of ptyalin in saliva, and amylopsin in pancreatic
juice, (jlucose thus formed cannot be broken up into other
substances because of loss of power of liver cells to effect the
change, so that this glucose passes directly into the blood,
from which it is eliminated by the kidneys.
What chemical changes take place as a result of mus-
cular activity?
Oxida/tion of tissue substance with increased formation and
elimination of urea from decomposed nitrogenous structures.
Increased rapidity of circulation brings formative material
to quickly repair this loss or waste, so that tissues are rapidiy
destroyed, rapidly replaced, and the waste rapidly removed
through exercise.
What is the difference between fermentation and putre-
faction?
Fermentation is the decomposition of a complex substance
by the action of a ferment.
Putrefaction is the decomposition of nitrogenous bodies by
the action of bacteria.
Mention the antidotes applicable in a case of poisoning
from iodine.
Starch, mucilaginous drinks, flour, milk, white of eprjr.
238
CBEMISTRY.
r
Describe chloral hydrate.
Chloral hyxirate, CCl,COH.HjO.
A colorless, transparent, crystalline solid, punpent odor,
aerid taste, very soluble in water. It liquefies if triturated
with camphor, phenol, menthol, or thymol. Used as a hyp-
notic.
Give a chemical explanation of the souring and curdling
of milk.
A ferment acts upon the sugar of milk changing it to
iaetic acid; this lactic acid then, produces a sour taste and
coagulates the ca.sein.
Name each of the following: (a) H^SO^, (b) H,SO„ (c)
H„SO., (d) H,S,0,.
(a) ITyposiilphurous aeid; (b) sulphurous acid; (e) sul-
phuric acid; (d) thio-sulphuric acid (from which the claea
of salts known as hyposulphites is obtained).
What are the chemical constituents of biliary calculi?
Cholesteriii, pigments, biliary acids, mucus, epithelium, car-
bonate of calcium, fate.
Describe your mode of procedure in making a chemical
examination of suspected urine.
AseertAin quantity passed in 24 hours and obtain an aver-
age specimen. Note color, appearance and odor. Test the
reaction with litmus paper and take the specific gravity.
Filter the urine and t«art for albumin by heat or nitric acid
tests, and for sugar by Fehling's or Haines' tests. Deter-
mine the amount of urea by the hypobromite method. Test
for chlorides with acidified silver nitrate, for sulphates with
acidiJied barium chloride, and for phosphates with magnesia
mixture. Te«t for indioan by use of concentraled hydro-
chloric acid.
Describe the theory of the construction of the metric
system.
The metre, unit of linear mea-sure, is the one ten-millionth
CHEMISTRY. 239
of a quadrant of a great circle of the earth. The metre is
39.37 inches in length. It is divided into ten equal parts
called decimetres.
Each decimetre is divided into ten equal parts called cen-
timetres.
Each centimetre divided into ten paiis called- millimetres.
Ten metres measure one dekametre; ten dekametres equal
one hectometre; ten hectometres equal one kilometre.
A cubic centimetre of distilled water, at four degrees Cent.,
weighs one gramme, the unit of weight equaling, in the Eng-
lish system, 15.432 troy grains.
The gramme is divided and subdivided, like the metre, into
deci-, centi-, milligrammes, and we also have the multiples,
deka-, hecto-, kilogrammes, referring respectively to 10, 100
and 1000 grammes.
A cubical vessel with a length of side of one decimetre
holds one litre of liquid, the measure of capacity. A litre
contains 1000 cubic centimetres, and is nearly equal to the
English quart.
Wherein dp wine, beer and whiskey differ?
Wine is a fermented fruit juice containing from 6 to 25 per
cent, of alcohol, has present as well compound aromatic etliers
and other volatile principles.
Beer is a malt liquor containing 4 to 5 per cent, alcohol,
with bitters (hops), and extractives (malt).
AMiiskey is a distilled liquor containing 30 to 60 per cent
alcohol, containing also aromatic substances.
The skeleton of a man weighs 24 pounds and contains
58 per cent, of calcium phosphate, Ca3(P04).^. Find the
weight of phosphorus present. (Atomic weight of Ca, 40;
of P, 31.)
There are present in the skeleton 13.92 lbs. of calcium
phosphate (58 per cent, of 24 = 13.92).
Calcium phosphate, molecular weight 310, contains 62 of
phosphorus.
310 : 62 : : 13.92 : X = 2.784 lbs. of phosphonis. Answer.
I
240 CHEMISTRY.
Distinguish between physics and chemistry.
Physics treats of the pheuoinena presented to us by bodiee
or masses of matter as such. Chemistry treats of the compo-
sition of matter and of the changes which this composition
may undergo.
What is the unit of comparison in determining the spe-
cific gravity of liquids? Of gases?
For liquids, pure water at 4° 0. and standard liarometric
pressure (760 niillimetree) .
For specific gravity of gases we use pure dry atmospheric
air at 0° C. and 760 miltimetres pressure or pure dry hydro-
gen at the same (standard) temperature and pressure.
Define qualitative analysis and give a principal method.
Qualitative analj^sis is that form of analysis which seeltB to
determine the kind of substances present iu a compound or
mixture.
A common method is to dissolve the substance to be ana-
lyzed and then by means of appi-opriate reagents to precipi-
tate and filter off successively its constituent parts.
Define (a) element, (b) compound, (c) mixture, (d)
solution, (e) precipitate.
(a) A substance all of whose atoms are of the same kind.
(b) A substance containing at least two different kinds of
atoms chemically combined. (c) A mechanical mixture of
two or more substances, which siibstances may be in any pro-
portion and may retain their characteristic properties, (d)
A solution is a liquid in which a solid, or a gaseous substance,
has been dissolved, (e) A substance made insoluble in the
liquid in which it ivas dissolved, by chemical action.
Which of the elements are gases at ordinary tempera-
lure and pressure?
Hydrogen, oxygen, nitrogen, chlorine, Huoi'iue, argou. and
n number of elements recently discovered.
\
CHEMISTRY.
Where do Na, Hg, Cu occur in nature? Which occur
free?
Copper occurs free in nature, and also in a number of
mineral eombinationB, the sulphide, carbonate, ojdde, etc.
Mercury occurs free, although but in limited quantity.
Sodium occurs principally in union with chlorine as NaCl
fotind in sea water, luineral springs, in natural waiter, in
nearly all plant and animal structures. Mercury is found
Ie nature chiefly in the ore cinnabar, IlgS.
Describe hydrochloric acid as to its occurrence.
We 6nd hydrochloric acid presemt in cei-tain animal Quids,
as in gastric juice, and it ie found in a few natural mineral
waters.
How does each of the following affect litmus paper:
(a) H,0, (b) H,SO„ (c) (NH),OH?
(a) No effect, (b) Turns it red. (c) Turns it blue.
The quantity of unne being insufficient for ttie urino-
meter, how would you proceed?
Use a small piknometer, or specific gravity flask ; weigh the
flask filled with urine and then when filled with pure water.
Divide the weight of the urine by -the weight of water.
Or, dilute the urine with a measured quantity of water and
determine the epeeifie gravity of tihe dilute mixture by means
of the urinometer. Prom this calculate the true specific grav-
ity, e. g., if 2 parts of water were added to 1 part of urine,
and the specific gravity of this mixture were 1005, the true
specific gravity of the urine would be 1015.
Distinguish between starch and sugar. By what histO'
logic element is starch converted into sugar?
Starch is colloidal, its formula CgllioOj. It is soluble in
cold water, forms a mucilage in hot water. Tuma iodine
blue, rotates light to the right, has no sweet taste.
Suear is cryHtalline, its formula CinHjjO,,. It is soluble
t>t water, it rotates ligbt to the 'left, it jnelds no
color with iodine, it possesses a characteristic sweet taste.
Starch is converted into sugar (maltose, C„HjjOi,, and glu-
cose, CgHijOg) by ptyalin and by amylopsin.
Complete the equation CaCI^+NaXO, = .
CaCL + NaX-0, = t'aCO, + 2NaCl.
Mention the antidotes applicable in cases of poisoning
from (a) oxalic acid, (b) copper sulphate.
(a) Magnesia and lime water.
(b) Albumin and ferrocyunidc of potassium.
What is chemical decomposition?
Chemical decomposition refers to the breaking up of a com-
pound inlo simpler substances.
Give an example of a synthetic operation.
The forinatiou of eupric oxide by heating the metal copper
in air or oxygen: or, mixing two parts hydrogen and one
part oxygen by volume and heating, an explosion occurs and
vapor of water is formed.
What are the products of the combustion of ordinary
coal?
Principally carbou dioxidic. There may also be producetl
carbon monoxide, sulphur dioxide, water, and other sub-
stances resulting from the burning of impurities in the coal.
In composition with what elements are the following
most commonly found in nature: (a) Iron, (b) gold, (c)
silver, (d) copper, (e) chlorine?
(a) Oxygeu or sulphur, (b) Sulphur, (c) Sulphur, tel-
lurium and chlorine, (d) Sulphur, oxygen, (e) Sodium.
Describe the production of oxygen by decomposition of
potassium chlorate. Give the formula and equation.
Hpat potassium chlorate with or without an addition of
manganese dioxide and oxygen will be liberated.
2KC10, + heat = 2KC1 + 30,.
CHEMISTRY. 243
Explain an experiment to prove that chemical action
may be induced by electricity.
Mix equal volumes of hydrogen and chlorine gases in a
tube through the sides of which pass two platinum wires
connected with a battery or induction coil. An electric
charge being sent through the wires the hydrogen and chlorine
combine with explosive violence to form hydrochloric acid.
Name and describe some of the more important potas-
sium salts.
Potassium carbonate, KjCOg. May be prepared from wood-
ash and from the chloride, a white granular, deliquescent
powder, very soluble in water, insoluble in alcohol.
Potassium chlorate, KCIO3. Colorless, pearly, plate-like
crystals, soluble in 16 parts water, permanent in air, a strong
oxidizing agent.
Potassium nitrate, KNO3. Made by the reaction between
sodium nitrate and potassium chloride. Prismatic crystals
of cooling, saline taste, slightly hygroscopic in moist air.
Soluble in 3.6 parts water, very sparingly soluble in alcohol.
A strong oxidizing agent.
Potassium bromide, KBr. White cubical crystals of saline
taste, soluble in 1.7 parts water and in 12.5 parts alcohol.
Potassium iodide, KI. Similar to the bromide, soluble in
0.7 part water and in about 12 parts alcohol.
Potassium acetate, KCjHjOo. A white powder or in crys-
taline masses of a satin-like lustre, odorless and having a
warming, saline taste. Very deliquescent, soluble in 0.4 part
water, and in 2 parts alcohol.
What is the formula for (a) chloroform, (b) sulphuric
ether, (c) alcohol?
(a) CIICI3. (b) (C2HJ0O. (c) C^HbOH.
How would you conduct an autopsy for the purpose of
testing for arsenic in the stomach and tissues?
The analytical chemist should be present, if possible, at the
244 CHEMISTRY.
autopsy. Tie both pyloric and cardiac ends of the Btomach
and place with its contents, in a Cheinieally clean glass jar.
Close the jar with a close-fitting glass stopper ; seal it, and im-
print a design upon the seal in such manner that the design
will be broken should the jar be opened. Proceed, in the
same manner, to save a portion at least of the liver, the small
intestine, portion of large intestine, the spleen, one kidney,
the brain. Each of these organs to be kept separately.
Complete the following equations and write the name
of each resulting compound under its formula:
2NaCl -f H,SO, =
CaCO, -f 2HC1 =.
2NaCl + H„SO, = Na,SO, + 2HC1.
Sodium sulphate Hydrochloric acid.
CaCO, + 2HCl=CaClj + CO, + H.O.
C^kiuQi chloride Carbon dioxide water.
How would you determine, chemically, whether a uri-
nary deposit were composed of urates or phosphates?
Ileat would dissolve a deposit of urates, but would not
dissolve phosphates.
Nitric acid would dissolve a deposit of phosphates, but
would not dissolve urates.
What is dialysis, and how would you construct a di-
alyzer?
Dialysis is the process of separating crystalloids from col-
loids when both are in the same solution.
It is performed in a dialyzer, which consists of a gl'Sss
vessel, the hottom of which is formed of parchment or parch-
ment paper, set in a larger vessel containing distilled water.
The mixture is placed in the smaller vessel.
In a short time the crystalloidal substances will have
passed through the membrane into the distilled water, where
they may be detected, and from which they may bo separated
by evaporation. The colloidal material remains in the dia-
lyzer, not being able to pass through the membrane.
CHEMISTRY. 2Ab
What is the difference between the mercurous and mer-
curic chloride?
Mercurous chloride, Hgfil^ or 2HgCl. A white impalpable,
insoluble powder, tasteless, odorless, turned black by am-
monium hydroxide. Acts as a laxative. Has tmt slight
poisonous action in single dose.
Mercuric chloride, HgClj. A white, crystalline, soluble
substance, of a sweetish, burning, metallic taste, giving a
^ite precipitate ^th anmionium hydroxide. Is very pois-
onous; used externally as an antiseptic, and in concentrated
solutions as a disinfectant; internally ^a an anti-specific,
alterative, tonic.
What impurities may be present in sulphuric acid, and
how would you detect them?
Lead. Appearing when strong sulphuric acid is diluted
with water, as a white precipitate or haziness of sulphate
of lead.
Arsenic: Recognized by Marsh's test.
Selenic acid: Showing its presence by communicating to
the acid the power of dissolving gold.
Nitric acid, or oxide of nitrogen: Detected by adding to
the suspected acid a mixture of strong pure sulphuric acid
and phenol, and evaporating in a porcelain dish to dryness,
when on heating slightly, should nitrates or nitric acid be
present, a pink coloration is observed.
Organic matter in sulphuric acid causes a brown or black
coloration.
What is sulphuric ether, and what is its action upon
man?
It is the oxide of ethyl, (C2Hb)20, or ordinary ether. It is
a colorless liquid, lighter than water, readily vaporizing at
ordinary temperatures, its vapor being heavier than air and
of a characteristic odor. Ether produces in man, or other
animals inhaling its vapor, unconsciousness and muscular re-
laxation, and may occasion death, through a centric paralysis
of respiration.
I
246 CHEMISTRY.
How would you detect the presence of bile in the urine?
Float urine in test-tube, over yellow nitric acid; at point
of contact, should bile be present, there will appear a baud
i>f colors, green, blue, violet, and red.
Add cane-sugar to urine, and warm a drop or two of this
mixture on a white porcelain surface; add a drop of strong
sulphuric acid, when, should bile be present, there will ap-
pear a play of colors forming in concentric rings, the colors
particularly pi-oniinent being yellow, red and green.
Give a reliable quantitative test for albumin.
To a measured quantity of urine, add acetic acid to as-
sure its acidity, boil, cool and filter through a weighed filter
paper, wash the coagulated material with water containing a
few drops of acetic acid, with ether, with alcohol, and again
with boiling acidified water. Then dry at 212° P., and again
weigh; deduct from this weight, weight of filter paper, and
from result calculate the amount of albumin. Clinically
albumin is detennined by means of Esbaeh's albuminometer.
What is mucin? How would you recognize it in urine?
Mucin is a oompouud proteid, occurring in cement sub-
stance of connective and epithelial tissues; in bile and in
secretions of mucous surfaces.
Test; It is not preeipi tjited from urine by boiling, but is
precipitated on the addition to iirine of either alcohol, dilute
mineral acids, acetic, picric or citric acids. To detect it add
acetic acid to form a layer below urine without heating, when
at point of contact a poorly defined line of precipitate will
appear.
Describe the usual method of determining chemically
the presence of blood in the urine.
To urine add a few drops of tr. guaiaeum and then ozon-
ized ether; the ether separates and becomes of a fine sapphire-
blue should blood 'be present.
CHEMISTRY. 247
Give a reliable quantitative test for sugar in the urine.
In each of two battles of about six ounees capacity place
four ounces of urine, adding to one of the battles a small frag-
ment of yeast. Stopper the bottles loosely and place in a
warm place, allowing them to remain undisturbed for from
12 to 24 hours and then again take the specific gravity.
The loss in specific gravity in urine to which the yeast was
added, multiplied by 0.2196, gives the percentage of sugar
present.
What is alcohol, and how Is it formed?
Alcohol is a compound of a hydrocarbon radical with
hydroxyl, e. g., common alcohol, CjHgOH, formed by the
fermentation of sugar.
How Is uric acid recognized chemically?
Uric acid is recognized chemically by the murexid test:
Evaporate with a few drops of nitric acid and to the residue
add a drop of ammxmium hydroxide — a fine purple color is
obtained.
Name the antidotes in a case of stramonium poisoning.
Tannic acid, strong infusion of coffee, morphine, physo-
stigmine, pilocarpine.
What Is the principal pigment in normal urine?
Urobilin or urochrome.
Give two chemical tests that you would use In water
supposed to be contaminated by sewage.
(a) Add to the water a drop or two of dilute sulphuric
acid and enough potassium permanganate to give a decided
pink color, cover the vessel with a glass plate, and if the pink
color disappears inside of 10 minutes the water is probably
contaminated.
(b) Estimate the chlorides in the water, using a standard
solution of silver nitrate with potassium chromate as an in-
dicator. If the water contains an excessive quantity of
chlorides the presence of sewage would be probable.
CHEMISTRY.
Qive tests for the purity of chloroform.
For Chlorine: Drop the suspected ctloroform through a
watery solution of potassium iodide in a test-tube. Should
the chloroform acquire a pink color, and the supernatant
liquid become yellow or brownish in tint, the presence of
free chlorine is indicated.
For HCl : Shake the chloroform with water, and after
separating pour the water into a clean tube, and rendering
it acid with a drop of nitric acid, add silver nitrate solutioa;
should hydrochloric acid or chlorides be present a white
precipita.te will form.
For hydrocarbons: Evaporate suspected chloroform on
clean porcelain surface, when no residue should be left, nor
should there be -any foreign -odor.
For water: Add to the chloroform white anhydrous copper
sulphate; should tlie copper sulphate become blue in color
the presence of water would be indicated.
For acidity: By shaking the chloroform with water, pour-
ing off the water and testing it with a drop or two of litmus
solution, a red tint would indicate free acid.
Explain the process of bleaching with chlorine.
Chlorine bleaches organic colors only in the presence of
moisture. Chlorine unites with the hydrogen of moisture,
setting the oxygen free. In "bleaching with chlorine we make
use of a mixture of chlorinated lime and water. The fabric
to be bleached is first "soured" by passing through a
dilute acid solution. It is then placed in the bleaching mix-
ture and afterward thoroughly washed with proper reagents
to remove any excess of acid, chlorine or lime.
State the most common and convenient antidotes for
poisoning by mineral acids. State also the course to be
pursued when the poison to be antidoted is unknown.
Convenient antidotes for poisoning by mineral acids are :
Calcined magnesia, and alkaline carbonates, as baking soda,
chalk, and soap. Then use oils, fats, milk, flour, eggs.
F
CHEMISTRY. 249
If xx>isoii 'be of unknown cliaraeter administer an emetic,
as mustard and water, or use stomach pump or syphon tube.
If reason to suspect poison to be of alkaloidal nature give
tannic acid or permanganate of potassium. Milk with white
of egg is a generally useful antidote for irritant poisons.
Use ammonia, whiskey or strong coffee as stimulants, and
meet symptoms as they arise.
How would you make Fehling's solution?
Prepare in 2 parts. I. 34.639 grammes pure crystalized
copper sulphate dissolved in water and diluted to 500 Cc.
II. 173 grammes Boehelle salt and 60 grammes sodium hy-
droxide, dissolved in water and diluted to 500 Cc. For use
mix equal volumes of I. and II. Ten Cc. of the mixed solu-
tion will be reduced by 0.05 gramme of glucose.
What element composes over half the matter of the
earth?
Oxygen.
What is oxidation?
Chemical union with oxygen.
What is ozone?
An aUotropic form of oxygen, each molecule consisting of
three atoms of oxygen.
What Is Paris green?
A double salt of copper metarsenite and copper acetate.
CuCCjHjOJa. SCuCAsOJa.
What is 'the chemical name of Rochelle salts?
Potassium sodium tartrate, KNaC4H40e.
What is the chemical designation of the ordinary alco-
hol of commerce?
Ethyl alcohol.
From what substances is ether obtained?
Ether results from distilling together sulphuric acid and
ethyl alcohol.
■250 CHEMISTRY.
Name the various states in whicli matter may exist.
Solid, liquid, gaseous, and C'rookes or radiant state.
What is the difference between atomic weight and spe-
cific gravity?
Atomic weight is the i-elative weight of one atom of a
substance as compared with the weight of an atom of some
other subsrtance taken as a standard. Specific gravity is the
relation weight of one volume of a substance as compared
with the weight of an equal volume of some other substance
taken as a statidard.
Name and describe a deliquescent salt.
Potassium carbonate. K,CO,, a white granular powder,
ixiorless and having a strongly alkaline taste, veiy deliques-
cent and very soluble in water, insoluble in alcohol.
Complete the following equations:
(a) 2NH,C1 + Ca(0n),=
(b) 2KN0, + H,SO, =.
(a) 2NH.C1 + Ca(OH ), = CaCI, + 2NH, + 21130.
(b) 2KN03 + n,S0. = K,S0, + 2HN0,,.
Explain the reaction which occurs when the solution of
the two parts of a seidlitz powder are mixed.
Seidlitz powder consists of Rochelle salts, 120 grains; sod-
ium bi-carbonate, 40 grains; these are wrapped in the blue
paper.
In the white paper is placed 35 grains of tartaric acid.
HnC.H,0„ -I- 2NaHC0a = NajC^H.O, + 2II.0 -(- 2C0j.
To what salts do most cathartic mineral waters owe
their virtues?
To magiu'sium sulphate, or to sodium sulphate.
Explain the construction of the safety lamp used by
miners, and state the principle involved.
The flame of the lamp is surrounded by a fine wire gauze,
the mesh of which is very email. Each individual mesh eon-
CHEMISTRY. 251
tains its film of -air, and as air is a poor conductor of heat,
the transmitted heat of the flame is decreased below the
ignition point.
What is pepsin?
A proteolytic ferment or enzyme obtained from the glajidu-
lar layer of the fresh stomach of the hog — ^the principal fer-
ment of gastric juice. A yellowish or greyish-white powder,
soluble in water and glycerin, but insoluble in alcohol.
Mention the antidote applicable in case of poisoning
from silver nitrate.
Common salt, NaCl.
What Is a chemical symbol?
An abbreviation for the name of an element.
What is the chemical composition of ordinary alum?
Alum is a double sulphate of aluminum and potassium.
Its formula is Al^CSOJsK^SO^ . 24H2O, or, (U. S. P.),
AlK(SOJol2H20.
Write the formula of (a) common salt, (b) nitric acid»
(c) sulphuric acid, (d) hydrochloric acid, (e) . carbonic an-
hydride.
(a) NaCl; (b) HNO3; (c) ILSO^; (d) IICl; (e) CO^.
What is the simplest test of the presence of (a) an
acid, (b) iodine?
(a) Turns litmus paper red; (b) turns starch mucilage
bluish-black.
Complete the following reactions:
CaClo + Na^CO., =
(CJIJHO + C2H5HSO, =.
CaCla + Na^COo = CaCOg + 2NaCl.
(C^HJIIO + C2H,HSO,=:(C,IIJoO + H2SO4.
Mention a test for ozone. Explain how ozone may be
CHEMISTRY.
prepared in the laboratory, and compare its properties
with those of oxygen.
Gives a dark blue color to paper that has been wet with
iodide of potassium and starch mucilage. Ozone is prepared
by subjecting air or oxygen to silent electric discharges, as
in the "Siemens" induction tube, or by the slow oxidation of
moist phosphorus.
Its properties are similar to those of oxygen, save that it
acts more vigorously as an oxidizing agent and in concen-
trated form is irrespirable.
Name four elements that enter into the formation of
organic bodies.
Carbon, hydrogen, oxygen, nitrogen.
What preparation of gun cotton is used in medicine,
and what is its solvent?
Pyroxylin. Soluble in 25 parts of a mixture of 3 volumes
of ether and 1 volume of alcohol.
How may uric acid be obtained from urine?
By adding to the urine strong hj-drochloric acid, when
after the mixture has stood from 12 to 24 hours uric acid
will appear in minute crystals.
Mention the antidotes applicable in cases of poisoning
from zinc chloride.
Albimiin, white of egg in milk, magnesia in jmW. tannin.
Mention the elements that, under ordinary circum-
stances, exist as (a) liquids, (b) gases.
(a) Bromine and mercury, (b) Oxygen, hydrogen, nitro-
gen, chlorine, fluorine, argon.
Qive the preparation, formula, properties And uses of
potassium cyanide.
Potassium cyanide, KCN. Prepared by saturating potas-
sium hydroxide with 'hydrocyanic acid. A white amorphous
deliquescent salt, easily fusiWe, and smelling of cyanogen.
CHEMISTRY. 253
Very solu^ble in water, highly poisonous, used in electro-
plating, in metallurgy, and medieinally, as a cardiac seda^
tive, as a sedative addition to cough mixtures in gastralgia,
reflex headaches, nervous vomiting, etc.
Define valence, radical. Illustrate.
By valence we refer to that property by virtue of which
an element or radical will hold in combination a certain
number of atoms of another kind. Thus oxygen has a val-
ence of two, as shown in water, HgO.
A radical is an atom or group of atoms incapable of exist-
ing in an uncombined state. E. g. (SO4) a radical with
valence of II. occurring in sulphuric acid, H2SO4, and in
sulphates.
What is the formula of carbolic acid?
CeH^OH.
How ntay phosphorus be obtained? Describe the alio-
tropic forms of phosphorus.
To bone-ash add sulphuric acid and water; after stand-
ing 24 hours decant the liquid, evaporate it to dryness and
heat the residue strongly ; to this result add sand and char-
coal and distil, receiving the resultant phosphorus vapor un-
der water, where it solidifies.
Ordinary phosphorus is a translucent wax-like solid, lumin-
ous in the dark, poisonous, insoluble in water, slightly soluble
in alcohol, soluble in oils and in carbon disulphide. Red or
amorphous phosphorus is a reddish brown amorphous powder,
not luminous in the dark, not poisonous, insoluble in oils and
in carbon disulphide. There is also a ** metallic" form of
phosphorus occurring in black, needle-like crystals.
Give the formula and chemical name of each of the
following substances, indicating those soluble in watery
Nitre, Epsom salts, lunar caustic, aqua fortis, Paris green,
gypsum.
Nitre, potassium nitrate, KNO3, soluble. Epsom salts, mag-
254
CHEMISTRY.
nesium Bulpbate, MgSOj, soluble. Lunar caustic, silver ni-
trate, AgNO,, soluble. Aqua, fortds, nitric acid, HNO3,
soluble. Paris green, cuprie acetometareenite. Cu(C5H505);:
3Cu(AsOi,)i, insoluble. Gypsum, calcium sulphate, CaSO,,-
2H„0, insoluble.
What is the chemical designalion of nitroglycerin?
How is nitroglycerin manufactured?
Glyceryl trinitrate, CjHs(NOn)i. Nitroglycerin is made
by cautiously adding glycerin to a mixture of strong nitric
and sulpburic acids.
What are amins? Give an example.
They are substances which result, when the hydrogen ol'
ammonia is replaced by hydrocarbon radicals.
Example: When NH, has one hydrogen atom replaced by
CsH, it forms NHjC^H^, ethyl amin.
Define porosity, capillary attraction.
Porosity refers to that effleritial property of matter by
virtue of which spaces called pores exist between the mole-
oulea of all substances. Capillary attraction is the exhibi-
tion of the property of adhesion, between the molecules of a
liquid and the material of a tube, rod or surface wetted by
it, shown most characteristically in the rise of liquids in
small (capillary) tubes.
How do chemical antidotes and physiologfic antidotes
differ in action? Illustrate.
A chemical antidote fontis an insoluble or harmless sub-
stance by combining chemically with the poisonous substance;
thus magnesium sulphate is antidotal to soluble salts of lead,
as it combines chemically mth lead to form the insoluble
sulphate. A physioloKie antidote acts, not directly upon the
poisonous body, but by producing a physiologic action op-
posed to that which the poison occasions; thus we use atro-
pine as the physiologic antidote to morphine.
CHEMISTRY. 255
Mention two elements of each of the following: groups:
Univalent, bivalent, trivalent, quadrivalent.
Univalent: Hydrogen and chlorine.
Bivalent: Oxygen and magnesium.
Trivalent: Arsenicum and boron.
Quadrivalent: Silicon and platinum.
What is the difference between analytic methods and
synthetic methods in chemistry?
Analytical methods seek to break down compounds into
simpler bodies.
Synthetic methods seek to build up compound bodies by
the union of simpler ones.
What s^ases are usually j^enerated during the process of
destructive distillation?
If the destructive distillation be of soft coal, we find among
the gases resulting hydrogen, marsh gas, olefiant gas, acety-
lene gas, ammonia, sulphuretted hydrogen, carbon monoxide
and carbon dioxide.
Describe sulphur, and mention its important compounds.
Sulphur: symbol S, atomic weight, 32, (31.83), valence II.,
IV., found free, in volcanic regions, and in combination in
form of sulphates and sulphides. It is a lemon-yellow solid
element. No taste or odor. It is strongly electro-negative,
is non-metallic, resembles oxygen in its chemical combinations.
It is insoluble in water, slightly soluble in hot alcohol, freely
soluble in carbon disulphide.
Important compounds are, sulphur dioxide, sulphurous
acid, sulphuric acid, sulphur iodide, and hydrosulphuric acid.
Combined with metals we have many important sulphates,
sulphites, and sulphides.
What is boron? Give its principal compounds. What
is the chemical importance of boron In medicine?
Boron: symbol, B, atomic wei^t, 11(10.9) valence III., is
a rare, solid, non-metallic element, important because of its
256 CHEMISTRY.
principal compounds, boric acid HjBOj, and boras or sodioin ]
borate, NajB,Oj, both of which are antiseptic, mildly astrin-
gent and detergent. |
Describe the incandescent electric light, and explain its
use as an aid to diagnosis in medical and surgical practice.
The incandescent electric light consists of a thin glass bulb
exhausted of air and containing a filament of carbon or
platinum wire coiled in semicircle or other design. On passing
a current of electricity this filament, becaiise of the resistance
it offers, becomes incandescent, thus giving light.
The incandescent electric light has considerable value in
medicine and surgery for illuminating passages which can-
not be directly lighted: thiis we use it in the examination of
larj-ns; in the form of the cystoseope, in the bladder. It
is need also to illuminate the interior of the stomach, thus
facilitating the examination of this organ.
Give the composition and properties of chloroform.
Chloroform, CUClj, is a colorless, heavy, volatile liquid,
with speeiiie gravity about 1.5 and a characteristic sweet-
ish odor. It is soluble in 200 parts water and freely soluble
in alcohol, ether, and oils. Used for producing genera!
anesthesia, and as a solvent.
Complete the following equation and give the resulting
compounds:
2C,II,K:0j + H,SO, =
2C,H,K0, + H,SO, = K;SO. + 2HC,H,0j.
PolBssium Bulpbaie Acetic acid.
What organic acids are present In vegetables and fruits?
Citric acid, malic acid, tartaric acid, oxalic acid, gallic
acid, tannic acid, etc.
Describe and illustrate the distinction between organic
and inorganic compounds.
Inorganic compounds occur in the mineral kingdom, and
CHEMISTRY. 257
»
nmy contain any of the elementary forms of matter; the
number of atoms in the molecule of inorganic compounds is
usually small. Examples: Sodium chloride, magnesium sul-
phate.
Organic compounds all contain carbon, combined with one
or more of the following — oxygen, hydrogen, nitrogen, sul-
phur and phosphorus — there are frequently many atoms pres-
ent and the molecules are often complex. Examples : Starch,
albumin.
Give the chemical composition of (a) Glauber's salt,
(b) Epsom salt.
(a) Sodium sulphate, Na2S04. (b) Magnesium sulphate,
MgSO,.
Into what two principal groups are elements divided?
Mention five elements that exist uncombined in nature.
Into the electro-positive metals and the electro-negative
non-metals. Oxygen, nitrogen, sulphur, gold, silver.
Mention the acid constituent of bile.
Taurocholic and glycocholic acids.
What is hemoglobin? On what does its color depend?
It is the organic coloring principle of red blood corpuscles,
a compound of the iron-holding substance hematin and the
proteid substance globin.
Its color depends upon its degree of oxidation, oxyhemo-
globin in mass giving a scarlet, hemoglobin, a bluish red.
Differentiate nitrates and nitrites. Mention two com-
pounds of each group commonly used in medicine.
Nitrates are salts of nitric acid and contain the i^adical
NO.T Nitrites are salts of nitrous acid and contain the
radical NO^. Examples: Potassium nitrate, KNO3, l^a<i ti-
trate Pb(NOo). So<lium nitrite, NaNOj, amyl nitrite
CJInNO,.
17
258 CHEMISTRY.
What reaction takes place when chloral hydrate is
mixed with an alkali? Illustrate.
There results chloroform, a metallic formate and water.
CCUCOH.H,0 + KOH = CHCl, + KCOOH + H,0.
What salt of mercury is soluble in water? Give the
name and formula of a salt of silver used in medicine.
Mercuric chloride, HgCL. Silver niti-ate, AgNOj.
Describe the test for detecting Ihe presence of strych-
nine-
Dissolve a crystal of the alkaloid in a drop of strong sul-
phuric aeid on a watch-^lass, and drag tlirough the solution
by means of a glass rod a fragment of potassium dichromate,
a play of colors will be produced— dark violet-blue, purple,
cherry-red, and reddish yellow.
What is a hydrocarbon?
A hydrocarbon is an organic compound, the molecule of
which consists of carbon and hydrogen atoms only.
What is the faradic current? How is it produced?
The faradic current is an induced current of electricity
obtained by use of an induction coil. An induction coil is
constructed aa follows: A small coil of large diameter wire
is surrounded by a coil of longer and much thinner wire.
An interrupted current of electricity from a battery is sent
through the inner (primary) coil — with each "make" and
"break" of this primary current a secondary current is in-
duced in the outer (secondary) coil. This secondary, in-
duced, interrupted current is the Faradic current.
What is synthesis? Mention three coal-tar products
extensively used in medicine that are prepared in the
chemical laboratory by synthesis.
Synthesis is the act of constructing a compound body from
its component parts. Synthetical compounds used in medi-
■ cine obtained from coal tar include salicylic acid, phenacetine,
saccharin.
CHEMISTRY. 259
Differentiate a mass of matter, a chemical compound
and an elementary body.
An elementary body is a substance that cannot be reduced
to any simpler form, that is, it contains but one kind of
atom. A chemical compound is the result of the chemical
union of two or more elementary bodies. A mass of matter
is an aggregation of either elementary or comx)ound molecules.
Explain the following terms: Chemical reaction, alka-
line reaction.
Chemical reaction refers to the interchange of atoms or
radicals which occurs during a chemical change. A sub-
stance is said to have an alkaline reaction when it changes
red litmus to blue.
Describe some method for (a) analysis of water, (b) the
synthesis of water.
(a) Pass water in the form of steam through an iron pipe
heated to redness, — ^the oxygen will enter into chemical union
with the iron, forming magnetic oxide of iron, Pe304, and
hydrogen \\dll issue from the distal end of the pipe.
(b) Pass dry hydrogen over copper oxide placed in a hard
glass tube and heated to redness, — the hydrogen will enter
into chemical combination with the oxygen, and vapor of
water will issue from the distal end of the tube.
State the chemical properties of carbon. Describe two
allotropic forms of carbon.
Carbon: symbol C, atomic weight, 12(11.91), valence. II.,
rV., an electro-negative solid element. It resists the action of
most reagents but, at high temperatures, combines readily
with oxygen to form two oxides, carbon monoxide and carbon
dioxide. Combines with hydrogen to form many bodies
known in organic chemistry as hydrocarbons. It forms bin-
ary combinations with most non-metals and with a few
metals. It is non-poisonous.
An allotropic form of carbon is graphite ; an opaque, grey-
260
CHEMlSTRy.
P
i6h-'b]ack substanc* crystallizing in hexa^nal plates used hb
a lubricant, for makiag ■crucibles, lead pencils, etc. Diamond,
another allotropic form of carbon, occurs in transparent octa-
hedral crystals, of high refracting power, is the hardest sub-
stance known, and is insoluble in all liquids.
Mention the principal constituents of muscle.
Water about 75 per cent. nn<l solids about 25 per cent.
The characteristic solid is myosinogen belonging to the class
of globulins. Other substances are creatine, creatinine, gly-
cogen, glucose, lactic acid, sarcine, adenine, etc. The chief
mineral constituent present is potassium phosphate.
How is the air of an apartment tested to determine the
presence and amount of carbon dioxide in it?
A measured volume of air is drawn through two weighed
tubes; the first, containing calcium chloride, absorbs the
moisture, the second, containing potassium hydroxide, absorbs
the carbon dioxide. By the increase in weight of the
second tube the amount of carbon dioxide in the air may be
determined.
Give names and formulas of the salts of iron commonly
used in medicine.
Ferrous carbonate. FeCO„: ferrous iodide. Fel, ; ferrous
sulixhate PeSO,; ferrous lactate. Fe(C,H„0,)j. Ferric
chloride, FCjCla; ferric hydroxide. Fei(OH)B; ferric sul-
phate, Fe,{SO,),; ferric alum, Fe,(SO.)3(NH.),S0..24H,0;
ferric nitrate, Fej(NO„)„; ferric phosphaite, Pe^CPO.),; ferric
pyrophosphate. Fe,(PaO,),v There are, also, the so-called
scale compounds, salts of iron, of iron and ammonium, of
iron and potassium and of iron, quinine and strychnine, with
citric and tartaric acids.
Mention two salts of mercury commonly used in medi-
cine. Give their formulas.
Mercuric chloride HgCl,.
Mercurous chloride llgjClj. or 2IIgCl.
CHEMISTRY. 261
What conditions favor putrefaction? Wiiat conditions
may prevent putrefaction in dead organisms?
Presence of moisture, warmth, and bacteria. Putrefaction
may be prevented by the exclusion of bacteria, by exclusion
of moisture, by the preservation of low temperatures, and by
the use of germicides.
Give source, character and uses of atropine. Describe
the symptoms of poisoning by atropine.
Atropine is an alkaloid obtained from belladonna. A white,
crystalline powder soluble in 450 parts of water and in 1.46
parts of alcohol. Solutions are alkaline in nature. Typical
symptoms produced are dilatation of pupil of eye, dryness
of throat, flushing of face, talkative delirium ; later paralysis
of centric origin. Pulse at first slow, hard; later soft and
dicrotic, rapid.
Give the properties of common alum.
It is a white odorless crystalline substance of a sweetish,
strongly astringent taste, a mechanical emetic. It is soluble
in cold water, more soluble in hot water, insoluble in alcohol.
Heated, it loses its water of crystallization forming the so-
called exsiccated alum.
What metallic chemical elements are found in the body
in various combinations?
Iron, magnesium calcium, potassium and sodium.
Differentiate hydracids and oxyacids.
A hydracid is an acid containing no oxygen. An oxyacid
is an acid containing oxygen.
Give the chemistry of lithium.
Lithium, symbol Li, atomic weight, 7 (6.98), valence I.,
occurs in nature as the chloride, carbonate, and phosphate.
A soft silvery-white metal, sp. gr. 0.589, oxidizes on ex-
posure to air, decomposes water, setting the hydrogen free.
A member of the alkali group of metals.
262 CHEMISTRY.
What is the principal source of urea in the human
economy?
TJrea is the result of the oxidation of nitrogenous tissues:
it is the end product of normal nitrogenous metabolism.
Give the formula of ammonium chloride. Describe the
method of preparing ammonium chloride.
Ammoniuiu chloride, NHjCl. It is prepared by saturating
aniinomuui hydroxide with hydrochloric aoid, and evaporat-
ing the solution.
Give the chemical name and properties of (a) cream of
tartar, (b) plaster of Paris.
(a) Potassiuin-hydrocfeu tartrate or potassium bitartrate,
KHCjHjOb occurs in colorless crystals or as a white powder
permanent in air, soluble in 200 parts water; very sparingly
soluble in alcohol, is erystallizable white salt, soluble in water.
Calcium sulphate, CaSOj, a tine white, odorless and taste-
Ites powder, nearly insoluble in water. Mixed wilh one-half
its weight of water it forms a paste which hardens to a
firm pla.ster.
Give the physical and chemical properties of hydro-
chloric acid. How is hydrochloric acid prepared?
Hydrochloric acid IICl, is a colorless gas, soluble in water.
In this form, when pure, it occurs as a colorless liquid, fum-
ing in air, with caustic and corrosive action upon organic
tissues. Specific gravity is about 1.2.
It is a monobasic hydracid, and in union with, bases fomw
salts called chlorides nearly all of which are soluble in water.
Hydrochloric acid may be prepared by heating sodiam
chloride with sulphuric acid.
Describe Fehling's test for sugar in urine.
Fehling's t«st: Dilute the Fehling's solution with three
volumes of water, heat to boiling — the solution should re-
main clear — and then, to the hot solution, add the urine
drop by drop. A yellowish red precipitale of cuprous hy-
droxide and oxide indicates the presence of glucose.
CHEMISTRY. 263
Complete the following reaction:
PCla + 3H2O =
PCI3 + 3H2O = HsPOa + 3HC1.
How are the phosphates produced in the animal body?
The phosphates exist ready formed in plant foods, as
in wheat. They are also found in the animal tissues that af-
ford food for the human subject.
Give the symbol, atomic weight and the occurrence in
nature of bismuth.
Symbol, Bi. Atomic weight, 207(206.9). Occurs native
and as the 'sulphide, frequently associated with arsenic.
Give the formulas of the nitrogen acids. How is nitro-
gen prepared in the laboratory?
Hyponitrous acid, UNO. Nitrous acid, HNOg. Nitric
acid, HNO3.
Nitrogen is prepared by burning phosphorus in a confined
space until the oxygen is all removed, or, by heating ammon-
ium nitrite. NH.NOg + heat = N^ + 2H2O.
Give chemical name of (a) common table salt, (b) soot,
(c) vinegar, (d) verdigris.
(a) Sodium chloride, (b) Carbon, (c) Dilute acetic
acid, (d) Basic cupric acetate.
What reaction of urine favors the deposition of uric
acid gravel or calculi? What is the reaction of the urine
during the formation of a phosphatic calculus?
(a) A strongly acid reaction, (b) An alkaline reaction.
What is nitroglycerin? Give the medical properties of
nitroglycerin.
Nitroglycerin is, chemically, glyceryl trinitrate C3H5-
(^03)3. Made b^ the action of nitric acid on glycerin, in
the presence of strong sulphuric acid — ^is glycerin in which
three hydrogen atoms have been replaced by three NO3
radicals.
264
CHEMISTRY.
1
It is used medicinally in a one per cent, alcoholic solution,
88 a vasodilator, to relieve heart tension by lowering tht-
blood pressure.
What is (a) starch, (b) dextrin?
(a) Starch, C„H,o05, is a white odorless, tasteless carbo-
hydrate, insoluble in other, alcohol, or cold water, forming
a colloidal mucilagiuona mass in hot water. Found in all
plants, mogt abundantly in the root, soft parts, and seeds.
(b) Dextrin, C„H,„05, isomeric with starch, may be pro-
duced from it by the action of dry heat, by the action of
ferments, and by the action of dilute acids. An amorphous
substance insoluble in ether or alcohol but solutle in cold
water.
Describe and state the uses of the thermometer, the
barometer and the hygrometer.
A thermometer is a capillaiy tube containing mercury
hermetically sealed, with a bulb at the lower end and a gradu-
ated stem above. It is used to determine the degree of
temperature by the expansion of tbe mercury in the tube.
A barometer is an instrument for measuring atmospheric
pressure. Fill a long glass tube sealed at one end, with
mercury and invert it in a cup of mercury. The mercury
in the tube will fall until its weight is just balanced by the
atmospheric pressure. Ordinarily the height of the mer-
cury column will be about 30 inches. As the atmospheric
pressure lessens, the mercury falls, as the atmospheric pres-
sure becomes greater, the mercury rises.
A hygrometer is used to determine the degree of humidity
of the atmosphere. The most usual form of instrument is
that known as the "Dry and Wet Bulb" — -two thermometers,
side by side, the bulb of one exposed to the air, the bulb of
the other kept constantly wet by threads of cotton dipping
in a compartment containing water. The drier the air the
greater the difference in temperature reading between the two
instruments. Tables have been prepared by which the exa^t
humidity of the atmosphere may be determined.
CHEMISTRY. 265
Explain the method of producing: X or Roents:en rays.
The X or Boentgen rays are produced by passing a current
of electricity of high potential through a glass tube that has
been, as far as possible, exhausted of air.
(a) Express in cubic centimeters of distilled water the
value of one ounce avoirdupois, (b) How many minims
does a cubic centimeter contain?
(a) 28.3 Cc. (b) 16.2 minims.
What is hydrogen sulphide? Show by formulas and
equation how it is obtained by the action of hydrochloric
acid on calcium sulphide.
A compound of sulphur and hydrogen, HjS, a colorless
iras of offensive odor.
CaS + 2HC1 = CaCla + H^S.
What salt forms the tartar deposited on the teeth?
From what source is the tartar derived?
Chiefly calcium phosphate, with a little calcium carbonate,
and salts of the alkalies. These salts are mixed with silica,
organic matter and bacteria. The tartar is derived from
food residues and from the saliva.
What are the properties of antimony? How is it found
in nature?
Antimony: symbol, Sb, atomic weight 119 (119.3) valence,
III., v., is a bluish-white, brittle, crystalline metal. Ignites
at a red heat forming SboOg.
Used chiefly in alloys, it increases hardness, lowers fusion
point, gives smoother surface, causes expansion of alloy when
cooled after fusion, gives rigidity to soft metals. Antimonv
occurs in nature chiefly as the sulphide.
(a) What is an amorphous substance? (b) What are
isomorphous substances?
(a) A substance, not crystalline having no regularity of
internal structure, (b) Substances which crystallize in the
same form.
266
CHEMISTRY.
Give uses of the urinometer. State its importance i
an aid to diagnosis.
It is used to determine the specific gravity of the urine.
Taken into considei'ation wilh tlie amount of urine passed, it
indicates the amount of solid matter being excreted by the
kidney. Certain diseases present a lessened excretion o£
solids, others an increased excretion; the determination of
this factor, then, may be of importance in deciding upon the
condition actually present. By it we learn of the condition
of the kidney function and also of the body metabolism.
Describe potassium.
Potassium; symbol, K, atomic weight, 39(38.86), valence
I., a soi^ silver-white metal, oxidizing in the air, and de-
composing water in the cold with liberation of hydrogen gas
and the formation of potassium hydroxide. It melts below
the boiling point of water, is lighter than water, and is one
of the most electro- positive of metals.
Write a chemical equation showing a double decompo-
sition.
AgNO, -1- HCl = A^ + HNO,.
Give the physical and chemical properties of mercury.
How is mercury obtained from the native ore?
Mercury: symbol, Hg; atomic weight, 198.5; valence, II; is
a silver-white metal liquid at ordinary temperalui'cs, 13i^
times heavier than water; it is volatile at all temperatures,
opaque, insoluble in water, soluble in nitric acid. Chem-
ically, it is electro-positive, and capable of forming two dis-
linet classes of compounds — the mcrenrouB and the mercuric.
It forms alloys {amalgams) with most metals. Mercury is
obtained from cinnabar, IlgS, by roasting the ore, thus burn-
ing out the sulphur and distilling over the mercury.
Define decay.
Decay refers, generally, to the slow oxidation, resulting
in the decomposition of organic substances.
CHEMISTRY, 267
Describe distillation, filtration and precipitation as ap-
plied to processes for purifying drinking water.
There are two forms of distillation practiced, the oontinu-
ous and the intermittent. In continuous distillation the
water is fed constantly into the retort, and the distillate con-
tains the gases and volatile products produced from the
organic matter present. Such a water acquires a disagree-
able odor and taste on standing, but is of course free from
germ life. In intermittent distillation a given amount of
water is introduced into the retort, the first part of the dis-
tillate is rejected, this containing the volatile organic pro-
ducts, then a middle portion is saved, and the final portion
left in the retort is rejected. By this process we get a pure
water which requires, however, to be aerated to be palatable.
Filtration on a large scale is through beds of sand and
gravel. Suspended matter is removed and bacteria are
largely destroyed. On a small scale filtration is generally
through porcelain, suspended matter and bacteria are held
back by the smallness of the interstices in the filtering me-
dium. Such filters must be frequently and thoroughly
cleansed.
Precipitation is effected by the addition to the water of
one or more substances which shall piH)duce a voluminous,
more or less gelatinous, precipitate. In this will be carried
down the suspended matter and the major part of the germ
life. Iron salts, and alum, are among the chemicals gener-
ally used.
What is freezing? State the Fahrenheit freezing point
of (a) water, (b) alcohol, (c) mercury. ,
Freezing is the change of a liquid to a solid upon the
lowering of temperature.
(a) 32^ F. (b) — 40° F. (c) 202.9° F.
Complete the following equation:
C,HjOII -f- NaQIIjO, + H^S04 =
C,HjOII -f NaCjHA H" H^SO^ ^ CaHjO,fI,0, -h NallSO^ -|- 11,0.
268 CHEMISTRY.
Explain the difference between a sulphate and a sul-
phite.
A sulphate is a salt of sulpliiirii! add and contains the
acidulous radical, SO,.
A sulphite is a salt of sulpinirous acid and contains the
aeiduloiis radical, SOj.
Name the elements in the potassium group, and give
their physical and chemical properties.
Lithium, sodiuiJi, potassium, and the rare metals, rubidium
and caesium.
All are white metals, the softest being but little harder than
wax. They melt below the boiling- point of water, oxidize in
air, decompose water liberating hydragen. All arc strongly
electro-positive, forming strong alkaline bases — oxides and
hydroxides. Eaoh communicates a distinctive color to flame
when incandescent. All ai-e monads, their carbonates all
vaporize unchanged when heated. The carbonates and phos-
phates of all are freely soluble in water.
Describe the element silver, stating its compounds and
their uses in medicine.
Silver: symbol, Ag, atomic weight 107 (107.12), valence I.,
a pure white metal, ductile and malleable, the best conductor
of heat and electricity. Specific gravity 10.5.
Silver wire is used in surgery.
The compounds used in medicine are the oxide, nitrate,
the cyanide and iodide. Tiie nitrate is used in the solid
state as a stimulant and caustic, and. internally, in solution,
as an astringent and alterative especially in stomach and
bowel disturbances.
Name five compounds of nitrogen and oxygen, and give
their formulas.
Nitrous oxide or nitrogen monoxide, N,0; nitric oxide or
nitrogen dioxide, NjOj; nitrous anhydride or nitrogen tri-
oxide, NjOjj nitric anhydride or nitrogen pentoxide, NjOb:
nitric peroxide or nitrogen tetroxide, NOj,
I
CHEMISTRY, 269-
What Is the presumption as to abnormal constituents in
urine having a specific gravity of 1005 or less? What
tests should be applied, and how, to verify the surmise?
It indicates a greatly decreased excretion of solids by the
kidneys or an excessive polyuria ; this may be due to lack of
nervous control over excretory function of kidney, as in
hysteria, chorea, etc., or it may be from large imbibition of
fluids. It may be due to diseased conditions of kidney with
destructive changes in structure. Such a low specific grav-
ity always calls for a careful examination for albumin, which,
if present and accompanied by urinary casts, would indicate
a structural disease of the kidneys. Tests for albumin have
been given.
What are the differences between common alcohol and
absolute alcohol?
Absolute alcohol contains not more than 1 per cent, of
water and this is in chemical combination with the alcohol.
Sp. gr. not higher than 0.797 at 15.6° C.
Common alcohol contains about 7.7 per cent, of water,
partially in mixture and partially in combination with the
alcohol. Sp. gr. about 0.816 at 15.6° C.
Complete the following equations:
C,II,Cl + AgIIO =
CaCOa + 2HC1 =.
CoH.Cl + AgHO = AgCl + C JI5OH.
CaCbg + 2I1C1 = CaClo + ILO + COo.
What are the physical and chemical properties of SOo?
It is a heavy colorless gas, dissolving in and chemically com-
bining with water to form sulphurous acid. It has a suffo-
cating, irrespirable odor, can be liquefied and solidified. It
will not support combustion nor will it burn. It has a power-
ful aflfinity for moisture, forming, therewith, sulphurous acid.
Sulphur dioxide is useful as a bleaching agent and as a
disinfectant.
p
CHEMISTRY.
What is reduced iron (ferrum redactum) and how is il
obtained?
It is a chemjeally pure form of iron oocurring in fine
powder. It is obtained by passing dry hydrogen gas over
heat«d ferrio oxide in a tube
Describe ethyl oxide, giving derivation, ordinary name,
chemical formula and mode of production.
Ethyl oxide, ordinary ether, (CiHoJ^O, is obtained by the
replacement of two hydrogen atoms in a molecule of water
by two ethyl radicals. It is manufactured by distilling a
mixture of alcohol and sulphuric acid.
c.njiso. + c,H,OH = (c,n,)„o + h„so,.
What is the presumption as to abnormal constituents in
urine having a specific gravity of 1038?
Suth urine will probnbly be found to contain glucose.
Give an equation showing the reaction when NH^ comes
in contact with an acid.
Nil, + IIC1 = NII.C1.
Define emulsion, soap.
An emulsion is a liquid holding in suspension oil in so finely
divided a condition, that, the individual drops are invisible
to the naki-d eye. There is generally required to be present
a substance of mucilaginous nature.
A soap is a metallic salt of a fat acid. It is usually a
potassium or sodium salt of oleic, stearic or palmitic acid.
Give the sources and explain the uses of benzene.
Cnllfl, benzene. It is found in the lighter oils produced
in the distillation of coal tar.
It is used as a solvent for fats, oils, resins, and many
other orgajtic su'bBtances. Used in medicine as an anti-
spasmodic and anticatarrhal remedy.
CHEMISTRY. 271
What Is an alkaloid? Name three alkaloids used in
medicine.
An organic nitrogenous substance, basic in character, cap-
able of combining directly with acids to form salts. The
volatile alkaloids contain carbon, hydrogen, and nitrogen;
the non-volatile alkaloids contain carbon, hydrogen, nitrogen
and oxygen. Examples: strychnine, quinine, and morphine.
State the chemical meaning of the term incompatible.
Chemically, substances are incompatible when on mixing
their solutions there results an insoluble body, or a new sub-
stance having markedly different properties ; or when two or
more substances, in themselves harmless, form a poisonous,
explosive, or inflammable substance when brought in contact;
or if bringing them together impairs in any other way their
individual characteristic properties.
State the use and the principle underlying the use of
the blow-pipe.
The blow-pipe serves to provide, and to concentrate at a
particular point, a jet of flame of extremely high temper-
ature, this high temperature being attained by the perfect
combustion resulting from the mixing of the air with gas be-
fore the latter burns.
Define electricity.
Electricity is that physical force generated by chemism,
magnetism or friction, which manifests itself by producing
attraction or repulsion between certain substances, and gives
rise to heat, light, magnetism, and chemical action.
(a) In what compound is sodium most abundant? (b)
In what calcium? (c) In what hydrogen?
(a) Sodium chloride, (b) Calcium carbonate, (c) Water.
What is glycerin and how is it obtained?
Glycerin, CgHsOg, or Call, (Oil) 3. It is a tri-atomic al-
cohol derived from propane, CjHg. Made by decomposing
272 CHEMISTRY.
fat either by means of superheated steam, or by heating t
fat with an alkali.
Explain the difference between it galvanic and a fsradic I
current.
A galvanic eiiri'eiit rc-siilts from chemieal action, and I
but low potential with large quantity. Its direction of fl
is always the same. A faradic current is an induced cun'eirf
obtained by use of on induction coil. Such a current pes-
aesses high potential, small quantity, and its direction of
flow is to and fro, or alternating.
What products of phenol are of interest in medicine?
The phenates or carbolates, e. g. sodium pbenatc; the
phenols ulpbonates, and trinitrophenol or picric acid. Sali-
cylic acid and its various products may be syntbeticaily pre-
pared from phenol.
Designate the following as chemical or physical changes:
(a) The souring of milk, (b) Decomposition of sunlight
by means of prisms, (c) Converting water Into steam.
(d) Dissolving salt in water, (e) Decay of wood.
(a) Chemical; (b) physical; (e) phj-sieal; (d) physical;
(e) chemical.
Mention the chief properties of nitrogen.
Nitrogen: symbol N. atomic weight, 14, (13.93), valence
in., V„ is a colorless, odorless, tasteless gas, a little lighter
than air, in«onibustible, a non-supporter of combustion, does
not support life, is not poisonous.
What metal is liquid at ordinary temperature?
Men-ury,
Mention a substance containing albumin, (a) as a liquid,
(b) as a solid.
(a) Blood, (b) Albumin exists naturally only in solu-
tion, an example of a solid (coagulated) albumin would be
the white of a hard-'boiled egg.
CHEMISTRY. 273
What is the chemical cause of spontaneous combustion?
An active oridation or other chemical change resulting
in the development of sufficient heat to cause self-ignition.
Describe a test for the presence of organic matter in
water.
Distill the water until free from ammonia, then add to
the residue in the retort an alkaline solution of potassium
permanganate, when if, on again distilling, ammonia ap-
pears in the distillate, the presence of organic matter would
be indicated.
Give the names and formulas of five acids used in med-
icine.
Nitric acid, HNO3; sulphurous acid, H2SO3; hydrochloric
acid, HCl; phosphoric acid, H3PO4; acetic acid, HCaHjOj.
Mention the elements existing uncombined in nature.
Hydrogen, oxygen, nitrogen, carhon, sulphur, gold, silver,
platinum, copper, mercury, and a few other metals.
What is carbon dioxide? Give its formula, properties,
uses, and mode of production.
Carbon dioxide, CO2, a colorless gas, generally with a faint
acid odor, soluble in water, a non-supporter of combustion
and incombustible. It will not support life but is non-pois-
onous. Carbon dioxide is produced by respiration of ani-
mals, by the complete burning of carbonaceous matter, by
heating many metallic carbonates, and by treating carbon-
ates with acids. It is used in making **soda water*' and
other artificial effervescent drinks; liquified COo is used for
freezing purposes. It is essential to plant life.
When and why is a flame produced by combustion?
When the combustion is sufficiently rapid and active to
raise the temperature to the ignition point.
Give the preparation of Fowler's solution, and describe
the salts contained in it.
Boil one part arsenious oxide with two parts potassium bi-
18
CHEMT8TRT.
cart)onate in 94 parts water and add three parts eonipound
tincture of lavender. The solution so made contaius po-
tassium metarsenite, an easily soluble compound of arsenic,
not used in the solid state,
As,0, + 2KHC0, = 2KAsO, + ILO + 2C0,.
What is chloroform and how is h made?
Chlopofonii, triehlormethane, CHC1„. It is a heavy color-
lees liquid, specific gracity of 1.5, with a characteristic etheriaJ
odor and a aweet buniing taste. Boils at 60-61° C. Pre-
pared by the action of "bleaching powder" on alcohol, by
the action of "'bleaching powder" on acetone, and by the
action of an alkali on chloral.
Describe and illustrate alcoholic fermentation.
Alcoholic fermentation is the decomposition of a sugar by
a ferment, with the pi-oducfion of carbon dioxide and alcohol.
C„ir,,0„ = 2CO., + 2aH,OH.
What is ethyl hydrate? Give its formula and state
how it is produced.
Elhyl hydrate, CJlnOII. is ordinary alcohol. It is pro-
duced by the fermentation of glucose.
Complete the following equations:
2NaC! + Ag.SO^ =
BaO, + CO^ + H^O =
2NaCl + Ag.SO. -- 2AgCl + Na,SO.
BaO, + CO, + H,0 = BaCO, + 11,0,
Define matter.
Matter is that which has weight, and occupies apace.
Define and illustrate osmose.
Osmose is that property' by which liquids and certain sub-
stances in solution pass through porous partitions. Thus, if
copper sulphate in solution be placed in an unglasied earthen-
ware vessel, and this be set in a larger vessel containing dis-
tilled water, the salt will pass through into the water (ex-
CHEMISTRY. 275
osmose) , while the liquid in the inner vessel will increase in
quantity (endosmose).
Give an illustration of decomposition by (a) heat, (b)
electricity, (c) light.
(a) Mereurie oxide heated, fields oxygen and mercury.
(b) Pass a galvanic current through water and the latter
will be decomposed, hydrogen and oxygen being set free.
(c) Expose silver chloride to the action of sunlight; it un-
dergoes decomposition, producing a subchlorid of silver, and
changing in color from white to grayish- violet.
What is a compound radical? Give three examples of
compound radicals, indicating the valence of each,
A compound radical is a group of atoms capable of play-
ing the part of an elementary substance and incapable of
existing in the free state.
Examples : NO3, valence I. ; SO4, valence II. ; PO4, valence
III.
Describe the medicinal uses of oxygen, stating how it is
brought to the bedside and how it is applied.
Oxygen gas subjected to pressure is licpiefied and stored in
steel cylinders. The gaseous oxygen from the cylinder
is conducted into a rubber bag, and from this through a wash
bottle containing a small quantity of water. In the use of
the oxygen we secure a continuity of flow by allowing the bag
to fill with the gas and then compressing it. Oxygen is in-
dicated wherever respiration is embarrassed, in pneumonia,
pleurisy, asthma, etc. It is also used for its general stimulant
effect.
State the composition, mode of preparation and prop-
erties of sal ammoniac.
Sal ammoniac, ammonium chloride, NII4CI, prepared by
saturating h\^lrochloric acid with ammonia. It is a white
crystalline soluble substance with saline taste and neutral
p
276 CHEMISTRY.
propertaea. It yields ainmonia gas when heatol with strong
bases. Used in medicine as an alterative and as a stimulate
ing expectorant.
What are the distinguishing characteristics of urates
and of uric acid as deposited in the urine?
Uric aeid is deposited in reddish grains which settle rap-
idly to the bottom of the vessel and are not dissolved on
warming.
Urates form generally a more bulky sediment, pink or white
in appearance, settling more slowly, and easily dissolved on
warming.
Both uric acid and urates respond to the murexid test.
Under the microscope uric acid appears in yellowish lozenge-
shaped crystals often in rosette-like groups, while urates are
generally amorphous or semi -crystalline.
Mention two substances that are fusible, two substances
that are volatilized by heat, two substances that are un-
affected by heat.
Lead and iron are fusible. Iodine and sulphur volatilize.
Carbon and silicon in absence of air, are unaffected by heat.
Describe iron and Its preparations. Why is iron pre-
scribed in anemic conditions?
Iron: symbol, Fe, atomic weight, 56 (55.5), valence II.,
rV., (Pe^VI), specific gravity 7.84, a gray-white metal, with
very high melting point, the most tenacious of metals, ductile
and malleable.
It oxidizes in air in the presence of moisture and oceura
in nature chiefly in the form of oxides.
Preparations frequently used: Ferric chloride, ferric sul-
phate, ferric acetate, ferric hydroxide, ferrous sulphate, fer-
rous carbonate, and the metal itself; organic salts of the
metal, as the peptonate, albuminate, eitrat*, and tart.rate.
Iron is prescribed in anemic conditions to afford the neces-
sary element for the making of red blood corpuscles.
CHEMISTRY. 277
Give illustrations differentiating combustion, fermenta-
tion, putrefaction and decay.
Heat wood in air and it undergoes change into carbon
dioxide, water, and a residue, called ash. This change, com-
bustion, is accompanied by a rise in temperature and the
production of a flame. Wood exposed to air and moisture
for a lengthy period of time, slowly undergoes destructive
change, a decay, yielding finally the same products as those
produced in combustion.
Fermentation is tlie decomposition of complex substances
by organized ferments or by enzymes. As an example we
have the conversion of glucose into alcohol and carbon dioxide
by the organized ferment, yeast.
Putrefaction is the decomposition of nitrogenous organic
matter by the action of bacteria.
Explain the use of symbols and formulas. Give and
translate five examples of each.
A symbol is used as a representation of one atom of an
elementary substance. A formulii, an aggregation of sym-
bols, represents one molecule of a substance.
Oxygen, 0 ; chlorine, CI ; bromine, Br ; nitrogen, N ; hydro-
gen, H.
HNOs, nitric acid; H0SO4, sulphuric acid; PbO, litharge;
NH3, ammonia; NaCl, sodium chloride.
What is the source of tartaric acid? What is its use in
medicine?
It is obtained from argol, the impure cream of tartar de-
posited during the fermentation of grape juice. It is used
pure in the seidlitz powder, occasionally as an antiscorbutic,
etc. Used chiefly in the form of its salts, cream of tartar,
Rochelle salt, and tartar emetic.
Explain the principle of the action of yeast.
Under favoring conditions of proper temperature, presence
of moisture, and of air, the yeast plant causes, by its growth,
CHEMISTRY.
such a rearranpemeat of the atonis of C, H and 0 in glucose
Hs to produce fi-om one luoloeule of glucose two molecules of
alcohol and two molecules of carbon dioxide gas.
How is an excess of urates determined in a sample of
urine?
To 200 Ce. of urine add 20 Co. of strong hydroeloric add
and let the mixture stand 48 hours. The urates will be de-
composed and uric acid deposited. Collect the sediment on
a previously wrighed filter paper, wash, dry, and weigh again.
What antidote should be employed in a case of strych-
nine poisoning?
At once adiiiinister an emetic and tannic a«id, then give
potassium bromide in drachm doses; if convulsions occur use
inhalation of ether or chloroform. Uao rectal injections of
chloral, etc.
Define hydride, specific heat, haloid salt.
A hydride is a binary compound containing hydrogen an:d
one other element.
By specific heat we mean the amount of Tieat given off or
aihsorbed 'by a definite weight of a substance in undergoing a
measured change of teinpierature, as compared with the
amount of heat given oft' or absorbed by an equal weight of
water in undergoing the same change in temperature.
A haloid salt is one containing a metal or basic radical in
combination with a member of the halogen or chlorine group.
in u-hat respect does sterilized milk differ from raw
milk?
The sterilizing of milk coagulates the lactalbumin and
the globulin, and modifies the casein. On acidifj"ing the ster-
ilized milk all the proteitfe are precipitated at once in a firm
curd not easily digested. In sterilizing milk, germs thait
may be present are killed.
CHEMISTRY.
279
Complete Ihe follouinj; equations and write the name
of each resulting compound under its formula:
Aa,0, + 3H,S =
n,SO, + NaNO, =
As,0, + 3H,S = AsjS, + 3H3O
Araenic trinulphide. Water.
H,SO, + NaNO, = NaliSO. + HNO,
Sodium livdrogen »iilp1iBle. Nilric >cid.
Explain the chemistry of a candle flame.
Candle flame shuws three distinct zones: Inner one con-
sisting of vaporized hydi-ocarbous gives no illumination and
ncarcely any heat. Middle ilaiue, the illuminating flame,
(Consists of solid carbon in fine subdivision rendered in-
candescent by the hea-t due to the combination of oxygen
»-itii hydrocarbon vapors, gives a large amount of heaiL
Third or surrounding zone, darker in color, contains solid
particles of carbon, as soot, also carbon dioxide and vapor
of water, as a result of the burning of tlie hydrocarbon
vapors, supplies but little heat or light.
Write the chemical name and formula for laughing gas.
Nitrous oxide, or niTm>reii iiionoxide. X.O.
What is the chemical change which occurs in the making
of malt?
Starch under the action of a ferment is changed to maltose,
through ehemical union with water.
2C„11,^0, + 11,0= C,,H,,0,.-
Explain how water containing organic impurities may
become purified by running in a shallow stream or over a
precipice.
All [>arts of the water and its contained impurities are
brought in contact with atmospheric oxygen ; the organic
matter is oxidized and decomposed.
What is ammonium?
Ammonium, Nil,, is a basic radical forming compounds
280 CHEMISTRY.
similar to those of the alkali metals. Its relation to ammonia,
NH„ is shown in the manner of formation of its compounds,
e. g. ammonium ehloride, NII3 + HC1 = NH,C1.
Alention a te&t of CO^, and also its chief properties.
When passed into clear lime-water it produces a white
precipitate of ealeium carbonate. Carbon dioxide is a gaa
about iy2 times the weight of air, a non-supporter of com-
bustion and incombustible, produced by the complete oxi-
dation of carbon. It is colorless, has a faint acid odor, and
is soluble in water.
What elements enter into the composition of all alka-
loids?
Carbon, hydrogen, nitrogen, in volatile alkaloids. Carbon,
hydrogen, nitrogen and oxygen, in fixed alkaloids.
Explain an experiment to prove that chemical action
may be induced by light.
The sun's rays or diffused daylight will bring about chem-
ical union between hydrogen and chlorine to form hydro-
chloric acid, this union being accomplished with explosive
violence. Mix equal volumes of hydrogen and chlorine in a
glass jar and place in the sunlight.
What is the technical name of (a) aqua regia, (b) aqua
fortis, (c) oil of vitriol?
(a) Nitro-hydrochloric acid ; (b) nitric acid; (e) sulphuric
I
Describe the properties of hydrogen, and mention a test
to prove that it will not support combustion.
It is a co!orles.s, tasteless, odorless gas, lightest of the well-
known elementary gases; burus in air or oxygen; will not
support. 'combustion nor animal respiration. It is strongly
electro- positive. A proof that it does not support combustion
is afforded by plunging a lighted taper into a jar of hydro-
gen, held mouth downward; the flame of the taper is extin-
4
CHEMISTRY. 281
guished, although the hydrogen may bum at the mouth of
the jar.
Give the composition of aqua ammoniae.
Ammonium hydroxide NH^OH, is theoretically composed
of one molecule of ammonia gas, NH3, dissolved in and chemi-
cally combined with one molecule of water. The aqua am-
moniae of the U. S. P. is an aqueous solution of ammonia
containing 10 per cent, by weight of the gas.
What is peroxide of hydrogen?
Peroxide of hydrogen or hydrogen dioxide, H2O2, in its
purest form, is a syrupy liquid. The usual strength in com-
merce is a 3 per cent, by weight solution gi^^ng off 10 volumes
of available oxygen.
Account for the poisonous property of illuminating gas.
The poisonous action is due to the presence of carbon
monoxide and in less degree to carbon dioxide, various hydro-
carbons and sulphur compounds.
What is the normal reaction of (a) saliva, (b) bile?
What causes the reaction?
(a) Alkaline, from the presence of bicarbonates and phos-
phates of the alkalies and alkaline earths; (b) alkaline, from
the presence of alkaline carbonates, and the sodium salts
of organic acids.
Give formula for (a) mercuric chloride, (b) sodic sul-
phate, (c) potassium chlorate, (d) cupric nitrate, (e) cal-
cium carbonate.
(a) HgCl^; (b) Na,SO,; (c) KCIO3; (d) CuCNO.,),; (e)
CaCOg.
Define saturation.
«
The term saturation, applied to a liquid, means that the
liquid holds dissolved all of a solid or gaseous body that it is
capable of dissolving.
CHEMlSrHY.
Discuss the value of sulphur as a germicide.
Sulphur will act as a germicide only when oombined with
oxygen to form sulphur dioxide.
In its treriiiieidal action, the sulphur dioxide extracts mois-
ture to form sulphurous acid and this acta as a deoxidizing
or reducing agent.
Practically it imist be remembered, that sulphur dioxide
is a bleaching agent, so that care must be taken to remove
from the room colored fabrics of value.
By what forces can (a) a solid be changed into a liquid
or a gas, (b) a gas be changed into a liquid or a solid?
(a) By heat or by lessened pressure; (h) by cold or by
increasing pressure.
What is the composition of bailing powders? How are
they adulterated? What is their mode of action?
They all c<mtain sodium bicarbouale mixetl with an acid
salt a.s potassium bi-tartrate, or a weak acid.
In the presence of heat and moisture their contained chemi-
cals i-eaet with the evolution of earbon dioxide.
KHC.H.O, -t- NaTICO, -- KNaC.H,0„ + 11,0 + CO,.
Among adulterants are aium, flour, chalk and gypsum.
What is turpentine?
Turpentine. Cmll,,,, an essential oil, is a hydrocarl)ou ob-
tained fmm the exudate of pine trees.
State the properties and uses of H^SO,.
Sulphuric acid, ILSO,, a heavy corrosive liquid, colorless
when pure but often brown f i"om presence of carbon. It has
a strong affinity for water, the union of the two being accom-
panied by the evolution of heat. It is one of the most im-
portant of all known manufactured substances, being used
directly or indirectly in a great variety of industries. It is
an important chemical reagent and forms many salts of ira-
porlanee medicinally.
CHEMISTRY. 283
How does diet affect the elimination of urea?
A nitrogenous diet tends to increase the elimination of urea.
A restricted diet, starvation, or a non-nitrogenous diet
diminishes the elimination of urea.
Disease accompanied by rapid or long-continued tissue
changes, as during high fevers, may be accompanied by in-
creased elimination of urea even in the absence of a nitro-
genous diet.
What are bromides, iodides, chlorides?
Bromides are salts of hydrobromic acid; ioiiides are salts
of hydriodic acid; and chlorides are salts of hydrochloric
acid.
Write the formula of (a) sulphurous acid, (b) acetic
acid, (c) hydrochloric acid, (d) water, (e) cupric sulphate.
(a) H^SO,; (b) IICJI3O2; (c) HCl; (d) ILO;(e) CuSO,.
What are mineral waters?
^lineral waters are such waters as contain too great a quan-
tity of dissolved mineral salts to warrant their use for ordi-
nary drinking purposes.
They possess various medicinal virtues in axjcordance with
the particular kind of mineral salts contained.
Give the composition of water by volume and by weight.
Water is composed of two volumes of hydrogen and one
volume of oxygen.
Water is composetl of two partes by weight of hydrogen
with 16 parts by weight of oxygen.
Give test for the presence of sulphuric acid in vinegar.
To vinegar add a few drops of a solution of barium nitrate,
when, should sulphuric acid be present, there will form a
white precipitate insoluble in acids.
How may the presence of arsenic in wall-paper be de-
tected?
Use the Reinsch test : The paper, torn into fragments.
284
CHEMISTRY.
is placed in a beaker along with hydrochloric aeid and water,
bring to a boil and introduce a strip of clean copper foil.
If a gray coating form on the copper dry it carefully and
heat in an ignition tube. If the coating be due to arsenic
it will be volatilized and will deposit on the cooler portion of
the tube in crystals of arsenious oxide.
What chemical changes take place in decaying bodies?
All the body tissues including the complex albuminoid
substances are split up, by decomposition, info simple suli-
stanees. Among these products of decomposition, are pep-
tones, ptomaines, leucin, tyroisin, amines, acids, ammonia, am-
monium sulphide, hydrogen sulphide, etc. Finally we have
produced, simply, water, carbon dioxide, ammonia, hydrogen
sulphide, and miueral residues.
What is the antidote for poisoning from hydrocyanic
acid?
Hydrogen dioxide. There is also used a soluiion of mixed
ferrous and ferric sulphates with sodium or potassium hy-
droxide or carbonate added. Use ammonia by inhalation,
artificial respiration, faradism to the heart.
What antidotes should be used in phosphorus poison-
ing? Why?
Copper sulphate in solution acts antidotally to phos-
phorus tlirough producing an insoluble copper phosphide.
Old French ozoniaed oil of turpentine acts as an antidote
to phosphorus, by osidizing it to a comparatively harmless
form.
What double salts of tartaric acid are used in medicine?
Double tartrate of potassium and sodium, or Koehelle salt.
Double tartrate of potassium and antimony (SbO), or
tartar emetic.
Double tartrate of potassium and hydrogen, or cream of
CHEMISTRY, 285
Mention five common vegetable poisons, and state tlie
antidote for one of tliem.
Opium, belladonna, aconite, digitalis, nux vomica.
Antidotes to opium are permanganate of potassium, atro-
pine, caffeine.
Describe tlie preparation of liydrogen dioxide, writing
tlie reaction. Give uses of hydrogen dioxide.
Mix barium dioxide with water, pass COo gas through
the mixture, filter, concentrate the filtrate by evaporation in
vacuum over strong sulphuric acid. BaOo + HaO + CO2 =
BaCOg + H2O2. Made also by the action of an acid on barium
dioxide BaO^ + H.SO, = BaSO, + HoOo. Uses : For bleach-
ing, disinfection and for destroying pus; it is a strong oxid-
izing agent.
Complete the following equations:
CuSO, + 2K0II =
NaIIC03 + HCl =
CuSO, + 2K0I1 = Cu(OH)o + K^SO^.
NaHCOa + HCl = NaCl + H^O + 00^.
Describe an electric battery, and explain the operation
of the chemicals used.
An electric batteiy is composed of several cells. An elec-
tric cell may be made as follows: Two plates of dissimilar
substances are immersed in an acid or other fluid which acts
upon one of the substances more than upon the other. If
these two plates are joined outside of the cell by a wire a
current of electricity will flow, from one plate to the other
through the liquid, returning by the -connecting wire. If the
plat.es are made of carbon and zinc, and the solution used is
dilute sulphuric acid, the zinc plate will gradually dissolve,
zinc sulphate will a-ccumulate in the solution, and hydrogen
gas will be given off at the carbon plate. The current is
.said to flow from the zinc Xo the carbon through the liquid,
and from the carbon to the zinc through the connecting wire.
b
CHEMISTRY.
Give the sources and uses of ammonia in medicine and
in the arts.
Animonia is obtained from the animoniacal liquor produced
in Ihe manufacture of illumJnating gas from coal. The gas
may 'be obtained in a pure state by heating a salt of amnion-
witb a strong base.
Amniouia is used in medicine as a cai-diac and a general,
quickly-acting, stimulant. In the arts it is used as a volatile
base, as a cleansing, detergent substance, jis an ant-acid.
Show by equation how nitric acid is formed by the action
of sulphuric acid on potassium nitrate. How is nitric acid
distinguished from the other mineral acids?
2KN0;, + IKSO, = 2HN0,, + K.,HO..
Nitric acid in contact with metallic copper j-ields a greenish-
blue liquid, and gives rise to orange-red fumes of N.O4, this
action not being brought about by any other of the mineral
acids.
Indicate by chemical sign and symbols the reactions
that occur when (a) a phosphorus match is lighted in the
air, <b) sodium is placed on the surface of the water, (c)
hydrochloric acid is poured on marble, (d) two portions
of seidlitz powder are mixed in water.
(a) P, + air(500 = 2PA,-
(b) Na, + H,0 = Na,0-f Hj; then Na,0-f 11,0 = 2NaOH.
(c) 2HC1 + CaCO, = CaCl, + H,0 + CO^.
(d) KNaC,H,0, + NaHCOs + H,C,H,0,=
KNaC,H^O„ + NallC.HjO. + H^O + CO,.
Describe the chemistry of alcohols and ethers.
An alcohol ia a compound of a hydrocarbon radical witii
hydroxy 1.
An ether is an oxide of a hydrocarbon radical.
What treatment is indicated in a case of poisoning by
mercuric chloride?
Administer albumin, of eggs, milk, flour, etc., and then
CHEMISTRY. 287
use stomach pump, or emetic, to at once remove the newly
foniied albuminate of mercury. Repeat this process several
times.
Explain the constitution of the fats and the process of
saponification.
A fat is a chemieal union of glycerin with a fat acid.
If a base, such as caustie potash, be boiled with a fat, the
glycerin is separated from the acid, and the latter combines
with the base to form a salt known as a soap.
Complete the following equations:
AgN03 + NaCl =
SiOo + HF =
AgNOa + NaCl = AgCl + NaNOg.
SiO. + 4IIF = SiF, + 211.0.
Find the weight and the volume of hydrogen contained
in 17 grams of NH,.
The atomic weight of nitrogen is 14, of hydrogen 1, the
molecular weight of NII^ is, therefore, 17, and in 17 grams
of NITs there uuist be 3 grams of hydrogen. One litre of
hydrogen weighs 0.0899 gram ; three grams of hydrogen, then,
must measure 33.48 litres (3 -^- 0.0899).
What is sulphuretted hydrogen? Give its formula,
property and uses.
Sulphuretted hydrogen or hydrogen sulphide, IIjS is a
colorless gas, slightly heavier than air, of offensive odor and
poisonous action. It is soluble in water, and burns in air
with a blue flame, forming sulphur dioxide and water. It is
used lus a group reagent, precipitating a number of metals
in the form of insoluble sulphides.
Name and give the formulas of three important salts of
potassium used in medicine.
Potassium acetate, KCoIIgOa.
Potassium nitrate, KNO3.
Potassium chlorate, KCIO3.
288
CHEMISTRY.
What is methylic alcohol? What are its properties and
uses?
Methylic or wood alcohol, CHjOH, is obtaioed as a product
of the deetru-ctdve distillation of wood. It is a light, coloriesa
liquid, ttiiseible with water, inflammable, 'burning with a non-
luminous flame.
It has a large use in the arte as a solvent for resinous and
gum-like substjinces, as in the making of varnishes ; and is
used as a fuel.
Defend the statement, " Matter is indestructible."
That matter is indestructible may be illustrated by the
burning of a candle, where although the candle loses in weight
from the consumption of its was. yet if care be taken to save
and weigh the results of tie combustion it will be found that
nothing baa been lost, that the burned substance has merely
assumed a different form.
Explain and illustrate the law of chemical combination
by volume.
Law of Gay-Lussac: When two or more gases combine
ehemieally to form a gaseous compound the volumes of the
individual constituents bear a simple relation to the volume
of the product. Thus one voluriie of hydrogen combines
with one volume of chlorine to form two volumes of hydro-
chloric acid vapor. Again, three volumes of hydrogen com-
bine with one volume of nitivigen to form two volumes of
ammonia.
Qive the history, occurrence in nature and preparation
of oxygen.
Altention was first called io the existence of oxygen by Dr.
John Mayow, of England, in 16fi4. Oxygen was discovered by
Dr. Joseph Priestley, of Birmingham, England, on August
1st, 1774. It was given the name oxygen, "acid-producer,"
by Lavoisier, the French chemist, because it was believed to
be an essential oonstituent of all acids.
It is found free in air and dissolved in water. It is found
CHEMISTRY, 289
in combina'tion in water and in most animal, vegetable, and
mineral compounds. It may be prepared by heating a mix-
ture of manganese dioxide and potassium chlorate.
Give reasons from a chemical standpoint for the use of
gold and silver for coin.
They do not oxidize in air or water ; when properly alloyed
they are durable; their degree of purity may be readily de-
termined by reagents; they do not communicate an odor or
a poisonous effect when handled and their intrinsic value
is fairly constant.
Name three metals of the alkaline earths, giving a com-
pound of each with its formula.
Barium ; barium chloride, BaClg.
Strontium; strontium nitrate, 'Sr(N03)2.
Calcium; calcium carbonate, CaCOg.
What are the general characteristics of the metals of
the iron group?
When at a red heat they decompose water; their oxides,
hydroxides, phosphates and carbonates are insoluble in water.
They have relatively high fusing points, and considerable
tenacity, malleability and ductility. They are all precipi-
tated when in alkaline solution, by hydrogen sulphide.
What is coal-oil, and what are some of its principal
products used in the practice of medicine?
Coal oil, or petroleum, is a brown-colored oil found in
nature and probably produced from decomposition of or-
ganic matter. It is a mixture of liquid paraffin hydro-
carbons, containing the gaseous and solid hydi-ocarbons in
solution. Some of the principal products used in medicine
are benzin or benzinum, petrolatum liquidum or liquid vase-
line, petrolatum or vaseline, arid paraffinum or paraffin wax.
Complete the following equation and write the name of
the resulting compounds:
C JTC1,0 + KOII =
C JICI3O + KOII = KCOOII + CHCI3
Potawtium formate. Chloroforiu.
19
290
CSEMISTRY.
Give the general properties of alkaloids.
The alkaloids may be described as organic nitrogenous sub-
stances, basic in character, capable of combining directly with
acids to form salts. They are commonly divided into two
grouT>s: (1) Liquid or Volatile alkaloids, containing carbon,
hydrogen and nitrogen. (2) Fi."ied or non-volatile alkaloids
containing, carbon, hydrogen, nitrogen and oxygen. They
may also be classified aeconiing to origin as vegetable, ani-
mal, or synthetic. The volatile alkaloids are volatile liquids
colorless when pure and fi-esh!y prepared, but turning brown
on exposure to the air. Examples, nicotine, coniine, spar-
teine. The non-volatile alkaloids are crystalline solids. Ex-
amples, morphine, aconitine, quinine. Most alkaloids are
soluble or very slightly soluble in water, more soluble in al-
cohol and in chloroform while the salts of the alkaloids are
generally soluble in water and alcohol and less soluble in
chloroform.
What is the percentage composition of NaNOj?
Atomic weight of Na is 23 ; of N, 14; of O, 16; of O., 48.
The molecular weight then, of NaNO, is 85.
85 :100 : :23 -.X = sod ium, 27. per cent.
85 a00::14:X = nitrogen, 16.4 "
85 :100 : ;48 -.X = oxygen, 56.6 "
I
100.0
Why is capillary attraction so called? Mention some
familiar examples.
Because this force is best observed in liquids enclosed in
minute tubes, hair-like in size; (Capillus, hair.)
The rise of oil in a lamp wick. The flow of sap through
vegetable fibre. The absorption of a liquid by blotting-paper.
Define sterilization.
Sterilization is the process of removing that upon which
germs depend for food and existence.
CHEMISTRY, 291
How does permanganate of potassium act as a disin-
fectant?
In <K)nta<5t with organic matter it undergoes decomposition,
liberating its oxygen in a nascent form.
Upon what theory are e^^s given in cases of poisoning
by corrosive mercury?
That the albumin of the Q^g will form an insoluble album-
inate of mercury.
Give the boiling-point (Fahrenheit) of water, alcohol,
of ether, of mercury.
Water boils at 212° ; alcohol at 173° ; ether at 96° ; mer-
cury at 675°.
Give the names and formulas of four iodides commonly
used in medicine.
Mercuric iodide, or the red iodide of mercury, Ilglj ; potas-
sium iodide, KI ; sodium iodide, Nal ; strontium iodide, Srlj.
Give the formula for carbolic acid. How is it obtained,
and what are its properties and uses?
Carbolic acid, phenol, C0II5OH, produced in the destruc-
tive distillation of coal, is obtained from coal tar. When
pure is a crystalline solid with a characteristic odor, pun-
gent and caustic taste, forming a white eschar on the skin.
The cr>Tstals require an addition of but five per cent, of
water to liquefy them ; if more water be added a turbid mix-
ture results, which again becomes clear when 20 parts of
water have been added. Carbolic acid is soluble in 20 parts
of water; easily soluble in alcohol, glycerin and oils. It is
used as an antiseptic, a disinfectant and a caustic. It has
slight local anesthetic properties.
Give the comparative constituent of cows' milk and
human milk as relating to water, fat, sugar, albuminoids.
Cow's milk, according to Frankland, will show on the aver-
age, water 87.5 p. e., fat, 3.8 p. c., sugar, 3.8 p. c. and al-
buminoids (proteids), 4.2 p. c.
I
CHEMISTKY.
"Woman's milk will show water, 88.6 p. c, fat, 3.5 p. c,
sugar, 5.0 p. e. and albuminoid (protcids) 2.7 p. c.
Human milk contains, then, rather less proteid, more sugar,
about the same amount of fat, and rather less water, than
row's milk.
How are the compounds containing two, three, or four
elements distinguished by name? Define hydroxide.
Compounds composed of two elements are called binary
compounds, and their names, if tliey ar« salts, end in "ide."
Compounds containing three elements ai-e ternary com-
pounds and, if acids, their names terminate in "ic," or in
"ous;" while if salts tbeir names end in "ate," or "ite."
Compounds made up of four elements are called quater-
nary eompounda.
A hydroxide is a compound of the radical, bydroxyl OH,
with a metal or basic radical.
Define anhydrous, deliquescent, electrolysis, decantation.
An anhydi»us substance is one from which water has been
removed, as anhydrous sulphate of copper.
A deliquescent substance is one which will absorb moisture
on exposure to air.
Electrolysis is decomposition of a fluid into its constituents
by the action of an electric current.
Decantation refers to the aet. of pouring off a supernatant
liquid from a precipitate or sediment.
Give the reaction of tannin with (a) preparations of
iron, (b) gelatin.
(a) A pnrplish-hlack precipit-ate of a tannate of iron is
formed, (b) Forms immediately a bi-ownish precipitate.
What relation does the amount of solid matter in urine
bear to the specific gravity of urine?
The total solids in 1000 C*. of urine are approximately
equal to 2.33 (Hiisers coefficient) limes the last two figures
of the specific gravity.
CHEMISTRY. 293
Give source and characteristics of citric acid.
Citric acid, II^C^lIj^Oj, IlgO, is obtained from lemons and
limes. Occurs as colorless, rhombic crystals, odorless, acid
taste, efflorescing in warm dry air and deliquescing in moist
air. Soluble in water and alcohol, antiseptic, antiscorbutic,
and refrigerant.
Give the formula, synonyms and properties of (a) mer-
curous iodide, (b) mercuric iodide.
Mercurous iodide, Hgglo or 2HgI, known also as proto-iodide
of mercury, and yellow mercurous iodide, is a yellow, odorless,
tasteless powder, almost insoluble in water, insoluble in al-
cohol, easily undergoing decomposition into mercuric iodide
and mercury.
Mercuric iodide, bin-iodide of mercury, or red mercuric
iodide, Hglg, is a scarlet-red, odorless, tasteless powder, al-
most insoluble in water, slightly soluble in alcohol, becomes
yellow on heating, regaining red color when cooled. It is
poisonous and resembles mercuric chloride iu therapeutic
activity.
Give the formula, preparation and properties of nitrate
of silver. Mention a test for nitrate of silver.
AgNOg ; formed by dissolving silver in nitric acid, evapor-
ating the excess of acid, dissolving the residue in water and
evaporating to crystallization. It occurs in colorless rhombic
crystals, odorless but with caustic, metallic taste. Easily
soluble in water, less soluble in alcohol. It is a self-limiting
caustic, and is employed internally, as an astringent and
alterative. Test: A soluble chloride added to silver nitrate
solution precipitates curdy white silver chloride, soluble in
ammonium hydroxide, insoluble in nitric acid. Evaporated
with phenolsulphuric acid a pink coloration, characteristic of
nitrates, is obtained.
Mention the properties of (a) hydriodic acid, (b) hydro-
bromic acid.
(a) Hydriodic acid, HI, is a fuming, colorless gas, strongly
294
CHEMISTRY.
P
acid, freely soluble in water to form a colorless solution
lurning brown from decomposition and separation of free
iodine. Ilydriodic acid possesses, in less marked degree the
general properties of hydrochloric acid: its liinary salts are
used medipinally.
(b) Hydrobromic aeid, HBr, is a colorless gas of acid na-
ture, soluble in water forming a clear colorless liquid having
properties closely resembling those of hydrochloric acid —
its binary salts are used in medicine.
Give a test for the detection of alum in baking-powder.
Dissolve in 25 Cc. water and add 5 Ce. of a 5% solution
of ammonium carbonate. If alum is present, a violet or la-
vender color is produced.
Give the chemical changes occurring when potassium is
placed on water.
Two atoms of potassium displace two atoms of hydrogen
from a water molecule to form K^O and this combines witii
a second water molecule to form two molecules of potassium
hydroxide. The liberated hydrogen takes fire from tiie heat
of the chemical action.
H,0 + K, = K,0-f H„
K,0-+-PL0=2KOH.
Define photography.
It is the art of obtaining in permanent form the images of
the camera obscura, by causing light to produce chemical
changes on sensitive substances.
Write the graphic formula of (a) sulphuric acid, (b)
nitric acid, (c) calcium hydrate.
,<^0
•■"J HO
>S
^0
Cb)HO-N^g
(c) HO— Ca — OH
CHEMISTRY. 295
Describe the relations of oxygen to combustion and to
life.
Oxygen is the great, universal supporter of combustion,
entering into chemical union with all well-known elements
(except fluorrine) often with sufficient energy to produce heat
and light (active combustion).
Since life is maintained only through a constant oxidation
of existing tissues, (a form of slow combustion) and the
replacement of these oxidized and decomposed structures by
new materials, oxygen is essential to life.
What mineral acids are incompatible with mercurous
chloride? Give synonyms of mercurous chloride.
Mercurous chloride, Hg2Cl2 or 2HgCl, known also as
calomel, mild mercurous chloride, and proto-chloride of
mercury.
This substance is incompatible with sulphurous acid, hydro-
chloric acid, and, in general, with all strong mineral acids.
Describe the appearance of urine containing bile.
Such urine varies in color from greenish-brown to a brown-
ish-black (porter-colored), and produces on shaking, a per-
sistent froth, yellow in color.
Define decomposition, putrefaction.
Decomposition refers to the breaking up of a complex or
compound substance into simpler substances.
Putrefaction is the decomposition of a nitrogenous or-
ganic substance into simpler bodies by bacterial action.
Give the general definition of an ether.
An ether is an oxide of a hydrocarbon radical.
Give a test for the detection of hydrocyanic acid in
solution.
Silver nitrate produces a curdy white precipitate of silver
cyanide, soluble in ammonium hydroxide, and in strong boil-
ing nitric acid. *
296 CriEMlSTKY.
Complete the following equations:
CH.Cl + HCl + Zn--
2PeCl, + H,S =
CH.Cl + HCl + Zn = CH. + ZnCL.
2PeCl3 + ni,S--2FeC1; + 2IIC1 + S
Give the symbol, valence and a principal compound of
each of ten elements.
Hydrogen, symbol II, vaJence I, water, HjO.
Oxygen, sjTnbol O, valence II, nitrous oxide, NjO.
Ni'trogen, symbol N, valence I, III, V, ammonia, NH,,
Iodine, symbol I, valenee I, potassium iodide, KI.
Sulphur, symbol S, vaJenoe II, TV, VI, hydrogen sul-
phide, HjS.
Bromine, symbol Br, valence I, sodium 'bromide, NaBr.
Iron, sj-mbol Pe, valence II, IV (Pej VI) feiTous sul-
phate, PeSO..
Calcium, symbol Ca, valence II, oaleium hydroxide,
Ca(OH},.
Magnesium, symbol Mg, valence II, magnesium carbon-
ate, MgCO,.
Silicon, symbol Si, valence IV, silicon oxide, SiOj.
State the normal reaction of synovial fluid.
Alkaline.
Describe the microscopic appearance of (a) uric acid,
(b) triple phosphates.
(a) Yellow to orange-red in color, loeenge-shaped, rhombic
prisms or modified forms, often grouped in stur-shaped, or
fan-shaped clusters, sbarply pointed at angles.
(b) 'ftTiite, triangular prisms, eofSn-shaped ; or in star-
shaped, feathery erj'srtals.
Give a typical example and state the principal ingre-
dients of each of the following mineral waters: Saline
cathartic, alkaline, sulphurous.
Saline cathartic water may be represented 'by Carlsbad
CHEMISTRY. 297
mineral water containing sulphates of sodium and potassium,
and carbonates of sodium, calcium and iron.
An alkaline mineral water as Buffalo lithia water contains
carbonates of lithium, calcium, sodium and potassium, and
usually an excess of CO^ although not in suflScient amount to
I)ix)duce effervescence.
A sulphurous water, as that of red sulphur spring of Vir-
ginia, usually contains hydrogen sulphide, or an alkaline
poly-«ulphide.
Give the characteristics of (a) nephritic urine, (b) cys-
titic urine.
In acute nephritic conditions the urine may be diminished
in amount with normal or increased specific gravity and con-
siderable albumin. In chronic nephritis the urine may be
normal or increased in amount, the specific gravity low and
the albumin variable. Nephritic urine always shows casts of
the uriniferous tubules.
In acute cystitis the urine shows pus, mucus, and epithe-
lium and the reaction may be neutral or acid. In chronic
cystitis the urine contains pus, mucus, epithelium and separ-
ated ** triple phosphates'' and the reaction is ammoniacal.
Express the following in apothecaries' weight and
measure:
Ammonii carb 5 grams
Syr. aurantii 60 c. c.
Aquffi destil. ad 120 c. c
Ammonia carb lerrs. Ixxvii
Syr. aurantii ,? ij
Aquae destil. ad § iv
Complete the following equations:
CjH.NOs + KOH =
CaCOa + 2HC1 =
C^n^NOs + KOII = CoH.OII + KNO3.
CaCOa + 2HC1 = CaCij + H^O + CO^.
I
Give the general characteristics of bismuth.
BismutJi, Bi, alomk weight, 207 (206.9), valence III,
specific gravity 9.9, melts 512° F,, is a brittle, white metalloid
with rodciish tint, crystalline, occurs native and as the sul-
phide, frequently associated with arsenic.
Define and illustrate monatomic element, neutral salt.
A monatomic element, like mercury, is one whose molecule
contains but one atom, and whose molecular weight corres-
ponds with the atomic weight.
A neutral or normal salt is one formed from an acid by
substituting a metal or basic radical for all of the replaceable
hydrogen. Example: Sodium sulphate, Na^SO,, formed from
sulphuric acid, "H-SOi.
Indicate the sources of the following acids: Lactic,
butyric.
Lactic acid is developed from lactose in souring milk.
It is produced on the large scale by the lactic fermentation
of cane sugar or glucose.
Butyric acid occurs in rancid bntter, and cheese. It is
prepared by fermenting a mixture of sugar and old cheese.
Mention a diatomic element and give its chemical prop-
erties.
Oxygen, symbol 0, atomic weight 16, valence II., electro-
negative, supporter of combustion, combines with all well-
known elemen'ts except fluorine.
Give an explanation of the formation of ammonia in the
urine.
Under the influence of the micrococcus ureae taken up from
the atmosphere, the urea is changed into ammonium carbon-
ate.
CO(NH,),-f 211,0 =(NHJ,CO„.
Complete the following equations:
2FeCl, + 2HC1 + 0 =
2Na,HP0. -f-3CaCl,=
CHEMISTRY. 299
2FeCl2 + 2HC1 + 0 = Fe^aa + H2O.
2Na2HPO, + 3CaClj = CajCPOJ^ + 4NaCl + 2HC1.
Give the formula and properties of (a) chlorate of po*
tassium, (b) ammonia gas, (c) tartaric acid.
(a) Chlorate of potassium, KCIO3, white crystalline Bolid^
permanent in air, soluble in 16.7 parts of cold water and 1.7
parts boiling water. A strong oxidizing agent, decomjKwible
by heat into oxygen and potassium chloride, forms explosive
mixtures when in contact with strong acids or organic matter.
It is a mild astringent and antiseptic.
(b) Ammonia gas, NHj, is a strongly basic, dilBfusible, irre-
spirable gas, extremely light, and very soluble in water ; it is
colorless, alkaline and caustic in taste and effect.
(c) Tartaric acid, II2C4II4O0, found in vegetables and
fruits : in its pure form occurs as colorless, transparent prisms^
strongly acid and readily soluble in water and in alcohol;
crystals melt at 135° C. It forms salts, of which Rochelle
salt, KNaC4H40e, cream of tartar, KHC4H40<„ and tartar
emetic, KSbOC4ll40fl are medicinally useful.
How is anilin obtained? State how anilin dyes are
manufactured from anilin.
Anilin, C0H5NII2 is obtained by the action of nascent hy-
drogen on nitrobenzene.
Anilin dyes are made by oxidizing mixtures of anilin and
toluidin with nitric or chromic acids or other oxidizing agents.
Mention two reactions by which hydrocyanic acid is
formed. Give the properties of hydrocyanic acid.
Add hydrochloric acid to potassium cyanide and obtain
potassium chloride and hydrocyanic acid. Add hydrochloric
acid to silver cyanide and obtain silver chloride and hydro-
cyanic acid.
Hydrocyanic acid is a volatile colorless liquid, with odor
of bitter almonds. It is extremely poisonous and is em-
ployed in medicine in a 2% water solution.
'cWemistry. '
Give the symptoms and diagnostic features of oxalic
acid poisoning. With what commonly used salt is oxalic
acid likely to be confused?
Syiuptoiiis: a hot, buruiug, sfjiit- taste, burning sensation
extending to stomach, great burning pain in stomach and ab-
domen, prostration, slight stupor, convulsions, pulse small
and irregular, numbness of extremities, irregular, spasmodic
breathing, death. It acts as an irritant and as a heart de-
pressant.
Oxalic acid has been frequently confused with ma^esium
sulphate.
What are aldehydes? Mention the properties and prin-
cipal derivatives of aldehydes.
Aldehydes are substances formed by oxidizing (taking two
hydrogen atoms from) primary alcohols.
Aldehydes combine directly with ammonia, hydroeyajiic
acid, alkaline sulphites, etc. They are strong reducing agents.
their oxidation produces fatty acids, their reduction pves
rise to alcohols.
Formaldehyde and paraldehyde and, a derivative, trichlor-
aldehyde or chloral, are all used in medicine. Derived from
chloral are many addition and decomposition products.
How are soaps made? What constitutes (a) hard soap,
(b) soft soap, (c) castile soap?
By heating a fat, with a strong alkali, (a) Hard soap is
the sodium salt of a fat acid, (b) Soft soap is tlie potassium
salt of a fat acid. (■?) Castile soap is a mixtitre of oleate,
palmitate and stearate of sodium obtained by saponifying
olive oil.
Complete the following equation:
K,Cr,0, + 4H,S0, =
K,Cr,OT -1- 4H„S0. = Crj(SO.), + K,SO, + 411.0 + 0..
What Is an ion? Give an example of ionization.
Wlien acids, bases and salts are dissolved in water they dis-
CHEMISTRY. 301
sociate, the molecules break apart. Each particle carries a
charge of electricity, and is called an ion. Hydrochloric acid
dissolved in water dissociates into positive ions of hydrogen
(cations), and negative ions of chlorine (anions).
What simple tests should be employed to determine
whether or not a suspected water contains albuminoid
matters sufficient to make its use unhealthful?
Add to the water a drop or tw^o of dilute sulphuric acid
and enough potassium permanganate to give a faint pink
color, cover the vessel with a glass plate and if the pink color
still peraists after the lapse of fifteen minutes the water is
not greatly impure from organic matter.
Shake a stoppered flask half full of the suspected water;
if no odor is discernible, wami flask and contents for fifteen
minutes at a temperature not higher than 110° F. and after
again shaking vigorously should there still be no odor the
w^ter is probably free of any material quantity of dissolved
organic matter.
Mention the principal uses of the following elements
and their compounds: (a) Fluorine, (b) chromium, (c) sili-
con, (d) selenium.
(a) Hydrofluoric acid is used as a solvent for glass; calcium
fluoride and the double fluoride of sodium and aluminum
are employed as fluxes.
(b) Chromium is used in steel-making; lead chromate and
barium chromate are used as pigments; potassium and sodium
diichromate are important reagents; the oxides are oxidizing
agents and glass pigments. The oxide CrOg is a powerful
caustic.
(c) Silicon in the form of its oxide SiOo is used in making
glass and glass-like substances; hydrofluosilicic acid is a
chemical reagent; SiOo is also used for polishing, filtration, etc.
(d) Selenium is used, from its non-conducting property, in
certain electrical appliances; selenic acid, HjSeO^ is used as.
a solvent for gold.
302
CHEMISTRY.
Slate the atomic weight, valence and uses of sulphur.
Sulphur, atomic weight 32 (31.83), valence II, IV, VI.
Is used in making gun powder, matches, as a medicine, is
inoorporaied into rubber, is burned to form SO, and in tliis
combination iised for disinfection, bleaching and in makingr
sulphuric acid.
Complete the following equations:
BaCl, + Na,SO, =
3P + 5HNO3 4- 2H,0 =
BaCl, + Na.SO, = Ba!?0, + 2NaCl.
UP + ailNO^ + 211,0 = 3H,P0, + 5N0.
Differentiate arsenic from antimony.
Ill Marsh's test on burning the evolved gas both arsenic
and antimony produce brown-black stains on a piece of cold
porcolain held in the flame, but the stain due to arsenic is
freely soluble in chlorinated lime solution while the anti-
tnonial stain is almost insoluble in this reagent. If ansenl-
(■al and antimonial substances be strongly heated in air.
armnic forma octahedral crystals of AsjOj which dissolving
in water produce green and yellow precipitates respectively
with cupric ammonium sulphate and silver ammonium nt-
trulc; while antimony, oxidizing, gives needle-like corals
or an amorphous deposit, soluble in water but not precipitated
by the reagents named.
(live (wo chemical tests for blood.
A<UI a drop of euspecled liquid to a freshly-made tincture
of guuiu4'U]ii, ill a test-tube, then on the surface of this liquid
Ihwt an ftherial solution of hydrogen dioxide. If the sus-
appt'lnl liquid contains blood, a blue color band forms at the
junotion of the two liquids.
'I'll a di-op of blood on a glass slide add a drop or so of
tt))K*iHl acetic acid and a small crystal of sodium chloride.
Hi>at iilowly to boiling, then cool and examine under tJie mi-
i'i\«nH>iu* fur crystals of hematin hydrochloride.
CHEMISTRY. 303
Describe the tests for acetone, and for diacetic acid in
the urine.
For acetone add to the urine suflScient sodium hydroxide
to give a decided alkaline reaction and then add a few drops
of an aqueous solution of sodium nitroprusside. The mix-
ture assumes a ruby-red color. Acidify with glacial acetic
acid — a purple-red color indicates the presence of acetone.
Test for diacetic acid: To a freshly-passed specimen of
urine add a few drops of a ferric chloride solution ; if a pre-
cipitate forms, filter, and to the filtrate add a few more drops
of the reagent. If diacetic acid be present there is produced
a dark red color which fades on boiling.
Describe a test for excess of hydrochloric acid in the
gastric contents.
To 100 c.c. of filtered gastric contents add a few drops of
tropaeolin indicator solution, and then titrate with ^^^ alkali
solution until the magenta color of the solution is destroyed.
If more than 55 c.c. of the alkali solution are required to neu-
tralize then the acid is in excess.
Define albumose; give a test for detection.
Albumoses are transition compounds formed in the conver-
sion of albumin into peptone. Albumose is precipitated by
nitric acid in the cold, dissolves on heating, and is again
precipitated on cooling.
Define bilirubin; describe its properties; give test for
its presence.
Bilirubin, the principal bile pigment, CjellisNoOa, is a
reddish-yellow substance, derived from hematin, slightly sol-
uble in water, more soluble in hot chloroform.
A drop of the fluid is spread in a thin film on a porcelain
plate and a drop of yellow nitric acid added. In the pres-
ence of bile pigment the drop of acid is surrounded by
colored rings — green, blue, and reddish-yellow.
1
I
CHEMISTRY.
What aahstaaces in the nriae, other than glucose, may
rodncc ae reactioH of the Fehltng's tesL
GljvDronic aetd ^v«5 the smme reaction as does glucose.
Urie aeid. ereatimiie. pxroeate^in. Isictose, pentose, chloro-
form, ete.. may prttdoce partial reaetioos.
Describe a chemical test that would sug^st the pres-
ence or absence of gastric carcinoma.
A marked diminntioo in or abseoce of free hj-drochloric
ipeid ID the gastric contents as shown by titration with a. ■^'V
'•Ikali solution. Normallr abont 55 Cc. of ^ alkali are re-
quired to neutralize 100 Cc. of gastric juice.
Give chemical tests for the various forms of urinary
calculi.
A calculus which on heating to redness burns entirely away
nwy be of uric acid, urate of ammonium, xanthine, cystin,
or fibrin. Test a portion of the powder with boiling water;
urates dissolve, uric acid remains undissolved. Apply the
miirexid test — cvaporBtc with nitric acid and touch the re-
sidue with a drop of ammonia water. A purple-red color in-
dicates uric acid or urates.
If the caleuhts fuses when heated, giving off water vapor
and ammonia, it is a "fusible calculus" and consists of a
mixture of calcium, magnesium, and ammonium phosphates.
If the calculus leaves a residue when heated and gives a
wurexid test it consists of sodium urate. If it dissolves in
acetic acid aud a precipitate is formed on adding ammonia
wat^r it is a phosphate of calcium or magnesium. If it is
iiiai)luble ill acetic acid hat soluble in hydrochloric acid, it is
isiUmuiu oxalate. If on adding an acid an effervescence is
ppotiuiH-d a carbonate is present.
hetall A test for the detection of indoxyl-potassium aul*
phalc (inJican).
'IVt 'i IV. coiicentrntod fuming hydrochloric aeid add 20
di^*!"* of uriuc. and warm, but do not boil, the mixture. With
^
CHEMISTRY. 305
normal urine the resulting color will be yellow or a very
pale violet, while with increased indiean a darker violet or
blue win be obtained. If the hydrochloric acid is not suffi-
ciently concentrated add 1 drop of nitric acid before adding
the urine.
20
PATHOLOGY AND BACTERIOLOGY.
Describe the protective agencies by which the body
guards itself against the entrance and harmful effects of
pathogenic bacteria.
Phagocytosis, the ingestion and possible destruction of
bacteria by certain leukocytes. Antitoxins, substances
formed in the body that are antidotal to bacterial toxins.
Bacteriolysins, substances resulting from the union of two
bodies known as complement and addiment that produce the
solution of bacteria. Antiseptic substances present in the
blood serum and tissues that restrain bacterial growth.
What is immunity? How is immunity produced?
Immunity expresses the degree of resistance of the living
organism against disease. It is produced by attacks of dis-
ease, by the introduction into the body of living or dead bac-
teria or their products, or of antitoxins or by heredity.
Give the pathologic changes occurring in acute phlebitis.
Congestion of vessels of vasa vasorum and effusion in the
walls of vein of serum and leukocytes, with formation of
thrombus within vessel. This may terminate in absorption
and resolution, the permanent occlusion of the vein, or in
suppuration.
What conditions (non-traumatic) favor cerebral hemor-
rhage? Mention the vessel from which cerebral hemor-
rhage occurs most frequently.
a. Arterio-sclerosis or aneurysm of cerebral vessels and
their causes, cerebral tumor, infarction, whooping cough or
convulsions, leukemia, pernicious anemia.
b. The left lenticulo-striate artery.
(307)
PATHOLOGY AND BACTERIOLOGY.
Give the histologic characteristics of amyloid degen-
eration.
The amyloid substance appears in the form of irregular
homogeiieoua, translucent, faintly granular areas of fused
and infereelluiar substance affecting chiefly the con-
nective tissues about the capillaries, as in the glomerules of
kiduey or spleen. The adjacent epithelial cells may show
atrophic changes or fatty degeneration. The urinary tubules
may eont-ain amyloid casts.
What are the blood changes in progressive pernicious
anemia?
A marked and disproportionate oligocythemia, slight leu-
eopeoia. poikilocytosis, and the presence of nucleated red
corpuscles.
Give the gross and the microscopic appearance of an
epithelioma of the lip.
A crushed papule or warty grovrth, with iufiitrated base,
that tends to undergo crater-like ulceration. Microscopically,
an. invasion of the subcutaneous and deeper tissues by irreg-
ular columns composed of squamous epithelial cells that often
contain pearly bodies is seen.
Give the functions and the products of bacteria.
Functions are reproduction, motion, absorption, excretion,
growth; also fermentation, decomposition, disease- production.
They may produce as products fennents, toxins, phosphores-
cence, pigments, acids or alkalies.
Give the causes of edema.
Passive hyperemia, anemia, change in vessel walls or in
vascular innervation, reduction in extra- vascular pressure,
lymphatic obstruction.
What are cysts? How are cysts formed? Give the
varieties of cysts.
Abnormal, persistent, encapsulated collections of liquid
PATHOLOGY AND BACTERIOLOGY. 309
formed by obstruction to outlet of glands by secretion in a
cavity without outlet, extravasation of blood or other liquid,
softening of tissues, tumor formation, or by the presence of a
parasite or foreign body. Varieties are simple, compound,
and proliferous, congenital, retention, extravasation, soften-
ing, neoplastic and parasitic cysts.
What is the special cause of the croupous inflammation
found in diphtheria?
The toxin of the diphtheria bacillus.
Describe the comma bacillus and ^ve the manner of its
introduction into the system.
A spirillum, a short, curved rod .8 to 2 microns in length,
motile, flagellate, readily staining but decolorized by Gram's
method, usually enters through the alimentary canal with
contaminated water, milk or solid food.
What conditions give to the system immunity from the
harmful action of bacteria?
The bacteriolysins, the antitoxins, the phagocytes, the anti-
septic action of tissue cells and juices, the protecting layers
of epithelium.
(a) Give the microscopic appearance of a melano-sar-
coma and (b) state its usual sites of development.
(a) Consists usually of vascularized tissue consisting of
spindle cells, or at times of round cells, that have vesicular
nuclei, and many of which contain dark pigment granules,
(b) Skin and choroid.
Describe the pathologic conditions in meningitis.
An inflammation of tlie membranes of brain or cord char-
acterized by congestion of meningeal vessels, edema of arach-
noid, effusion of serum, fibrin, or pus into the cavity of arach-
noid, at times petechial or larger hemorrhages within or with-
out arachnoid. Adjacent degeneration of nervous substance
may occur.
310 PATHOLOGY AND BACTERIOLOGY,
Give the pathology of cirrhosis of the liver.
L marked hyperplasia of tlie interlobular connective Ussue,
\ oft«n of inlerloldilar bile ducts. The new-formed con-
live tissue tends to contract, corapi-essing the lobules and
perhaps causing degeneration of the hejmtic cells. The liver
may become much smaller and show a rough ("hob uail")
surface.
(a) How is fibrous tissue formed? (b) What tumors
are composed largely of fibrous tissue, and in what part of
the body do they usually occur?
(a) By a proliferation of ceils of the pre-existing, adjacent
librous tissue. The young cells or fibroblasts being nourished
by new capillary blood-vessels that sprout from neighboring
pre-existing vessels and invade the formative area.
lb) Fibromas and fibi-omyomas chiefly occur in the uterus.
What is the significance of tube-casts in the urine?
Tube-easts result from irritative and degenerative ehangcK
in the epithelium of kidney, permitting an exudation of coag-
ulable substance into the tubules, and signify renal irritation
or disease. They are minute cylindrie 'bodies having a homo-
genie matrix, in which there may he imbedded cellular or
granular particles.
Describe yellow or crude tubercle.
A yellowish, i-ouiided, firn., adherent body, one to several
millimeters in diameter, showing under microscope a central
caseous area, an intermediate zone of epithelioid cells and
often giant cells, and a peripheral zone of lymphocytes.
Give the structural differences between sarcoma and
carcinoma.
Sarcoma consists of couneclive tissue of embryonic type
containing imperfectiy formed blood-vessels. Tissue may
consist of rouDil, oval, spindle or, in part, of giant cells.
Carcinoma is less circumscribed,- consists of alveoli filled by
cuboidal, coliinmar or squamous epithelial cells in a stroma.
PATHOLOGY AND BACTERIOLOGY. 311
usually of fibro-eonnectiye tissue, that contains well-informed
blood-vessels and lymphatics.
Define anemia, hyperemia, leukemia.
Anemia is deficiency in the quantity or quality of circulat-
ing blood.
Hyperemia is an excessive quantity of circulating blood in
a part.
Leukemia is a grave primary anemia characterized by enor-
mous leuoocytosis and pathologic changes in the spleen, red
marrow or lymphatics.
State the difference between degeneration and infiltra-
tion. Illustrate.
Cell degeneration is a condition in which the cell contents
become abnormal. If abnormal from the deposit of substance
f i^m without it is termed cell infiltration, as in fatty infiltra-
tion. If abnormal from transformation of cell contents it is
termed a cell metamorphosis, as in fatty metamorphosis.
Patty infiltration and fatty metamorphosis are both examples
of cell degeneration.
Give the morbid anatomy of chronic bronchitis.
Mucous membrane may be red and thickened arid covered
by thick mucus; or pale, thinned, and showing adherent, in-
spissated mucous masses. The thickening is due to leuco»
cytic infiltration and overgrowth of fibrous tissue; the thin-
ning to atrophy of the mucous membrane. The ciliated cells
may be replaced ^iy columnar or polygonal epithelium.
What is thrombosis? Describe the manner of its for-
mation.
Thrombosis is the intravascular coagulation of blood during
life resulting from the arrest of circulation and the formation
of fibrin by the action of fibrin ferment upon the fibrinogen.
(a) What is mucoid degeneration? (b) What is col-
loid degeneration?
(a) A conversion of cells and intercellular substance into
mucin.
PATHOLOGY AND BACTERIOLOGY.
312
(b) A inversion of cells into colloid material, a substaDce
reserabling mucin but not giving its reaction.
State the results of stenosis of the tricuspid valves of
the heart.
Dilatation of right auricle, cyanosis of face, passive hy-
peremia of pulmonary and abdominal organs, anasarca.
(a) Define fatty metamorphosis, (b) Give its termin-
ations.
(a) Conversion of cells into fat.
(b) Destniction of cells, colliquation or caseous necrosis.
What are the possible lesions in the third stage of
syphilis?
Gummata, sypliilitJe rupia, sclerotic changes in organs,
especially the arteries, liver, kidneys and spinal eord.
Describe the local appearances in a case of embolism of
the middle meningeal artery.
The affected vessel contains thrombus extending from thu
seat of embolism back as far as the first coUatei-al branch.
The distal 'branches may be shmnken, anemic, and associated
with cerebral softening or distended, and in the midst of a
hemorrhagic effusion (hemorrhagic infarction).
What is productive inflammation?
Inflammation characterized by the formation of new tissue,
usually of the fibro-connective tissue type.
What changes take place in hypertrophy of the heart?
An increase in thickness of the muscular walls of the heart,
chiefly affecting the ventricle, blunting tlie apex. The cavi-
ties may or may not be increased in size.
Give the origin and appearance of papillomata.
Originate from overgrowth of the papillarj' body, and are
wart-like, villous, dendritic or polypoid outgro\vtIi8 from sldn
or mucous membrane covered by epithelium.
PATHOLOGY AND BACTERIOLOGY. 313
Briefly describe the types of gangrene, and give the
conditions determining each.
Dry gangrene or putrefactive death of a part with mummi-
fication is characterized by a dry, shriveled, blackish, leathery,
friable area, and is caused by arterial obstruction, such as
occurs in old age (senile gangrene), from arterio-selerosis, in
Raynaud ^s disease, from ergot poisoning and frostbite.
Moist gangrene is characterized by swollen, greenish or
blackish, cool, moist, soft, fetid area, with bleb-covered sur-
face, loosened epidermis and crepitation on palpation, and is
due to severe infection (pulmonary gangrene, malignant pha-
gedena, hospital gangrene), trauma, venous obstruction, dia-
betes (diabetic gangrene), and deficient trophic innervation
(decubitus).
Describe the histological elements of carcinoma.
Acini containing epithelial cells. The amount of protoplasm,
as in other epithelial cells, is large in proportion to the size of
the nucleus. CeUs may be squamous cylindric, cuboidal or
polyhedral. The nuclei are usually vesicular and atypical
kar>'okinetic, and other cell figures may be present. The
stroma usually consist of well-formed fibro-connective tissue
containing lymphatics and well-formed blood-vessels.
Describe tuberculosis of the skin in any of its forms.
Lupus vulgaris is characterized by brown nodules originat-
ing in corium, and consisting of a rather vascular granula-
tion tissue composed of epithelioid cells, lymphoid cells, and
frequently of giant cells. The nodules may lead to extensive
ulceration and cicatrization.
Describe the changes in the heart due to fatty meta-
morphosis.
Diffuse or circumscribed, yellowish, opaque, soft, friable
areas of heart muscle, in the circumscribed form chiefly occur-
ring under endocardium of papillary muscles. Microscopic-
ally, the muscle fibres lose their striation and show fatty
granules, usually first about the nuclei; finally fibres may
break down into fatty particles and detritus.
What histological changes occur in acute simple inflam-
mation?
Dilatation of blood-vessels, retardation and stasis of blood
current, exudation into tissues of modified plasma, transmi-
gration of leukocytes, and oflen diapedesis of er>*throej"tes,
distension of lympbatics by exudate of ceils and tluid, regen-
erative or degenerative changes in the tissue eelLs.
Give the pathology of carcinoma.
Cai-cinoma is a malignant, uncircumscribed tumor consist-
ing of acini, containing invaded epithelial cells in a vascular-
ized stroma that usually consists of fibro-connective tissue.
The epithelial cells tend to a progressive invasion tiii-oufrh
the lymphatic channeJs.
What is fibrinous degeneration?
A reti-ogressive process in which, by the action of fibrin
fennent upon fibrinogen, fibrin is formed.
What do you understand by the term cirrhosis of the
liver?
Overgrowth in the liver of connective tissue that contracts,
rendering the organ smaller and firmer.
Is cerebro-spinal fever more generally sporadic or en-
demic?
Cerebrospinal fever generally occurs in the form of small
sporadic epidemics.
Give some of the lesions in chronic diffused or inter-
stitial nephritis.
Macroscopic. Small, granular-surfaced kidney with adhe-
rent capsule and thinned cortex.
Microscopic. Thickening of Bowman's capsules, hyaline
degeneration of glomerules, increase of intertubular tissue,
dilatation of certain tubules.
PATHOLOOY AND BACTERIOLOGY. 315
What anatomic changes take place in the skin in chronic
eczema?
Enlargement of papillae, dilatation of blood and lymph
vessels, perivascular cellular infiltration, hyperplasia of con-
nective tissue and epithelium, atrophy of sebaceous and sweat
glands.
What are the characteristic features of diphtheritic ex-
udation or infiltration of mucous membrane?
The layers of mucous membrane undergo coagulation ne-
crosis, and are infiltrated by a granular or fibrillar exudation
of fibrin, and by leukocytes.
What abnormal organic ingredients are found in the
urine in chronic morbus Brightii?
Tube casts — hyaline, granular or cellular; cylindroids,
epithelial cells from urinary tubules, albumin, and at times
leukocytes and erythrocytes.
In what general respects do ** anemia and progressive
pernicious anemia '* differ?
Anemia refers to any blood impoverishment. Pernicious
anemja is a very serious type of an essential anemia in which
there is a disproportionate oligocythemia. ^ In most anemias
this is proportionate to the oligochromemia.
What is cretinism, and with what is it associated?
A disease developing in early life characterized by disten-
sion (at times myxomatous) of subcutaneous tissues and by
general mental and physical ill development, that is always
associated with abnormality or absence of the thyroid gland.
How should sputum be examined for tubercle bacilli?
A selected portion of morning expectoration is thinly spread
on a cover-glass, dried, fixed by heating, stained for three
minutes in hot carbol-fuchsin, washed, decolorized and coun-
ter^tained for one-half minute in Gabbet's solution, washed,
dried, mounted in balsam', and examined under a one-twelfth
316 PATHOLOGY AND BACTERIOLOGY.
oil immersioi} objective for minute red rods— the tubercle
bacilli.
What is infective inflammation? How does it differ
from simple inflammation?
Infective iniiaumiatiou is tiiat form due to the action of
bacteria, while simple inflammation is not due to miero-
organismfi. Infective inflammation tends to spread, is more
severe, and is often associated with marked constitutional re-
action, the reverse being the case in simple inflammation.
Qlve the morbid anatomy of acute lobar pneumonia.
In engorgement (first stage) the affected lobe is deep red.
I'Oggy, slightly crepitant, and on section e.xudes bloody serum ;
this passes into red hepatization (second stage), in which
the affected lobe is dark red, solid, airless, friable, with dry,
granular surface of section, while in gray heijalization (third
stage) the lobe is grayish- white, solid, friable, with moister
surface of section. Microscopically, in tiie first stage, there
is intense hyperemia, with presence of serous liquid and red
and white corpuscles in alveoli. In the second stage the air
cells are filled by red and white corpuscles entangled in
coagulated fibrin, while in the third stage the fibrin, erythro-
cytes and hyperemia disappear and the alveoli are distended
by leukocytes and granular detritus. Resolulion (fourth
stage) is characterized by liquefaction necrosis, absorption
and expulsion of exudate.
Give the causes and process of cerebral softening.
The chief causes are the obstruction of cerebral arteries by
an embolus, thrombus or arterio-sclerosis. The area thus ren-
dered anemic degenerates and undergoes colliqnation necrosis,
and if pyogenic bacteria are present an abscess may form.
Describe tbe rash and give the morbid anatomy of scar-
latina.
Scattered red points on a deep reddish base appear over
neck and chest by the second day, spread over the body, and
PATHOLOGY AND BACTERIOLOGY. 31T
after three or four days gradually fade, to be followed by
desquamation. There are no specific lesions, but usually
acute catarrhal or pseudo-membranous pharyngitis, acute
diffuse nephritis, and often follicular tonsillitis, lympha-
denitis (at times suppurative), catarrhal gastro-enteritis, in-
terstitial hepatitis, splenic enlargement, and as complications,
purulent otitis media, endocarditis, pericarditis, broncho-
pneumonia.
What is a giant cell? Give characteristics.
A very large cell with many nuclei, found in the tubercle,
in gumma, in bone marrow, and in myeloid sarcoma. It is
irregular, and often indefinitely outlined, with hyaline proto-
plasm and from four to one or two hundred nuclei, that may
be (as in tubercle) arranged peripherally, equatorially, at
the poles or (as in sarcoma) near the center of the cell.
Describe the formation of adipose tissue.
In protoplasm of connective tissue cells, fat droplets that
tend to coalesce and displace the nucleus are deposited.
Finally the nucleus is displaced to extreme periphery of cell
and may disappear, while the cell is transformed into a dis-
tended sac filled by fat. If this take place, in many adja-
cent connective tissue cells adipose tissue results.
What pathological changes occur in caries?
In caries (rarefying ostitis) there is a solution of bone with
or without the formation of pus. A round-celled infiltration,
often with the formation of granulation tissue, occurs in
medulla and in Haversian canals with solution of soft and
hard structure of bone, the ended pits being Howship's
lacunae.
How is dental caries produced?
Acids (especially lactic) formed by bacteria present in the
saliva acting upon starchy particles, progressively dissolve
the mineral structure of the tooth, whereupon saprophytic
micro-organisms present cause solution of the organic sub-
stance of the tooth.
318
PATHOLOGY AND BACTERIOLOGY.
Describe catarrhal inflammation.
An inflammation of a mucous surface, with tie fluid exuda-
tion consisting of mucus, serum, leukocytes and desquamated
epithelial celk in varying proportions. The area affected is
red, swollen and bathed by exuded secretion.
What is the line of demarcation in gangrene?
The zone of inflammutory rcat^lion observed in the living
tisue adjacent to the gangrenous area,
Wliat is the line of separation in gangrene?
The narrow zone of progressive ulceration and molecular
disintegration dJatal to the line of demarcaitiou that tends to
sever the eonnectioa between the living and dead tissues.
What post-mortem changes occur in the tissues?
Rigor mortjs, algor mortis, livores mortis, muscular relaxa-
tion, formation of adipocere, decomposition.
Define atrophy. Give the varieties of atrophy.
The diminution in size and functional capacity of a part.
It may be simple or degenerative, passive, active, senile, pres-
sure or neuropathic atrophy.
Differentiate fatty infiltration and fatty degeneration.
In fatty infiltration the fat is from without affected ceUs,
and appears as fat droplets that coalesce, displace and obscnre
the nueleuH, and distend, but do not entirely destroy, the cells.
In metamorphosis the coll protoplasm is converted into fat
that appears in the form of granules or minute droplets that
tend to cause the breaking down and destruction of proto-
plasm and nucleus.
Define fibromata. Qive the histology of fibromata.
A tumor of the type of fibro-conuective tissue, showing
under the microscope whorls or curving bundles of long, nar-
row fibers having occasional narrow spindle-shaped nuclei.
As a rule, fibromas are encapsulated and not very vascular.
r
PATHOLOGY AND BACTERIOLOGY. 319
Give the varieties, the histology, and the physical char-
acteristics of lipomala.
a. Diflfuse and circumscribed, sessile or pediculated.
b. Resembles normal adipose tissue, consisting of fat-dis-
tended cells supported in a light fibro-connective tissue frame-
work.
e. Greasy, lobulated, yellowish, encapsulated, soft growths.
The overlying skin ** dimples'^ when elevated.
What part of the cord is involved in locomotor ataxia?
Give the pathology of locomotor ataxia.
a. Posterior columns.
b. In columns of Groll and Burdach areas of degeneration
showing destroyed myelin sheaths and axis cylinders and a
proliferation of neuroglia occur.
What are the intestinal changes in chronic enteritis?
The mucous membrane and muscular wall may show hyper-
plastic thickenings or atrophy. Enlargement of lymph fol-
licles is frequent, and polypoid masses may project from
mucous membrane. Ulcers may be present.
Define myomata, neuromata, angiomata.
a. Myomata are tumors of the type of muscle.
b. Neuromata are tumors of the type of nerve tissue.
c. Angiomata are tumors of blood or lymph vessels.
Explain the development of pus corpuscles.
Migrating leukocytes pass through the walls of the adjsr
cent capillaries, and in large numbers invade the area of sup-
puration, and whether living or dead as soon as they are sur-
rounded by liquor puris are termed pus corpuscles.
Give the pathology of spina bifida.
The spinal lamina being congenitally imperfect, the con-
tents of the spinal canal tend to protrude in the form of a
tumor. The mass usually contains fluid, and is covered by
the attenuated cord, nerves, or by the membranes alone.
I
PATHOLOGY AND BACTERIOLOGY.
■ Bpiua bifida occulta is a form in which the vertebral cleft is
P unasociated with the formation of a tomor.
What are the pathologic conditions in gonorrheal op-
thalmia?
A punileut coujiinetivitia with marked chemosis, edema of
eyelids, profuse purulent discharge, aud as complications.
ulcerative or suppurative keratitis, with or without resulting-
perforation, anterior synechia, leucoma, staphyloma, iritis,
hypopyon.
What are the pathologic appearances of anemia of the
brain?
The blood-vessels are empty or imperfectly distended by
blood, and if the process has been long continued the brain
may show atrophy or degenerative changes in the involved
areas.
What is embolism?
Intravascular obstruction from the lodgment of a foreign
body.
What is an infarct?
The area of degenerative and inflammatory changes pro-
duced by the lodgment of an embolus in an end artery.
Describe the pathologic conditions present in atheroma.
A diffuse or circumscribed mesarteritis occurs witli involve-
ment of vBsa-vasomm and the production of new sclerotic
tissue that undergoes coagulation necrosis and fatty degener-
ation. This softened degenerative material is termed athero-
matous. It may become calcified, be discharged with the
formation of an atheromatous ulcer or cause a weakening of
the wall, favoring rupture or aneurysm formation.
What structural changes take place in chronic gout?
Polyarthritis, with deposits of urate of sodium in articular
cartilages, and al>out joints with formation of concretions
(tophi). Arterio-selerosis, hyperti-ophy of left ventricle and
d
PATHOLOOY AND BACTERIOLOGY. 321
sclerotic changes in liver and kidneys are ooramon, and there
is a tendency to inflammation of the larger serous sacs.
What are the four cardinal indications in inflammation?
Heat, swelling, redness and pain, to which may be added
altered function.
Define ascites.
An abnormal collection of serous fluid in the peritoneal
cavity.
What condition of the blood is generally prominent in
all forms of gout?
Excess of sodium urate.
Give some of the causes (pathologic) of paresis.
A chronic, progressive meningo-encephalitis characterized
by a productive arteritis involving especially the adventitia,
with degenerative atrophy and sclerosis of cortex and sub-
cortical portions of brain. Degenerative changes in spinal
cord are associated.
What is the pathology of aneurysm?
A localized enlargement of an artery containing blood or
clot, due to a circumscribed stretching of one or all the coats of
a vessel. It occurs in vessels weakened by trauma, arterio-
sclerosis, mycotic inflammation, or by ulceration, or proximal
to areas of thrombosis or embolism. The vessel walls forming
the aneur\'sm are thinned, often calcified, with impaired elas-
ticity, and usually having thicker or thinner lining of adhe-
rent, laminated fibrin.
Describe the pathological conditions in icterus.
The skin, conjuctivae, urine, blood and the various organs
are tinged a yellow color by the biliary pigment. The feces
are usually clay-colored. The pulse is slow; there is a ten-
dency to hemorrhage.
Define the term malignant as applied to new formations.
New growth having an inherent tendency to a fatal issue.
21
322
PATHOLOGY AJiD BACTESIOLOOY.
I
Oive the pathology of peritonitis.
The periloneiim is red from vascular injection, the surface
is dull, and may be covered by adherent fibrinous or puriform
exudate. The ca\'ity of the peritoneum contains serum, iu
which there may be Gbrin or pus. There is a tendenoy for
adjacent peritoneal surfaces to adhere, localizing the process.
What is understood by the phrase " new formation "?
A multiplication of certain cells of tie body producing b
mass of tissue that has no place in the normal organism, such,
for example, as a tumor.
By examining the fluid removed by lumbar puncture,
how may we distinguish between tubercular and other
forms of meningitisV
In tubei-culous meningitis the fluid contains chiefly lympho-
cytes, and by staining, or inoculation into animals, the pres-
ence of the tubercle bacillus may be demonstrated. In other
forms of meningitis the cerebro-spinat fluid, as a rule, is more
turbid, contains chiefly polymorpho- nuclear leukocytes, and
the ojiiisal organisms, as the pneumococcus, the diplococcus
intracetlularis meningitidis or other bacterium, but not the
luhi'i-ole bacillus.
Differentiate a tuberculous joint from one enlarged by
chronic rheumatism.
TulwwiilouB joint-disease occui-s chiefly in children, affects
imnally but a single joint, has insidious onset, with slight and
often charactoristically reflected pain, and muscular ri^dity;
ia pemistent, and tends to cause flexion and pale, doughy
ihiokcning of joint, with later the formation of cold abscess
tuid niniisra. Bbeiimatism usually involves several joints.
\\v» Rtnito onset, is transient, with marked localized tender-
\wm, and if severe, redness and swelling.
What part of the spinal cord is involved in progressive
tnuscular atrophy?
Thi- HutiTior boms of the gray matter.
PATHOLOGY AND BACTERIOLOGY. 323
What are the degenerative changes of arteries?
Calcareous infiltration, hyaline, fatty and amyloid degen-
eration.
What pathologic changes may cicatrices undergo?
Cicatricial contraction or distension, cicatricial keloid,
cicatricial carcinoma, abscess and ulceration.
What is ischemic paralysis?
The loss of voluntary motion in a living part, the result of
local anemia.
Differentiate between a tubercular and typhoidal ulcer
of the small intestine.
The tubercular ulcer results from the action of the tubercle
bacillus, is chronic, tends to have a long axis transverse (annu-
lar ulcer) to bowel, to show outlying tubercles and irregularly
thickened edges and base. The typhoid ulcer results from
the action of the bacillus of Eberth, tends to have its long
axis parallel to gut, to have undermined edges and thin floor,
and often causes hemorrhage or perforation.
Distinguish between burns inflicted on a body before
death and those inflicted after death.
Vesicles containing albuminous serum and an adjacent red
zone of inflammatory reaction indicate infliction of bum dur-
ing life, and are absent in case of burns produced after death.
Give the causes of hemorrhage.
Increased blood pressure, atheroma, aneurysm, fatty, calca-
reous, inflammatory change or malignant infiltration of vessel
wall, embolism, traumatism, hemophilia, scurvy, typhus fever,
venoms, phosphorus poisoning, and anomalous innervation,
as in hysteria.
What are the causes of lymphorrhagia?
Lymphatic obstruction or injury, as may result from
trauma, pressure of neoplasms, aneurysms or inflammatory
tissue, or obstruction by filaria or other parasites.
PATHOLOGY AND BACTERIOLOGY.
^
How does calcareous degeneration of the arteries influ-
ence the circulation?
Increases arterial pressure and the work of heart, causes
imperfect blood supply, at tiioes leading to gangrene, and
favors thrombosis and heuioi'rhage (hemiplegia).
Wliat are pyogenic bacteria?
Schizoiiiycetes capable o-f inaugurating suppuration.
What changes take place in simple atrophy of the liver?
A reduelion in size, with preservation of general outlines,
and without noteworthy increase of stroma, or degenerative
change in the liver cells.
Describe syphilitic gummata.
Kounded, soft or firm, grayish or yellowish, circumscribed
masses, from five mm. to several cm. in diameter, surrounded
by an area of fibro-eonneetive tissue, and consisting of a typ-
ical granulation tissue showing mucoid degeneration or cen-
tral caseous i
What changes characterize inflammation of bone?
An absorption of bone, with the ingrowth of new granu-
lation tissue {rarefying ostitis) or possibly abscess forma-
tion, or a progressive ossification with resulting thickening
and condensation Icondi'nsivg osHtis).
Where and what are the pathologic changes in bulbar
paralysis?
Degenerative atrophy and sclerosis, with shrinking of
motor cells and degeneration of pi-oeesses, aii'eeting the glosso-
labio-laryngeal nucleus in tlie medulla.
Qive the pathologic changes in sclerosis of nerves.
An overgrowth of the supporting connective tissue and
neuroglia, with thickening of blood-vessel walls and atrophic,
fatty or other degenerative changes in myelin sheaths and
axis cylinders.
I
PATHOLOGY AND BACTERIOLOGY. 325
(a) What features render a tumor malignant? (b)
Mention some of the growths considered malignant.
(a) Invasion of adjacent tissue, recidivity, metastasis, the
production of cachexia.
(b) Carcinoma, sarcoma, endothelioma.
What is lardaceous (amyloid, waxy, bacony) degener-
ation?
The transformation of tissue into a homogeneous, wax-like
albuminous material, giving a mahogany-brown color with
dilute Lugol's solution.
What is the pathology of plastic inflammation?
A modified serum, leukocytes and at times erythrocytes
escape from the vessels. The fibrin factors in this exudate
unite, producing fibrin that may cause adhesion between con-
tiguous viscera. Later this plastic exudate may break down,
or, if it be replaced by new fibro-connective tissue, more or leas
permanent adhesions may result.
What are some of the results of lymphorrhagia?
Chylous extravasation, Ijonph fistulae, chyluria, chylothorax,
chylous ascites, malnutrition, death.
What conditions may result from enlargement of lymph
spaces or lymph vessels?
Capillary, cavernous or cj^tic lymphangioma, cystic hy-
groma (** hydrocele of the neck''), raacroglossia (of tongue),
macrocheilia (of lip), elephantiasis, Ijonph scrotum.
What inflammatory conditions may result in enlarge-
ment of the lymphatic glands?
Infection by pyogenic bacteria, plague, syphilis, tubercu-
losis.
What non-inflammatory condition may produce enlarge-
ment of lymph glands?
Hodgkin's disease (pseudoleukemia), leukemia (especially
lymphatic types), lymphadenoma, secondary tumors (carci-
noma, sarcoma) in lymph glands.
326
PATHOLOGY AND BACTERIOLOGY.
Oive the pathologic features of mechanical hyperemia
of the liver (nutmeg liver).
A chronic, passive hyperemie coiidition resulting from val-
vular heart disease, emphysema, pleuritic exudations, aneu-
i-ysm, or other olistructions to venous I'etum. The liver is
more or less enlarged and is deeply mottled, this being due to
the distension of the capillaries near the center of the lobules
by blood, often with atrophy of tlie adjacent hepatic cells,
while the liver cells at the periphery of the lobulea may show
fatty or other degenerative changes.
1 acute abscess.
atioD, usually from the pres-
Describe the formation of i
By stages: 1. Local tissue irri
ence of pyogenic bacteria. 2. Exudation of modified serum
and many leucocjies. 3. Colliquatiou necrosis in affected
area, resulting in the formation of cavity (abscess) filled with
a liquid (pus), consisting of fluid part (liquor puris) and
many dead and living leucocytes (pus cells).
Describe symbiosis with special reference to patho-
genesis and cite an example.
Symbiosis refers to the modifications in the activities of
different speciis of bacteria resulting from their association
as compared with their activities when in pure culture. Thus,
the injurious affects of the tubercle bacilli upon the tissues
are greatly increased when the bacilli are in association with
stre-ptocoeei or staphylococci. Upon the other hand, antbras
bacilli become less virulent when mixed with cultures of
Bacillus prodigiosus.
Give a general description of the action of agglutinins.
Agghilinins are substances observed chiefly in the blood
serum of infected animals, which when brought in contact with
living or dead bacteria of the same species as those having pro-
duced the infection, cause the bacteria to become immotile, ajid
to agglutinate or collect in. clumps. The action is usually
specific; that is, it occurs only against bacteria of the same
4
PATHOLOGY AND BACTERIOLOGY. 327
, species as that causing the infection. It is not necessarily
associated with the death of the bacteria, and as agglutinins
may be produced by the action of bacteria upon culture
media, the animal body is not essential to their formation.
Describe the process of ulceration.
Ulceration or the production of an ulcer is an inflammatory
process in which a definite loss of substance from a surface
of the body is produced. The area may be destroyed by the
injurious action of physical or animate agents, by interfer-
ences with the circulation, or as a result of the progress of
tumors. The tissue of the involved area is first removed by
processes of necrosis, or mechanically. The area left has
borders of more or less healthy tissue which become the
seat of extension or of healing of the ulcer; and a floor or
base, which usually becomes occupied by granulations, or,
if the ulcer be progressive, by necrotic and sloughing tissues.
Ulceration may 'be a chronic, indolent process, may be pro-
gressive, leading to extension of the ulcer, or as usually
occurs, it becomes arrested and cicatrization, or healing of
the area, occurs.
Describe tlie clianges tliat occur in cartilage in arthritis
deformans.
The cartilage becomes softened, fissured, and develops sur-
face excavations which may extend deeply into the bone.
Simultaneously, other cartilage cells may proliferate and pro-
duce nodular, cartilaginous projections. Medullary spaces
invade the degenerating and proliferating cartilage, and it is
transformed in part into osrteoid tissue. Villous or nodular,
fatty, calcareous or bony outgrowths may spring from the
synovial membrane, and if they become detached, form free
joint bodies. The bones making up the joint become more
flattened, more porous, excavated, or the seat of new bony pro-
cesses; and fibrous ankylosis, subluxation or luxation fre-
quently follow.
328 PATHOLOGY AND BACTERIOLOGY.
Enumerate the most ordinary senile changes that occur
in the various tissues of the body.
In organs, atrophy and increase of tibro-conneetive tissue
elements. In bones, absorption of oseous tissue, and cer-
tjiin changes in form, especially noted in the edentulous man-
dible, and in the neck of the femur. In walls of arteries and
veins, arteriosclerotic changes, with tendency to calcification.
In joints, degenerative changes, resembling rheumatoid arthri-
tis of a mild type. In skin and adipose tissue, wasting and
a I r-ophy.
Describe how mitral stenosis and aortic regurgitation
respectively affect the cavities and musculature of the
heart.
In mitral steuosis, as tlie left ventricle receives insufficient
blood, it may atrophy. As the left auricle insofSeiently
empties, it hypertrophies and dilates. Secondarily, the back
pressure through the lungs increases the work of the right
ventricle, which hypertrophies. The cavities of the right
ventricle and left auricle are increased and their walls are
thickened. The cavity of the left ventricle decreases in size,
and has unaltered or thinned walls. In aortic regurgitation,
much of the blood which has left the left ventricle is per-
mitted to i-elum, so that the ventricle receives not only tihe
normal blood from the left auricle, but also the return leak
fi-om the aorta. This results in distension of the cavity and
compensatory hypertrophy. This may cause an enormous in-
erense in the thickness and size of the ventricle. Eventually
Iho ventricle becomes incompetent, or in its distension pro-
duces mitral insufficiency, and there ensues an auricular
hypertrophy, and dilatation, pulmonary congestion, and finally
iliHtension and hypertrophy of the right heart. An enormous
lii>Hrt. (cor^hovinuTn) may thus be produced.
Describe the bacillus tuberculosis, its habitat, mode of
growth and method of detection.
Tin- tuhi'ivle bacillus has the form of a minute, slightly
A
PATHOLOGY AND BACTERIOLOGY. 329
curved rod, with rounded ends, and an average measurement
of 2 X .35 microns. It occurs singly and in small groups. Its
habitat is the tissues of vertebrates. Precise knowledge of its
natural growth outside of the body is wanting. Its growth
under artificial cultivation is slow, requiring several weeks
for colonies to develop, and necessitates special media, such
as glycerine agar, or special blood serum. Pale gray or yel-
lowish, dry, wrinkled, rather firm, crustlike, surface masses
are formed by the growth of the bacteria. Growth usually
occurs only at a temperature about that of the body, in
the absence of strong light, and in the presence of free
oxygen.
It is detected — (a) by inoculating guinea-pigs with some
of the suspected material, and six weeks later killing them
and searching for the characteristic lesions of tu'berculosis.
Or — (b)by staining spread smears of suspected material three
minutes with hot carbol-fuchsin and decolorizing for five min-
utes with a three per cent, solution of HCl, in absolute al-
cohol. Tubercle bacilli retain the red f uchsin color after this
treatment, while nearly all other ba<?teria are decolorized.
Describe the microscopic appearances of acute paren-
chymatous nephritis and explain the origin of blood in
the hemorrhagic form.
The microscopic changes may 'be chiefly of the glomeniles
— glomenilo-nephritis, or in convoluted tubules — ^tubulo-ne-
phritis, or may aflfect all the parenchyma. In the capsular
spaces are glomerular or desquamated epithelial cells, leuko-
cytes, erythrocytes and plastic or granular exudate. The
epithelial cells may show cloudy swelling, fatty metamor-
phosis, or karyokinetic changes indicating regenerative ef-
forts. Where the walls of the vascular tuft in the glomerulus
give way, a hemorrhage occurs, distends the capsules, flows
down the renal tubules, coagulates there, and forms blood
casts. The cells lining the tubules (especially the convoluted)
show cloudy swelling, fatty metamorphosis, or even necrosis.
330 PATHOLOGY AND BACTERIOLOGT.
and hyaline, grnniilar, cellular, or hemorrhagic easts fill the
tuhules.
Describe the pathologic histology of amyloid liver and
state where the deposit occurs.
The amyloid substance is formed in the eomieiitive tissue
framework of the liver, appears in or about the walls of the
capillaries, as auuelear, homogeneous cylinders, and as irregu-
lar wax-like masses in the tissues which displace t!ie cells of
the parenchj-ma, and perhaps favor the alrophie, fatty, de-
generative changes that they sliow. The amyloid substance
does not take the usual nuclear stain, but is given a reddish
color by gentian violet.
Describe the lesions characteristic of chronic alcoholism.
The lesions produced by chronic alcoholism also occur from
other toxic causes, and it is difficult to state that any are
absolutely characteristic of alcoholism alone. In the nervous
system a form of multiple, peripheral neuritis (alcoholic
neuritis) characterized by swelling, redness, infiltration, and
degeneration that may be perineural or interstitial, occurs.
The myelin may be degenerated, and the axis cylinders show
varicosities or gramdar degeneration, and finally may be
destroyed and replaced by eouuective tissue that is sometimes
infiltrated with fat In the central nervous system opaque
thickening of the meninges with wasting of the cerebral
convolutions, are common- Hemorrhagic pachymeningitis
may also result. The liver may he reduced in size with irre-
gular surface, increase of connective tissue framework, and
degeneration of parenchyma (gin-drinkers' liver). The typi-
cal beer drinkers' liver is a much enlarged organ showing
fatty degeneration. The stomach and intestines may be di-
lated, the BJtropbied mucosa being the seat of a chronic
catarrii with fibrous interstitial changes. The artftries
usually show arterio-sclerotic changes, frequently associated
with cardiac dilatation. The supei-ficial capillaries and
venules, especially of the cheeks and nose, are dilated and
PATHOLOOY AND BACTERIOLOGY. 331
have thickened walls (acne rosacea). The kidneys are less
affected than the organs of the digestive tract, but are often
enlarged or contracted, and show arterionsclerotic changes.
The resistance to tuberculosis and other infections is de-
creased in topers.
Describe why and how obstructive disease of the cor-
onary arteries causes myocardial degeneration.
The coronary arteries are end arteries with only capillary
anastomoses between their terminal branches, and supply the
myocardium with nutriment. Therefore unless abnormal
anastomoses exist or a vicarious compensating flow through the
vessels of Thebesius and the coronary veins occurs, obstruc-
tion to the circulation in the coronary arteries results in
ischemia and degeneration or death of the heart muscle sup-
plied by the obstructed vessel. A coronary thrombus or em-
bolus causes a myocardial infarct. A more gradual obstruc-
tion may lead to a fibrous myocarditis.
Explain the pathological characteristics respectively of
exudative and productive renal degeneration.
In the exudative renal degeneration there is an escape of
blood serum, leukocytes, at times erythrocytes, and the pro-
ducts of epithelial cells into the capsules of Bowman, the
renal tubules, and at times into the intertubular connective
tissue. In the productive renal degeneration there is a new
growth of fibro-connective tissue about the capsules of Bow-
man, about the blood vessels, and in the capsule proper of
the kidney. Often there is an association of productive and
exudative changes in the same organ.
What varieties of degeneration may occur in lymph
glands?
Patty degeneration, pigmentary infiltration, calcification,
hyaline degeneration, amyloid degeneration.
Mention the malignant neoplasms.
The varieties of carcinoma, including epithelioma; sarcoma,
endothelioma.
332 PATHOLOGY AI\'D BACTERIOLOGY.
What tissues are most frequently the seat of tubercular
formation?
In order of frequency- — lungs, lymph glands, ileum and
larynx, joints, pleura, meninges, peritoneum, bones, spleen,
Iddnej-s and geui to- urinary organs.
(a) On what principle are tumors classified? (b) Men-
tion the important classes of tumors, giving an example
under each class.
The varieties of normal tissue that they typify.
1. Adutt eonuective tissue tj'pe, as fibroma.
2. Emhryonic connective ti^ue type, as sarcoma.
3. More highly specialized tissue type, as myoma, neuroma,
Ij'mph angioma.
4. Endothelial type, els endothelioma.
5. Epithelial type, squamous, columnar or glandular, as
squamous papilloma, columnar epithelioma, ado no-carcinoma.
fi. Tumoi-s of mixed type, as teratoma.
What pathologic changes may result from cerebral
hemorrhage?
Cerebral hematoma, softening, cyst, cicatrix, poreneephalus,
atrophy or sclerosis. Atrophy of voluntary muscles and
cutaneous tissues, secondary descending sclerosis of motor
paths.
Give the process of tubercle development.
(1) Ijodgment of tubercle bacilli, (2) Proliferation of epi-
thelioid cells and an invasion of lymphoid cells in the affected
area, {3) Fusion of epithelioid cells with fonnation of giant
cells, (4) Central coagulation necrosis, (5) Fusion of adja-
cent tubercles with caseation, producing yellow tubercle.
Wha-t is (a) productive inflammation? (b) Suppurative
inflammation?
(a) One characterized by the formation of new fibro-con-
nective tissue.
(b) One characterized by the formation of pus.
PATHOLOGY AND BACTERIOLOGY. 333
What structures are principally involved in bubonic
plague? How are these structures affected?
Lymphatic glands — suppurative lymphadenitis; lungs —
a form of bronchopneumonia; intestinal tract — ^hemorrhagic
gastro-enteritis ; kidneys — ^an acute interstitial and parenchy-
matous nephritis; spleen — hyperplasti-c splenitis.
Mention the varieties of eczema.
Squamous, papular, vesicular, pustular, impetiginous, ec-
zema parasiticum, rubrum, fissum, impetiginodes, marginatum,
populosum, vesiculosum, pustulosum, squamosum, sclerosum,
seborrheicum, ulcerosum.
What pathologic conditions increase the elimination of
urea?
Acute fevers, inflammations, bacterial infeations, in dia-
betes, rheumatism, gout, in lithemia.
Give the lesions of typhoid fever.
Catarrhal entero-colitis, infiltration and hyperplasia of
Peyer's patches, terminating in necrosis and ulcera4:ion, hem-
orrhages, perforation or cicatrization. Mesenteric lympha-
denitis. Splenic hyperplasia, parenehymatous hepatitis and
nephritis. At times degeneration of cardiac or voluntary
muscles, hypostatic congestion of lungs and ulceration of
larynx occur.
What pathologic changes take place in the blood
plasma?
Hypertonicity (excess of salt) hyperinosis (excess of
fibrin factors); hypinosis — deficiency in fibrin factors; hy-
dremia (excess of water) ; anhydremia — deficiency in water.
Tjipemia — contains fat droplets; melanemia — contains mel-
anin; hemoglobinemia — contains dissolved hemoglobin. Ab-
normalities in alkalinity.
What conditions may cause dropsical effusion in the
abdomen and in the lower extremities?
Cirhosis, or tumor of the liver, syphilitic hepatitis, valvu-
334
PATHOLOGY AND BACTERIOLOGY.
lar heart disease, pulmonary disease, neoplasms, parasites or
inflammatory exudates interfering with the portal circulation,
tuberculous peritonitis.
Give the causes and pathologic anatomy of lympha-
denitis.
Inflammation of lymphatic glands results from irritants,
especially the pyogenic bacteria, the tubercle bacillus and the
bacillus of plague. The glands are enlarged, hyperemie, soft,
pulpy, and infiltratd by serum and red and white corpuscles,
and may siippnrate.
What is calcific metamorphosis?
The transformation of cells into a calcareous or mineral
substance.
Name some of the causes of active hyperemia and give
illustrations.
Paralysis of vaso-constrictor or stimidation of vaso-dilator
nerves, mechanic, thermic or chemic irritation, as shown in
blushing, after friction of skin, application of heat or cold,
or action of bacterial or dnig irrihints.
Illustrate and define hypostatic inflammation.
When the circulation is insufficient the blood tends to settle
or stagnate in dependent parts of the body (hypostatic con-
gestion), and a form of inflammation may ensue (hypostatic
inflammation), such as the hypostatic pneumonia occurring
in low forms of typhoid fever.
What are some of the phenomena attending pus for-
mation?
Heat, redness, swelling, tenderness, throbbing pain, soften-
ing of tissue, fluctuation, pointing.
Describe the pathologic conditions in hectic fever.
Hectic fever is a persistent form characterized by high
exacerbations at night, and resulting from microbic action,
and, as a rule, the formation of pus within the body.
PATHOLOGY AND BACTERIOLOOY. 335
What are patholo^c conditions causing favus?
The proliferation in the hair follicles of a mold, achorian
schoenleinii.
How are secretions affected in anemia?
Usually decreased, although the urine may be increased
either in bulk or relative solid contents, while the free hydro-
chloric acid, which may be absent from the gastric secretion
in progressive anemia, may be present in increased amount
in chlorosis.
What organs are most subject to tuberculosis?
Lungs, lymph glands, serous membranes, bones, spleen,
kidneys, adrenals, genital organs, bladder, skin.
Name some of the changes which occur in extravasated
blood.
Coagulation, solution, replacement by granulation tissue,
decomposition and suppuration, desiccation and scabbing.
What glands are most frequently affected by amyloid
degeneration?
Liver, spleen, kidneys, lymph glands.
To what diseases does calcareous degeneration of the
arteries predispose?
Aneurysm, hemiplegia, cerebral softening, dry gangrene.
Give the varieties of tubercle.
Reticulated tubercle, lymphoid tubercle, epithelioid tubercle,
miliary tubercle, submiliary tubercle, gray tubercle, yellow
or crude tubercle of Laennec.
(a) What are bacteria? (b) What conditions are favor-
able to their increase, and (c) what is meant by their toxic
products?
(a) Fission fungi or schizomycetes. (b) Warmth, moistr
ure, albuminous media, usually best if of neutral or slightly
alkaline reaction, absence of strong actinic rays, (c) Poison-
336
PATHOLOGY AND BACTERIOLOGY.
oua substances, tosins, ptomaines or bacterial proteids formed
by or in bacteria.
Name some of the principal bacteria of the staphylo-
cocci and the streptococci groups.
Staph.vloeoecus auruus, staphylwoccus albus, slaphyloeoe-
cus citreua, streptococcus pyogenes, streptococcus erysipelatis.
Name the important pathogenic diplococci.
Diploeoeeus gonorrlitEiE, diploccweus pneumoniffi, diplo-
coecus meningitidis capsulatiis of Weicliselbaum.
What changes take place in cyanotic atrophy of the
liver? Give the microscopic appearance of this diseased
condition.
A persistent passive congestion, with secondary hyper-
plasia of the connective tissue and pigmentation of hepatic
cells; microscope shows wide dilatation of capillaries and
veins, with atrophy and pigmentation of hepatic cells and
overgrowth of perilobular connective tissue.
Define and illustrate bacilli, micrococci, spirilla.
(a) Bacilli are rod-ahaped; microeooci, Bphorical shaped;
spirilla, spiral-shaped bacteria, (b) Bacillus tuberculosis,
streptococcus pyogenes, epirillum cholerre.
Give the pathologic features of angioleucitis (lymphan-
gWs).
The lymph vessels are inflamed, red, swollen and dis-
tended 'by a cell-laden liquid. Their walls are edematous,
infiltrated by leukocytes, and may be broken down if the pro-
cess be suppurative. The cause is almost invariably mici-o-
orgauismal, and there is usually an associated lymphadenitis.
Mention the structural changes that occur in tubercular
joints.
Tubei-cies iu the synovial membrane, ffubsyno\ial tissue or
cancellous bone. Diffuse (tumor albus) or nodular (synovitis
tubei-osa) thickening of synovial membrane, or distension of
L
PATEOLOQY AND BACTERIOLOGY. 337
joint with inflammatory serum (hydrops) or puriform liquid
(empyema) ; erosion of cartilage and bone ; tuberculous ab-
Bcees and sinus formation.
Give the possible causes of occlusion of the bile-duct.
Catarrhal swelling of mucous lining, lodgment of calculus
or parasitic worm (as ascaris lumbricoides or distoma hepa-
tinum), invasion by coccidia, cicatricial contraction of walls
of duct, pressure from without by an adjacent tumor or
floating kidney, involvement in a neighboring carcinoma, sar-
coma, endothelioma or an inflammatory process, duodenal
disease involving the terminal papilla.
(a) What causes contribute to obesity? (b) What tis-
sues are most frequently Invaded in obesity?
(a) Anemia, hemorrhages, use of malt liquors, lack of exer-
cise, hereditary tendency, over-eating, certain dyspesias.
(b) The subcutaneous tissues and subserous tissues of abdo-
men, especially about kidneys, in great omentum and appen-
dices epiploicae.
In what order are the organs of the thorax and abdo-
men best examined at a post-mortem section?
Authorities differ. The following is useful: Inspection of
abdominal cavity, inspection of pleura, pericardium, heart and
vessels, examination of heart, lungs, organs of neck, spleen,
gastro-intestinal tract, liver, pancreas, genito-urinary organs,
abdominal aorta and sympathetic ganglia.
22
SURGERY.
Define peritonitis. State tliree ways in whicli the peri-
toneum may be invaded by bacteria.
By peritonitis is meant an inflammation of the peritoneum.
Bacteria may invade the peritoneum through the wall of the
intesftine, through a wound in the abdominal wall, or through
a perforating ulcer of the stomach.
What is the treatment for stenosis of the lachrymal
duct?
Dilatation by means of lachrymal probes. The passage of
the larger probes is preceded by division of the lower canali-
culus. If the stenosis is simply due to tumefaction of the
mucous membrane (as in the new-born) it may yield to
medicinal agents.
What are the causes of ischio-rectal abscess?
Infection of the ischio-rectal areolar tissue with pyogenic
organisms from the perineum or rectum, injuries to the peri-
neum or rectum, and exposure to cold or wet. Suppuration
in the ischio-rectal fossa may also be due to disease of adja-
cent or distant structures (sacro-iliac or hip joints, pelvic
bones, spine, prostate).
Give an operation for excision of the tongue for car-
cinoma.
Kocher's operation. After all aseptic precautions have
been carried out, tracheotomy is performed, a well-fitting
canula is introduced, and the pharynx packed with a carbol-
ized sponge which has a cord attached to it. The incision
commences near the lobule of the ear, passes down the ante-
(339)
340
SURGERY.
rior border of the stemo- mastoid muscle to its middle, along
the hyoid bone to near the median line, and then upwards to
the symphysis. This flap of skin and subcntaneoiis tissue is
disseettt! up and held out of the way by a retractor. All the
lymphatic glands in the submaxiUary triangle are removed,
as well as the submaxillary (and if necessary the sublingual)
salivai-y gland, and the facial and lingual arteries are ligated
close to the carotid. If any portion of the mandible is dis-
eased it may be removed by enlarging the wound. The oppo-
site lineal artery is now ted through a separate incision.
The mylo-hyoid muscle and the refleotion of the oral mucous
membrane are then divided close to the alveolus, the tongue is
drawn out through the wound and removed close to the epi-
glottis behind and close to the hyoid bone below. The entire
raw surface is now painted wiith Whitehead's vamisli, the
external incision is closed by sutures, escepting the lower-
most portion, in which a drainage tube is inserted, an aseptic
dressing is applied, and the sponge in the pharynx is replaced
by gauze packing.
How should ankylosis of the jaw be treated?
By di«sion of the neck of condyle, by excision of condyle,
removal of the vertical ramus as far as the alveolar border, or
by the excision of a wedge of bone (apex toward alveolar
border) from the neighborhood of the angle, and the estab-
lishment of an artificial joint in this situation (Esmarch's
operation). Excision of the condyle and Esmareh's operation
are the measures usually employed.
How should hemorrhage from the liver, occurring in the
course of an operation, be controlled?
By tamponing with iodoform gauze, by the thermo- cautery,
by ligature, and by suture.
Describe Pott's fracture of the lower extremity.
By Pott's fracture is meant a fracture of the fibula about
three inches above tie tip of the malleolus. Dependent upon
SURGERY. 341
the amount of violence, there may co-exist one or more of the
following lesions: 1. Rupture of the internal lateral ligament;
2. Tearing off of the internal malleolus; 3. Fracture of the
external portion of the articular surface of the tibia. The
foot is practically always everted, and shows a tendency to
slip backward. There are points of tenderness over the lines
of fracture, the foot may be moved from side to side in the
widened tibio-fibular mortise, and crepitus may be obtained.
Give the symptoms and treatment of section of the
median nerve.
If divided just above the wrist there will be anesthesia over
t-he radical side of the palm, over the palmar aspect of the
thumb, index, middle, and half of the ring fingers, and over
the dorsal aspect of the terminal phalanges of the same
fingers. There will be paralysis of the outer group of the
short muscles of the thumb (abductor, opponens, and outer
half of flexor brevis polHcis), as a result of which **opposi-
tion" is impaired, the thumb remaining extended by the side
of the fingers. The outer lumbricals are also paralyzed, caus-
ing loss of power of flexion of the index and middle fingers
at the metacarpo-phalangeal articulation. If divided at the
bend of the elbow or in the arm, in addition to the previously
mentioned symptoms, there will be loss of pronation (paralysis
of flexor carpi radialis) , loss of power in the hand-grasp, par-
ticularly on the radial side, with probable hyperextension of
the wrist (paralysis of flexor longus poUicis, of the flexor
sublimis, and. of the outer half of the flexor profundus
digitorum) , and paralysis of the palmaris longus.
Treatment : After all aseptic precautions have been carried
out, the ends of the nerve are to be sought in the wound and
approximated by sutures of the finest chromicized cat-gut.
One or more sutures should pass through the nerve and the
remainder merely through the sheath. A fine Hagedom
needle or a domestic sewing-needle without cutting edges
should be employed. If difficulty is encountered in bringing
the ends together, the wrist and elbow joints are flexed to a
342 SUBOERT.
right angle, and subsequently maintained in Ihis position by
a fixed dressing.
State the constitutional effects and give the treatment
of burns.
Stage of shock or collapse ; The surface of tlie body is cov-
ered with a cold and clammy sweat, the temperature is sub-
Qormal, the pulse is rapid and feeble, and the respirations
are quick and shallow. The tongue is dry, the patient ex-
periences great thrist, vomiting often occurs, and the urine
and feces may i>e passed involuntarily. There is congestion
of the internal viscera, particularly those in relation with
the portal system.
Stage of reaction : Symptoms of septic traumatic fever,
with spt'ciai s>'mptoms dependent upon inflammatory affec-
tions of the internal organs (meningitis, peritonitis, enteritis,
duodenal ulcer).
Stage of exhaustion or recovery : Symptoms of septicemia
or pyemia may make their appearance. Death may occur
from inflammation of the lungs or pleura or from amyloid
degeneration of the viscera. If repair is healthy, no abnormal
constitutional condition follows the second stage excepting
a certain amount of asthenia.
Local treatment: Superficial bums without vesication sim-
ply require a dusting powder such as tlour or boric acid.
If vesication is present, the blisters should be opened aseptic-
ally, and the part enveloped in lint soaked in carron oil
(eqnal parts of linseed oil and lime water, with one part of
oil of eucalyptus in ten of the mixture), or in aqueous solu-
tions of picric acid (1-200). In deep bums the part should
be cleansed as thoroughly as possible, and covered by a
moist an tificp tic dressing until the sloughs separate, when the
resulting granulating surface may l>e treated on general prin-
ciples. During the process of cicatrization, great care must
be exercised lest deformity result from contraction. Such
deformity may be prevented by the use of splints or weights,
and particularly by the employment of Thiersch's method of
SURGERY. 343
skin-grafting. When a limb has been hopelessly charred it is
best to amputate in healthy tissue at the earliest favorable
opportunity.
Constitutional treatment: Promote reaction by external
heat, hypodermatic injection of stryehnine, and some warm,
stimulating fluid given by the mouth or rectum. Intravenous
injection of warm saline solution is advisable in some cases.
If the pain is severe, opium may be administered. During
the second stage the secretions should be kept active, and
the patient placed on a liquid nutritious diet. In the third
stage, itonics, stimulants, and nutritious easily-digested food
are indicated.
Name five of the principal complications of gonorrheal
urethritis in the male.
Lymphangitis, bubo, prostatitis, cystitis, and epididymitis.
What are the indications for exsection of the knee-
joint?
Tubercular disease, disorganization of joint after pyemia
or osteo-arthritis, old, neglected cases of infantile paralysis
where liiere is a flail-like limb (Wright), certain cases of
compound fracture (particularly after gunshot wounds), and
deformity due to fibrous or bony ankylosis in a bad position.
What is the treatment of depressed fracture of the
skull?
All such cases should be trephined under aseptic pre-
cautions, and the exact amount of intracranial mischief deter-
mined. The depressed fragment may then be elevaited, and
any pressure upon the brain immediately relieved.
Give the indications for the removal of the mammary
gland.
Carcinoma, sarcoma, diffuse hypertrophy, diffuse septic or
tubercular disease, and certain cases of interstitial mastitis.
What is Paget*s disease of the nipple? State the special
significance of its occurrence.
Pa get's disease of the nipple is said by some to be a form
344
SURGE KY.
of eczema, but according to high authority, it is a destructive
dermatitis of the papillary layer of the skin. It may be due
to psorosperms, but this is not de6nitely settled. The nipple
affected has an excoriated, bright red surface, which dis-
charges a yellowish viscid fluid. The excoriation spreads
until the entire areola is involved and the patient complains
of burning pain.
The special significance of the occurrence of the disease is
that it is almost alwaj's a precursor of cancer, but this is not
invariably the case.
What are the indications for incising the membrana
tympani?
The evacuation of serum, mucus or pus from the tympanum,
the relief of anomalies, of tension of the drum membrane,
and to gain access to the tympanum for the purpose of re-
moving intratympanic polypi or dividing synechiie.
Describe the steps in the treatment of a scalp wound.
Hemorrhage is to be controlled by pressure or ligation. The
scalp should be shaved for a distance of several inches from
the margins of the wound. If the woimd is very extensive
the entire scalp should he shaved. AU foreign substances are
removed from the wound, and it is disinfected with antiseptic
solutions (bichloride 1-1000). The wound should now be
sutured with silkworm gut and a moist bichloride dressing
(1-4000) applied. If the wound subsequently shows signs of
infection, one or more of the sutures should be immediately
removed, the wound again disinfected, packed with iodoform
gauze, and allowed to granulate. After granulation has oc-
curred it may he closed by secondary sutures. Primary suture
should be the routine treatment in almost every case.
How can the danger of ankylosis be averted after in-
jury to a joint?
By surgical cleanliness, rest, and the early employment of
massage and passive motion.
J
SUROERY. 345
What are the symptoms of morbus coxae in its different
stages?
Firsrt stage : Pain in affected joint and corresponding knee,
limping or shuffling gait, more or less fixation of the joint
from muscular rigidity, the knee is slightly flexed and the
limb is usually abducted. Swelling is most marked in the
arthritic variety of the disease. Heat and redness are usually
absent on account of the distance of the articulation from
tlie surface.
Second stage : Pain is more acute, the child limps decidedly,
atrophy of the thigh is apparent, and rigidity of the abductors
is marked. The limb is somewhat flexed, abducted, everted,
and apparently lengthened. Flattening of the buttocks is
present, and the sulcus between the nates is no longer vertical,
but inclined toward the affected side. Full extension and
abduction are restricted, **starting'' pains are present.
Third stage : Flexion is marked, adduction is present, and
shortening is observed which is apparent at first, but sub-
sequently actual. The whole extremity, including the gluteal
region, is greatly atrophied. If the diseased leg is extended
so that «the knee touches the table, the lumbar curve becomes
so pronounced that there is frequently room for the arm of
the surgeon between it and the table. The rima natium is
inclined away from the affected side and there is a compen-
satory double lateral curvature of the spine. Abscesses may
form and point at the outer side of the thigh below the tro-
chanter (disease of head of femur), in the pubic region
(disease of acetabulum), or in the gluteal region (either
form). If the abscess points above Poupart's ligament, it is
intrapelvic, if below, extrapelvic.
What is hydrophobia and how is it treated?
Hydrophobia is an acute infectious disease resulting from
the inoculation of a specific virus from an animal suffering
from rabies.
Prophylactic treatment: Most important, as no curative
346
8VR6EB¥.
treatmeot exists. The wound, if made by a supposedly rabid
animal, should be freely excised or thoroughly cauterized
(actual cautery is beat, «iustic potash, fuming nitric acid).
If this eauont be doue at once, coustriction should be applied
upon the proximal side of the wound. The wound resulting
from excision should be thoroughly disinfected and sutured
or treated openly, according to the exigencies of the case.
Prophylactic inoculations with emulsions of the dried spinal
cords of rabbits infected with hydrophobia (Pasteur treat-
ment) should be made in aJl eases where the animal inflicting
the bite was rabid, and iu those eases in which it can not be
proven that the animal did not have rabies. The prophy-
lactic treatment also includes the muzzling of dogs and the
ri^d maintenance of a dog quarantine.
Palliative treatment: The free use of morphine, chloral
and chlorofom. The patient is kept in a darkened room,
and all external sources of iritalion are removed. Nutritive
eneniata may be given.
How would you perform traeheotomyV
The patient is placed iu the dorsal position, with the head
extended, and a eylindric cushion placed beneath the neck.
An aastant holds the head so that the median line of the
faee wiU correspond to the median line of the neck. After
all aseptic precautions have been observed and the various
landmarks (pomum Adami, cricoid cartilage) located, an
incision, two and a half inches in length, is made in the median
line, terminating at the lower border of the thyroid cartilage.
This incision is made from below upward, and divides the
skin and superficial fascia. The anterior jugular veins lying
to either side of the median line should be avoided by cutting
between them and drawing them aside. The deep cervical
fascia is now divided, the interval between the pretracheal
muscles recognized, and the wound deepened by blunt dissec-
tion. The pre.tracheBl fascia is now divided, and the isthmus
of the thyroid gland drawn downward. After hemorrhage
has been checked and the tracheal rings clearly exposed, the
J
SURGERY. 347
trachea is steadied by a tenaculum, and two or three rings
are divided from below upward with a narrow-bladed knife.
The edges of the tracheal wound are then held apart and the
tracheal tube inserted.
What are the symptoms of septic surgical fever?
There is a sharp rise of temperature 24 or 36 hours after
the operation or injury. The skin is hot and dry, the pulse
is rapid, and the tongue is coated. Constipation, anorexia,
local heat, thirst, restlessness and delirium are present. The
urine is scanty and highly colored. The lips of the wound are
red, swollen and tender. The temperature falls with tho
advent of suppuration.
What are the indications for trephining in fractures of
the skull?
All punctured fractures, all compound depressed fractures,
all simple depressed fractures, and all cases in which there are
symptoms of intracranial mischief.
Mention the different kinds of displacement in fracture.
In what directions does the line of fracture extend in the
case of the long bones?
Varieties of displacement: Angular, transverse, longitud-
inal and rotary.
Directions of line of fracture: Transverse, oblique, spiral,
longitudinal, toothed, V-shaped, and T-shaped.
What general principles govern the diagnosis of a
tumor?
The age and sex of the patient, hereditary influence, the
history of previous trauma, the location, shape, size, con-
sistency, and rapidity of growth of the tumor, whether the
tumor is freely movable or fixed to the surrounding tissues,
whether it is painful, whether it is encapsulated, whether it
has given rise to metastases, and whether these have occurred
through the lymphatics or through the blood-vessels, whether
the neighboring lymphatic glands are involved, and the pres-
ence or absence of cachexia.
348 SUfiGERY.
What is the most common seat of rupture of the quad-
riceps extensor femoris? Give the symptoms and treat-
ment.
At its insertion into the patella.
Symptoms: Sudden pain in the part, inability to extend
the leg, and the appearance of ecchj-mosis several da>'8 after
the injury, A swelling may be felt just above the patella
(extravasation) or a gap may be observed (retraction of
muscle).
Treatment: The treatment usually advised is to place the
part at rest, tlie leg being extended on the thigh, and the thigh
being flexed at the hip. This position tends to bring the
torn ends together. A certain amount of compression is made
at the site of the injury, and the extremity is kept in the
position described until union has occurred. If perfect
asepsis can be obtained, however, primary suture of the mus-
cle (if healthy) will give better results.
What are the steps in the ligation of arteries?
Tlie preparation of the reg-ion in whieh the ves-sel is situated
for an ssoptie operation, the incision dividing the skin and
HUperfical fascia (at an angle of about five degrees to the
course of the artery), the division of the deep fascia, the
recognition of muscular or bony landmarks, and the location
of the vessel by ita pulsations, the opening of the sheath, the
passage of the aucurysm needle, the tying of the ligature, and
the closure of the wound.
Qive the treatment for talipes calcaneus.
Division of the extensor tendons. If the teudo Aehillis is
attenuated, a portion of it may he excised and the ends united
by suture. In other cases the tendon of a healthy peroneua
longus may be grafted into the tendo Aehillis, or the tu'bercle
of the OS calcis, into which the tendo Aehillis is inserted, may
be sawn off and reattached by a peg to the bone at a lower
level (Walsham). In the paralytic variety some form of
apparatus must always be worn.
SURGERY. 349
What are the causes and treatment of paraphimosis?
Causes: Gonorrheal balano-posthitis, ulceration from chan-
cre or chancroid, violent coitus, and edema following upon
the retraction of a tight prepuce.
Treatment: The glans should be rendered bloodless by
digital pressure or by the compression of a finger bandage
and well anointed with sweet oil. The index and middle
fingers of each hand are now crossed behind the glans and an
attempt made to force the glans through the constricted pre-
putial orifice by pressing upon it with the thumbs. If the
edema of the prepuce is very marked, it may be punctured in
several places to relieve tension. Should this measure fail,
the preputial orifice (at the bottom of the second groove) is
to be divided with a sharp-pointed, curved bistoury. Lead
water and laudanum may then be applied to reduce the in-
flammatory swelling.
In what portion of the base of the skull may fractures
lead to the escape of cerebro-spinal fluid?
Cerebro-spinal fluid may escape through the nose in a frac-
ture of the anterior fossa involving the cribriform plate of
the ethmoid (if there is a laceration of the mucous membrane
below the fracture and of the dura and arachnoid above it) ;
it may escape through the ear in a fracture of the middle
fossa (if the fracture passes across the internal auditory
meatus, if the tubular prolongations of the membranes in this
meatus are torn, if there is a communication between the
internal ear and the tympanum, and if the membrana tym-
pani is lacerated).
Give the symptoms of sacro-iliac disease and mention
the affections from which it must be differentiated.
Pain and a sensation of weakness in the lower part of the
back, which is increased by standing, sneezing, or any move-
ment which suddenly calls the abdominal muscles into play
and drags on the ilium. The unfortunate individual feels
as though his pelvis were coming to pieces. The pain is fre-^
350
SUR6ERT.
quently referred to the gluteal i-egion or leg ( lumbo-aaeral
cord) , If the pelris is not supported, mnvemenls of the lower
extremity are painful. There is apparent lengthening upon
the affected side, owing to the tilting downwards and forwards
of the innominate bone. Lateral compression of the pelvis
causes pain. The region over the joint is often swollen and
tender. Abscesses may form, and these may point over the
articulation, upwards into the lumbar region, forwards into
the groin, or downwards into the pelvis. Sacro-iliac disease
must be differentiated from sciatica, hip-joint disease, and
lumbar spondylitis.
Give the differential diagnosis between fracture of the
neck of the humerus and dislocation of the shoulder joint-
Elbow rtiidily a[ipruiimated lo s[de.
Elbow oin be made lo touch chest
with hand of alfected extremtly
upon the Bound shoulder.
CrepitUB.
Preternalural mobilil?.
Shape of shoulder-juinl unchnnged.
Deform it J recurs afi
Shortening of the ai
Elbow cannot he apiiro^imatsd to
Hide without CBUning great pain.
Elbow cannot be made to loueh chest
with hand of aSected eitremiljr
upon tbe sound shoulder.
No crepitus.
More or less Gtation.
Flattening of shoulder-joint, the head
of (be bnne being feU in an ab-
normal pfKiiliun.
Deforniity does not recur after redoe-
tio;
Elongnlion may
glenoid}, or tb
Bide.
present (twb-
iit of opposite
What are the indications for thyroidectomy?
Fibro-adenoinatous and cystic goitres, parenchymatovis
goitres which increase in sii'^ in spite of palliative treatment,
and carcinoma and .sarcoma of the thyroid gland.
Describe active congestion, passive congestion. State
their points of difference.
Active congestion is an increase in the amount of blc
SURGERY. 351
the more or less dilated arteries of a part, with an increase in
the velocity of the blood stream.
Passive congestion is an increase in the amount of blood in
the more or less dilated veins and capillaries of a part, with a
diminished velocity of the blood stream.
In active congestion the part is reddened, not perceptibly
enlarged, and the velocity of the blood current, the tempera-
ture and the functional activity of the part are increased.
In passive congestion the part is bluish, greatly swollen,
and the velocity of the blood current, the temperature and
the functional activity of the part are diminished.
What is the usual site of a vulvovaginal abscess? Give
the symptoms and treatment.
In the glands of Bartholin at either side of the entrance of
the vagina.
Symptoms: Heat, redness, and tenderness, together with a
peculiar pyriform swelling. In the early sitages this swelling
is best detected by introducin-g the finger in the vagina and
pi^essing outward against the pubic ramus.
Treatment: Incision and drainage. The wound should be
irrigated, packed with iodoform gauze, and made to heal up
from the bottom. The principles of antisepsis obtain here as
elsewhere.
How would you operate for the radical cure of complete
fistula in ano?
The bowels should be completely evacuated by a suitable
purgative, and also by an enema, about an hour before the
operation. The patient is etherized, placed in the lithotomy
position, and the perineal and anal regions shaved and prop-
erly cleansed. The external sphincter is forcibly stretched
by the thumbs in the rectum, and a grooved director is then
passed into the external orifice of the fistula, through the
fistulous tract, and brought out through -the internal orifice.
A curved bistoury is now introduced along the grooved
director, and all the overlying tissues are divided. All
352
SURGERY,
pockets and tributaiy branches of the Hstula moat be opened
up and curetted. All undermined tissue and unhealthy tags
of skin should be removed. Hemorrhage should be checked,
the cavity carefully packed with iodoform gauze, and com-
pression made over the anal region by a thick pad of sterile
gauze and a T-binder.
What affections occur on the female external genitalia?
Vulvitis, vulvovaginal abscess, vulvovaginal cj'st, hema-
toma of vulva, pruritus vulva, hypertrophy of the clitoris or
of the nymphffi, uretliral caruncle, noma pudendi, chancre,
chancroid, syphilitic ulcerations, venereal warts, papilloma,
myxoma, and epithelioma, A labial hernia or a hydrocele of
the round ligament may make its appearance in this situa-
tion.
What is the cause of the impulse felt in a scrotal hernia
on coughing? When is this impulse absent in such a her-
nia, and in what other condition resembling hernia may it
be present?
In a scrotal hernia a portion of the abdominal cavity is, so
to speak, within the scrotum, and any increase in the intra-
abdominal pressure will, of course, be transmitted to the
hernial sac.
This impulse is absent wben strangulation is present.
An impulse on coughing may be present in a congenital
hydrocele.
Differentiate between true and false sacculated aneu>
rysm.
The sac of a true sacculated aneurysm contains all of the
coats of the blood-vessels. In a false sacculated aneurysm
some of the coats of the blood-vessel are absent.
Describe the signs of each variety of fistula in ano.
Complele fistufa: There is an external opening in the skin
and an internal opening in the 'bowel.
In complete external fistula: There is an external opening,.
but no internal opening.
SURGERY. 353
In complete internal fistula: There is an inliemal opening,
but no external opening. The internal opening may be dis-
covered by direct inspection through a speculum and some-
times by palpation. This fii^tula is often associated with
undermining of the mucous membrane or with stenosis of the
bowel. Signs of inflammation may be present and pus may
be discharged from the rectum.
Describe the anatomic varieties of abdominal hernia.
Oblique, or external inguinal : The hernia in all cases enters
the inguinal canal through the internal abdominal ring, ex-
tertuU to the deep epigastric artery. This variety is called
complete if it escapes through the external abdominal ring
(scrotal hernia in the male, labial in the female) ; it is called
incomplete (bubonocele) if it remains in the inguinal canal.
Direct, or internal inguinal : The hernia gains entrance to
the inguinal canal by passing through Hesselbach's triangle
(bounded by edge of rectus, deep epigastric artery, and Pou-
part's ligament). It does not pass through the internal
abdominal ring, and the neck of the hernia is interiial to the
deep epigastric artery.
Femoral: The hernia passes out of the abdominal cavity
through the femoral canal and makes its appearance upon the
thigh.
Umbilical : The hernia passes through the umbilical ring.
Obturator: The hernia passes through the obturator canal
and may make its appearance upon the thigh.
Sciatic : The hernia passes out of the pelvis through one of
the sacro-sciatic foramina (usually through the greater) and
makes its appearance at the lower border of the gluteus maxi-
mus. The neck of the hernia is above the great sacro-sciatic
ligament.
Perineal : All hernias which protrude through the muscular
floor of the pelvis toward the perineum are designated as
perineal hernias. The neck of the hernia is below the great
sacro-sciatic ligament. They receive special names according
23
354 SURGERY.
as to whether the skin, the vagina, or the rectum is pushed
in advance of the hemiaJ protrusion.
In guim> perineal (Coley) : A hernia associated with mal-
descent of the testis. In these cases the testicle is in the
perineum and the hernia follows the testicle.
Diaphragmatic: The hernia protrudes through the dia-
phragm. Many of these cases are not true hernias, as they
have no sac of peritoneum.
Ventral : The hernia appears at any portion of the anterior
abdominal wall except the umbilicus. They are subdivided
into epigastric hernia (in the median line above the navel),
hernia of tlie linea alba (below the navel), and lateral ventral
hernia.
Lumbar: A hernia making its appearance in the lumbar
region. It is commonly taught that it passes through Petit's
triangle, but no such instance has ever been proved by dis-
section (Sultan). In some instances it passes through
Braun's space.
Internal hernias: 1. Hernia through the foramen of Wins-
low. 2. Hernia through the duodeno- jejunal recess (retro-
peritoneal). 3. Hernia through the retro-cecal and ileo-cecal
recesses (retro-peritoneaO- 4. Hernia through the inter-
sigmoid recess (retro-peritoneal). 5. Retro-vesical hernia.
The lateral vesico-umbilieal fold is so markedly developed
that a peritoneal pocket is produced at one side.
Describe the symptoms and g;ive the treatment of hem-
orrhage from the middle meningeal artery.
Symptoms: The first sjinptoms are those of concussion.
These are followed by a temporary return of consciousness
(very important) and the gradual onset of coma within 24
hours, usually without any rise in the temperature. Sinc«
the blood clot presses upon the motor area, localized twitch-
ings or paralyses may be present. The paralysis is apt to be
progressive, commencing in the face and then extending to
the arm and leg. If the dot gravitates toward the base the
pupil of the same side will be dilated and immobile ; if on the
SURGERY. 355
left side aphasia will be present, the pulse will be frequent,
the respiration slow and stertorous, and the temperature will
rise to 101° to 103° (or even higher) upon the side opposite
the clot.
Treatment: The anterior branch of the middle meningeal
is the one commonly involved, but the posterior may bIso be
the source of the bleeding. After all aseptic precautions
have been carried out, a semicircular flap is turned down and
the skull trephined. The pin of the trephine is placed upon
a point one and one- fourth inches behind the external angular
process at the level of the upper border of the orbit (anterior
branch). If the clot is not found the trephine should be
immediately reapplied just below the parietal eminence at
the same level as the first opening (posterior branch). The
clot should now be removed, the trephine opening being en-
larged with rongeur forceps if necessary, and the cavity
thoroughly irrigated with sterile water. If the artery is still
bleeding it should be tied by passing a cat-gut ligature through
the dura and about the artery by means of a Hagedom needle.
Drainage should be provided for and the wound closed in the
ordinary manner. If there is evidence that the clot is gravi-
tating toward the base, the first trephine opening should be
made at a point one-half inch lower than that above given.
Give symptoms and treatment of fracture of the nasal
bones.
Symptoms: Crepitus, deformity (depression or lateral dis-
placement) , preternatural mobility, swelling, and ecchymosis.
Severe epistaxis, surgical emphysema, and cerebral symptoms
are oocasionaly encountered.
Treatment: Reduction at the earliest possible moment in
order to avoid the persistence of the deformity. It is best
to give an anesthetic, as these parts are exceedingly sensi-
tive, and the reduction should be accurate and deliberate.
The fragment is best returned to its proper position by a
padded dressing forceps carried well up into the nose and
assisted by external manipulation. Should there be any
356 8VRGERY.
tendency toward a recurrence of the dieplacement the nasal
chamlier should be carefully packed with sterile gauze and
the paeking renewed every 24 hours.
Describe the steps in the operation of stretching the
facial nerve.
After the aseptic precautions have been observed, an inci-
sion is made commencing behind the pinna opposite the ex-
ternal auditory meatus and eJrtending downward and forward
behind the lobule of the ear to the angle of the jaw, Thia
incision divides the skin, su'perficial fascia, superficial layer
of the deep fascia, and branches of the auricularis magnus
nerve. The flaps are now dissected from the parotid gland,
aterno-mastoid muscle, and mastoid process, care being taken
to avoid the posterior auricular nerve, vein, and artery. The
internal jugular vein is close to the posterior margin of the
wound. After the parotid gland has been separated from
the mastoid process the trunk of the nen'e is found lying on
the styloid process just above the posterior belly of the digas-
tric muscle. The nerve is stretched by lifting it up with a
blunt hook. The external incision is sutured and an anti-
septic dresdng applied.
How would you expose the brachial artery for ligation
in the middle of the arm?
After all aseptic pi-ecautious have been observed, an inci-
sion is made along the inner edge of the biceps muscle. The
line of the artery is from a poiut just to the inner side of the
center of the clavicle to midway between the two condyles.
The incision divides the skin, superficial fascia, twigs of the
internal cutaneous nerves, and small branches of the superior
profunda and anterior circumflex arteries. The deep fascia
is now divided and the inner edge of the biceps recognized.
The arm should be held at right angles to the body and not
allowed to rest upon any support, since the -triceps muscle
would displace the biceps and our muscular guide would be
lost. The biceps is now displaced outwards and the pulsa-
SURGERY. 357
tions of the artery sought for. The median nerve generally
lies over .the artery in this position of the arm. It should be
drawn inward and the sheath of the vessel oi)ened.
Give the treatment of foreign bodies in the trachea.
The performance of a low tracheotomy, a sufficiently exten-
sive opening being made in the trachea. If the foreign body
cannot be removed at the time of the operation, by means of
delicate forceps, coin-catcher, wire loop, or hooked probe, the
edges of the tracheal wound should be sutured to the cuta-
neous incision, and the foreign body, if movable, will usually
be spontaneously expelled. If the foreign body is not ex-
pelled within a day or two, the trachea and bronchi should
be examined with a long probe. This excites violent cough-
ing, which, may dislodge the foreign body. The jmtient may
be also inverted and simultaneously struck upon the back at
the level of the tracheal bifurcation (fourth, dorsal vertebra) .
Describe a method of differentiating between (a) the
urethra, (b) the bladder, and (c) the icidneys as the
sources of pus in the urine.
Urethra : It is usually stated that if the urine is passed into
two beakers, the first quantity will be turbid and the second
one clear. If the pus originates in the xwsterior urethra,
however, it regurgitates into the bladder and both specimens
will be turbid. (Finger). The urine will usually be acid,
the pus will be in small quantities, and there wiU be signs of
the local inflammation.
Bladder : The freshly drawn urine wiU be alkaline, and may
contain crystals of triple phosphate. The urine is increased
in amount, and the last portions passed contain ropy, thick
mucus. It may be possible to identify bladder cells in the
sediment, and the pus corpuscles are said to be 'better formed
than when they originate in the kidney.
Kidney: In pyonephrosis the discharge of pus may be
intermittent, clear specimens being obtained for days or even
358 SURGERY.
weeka. In calculous aud tubercular pyelitis the pyuria is
usually continuous. The pus is more intimately mixed with
the urine than when it originates in the bladder or urethra,
and the urine is acid in reaction.
In all three in&tanees the history of the case will be of
value.
Describe in detail the condition known as talipes equino-
varus.
In the affecbon known aa talipes equino-varus the heel is
drawn up and the anterior half of the foot is adducted and
drawn inwards. The inner border of the sole is iconcave, and
travei-sed by a sulcus corresponding to the position of the
mid-tarsal joint; the outer border is convex, and this con-
vexity is usually covered by a bursa. The sole of the foot is
arched from secondary contraction of the plantar fascia and
some of the plantar muscles (particularly the abductor hal-
lucis), and its center may be marked by a longitudinal crease
due to a folding over of the outer metatarsal bones. The
individual walks upon the outer border of the foot, and, in
neglected cases, even upon the dorsal aspect of the cuboid
bone.
In acquired cases the extensor and peroneal muscles are
paraJyzed. and the tibialis anticus, tibialis posticus, flexor
longus digitorum, and the tendo-Achillis are seeondarly
shortened.
The astragalus is displaced forwards and outwards, and is
the most deformed of all the tarsal bones. The neck of the
bone is elongated, and the angle between the neck and the
body, instead of being 35 degrees (child) or 10 degrees
(adult), is increased to 50 decrees or even more. The sca-
phoid is pushed to the inner side of the astragalus, the tuber-
osity approaching or even touching the internal malleolus.
The ligaments on the inner side of the foot are contracted
(anterior portion of deltoid), inferior calcaneo-scaphoid, long
and short plantar ligaments).
SURGERY. 359
What means has the surgeon at his command for the
separation of tissues?
Knife (scalpel, bistoury, tenotome), scissors, thermo-cau-
tery, ecraseur, snare, elastic constriction, saw, trephine,
(jhisel, osteotome, and the osteoclast.
Describe talipes equinus and give its treatment.
In the affection known as talipes equinus the heel is drawn
up so that the patient walks upon the metatarso-phalangeal
joints and the toes. The degree of deformity ranges from
those cases in which there is simply a slight elevation of the
heel to those in which the foot is almost vertical, and the
plantar muscles and fascia so contracted that the patient
walks upon the heads of the metatarsal bones, the toes being
in a position of hyperextension (or even of hyperflexion).
Treatment: The milder cases may be treated by means of
Sayre's apparatus, but subcutaneous division of the tendo-
Achillis is usually required. The foot is subsequently placed
in its normal position and put in plaster of Paris. The foot
is kept in plaster for three months, and a mechanical support
(rendering extension beyond a right angle impossible) should
be worn for a year. In severe cases it may be necessary to
divide the plantar fascia and elongate the tendo-Achillis by
splicing. In the most obstinates cases some surgeons excise
the astragalus.
What are the symptoms of a foreign body in the stom-
ach? Give the treatment.
The symptoms of a foreign body in the stomach are fre-
quently most obscure. There may be a sensation of weight
and distress, and if the object is rough and irritating there
may be local tenderness and vomiting of blood-tinged fluid.
The X-ray will usually furnish valuable aid.
Treatment : If the foreign body is small, non-irritating, and
capable of being passed per rectum, the patient should be
made to eat large quantities of foods leaving a considerable .
360 SVMOERY.
residne. If the foreign body will not pass the pylorus it
sboold be removed by gastrotomy.
What are the causes of acute prostatitis? Describe a
typical case of acute prostatitis and give the treatment.
Causes: Urethritis (usually gonorrheal), traumatism, stricl>
ure, retention of decomposing urine, prostatic calculi, and
cyetitie.
Symptoms: Deep-seated pain, accompanied hy a sensation
of heat and weight in the perineum. The desire to pass water
is frequent and micturition is painful, particularly at the
cwnclusion of the act Defecation is painfu), and digital
examination per rectum reveals a hot and exquisitely tender
swelling of the prostate gland. The perineum is also hot and
tender. The patient cannot sit comfortably, but will support
his wei'ght upon one buttoelc to avoid any pressure upon his
perineum. If suppuration occurs, as is usually the case, the
pain becomes more marked and of a throbbing character, the
perineum becomes red and edematous, retention of urine may
occur, and tlie passage of a catheter causes excruciating pain.
Fever is present, and there may be a marked chill. The
abscess may discharge through the urethra, rectum, perineum,
or above Poupart's ligament.
Treatment : Absolute rest in bed, and a bland, non-irritating
diet. The bowels should be kept loose to avoid the pressure
of hardened feces upon the inflamed organ. Hot hip baths
sometimes cause a marked diminution of the pain. If the
ease is seen early, leeches fO'llowed by hot fomentations should
be applied to the perineum. If the pain is intense, supposi-
tones of morphine and belladonna should be given. If reten-
tion is present the urine should be drawn off with a small
rubber catheter. If suppuration has occurred the passage of
the catheter will ocasionally rupture the abscess, which may
then evacuate itself through the urethra. If this does not
occur, and there are evidences of deep-seated suppuration,
or if the pus does not discharge freely, the patient should be
etherized and placed in the lithotomy position. The finger
SURGERY. 361
is now introduced into the rectum and an incision made in
the median line of the perineum down to the seat of pus for-
mation. The abscess -cavity is then evacuated, irrigated, and
a drainage tube introduced.
Give the course, symptoms, and treatment of varicocele.
Course: The affection appears in early adult life (rarely
after 35), and is practically always upon the left side, vari-
cocele of the right side alone being almost unheard of. In
many cases it persists throughout life without any injury to
the individual, while in some cases it may lead to atrophy of
the testicle.
Symptoms: A swelling situated along the spermatic cord
and feeling like a bunch of earth-worms. The swelling is
compressible, gives an impulse upon coughing, disappears
when the patient lies down, and reappears when he stands up,
even though firm pressure is made over the site of the external
ring. In most cases the scrotum is relaxed and flabby, and
there may be a sensation of dragging weight, or even of actual
pain. The testicle upon the affected side may be smaller or
flabby, but it is nearly always perfectly healthy. Many indi-
viduals with this affection worry themselves into a condition
of mental disquietude out of all proportion to the local dis-
ease.
Treatment. Palliative: A well-fitting suspensory bandage.
(>perative: Operative treatment is to be adopted if the
patient desires to enter the army or navy, if the affection
causes physical discomfort despite the wearing of a suspen-
sory, and if the mental condition of the patient cannot be
relieved until the varicocele is removed. The operation for
the cure of varicocele consists of the excision of a section of
the dilated veins. The incision is to be made in the groin,
arid not in the scrotum, as was formerly practiced. About
two inches of the cord is drawn up through the incision, the
vas deferens (feels like a ** whip-cord") and its accompany-
ing vessels are carefully isolated and not included in the
'd&2
SUROERT.
double ligature ( chromicized cat-giit). The ligatures are-
placed at a distance of from one to two inches from each
other and the intervening bundle of veins is removed. One
end of each ligature is cut short, and the other ends are tied
so that the cord is shortened and the testicle elevated. To
insure accurate apposition of the two stumps it is well to
insert one or two sutures of fine cat-gut. All hemorrhage
must be thoroughly arrested to insure the best results. The
testicle ia now drawn down into the scrotum and the cuta-
neous incision sutured in the customary manner.
Describe McBurney's "grid-iron" incision for appen-
dicitis. What is the advantage of this incision and what
is the disadvantage?
After the skin has been carefully disinfected, an oblique
inttisioD about three inches in length is made, commencing
one inch above McBurney's tine and crossing this line about
an inch and a half internal to the anterior-siiperior spine.
The position of the incision will naturally vai-y .somewhat
according to the location of the swelling, but it should always
be made in the direction of the fibres of the external oblique
muscle. The aponeui-osis of the external oblique and a small
portion of the muscle itself are now divided in the direction
of the external incision. The fibres of the external oblique
muscle should be separated (not incised), great care being
taken that none of the fibres are divided transversely. Re-
tractors are now placed in the wound and the internal oblique
and the transversalis muscles are similarly split in the direc-
tion of their fibres. The transversalis fascia and peritoneum
are then divided in the iisual manner.
The advantage of the incision is that the abdominal wall is
not weakened as much as if the miiseular fibres were cut
across, and therefore there is consequently less tendency to
subsequent ventral hernia.
The disadvantage of the incision is that the amount of
room to work in is somewhat lessened, and the performanet-
of the operation consequently rendered more difficult.
SURGERY. 363
What Is the difference between congestion and inflam-
mation?
Arterial coiigestion is an excess of blood in the more or less
dilated arteries of a part, the velocity of the blood-current
being increased. The part is reddened, the temperature is
increased, swelling is scarcely appreciable, pain is not present,
except that the patient may complain of a throbbing sensa-
tion, and the function and nutrition of the part are increased.
If the congestion continues the part becomes either hyper-
trophied or inflamed.
* * Inflammation is the succession of changes which occur in
a living tissue when it is injured, provided that the injury is
not of such a degree as to at once destroy its structure and
vitality." (Burdon Sanderson). The part is reddened, the
temperature is increased, swelling may be considerable, and
pain is present dependent upon the character of the tissue
involved and the severity of the inflammation. The function
of the part is diminished and fever is usually present.
How would you diagnose and treat a case of fracture of
both bones of the forearm occurring at the middle third?
The diagnosis is usually apparent at a glance. There will
l)e angular deformity, as a rule, crepitus, a new point of
motion (preternatural mobility), pain, and subsequently
swelling and ecchymosis. The power of supination and pro-
nation is entirely lost. In those cases in which the diagnosis
might be doubtful the X-rays will reveal the nature of the
lesion.
Treatment: Reduction by extension and counter-extension
combined with manipulation at the site of the fracture.
After the deformity has been reduced the forearm should be
kept flexed at a right angle to the arm and in a position
midway between pronation and supination {thumb up!)
Two splints should be applied, a palmar extending from the
bend of the elbow to below the wrist. The splints should be
firmly and evenly padded, and must be broad enough to pre-
vent circular constriction of the forearm. A primary roller
364 SURGERY.
should never 'be applied, and an interosseous pad is not to be
employed. Union is usually complete in four or five weeks.
Define amputation in the continuity and amputation in
the contiguity of a limb.
By amputation in the continuity of a limb is meant an
ajnputa-tion througrh the bone or bones of the extremity.
By an amputation in the contiguity of a limb is meant an
amputation through any of the joints of the extremity.
Define the following terms: (a) Bursitis; <b) bunion;
(c> paronychia. Give the treatment for each disease.
By bursitis is meant the inflammation of a bursa.
By a bunion is meant an inflamniation of one of the bursfe
about the foot, usually over the in eta tarso- phalangeal joint
of the great toe.
By paronychia or felon is meant an inflammation of a fin-
gev. It may be subcuticular, subcutaneous, thecal (suppur-
ative teno-synovitis), or subperiosteal (bone felon).
Simple acute bursitis is treated by keeping the part at rest
and the application of fomentations. If the effusion per-
sists it may be aspirated or the entire cavity may be excised.
Suppurative bursitis should be treated by early and free
incision and the subsequent maintenance of effective drain-
age. Chronic bursitis may be met by rest and counter-irri-
tation; if these measures fail the burea should be dissected
out. Special care must be exercised in dealing with burate
which communicate with a joint. In tuberculous bursitis
the part should be freely incised, the tubercular tissue
scraped away, and tlie cavity packed with iodoform gauze.
The treatment of bunion is that of acute or of suppurative
bursitis. If the bone is diseased it must be removed, and any
malposition of the toe corrected during the period of convar
lescence. In some cases the underlying joint must be rfr
sec ted.
All varieties of paronj-chia are best treated by a free and
early incision extending well into the inflamed area. In tiie
SUROEBY. 365
subcuticular and subcutaneous varieties care must be taken
not to incise the sheaths of the tendons and thus give rise t(!V
additional infection. In the subperiosteal whitlow, the inci-
sion should go down to the bone, and cannot be made too early.
Describe the various steps in the operation of inguinal
colostomy.
After all aseptic precautions have been observed, an inci-
sion about two inches in length is to be made, one and one-
half inches above and parallel with the outer portion of
Poupart's ligament. This incision should be carried down
to the peritoneum. All hemorrhage having been checked,
the parietal peritoneum is to be incised for about two-thirds
the length of the external wound and accurately stitched to
the skin. While this step of the operation is being i)erformed
the intestines should be held out of the way by a sterile gauze
pad. After the colon has been found it should be drawn out
of the wound, pulling from above downward, and returning
the protruding bowel through the lower angle as it is drawn
out from the upper one. As soon as the colon is almost taut,
an opening is made in the meso-sigmoid (or descending meso-
colon, as the case may be) and a glass rod passed through it
so as to bring a coil of intestine out of the wound, the ends of
the rod resting upon the skin. The two limbs of the intes-
tinal coil are fixed by suturing them together beneath the
glass rod. An aseptic dressing is now applied. Adhesions
will be sufficiently firm by the third or fifth day, when the
intestine may be opened by a transverse incision. This latter
step may be performed without an anesthetic. A few days
later all of the bowel projecting above the skin may be cut
away and the bleeding carefully checked. Should it be neces-
sary to open the bowel immediately, the intestine should be
accurately sutured to the lips of the cutaneous incision and
a Paul *s tube tied in place.
Describe an operation for wry-necic.
Open myotomy of the stemo-cleido-mastoid muscle. All
366 SURGERY.
aseptic details having been observed, the skin is freely incised
&bout a half inch above the clavicle, and the etemo-cleido-
mastoid muscle is freely divided at the level of the cutaneous
incision, the external wound is closed, and an aseptic dressing
is applied. The faulty position of the head is then over-
corrected and fixed in its new position by a plaster of Paris
bandage or other suitable contrivance.
What are the causes of dysphagia?
1. Pharyngeal: Acute or chronic inflannnntion, tubercu-
losis, sj'philis, malignant gnmths, stricture, paralysis, naso-
pharjTigeaJ poijiii, impaction of foreign bodies, and retro-
pharyngeal abscess or tumor.
2. Laryngeal: Acute or chronic inflammation, tuberculosis,
syphilis, or malignant growths.
3. Esophageal: Acute or chronic inflammation, impaction
of foreign bodies, the presence of diverticula, esopbagospasm,
and simple or malignant s.tricture.
4. Extrinsic causes: Aneurysm, goitre, enlarged glands,
mediastinal growths, pericardial effusion, tumors growing
from the bodies of the vertebra, and backward dislocation of
the sternal end of the clavicle (modified from Rose and Car-
What are the varieties of arterio-venous aneurysm and
state their points of difference.
An arterio-venous aneiirj'sm is either an aneurysmal varix
or a varicose aneurysm.
An aneurysmal ^-arix is a direct communication between
an artery and a vein without the interposition of a sae.
A varicose aneurysm is an indirect communication between
an artery and a vein with the interposition of a sac.
Give the main points of difference hetween acromegaly,
ostitis deformans, and leontiasis ossea.
Acromegaly occurs in voum^ adults (20-30). It affects the
bones of the hands and feet and those of the face (particu-
SURGERY. 367
larly the lower jaw and the nasal bones) . The cranial bones
are not affected, with the exception of the lower i)ortion of
the frontal bones and the margins of the orbits. The bones
of the hands and feet are broader, but there is no increase in
their length. Microscopically the osseous structure does not
differ from that of normal bone.
Ostitis deformans begins more commonly in men past mid-
dle life. It affects the long bones of the extremities and the
bones of the cranium. The facial skeleton shows little
change. Kyphosis is present Pain is present in the early
stages of the disease, but, unlike other bone pains, it is not
worse at night. The affected long bones are increased in
length. The microscope reveals changes similar to those of
rarefying ostitis.
Leontiasis ossea begins in early life, and the extremities are
not affected. Both the facial and the cranial bones are in-
volved, the bones of the jaws first becoming enlarged.
Give the treatment for mammary carcinoma.
The treatment of mammary carcinoma consists of the earli-
est possible removal of the entire breast, together with the
axillary and supraclavicular glands. All these structures
should be removed in one continuous piece, so that no infected
Imyphatic vessel is divided. Advanced cases may require the
removal of the sternal portion of the pectoralis major and of
the pectoralis minor, and in such cases the entire mass re-
moved should also be in one piece. The sharpest knife ob-
tainable should be used. The first thought in the mind of the
surgeon should be to remove all of the cancerous tissue, the
closure of the wound being a consideration of secondary
importance. Adequate drainage should be provided, and
skin grafting should be resorted to if sufficient cutaneous
covering cannot be safely left to close the wound. Those
cases are to be regarded as inoperable in which the disease is
no longer local. Palliative operations may be performed for
the relief of pain in certain well-selected cases.
c
368 StlROEEY.
Describe the various steps in amputation at the wrist
by a long palmar flap.
After all aseptic precautions have been observed, the band
is supinated, the thumb is abducted, and an. incision is made
commencing at the styliod process of the i-adius and extend-
ing over the thenar etuinence to the distal transverse palmar
crease. This incision is continued transversely across the
palm and then up over the hypothenar eminence to the styloid
process of the ulna. This flap is now dissected away from
the bones, and contains all of the stnMJtures of the palm ; the
Hesor tendons and large nerves should be divided at the level
of the wrist joint and removed. The hand is tien placed in
the pronated position and a slightly curved incision is made
connecting the two styloid processes, the convexity of the
incision being directed downward. The extensor tendons
and the lateral and posterior ligaments of the wrist are
divided and the hand removed. After all hemorrhage has
been checked the palmar flap is brought over the ends of the
bones and held in position by interrupted sutures of silk-
worm-gut. An aseptic dressing is then applied.
How does ulceration differ from mortificBtion?
By ulceration is meant tJie molecular death of a part; by
mortification {or gangrene) is meant molar death or the
death of the part en masse.
Differentially diagnose phimosis and gonorrhea from
phimosis and subpreputial chancroid.
In phimosis and gonorrhea there is no history of a sore on
the glans or prepuce, the preputial swelling is at fii-st simply
edematous, the discharge is usually purulent, there is no local-
ized area of hardness or tenderness, chordee is frequently
present, the ardor urinte is felt along the entire urethra,
vesical symptoms are not uncommon, and bubo is very rare.
In phimosis and subpreputia! chancroid there is a history
of a sore, the preputial swelling is due to plastic exudate
about the nicer, the discharge is frequently bloody, a localized
area of hardness or tenderness is usually present, true chordee
SURGERY. 369
never occurs, the ardor urinae is experienced only when the
urine comes in contact with the ulcerated foreskin, vesical
symptoms are absent in uncomplicated cases, and bubo is
common.
Describe Bassini's operation for the radical cure of ob-
lique inguinal hernia.
After all aseptic details have been observed, an incision is
made parallel to and one-half inch above Poupart's ligament.
This incision extends from above the center of Poupart's lig-
ament to the base of the scrotum, and exposes the aponeurosis
of the external oblique and the external abdominal ring. All
hemorrhage having been checked, a grooved director is carried
into the inguinal canal, and the aponeurosis of the external
oblique is divided \o a point well above the internal abdominal
ring. The upper flap of aponeurosis is freed until the arching
fibres of the conjoined tendon come into view ; the lower flap
is drawn down until the shelving edge of Poupart's ligament
is exposed. The sac is now separated from the cord (the cord
usually being behind the sac), and this separation is carried
up to the internal ring. The sac is opened, adhesions prop-
perly dealt with, omentum ligated in sections, and the intestine
returned to the abdominal cavity. The sac is then ligated at
a point high up, just above the internal ring, and the redund-
ant portion cut off about a centimeter below the ligature.
The cord is now held up out of the wound by a strip of sterile
gauze, and the conjoined tendon sutured to the deep shelving
of Poupart's ligament by four or five sutures. It has been
advised to place one suture above the cord, as this is the point
at which the recurrence is most likely to occur. None of these
sutures should be tied too tightly, as strangulation of the
tissues greatly favors infection and interferes with primary
union, which is absolutely essential to the success of the
operation. The cord is now laid upon its newly-formed bed
(after resection of some of the veins if necessary), and the cut
edges of the aponeurosis of the external oblique are united
by a continuous suture. Great care should be taken to pre-
24
370 SUROERY.
vent any suture interfering with the circulation in the cord.
The cutaneous wound is then closed with a. subcuticular stitch
and an aseptic dressing applied. The deep sutures should
consist of kangaroo tendon, the superficial ones of cbromi-
cized cat-gut. If the operator is not sure of the asepticity of
the tendon or cat-gun, silk sutures should be employed.
Give the differential diagnosis of abscess.
If an ahscGss is present there will a history of a preced-
ing inriammation, fluctuation, a tendency to point, an absence
of thrill, an absence of bruit, a febrile temperature (as a
rule), and an examination of the blood usually reveals a poly-
morphonuclear leukocytosis. If the abscess lies over a blood-
vessel it may have an up-and-down pulsation, but if the
abscess is pushed to one side this pulsation ceases. In such a
case the abscess will not change in size if pressure is made
upon the vessel above or below the abscess. The exploring
syringe reveals pus.
Aneurysm : If an aneurysm is present there will be no his-
tory of a preceding inflammation, fluctuation is rare, the
swelling preserves its fusiform or nmuded shape, showing no
tendency to point, thrill and bruit are present, the pulsation
is ejtpansile, the swelling cannot be moved fi-om the line of
the blood-vessel, pres.sure above the aneurysm decreases its
size and expansile force, pressure below the aneurysm in-
creases its size and expansile force, there may be a difference
in the pulse to the distal side of the aneurysm as compared
with the corresponding vessel upon the opposite side, and
leukocytosis and fever are absent (unless thesac is inflamed).
The exploring syringe reveals blood.
Cysts : The overlying tissues are not edematous, nor is there
a history of a preceding inflammation. The exploring syrin^
is of value in doubtful cases.
Tumors: The only tumor apt to be confused with an ab-
scess is a rapidly growing sarcoma (small round cell). Al-
though these tumoi-s may fluctuate, inflammatory symptoms
are absent, and the exploring syringe reveals a bloody fluid.
SURGERY. 371
Describe intermediate and secondary hemorrhage, giv-
ing both preventive and curative treatment of each.
By intermediate hemorrhage is meant a hemorrhage recur-
ring within twenty-four hours of an accident or operation.
Preventive treatment: The proper method of tying the
ligatures (surgeon's knot), which should include the artery
alone, and not the surrounding tissues. All bleeding points
should be carefully and completely controlled at the time of
the accident or injury, and stimulants should not be injudi-
ciously employed.
Curative treatment: Elevation and pressure. If these
measures are not successful, the wound should be opened up,
irrigated with hot sterile saline solution, and all bleeding
points tied. If ligatures cannot be applied, the actual cau-
tery may be employed, or the wound may be packed with
antiseptic gauze.
By secondary hemorrhage is meant any hemorrhage occur-
ring in a wound after the lapse of twenty-four hours from
the time of the injury or operation.
Preventive treatment: Thorough asepsis, the proper appli-
cation of ligatures to all bleeding points, and the avoidance
of the injudicious use of stimulants.
Curative treatment: This will depend upon whether the
hemorrhage comes from the end of a divided artery (as in a
stump) or whether it comes from an artery which has been
ligated in its continuity.
If the hemorrhage -comes from the end of a completely
divided artery (as in a stump), elevation, exposure to the air,
irrigation with hot sterile saline solution, and firm bandaging
may suffice in the milder cases. If the hemorrhage recurs,
the wound must be opened again, and the bleeding points
ligated. If ligatures cannot be employed on account of the
septic condition of the tissues, the actual cautery will be of
ser\nce. All septic sloughs should be removed by the Volk-
mann spoon, and the wound swabbed out with carbolic solu-
tion (1-20) or with a solution of chloride of zinc (1-12).
The wound should then be dusted with iodoform crystals.
373 SVEGERY.
firmly packed with iodoform gauze, and a firm bsndage
applied. If the secondary hemorrhage occurs later in the
case, the wound must be opened up, the bleeding vessel iso-
lated from the surrounding structures, and ligated higher up.
If this is imjMJSsible, the artery must be ligated still higher
up, or a re-amputation performed. If the secondary hemor-
rhage occurs after a shoulder or hip amputation, proximal
ligation is the only measure to rely upon should the local
treatment fail,
If the hemorrhage oomes from an artery which had been
ligated in its continuity, the same local treatment should be
adopted as in the former instance. If this is unsuccessful.
the treatment will depend upon the situation of the vessel.
If the vessel is in the trunk (iliac) or neck (carotid) tlie
wound must be opened up, the artery again ligated above and
below, and the septic condition of the tissues combated by
pacting with antiseptic gauze. If this fails, and proximal
ligation is impossible, pressure will be the last resort. In
the arm, if cold, pressure and elevation are without effect,
the original wound must be enlarged, and the vessel tied
above and below. If the hemorrhage still continues, the
artery must be exposed and ligated higher up through «n
independent incision, or amputation will have to be per-
formed. In the leg, a second ligature at a higher point is of
questionable value on account of the poorer collateral circu-
lation. Should it control the hemorrhage, gangrene will re-
sult, and consquently amputation should at once he per-
formed if the local measures are unsuocessful.
State the differences between sthenic and asthenic in- -
flammatory fever.
Sthenic inflammatory fever occurs in the young and in the
robust. It nirely commences with a chill, the temperature
rises to 102 degrees or 103 degrees P., delirium if present is
maniacal, the pulse is full and strong, the skin is hot and dry,
and constipation is present.
Asthenic inflammatory fever occurs in the aged and in the
debilitated. It usually commences with a chill, the temper-
J
SURGERY.
873
atureil rises to 104° or 105° F., the delirium is low and mutter-
ing, the pulse is rapid and weak, the skin is cold and clammy,
and diarrhea is present.
Differentiate dislocation of the head of the femur from
fracture of its neck, and give main essentials of treatment
of each.
Dors.il DisloeaJtion,
Inversion of foot.
Immobility.
Head of femur not felt in its natural
position.
The buttocks of the affected side are
unduly prominent, due to the pres-
ence of the head of the dislocated
bone.
Crepitus is absent.
Immediate shortening of two or three
inches.
Rarely occurs after forty-five, and
more commonly in the male.
Violence usually considerable.
IntraeapnUar Fracture,
Eversion of foot.
Preternatural mobility.
Head of femur felt in its natural
position.
Flattening of hip, the great trochanter
moving in an arc of smaller radius,
and relaxation of the ilio-tibial
band.
Crepitus may be elicited (unless im-
paction is present).
Immediate shortening of a half-inch,
consecutive shortening of two or
three inches.
Much more common in advanced life
and in the female.
Violence usually trivial.
Treaimefnt,
Reduction by flexion of le g upon
thigh (for leverage), flexion of
thigh upon abdomen (to relax Y-
ligament), external circumduction,
and extension. When reduction
has been effected, the knees should
be bandaged together, and the pa-
tient kept in bed for two weeks.
Reduction by extension and counter-
extension. Buck's extension should
be permanently employed. A sand-
bag extending from the axilla to
the external malleolus should then
be placed upon the outer side of
the extremity, and one extending
from the groin to the internal mal-
leolus upon the inner side of the
extremity.
In some cases it may be advisable to
apply a plaster cast over the abdo-
men and over the injured extremity
to below the knee, and to allow the
patient to change her position. In
other cases tlie general condition of
the patient makes it imperative to
absolutely disregard the fracture.
Describe a method of amputation of the thigh.
The nielhod giving the best results will generally be a flap
amputation through the skin and a circular amputation
through the ntuscles ( mixed method) . After all aseptic pre-
cautions have been observed, and a tourniquet properly ap-
plied, the surgeon takes his position upon the right side of the
extremity to be amputated and makes a straight incision upon
either side of the thigh. These incisions commence at the
level at which the ibone is to be divided ; they are as long as
the diameter of the limb at tieir point of origin, and they
divide the skin and subcutaneous connective tissue. The
lower ends of these incisions should be connected by a trans-
verse cut of similar depth, and the corners of the flap roundc<i
off. The centers of the two incisions should now be joineil
by a posterior transverse incision, the corners being rounded
off as before. The anterior flap is now raised, and consists of
nothing but skin and subcutaneous fat, excepting at its base,
where aeertain amount of muscular tissue should be included.
The posterior flap is then dissected up, and should consist of
nothing but skin and subcutaneous fat throughout. The
muscles are now to be divided by a circular sweep of the knife.
An assistant retracts the muscular tissue, a cuff of periosteum
is raised, and tlie bone is sawn through as high up in the
wound as possible( about one and one-half inches above the
angles of junction of the flaps). After the main vessels have
been secured the tourniquet should be loosened and all bleed-
ing points caught and ligated. Large nerves are drawn out
and divided with scissors at tlie highest possible level, any
projecting tendons are retrenched, and capillary hemorrhage
is checked by hot sterile saline solution. The muscular tissue
may then be sutured over the end of the bone if desired, and
the edges of the flap united by interrupted sutures. The
opration is concluded by the application of an aseptic
dressing.
Give the symptoms and treatment of luxation of the
SURGERY. 875
elbow-joint with special reference to the prevention of
ankylosis.
The most frequent dislocation, that of both bones back-
ward will be selected.
Symptoms : The elbow is flexed, the forearm is midway be-
tween pronation and supination, and slight motion causes great
pain. The olecranon and the head of the radius may be felt
posteriorly while the lower extremity of the humerus is
prominent anteriorly. The forearm is shortened and the
olecranon projects above a line connecting the two condyles.
Treatment : The patient is seated in a chair. The surgeon
places his knee in the bend of the elbow and makes pressure
against the lower end of the humerus, simultaneously fixing
the forearm by grasping it just above the wrist. After
maintaining this pressure for a short time the forearm is
slowly but forcibly flexed upon the arm, the knee of the
surgeon acting as a fulcrum and disengaging the coronoid
process of the ulna from the trochlear surface of the hu-
merus. The elbow is then put upon an angular splint or en-
cased in a plaster of Paris bandage for two weeks after
which passive motion and massage should be employed daily
to prevent ankylosis. A lighter splint should be worn be-
tween the periods of massage for at least one week longer.
Outline the treatment for irreducible umbilical hernia.
If any contra-indication to operation exists and there is no
risk of strangulation some retentive apparatus may be worn.
Practically all of these cases, however, should be operated.
The entire hernial site is excised, the contents are reduced, and
the abdominal wound is closed layer by layer. The patient
should be kept upon her back until the union is firm and
an abdominal belt may be worn for several months.
Describe the operation of perineal prostatectomy.
After all aseptic precautions have been carried out the
patient is placed in the lithotomy position and an inverted
V-shaped incision is made through the skin and superficial
376
SVROEBY.
f
fascia, the apex of the V being over the posterior part of
the bulb ajid the branches extending to a point midway be-
tween the amiB and the tuberosity of the ischium. The central
tendon of the perineuin and the recto-urethralis muscle are
divided so that the rectum may easily be retracted backward
ginng free access to the membranous urethra and the ai>ex
of the prostate gland. The membranous urethra is incised
longitudinally upon a grooved staff, the edges are caught with
forceps and Young's prostatic tractor is introduced and
opened out By pulling upon the tractor the prostate is
brought well down into the wound and may be readily
enucleated. By making two divergent incisions into the pros-
tate as advised by Young, the ejaculatory ducts, and the floor
of the urethra may be spared. If a median bar or lobe he
present it may be made to project into one of the lateral
cavities and also enucleated. In some ca.ses the finger may Iw
aubstiluled for the prostatic tra^jtor with advantage.
Describe any one of the dislocations of the shoulder-
joint.
Subeorncoid dislocation. There is a flattening of the
shoulder- joint, the head of the humerus being felt beneath the
coraooid process. The vertical circumference around the
axilla is increased (Callaway's sign). A ruler or straight-
edge may be brought in contact with the tip of the acromion
and the external condyle of the humerus simultaneously
(Hamilton's sign). If the hand of the dislocated extremity be
placed upon the sound shoulder the elbow cannot be approxi-
mated to the chest-wall (Dngas' sign). The elbow is away
from the side and slightly posterior. " The axis of the arm is
altered. The patient is unable to touch the top of his head
with the hand of the dislocated extremity.
Give the diagnostic symptoms and the surgical treat-
ment of congenita) inguinal hernia.
Sj-mptom.s: The sudden appearance of an inguinal swelling
which soon extends into tiie scrotum. This swelling gives
A
SURGERY. 377
an impulse on coughing and when reduced flops back with a
gurgle. It is not translucent. The hernia is always of the
indirect variety. The hernial contents can not be differenti-
ated from the testicle as readily as in a hernia of the ac-
quired type. In a congenital inguinal hernia, the testicle is
at the bottom of the scrotum while in the acquired variety the
testicle is on the posterior wall of the scrotum at the junction
of the middle with the lower third. As in the acquired
variety, the symptoms will also depend upon the nature of
the hernial contents. A ''congenital hernia '* may develop at
any period of life, it is only the sac which is present at birth.
Surgical treatment: Bassini's operation (described else-
where). Instead of removing the entire sac as in a typical
Bassini, a tunica vaginalis is fashioned from its lower por-
tion. The upper portion of the sac is ligated or sutured as in
the ordinary operation for the radical cure of the acquired
variety of inguinal hernia.
Give the symptoms and treatment of acute ischiorectal
abscess.
Symptoms : Severe stabbing pain at one side of the rectum
which is increased by defecation and digital examination.
The patient is unable to sit squarely upon the buttocks but
rests upon the healthy side allowing the inflamed area to pro-
ject beyond the edge of the chair. Inspection reveals a
hard brawny swelling at the side of the anus, which is ex-
quistely tender ; the overlying skin is reddened and edematous.
The swelling soon softens and exhibits fluctuation upon pal-
pation. A considerable amount of fever is usually present.
Treatment: Free incision and the maintenance of gauze
drainage so that the cavity will heal up from the bottom.
Give symptoms and treatment of gun-shot and stab-
wounds of the abdominal wall involving the intestines.
Symptoms: The presence of a wound of entrance and pos-
sibly also one of exit. The most characteristic symptoms of
a wound of the intestine are localized pain and rigidity of the
378
SURGERY.
overlying muscles. The other symptoms are bo variable that
email dependence may be placed upon them. Shock may or
may not be present.
TreatTneut: While a masterly inactivity may be justifiable
in military pi-actiee, there is but one course for a competent
abdominal surgeon to pursue when he can give his patient the
advantages of thorough asepsis. After all a.septie precau-
tions have been insured, the wound of entrance should be en-
larged though it is usually best to make a median incision of
sufficient lengtli to allow the operator to quickly inspect the
entire length of the intestinal tract. The small intestine
should be followed from one end to the other, the assistant
replacing the bowel as soon as the surgeon finishes his ex-
amination so that only a single coil is exposed at any one
time. The large intestine is tlien to be quickly but thoroughly
examined. The possibility of an extraperitoneal wound
should also be remembered. All perforation should be
quickly closed hy Lembert or purse-string sutures. If sev-
eral perforations are close together, time may 'be gained by
resecting the gut aiid making an end-to-end anastomosis by
means of a Murphy button. If more than half of the lumen
would be encroached upon by repairing a perforation, resec-
tion is advisable. If these cases are opei-ated upon earlj'
(within four hours) irrigation is not necessary. If extravasa-
tion has occurred, however, the peritoneal cavity must be
thoroughly irrigated with a large quantity of normal saline
solution. Drainage may or may not he necessary. Thorough-
ness and rapidity are indispensable to the success of the
operation.
Give the symptoms and treatment of fracture of the
base of the skull.
The general symptoms may be those of concussion, com-
pression or laceration of the brain.
The local symptoms will depend upon the cerebral fossa
involved.
In the anterior fossa, if the orbital plate be involved, .there
SURGERY. 379
will be subconjunctival ecchymosis and possibly a certain de-
gree of proptosis as the eyeball may be pushed forward by
retrobulbar hemorrhage. If the cribriform plate of the eth-
moid be involved, blood and cerebrospinal fluid will escape
from the nose. Loss of smell may be present.
In the middle fossa those signs will be present which are
described upon page 409.
In the posterior fossa the symptoms are ill defined. There
may be bleeding from the mouth or the blood may be swal-
lowed and subsequently vomited. Deep-seated eochymosis
may become manifest among the muscles at the back of the
neck. The cranial nerves are rarely involved.
Treatment: Absolute rest in bed. Perfect quiet, the exclu-
sion of light and sound, a restricted diet and the administra-
tion of a brisk mercurial purge. The external auditory
meatus should be thoroughly disinfected, plugged with anti-
septic gauze, and further protected by an antiseptic pad over
the ear of the affected side. The nares and throat should be
kept as clean as possible by the use of an antiseptic spray.
Describe the varieties and the treatment of fractures
of the patella.
The ordinary fracture of the patella is due to muscular ac-
tion. It is transverse, almost ahvays complete, and the frag-
ments are usually distinctly separated.
The safest method of treatment is to fix the knee-joint, re-
duce the intra-articular effusion by evaporating lotions, pres-
sure, or aspiration and then to hold the fragments in position
by the use of Agnew's posterior splint, adhesive plaster, and
bandages. This treatment can effect only a fibrous union.
The only way in which a perfect result may be secured is
by making a free longitudinal incision over the fracture, re-
moving the clots and fibrous tissue from between the ends of
the fragments, drilling the fragments obliquely, and wiring
them together. If rigid asepsis is not secured the patient
may lose his leg or even his life. This is the treatment to be
adopted in young active patients whose livelihood depends
380
SURGERY.
upon a perfect functional result. If the patient be past middle
age and of sedentary habits the treatment with the posterior I
splint and the resulting fibrous union may be perfectly sati*- I
factory to him if he does not care to assume the risk of the ]
operative procedure.
The second and i-arer variety of fracture of the patella is
that due to direct violence. It is iisually stellate but may be
oblique, longitudinal, or even transverse. It is frequently in-
complete and the fibrous expansion of the quadriceps may not '
be torn, so that the fraoTnents are not displaced. The 01
lying t.is.sues are bruised and swollen.
The posterior splint and evaporating lotions usually give |
good results in these cases. They are not so favorable for ,
operation on account of the contusion of the overlying ,
tissues. It is exceptional that operation is retjuired for a
fracture of this type.
Describe the treatment for fracture of the shaft of the
femur at the middle third.
These fractures are to be ti-eated with a long external splint
provided with a foot piece (Desault's), by three shorter splints
applied to the eirciimfercnce-of the thigh, and by extension.
The bed should be hard and firm. The foot is firmly ban-
daged to the foot-piece by a figure-8 bandage, all bony
prominences being cai-efully padded. The short splints arc
then applied to the anterior, inner and posterior aspects of the
thigh and should extend to the knee-joint or slightly beyond
it. They are to be held in position by two broad pieces of
elastic webbing. An assistant now makes traction upon the
splint until the deformity is reduced and the extremity is of
the same length as its fellow. The pieces of webbing are
then lightened and secured, and the upper portion of the
splint is fixed to the hody of the patient, preferably by a
broad piece of muslin which is sewn to the splint, passed be-
neath the body of the patient and then brought back to the
splint where it. is secured. This broad piece of muslin pre-
vents anterior displacement of the splint. In addition to
SURGERY. 381
this, most surgeons prefer to make permanent extension, the
stirrup for which is applied before the extremity is fixed upon
the external splint. Union should be secured in about eight
weeks but no weight should be born upon the extremity until
the end of the twelfth week.
Describe a cartilaginous tumor. Where are such
growths most commonly found?
A cartilaginous tumor (chondroma) is a tumor composed
of hyaline cartilage. They are most commonly found in con-
nection with some of the long bones, particularly the meta-
carpal bones and phalanges of the hand, the humerus, the
tibia, the femur, and rarely the ribs. They may also occur
in the parotid gland, testicles, breast, or thyroid gland, but
in these situations they are usually associated with some other
variety of tumor.
Mention the inflammatory diseases of bone.
Periostitis, ostitis, and osteomyelitis.
What is inflammation? How does inflammation extend
and how may it terminate?
** Inflammation is the succession of changes which occur in
a living tissue when it is injured, provided that the injury is
not of such a degree as to at once destroy its structure and
vitality. *' (Burdon Sanderson.)
Inflammation may extend by continuity, by contiguity,,
through the blood vessels, and through the lymphatics.
Inflammation may terminate by resolution, retrogression,
suppuration, ulceration, or gangrene.
State the distinction between the antiseptic and aseptic
wound treatment.
In antiseptic wound treatment an effort is made to destroy
the germs in a wound, as well as to prevent the entrance of
more bacteria. The greatest reliance is placed upon chemical
agents.
In aseptic wound treatment an effort is made to prevent the-
entrance of germs into a. wound. The greatest reliance is
placed upon naechanieal purifieatJon and upon sterilization
by heat.
Mention the general characteristics of a benign tumor
as distinguished from a malignant tumor.
Benign tumors, in contradistinction to malignant tumors,
are usually encapsulated, grow slowly, do not infiltrate, are
not painful (except by pressure), do not give metastasis, do
not recur upon removal, produce no cachexia, and do not cause
death (except by location).
What are the indications for ligature of the lingual
arteryV Give the steps of the operation, omitting aseptic
details.
Thy lingual artery is nnwt frequently tied as a preliminary
procedure to removal of the tongue. Other indications for
its ligalion are to control hemorrhage from the artery or its
branches, to check the growth of advanced carcinoma of the
tongue, and certain cases of maeroglossia.
The patient should be on his back, his shoulders raised, and
his head extended and turned to the opposite side. Starting
just below the symphysis of the chin, an incision is made
which passes downward and outward to the greater comu of
the hyoid bone, and then upward to the angle of the jaw,
ending at about the level of commencement of the incision,
but not endangering the facial artery. This incision divides
the integument, both layers of the superficial fascia with the
enclosed platysma, and exposes a portion of the submaxillary
gland. The deep fascia covering the submaxillary gland is
now incised and the gland loosened and held up by a retractor.
We have now exposed Lesser's triBugle. formed by the hypo-
glossal nerve above and the two bellies of the digastric mtiscle
below. The floor of this triangle is formed by the hyoglossus
muscle. The stylo-hyoid and the tendon of the digastric are
now drawn downward, the lingiml vein and the hypoglossal
nerve are drawn upward, and an incision is carefully made
SURGERY. 383
through the hyoglossus muscle just above the hyoid bone. In
making this last incision, which exposes the artery, care must
be taken to avoid wounding the middle constrictor and con-
sequently opening the pharynx. The submaxillary gland
and its duct must also be protected from injury lest a salivar>'
fistula result. The aneurism needle is now passed about the
artery, the ligature tied, the external wound sutured, and an
aseptic dressing applied. The artery may also be secured
before it passes beneath the hyoglossus, and the danger of
opening the pharynx is thus greatly lessened.
Name the different varieties of malignant tumors.
Sarcoma (round, spindle, and giant-cell, melanotic, alve-
olar, lympho-sarcoma, and endothelioma) and carcinoma
(epithelioma, scirrhus, encephaloid, melanotic, and colloid).
What are the chief affections of the scrotum?
Intertrigo, eczema, erysipelas, ecchymosis, edema, chancre,
chancroid, syphilitic eruptions, tubercular ulceration, ele-
phantiasis (lymph-scrotum), urinary fistula, tubercular si-
nuses, gangrene, lipoma, sebaceous cyst, and epithelioma.
What other methods beside the use of the knife are
employed to remove a carcinoma from superficial sur-
faces?
Caustics and the X-rays.
Name the principal operations for stone in the bladder.
Perineal lithotomy, supra-pubic lithotomy, and litholapaxy.
Name the different varieties of benign tumors.
Lipoma, fibroma, chondroma, osteoma, glioma, myxoma,
angioma, lymphangioma, myoma, neuroma, adenoma, and
papilloma.
Relate the causes of intestinal obstruction.
Acute obstruction : 1. Strangulation by bands, adhesions
or apertures; 2. Volvulus; 3. Impaction of foreign bodies;
4. Kinking of the gut (rare) ; 5. Acute intussusception; 6.
The termination of a chronic obstruction.
3U
SURGERY.
Cbronic obstniction : 1. Impaetion of feces, gall-stones, for-
eign bodies; 2. Intestinal affections, such as stricture, tumors,
angulation of the gut from contractiou of adhesions, matting
together of intestinal coils; 3. Compression of the intestine
by tumors or exudates outside of the bowel.
Describe the ligation of the femoral artery at any
selected point.
Ligation at the apex of Scarpa's triangle. The line of the
artery is from a point midway between the anterior superior
spine of the ilium and the symphysis pubis to the adductor
tubercle on the inner condyle of the femur. The patient
should be on his back, with the thigh abducted, rotated out-
ward, and slightly flexed. After all aseptic details have been
carried out, an incision is commenced three inches below Pou-
part's ligament and carried downward for about three inches
in the line of the artery, dividing the skin, superficial fascia,
and fascia lata. If the lymphatic glands are exposed they
may be held to one side or removed. In making the incision
the internal saphenous vein should not be wounded. The
sartorius muscle should now be located, and beneath this mus-
cle the artery will be found. Remember that the fibers of the
sartorius run downward and inward, while those of the
adductor longus run downward and outward. The sheath
should be opened upon the outer side and the crural branch
of the genito-crural ner\-e and the long saphenous nerve
avoided. The aneurysm needle is to be passed from within
outward. The cutaneous wound is then sutured and asep-
tic dressing applied.
What are the chief surgical diseases of the groin?
Inguinal hernia, femoral hernia, lymphadenitis, and en-
cysted hydrocele of the cord. Psoas abscess, hip disease, and
pelvic abscess may give rise to swellings, which are first
observed in the groin.
How are wounds classified?
Incised, lacerated, contused, punctured, poisoned, and gun-
SURGERY. 385
shot. They may also be divided into septic and aseptic.
Wounds in the vicinity of great serous cavities are divided
into penetrating and non-penetrating. Wounds are also
spoken of as being either subcutaneous or open.
Describe the anastomosis which talces place after liga-
tion of the femoral artery at its middle third.
The profunda femoris anastomoses with the articular
branches of the popliteal and with the tibial recurrent; the
comes nervi ischiadici anastomoses with the perforating
branches of the profunda femoris and with the articular
branches of the popliteal and tibial recurrent.
Where should the opening be made in order to reach the
antrum in a case of abscess of the middle ear?
In the posterior superior angle of the suprameatal triangle
of Macewen, which is bounded above by the posterior root of
the zygoma, in front by the upper and posterior segment of
the osseous external meatus, and behind by a line drawn tan-
gent to the bony meatus and almost at right angles to the
posterior root of the zygoma. The chisel is to be directed
slightly forward to avoid wounding the sigmoid sinus, and
care should be taken to avoid injury to the facial nerve.
What agents are employed for the production of local
anesthesia?
Ice and salt, carbolic acid, ethyl chloride, cocaine (intra-
dermic, infiltration, perineural and paraneural methods),
eucaine, and nirvanin.
What are the causes of secondary hemorrhage?
Chief cause: Septic arteritis.
Contributory causes: 1. Early absorption of ligature; 2.
Faulty application of ligature; 3. Ligature too near a col-
lateral branch; 4. A diseased condition of the arterial wall;
5. A state of the blood unfavorable to wound repair (albu-
minuria or diabetes) ; 6. Increased blood pressure (plethora,
25
386 - 8UB0EBY.
Bright'a disease, fever, ex.-citemeitt, injudicious administra-
tion of stdmulan'te}.
What are the causes of esophageal stricture?
Gongenital narrowing, the cicatricial contraction of healed
ulcers( due to tlie ingestion of corrosive liquids or to syphilis) ,
carcinoma, polypoid tumors projecting from the mucosa, and
eiternai pressure (aneurism, goitre, sarcoma of glands or of
vertebne, pericardial effusion). Strictures near the cardiac
orifice may arise from the h«aling and contraction of a gastric
ulcer.
At what point is paracentesis thoracis preferably per-
formed?
At the most dependent point of the effusion. The site
usually selected is iu the seventh or eighth interspace just
below the angle of the scapula or iu the posterior axillary line.
What are the predisposing and what are the exciting
causes of abdominal hernia?
Predisposing causes: Early life, male sex, occupations de-
manding great muscular exertion, structural defects (elonga-
tion of the mesentery, a patent funicular process), heredity,
relaxation of the abdominal wall from disease, weakening
certain portions of the abdominal wall by injury or operation,
phimosis, pertussis, bronchitis, urethral stricture and consti-
pation.
Exciting cause: Any increase of the intra-abdominal pres-
What are angiomata?
Angiomata are tumors composed of blood vessels, some of
which are of new formation.
Define volvulus and give its treatment.
By volvulus is meant a twisting of the gut in such a manner
that the intestinal lumen is occluded and the circulation of
the bowel affected. Treatment: Celiotomy. An attempt may
be made to untwist the intestine, but this is usually impos-
^
SURGERY. 387
sible. If the attempt succeeds a recurrence of the condition
should be guarded against by shortening the mesentery. If
the attempt fails one of three courses may be pursued :
1. An anastomosis may be performed between the bowel
ahove and that below the volvulus.
2. Resection of the portion of intestine involved, followed
by circular enterorrhaphy.
3. The making of an artificial anus. If the large intestine
is involved, as is usually the case, the latter course is prob-
ably the best one.
What is an abscess?
An abscess is a circumscribed collection of pus in a cavity
of abnormal formation.
How does a carbuncle differ from a furuncle?
A carbuncle is a gangrenous inflammation commencing in
the subcutaneous tissues and extending to the skin. Car-
buncles are usually single, occur most commonly after middle
life, show a predilection for the back of the neck of inter-
scapular region, and discharge through more than one open-
ing. They are larger, flatter, and accompanied by greater
constitutional disturbances than are furuncles.
A furuncle is a gangrenous inflammation commencing in
the skin and extending to the subcutaneous tissues. Pur-
uncles are usually multiple, occur most commonly during
adolescence and early adult life, show no predilection for any
portion of the body, and discharge through a single central
opening. They are smaller, more conical, and accompanied
by less constitutional disturbance than are carbuncles.
What anesthetic would you select for an operation
about the mouth?
Chloroform, unless contra-indicated.
What is an adenoma?
An adenoma is a tumor, the minute structure of which re-
sembles that of a gland. Unlike normal glands, these tumors
have no secretory ducts and no physiologic function.
388 SURGERY.
Through what channels is carcinoma disseminated?
Through the lymphatic channels.
Describe a dissecting aneurysm.
A dissecting aneurysm is one in which the blood breaks
through an atheromatous ulcer in the intima and burrows ita
way through the substance of the media; the sac of the aneu-
rysm is formed within the wall of the vessel.
What are the varieties of hydrocele?
Hydroceles of the cord: 1. Diffuse; 2. Encysted.
Hydroceles of the testicle: 1. Vaginal; 2. Congenital; 3.
Infantile; 4. Hydrocele of the funicular process (lower por-
tion) ; 4. Encysted ; 6. Hydrocele of a hernial sac.
Enumerate the diagnostic points in intussusception.
Colicky abdominal pain, vomiting, tenesmus, the passage
of blood-stained mucus or piire blood, and the presence of a
sausage-shaped tumor, which usually is siluated in llie line
of the colon, an absence of resistance being observed in the
iliac fossa. In advanced cases rectal examination may reveal
the presence of the intussusceptum. Acute intussusception
is more common in early childhood; chronic intussusception
is more frequently observed in adults.
What structures are divided in the operation for stran-
gulated femoral hernia?
Skin, superficial layer of superficial fascia, cribriform fas-
cia, femoral sheath, septum crurale, subserous areolar tissue,
parietal peritoneum, and the seat of constriction, which is
practically always the lunated edge of Gimbernat's ligament.
The superficial external pudic artery is always cut and the
superficial epigastric is usually divided.
With what conditions may aneurysm be confounded?
Abscesses, tumors and cysts which are situated near a blood-
vessel, and pulsating lumoi-s of bone.
SURGERY. 389
Where is the swelling and fluctuation most prominent
in synovitis of the ankle joint?
At both sides of the tendo Achillis and in front of both
malleoli (between the external malleolus and the extensor
communis digitorum tendons and between the internal mal-
leolus and the tibialis antieus tendon) .
Give a classification, either original or from competent
authority, of burns.
Dupuy trends classification is the best. He divided all burns
into six classes or degrees: 1. Superficial burns followed by
redness and desquamation of the epidermis; 2. Bums fol-
lowed by the formation of vesicles or bullae; 3. Burns de-
stroying the cuticle and a portion of the true skin ; 4. Burns
extending into the subcutaneous areolar tissue; 5. Burns
involving deeper structures, such as muscles and tendons; 6.
Burns involving all of the constituents of the part.
Define an acute and a chronic abscess.
An acute abscess is one which develops with all the signs
and symptoms of inflammation. It contains pus.
A chronic abscess is one which is formed without the signs
and symptoms of inflammation. As a rule they are tuber-
cular, and do not contain true pus unless a mixed infection
has occurred.
Mention the causes of dislocation. Give the cardinal
symptoms of dislocation.
Predisposing causes: 1. The anatomic peculiarities of the
joint; 2. The situation of the joint; 3. Active adult life; 4.
The male sex.
Exciting causes: 1. External violence (direct or indirect) ;
2. Muscular action.
Symptoms: 1. An alteration in the shape of the joint, the
displaced articular extremity being frequently felt in an
abnormal position; 2. An alteration in the length of the
affected member (shortening or elongation) ; 3. More or less
390
SURGERY.
immobility of the affected joint; 4. An alteration in the direc-
tion of the axis of the extremity.
Disloeationa, like fractures, are usually a^ompanied by
pain, swelling and ecchymosis.
How are amputations classified in regard to time of
operating? Wliat period is most favorable for operation?
Primary; the amputation is performed before the develop-
ment of inflammation.
Intermediate; the amputation is performed during the es-
istence of active inflammation.
Secondary; th« amputation is performed after the subsi-
dence of the inflammatory phenomena.
The primary period is the one moat favorable for operation.
Under what circumstances should an artery be ligated
in its continuity? What instruments are required for the
operation?
An artery should be ligated in its continuity to check
hemorrhage, to promote the cure of an aneurj-sm, to dimini.sh
the rate of growth of a tumor, to reduce the blood supply of
an organ, and as a preliminary step to the removal of some
vascular structure (such as the tongue). The instruments re-
quired are a scalpel, dissecting forceps, retractors, a grooved
director, several hemostats, an aneurysm needle, ligatures,
needles, and sutures. '
What are the causes of stricture of the rectum? i
Congenital malfonnation, syphilis, carcinoma, dysentery,
tuberculosis, gonorrhea, Irauraatism or operations involving
the greater portion of the circumference of the bowel, repeated
attacks of inflamed hemorrhoids, chronic proctitis, inflamma-
tory thickening outside of the gut, as in cases of pelvio
cellulitis after labor, and tujnors pressing upon the rectum
and narrowing its lumen.
Define nephrorrhaphy, nephrotomy, nephrectomy. Give
an indication for the performance of each.
By nephrorrhaphy is meant the stitching of a kidney to the
posleriiir wall of the abdomen. Indication, floating kidney.
i
8UB0EBY. 391
By nephrotomy is meant the cutting into kidney. Indi-
cation, renal calculus.
By nephrectomy is meant the excision of a kidney. Indi-
cation, a primary malignant renal growth.
Name the methods of inflating the tympanum.
Valsalva's, Politzer's, and by means of the Eustachian
catheter.
What are the conditions which render excision of the
lower jaiv advisable?
Malignant tumors of the mandible, malignant tumors in
tbe adjacent tissues involving the bone secondarily, trau-
matism, and necrosis may render excision advisable.
What are the complications of dislocation of the hip?
Fracture of the acetabulum (with or without injury to the
pelvic viscera), fracture of some portion of the upper ex-
tremity of the femur, rupture of the femoral artery, paralysis
from compression or rupture of a nerve-trunk, and extensive
laceration of the neighboring soft parts.
What arteries need ligating in amputation at the middle
third of the leg? Describe your method of ligating.
The anterior tibial, the posterior tibial, and the peroneal.
The anterior tibial artery will be found just above the inter-
osseous membrane lying between the tibialis anticus and the
extensor proprius hallucis. The artery should be freed from
the surrounding structures and ligated separately or to-
gether with the two venae comites, care being taken not to
include the anterior tibial nerve. If the artery cannot be
reached owing to excessive retraction, the patient should be
turned on his face, when the weight of the stump will extend
the limb and make the vessel much easier of access. The pos-
terior tibial will be found behind the tibia lying upon the
flexor longus digitorum or between it and the tibialis pos-
ticus. It should be freed from surrounding structures and
ligated separately or together with its two venae comites;
392
SURGERY.
care must he taken not to include the posterior tibial nerve.
The peroneal artery will be found behind the fibula between
the tibialis poslicus and flexor longus hallucis or surrounded
by the fibres of the flexor longiis hallueis. It should be freed
from surrounding structures and ligaled separately or to-
gether with ils two venae comitea. Bolh the posterior tibial
and the peroneal arteries will be found anterior to the deep
transverse fascia of the leg. Afler these three arteries have
been secured, the tourniquet should be loosened and any other
bleeding point seized and tied.
Where may a ligature be applied for aneurysm of the
popliteal artery?
I'refci'ubly at the apes of Scarpa's triangle or in Hunter'^
canal. It may also be applied in the upper portion of the
popliteal space, just after the passage of the artery through
the opening in the adductor magnus.
What are the indications for litholapaxy (rapid litho-
trity) as compared with (a) lateral perineal lithotomy;
(b) median perineal lithotomy: (c) suprapubic lithotomy?
Unless some coutra-indication exists litholapaxy is the
operation par excellence. The contra-indications are: 1.
Encysted calculus (absolute contra-indieation) ; 2. A stone
larger than IV2 inches in diameter, though many surgeons
will crush much larger stones; 3. Stones consisting of calcium
oxalate are so hard that the crushing operation is difficult
and sometimes impossible; 4. Excessive irrilability of the
urethra; 5. Urethral stricture of old standing not capable of
dilatation or the existence of false passages; 6. Cystitis; 7.
Enlarged prostate; 8. Sacculated or contracted bladder (hold-
ing less than six ounces) ; 9. Extensive renal diseaiie (unlesa
there is no doubt that the operation may be quickly per-
formed).
Lateral perineal lithotomy is indicated: 1, Where cystitis
and great irrilability of the bladder are present; 2. In phos-
phatic concretions; 3. If the bladder is contracted.
SURGERY. 393
Median perineal lithotomy is rarely performed, as the open-
ing is much smaller than in the lateral operation. The
advantages claimed for it are the small amount of hemor-
rhage and the lessened danger of urinary infiltration and
injury to the ejaculatory ducts.
Suprapubic lithotomy is to be performed: 1. When the
stone is too large to crush ; 2. If the stone is encysted ; 3. If
old strictures or an enlarged prostate is present; 4. When the
patient cannot assume the lithotomy position (ankylosis of
left hip, rachitic contraction of pelvis, presence of a tumor) ;
5. When the crushing operation is not deemed advisable in
young boys.
The indications for the suprapubic operation have been
greatly extended in recent years at the expense of the perineal
method. The only two absolute contra-indications to the
procedure are severe septic -cystitis and contraction of the
bladder.
What fractures do not present mobility? Under what
circumstances is crepitus absent?
Impacted fractures and incomplete fractures do not present
preternatural mobility.
Crepitus is absent in impacted fractures, in incomplete
fractures where there is great separation or over-riding of
the fragments, and where portions of muscle, tendon, or peri-
osteum are between the fragments.
What symptoms follow division of the radial nerve?
Anesthesia over the radial side of the dorsal surface of the
wrist and hand and over the dorsal surface of the thumb,
index, middle, and radial half of ring fingers, excepting over
the terminal phalanges.
What conditions of the kidneys require nephrectomy?
Any of the following conditions may require nephrectomy :
Carcinoma, sarcoma, tuberculosis, calculous pyonephrosis,
hydronephrosis, traumatic lesions (particularly if compli-
394 SURGERY.
cated by laceration of the peritoneum), and some cases of
ruptured ureter.
How may a quart of normal salt solution be prepared
at the patient's home?
By dissoMng two teaspoonfuls of salt in a quart of water.
The solution maj- be sterilized by boiling. The percentage of
salt is not accurate, but it is near enough for practical pur-
poses.
What are the principal affections of synovial bursae?
Acute simple bursitis, aeute suppurative bursitis, chronic
fibroid bursitis, chronic bursitis with effusion (house-maid's
knee), chronic tuberculous bursitis, syphilitic and gouty de-
What muscles are divided in the operation for (a) di-
verging strabismus, (b) converging strabismus?
(a) The external rectus, (b) The interaal rectus.
How would you reduce a dislocation of the inferior
maxillary bone?
It is only necessary to depress the condyle below the level
of the emiuentia articularis, when the masseter, temporal and
internal pterygoid muscles will readily draw it back into the
glenoid cavity. The patient is to be seated, the surgeon
stands in front of the patient and presses down upon the
molar teeth with his two thumbs, which are guarded by a
towel. This pressure is continued in a downward and back-
ward direction until the condyle clears the emiuentia articu-
laris, when the chin is to be raised by the fingers. The jaw
should be kept at rest for four or five days by a Barton
bandage.
Name the varieties of shoulder-joint dislocations.
Anterior (subcoracoid, intracoracoid, 8ubcla\'icu]ar), down-
ward (subglenoid, erecta), posterior (subacromial, subspi-
nous), and upward (supraglenoid).
SURGERY. 395
What are the possible mechanical obstructions in the
reduction of fractures?
Muscular spasm, the interposition of muscle or periosteum
between the ends of the fragments, impaction of the frag-
ments, perforation of the skin by one of the fragments, and
effusion into a joint (in fracture of patella or of olecranon).
What are the sources of wound infection?
A wound may be infected by the foreign body making the
wound, by any foreign substance or fluid coming in contact
with the wound, by the blood, by the skin of the patient, by
the hands of the surgeon and assistants, and by instruments,
ligatures, sutures or dressings. Aerial infection is very rare,
though possible.
Relate the difference between a sinus and a fistula.
A sinus is an abnormal canal leading from the skin or
mucous membrane to an abnormal cavity. It has but one
opening.
A fistula is an abnormal communication between the skin
or mucous membrane and a normal cavity. It has two open-
ings.
Define pyemia and give its symptoms.
By pyemia is meant a general infection of the blood with
pyogenic organisms. It is septicemia plus metastatic ab-
scesses.
Symptoms: Repeated rigors with a markedly remittent
temperature, exhausting diaphoresis, hyperesthesia of the
skin, suppuration in joints not usually involved in other
febrile affections (sterno-clavicular, sacro-iliac), and diar-
rhea. If there is an open wound it will become dry and
glazed. Physical examination will reveal the signs of pulmo-
nary congestion or pneumonia, metastatic abscesses may be
detected in various portions of the body, and examinations
of the blood show a leukocytosis. The mind is usually clear.
Toward the termination of the affection the imtient may fall
into the typhoid state.
What are the indications for castration?
Castration may be performed for malposition, for tuber-
culous disease, for old standiu^ hematoceles, for Bimple or
malignant tumors, after some injuries, and for chronic en-
largement of the prostate.
Give the causes and sequelae of suppurative middle ear
disease.
Causes: Inflammations in the naso-pharynx and infected
wounds of the membrana tjmpani.
Sequelffi: These may be divided into the extracranial, era-
nial and intracranial.
Extracranial: Eczema of meatus, furuncles of meatus, sub-
periosteal abscess and necrosis of tympanic plate.
Cranial: Necrosis of ossicles, caries or necrosis of temporal
bone, polypi, faeial paralysis and mastoiditis.
Intracranial: Extradural abscess, localized or diffused men-
ingitis, thrombosis of 1:he lateral sinus, and cerebral or cere-
bellar abscess. Remember that 50 per cent, of all eaeen of
brain abscess are due to this cause.
State the causes of exophthalmos.
Paralysis of the third cranial nerve, intra-orbital anenrysm,
intra-orbital tumors, thrombosis of cavernous sinus, fracture
of anterior fossa with laceration of eavernous sinus, em-
pyema of the antrum, tumors of the antrum, and exoph-
thalmic goitre.
What are gliomata and where are they found?
Oliomata are tumors composed of neuroglia. They occur in
the brain, spinal cord, and rarely in the cranial nerves. The
so-called glioma of ihe eye-ball is really a sarcoma.
Mention obstacles to reduction of dislocations.
Mnscnlar resistance, anatomical peculiarities of the joint,
the intei-position of shreds of the capsular tigwraent, fracture
ol the bone involved, and the presence of adhesions (old dis-
locatioiis).
SURGERY. 397
Define torticollis. Give the differential diagnosis of
torticollis and cervical caries.
Torticollis or wry-neck is a deformity due to contraction of
certain muscles on one side of the neck. The sterno-mastoid
is first affected, but the trapezius, the splenius, the platysma,
and even the cervical fascia may be involved.
In cervical caries motion in all directions is restricted, and
pain is elicited by pressing upon the cervical vertebrae; in
torticollis motion is restricted in but one direction, that in
which the muscle involved is put upon the stretch.
Describe hypospadias, epispadias, phimosis, and para-
phimosis.
Hypospadias is a malformation in which the urethra open.5
upon the under surface of the penis.
Epispadias is a malformation in which the urethra is par-
tially or wholly exposed on the upper surface of the penis.
Phimosis is that condition in which the prepuce is elon-
gated, and in which the preputial orifice is so narrow that it
can not be retracted behind the corona glandis.
By paraphimosis is meant a strangulation of the glans penis
by a prepuce which has been forcibly retracted and cannot be
replaced.
What is genu valgum? State how genu valgum should
be treated.
Genu valgum or knock-knee is a deformity in which there
is an abduction of the legs from the median line, together
with a certain amount of external rotation. The two inner
condyles may be brought into apposition, while the two inter-
nal malleoli are separated. Young children (up to the fifth
or sixth year) in whom the defoniiity is not great may be
treated by mechanical appliances. If due to rickets appro-
priate constitutional treatment must be observed. When the
deformity is great and the a<re of the patient precludes the
hope of a cure by mechanical means, osteotomy is indicated.
The best method of performing osteotomy is that of Macewen.
398
SURGERY.
What are the symptoms when the ulnar nerve has been
divided on a level with the pisiform bone?
Loss of adduction and abduction of the fingers, flexion of
the last two phalanges of each finger, and hyper-extension at
the metacarpophalangeal joint ("claw-hand"). The inter-
osseous spaces become very marked from the atrophy of the
muscles involved (the two inner lumbricales and all of the
interossei). There is also a paralysis of the short muscles
of the little finger, of some of the thumb muscles (adductor
transversus, adductor obliquus, and part of flexor brevis poi-
licis), and of the palmaris brevis. There is anesthesia of the
ulnar side of the dorsum and palm of the hand, and of both
dorsal and palmar surfaces of the little and ulnar side of the
ring fingers.
What tissues are divided in the operation for oblique
inguinal hernia?
Skin, superficial fascia, intercolumnar fa.scia, cremaster
muscle, infundibuliform fascia, subserous areolar tissue, and
parietal peritoneum. The superficial epigastric and the
.superficial external piidie arteries are always divided.
What are the indications for the operation of gastros*
tomy?
Malignant disease of the esophagus and stricture op stenosis
of the esophagus from any cause, when the patient is unable
to take sufficient nourishment.
What is the differential diagnosis between septicemia
and pyemia?
Septieemia occurs before the advent of suppuration, re-
peated rigors and metastatic abscesses are absent, and the
patient is delirious.
Pyemia occura after the advent of suppuration, repeated
rigors and metastatic abscesses are present, and delirium, if
present at all, is apt lo be nocturnal.
A differential diagnosis is frequently impossible, but the-
oretically the points ^ven above are those to be expected.
SURGERY. 399
Give the differential diagnosis between sacro-iliac dis-
ease and morbus coxarius.
In sacro-iliac disease pressure upon the crests of the ilia
causes pain; if the pelvis be supported, the thigh may be
moved in all directions without much discomfort; apparent
or real shortening of the lower extremity is never present.
In morbus coxarius pressure upon the crests of the ilia
produces no pain; motion of the thigh is accompanied by
pain ; apparent or real shortening of the lower extremity is
always present at some stage of the affection.
What are the principal affections of muscles?
Contusion, sprain, rupture of sheath, rupture of muscle or
tendon, displacement of tendon, myositis (traumatic, rheu-
matic, acute suppurative, tubercular, syphilitic, parasitic, and
myositis ossificans), primary tumors (angioma, fibroma,
chondroma, myxoma, and sarcoma), and secondary tumors
(carcinoma and sarcoma).
Give the indications and methods for ligature of the
common carotid artery.
The common carotid artery is tied for aneurysm, for wounds
of the internal or external carotid artery or their branches,
to check malignant growths, and as a preparatory procedure
to the removal of tumors.
Ligation in superior carotid triangle. The patient should
be on his back with his shoulder elevated, the head thrown
back, and the face turned slightly to the opposite side. After
aU aseptic precautions have been carried out an incision three
inches in length is made in the line of the artery (from the
stemo-clavicular articulation to a point midway between the
angle of the jaw and the mastoid process), the center of the
incision being opposite the cricoid cartilage. The skin, super-
ficial fascia, platysma myoides, and superficial layer of the
deep fascia are to be divided, the sterno-mastoid muscle drawn
outward, the tendon of the omo-hyoid drawn downward, and
the pulsations of the artery sought for beneath the stemo-
400
SURGERY.
mastoid. The sheath is now opened upon the inner side, the
aneurysm needle is passed from without inward, threaded,
and withdrawn.
Ligation in inferior carotid triangle. Patient in same
position as before. The incision is made in the line of the
artery from the level of the cricoid cartilage to the sterno-
clavicular articulation, and divides skin, superficial fascia,
platyama, and superficial vessels and nerves. The superficial
layer of the deep cervical fascia is then divided, the sterno-
iiiasloid muscle drawn outward, and the sterno-hyoid and
sterno-lhyroid muscles drawn inward. The sheath is opened
upon the inner side, and the aneurysm neeiite passed from
without inward.
What operations are perforined for intractable neural-
gia of the fifth nerve?
Neurotomy, nerve stretching, removal of Meckel's ganglion.
neurectomy, and removal of the Gasserian ganglion. Accord-
ing to the symptoms, one or more of the following nerves may
be resected: Supra-orbital, supra- trochlear, infra-orbital, in-
ferior maxillary division of the fifth, lingual, inferior dental,
and mental.
State the most common seat of fracture of the clavicle
and describe a method of treatment.
At the outer end of the middle third of the bone.
Sayre's method. Three strips of adhesive plaster three and
(lue-half inches wide and long enough to encircle the chest and
arm are required. A loop is made in the end of tie first strip;
this loop is secured by stitches and made to encircle the arm
close to the axilla, the non-adhesive surface of the plaster
being nest to the skin. The shoulder is then drawn backwards
and the adhesive strip carried around the chest from behind
forward (adhesive surface nest to skin), passing over the
front of the chest, under the axilla, and finally attached to the
part crossing the back. The elbow of the in,iured side is now
brought forward and the hand placed upon the sound sboul-
SUROERY. 401
der. As the loop of the first strip acts as a fulcrum, the shoul-
der and outer extremity of the clavicle are carried backward.
With the arm in this position the end of the second strip is
fixed to the sound shoulder, and the strip is then brought
downwards across the back to the elbow of the injured side
(a hole being eut in the plaster to accommodate the olecra-
non) , upwards across the front of the chest and forearm, and
fastened to the other end over the top of the sound shoulder.
This strip holds the shoulder back and keeps it raised. The
third strip is passed horizontally about the chest and forearm
to hold the extremity against the body. A towel should be
placed in the axilla, and all contiguous cutaneous surfaces
should be separated by pieces of lint. This position is to be
maintained until union occurs (about three or four weeks),
and the movements of the arm should be restricted for a week
or so longer.
Give the causes of atrophy.
Causes: 1. Diminished functional activity; 2. Defective
nutrition; 3. Pressure; 4. Nervous influence (neuropathic
atrophy) ; 5. Senility.
What symptoms follow division of the facial nerve?
Paralysis of the same side of the face without implication
of palate or uvula (it is presumed that the nerve has been,
divided after its exit from the skull). The paralyzed side of
the face is immobile, devoid of expression, and the natural
folds and wrinkles are obscured. The eye-lids cannot be
completely elosed, the eye-ball rolling upward and outward
when forcible clasure is attempted. Epiphora is present
from the drooping of the lower lid. The lips cannot be
firmly closed, and whistling is impossible. If attempts are
made to move the face (to show the teeth or laugh) marked
asymmetry is produced, the face being drawn toward the
non-paralyzed side. Owing to the paralysis of the bucci-
nator, food collects between the teeth and the cheek.
26
402 SURGERY.
•
What method of treatment affords the most prompt
relief in paronj-chia?
Evacuation of Uie pus or inflamraatory exudate by meana
of an incision, the introduction of a small strip of icMioform
gauze for drainage, and tlie application of a moist antiseptic
dressing.
Describe the operation for ligature of the subclavian
artery in its second part.
The patient should be in tlie dorsal position, with a cushion
beneath the shoulders, face turned to the opposite side, and
the shoulder depressed. After all aseptic precautions have
been carried out, the skin should be drawn down over the
clavicle, and an incision made over the bone extending from
the middle of the clavicle almost to the sterno-clavicular
articulation. The skin is then allowed to retract, and the
wound will be half an inch above the clavicle. This incision
divides the skin, superficial fascia, platysma myoides, and the
superficial layer of the deep cervical fascia. The clavicular
head of the stemo-mastoid muscle should then be divided,
and any veins overlying the prevertebral fascia covering the
scalenus anticus ligaled. The pi'evertebral fascia is then
incised, the phrenic nerve drawn inward, and the outer two-
thirds of the anterior scalenus muscle divided close to ita
attachment to the first rib. Care must be taken not to wound
the anterior jugular, exteraal jugular, internal jugular or
subclavian veins, the phrenic nerve or the pleura. The needle
is passed from before backward and from below upward-
What are the varieties of ankylosis?
Incomplete or fibrous and complete or bony. Ankylosis is
also spoken of as being either true (involvement of articular
structures) or false (result of estra-articular lesions).
When is operative interference advisable in the treat-
ment of malignant tumors?
Operative interference is advisable when the tumor can be
SURGERY. 403
thoroughly removed, when the operation will diminish pain
or make the patient more comfortable, and when it will
lengthen the life of the patient.
. Describe the several varieties of clubfoot.
Talipes equinus. The heel is drawn up and the patient
walks upon his toes.
Talipes calcaneus. The toes are raised from the ground
and the patient walks upon his heel.
Talipes varus. The anterior half of the foot is adducted,
the inner side of the foot is raised, and the patient walks upon
the outer side.
Talipes valgus. The anterior half of the foot is abducted
and everted, the patient resting upon the inner side of the
foot. Various combinations of these forms are indicated as
follows: Talipes equino-varus, talipes equino- valgus, talipes
calcaneo-varus, and talipes calcaneo-valgus.
Name the most common varieties of fistula.
Fistula in ano (complete, blind internal, blind external),
vesico-vaginal, urethro-vaginal, recto-vaginal, urinary, sali-
vary, biliary, and intestinal.
What is lupus?
Lupus vulgaris is a chronic inflammatory disease of the
skin and mucous membranes due to the tubercle bacillus, and
characterized by the formation of nodules of granulation tis-
sue. These nodules usually ulcerate (lupus exedens), but
such is not always the case (lupus non-exedens) .
What are the indications for enucleation of the globe?
Malignant disease, either primary or extending from adja-
cent tissues, rupture and collapse of eye-ball, a large irregular
foreign body in the eye not capable of being successfully
removed, a large wound in the dangerous region in which
little hope of obtaining useful sight remains, a small wound
in the dangerous region with commencing irido-cyclitis, a small
foreign body not removable by the electro-magnet and causing
8UR0EBT.
inflammation and shrinking, a wound in the dangerous region
complicated with traumatic cataract, a corneal wound in
which severe iritis and panophthalmitis develop in spite of
ti-eatment, and any case iu which sympathetic ophthalmia is
threatened. (Modified from Jacobson.)
Give the symptoms, diagnosis, and treatment of phle-
bitis.
Symptoms: The vessel affected becomes swollen, hard, and
painful. Localized eniargementa corresponding to the posi-
tion of the valves are observed. The overlying tissues are
dnsky and congested, and there may be some edema in the
area drained by the vein. The part is hot to the touch and
the patient usually lias fever. If suppuration occurs the
symptoms are those of a localized abscess.
Diagnosis: In lymphangitis the redness is brighter and
more localized, enlarged and painful glands are present, there
is no hard eord-like vein, and the swelling is much less marked.
In erysipelas the redness is characterized by an abrupt raised
margin, and gastric disturbances are frequently present.
Treatment: Absolute rest iu bed, with elevation of the
affected extremity to promote the return of venous blood.
The affected area is covered with a mixture of equal parts of
extract of belladouua and glycerine, and the limb is swathed
in a thick layer of cotton and lightly bandaged to a splint.
The diet should be nutritious and non-stimulating. Wlieo
the inflammatory symptoms have subsided, and the clot has
had time to become organized or absorbed, massage should be"'
practiced to get rid of the edema and inflammatory thicken-
ing, If an absce.ss forms it should be opened antiseptically.
In septic phlebitis, if seen early, the vein should be ex-
posed, ligated, the whole of the infective clot turned out, the
vessel swabbed out with pure carbolic acid or bichloride sola-
tion (1-500). and stuffed with antiseptic gauze. If the
deeper veins are infected and this treatment is impossible,
amputation may be demanded, provided that general infec-
tion has not taken place.
I
SURGERY. 405
Qive the causes, symptoms, and treatment of acute
vaginitis.
Causes: The presence of irritating foreign bodies, the use
of irritating injections, the contact of irritating secretions,
the irritation of excessive coition, and infection with gonor-
rhea.
S>Tnptoms : Local heat, pain, and muco-purulent discharge.
Inspection shows congestion and sometimes excoriations of
the vaginal mucous membrane.
Treatment : Rest in bed, saline cathartics, and frequent hot
hip-baths. The vagina should be copiously douched twice
daily with borax (one dram to a quart of water) or with
liquor plumbi subacetatis (half a fluid-ounce to a quart of
water). As soon as the acute symptoms have subsided the
walls of the vagina should be separated by a fold of lint
soaked in oxide of zinc cream. This lint should be carried
well up into the posterior fornix, allowed to protrude at the
vulva, and changed every 24 hours. After the disease has
subsided the parts should still be douched ocasionally to
prevent recurrence.
In gonorrheal vaginitis the vagina should be washed out
every two or three hours, first with a pint or two of an alka-
line solution, then with a pint of plain water, and then with
a pint of a medicated solution (acetate of lead, acetate of
zinc, sulphate of zinc, protargol, alum, tannin).
Define homologous tumor, heterologous tumor.
A homologous tumor is a tumor consisting of tissue iden-
tical with that of the part in which it grows.
A heterologous tumor is a tumor consisting of a different
tissue from that of the part in which it grows. (These tumors
are more properly called heterotopic tumors.)
How are dislocations distinguished from fractures?
Dislocations are characterized by more or less immobility,
by the absence of crepitus, and by the fact that the deformity
does not usually recur after reduction.
Fractures are characterized by preternatural mobility, by
the presence of crepitus, and by the fact that the deformity
iiaually recurs after reductJon.
What is milium? Qive the treatment.
Milium is an affection etiaraeterized by the appearance of
small, pearly, no n- inflammatory elevations, which result from
the accumulation of inspissated sebum in ducts, the outlets of
which have been occluded.
Treatment: The lesion should be excised, the contents ex-
pressed, and the same remedies employed as in seborrhea
(improvement of genei-al health, relief of constipation, and
the application of ointments of sulphur, mercury, tar, car-
bolic acid, or resorcin).
Describe an operation for circumcision.
After all aseptic precautions have been carried out, the
prepuce is drawn forward and grasped by a clamp placed
just in front of the glans. The portion of the prepuce in
front of the clamp is then cut off with a sharp bistoury and
the clamp removed. It will be observed that the skin has been
removed, but that the mucous surface of the prepuce still
covers the glans. One blade of a pair of scissors is now intro-
duced into the preputial orifice and the mucous layer divided
down to its attachment to the corona. All adhesions between
the prepuce and glans must be thoroughly broken up and the
smegma removed. The entire mucous surface of the pre-
puce is to be trimmed away to within an eighth of an inch of
its attachment to the corona. Special attention should be
given to the removal of sufficient tissue from the under side
of the penis in order to avoid an unsightly projection in the
neighborhood of the freniim. Hemorrhage should now be
controlled, the edges of the wound adjiisted by a few fine
catgut sutures, and the line of incision covered by some non-
irritating antiseptic dres.sing.
Qive the local treatment of venereal bubo.
Syphilitic butw requires no local treatment.
SURGERY. 407
Gronorrheal bubo may sometimes be aborted by the use of
pressure and iodine. If the gland suppurates it should be
incised under antiseptic precautions, curetted, and treated
like any abscess. If the suppuration is vrithin the gland and
limited by the capsule the entire mass should be dissected out
and the wound closed by primary suture. The latter treat-
ment is the best method of dealing with suppurating buboes,
provided that it is adopted at the proper time.
Give the palliative and the remedial treatment of hy-
drocele.
Palliative treatment: Tapping, the use of the suspensory,
and evaporating lotions (when inflammation of the testicle
is present) .
Remedial treatment: Tapping and injection should never
be employed. The open method of treatment is now gener-
ally adopted. One of two methods may be pursued: 1. The
cavity of the tunica vaginalis may be opened and the tunica
stitched to the skin. The cavity is drained, washed out daily,
and the drainage tube gradually shortened. Instead of a
tube, the cavity may be packed with iodoform gauze. 2.
The parietal layer of the tunica vaginalis may be excised.
Give the differential diagnosis of congenital talipes
equino-varus and paralytic talipes equino-vanis.
In congenital talipes equino-varus the affection exists from
birth, it is usually bilateral, the circulation is good, there is
but little wasting of the muscles, the electric reactions are not
much impaired, the growth of bone is much as usual, and
furrows are present in the sole.
In paralytic talipes equino-varus the affection is not de-
veloped until the second or third year (ushered in by convul-
sions and fever), it is more frequently unilateral, the circula-
tion is feeble, the muscles show extreme wasting, electrical
reactions are almost entirely absent in the paralyzed muscles,
the growth of the bones is considerably diminished, and there
are no furrows in the sole (after Tubby).
Describe an approved method for the removal of im-
pacted cerumen.
The external auditory meatus iB to be syringed with warm
water (105° F.), to which some bicarbonate of soda has been
added, aud the syringing continued until the canal has been
thoroughly cleansed. The soda solution is then to be washed
out with sterile water, the ear wiped dry, and a cotton plug
worn until bedtime. If the mass should prove obdurate, a
little warm sweet oil may be dropped into the meatus several
times during the succeeding 24 hours, and the attempt re-
newed upon the following day.
Define malignant pustule and give treatment.
Malignant pustule or anthrax carbuncle is a local lesion
produced by infection with the bacillus anthraeis. It differs
from ordinary carbuncle in the following respects: Presence
of a central depressed blackish slough, absence of localized
pain, absence of suppuration (nnlera mixed infection is pres-
ent), and the constitutional symptoms are more marked.
Treatment: Complete excision at the earliest possible mo-
ment. The incisions should be carried wide of the disease,
and the resulting wound should be carefully swabbed ovej
with pure carbolic acid or with a solution of zinc chloride
(1:8). The constitutional treatment should be of a support-
ing character.
What are the parietal effects of a severe blow upon the
abdomen?
Swelling, discoloration, tenderness, and pain. If a vessel
of considerable size ia lacerated a large extravasation of blood
■fill take place, which may descend into the scrotum. Rup-
ture of one of the muscles of the abdominal wall may occur,
and this is most frequently observed in the reclns. As far
as the abdominal parietes are concerned, contusions may re-
sult in localized peritonitis, abscess, or in ventral hernia.
SURGERY. 409
Describe the symptoms of fracture of the base of the
skull in the middle fossa.
Hemorrhage from the external auditory meatus, or from
the nose. The blood may be swallowed and subsequently
vomited. Cerebro-spinal fluid may be discharged from the
external auditory meatus, and, when present, is one of the
most characteristie signs of fracture in this situation. If
the facial and auditory nerves are injured as they lie in the
external auditory meatus, there will be signs of paralysis of
the muscles of expression and deafness upon the affected side.
In addition to these local signs, symptoms of concussion, of
compression, or of laceration of the brain may be present.
What general methods obtain in plastic operations?
Displacement: Stretching or sliding of tissues. 1. Simple
approximation after freshening the edge; 2. Sliding into
position after the transference of tension to adjoining
localities.
Interpolation: The tissue is taken from adjacent regions,
from a limb, or from another person. 1. Transferring a flap
with a pedicle; 2. Transplanting without a pedicle (includ-
ing skin-grafting).
Retrenchment: The removal of redundant material causing
cicatricial contraction. (Abbreviated from Keen and White.)
What is the treatment of diphtheritic stenosis of the
larynx?
Intubation or tracheotomy. The usual treatment of diph-
theria should also be instituted or continued (injection of
diphtheria antitoxin, administration of whiskey, hypoder-
matic injections of strychnine, absolute rest in bed, nutritious
fluid diet). If tracheotomy has been performed the temper-
ature of the room should be maintained at 80° F., and the
air kept moist with steam.
Describe a conlpound fracture.
A compound fracture is one in which the seat of fracture
410
SURGERY.
eoiumiinicates with the external air. Such a fracture may
be compound throiig^h the skin or through the mucous mem-
brane. These fractures are also called opew fractures.
Give the etiology, varieties, and symptoms of erysipelas.
Etiology: Infection with the streptococcus eryslpelatis.
Varieties: Cutaneous, cell ulo- cutaneous (phlegmonous),
and cellular (cellulitis).
Symptoms: Cutaneous erysipelas is usually ushered in by
a chiil and more or less gastric disturbance. Witliin 24 hours
a rash appears in the neighborhood of the wound. There is
increased tension in the part and a sensation of itching. The
rash is yellowish-red in color, disappearing upon pressure,
and has a characteristic elevated border. The area affected
is well defined, and the margins usually present an irregular
zigzag outline. When the inflammation reaches its height
the glazed area is covered with vesicles or buUie filled with a
clear fluid, which soon becomes turbid. The rash advances
more or less rapidly with a continuous margin (remaining
in one situation for about four days), and as it extends to
new areas it fades in the region first involved and undergoes
branny desquamation. The neighboring lymphatic glands
are usually enlarged and painful. Fever is present as long
as the rash persists. In severe eases the fever is at first
sthenic, the pulse full, and the delirium noisy and active, but
the pulse subsequently becomes quick and weak, and there ia
low muttering delirium and great prostration.
What is shock, and how should it be treated?
Shock is the immediate constitutional effect of an injury.
Treatment: In mild cases very little is needed except rest
in the recumbent position and tbe exhibition of some pungent
aromatic to the nostrils. In more severe eases the patient
must be put absolutely at rest, surrounded by blankets and
hot water bottles, and all external sources of irritation re-
moved. Over-stimulation should be avoided, and in many
cases a cup of hot beef tea may do as much good ds a stronger
SURGERY. 411
stimulant If the patient appears to be in imminent danger,
however, more active measures must be adopted. The head
should be kept low and surrounded with flannel cloths wrung
out of hot water and frequently renewed. The extremities
should be wrapped in blankets and external heat applied,
care being taken not to bum the patient. Ammonia should
be exhibited to the nostrils and small quantities of brandy
given by the mouth. If the patient cannot swallow, the
brandy may be diluted and given by the rectum. The rectal
injection of two or three pints of warm normal saline solution
(100° F.) is highly recommended. Ether, digitalis, atropine,
or strychnine may be given subcutaneously, the latter drugs
being particularly valuable. If the shock is combined with
loss of blood, a pint of sterile normal saline solution should
be injected beneath the skin or into a vein. If a mangled
limb seems to act as a source of depression it may be proper,
under certain circumstances, to amputate at once.
What are the symptoms and treatment of a sprain?
Symptoms: The patient inmiediately experiences severe
sickening pain. Swelling soon makes its appearance, due at
first to extravasation of blood and subsequently to the effu-
sion of inflammatory products. The patient is unable to bear
any weight upon the injured extremity, and motions of the
joint are attended by exacerbations of the pain.
Treatment: Early and systematic massage is invaluable in
these injuries. Ten or twenty minutes is usually enough for
the first treatment, and the period can be lengthened upon
the following days. During the intervals between the mas-
sage of the part, it should be kept at rest upon a well-padded
splint and moderate compression applied. The immediate
application of cold, followed by heat, is of great advantage
in some cases. If the sprain is in the ankle or wrist, the
patient should be encouraged to move his toes or fingers while
the massage is being performed. The old treatment con-
sisted in keeping the part at rest until all pain and swelling
had disappeared, and then employing massage and passive
motion.
How and in what part of the inferior maxillary bone is
fracture most liable to occur, and what is the treatment?
The inferior maxillary boue is usually fractured by direct
violence.
The most frequent site of fracture is at a point just ante-
rior to the mental foramen.
Treatment : Reduction of the displacement, the application
of a Barton banda^ and the maintenance of the oral cavity
in as aseptic a condition as possible. In some cases a leather
or pasteboard splint may be applied over the point of the
chin. If there is a great displacement a Hammond splint
may he placed about the teeth or, if these are defective,
Kingsley's apparatus may be employed. Some few eases may
require wiring of the fragments. The parts are to be kept
at rest for about three weeks, the patient being restricted to
a fluid diet.
Describe enucleation of the eye-bail.
Bonnet's method: All aseptic precautions having been car-
ried out, the conjunctiva near the cornea is grasped by for-
ceps and divided with scissors entirely aroiuid and close to
the corneal margin. The conjunctiva is loosened up from
the eye-ball and the diBsection carried well back in every
direction. The recti muscles are now caught up separately
by a strabismus hook and their tendons divided close to the
ball, After the orbital tissues have been well dissected away
from the ball the enucleation scissors are passed back in the
orbit until they touch the optic nerve, when their blades are
opened and the nerve divided as far back as possible. The
oblique muscles and other remaining tissues are now quickly
severed, the hemorrhage is checked by hot water or torsion,
and the orbit flooded with a hot bichloride solution (1 : 5000).
A drainage tube is then inserted into the cavity_ and an
antiseptic dressing applied.
SURGERY. 413
How is resection of the spinal accessory nerve effected?
What are the reasons for this operation?
After all aseptic precautions have been observed, an inci-
sion is made along the anterior border of the stemo-mastoid
muscle, extending from the mastoid process to the cornu of
the hyoid bone and avoiding the external jugular vein. This
incision divides skin, superficial fascia, platysma, a branch
of the auricularis magnus, and the deep fascia. The sterno-
mastoid is now drawn outward, and the nerve (with its accom-
panying sterno-mastoid artery) can be felt just below the
transverse process of the atlas. The nerve emerges from
beneath the posterior belly of the digastric and lies upon the
levator anguli scapulae, beneath the prevertebral fascia. It
enters the deep surface of the sterno-mastoid muscle midway
between its two borders and one inch below the tip of the
mastoid process. A portion of the nerve is now excised, the
external wound sutured, and an aseptic dressing applied.
The spinal accessory nerve is excised for spasmodic torti-
collis of central origin.
What are the methods of reduction in sub-coracoid dis-
location of the humerus?
1. Reduction by manipulation (Kocher's, Smith's).
2. Extension and counter-extension.
3. Traction in an outward and upward direction.
How would you arrest epistaxis?
If position, rest, cold, hot water, pressure, and spraying
with peroxide or with a 5 per cent, solution of antipyrine
(with 2 per cent, cocaine) are inefficient, more active meas-
ures must be adopted. If the bleeding point can be seen it
should be cauterized (electricity, chromic acid). When other
means fail the anterior nares should be packed with a strip
of sterile gauze, the initial extremity of which is carried well
back toward the naso-pharynx. In rare cases it may be
necessary to plug the posterior nares by means of Belocq*s
cannula or a soft rubber catheter. Plugs of gauze should
never be let in the nose unchanged for more than 24 hours.
414
SURGE 1{¥.
Differentiate between the following forms of inflam-
mation: Serous, sera-fibrinous, sero-hemorrhagic.
In serous inflammation there is a copious exudation of fluid
with comparatively little cellular matter.
Id sero-fibrinous inflammation the exudate contains more
fibrin, and shows a marked tendency to clot.
In sero-hemorrhagic inflammation the exudate contains
large numbers of red blood corpuscles, and is correspondingly
tinged.
What is hare-iip? Give the treatment of hare-lip.
By hare-lip is meant a congenital fissure of the upper lip
which may extend for a variable distance through the soft
tissues. It may be associated with a cleft in the palate.
Treatment : A straight tistoury should be introduced just
above the angle of the fissure, and both sides of tie cleft
pared by cutting through the lip in a crescentrie manner so as
to constitute a slight angular projection or prolabiiun when
the freshened surfaces are brought into apposition. If the
nose is much flattened more tissue should be removed from
the outer than from the inner side, so that when the parts are
sutured together tlie nostrils become as nearly sjTnmetrical
as possible. By paring the edges in a curved or angular
manner the depth of the lip is increased to allow for subse-
quent contraction. Two deep silk-woi-m-gut sutures should
be introduced, one just above the red margin and one close
to the nose. The vermilion borders must be accurately ap-
proximated and the edges of the wound carefully brought
together with cat-gut sutures. The dressing consists of gauze
and collodion. The gauze is cut in the shape of a paddle, the
broad ends being fastened to the cheek. This should be so
applied as to prevent tension upon the wound. The silk-
worm-gut sutures are removed upon the fourth day. The
operation above described is that of Malgaigne. Other opera-
tions are those of Nelaton, Rose, Miranlt, and Konig. Double
hare-lip may sometimes be treated by operating upon each
SURGERY. 415
side, as in a unilateral "Clef t, but if the os incisivum projects
it must be either removed or replaced.
Give the etiology of inflammation.
Predisposing local causes: Defective circulation, loss or
impairment of the nervous supply of a part, a previous
attack of inflammation.
Predisposing constitutional causes: Anything producing
an impairment of the general health, such as old age, weak
action of the heart, an unhealthy condition of the blood, and
the presence of some constitutional disease.
Exciting causes: Mechanical irritants, heat, cold, electric
irritants, toxic irritants (chemical, vegetable, animal), and
micro-organisms.
Give the treatment of fracture of the ribs.
The affected side should be firmly strapped with strips of
adhesive plaster so as to limit its range of motion. These
strips (2 inches in width) should extend beyond the median
line both anteriorly and posteriorly, and are to be applied
from below upward, each strip overlapping above one-half of
its predecessor. Each strip should be put on while the chest
is in a state of forcible expiration. If the patient has ad-
vanced pulmonary emphysema or chronic bronchitis, strap-
ping is not advisable, as it adds to the respiratory difficulty,
and in such a case the patient must be placed in bed or
propped up, and the fracture left to take care of itself.
Strapping is also contra-indicated if the broken fragments
are driven inwards, and if the fracture is in the lower part
of the chest and the pressure irritates the diaphragm, causing
hiccough. If there are associated injuries of the thoracic
viscera, pneumo-thorax, or hemothorax, they must be appro-
priately treated.
Mention the varieties of hip-joint dislocation, and de-
scribe in detail two of these varieties.
Dorsal, dorsal below the tendon (sciatic), thyroid, and
pubic.
416
JSURGERY.
Dorsal dislocation : The head of the bone lies upon the dor-
sum ilii, the trochanter is above Netaton's line and nearer to
the anterior superior spine, the ilio-tibial band is relaxed, and
there is a shortening of two or three inches. A marked
hollow is present in the upper part of Scarpa's triangle, and
the head of the bone cannot be felt in ito usual position. The
thigh is flexed, addueted, and inverted, so that the axis of the
femur crosses the lower third of the sound thigh and the ball
of the toe rests upon the opposite instep. The ligamentuni
teres is torn and the capsule is lacerated. The smalt external
rotator muscles are usually lacerated, as may also be the
glutei and the pectineus. The great sciatic nerve may be
contused or compressed. The ileo-femoral ligament is un-
injured.
Dorsal helow the tendon (sciatic) : The signs of this dis-
location are somewhat similar 'hut less marked than in the
preceding form. There is not so much shortening, since the
intact obdurator internus tendon prevents the head of the
bone from traveling upward. The shortening is not more
than one-half inch or an inch, but it becomes more apparent
upon flexing the thigh (Allis). The thigh is flexed, ad-
ducted, and inverted, but the axis of the femur crosses the
opposite knee and the great toe rests against the ball of the
great toe of the sound side. The head of the bone is palpated
with great diBicuity owing to the greater thickness of the
gluteal muscles at this level. Practically the same muscles
and ligaments are injured as in the dorsal variety. The head
of the bone is helow the tendon of the obturator inlemiw.
whereas in the former dislocation it is above it,
Make a differential diagnosis of coma from injury, apo-
plexy, uremia, opium poisoning, and alcoholic intoxication.
Concussion: The individual is pale, the pulse is feeble and
fluttering, the respirations arc sighing, the skin is cold and
clammy, and the urine and feces may be passed involuntarily.
The pupils vary, sometimes being unequal, but they Tisualty
react to light. Convulsions occasionally occur. Paralysis is.
SURGERY. 417
not present, and examination of the extremities may give
some evidence that they have not lost their sense of feeling.
The patient can usually be aroused by shouting.
Compression: The unconseiousness is complete and the
pupils are dilated and do not respond to light. The skin is
usually hot and bathed in perspiration. The respirations are
slow, stertorous, and have a peculiar pufling character, due
to the paralysis of the muscles of the cheeks. The bladder
and intestines are usually paralyzed, but the incontinence of
retention may be present. The pulse is slow, full, and fre-
quently irregular. The wJiole body may be paralyzed, but
hemiplegia is the form most commonly observed. Mono-
plegias also occur, and are extremely valuable from the
standpoint of localization.
Apoplexy: Absolute unconsciousness, stertor, hemiplegia
or complete paralysis are present. Aid in the diagnosis is
furnished by the age of the patient and the condition of the
arteries. The temperature is usually higher in one axilla,
and conjugate deviation may be observed. The face is
flushed, the conjuctiva is injected, the pulse is full and slow,
and the breathing is stertorous. Urine and feces may be
passed involuntarily, and convulsive seizures are not infre-
quent.
Uremia: Paralysis and stertor are absent (unless apoplexy
co-exists). The legs may be edematous and the urine contains
albumin and casts. The breath is urinous, arterial tension is
high, and the aortic second sound is accentuated.
Opium poisoning: Paralysis is not present, and the pupils
are pin-point and will not dilate. The odor of laudanum
may be detected upon the breath. The pulse and respira-
tions are slow.
Alcoholic intoxication: Unconsciousness is not complete
and it is usually possible to arouse the patient. Some aid
may be furnished by the appearance of the patient, but this
is frequently misleading. Although the breath may be alco-
holic, it must be remembered that alcohol may have been
27
given in an attempt to revive the individual. The pupils are
osually contracted but dilate when the patient is aroused.
The temperature is geoeraUy subnormal.
Qive the symptoms and treatment of hammer-toe.
Symptoms: Hyperextension of the first phalani, flexion of
the second to an acute ang-le, and either flexion or e.ttension
of the terminal phalanx. The first int<>rphalangeal joint rubs
against the upper leather of the shoe, and the patient walks
upon the extremity of the terminal phalanx. Corns are pres-
ent over the points of pressure, and there is a subcutaueous
bursa over the head of the first phalanx, causing great pain
and discomfort. The affection is most frequently observed
in the second toe.
Treatment: If the case is seen early, treatment may be
commenced with the wearing of eorrectiy shaped boots, but
the affection has usually progressed so far that the excision
of the first interphalangeal joint or amputation of the toe is
required. The first operation is the preferable one, since
amputation is frequently followed by hallux valgus.
Describe dermoid cysts. In what situations are Ihey
most commonly found?
Dermoid cysts are cysts composed of stnictures which
naturally belong to the skin or mucous membranes, but which
occur in situations where these structures are not normally
found. They may contain all the elements of the skin, such
as stratified epidermis, a papillary layer, and even subeutar
neous connective tisue. Hair follicles and sebaceous glands
are frequent, and hairs of varying lengths are almost always
present. Some forms of dermoids contain teeth, nerve tissue,
muscle, and bone, and structures resembling intestine are not
of uncommon occurrence. They have been classified by
Bland Sutton into sequestration dermoids, tub ulo- dermoids,
and ovarian dermoids.
Dermoid cysts are found in the ovary, in the testicle, in the
peritoneum, at the outer angle of the orbit, aibove the noee, in
L
SURGERY. 419
the neck, in the floor of the mouth, in the membranes of the
brain, and elsewhere.
Describe suprapubic lithotomy.
A silver catheter is introduced into the bladder which is
to be filled with about ten ounces of a 3% solution of boric
acid. Some surgeons still distend the rectum by the intro-
duction and subsequent filling of a rubber bag. This is
hardly necessary, but if the operator employ the rectal bag
it should never contain more than 8 ounces, it should be
inserted after the catheter has been introduced into the
bladder, and before the bladder is distended with the boric
acid solution. An incision about 2^^ inches in length is made
in the median line just above the symphysis and is subse-
quently carried down to the areolar tissue in front of the
bladder. If the peritoneum bulges into the upper angle of
the wound it should be displaced upward out of harm's way.
There should be no diflBculty in recognizing the bladder when
distended and containing the curved end of the silver cathe-
ter. Two silk ligatures are now passed through the bladder-
wall and the bladder is opened between them by a quick
thrust of the knife. The index-finger is passed into the wound
and locates the stone, which is to be removed by the finger,
by the scoop, or by forceps.
Give the symptoms and treatment of any one form of
acute intestinal obstruction.
Strangulated hernia. Symptoms: Pain at the hernial ori-
fice and radiating toward the umbilicus. The hernia is hard,
tense, and gives no impulse on coughing. Vomiting which is
projectile, without preceding nausea, at first gastric, then
bilious and soon assuming a stercoraceous character. Abso-
lute constipation. Shock. Subnormal temperature.
Treatment: Immediate herniotomy.
Give any one of the dislocations of the knee-joint and
the method of reduction.
The anterior dislocation of the upper end of the tibia.
420
SUBOEKY.
I
The thigh should be flexed upon the pelvis, entension i» '
made upon the leg, and the surgeon endeavors to bring the
bones into their normal relation by pressure and manipula-
tion. The parts should be massaged from the first, but
passive motion should not be employed until the end of the
second week and then with great caution. The patient should
subsequently wear an artificial knee-cap to prevent a reenr-
rence of the displacement.
Define necrosis and Rive the cause and surgical treat-
ment.
By neernsis is meant the death of houe in mass.
Causes. Denudation of periosteum. Periostitis, ostitis, or
osteomyelitis. Tuberculosis. Syphilis. Exposure to the- '
fumes of phosphorus. The excessive administration of
mercury.
Surgical treatment: Sequestrotoray.
Give the symptoms of shock, and state when the prog-
nosis is grave.
Symptoms. The skin is pale, cool, and bathed in perspira-
tion, the pulse is rapid and weak, the respirations are shallow-
and irregular, and the temperature is subnormal. Nausea
and vomiting may occur, and the feces and urine may be
passed involuntarily. The symptoms vary according to the-
severity of the injurj', and the patient may suffer from any-
thing from a sensation of momentary weakness and fnintness
to a most profound muscular relaxation and unconsciousness.
The prognosis is grave when a vital part is injured, when
the injury is extensive, entailing a continued source of irrita-
tion and depression, when a reaction as regards tempei-ature ■
is not observed within four hours after the reception of the-
injury, when large quantities of blood have been lost, and in ,
old people who are the subjects of degenerative
How would you proceed surgically to remove the fluid
in a case of ascites?
The patient is seated in a chair and the abdomen is encir-
SURGERY. 421
cled with a flannel binder, the ends of which are split to
within six inches of the median line. The untom portion of
the binder is placed over the front of the abdomen and the
divided ends are crossed behind and held by assistants so as
to make continuous pressure upon the abdominal contents.
A spot is selected in the median line below the umbilicus
where absolute dulness is obtained upon percussion. After
all aseptic precautions have been observed, the skin over this
small area is anesthetized by a drop of carbolic acid or by the
intradermic injection of Schleich's solution, a small incision
is made through the skin, and a suitable trochar and cannula
is inserted. The fluid should be withdrawn slowly, continu-
ous pressure being made upon the abdominal contents by
means of the flannel binder. AH of the fluid should not be
withdrawn. After the withdrawal of the cannula the small
wound should be closed with aseptic gauze and sterile col-
lodion.
Differentially diagnose impacted and non-impacted frac-
ture of the neck of the femur.
Impacted Fracture, Non^mpaeted Fracture,
Crepitas is absent. Crepitas may be obtained.
Eyersion is less marked and inversion Eversion is present.
may be present (rare).
The head of the femur moves under The head of the femur does not move
the finger when the extremity is under the tinger when the extrem-
rotated. itv is rotated.
The shortening is not overcome by Shortening is overcome by extension.
moderate extension (danger !).
The symptoms of fracture are not so The symptoms of fracture are more
marked. marked.
The individual may be able to walk The individual is unable to walk.
(do not allow her to try).
Name and describe the different varieties of fracture.
Simple (subcutaneous) : No communication with external
air.
Compound (open) : Communication with external air.
Complete : The entire thickness of the bone is involved.
422
SURGES¥.
r
Incomplete; The entire thickness of tie bone is not in-
volved.
Multiple : The bone is fractured in more than one place J
and the lines of fracture do not communicate.
Single : The bone is fractured in but one place.
Comminuted ; The bone is fractured into a number of frag-
ments and the lines of fracture communicate with each other.
Complicated: In addition to the fracture, a neighboring
joint is dislocated, the main artery or nerve of the extremity
is injured, or there is a severe laceration of the soft parts.
Fissured r A linear split without displaeeraent. .
Stellate : The lines of fracture radiate from a central point. I
Depressed : There is a crushing in of a portion of the bone.
Impacted : One fragment is driven into the other.
Apophyseal : A separation of a scale of bone to which a
ligament or tendon is attached.
Lon^tudinal, transverse, oblique, and spiral: The desig-
nations indicate the directions of the line of fracture.
Qive the general symptoms of brain tumor.
Headache, pain upon percussion, vomiting, vertigo, t
leptic convulsions, choked disc, and finally, symptoms of com-l
pression.
Describe an operation for the cure of webbed fingers.
Didot's operation. After all aseptic precautions have been I
observed, a flap the length of the finger and half its widti I
(plus the added width of the web) is t-aken from the dorsal 1
surface of one finger and the palmar surface of the other. |
Each of these flaps is carefully applied to the denuded area i
upon the finger to which it is attached and secured by sutures. J
How is resection of the elbow-joint performed?
After all aseptic precautions have been observed, the fore- 1
arm is flexed to a right angle and held across the chest of the J
patient by an assistant. A vertical incision five inches inl
length is now made along the back of the joint, the center ofa
the incision being a line or two to the inner side of the tip of J
SURGERY. 423
the olecranon. This incision goes down to the bone and di-
vides the tendon of the triceps longitudinally. The tendon
is then separated from the olecranon and this process cleared
off, keeping the knife close to the bone to avoid wounding the
ulnar nerve on the inner side and the extension of the triceps
upon the outer side. The olecranon is now cut through and
removed. With the thumb in the wound to protect the soft
parts, the structures are gradually separated from the inter-
nal condyle by the knife (cutting towards the bone) or
periosteal elevator. In this manner the common flexor tendon
is separated from the bone and the internal lateral ligament
is divided. The external eondyle is now freed in a similar
manner, and the end of the humerus is protruded through the
wound by flexing the forearm until it touches the arm. The
articular surface of the humerus is now sawn off, and if any
carious areas are seen upon the surface of section they are to
be thoroughly gouged out. The bones of the forearm are then
forced through the wound and their cartilaginous surfaces
removed. Care must be taken not to injure the insertions of
the biceps and brachialis anticus. All diseased synovial mem-
brane and granulation tissue must be dissected away, any ex-
isting sinuses thoroughly curetted, and the parts flushed with
an antiseptic solution. A drainage tube is inserted in the
most dependent portion of the wound, sutures are introduced,
and an aseptic dressing applied.
Give the symptoms and treatment of naevus.
Capillary naevus occurs in the form of a slightly elevated
mass, which varies in color from purple to bright red, ac-
cording to the relative amount of contained venous or arte-
rial blood. These growths are congenital or occur soon after
birth, they may be multiple, and rarely exceed an inch or two
in diameter. They are usually found upon the neck or face.
They may shrink and disappear, persist unchanged, or
rapidly increase in size. Treatment : Excision or electrolysis.
Cavernous naevus usually involves both skin and subcuta-
neuos connective tissue. It usually occurs as a lobulated
4M
SUROEEY.
P
bluish or dusky red swelling, soft to the toueb, easily com-
pressible, but refilling upon the removal of the pressure.
Pulsation and bruit are usually absent. Treatment: Excision
wherever practical. Electrolysis when the growth cannot
be excised.
What is glaucoma? Give the treatment of glaucoma.
Glaucoma is a disease of the eye characterized by increased
intra-ocular tension, excavation of the optic disc, restriction
of the field of vision, corneal anesthesia, colored halos about
lights, and diminution of visual power that may result in
blindness. Treatment: Iridectomy.
What is a tumor?
A tumor is an atypical new growth which is not the result
of inflammation,
A tumor is an adventitious maiss of tissue, diffenng from
the tis-suc in which it grows in gross and minute structure,
tending to unlimited growth, having no function, the nutri-
tion of which is independent of the general uutrition of the
body, showing no tendency to spontaneous cure, and not co-
incident with nor dependent upon inflammation.
Describe the following forms of sutures; Interrupted.
button, continued, buried, secondary.
The interrupted suture consists of a number of single
stitches, each one being independent of its neighbor.
The button suture is made by inserting a needle threaded
with stout silver wire at some distance from the wound, carry-
ing it deeply through the tissues and bringing it out at a cor-
responding point on the opposite side of the wound. The
suture is secured at both ends to a flat lead button, the wire
being pulled as tight a^ is deemed advisable.
In a continued suture the suture traverses the wound con-
tinuously in the same direction, being tied only at the begin-
ning and at the end.
A buried suture is one completely covered by and not in-
volving the skin.
SURGERY. 425
Secondary sutures are those which are introduced at some
time (usually two or three days) subsequent to an operation.
What are the causes of atony of the bladder?
Chronic over-distension from obstructed outflow (enlarged
prostate, stricture), a single prolonged voluntary or involun-
tary over-distension, cystitis (particularly when gonorrheal),
senility, and infective fevers.
What is the treatment of fracture united with de-
formity?
Osteotomy or osteoclasis. If the deformity is not great no
treatment may be required.
Give the treatment for rattlesnake bite.
If the bite has been received upon a limb, a ligature should
be immediately thrown around the part above the wound and
drawn tight enough to prevent the entrance of the venom
into the circulation. The wounded area should then be freely
excised and bleeding encouraged for a short time. If the
bite is upon a portion of the body which cannot be constricted
by a ligature the wound should be excised as before, or if this
is impracticable vigorous suction of the wound should be
made. In the case of an extremity the ligature is to be slack-
ened at intervals to allow of the admission of any remaining
poison by instalments. The injection about the wound of a
1 per cent, aqueous solution of potassium permanganate has
been highly recommended. Antivenene may also be em-
ployed. The constitutional treatment consists of the free
administration of alcohol and hypodermatic injections of
strychnine.
What circumstances demand amputation of an ex-
tremity?
Amputation is demanded : 1. To trim up a stump of a limb
torn off by machinery, cut oil by wheels of a railway train,
or carried away by a cannon-ball ; 2. When the entire limb or
one of its segments has been totally disorganized ; 3. Where
426
SURGERY.
gangrene is immineiit or has supervened (particolarlx if it i« I
of the spreading type) ; 4. When marked symptoms of sepsis
make their appearance or exhaustion supervenes from sup-
puration, in a case where an unsuccessful attempt has 'been
made to save a doubtful limb; 5. In severe compound lacera-
tions of the foot in old people, laying open the eomtnon syn-
ovial cavity and involving the bones; 6. By primary malig-
nant growths of bone (sarcoma).
Amputation may be required for the relief of deformity.
for the removal of benign growths (enehondroma of fingers),
for laceration of the main artery of the limb, with other grave
lesions of the soft parts, and in cases where the limb, if saved,
would be of no practical use.
Define the terms thrombus, phlebitis, and varix, and
give the causes of each.
A Ihrombus is a clot of blood formed within the heart or '
blood-vessels. It is due to alterations in the blood current,
changes in the vessel-walls, and alterations in the blood itself.
By phlebitis is meant the inflammation of a vein. It may
he due to injury of the coat of the vein, to the formation of a
thrombus within the vein, to the extension of an inflammation
from surrounding tissues, to gout, or to infection with pyo- |
genie organisms.
By varix is meant a dilated, elongated, and more or lea
tortuous condition of a vein. It is due to increased pressure I
within the veins (long standing, habitual over-exertion, tight i
gartei-s), obstruction or occlusion of the deeper veins, and to ]
an abnormal communication with an artery (aneurysmal '
varix). Inherited weakness and the relaxation of the syatem |
from sedentary habits are predisposing causes.
Describe a chancroid. Give its usual symptoms and
possible complications,
A chancroid is an infectious venereal sore eharaoterized bv I
the absence of constitutional manifestations. It commences ]
as a pustule or ulcer, is frequently multiple, is round, oval.
8UR0ERY. 427
or unsyimnetrically irregular, is exoavated or ** puaiched
out," has a rough ** worm-eaten " whitish-gray surface, se-
cretes an albundant purulent discharge which is readily auto-
inoculable, runs an irregular course, is painful, and usually
responds to local treatment. The possible complications are
phimosis, paraphimosis, lymphangitis, and bubo.
What is a dislocation? Define the various kinds of
dislocation.
A dislocation is a displacement of one or more bones of a
joint from its natural position. It is also the displacement
of any organ from its natural position.
Traumatic, due to violence or muscular action.
Pathologic, due to disease.
Congenital, due to an error of development, as a result of
which a normal relation of the bony constituents has never
existed. (The term ** congenital dislocation '' is a misnomer;
it is a congenital malformation.)
What are the methods of controlling hemorrhage?
Exposure to air, cold, hot water, elevation, direct pressure,
styptics, cauterization, acupressure, forcipressure, suture,
torsion, and ligation.
Define hypertrophy and give the causes.
Hypertrophy is an increase in bulk of a tissue or organ
occurring independently of the general growth of the body
and without any structural change of the part effected. In
a true hypertrophy the function is increased.
Causes: Congenital predisposition, removal of pressure,
direct stimulation or intermittent pressure, disturbances of
nutrition, increased functional demand, and disturbances of
the nervous system.
Give the surgical palliative treatment of carcinoma of
the stomach at the pylorus.
(Jastro-enterostomy, preferably by Von Hacker's method
(posterior gastro-enterostomy).
428 SVEGEKY.
Mention Ihe causes of delayed union and give the treat-
ment.
The conBtitutioiial causes are general debility, osteomalacia,
scurvy, syphilis, senility { ? ) , pregnancy, and the cancerous
cachexia.
The local causes are faulty apposition, the interposition of
fluid, muscle, or aponeurosis between the fragments, want of
rest, defective blood supply, defective innervation, inHamma-
tion on the surface of the limb, faulty treatment, and local
affections of hone (malignant tumors, destruction of the peri-
osteum by inflammation).
Treatment : The removal of any local cause and the appro-
priate remedies for the underlying constitutional disturbance.
Change of air, tonics, regulation of the diet, and the adminis-
tration of tjie mineral acids will frequently effect a speedy
union.
What glandular structures are most commonly affected
in carcinoma of the anterior portion of the tongue?
The subnLeiital Ijiiiphalic glands, the submaxillary Ij-m-
phatic glands, and probably those lying beneath the stcmo-
mastoid muscles. The sublingual and submaxillary salivary
glands may also be involved.
What are the causes of ptosis and the remedial meas-
ures employed?
Paralysis of the oculo-motor nerve or its supra-orbital
hranch (syphilis, rheumatism), and faulty development or
injury of the levator palpebrse.
Treatment: If due to syphilis or rheumatism the appro-
priate constitutional treatment is to be instituted. In the
absence of constitutional causes, operations are performed to
increase the vicarious action of the frontalis muscles upon the
upper lid (Panas.) Wilder folds the tarso-orbital fascia upon
itself and establishes a firm adhesion between the fascia and
the frontalis muscle. If the action of the levator muade is
not entirely lost the principles of tendon advancement and
SURGERY. 42»
tendon resection may be employed. (Everbusch, Snellen,
Wolff.)
What articular changes take place in dislocation?
What are the general principles governing the treatment
of dislocation?
One or more of the ligaments and the capsule of the joint
are torn and the mutual relations of the articular ends of the
bones are changed. If the dislocation remains unreduced
the cavity of the joint becomes filled with granulation tissue
and the displaced and lacerated connective tissues become
condensed about the head of the dislocated bone, sometimes
forming a new capsule. Any irregularities of the dislocated
bone become rounded off and it contracts adhesions to the
surrounding tissues or forms a new joint by resting against'
a bony surface, its pressure stimulating the bone and peri-
osteum to the production of an osseous ring about the point
of contact, which possibly becomes covered with fibro-car-
tilage.
Principles of treatment: Relaxation of the muscles about
the joint, the reduction of the dislocation by causing the dis-
located bone to enter the capsule through the same rent which
it made upon leaving it (by manipulation, or by extension
and counter-extension), the fixation of the parts after reduc-
tion for a sufiicient length of time, and subsequent passive
and active motion.
Define a fracture. Give the causes, symptoms, and
varieties of fracture.
A fracture is a sudden solution of continuity of a bone.
Predisposing causes: Advancing age, male sex, and di-
seased conditions of the bone (atrophy, fragilitas ossium,
rickets, sarcoma, secondary cancer).
Exciting causes: Direct violence, indirect violence, and
muscular action.
Symptoms: A new point of motion (preternatural mobil-
ity), crepitus, deformity from displacement, partial or com-
plete loss of function, and signs of local trauma.
430 SUS6ERT.
Varieties: Complete and incomplete. Simple (subcutan-
eous), compound (open), single, multiple, complicated, com-
minuted, and impacted. Linear, stellate, longitudinal,
transverse, and spiral.
What diseases attack the antrum maxillae (Highmore)?
Hydrops, empyema, benign tumors (ehrondroma, tibroma,
myxoma, osteoma), and malignant tumors (sarcoma and
carcinoma) .
When do the secondary symptoms of syphilis normaliv
appear? When do the tertiary symptoms appear?
The secondary symptoms of syphilis normally appear from
six to ten weeks after the beginning of the infecting chancre.
. Tertiary symptoms may appear within six months of in-
fection or not for twenty or thirty years. The time of their
appearance is largely dependent upon the treatment received
by the patient. lu some cases which have been correctly
treated they may never make their appearance.
Give a resume of the constitutional and the local treat-
ment of inflammation.
Constitutional treatment: Rest, good hygiene, proper diet,
purgatives, emetics, arterial sedatives, diaphoretics, diuretics,
venesection, hypnotics, narcotics, alteratives, stimulants, and
tonics.
Local treatment: Rest, position, heat, cold, counter-irrita-
tion, local blood-letting (scarifications, leeches, wet cups),
moisture, stimulants, astringents, antiseptics, alteratives in-
cisions, surgical operations, compression, and massage.
Differentially diagnose chancre, chancroid, and herpes
progeni talis.
Chancre has a period of incubation not less than f«n days;
commences as an erosion, tubercle, papule, or ulcer; is single,
or simultaneously multiple; is round, oval, or symmetrically
irregular; is usually cup-shaped, saucer-shaped, or elevated;
h«8 a smooth shining red or glazed surface, and may be cot-
SURGERY. 431
ered by a diphtheritic membrane or scab ; has scanty, serous
secretion which is practically never auto-inoculable ; is almost
always indurated (cartilaginous or parchment-like), the in-
duration being circumscribed and disappearing under appro-
priate treatment; is accompanied by little or no pain, and
•>ften heals spontaneously.
Chancroid has no period of incubation; commences as a
pustule or ulcer; is often multiple (frequently by outo-
inoculation) ; is round, oval, or unsymmetrically irregular
(with borders described by segments of large circles) ; is
hollow, excavated, or punched out; has a rough, ** worm-
eaten, *' whitish-gray surface; has an abundant, muco-puru-
lent secretion (readily auto-inoculable) ; is only exceptionally
indurated (induration shades off into surrounding tissues) ;
is painful, and runs an irregular course.
Herpes progenitalis has no period of incubation, commences
as a group of vesicles which may coalesce; is multiple, is
irregular in shape (edges described by segments of small
circles), is always superficial, has a moderate amount of
secretion (auto-inoculable with difficulty), has no more in-
duration than any local ulcer, is painful, and usually heals
promptly under mild treatment. (Condensed from Keen
and White.)
How would you diagnose and reduce a backward dis-
location of the forearm?
The forearm is shortened, semiflexed, and midway between
pronation and supination. The forearm cannot be flexed
upon the arm. The olecranon is unduly prominent behind
the joint, and above it is a depression in which the tendon
of the triceps may be palpated. The head of the radius may
be detected as a globular swelling behind the external con-
dyle. The lower end of the humerus forms a broad promi-
nence in front of the articulation. This dislocation is dis-
tinguished from a supracondyloid fracture by the following
points: the olecranon is behind a line connecting the two
condyles, the condyles do not move with the displaced ole-
432
8VR0EBY.
cranon, the distance between the acromion and the external
condyle remains unaltered, and crepitus is absent.
Reduction: The patient is seated in a chair, the surgeon
places his foot upon the chair with his knee iu the bend of
the elbow, and preeaes against the lower end of the humerus,
at the same time fixing the bones of the forearm by grasping
them just above the wrist. When this pressure has been
maintained for some time, the forearm is slowly and forcibly
flexed upon the arm. By this procedure the interlocking bony
prominences arc disengaged and reduction is effected.
What are the principal causes of tinnitus aurium?
Acute otitis media, chi-onic catarrhal otitis media, chronic
suppurative otitis media, neurosis of the auditory nerve,
Meniere's disease, impacted cerumen, anemia, alterations iu
pressure in the labjTinth, obstruction of the Eustachian tube,
and large doses of quinine or of the salicylates.
What are the most approved operative procedures in
the treatment of varicose veins of the lower extremity?
Excision of the entire vein, excision of a number of sections
of the vein, excision of a portion of the internal saphenous
vein (in certain eases), and complete division and doable
ligation of all the superficial veins at the junction of the
upper and middle thirds of the legs (Schede's operation).
OBSTETRICS AND GYNECOLOGY.
Describe the female reproductive organs.
The ovaries are two small almond-shaped organs situated
one on either side of the uterus (described below) and at-
tached to the posterior surface of the broad ligaments. Each
is 4 em. long, 2 cm. broad and li/^ cm. thick, and weighs 6.4
gm. (100 grains). It consists of the oophoron or egg-bearing
portion and the paroophoron or fibrous portion.
The oviducts or Fallopian tubes are the trumpet-shaped
structures attached to the uterine cornua. Each tube is about
111/4 cm. long, and surrounds the corresponding ovary. The
outer end is the fimbriated extremity. The tube is lined with
ciliated epithelium, which facilitates the passage of the ovum
to the uterus.
The vagina or organ of eopulation is the passage from the
vestibule to the eervix. It lies at an angle of 60°to the hori-
zon. It has two walls, anterior and posterior. Its mucous
membrane lies in folds or rugae.
The hymen is the fold of vaginal mucous membrane guard-
ing the lower orifice of the vagina.
The vulva or external genitals includes the labia majora,
lubia minora, clitoris, vestibule and mons veneris. The labia
majora are the fleshy folds on either side of the vestibule;
the labia minora or nymphse are the two small mucous folds
situated A\ithin the greater lips, they unite above to form
the prepuce of the clitoris. The latter is the analogue of the
penis. The vestibule is the triangular space bounded above
by the clitoris, laterally by the labia minora, and below by the
orifice of the vagina. The mons veneris is the fleshy eminence
above the symphysis pubis.
28 ( 433 )
434
OBSTETRICS AND GYNECOLOGY.
dive a description of the physiology of menstruation.
JUeustrualioii is a periodic series of phenomena occurring
BoriDslI^' every 28 days in the non-pregnant female from
puberty to the menopause, consisting of certain symptoma
tnwuslruftl molimina) and a characteristic aero-sanguinolent
tlisctuuice derived from the congested muoosse of the tubes
aad uterus. The process consists in a growth of the stroma
of the uterine mucosa and a breaking down of the congested
vwiseK with consequent formation of laeunre, which rupture.
Wh«l Is the duration of menstruation and what are the
rcaultlag changes in the uterine mucous membrane?
Motut I'UKtion normaUy lasts IJ to 4 days. It is accom-
l>auK\l hy tt i;ri>wth in the stroma of the uterine mucosa, or
uouifwtiou of the vessels which rupture, and subsequent
d«4ttfuenttio» of the superficial layers of the mucosa.
\N hat Is vicarious menstruation?
A iwriwlic discliarge of blood or other fluid from the nose, I
biVAst, stwiiaeJi, or other organ during a period of suppressed ■
luvunti'ualiou.
What are the abnormalities of menstruation and give
Ihftr vtlology and treatment.
Tbo abitormalities of menstruation ai-e: Amenorrhea, or ^
iitMuuM of the menstrual fluid ; scanty menstrtiation, or insu
iw»i tK>w; mmorrhagia, or excessive flow at the menstrual I
)>tfrivt,(Mi nutrorrhoffia, or a flow between the periods; and j
Ljj^iMwMvrf^i^u, or painful menstruation. Amevorrhea results i
t\v<Mk <M»*u>i«. chlorosis, phthisis, nervous and mental dia- '
i'tituit^ of elimate, and uterine and ovarian defects of I
(AvvA't^iuvul. It is treated by diet, eseroise, iron, tonics, |
tM'WUkv iikutt the so-called emmenagogues. Mtnorrkagia and
>«Auyw rwiult from endometritis, tumors, salpingitis
1^ v^tk^ ■,>«ti»nt of pelvic congestion, including subinvolu-
ynttt *!V* lubor. They may be treated by astringents inter-
Milkltllv M tty^tnuAia, ergot, oil of erigeron, thyroid extract, and i
OBSTETRICS AND GYNECOLOGY. 435
mammary extract, or 'by local treatment, ineluding curettage.
Dysmenorrhea requires dilatation and curettement end re-
placement of displaced organs.
What conditions have a bearing on the time of life in
the female when menstruation first occurs?
Race, social development, climatic influences and predis-
position. The average age of puberty in this country is about
the fourteenth year.
What is the placenta? From what is it formed, what
is its structure, and what are its functions?
The placenta is the essential nutritive and respiratory organ
of the fetus. It is formed from the chorion frondosum and
the decidua serotina, and assumes its functions by the end of
the third month.
Describe the development of the placenta.
During the rapid development of the chorion frondosum,
or hajry chorion, a corresponding change takes place in the
decidua serotina; its tissues hypertrophy and become thick,
spongy and very vascular. The chorionic villi sink deeply
into this pulpy mass and become intimately connected with it,
permitting of osmosis or interchange of the maternal and
embrj^onic blood. By the third month these structures have
developed into the fully formed placenta.
What are the functions of the placenta?
1. The supplying of nourishment from the mother to the
fetus. 2. The oxygenation of the impure fetal blood. 3.
The excretion of the effete products from the fetus.
Describe the human uterus and give its anatomic
relations.
The uterus is a hollow muscular organ situated in the cen-
ter of the pelvis and embraced between the folds of the broad
ligaments. It is 7^ cm. long, 4 cm. broad, and 2% cm. thick;
it weighs 31 grams (7 drams). The upper portion above the
436
OBSTETRICS AND GYNECOLOGY.
point of entrance of the Fallopian tubes is the fundus, the
portion between the tubes and the internal os is the body
proper, and that between the internal and external os is the
cervix. The flattened anterior surface is in close juxtaposi-
tion with the bladder ; the posterior surface is separated from
the rectum by Dovglas' pouch or cul-de-sac. The cavity of
the uterus measures 61^ cm. (2^ in.).
How is the uterus supplied with nerves?
The uterus is supplied by filaments from the hypogastric
imd ovarian plexuses of the syiiijjathelie uervons sj'steiii.
Describe the normal non-gravid uterus, giving its func-
tion and relation to the other organs of generation.
The uterus has already been described. It lies above the
vagina, its axis being at right angles to the axis of the vagina.
The tubes are continuous with the eornua. and extend one to
either side of the fundus. The ovaries are one either aide of
the uterus below the tubes.
Describe the semen.
The semen is a thick, viscid, yellowish or opalescent fluid,
witb a faint characteristic lime-like odor, secreted by the tes-
ticles and prostate gland. Its most important constituenltt
are the sperniato2oids.
Define insemination and state the conditions necessary
to its accomplishment.
In.semiuatioD is the deposit of the semen within the vagina
during copulation. It is not necessarily followed by impreg-
nation.
What are spermatozoa? Where arc they found? De-
scribe their appearance and function.
The spennatozoa are microscopic, tadpole-like bodies pres-
ent in immense numbere in the semen. They are about 1-500
of an inch in length, and are derived from the gperm-oells of
the seminal tubules of the testicles. They have flat, oval
OBSTETRICS AND GYNECOLOGY. 437
heads, small bodies, and immensely elongated flagella or tails,
which are in constant motion. Their function is fertilization
of the ovum.
Give the definition, physiology and frequency of ovula-
tion and state whether ovulation and menstruation are
synchronous.
Ovulation is the formation, development and discharge of
a mature ovum from the ovary. It occurs once or twice in
a month, and is not necessarily synchronous with menstru-
ation.
What is the mechanism of the escape of the ovule and
its transmission to the tubes and uterus?
Upon the establishment of puberty certain Graafian folli-
cles assume extraordinary growth, and rapidly approach the
ovarian surface. Owing to the increased intrafollicular pres-
sure the capsule yields and the contents — an ovum and the
liquor folliculi — escape. The ovum is received into the Fal-
lopian tube either by direct introduction at the time of rupture
or by suction, and is then carried into the uterine cavity by
the action of the ciliated epithelium of the tube.
Define fecundation and describe its physiology.
Fecundation is the fertilization of the ovum by the sper-
matozoids. It is accomplished according to some in the tubes
or on the ovarian surface, and according to others in the
uterine fundus. The spermatozoids penetrate the vitelline
membrane of the ovum through the micropyle. The ovum
then undergoes a series of progressive changes.
Give the successive changes that take place in the ovum
after fecundation, and during its passage to the uterus.
1. Absorption of the \'ibratile extremity of the spermato-
zoid, leaving the head only, which is known as the male pro-
nucleus, 2. Union of the male and female pronuclei to form
the oosperm or blastosphere. 3. Division of the vitelline nu-
cleus, followed by segmentation of the vitellus, resulting in
438 OBSTETRICS AND GYNECOLOGY.
the formation of the morula or mulberry mass. 4. Appear-
ance in the center of the morula of a transparent fluid, which
condenses the morula into a thin cellular layer {blastoderm
or blastodermic vievibrane). 5. Division of the blastoderm
into the epiblast, mesoblast and hypoblast. 6, Aggregation
of the hypoblastic cells into the germinal or embryonic area.
7. Appearance in this of the pritnitive trace or embryonic
line, suri-oiindcd by a translucent space, the area pellucida.
8, Incurving of the extremities of the primitive trace t« form
the fetal ellipse. 9. Development of the embryonal parts.
Describe the vitellus, the allantois, and the amnion.
The vitellus is the protoplasmic yelk ot the ovum. The
allantois is a small pear-shaped vesicular structure which
develops from the lower portion of the embryonic alimentaiy
oanal at about the 20th day of intra-uterine life. It is a vas-
cular structure, and is the forerunner of tlie placenta. It is
intimately associated with the chorion. The amnion is a
smooth, tough, transparent, glistening, fibrous structure, the
innermost of the feta! meinbranea, surrounding the fetus and
continuous with it at the umbilicus; it secretes and encloses
the liquor amnii.
Describe the fully developed ovum.
The ovum is the vital element or reproductive cell of the
female. It varies in size from 1-500 to 1-120 of an inch. It
consists of a protoplasmic yelk or vitellus and a nucleus or
germinal vesicle {vesicula germinativa) enclosed within a
hyaline covering, the zona pellucida or vitelline membrane.
What is the character of the liquor amnii and what are
its sources and uses?
The liquor amnii is an algaline fluid, about a quart in
quantity, with a light specific gravity, an opaque white color,
and a characteristic odor. It prevents undue pressure of the
uterine walls upon the fetus, it saves the uterus from injury
due to the fetal movements, it maintains an equable temper-
L
OBSTETRICS AND GYNECOLOGY. 439
ature around the fetus, and it receives and dilutes the excre-
tions of the fetus. It is derived from the fetus largely, and
contains much fetal urine.
What is the umbilical cord and how is it formed?
The funis or umbilical cord is a cord-like structure extend-
ing from the umbilicus of the fetus to the placenta. It is
developed from the pedicle of the allantois at about the fourth
week of pregnancy. It measures at term about 50 cm. in
length.
What structures compose the fully developed umbilical
cord?
Two umbilical arteries, one umbilical vein, the vitelline
duct, the pedicle of the allantois, and the jelly of Wharton.
What are uterine hydatids (hydatid pregnancy) ? What
are their source and treatment?
This is an unusual name for hydatidiform mole or cystic
disease of the chorion, a rare affection of the chorion consist-
ing in a proliferative degeneration of the chorionic villi with
the production of a mavss of grape-like vesicles attached to the
placenta. The disease occurs about once in 2000 cases of
pregnancy. The treatment consists in immediate evacuation
of the uterine contents.
What changes take place in the female at puberty?
Hair appears above the pubis; the breasts develop; the
function of ovulation is established; menstruation appears;
the pelvis widens; and there is a growth of the sexual sense.
What are the differences between the male pelvis and
the female pelvis? Give the importance of the female
characteristics in labor.
Male. Heavy structure. Cavdty deep and contracted.
Sacrum narrow and slightly curved. Ischial tuberosities
closely approximated. Subpubic angle 75°-80°. Pelvic brim
triangular. Slight pelvic inclination. Thyroid foramen
oval.
440
0B8TEIBICS AND GXNSCOLOOY.
r
Female. Light Btructure. Cavity shallow hat roomy.
Saenim wide and deeply carved. Ischial tuberosities widely
separated. Subpubic angle 90°-100''. Pelvic brim cordate.
Great pelvic inclination. Thyroid foramen triangular.
The female eharacteristios favor ready transit of a fetus
Ihrough the peh-is.
Give the bones, divisions, straits and symphyses of the
obstetric pelvis.
The pelvis is composed of tlie two innominate boDes, the
sacrum and the coccyx ; it is divided into the true pelvis helow
and tlie false pelvis above the iliopeetineal line. This line
forms the boundary of the inlet or superior strait The lower
orifice is the inferior strait. The symphyses are three in num-
ber, viz., the pubic, and the two saero-iliac synchondroses.
Give the obstetric landmarks of the superior and infe-
rior straits.
Superior strait. The four cardinal points, viz., the sacro-
iliac synchondroses, and the iliopeetineal eminences; also the
promontory of the saemm, and the iliopeetineal line. Infe-
rior strait. The tips of the coccyx, the ischial tuberosities,
and Ihe subpubic angle.
Give the names and dimensions of the diameters of the
pelvic inlet.
The conjugate or anteroposterior, llcni. ; the transverse,
13% em., and the two oblique diameters {between one ilio-
peetineal eminence and the opposite sacro-iliao synchon-
drosis), 12% cm.
What are the diameters of the pelvic outlet? How is
the pelvic outlet bounded?
The tran.svcrse (between the ischial tuberosities) 11 em.,
and the conjugate (between the tip of the coccyx and tlie sub-
pubic ligament) 91^ em. at rest, and 11 cm. in labor. The
pelvic outlet is bounded by the tip of the coccyx, the ischial
tuberosities, the eacrosciatic ligaments, the thyroid foramina,
and the subpubic ligament.
OBSTETRICS AND GYNECOLOGY. 441
Differentiate the planes and axes of the pelvis and men-
tion their obstetric importance.
The plane of the superior strait forms an angle of 50°-60'^
with the horizon ; the plane of the inferior strait forms a line
of 10° with the horizon. The roomiest portion of the pelvic
cavity forms what is known as the pla7ie of pelvic expansion,
while the narrowest portion of the cavity forms the plane of
pelvic contraction. The axis of the pelvic cavity, known as
the curve of Cams, extends from the middle of the plane of
the superior strait to the middle of the plane of the inferior
strait, and foUoWs the curve of the sacrum. The greater its
curvature, the more difficult the labor; also the greater the
pelvic obliquity, the more difficult the labor.
What are the varieties of deformed pelvis?
The most commonly recognized varieties are the simple
fiat, the spondylolisthetic, the rachitic, the coxalgic, the sco-
liotic, the osteomalacic, Naegele's, Robert's, the kyphotic, the
kyphoscoliotic, the justo-minor, the generally contracted and
fiat, the justo-major, the split pelvis, and the pelves distorted
by tumors and fractures.
What difficulties arise during labor from malformations
of the maternal pelvis?
If the pelvis be increased in size a precipitate labor will
probably result. If it be contracted there will occur all de-
grees of obstruction, from the slightest retardation to total
blocking of the fetal progress. This will result in increased
severity of the labor pains, rise of the contraction-ring, early
escape of the liquor amnii, serious compression of the fetal
. head, malpositions and malpresentations of the fetus, and
sloughing of the maternal soft parts.
What varieties of deformed pelvis are liable to inter-
fere with obstetric procedures? How?
All pelves that are contracted in the superior or inferior
straits will more or less seriouslv obstruct labor. This in-
442
OBSTETRICS AND GYNECOLOGY.
F
eludes the vast majority of deformed pelves, whatever the
eauae of the defoniiity.
Describe and differentiate justo-minor pelvis and justo*
major pelvis, and state how each may complicate labor.
The justo-minor pelvia is one equally citiitracled in all of
its diameters; it is normal in shape, but undersized. The
justO'tnajor pelvis is one equally enlarged in all its diameters.
The former obstructs labor; the latter predisposes to precipi-
tate labor.
Describe a non-rachitic flat pelvis, and give the man*
agement of labor in such a condition.
This is a very common form of pelvic deformity, consisting
in a diminution in the anteroposterior diameter of the supe-
rior strait of the pelvis without any disturbance in the size of
the other diametei-s. As a rule, it does not result in serious
interference of labor, although instmmental delivoiy may be
required.
What structures enter into the formation of the pelvic
floor?
Fi-ora without inward the muscles of the pelvic floor are the
transversus peronei. the ischioeavernosus, the sphincter ani,
the sphincter vaginie, the eoccygeus, and the levator ani mus-
cles, together with the pelvic fascia and the perineal wedge
or body.
What changes occur in the uterus during pregnancy?
There is a general hypertrophy of all the uterine t
especially of the muscular substances. The blood-v
increased in number, size, length and tortuosity. The veins
lose all their coats hut the intiraa. The uterus slightly ro-
tates on its axis from left to ripht during its development.
What are the effects of pregnancy on the maternal
ori^anisms?
In addition to the uterine changes already described there
will be Doled the following: A deposit of fat in the abdominal
OBSTETRICS AND GYNECOLOGY. 443
wall, an edema of the joints of the pelvis, congestion of the
pelvic viscera, an increase in the quantity of blood and of the
urine, alterations in taste and disposition, and a softening of
the bones of the entire body.
What changes occur during pregnancy in the external
genitals and vagina?
There will be noted an increased vascularity, with edema
and softening of the tissues, and bluing of the mucous mem-
brane.
What changes occur in the breasts during pregnancy?
The breasts become enlarged generally and 'much engorged,
and a deposit of pigment takes place in the areola. This pri-
mary ring of pigment may be surrounded by a secondary
areola of light color. The glands of Montgomery become
enlarged and protuberant. The nipples become prominent,
and colostrum develops in the mammary glands.
What changes occur in the blood during gestation?
The general quantity of the blood is increased, while its
quality decreases; in other words, there exists a combined
hydremia and anemia. There is an increased tendency to
clot from the large amount of fibrinogen present.
Describe the human embryo during the second month,
during the fifth month, during the seventh month, and
during the ninth month, giving size and weight.
At the second month the embryo is the size of a pigeon's
egg ; the visceral clefts are closed ; the head forms more than
two-thirds of the embryo, and all its features may be distin-
guished; the hands and feet are w^ebbed; the length of the
fetus is 4 cm. {lyo inches) ; its weight is 4 grams (60-62
grains) .
At the fifth month the face is wrinkled and senile, the hair
and nails are fully formed, the vemix caseosa appears, the
eyelids begin to open ; the umbilical cord is about 12 inches
long; the length of the fetus is about 25 cm. (9% inches) ;
its weight 273 grams (10 8-10 ounces).
4i4
OBSTETRICS AND OYNECOLOOY.
its membranes i
nfectious diseases ti-ans-
[^-ulation; rarely it may
At the seventh montli the skin is stiU wrinkled and reddish,
the lanugo begiiis to disappear from the face, the eyelids are
open, the membrana pupillaris disappears; the length of the
fetus is 35 em. (13% inches); its weight 1213 grams (39
ounces) .
At the 7u»(h month the-senile appearance of the face dis-
appears, the lanugo begins to disappear from the body; the
length of the fetus is 45 cm. (17% inches) ; its weight 1990
grams (oi/, pounds).
Name the diseases of the
utero.
The fetus may suffer from various ii
mitted to it through the placental i
develop tuberculosis in this way; fetal rickets is a <
condition, as is also fetal syphilis; very rarely the fetus may
develop tumors in various portions' of the body; maternal
impressions may be noted; and various intracranial diseases,
as meningocele, hydrocephalus and the like; fetal ichthyosis
is rarely noted. The diseases of the membranes include
hydramnios, oligohydramnios, and cystic disease of the cho-
rion.
How would you diagnose the death of the fetus in utero?
In about the order of value the .signs of fetal death are: 1.
Cessation of abdominal and uterine growth, followed by sub-
sidence in the size of the uterus. 2. Subsidence of the signs
of pregnancy. 3. Absence of fetal heart-sounds and fetal
movements. 4. Absence of pulsation in the umbilical cord or
fetal precordium. 5. Decrease in the cervical temperature.
6. Appearance of milk in the breasts (occasional). 7. Pep-
tone or acetone in the urine. 8. Cranial crepitus in case of
maceration of the fetus.
How may death of the fetus in utero be recognized after
the period of viability? What should be done in such
cases?
Fetal death may be presupposed by a suppression of all
OBSTETRICS AND OYNECOLOGY. 445
the signs of pregnancy that have been present; by absence
of the fetal heart-sounds; by cessation of the growth of the
abdomen, with subsequent diminution in the size of the
abdominal girth, and occasionally by the appearance of milk
in the breasts. When fetal death js assured the uterine con-
tents should be removed.
Give the obstetric anatomy of the fetal head.
The fetal head at term consists of the two frontal bones,
the two parietal bones, the occiput and the bones of the face.
These various bones are separated by sutures, as follows;
The frontal, the sagittal, the coronal, the lambdoid, and by
the two fontanels, the anterior and the posterior.
Name the various diameters of the fetal head.
The diameters of the fetal head are as follows: The bitem-
poral, 8 cm.; the biparietal, between the two parietal emi-
nences, 914 cm-; the bimastoid, between the two mastoid
processes, 75^8 cm. ; the occipito-f rontal, from the root of the
nose to the external occipital protuberance, 11% cm.; the
occipito-mental, from the point of the chin to the external
occipital protuberance, 131/4 cm.; the suboccipito-bregmatic,
from the central point of the bregma to a point midway be-
tween the occipital protuberance and the foramen magnum,
9% cm. : the f rontomental, from the top of the forehead to the
point of the chin, 8 cm.; the trachelo-bregmatic, from the
central point of the bregma to the anterior margin of the
foramen magnum, 91^ cm.; and the mento-bregmatic or
cervico-bregmatic, from the central point of the bregma to
the junction of the chin and neck, 9^4 cm.
•
Describe the fontanels and their diagnostic uses.
The anterior or larger fontanel or hregma is a diamond-
shaped space left at the point of junction of the frontal,
coronal and sagittal sutures. The posterior or smaller fon-
tanel is situated at the point of junction of the lambdoid and
sagittal sutures, and is triangular in shape. It is felt in all
OBSTETRICS AND 6YNECOL0OT,
normal vertex presentations, and by its situation determines
the position of the head in labor. The bregma is never felt
in a normal presentation, but may be palpated in the presen-
tation of the top of the head, in a brow presentation, and in
presentation of the occiput in the hollow of the sacrum.
What is meconium and what are its diagnostic relations?
Meconium is the peculiar greenish substance contained in
the fetal bowels at birth. If it be discharged prior to the
delivery of the child, it generally indicates a breech pre-
sentation. Occasionally it will escape in difficult head-
deliveries.
Describe the fetal heart-sounds, give their rate, and
state when and where they are best heard.
The fetal heart-sounds constitute an absolute sign of preg-
nancy from the sixth month of gestation on. They resemble
the ticking of a watch under a pillow; their rate is about
twice that of the maternal heart-beat, averaging from 120 to
160 beats a minute. The position of maximum intensity
varies according to the fetal presentation. In anterior ver-
tex presentations they are best heard at a point midway be-
tween the-umbi!icus and the anterior spinous process of that
side upon which the fetus is resting, while in posterior vertex
presentations the point of maximum intensity would be in
the corresponding flank, slightly below a transverse line pass-
ing through the umbilicus.
What is baliottement, and how is it performed?
Ballotteraent is a balancing of the fetus in uleiv between
the fingers of the two bands. In vaginal baliottement th#
index and middle fingers of the left hand are inserted into thp
anterior vaginal fornix, tJie patient lying in the dorsal posi-
tion, while the fundus is steadied by the right hand placed
upon the abdomen. The vaginal fingers give a sudden im-
pulse to the anterior uterine wall, whereby the fetus is dis-
placed upward ; the latter gently falls back and strikes upon
OBSTETRICS AND GYNECOLOGY. 447
the propelling fingers. This sign is positive, and is available
from the middle of the fourth to the eighth months.
How would you diagnose pregnancy at five months, at
or before the end of the third month, and at full term?
In the first three months of pregnancy the following signs
are present: Menstrual suppression, nausea and vomiting,
and the four soft signs, viz., Goodell's sign (softened cervix),
Hegar's sign (softened lower uterine segment), the soft and
^ggy uterine body, and the soft and enlarged mamma, with
the darkened areolae.
At the fifth month there will be added to the foregoing
Jacquemin's sign (the bluing of the vaginal and vulvar
mucosae), Braxton Hicks' intermittent uterine contraction,
ballottement, and quickening; the uterus will also be con-
siderably more enlarged.
At term all the foregoing signs are present, save ballotte-
ment, and in addition the fetal heart-sounds may be detected,
and palpation will reveal the fetal outlines both above and
below.
What are the subjective signs of pregnancy?
The subjective signs of pregnancy are those recognized by
the patient herself. This includes menstrual suppression,
nausea and vomiting, vesical irritability, quickening, pain in
the abdominal walls from excessive distension, vertigo, palpi-
tation, and gastric disturbance.
What signs of pregnancy are determined by the touch?
The four **soft signs," the fetal parts and presentation,
ballottement, Braxton Hicks' sign, the uterine enlargement,
and the fetal movements.
What may be learned by abdominal palpation of the
pregnant woman after the eighth month?
The fetal movements, the fetal parts, the position and pre-
sentation of the fetus, the size and position of the uterus, the
degree of distension of the uterine and abdominal walls, the
size of the pelvic inlet, the movability of the fetal head.
448 OBSTETRICS AND OYNE
Classify the objective signs of pregnancy and state their
relative value.
The five positive signs of pregnancy are ballottement, fetal
raovemente, fetal hearl^sounds, blue diseoloratioD of tlie vulvn
and vagina, and intermittent uterine eontraetions. Other
vahiable objective signs are cervical softness (in primparffi),
Uegar's softening of the lower uterine segment, darkening
of the areolai of the breasts, the presence of colostrum in tiie
breasts, and the outlining of the fetal parts.
What are the signs of pregnancy, doubtful, probable,
and certain?
The doubtful signs of pregnancy are vesical irritability,
irregular gastric disturbances, increasing constipation, dimin-
ution but not actual snppresson of the menstmal flow, all
occurring in a woman exposed to the possibility of impreg-
nation.
The probable signs are total menstrual suppression, in-
creasing size of the uterus, darkening of tJie mammary
areola, development of Montgomery's tubercles, and fre-
quency of micturition.
The certnin signs are the positive signs already enumerated.
What is to be learned by abdominal auscultation in
pregnancy?
Auscultation of the abdomen mil reveal the placental
soiiffle or uterine bruit and the fetal heart-sounds. Occasion-
ally the umbilical souffle may be detected.
Describe the changes in position which the uterus un-
dergoes during pregnancy.
At first the uterus sinks inio the pelvis on account of its
increased specific gravity. There then follows a gradual and
progressive ri.se into the abdomen until 2 to 4 weeks before
term, when a secondary sinking {lightening) occurs, due to
the entrance of the fetal head into the superior strait.
OBSTETRICS AND GYNECOLOGY. 449
At what period does quickening usually occur?
In the middle of the fifth month of gestation.
How should external palpation of the pregnant woman
be performed?
The woman lies in the dorsal position with the limbs partly
flexed. General pressure is made with the tips of the fingers
and the ulnar borders of the palms upon the abdominal sur-
face from the median line towards the flanks. The hands
are permitted to dip beneath the central points of Poupart's
ligaments and beneath the pelvic brim in order to determine
the fetal presentation.
What is '' morning sickness," when does it begin, how
long does it usually continue, and what is its causation
and treatment?
The nausea and vomiting of pregnancy occurs usually at
the sixth week of gestation, and normally lasts for six weeks.
It may begin earlier or it may not appear at all. It is be-
lieved to be due to a reflex irritation of the nerve-endings in
the uterus resulting from the rapid growth of that organ.
It is best treated by the exhibition of nerve-sedatives, such as
sodium bromide, ingluvin, oxalate of cerium and the like.
Differentiate ordinary morning sickness from the hy-
peremesis of pregnancy. Mention the causes and de-
scribe the management of the latter.
The pernicious vomiting of pregnancy is an exaggerated
gastric disturbance which appears to become uncontrollable,
and may result fatally from extreme prostration. It is due
to a number of conditions, including the presence of toxins
of undetermined nature in the blood, probably resulting from
imperfect functionating of the liver. It occurs in women
whose uteri have been chronically diseased, and in those who
are of a neuroti<; tendency. It may also result from kidney-
failure, and from too frequent sexual intercourse. Its treat-
ment consists in proper hygiene, the correction of uterine
29
LANE UBRAP^ ^"ANFORO Um^tS^NX^
450
OBSTETRICS AND GYNECOLOGY.
r
displacements or cervical catarrh, restriction in diet, the use
of pi-oper therapeutic measures, aad, if need be, reetal ali-
mentation. The pregnancy should be terminated if the other
measures fail.
What is the nortnal duration of pregnancy? What are
the limits of the variations, and how should its duration
be calculated?
Prom a number of investigations it lias been found that in ■
the human being pregnancy normally covers 280 days (10
lunar or 9 calendar months). It may be extended up to 302
days and pregnancy still be considered legitimate. Fre- ■
quently the pregnancy terminates prematurely, and this may I
happen at any time subsequent to conception. The methods
of determining the date of confinement are mimerous. The ,
Naegele rule is to count back 3 months from the date of the (
appearance of the last menstruation and add 7 days. The
date of quickening usually occurs midway through gestation,
or at ^Y-- months. Other methods consists in mensuration of
the uterus and of the fetus, and the use of periodoscopes and
tables.
How would you differentiate between the first and
subsequent pregnancies?
In a primipara the fourchet is present; it is missing in a
multiparoua woman. The abdominal walls are relaxed and
marked witli stria; in the multipara, while in the primipara
the abdomen is full, rounded and tense. The nipples are ,
large and well developed in the multiparous woman, and ■
usually .small and undeveloped in the primipara.
Given a distended abdomen, how would you differen*
tially diagnose pregnancy, ovarian disease, ascites, and ^
gaseous accumulation?
In ovarian cyst there is generally an absence of the chief I
signs of pregnancy; the characteristic ovarian fades is pres- '
eot; the abdominal tumor is soft, Suctuating, usually more
or less directed to one side, and does not reveal the fetal signs;
0B8TETBICS AND GYNECOLOGY. 451
fcontinuance of menstruation is the rule; the cervix is not
unduly soft; and the history is obscure, the growth slowly
developing for a longer period than the full term of gestation.
In ascites percussion shows dulness in the flanks, with re-
sonance in the median abdominal line, the area of dulness
changing with the position of the patient; there is free fluc-
tuation; the usual signs of pregnancy are absent; the abdo-
men is flattened in the umbilical region, with bulging at the
sides; the umbilicus is always depressed; palpation does not
reveal any definite tumor; the cervix is not altered.
In gaseous accumulation or pseudocyesis, which most com-
monly occurs in elderly women at or near the menopause or in
young or hysterical women, some of the important signs of
pregnancy will be absent ; the uterus is not enlarged, and the
cervix is not soft; there is a tympanitic percussion-note over
the whole abdominal surface, and if the patient be anesthe-
tized the abdominal enlargement will disappear entirely.
Differentiate uterine bruit and umbilical souffle.
The uterine bruit or placental souffle is a rhythmic blowing
sound occurring synchronously with the maternal heart-beat.
It is first heard about the beginning of the fourth month, and
is generally located low down and to one or the other side of
the uterus. It is also known as the placental murmur. The
umiiUcal or funic souffle is a peculiar high-pitched hissing
sound heard most distinctly in the immediate vicinity of the
fetal heart, with the beat of which it is synchronous. It is a
sign of fetal danger, and indicates some stenosis of the um-
bilical arteries.
Describe the mammary glands and the changes they
undergo in pregnancy. When the child is still-born what
care should be taken of the mother's breasts?
The mammary glands are two large glandular structures
on the anterior surface of the thorax. They consist of a num-
ber of lobules, each of which has an excretory or galacto-
phorous duct which runs to the nipple. During pregnancy
452
OBSTETRICS AND GYNECOLOGY.
r
the breasts enlarge and become firm and heavy. Olistening
streaks appear upon tie surfaces from over-distension. Pig-
ment is deposited ai-ound the nipple in the areolce; the glands
of Montgomery enlarge and protrude from the surface; the-
nipples increase in size and become prominent and protrud-
ing. Colostrum appears in tie breast after the third mouth.
If the child is still-born the breasts must be strapped and
applications made to prevent the development of milk.
State the medico-(egal complications tliat may arise
from an erroneous diagnosis of pregnancy.
An erroneous diagnosi.s of pregnancy may result in eou- |
jugal unhappiness, witli divorce: it may cause the executioa j
of an innocent woman or unnecessary confinement in prison:
it may alter the tenus of a will or the dividing of an estate; ]
it may bring a Inw-suit against the physician.
What are the positions and attitudes of the fetus in- J
utero, and what are their causes?
The fetus may lie parallel with or at right angles to the |
long axis of the woman's body; it always lies in the long a
of the uterus, whether this be horizontal or vertical. It may I
lie obliquely if there exist a tumor or thickening in the uterine I
walJ, of if the uterine cavity be irregular in its outlines.
How many different presentations are liable to be met
in obstetric practice? What are they?
There are three presentations of the fetai body, viz.. the- I
cephalic or head, the pelvic, and the transverse or trunk.
The cephalic presentations include the vrrlex, face, bregma I
or anterior fontanel, brou; ear, and parietal eminence. The |
pelvic presentations include the breceli. knrc. and fool.
How Is a vertex presentation recognized by palpation? 1
Examinatiou of the abdomen shows the hard cephalic ex-
tremity of the child at the pelvic brim; vaginal examination j
reveals the depressed occiput and smaller fontanel at c
extremity of a pelvic diameter, while the sagittal suturfr i
extends obliquely from them in the line of the diameter.
OBSTETRICS AND GYNECOLOGY. 453
Differentiate the positions of tfie fetus at term as deter-
mined by external palpation.
Cephalic or head presentations show the fetal ellipse lying
longitudinally, with the fetal back to one or the other side
-and the hard cephalic extremity at the pelvic brim; fetal
movements are felt high up on the abdominal surface. In
pelvic presentations the conditions are reversed, the head
above and the breech below ; the head may be freely moved,
and the fetal movements are felt low down on the abdominal
-surface. In transverse presentations the long axis of the
fetus lies at right angles to the long axis of the mother's body ;
both extremities of the fetal ellipse may be readily palpated.
How may the knee be distinguished from the elbow
when presenting?
The knee is round and large, the elbow small and more
-angular; the elbow shows sharp bony processes to the sides
and posterior; the popliteal space may be felt behind the
knee; the arm may readily be brought down if the elbow is
present; the leg is brought down with more difficulty.
What is understood by the hygiene of pregnancy? In
a case of pregnancy how is the health of the patient main-
tained?
By the hygiene of pregnancy is meant the management of
the patient according to the rules of health. This includes
regulation of the diet, clothing, exercise, bathing and douch-
ing, and sexual intercourse; attention to the kidneys and
other emunctories; the correction of constipation and proper
occupation for the mind.
Describe the proper management of the breasts of the
mother before labor.
Proper development of the nipples should be favored by
judicious manipulation daily. The nipples should be kept
clean by soap and water and a weak solution of sodium borate.
If the breasts are painful they may be anointed at night with
cocoa-butter or lanolin.
454
OBSTETRICS AND GYNECOLOGY.
What is (he pathology of pregnancy? Name some oF
the diseases to which pregnancy predisposes.
Tile pathology of pregnancy includes a study of the dis-
eases to wliich a pregnant woman is exposed. The diseases
slie is nwst apt to develop are renal insufficiency. Bright 's
disoase, gingivitis, salivation, pica, indigestion, pemieioiis-
VDiuiting, constipation, hemorrhoids, jaundice, appendicitis,
dyspnea, cardiac palpitation, hydremia, pernicious anemia,
varicose veins, hemorrhage, uterine displacements, insanity,
ueurtitgias, and osteomalacia.
To what form of morbus Brightii are pregnant womeir
most fiable? How would you diagnose and treat it?
To acute nephritis, catarrhal or interstitial in nature. It
is frequently so called when in reality the kidney of preg-
nancy is meant.
Give the etiology, symptoms and management, as best
understood and practiced at present, of albuminuria of
pregnancy. What is the prognosis?
Uy the albvviinurin or kidney of prc/jnancy is meant a.
peculiar condition manifested by a certain proportion of
pivgiiniit women in which albumin appears in the urine in
varying amoimts, but which is unassociated with any grave
urgantti change in the kidneys. The condition is one of hemic-
intoxication, tlie poisons probably originating in an imper-
fcyt uiotulwlism on the part of the liver. The poisons irritate
till' kidneys, pi-oducing an arteriole contraction, whereby the-
kidneys appear pale and anemic, and become inadequate to
perfonn the work devolved upon them. The treatment of
nuial inadequacy consists in a careful supervision of the
Muidilion of the urine, and appropriate dietetic, hygienic and
tliernpoulic rcpmen. Milk diet or light diet, large draughts
(if Poland or lilJiia water, diuretics, laxatives, alteratives,
Ilaaham's mixture, irrigation of the bowel with hot normal
■fUlne Bolutiona, and the bromides and chloral hydrate consti-
tiiti' the treatment. If the disease proprfesses labor may have
III bl^ induced. Tlie prognosis is always anxious.
I
OBSTETRICS AND OYNECOLOOY. 455
How would you measure the severity of interstitial
nephritis in a pregnant woman, and how would you treat
such a condition?
By the early appearance of the symptoms, by the numt)er
and nature of the urinary casts, by the development of albu-
minuric retinitis, and by the rapidly increasing edema. The
disease requires an early evacuation of the uterine contents.
What is the cause of difficult and painful urination in
pregnancy?
When present this generally results from uterine displac-
ment backward, the cervix tilting up against the base of the
bladder and interfering with micturition.
How do uterine displacements originate, and how do
they influence conception and pregnancy?
Uterine displacements are generally the result of previous
labors, the floor being lacerated and the uterus remaining
subinvoluted and heavy. Such an organ falls back into the
hollow of the sacrum. Anteflexion of the uterus may result
from a ventrofixation. Any fixed displacement is apt to pre-
vent conception by rendering the ingress of the spermatozoids
impossible, and if pregnancy results and the displacement
persists, abortion is apt to occur spontaneously.
What uterine displacement is especially liable to inter-
rupt pregnancy, and what should be done to prevent it?
Retrodisplacement. Such a displaced uterus should be
replaced at once, and a pessary introduced and retained until
the fundus rises above the sacral promontory (fourth month) ;
it may then be withdrawn.
What treatment would you advise for a case of con-
tinued menstruation during pregnancy?
Such a condition indicates failure of union between the
decidua vera and decidua reflexa. The patient should be
kept quiet, especially at the menstrual epochs. No local
treatment is indicated as a rule. If the hemorrhage becomes
456 OBSTETRICS AND GYNECOLOGY.
profuse the treatment of threatened abortion must be insti-
tuted.
Name the diseases of the endometrium, and state their
effects in pregnancy.
Inflammation (cndomctrilis), acute or chronic, will teud
to produce abortioD. Chronic endometritis, especially if
syphilitic in origin, is probably the most common cause of
abortion. Atrophy of the decidua ( hypertrophied endome-
trium) causes the ovum to drop in the uterine cavity, and
may result in placenta previa. A catarrhal endometritis
may cause an accumulation of fluid between the layers of the
decidua, producing the condition known as hydrorrhcea gravi-
darum, or "false waters," Apoplexy of the decidua may
destroy the ovudi. Tumors may form in tlie decidua rarely ;
if benign they are known as benign deciduomata; malignant
deciduoma is rarely encountered.
What diseases of the mother are liable to injure the
fetus in utero?
Syphilis, tuberculosis, rickets, the exanthemata, renal in-
adequacy, puerperal eclampsia; any disease causing stagna-
tion in the circulation, as chronic valvular disease and apas-
modic maternal affections, as bronchitis, chorea and the like.
Mention some of the principal causes of sterility in
woman, and state how fertility may be promoted.
Stenosis of the cervical canal from anteflexion, retrodis-
placement of the uterus, cervical catarrh with profuse acrid
leukorrhea, chronic salpingitis resulting in occlusion of the
Fallopian tubes, and chronic endometritis. Rapid progressive
dilatation of a stenosed canal, replacement of a displaced
uterus, the local treatment of cervical catarrh and uterine
disease will do much to re»rtore a normal condition and pro-
mote fertility.
Define abortion, miscarriage, and premature labor.
Ahorliov is the discharge of the ovum during the first tri-
OBSTETRICS AND GYNECOLOGY. 457
mester of pregnancy. Miscarriage is the discharge of the
embryo during the second trimester. Premature labor is the
delivery of the fetus after the period of viability and before
full term.
What is the management of abortion, both preventive
and curative? Give its causes, diagnosis, and indications
for treatment.
The cauMs of abortion are numerous. They include cer-
tain morbid states of the ovum and fetus, as apoplexy of the
ovum, disease of the umbilical vesicle, disease of the fetal
membranes, malposition of the placenta, disease of the fetus,
as syphilis and hydrocephalus, death of the fetus, certain
paternal causes, as a diseased spermatozoid, certain maternal
diseases, as the exanthemata, valvular heart-disease, renal
inadequacy, convulsive disorders, as chorea and epilepsy,
malformations of the uterus, profound mental shock, and
traumatism.
The symptoms of abortion are sacral discomfort, steadily
increasing hemorrhage, uterine contractions, and finally ex-
pulsion of a part or the whole of the product of conception.
The diagnosis may be made by a study of the symptoms, by
the physical signs, and by an examination of the discharged
products. The preventive treatment consists in absolute
quiet and rest in bed, lowering of the head, the administra-
tion of nerve-sedatives, as sodium bromid, and the introduc-
tion of an opium suppository. The curative treatment con-
sists in vaginal and cervical tamponade to control bleeding,
followed by emptying of the uterine contents.
What are the premonitory symptoms of abortion?
At the best these are vague and unreliable. They consist
in a sense of discomfort or fulness in the pelvis, sacral pains,
a feeling of malaise, a tendency to vesical tenesmus, chilly
sensations, and beginning discharge of serum or blood from
the uterus.
458 OBSTETRICS AND GYNECOLOGY.
What are the symptoms of threatened abortion?
Pain, inereasing lieniorrhage, and opening of the uterine
mouth.
Describe the symptoms and give the management of an
incomplete abortion.
The body of the uterus will 'be lai^, soft and boggy; the
een'ieal canal will he patulous; the finger introduced into
the cavity of the utei-us will detect clots, fragments of mem-
brane and pieces of soft, pulpy, placental tissue; the discharge
will be dark, hemorrhagic and grumous, and there may or
may not be a fetid odor. The treatment consists in the asep-
tic removal of the uterine contents by means of the finger or
placental forceps, followed by an intra-uterine douche of mer-
curic chlorid, 1-4000, and the administration of small doses
of ergot if the hemorrhage persist.
What are the symptoms of an inevitable abortion?
Steadily increasing hemorrhage and pain despite the pre-
ventive treatment, and the presence of Tamicr's xign, namely.
obliteration of the angle of flexion between the upper and
lower uterine segments by the descent of the detached ovum.
What means should be employed to prevent threatened
abortion during the first three months of pregnancy?
The avoidance of over-exertion, the correction of uterine
displacement, rest in bed at the menstrual epochs, the admin-
istration of sodium bromide, viburnum pruuifoiium and other
sedatives, and occasionally the use of an opium suppository.
How should inevitable abortion be managed?
A vaginal and intracervieal tampon should be introduced
and left in situ for 8 hours. On its removal the svum will
probably be found attached to it. If not, a second tampon
may be introduced and retained for from fi to 8 hours. If this
fails to bring the ovum away the patient should he anesthe-
tized and the product removed by the finger or the plaeentat
forceps.
OBSTETRICS AND OYNECOLOOY. 459
When and how should abortion be induced?
The induction of abortion is indicated when maternal life
is menaced by some grave pathologic state of the fetus or of
the mother, as cystic disease of the chorion, acute hydramnios^
large uterine or pelvic tumors, extreme pelvic contraction,
pernicious vomiting, pernicious anemia, chronic nephritis
and the like. The best method of inducing abortion consists
in rapid dilatation of the cervix after thoi-ough asepsis of the
vagina, with the immediate removal of the ovum by the finger
and placental forceps.
Is the production of premature labor ever justifiable?
If so, when and how would you accomplish that object?
The indications for the induction of premature labor in-
clude all conditions menacing fetal or maternal life, as well
as those pathologic states of either mother or child that will,
if the pregnancy be allowed to continue to tenn, be productive
of grave degrees of dystocia. These are, oversize or prema-
ture ossification of the upper portion of the fetal skull, acute
hydramnios occurring late in pregnancy, habitual death of
the fetus during the last days or weeks of pregnancy, pelvic
deformity, placenta previa, pernicious anemia, pernicious
vomiting, increasing albuminuria, eclampsia, grave valvular
disease, advanced pulmonary tuberculosis, tumors in the pel-
vic canal. The best method of inducing labor is the intro-
duction of an aseptic rubber catheter into the uterus. Other
methods include the use of Barnes' or Champetier de Ribes'
bags, and rapid digital divulsion of the cervix with the per-
formance of podalic version.
Define and classify ectopic pregnancy. Give its causes^
symptoms and treatment.
Ectopic or extra-uterine pregnancy is a generic term mean-
ing pregnancy at any point outside of the uterus. This
includes tubal pregnancy, interstitial pregnancy, tubo-ovarian
pregnancy, ovarian pregnancy, and primary and secondary
abdmninal pregnancy. The causes of this condition are un-
460
OBSTETRICS AND GYNECOLOGY.
Y
known. The condition is generally encountered in women
wlio are between 20 and 30 years of age, and who pi-esent a.
history of a protracted period of sterility foUowing one or
more pregnancies. It was formerly believed to be due to a
salpingitis, but Sutton now states that it is more liable to
occur in a healthy tube. Tubal diverticula may produce it.
The symptoms are the presence of all the signs of early ges-
tation, irregularity in the menstrual history, vaginal pulsa-
tion, lancinating, cramp-like pains in the affected stide, slight
elevation of temperature, and lateral displacement of the
uterus by a very sensitive mass. The treatment consists in
immediate abdominal section and removal of the gestation-sac.
What are some of the possible terminations of a tubal
pregnancy?
Tubal pregnancy may terminate in rupture, which is usual.
In a certain percentage of eases the embryo may die within
the first few weeks of gestation ; this is known as the sponta-
neous cure of extra-uterine pregnancy. Rarely the condition
may go to term.
What are the symptoms of rupture in ectopic preg-
nancy? What should be done when such rupture occurs?
The symptoms of rupture are sudden and characteristie.
They consist in exceedingly severe cramp-like pains in the
iliac region of the affected side, associated with collapse and
the symptoms of concealed hemorrhage, namely, extreme
pallor of the surface, feeble ninnng pulse, air-hunger, moist,
clammy skin, coldness of the extremities, vomiting, and fre-
quently coma. There is an increased discharge from the
vagina: large masses of decidual tissue are usually discharged
at this time. Immediate laparotomy should be performed.
What preliminary preparations would you suggest for
a case of labor?
The thorough disinfection of the physician, nurse and
patient according to the accepted methods, the opening of the
OBSTETRICS AND GYNECOLOGY. 461
patient's 'bowels by means of a rectal enema, the proper
preparation of the patient's clothing and bed. The nurse
should have on hand the various drugs and instruments, as
well as hot water, for whatever obstetric operation may be
required.
What is labor?
Labor is that natural process by which a pregnant woman
expels the product of conception at the full expiration of the
period of pregnancy, 280 days after conception.
Into what stages is labor divided, and where do these
stages begin and end?
There are three stages of labor. The first or stage of dila-
tation begins with the first labor pain and continues until the
OS is fully dilated. The second stage or stage of expulsion
extends from full dilatation until the delivery of the child
is accomplished. The third stage or stage of the placenta
extends from the delivery of the child until the expulsion of
the after-birth.
What are the prodromata of labor?
The onset of labor is indicated from 2 to 4 weeks before by
the phenomenon known as lightening. This is produced by
the entrance of the child's head into the superior strait, and
occurs 2 weeks before t^rm in multipara? and 4 weeks before
term in primiparas. The symptoms of beginning labor are
pain, beginning dilatation of the os, and a bloody discharge
kno^^^l as the show.
What is the diagnosis of false from true labor pains?
False labor pains are annoying, colicky sensations occur-
ring during the last 2 or 3 weeks of pregnancy, which usually
depend upon constipation or pressure upon nerve-trunks.
They are irregular in their location, and are not accompanied
by dilatation of the os. True labor pains are involuntary
and painful contractions of the uterine muscles occurring
intermittently and with increasing severity at decreasing in-
462
OBSTETRICS AND GYNECOLOGY.
tervats. They are usually felt in the small of the back, and
from this point pass around the ahdoinen. They may reverse
this direetioD, and, commencing at the umbilicus, pass back-
ward to the sacrum. They are cumulative in nature, of
unequal intensity, and last from one-half to one minute.
They result in dilatation of the os.
Give the character, situation and cause of the pains
during the first and second stages of labor.
During the first stage of labor the pains are as described in
the foregoing answer. They result from squeezing of the
nerve-fibrils by the contracting of the uterine muscles. They
are colicky in nature, and aside from opening the os do not
favor the expulsion of the child. In the second stage of labor
the character of the pains changes. They become bearing-
down or expulsive in nature. The pain now is due to pres-
sure upon the soft tissues of the lower parturient canal, as
well as to the pressure iipon the nerve-fibrils above.
What means are employed to stimulate ineffective
uterine contractions?
The administration of quinine in large doses, the application
of a firm abdominal binder, keeping the woman upon her feet,
and the taking of a small amount of food may all result in an
increase of the uterine pain. Ergot or its substitutes should
not be administered.
What is meant by the mechanism of labor?
By the mechanism of labor is meant the manner in which
the fetus and secundines pa.ss through the pai^urient canal
and are expelled.
Define and differentiate position, presentation, and ro-
tation.
By position is meant; 1. The varying relationship borne
by the most prominent point of the presenting part of the
fetus to the cardinal points of the pelvis. 2. The relationship
existing between the long axis of the fetus and tJiat of the
maternal body.
OBSTETRICS AND OYNECOLOOY. 463
By presentation is meant that portion of the fetal body
which is detected by the examining finger introduced to the
center of the plane of the superior strait.
By rotation is meant the turning of the presenting part
from right to left or left to right after it has struck the pelvic
floor, so that it comes to present under the pubic symphysis.
External rotation is a return of the presenting part to the
side from which it comes after it has been delivered through
the vulvar orifice.
Give the normal vertex presentations in the order of
their frequency.
1. Left occipito-anterior, L. 0. A.; 2. Right occipito-pos-
terior, R. 0. P. ; 3. Right occipito-anterior, R. O. A. ; 4. Left
occipito-posterior, L. 0. P.
What is the most common presentation and which the
most frequent position of the presenting part in norma!
labor? Give the average duration of a natural labor.
The most common fetal presentation is the occipital or
vertex; the most frequent position is the left occipito-anterior,
L. O. A. The average duration of labor in a primipara is
from 12 to 15 hours ; in a multipara from 8 to 10 hours.
Give the formation of the caput succedaneum. Where
does the caput succedaneum appear in the third position?
The caput succedaneum or ** accessory head" is the tumor
situated upon the presenting part of the fetus. It is formed
by a seposanguineous infiltration of the connective tissue of
the part. It is due to an edema of the part that is not com-
pressed by the maternal structures. In the third position
of the vertex, R. 0. P., the caput appears on the left parietal
eminence.
Describe the mechanism of labor in L. O. A. presen-
tation.
Adaptation of the fetal presentation to the pelvic strait.
It consists of three steps, namely, preliminary flexion and
OBSTETRICS AND GYNECOLOGY.
464
moulding occurring with the plienomeuon of lightening; fur-
ther flexion and moulding occurring with the first labor pains ;
and Naegele'sobliquity, or lateral inclination of the fetal heaj
toward the maternal sacrum, the right parietal bone present-
ing. The birth-eajial is next, prepared by being dilated by
means of the bag of waters. The presentation nest descends
to the pelvic floor, the occiput resting on the floor. Internal
anterior rotation of the occiput from left to right now occurs.
the occiput resting beneath the symphysis pubis. Birth of
Ihe head by a process of extension follows, the perineum
retracting over the face, which appears first at the forehead
and eyes and finally at tlie chin. Restitution or untwisting
of the neck is then followed by external rotation of the head,
which becomes transverse, with the occiput to the left aide.
The birth of the shoulders follows, the anterior or right shoul-
der rotating from right to left; Uie rest of the trunk is then
rapidly expelled.
Describe the mechanism of labor in the L. 0. P. position.
The steps of the mechanism are the same as in the foregoing
except that the head has further to rotate in order to reach
the symphysis, and this excessive rotation requires a rotation
of the shoulders at the superior strait from the right into the
left oblique diameter, the anterior shoulder rotating from
left to right. After restitution this shoulder rotates bacli
again to the middle line from right to left. The rest of thi>
mecbimism is as in the L. 0. A. presentations.
Name and describe ttie various forms of head-presenta*
tion, with the management appropriate to eacli.
The vertex presentation is most common; its management
is that of an ordinary case of laljor. Brow and face presen-
tations are always abnormal, and will be described further
on. Presentation of tlie ftret/ma is the so-called "military posi-
tion" of the fetus, the head being midway between flexion and
extension, and set squarely on the shoulders. The large
occipito-frontal diameter of the fetal sknll (11% cm.) pre-
OBSTETRICS AND GYNECOLOGY. 465
sents. This presentation must be converted into an occipital
presentation in order to permit labor to proceed. Ear pre-
sentation is a laterally deviated vertex presentation, and can
jrenerally be corrected manually or by altering the position
of the patient.
Give the face and breech presentations of the fetus.
The face presentations are: 1. Left mento-anterior, L. M.
A.; 2. Right mento-anterior, R. M. A.; 3. Right mento-pos-
terior, R. M. P.; 4. Left mento-posterior, L. M. P. The
breech presentations are: 1. Tjeft sacro-anterior, L. S. A.; 2.
Right sacro-anterior, R. S. A.; 3. Right sacro-posterior,
R. S. P. ; 4. Tveft sacro-posterior, L. S. P.
Give the causes of cephalic presentations, and state why
vertex presentations are favorable.
The causes of cephalic presentation are: 1. The peculiar
shape of the uterus and of the fetal ellipse, the smaller ex-
tremity of the fetal ellipse accommodating itself to the smaller
portion of the uterine cavity; 2. The fetal center of gravity
lies near the head, which becomes the dependent portion.
How would you know a head-presentation? How a
breech presentation? How a transverse presentation?
Tn cephalic presentations palpation externally reveals the
hard fetal skull at the superior strait; vaginal examination
will reveal the dome-like projection of the brow or the vertex,
or the features of the face. Tn breech presentations, if the
membranes have broken, there will be a discharge of meco-
nium; palpation will also show the soft pelvic structures,
while externally the head can be felt at the upper portion of
the abdominal wall. In transverse presentation the long axis
of the fetus lies at right angles to the long axis of the maternal
body; vaginal examination is liable to show an arm or elbow
presenting.
Describe the mechanism of expulsion in natural labor.
Expulsion is accomplished by the direct action of the
30
466 OBSTETRICS AND GYNECOLOG
uterine muscles upon the fetal body. The fetus is expelled
because there is a decided diminution in the intra-utCrine
space, and the intrauterine contents are propelled in the
direction of least, resistance, down the lower canal.
What is the " bag of waters," its functions and man-
agement during labor?
The bag of watei-s is the tough elastic membrane containing
the liquor amnii, which can be felt protruding through the
OS during the process of dilatation. Its function in labor is
to distend the cervical fibers, which it does by hydraulic pres-
sure. It should never be ruptured in primiparous women,
and in multipane only after full dilatation of the os h^ been
accomplished.
State the causes of dilatation of the os and cervix uteri
as related to labor.
There ai-c two cnu.ses of cervical dilatation in labor, namely,
the wedge-like action of the bag of waters acting on the
edematous cer^neal tissues, and tlie upward traction exerted
by the longitudinal layer of muscular fibers in the uterine
walla.
Give a brief description of the three stages of labor.
During the first stage of labor the pains occur at intervals
of 30 to 5 minutes; they aeeomplish during this time the
dilatation of the or. This stage may take from 2 to 20 hours,
and the patient for most of this time may remain out of bed.
In the second or expulsive stage, the patient lying in bed, the
pains occur every i^ to 5 minutes, and are assisted by volun-
tary bearing-down on the part of the patient This drives
the presentation down upon the perineum, which bulges, and
by ils resistance directs the presentation to the vulvar orifice,
through which it finally emerges. This stage consumes from
30 minutes to 2 hours. The third stage, which seldom lasts
over half an hour, consists in the espulsion of the placenta
and membranes.
What may cause premature rupture of the membrane?
OBSTETRICS AND GYNECOLOGY. 467
flow may this rupture influence the progress and conduct
of labor?
Undue tenuity of the membranes may cause rupture to
occur with the first labor pains. They may also be ruptured
by the careless introduction of the finger during a pain.
When the water escapes early the labor is said to be **dry."
This results in slow progress of the presenting part, and in
tedious dilatation of the os. The cervix is liable to extensive
lacerations in such cases.
Give the management of the second stage of labor.
The patient lies upon the side toward which the fetal back
is directed. In multiparaj, if the membranes fail to rupture
after full dilatation of the os, the obstetrician may break
them with the finger-nail during the interval between two
pains; the water should be allowed to escape slowly. As the
head descends to the floor the perineum must be guarded
from laceration; on delivery of the head it should be sup-
ported until the shoulders emerge, and as the child descends
the hand should be placed upon the fundus uteri to maintain
good contraction of the uterine muscle.
Define the third stage of labor, and state how it should
be managed.
This is the period of placental expulsion. Immediately
iifter the birth of the child the uterus contracts and the pla-
centa sinks to the lower uterine segment. Here it lies for 15
to 30 minutes, when a strong contraction occurs and the pla-
centa is expelled. The accoucheur may, after ligation of the
cord, hasten this delivery of the secundines by the applica-
tion of Crede 's method. If hemorrhage occurs or the uterus
fails to contract, fluid extract of ergot may be administered,
and a firm pad and binder should be applied.
Describe the delivery of the placenta after the method
•of Crede.
This consists in applying gentle rotatory friction to the
466
OBSTETRICS AND GYNECOLOGY.
fundus ut«ri until it is felt to harden under the influence of"
a uterine contraction ; the fundus is then grasped by ihe hand
and compressed, while at the same time pressure is niade'
downward and backward in the line of tlie axis of the par-
turient canal. The placenta is rapidly expelled by this
Describe the preparation of the bed, the woman, the
physician and the nurse for a case of labor.
The bed-linen shoiUd be clean, and on the side on which
the woman lies the special temporary coverings should be-
laid. These include a large pad, a clean sheet, and a rubber
blanket. These are removed after delivery is accomplished.
The woman, as soon as labor begins, is given a full bath, and
the external genitalia are cleansed with green soap and alco-
hol. A clean garment is worn, and this is rolled up above
the hips to prevent soiling. She is covered with a clean sheet.
The physician and nurse disinfect themselves according to
the accepted methods of aseptic surgery.
Give the causes of separation of the placenta. State
how the placenta normally presents at the os uteri. De-
scribe the treatment.
It is probuble that Ihe main cause of placenta! separation
is a diminution in the area of placental attachment due to the
excessive uterine contraction. Another view is that there
occurs a partial central detachment of the placenta, with sub-
sequent retroplacental hemorrhage. The separation does not
occur until the beginning of the third stage of labor. The
placenta, once separated is expelled to the os uteri by passing
through and inverting the membranes which drag after it;
the body of the placenta bulges forward in a spherical form.
Duncan's theory is that Ihe placenta slides down tJie lower
uterine segment edgewise. The treatment of placental sepa-
r%ttoQ is expulsion by Crede's manipulation.
What is the management of retained placenta?
Retained placenta is quite distinct from iidhertut placenta.
OBSTETRICS AND OYNECOLOOY. 469
The former means a resting of the detached placenta in the
temporarily paralyzed lower uterine segment. It is a harm-
less condition, and is treated by Crede^s expression. Adhe-
rent placenta is one that is partially detached, but remains
adherent at points to the original site of placental attach-
ment. It causes post-partum hemorrhage, and requires imme-
diate manual extraction.
How should the first examination be made at the bed-
side of a woman in labor?
The object of the examination is to determine the position
and presentation of the child, its condition, the progress of
the labor, the size of the maternal pelvis and the condition
of the soft structures of the parturient canal. The abdomen
is first palpated and ausculted, the patient lying on her back.
A vaginal examination is then made with the patient in the
left lateral recumbent posture. The finger is retained against
the membranes until the patient has had a pain in order that
the efficiency of the pains may be determined.
What is the perineum? How is it endangered in labor,
and how should it be protected?
The perineum is the pelvic floor, composed mainly of mus-
cles and fibrous tissues. The main muscle is the levator ani,
a large butterfly-shaped muscle, which affords the chief sup-
port to the pelvic viscera. As the head descends it impinges
on the perineum and stretches it; not infrequently serious
lacerations result in consequence of too precipitate delivery,
disproportion between the head and vulvar orifice, or imper-
fections in the mechanism of labor. There are various means
of protecting the floor in labor. The head may be retarded
by HohVs method, which consists in pressing the thumb
against the occiput above and the index and middle fingers
posteriorly against that portion of the head nearest the four-
chet. The forceps may be applied and the movement of the
head controlled. Fit fiends method of elevating the head and
Olshausen's method of rectal expression are both valuable.
OYNECOLOQY.
What is episiototny, and when is such interference in-
dicated?
Episiotomy is the making of a lateral incision of the vulva
for the purpose of relieving vulvar and perineal tension.
The incisions are made during the height of a pain upon the
mucosa just within the vulvar cleft, and are from */^ to %
inch long and Vi J^^^h deep. The operation should not be
performed, -simple perineal laceration 'heing preferable.
How should laceration of the perineum occurring dur-
ing labor be treated?
By immediate suturation if the tear be over i,^ inch long.
Simple tears of the fourchet do not require suturing. Inter-
nal tears of the sulci and tears involving the sphincter require
immediate repair. If the t«ar is a simple median tear, and
the tissues are severely bruised, a primary perineorrhaphy
may not prove successful.
Give the causes and treatment of laceration of the cer-
vix uteri.
Abortion or miscarriage when the cervix is still rigid; pre*
cipitate delivery, especiaJJy if the woman be on her feet;
oversize of the fetal parts; instrumental delivery, the head
not yet having escaped from the uterus. If there is no hem-
orrhage from the tear nothing should be done. If the circular
artery has been cut a suture must be introduced at once.
Give the rules for administering anesthetics in labor,
stating when they are indicated.
No anesthetic is required in a normal lalwr until the head
is down on the perineum; it is then well, if the pains be severe
and the patient suffering unduly, to administer a few drops
of ether or chloroform, not sufficient to arrest the uterine
contraction, but enough to dull the pain. In all operative
procedures full anesthesia will be required. In puerperal
eclampsia during the convulsions chloroform should be ad-
ministered; also in the spasms of major chorea.
OBSTETRICS AND GYNECOLOGY. 471
, State the effects of anesthetics on the os uteri, cervix
uteri, abdominal muscles, perineum and child.
If the anesthesia be complete the cervix, os and perineuni
become relaxed ; all voluntary motion ceases, and the rigidity
of the part is overcome. A certain amount of fetal asphyxia
results in profound maternal anesthesia. The labor is neces-
sarily protracted, since the uterine contractions are largely
or completely abolished.
What are the antiseptic measures to be employed in the
care of a case of labor? Define the terms asepsis and
antisepsis, and give their proper application in the lying-
in chamber.
Asepsis means absence of septic matter, or freedom from
infection. Antisepsis means exclusion of the germs that
cause putrefaction or infection. As applied to labor it means
the thorough cleanliness of the patient, bed, room, water,
instruments, dressings, clothing, physician and nurse. It in-
cludes the use of antiseptic agents, such as carbolic acid,
mercuric chloride, creolin, lysol, and the like. It includes for
some the use of rubber gloves and the exclusion, as far as
possible, of the vaginal examination.
What would contraindicate the use of anesthetics in
labor?
Grave renal disease and any severe pulmonary affection.
What preliminary preparations are necessary for the
safe conduct of labor?
The nurse should have on hand aseptic dressings, anti*
septic agents, sterile water, hemostatic remedies, as gauze,
ergotin and hot water, bichloride tablets, creolin or lysol,
chloroform to meet an eclamptic seizure, obstetric forceps,
and whatever else may be needed to meet any emergency.
What are the dangers to the mother during the second
stage of labor, and how can they be minimized?
The dangers are uterine inertia, with prolonged pressure
KICS A^fD GYNECOLOGY.
flC thft flMl bnd upon the matemal tissues, which might
smIK m a doo^; the onset of eclampsia; rupture of the
iMMn» IkMn obstniction ; laceration of the cervix and peri-
qiM^ friHi jis()n>portion betweeo the head and vulvar orifice,
<ir^ CtWB pncipitate labor; hemorrhage from premature sepa-
; of the pUccnta; apoplexy or syncope; rupture of
[ arc the uses and dangers of ergot in obstetric
TW roudjoe administration of ergot is to be condemned.
t% sktwJil be employed in uterine exhan^ion and inertia
>liinii|t dw late second and tlurd st-ages of labor and after
4*bv«rj' k»» Nfen eompieted. If given too early it may cause
*a irtw^oilBr hour-glas contraction of the uterus, with reteii-
iMtt of pIat.>eDta, etots, membranes, or debris. It has a re-
Uu>ttU)C oiHufoee upon tlie development of the milk. It may,
it xiV1^u «ttrt>'. cause fetal asphyxia from tetanic uterine eon-
tiwSnfU- It iilso increases the danger of cervical and peri-
(Mkt iuiMrtitkiiis.
Iftefe* MDttcr what circumstances the vaginal douche may
Im nmftiij Til before, during, and after labor. Give the
tFlthMl klw pttlient be already iufected, as from gonorrhea,
% tinrmtl Uouohe should not he given before labor, in order
IV,MtWMU ialmluotion of germs with the nozzle of the syringe
Wti Mli» wnshiiit: AA'ay of the normal vaginal secretion. Dur-
ing hfebtw « tkniche is given only when there is a profuse
j^MH^^tvttl UiM'harge or when some obstetric operation is
gjftftit ^ ^ {i^rformed. After normal labor no douche is re-
uWN«t w» * ">'*'- I^ there has been much manipulation of
Um ja^^v vw XYTsion or other operation has been performed,
4IM Am«W KtKHtld 1>e given, mercuric chloride 1-2000 being
I^W— t ir ihe lochia become offensive at any time, vag-
MMi JtjjjLt^iiTii: should be begun at once.
OBSTETRICS AND GYNECOLOGY. 473
Describe the duties of the accoucheur during normal
labor.
He is to act simply as an overseer. Examination should
not be made too freely ; only often enough to note a satisfac-
tory progress of the laJbor. During the second stage he should
regulate the descent of the head, institute measures to pre-
serve the perineum, support the head after delivery until the
shouldera are born, attend to the mouth and eyes of the child,
ligate the cord, and superintend the discharge of the secun-
dines. He should see that uterine relaxation does not occur,
and after the patient has been cleaned he should apply the
pad and binder. He should see that the proper toilet for the
baby is made.
What care does the mother require after labor?
She should be covered to prevent chilling and shock. She
should be cleaned as soon as povssible, and the proper occlu-
sive dressing of the vulva applied and secured to the abdom-
inal binder. The bed should be made, and clean clothing for
it and the patient be provided. If there is a tendency to
relaxation of the uterus, ergot should be administered. The
head should be kept low and visitors excluded. The visits
should be made at suitable intervals, and careful watch kept
of the pulse, temperature, discharge and breasts. The prog-
ress of involution should be noted. The bowels should be
•
opened by the third day and the proper diet instituted.
What is involution? Define subinvolution. How long
a time is usually required for involution, how may it be
promoted, and what causes may operate to delay or pre-
vent it?
By involutionj as applied to the uterus, is meant the retro-
gressive change undergone by that organ after parturition,
by which it returns to its normal weight and condition. It
is brought about mainly by a rapid fatty degeneration of the
hypertrophied muscular tissue. It is completed in six weeks,
474
OBSTETRICS AND GYNECOLOGY.
aod is favored by i-est in bed, the repair of cervical and peri-
neal lacerations, tlie prevention of uterine displacements, and
the nursing of the child. It is delayed hy early rising, bottle-
feeding of the baby, neglect of the cervix, uterus and peri-
neum, and an early resumption of hoiisehold duties. Subin-
volution is a failure of the uterus to return to its normal size.
What are after-pains? State their cause and give the
treatment.
After-pains are irregular and painful contractions of the
uterus produced by efforts on the part of that organ to expel '
clots or shreds of membrane; they indicate a partial relaxa-
tion of the uterine tissue, and are more common in multipane.
They are relieved by pressure, and are followed by the dis-
cbarge of elots. The treatment consists in the administration
of opiates and fluid extract of ergot, embrocations of chloro-
form ond belladonna liniments or a hypodermic injection of
morphine.
What general directions should be observed in passing
the catheter on a patient during the puerperal state?
Absolute cleanliness of the meatus and vestibule, as well as
of the catheter, to prevent cystitis. The parts should be
bathed in mercuric chloride 1-5000. and tlie patient should
not be catbeterized oftener than once in eight hours.
What changes occur in the fetal circulation at birth?
With the stopping of the feto-plaeental circulation there
occurs a closure of the foramen ovale, the Eustachian valve
atrophies, and the ductus veuosus and ductus arteriosus close
and atrophy; the pulmonary circulation increases at once and
becomes as in the adult individual.
What indications of premature birth can be determined
in the infant? '
Uudersize of tlie infant; the nails do not project over the
finger-ends; there may be some lanugo present, and there is
an excess of vernix easeosa; the face is senile and wrinkled.
OBSTETRICS AND GYNECOLOGY. 475
and the development of the limbs imperfect; there is a ten-
dency to subnormal temperature.
How soon after the birth of the child should the um-
bilical cord be ligated, and describe your method of pro-
cedure? How should the umbilicus be managed?
The cord should be ligated only after the pulsations have
entirely ceased. A small-sized tape should be used, and the
cord tied about two inches from the umbilicus, a surgeon's
knot being used. It may be necessary in very thick cords to
** strip '* the cord so as to remove the excess of Wharton's
jelly. The stump and umbilicus should be thickly dusted
with a powder of salicylic acid 1 part and starch 4 parts, and
then covered with salicylated cotton, through which the cord
is passed. The whole is then supported by the binder.
Describe the care of the infant durirfg the first 24 hours
after birth.
After the establishment of respiration and the severing of
the cord the baby should be given a bath. The vernix caseosa
must be removed by rubbing with sweet oil. Castile soap
and warm water are used in cleansing, and care must be
taken not to irritate the delicate skin by nibbing. Diapers
must be changed hourly, and plenty of talcum powder dusted
on the body to prevent chafing. The breast should be given
the baby every four hours. In this way it learns to nurse,
consumes the colostrum, whereby tlie meconium will be ex-
pelled, and by reflex action causes firmer uterine contraction.
Describe the immediate care of the new-born child when
for any reason the mother cannot nurse it. Give the rules
for artificial feeding.
The new-born baby does not need food for the first 24-36
hours. It may be given a spoonful of water now and then,
and if it seems hungry it may be given two or three spoon-
fuls of a mixture of condensed milk and water 1 part to 12.
If it becomes necessary to feed the baby from the bottle the
476 OBSTETRICS AND GYNECOLOGY,
Jatter must be kept absolutely cleau, and a mJlk-preparalion
of suitable strength should be giveu. Gerins may be de-
stroyed by Pasteurization, The preparation usually employed
consists of condensed milk 1 part, boiled water 12 parts,
cream 1 part, aud limewater 1 part. The baby should be fed
every 2 to 21/^ hours during the first month. The nursing
should consume from 15 to 20 minutes.
What instructions should be given a primipara in re*
gard to lactation?
She should be instructed as to the frequency of nursing
and care of the nipple. Every 2 to 2iA hours by the clock
is often enough for the feedings, and after the nursing Ihe
nipple should be bathed in warm water, thoroughly dried
with a soft towel or lint, and auoiuted with sweet oil. The
oil should be removed before the nipple is given to the infant
at the Uf.xt feeding.
How soon after parturition should a woman men-
struate?
If she nufsii her baby, menstruation doi'S not normally
return until the ninth montJi. An early appearance of the
menstrual flow usually indicates subinvolution of the ot«rm
or cervical laceration.
What is the puerperal state?
The puerperal state or jnterperiiivi is the period following
the delivery of the placenta, in which the processes of involu-
tion are being carried on. It is characterized by rapid dimin-
utioii in the size of the uterus and vagina, decrease in the
pelvic circulation, and lessening in the quantity of blood
circulating in the body.
What are the most frequent complications of the puer*
peral period?
Infection of the birth-canal, subinvolution, inflammation
and abscess of the mammary gland, postpartum hemorrhage,
and constipation.
OBSTETRICS AND GYNECOLOGY. 477
How should a case of labor be conducted to avoid puer-
peral infection? What are the sources of septic infection
in the puerperal state, and what would be the proper
management if infection should occur?
Thorough asepsis of the womau, bed, surroundings, physi-
cian and nurse, as already delineated, must be insisted upon.
The hands of the physician and nurse, the water employed,
and the instruments are the chief sources of danger. Should
infection occur, the vagina and uterus should be well douched
with mercuric chloride 1-2000-4000, and the uterus curetted
with a dull curet to remove decaying fragments of placenta
and membranes. This will generally be sufficient for local
treatment. Internally, quinine, stimulants and stryehnine
must be administered. The graver forms of puerperal sepsis
require special courses of treatment.
Describe the proper method of delivering an adherent
placenta at term.
The hand, which should be aseptic, must be immediately
introduced into the uterine cavity to the fundus, following
the umbilical cord to the placental site. The placenta should
be grasped and the adherent portions pinched off rapidly.
The external hand grasps the uterine fundus and the internal
hand is expelled by the uterine contractions. A hot douche,
intra-uterine, must then be given, and ergot administered by
the mouth or hypodermatically. Firm uterine contractions
must be secured before the patient is left.
How would you treat asphyxia in the new-born child?
What are its causes and symptoms?
The causes of asphyxm neonatomm are syphilitic stenosis
of the vessels of the cord and placenta, abnormality of the
heart or great vessels, early separation of the placenta, undue
pressure upon the cord, sudden maternal death, renal in-
adequacy, and grave maternal lung disease. The condition
appears in two forms, viz., asphyxia livida and asphyxia
478
OBSTETRICS AND GYNECOLOOT.
pallida. In the former the baby is blue or livid, there are
irregular gasping efforts, the heart-beats are strong, and the
reflexes are preserved. In the pale variety respiration is
altogether abolished, the surface is pale, the heart-sounda are
weak and irregular, and the reflexes are absent. The treat-
ment consists in early ligation of the cord, suspension of the
child by the feet, cleansing of the throat and mouth by the
finger, slapping the back and buttocks, the pouring of water
or ether on the epigastrium, and in the pronounced eases the
employment of some form of artificial respiration, notably the
methods of Dew, Laborde, Schulty^ and Prochownick, Oeea^
sionaliy mouth-to -mouth insufflation, catheterization of the
larj'nx, or tracheotomy may be required.
Describe a method of resuscitation of the new-born.
Dew's method is excellent. The infant is grasped in the
left hand in such a manner that the neck rests between the
thumb and forefinger and the head hangs over in the position
of full extension ; the iipper portion of the back rests in the
palm of the hand, while the remaining fingers are inserted
into the left axilla. The knees are grasped by the right hand,
the right knee resting between the thumb and forefinger, the
left knee between the index and middle fingei-s, and the thighs
in the palm of the hand. The right hand depresses the body
to favor inspiration, while to secure expiration the movement
is reversed and the child doubled upon itself.
What are the results of subinvolution of the uterus,
and what is its treatmenlV
Subinvolution of the uterus, if not corrected, results in a
chronic endometritis, retrodisplacement, and subsequent pro-
lapse of the uterus from increased specific gravity, and the
development of a chronic invalidism. The treatment consists
in the retention of the uterus in its normal position by means
of a pessary, curettage of the uterus, suturation of all cervical
and perineal lacerations, and the administration of tonics,
ergot and thyroid extract.
OBSTETRICS AND GYNECOLOGY. 479
How would you recognize retention of urine during
labor and how after labor? Minutely describe the treat-
ment that should be employed in each case.
Retention of urine during labor is exceedingly unwmmon.
It might result from an uncorrected retrodisplacement of the
uterus that has gone on to succulatioik In such a case, if
catheterization of the bladder by the prostatic catheter fails,
suprapubic puncture of the bladder would be required. Re-
tention of urine after la'bor is not uncommon. It is char-
acterized by inability on the part of the patient to urinate,
severe pain in the bladder, and the development of a cystic
tumor over the symphysis, which presents dullness on percus-
sion. The treatment consists in aseptic catheterization, with
withdrawal of one-half to three-fourths of the vesical con-
tents, in order to avoid syncope.
Describe the technic of intra-uterine irrigation and state
when its employment is justifiable.
Intra-uterine irrigation is required only after some intra-
uterine manipulation, as the performance of version, manual
extraction of the placenta, or high forceps application, or in
case puerperal sepsis has developed. The technic consists in
antiseptic douching of the vagina and vulva, followed by the
introduction to the uterine fundus of the two-way catheter.
Mercuric chloride 1-4000, creolin, lysol or sterile water may
be employed. The douching may be resorted to once, twice
or three times daily, according to the gravity of the patient's
condition.
Mention the pathogenic bacteria that invade the vagina,
and state how the vagina is normally protected from them.
A number of pathogenic germs have been discovered in the
vagina. The most common are the streptococcus pyogenes,
staphylococcus pyogenes aureus, staphylococcus pyogenes
albus, bacterium, coli commune, bacillus pyocyaneus, bacillus
pyogenes foetidus, and others. There normally exist in the
480 OBSTETRICS AND GYNECOLOGY.
vagina a large number of long-rod bacilli known as Doder-
lein's bacilli. These secrete an acid which destroys patho-
genic germs.
Define puerperal sepsis, and state how to prevent it and
how to overcome it. What is auto-infection?
Pucrperiil sepsis is the infection of the puerperal woman
by pathogenic germs. It may be prevented 'by careful atten-
tion to the laws of asepsis and antisepsis. If septic infection
developed it should be combated in the manner already de-
scribed. Axtio-infection of the puerperal woman is a rare
form of sepsis, in which the germs are already in her system
before the onset of labor, and become active immediately
after parturition.
Slate the causes, pathology, symptoms, treatment and
sequelae of puerperal phlebitis.
Puerperal phlebitis is a rare form of puerperal sepsis
originating in the sinuses of the uterus. The germs invade
the clots in the months of the sinuses; these quickly liquefy,
and give rise to hemorrhages and to emboli, which are carried
to remote portions of the body. This may result in instant
deatli or in pyemia, with septic pneumonia, paralysis, and
other serious consequences. The treatment consists in tlie
general treatment of puerperal sepsis, with avoidance of all
local interference other than the introduction of a gauze tam-
pon to control the hemorrhage.
How would you diagnose puerperal metritis, and what
methods would you employ in its treatment?
Puerperal metritis is a late septic inflammation of the
uterine muscle. It is characterized by an offensive loehial
discharge, which contains fragments of necrotic tissue and
detached portions of muscular fibers that have sloughed from
the uterine wall. The uterus is large, soft, boggy and sen-
sitive. There is danger of perforation of the uterine watia
and the development of general peritonitis. Uterine phlebitis.
OBSTETRICS AND GYNECOLOGY. 481
may also develop, with a resulting general pyemia. The
treatment consists in hysterectomy performed with thorough
asepsis.
Define hysterectomy, and state when it is applicable in
obstetric complications.
Hysterectomy is excision of the uterus. It is indicated in
puerperal metritis, extensive involvement of the broad liga-
ments, and when tubal and ovarian infection is associated
with profuse hemorrhage from the uterus.
What is phlegmasia alba dolens? Give the varieties,
symptoms and treatment.
Phlegmasia alba dolens or '* milky leg'^ is a peculiar late
manifestation of puerperal sepsis, in which there occurs a
thrombosis of the iliac or femoral veins on one side, usually
the left, with an immense edema of the affected limb, which
presents a characteristic white or milky appearance. In the
plilebitic or thwmbotic form the edema first appears below
at the ankle, the disease occurring as a sequel of uterine
phlebitis, coagula being carried from the placental site into
the hypogastric veins. In the cellulitis form the disease
occurs as a result of a direct extension of an inflammatory
process from the uterus through the broad ligament and pelvic
cellular tissue, the exudate occluding the iliac veins. The
symptoms are pains in the affected limbs along the course of
the femoral vein, rapid pulse, elevation of temperature,
cramp-like pains in the calf, edema, and extreme pallor of the
limb, or, in a certain proportion of the cases, bluing of the
leg; abscess or gangrene may follow. The treatment consists
in the administration of stimulants and tonics, disinfection
of the birth-canal, gentle laxatives, and immobilization of the
limb, which should be elevated and kept warm. Anodyne
poultices, and later ichthyol and belladonna ointments, may
be applied. Abscesses should be opened, and if gangrene
occurs amputation is necessary.
31
482
OBSTETRICS AND GYNECOLOGY.
What is postpartum hemorrhage? State the causes and
varieties, and give the treatment, including prophylaxis.
Postpartum hemorrhage or "flooding" is hemorrhage oc-
curring at any time during the 2i hours aft«r parturition.
It may be primary, at the time of delivery, or secondary,
when it occurs after contraction, of the uterus "has been
secured. Its causes are retention of placental debris, adher-
ent placenta, uterine inertia, or severe laceration of tbe lower
birth-canal. The symptoms are free escape of blood, pallor,
running pulse, restlessness, and coma. The prophylactic
treatment includes the use of strychnine and tonics during
the last trimester of preg^naney, and at the time of labor the
avoidance of extreme exhaustion, and if the uterus be atonic
the administration of a dram of ergot as soon as the head is
born. The active treatment consists in the immediate removal
of all clots and debris, the application of Crede's manipula-
tion, the hypodermic injection of ergot or ergotin. tbe intra-
uterine injection of hot water, or the introduction of a larga
tampon of iodoform or sterile gauze. Herman's method ot
continual manual compression of the uterus and compression
of the abdominal aorta may be tried in extreme eases. Trac-
tion on the cervix with volsella-fovceps will often control the
bleeding. Bleeding from the lower birth-canal must be coa-
trolled by tlie introduction of sutures.
I
it made and when is It ]
utions are to be observed in j
What is a tampon?
properly used? What precai
its use?
A tampon is a plug of cotton, gauze, wool or oakum used.]
to stop some canal or compress a bleeding surface. It mayi
be made by passing a string around a iMirtion of the substancfrl
used, or it may consist of a long strip of materia! packed Jul
firmly. It is indicated in obstetrics in excessive hemorrhage)!
as from placenta previa, relaxation of the uterus, or lacerir J
tions of the lower birtJi-canal. Care must be taken to swl
that tbe material used is thoroughly aseptic, and that tbeJ
L
OBSTETRICS AND GYNECOLOGY. 483
cervix and vagina are not so distended as to give entrance to
air, whereby air-embolism may be induced.
Differentiate eutocia and dystocia. Mention important
varieties of the latter.
EuMocia is normal or easy labor ; dystocia is abnormal, diffi-
cult, or painful labor. Dystocia may consist in precipitate,
retarded or obstructed labor, or labor complicated by fetal
or maternal accidents, or by gross fetal or maternal disease.
This includes hydrocephalus, malpositions and malpresenta-
tions of the fetus, eclampsia, rupture of the uterus, prolapse
of the cord, placenta praevia, premature separation of the
placenta, contracted pelvis, and various other conditions on
the part of the fetus and mother.
Give the causes of dystocia in the uterus, vagina, pelvis,
and vulva.
In the uterus as causes of dystocia may be mentioned the
presence of tumors, double uterus, abnormal placental attach-
ment, rupture of the uterus, and mal presentations of the
fetus. In the vagina, septa, stenosis, and tumors; in the
pelvis the various forms of contraction and bony and carti-
laginous tumors; in the vulva, hematomata, stenosis or atresia,
imperforate hymen and tumors.
Describe the difficulties which arise during labor from
malposition of the fetal head.
If the head lie transversely in the •superior strait it will
become partially extended, and cause larger diameters of the
fetal skull to engage than in vertex presentations. This will
cause prolongation or absolute blocking of the labor. Exces-
sive moulding and disfiguring of the fetal presentation will
follow; forceps or version may be necessitated. If the face
or brow present, labor may become impossible.
How would you diagnose and manage a case of occipito-
posterior presentation?
In this case the vertex may \Ht directed to the right or to
484 OBSTETRICS AND GYNECOLOGY.
tile left sacro-iliac syDchoudrosis, and the sagittal suture will
lie in the right or left oblique diameter respectively. The
R. 0- P. is the most eommon of the occipito- posterior presen-
tations. The case must be treated by laying the woman upon
the side toward which the felal back is directed in order to
Mcure full flexion of the head, and thereby prevent backward
rotation of tlie occiput. A fiiia binder should be applied,
and quinine must be administered and delivery accomplished.
As the head rotates anteriorly, the instruments must be witti-
dniwn and reapplied in the new oblique diameter.
How would you diagnose and deliver an occiput in the
hollow of the sacrum?
In this case the small fontanel will be felt in the median
line posteriorly and the large fontanel high up anteriorly.
The cars may be palpat«d to either side in the transverse
diameter. Labor will be blocked. Forceps must be applied,
and as traction is made the handles must be elevated in order
to overflex the head. When the occiput begins to greatly dis-
tend the perineum and the brow comes under the symphysis,
the handles must be earned downward, and the head deliv-
ered with the face emerging from under the symphysis.
Describe in detail the proper procedure when the head
is movable above the brim of the pelvis but does not en-
KiKe.
Thei-e is probably sgrne degree of pelvic flattening present.
If so, the head will lie transversely. Axis-traction forcepa
sliould bo applied and the head made to engage. If this be
imiKWKible. and the contraction of the pelvis is not too great,
poilalie version is indicated. In more extreme degrees of
wnUvni'lion Cesarean section must be performed.
(Mnc the frequency, causes, diagnosis, prognosis, treat-
mciil and danKers to the fetus in pelvic presentations,
IVlvie piiwnliilions of the fetus occur in about 3 per cent j
s\t «tl PWH"* of labor. The cavscs of breech presentations a
OBSTETRICS AND GYNECOLOGY. 485
reversal of the shape of the fetus or of the uterine cavity,
hydrocephalus, fibroid tumors of the uterus, prematurity of
the fetus, hydramnios, fetal monstrosities, and multiple preg-
nancy. In these cases the fetal head is freely movable and
high up in the abdominal cavity; the fetal heart-sounds will
be heard above the umbilicus and to either side. Vaginal
examination shows an absence of a hard and protuberant pre-
sentation ; the presentation is high up, and the bag of waters
long and finger-like. If the membranes have ruptured, a dis-
charge of meconium will be noted. The prognosis is serious
for the fetus. Thirty per cent, of these babies perish from
asphyxia or injury to the head and neck in delivery. The
treatment consists in non-action until the birth of the umbil-
icus; then there must be speedy extraction of the after-
coming head in order to avoid fetal death.
Describe the management of an impacted breech pre-
sentation.
If the breech become impacted, attempts may be made to
decompose it by GoodelVs method^ viz., the dragging down
of one leg, upon which traction is made. If this does not
succeed, axis- traction forceps may be applied over the pelvis ;
this is a very efficient method. Other methods consist in the
use of a fillet around the waist and thighs, and in dead babies
the blunt hook over one thigh.
Give the frequency, causes, mechanism and treatment
of face presentation, L. M. A. position.
Pace presentation occurs in about Vij per cent, of all cases
-of labor. It results from anything which will prevent thor-
ough flexion of the head, such as an enlarged thyroid or
thymus gland or a prominent thorax, or anything that will
disturb the relationship existing between the long axes of the
'body and head of the fetus, as dolichocephalus. The mech-
anism insists in full extension and moulding, descent of the
chin to the pelvic floor, anterior rotation to the symphysis,
tinder which it lodges, and birth of the head by a process of
486 OBSTETRICS AND GYNECOLOGY.
flexion ; the shoulder and hip then rotate from the opposite
side, and the rest of the meehanism is the same as in vertex
presentations. If the chin be anterior the labor will probably
be easy, since small diametere present. If the head sticks,
forceps may be applied and the chin drawn down, after which
labor will proceed.
Give the diagnosis of face presentation before and after
rupture of tlie membranes.
Before rupture of the membranes the presentation will be
noted as high ; there is an absence of the dome-like projection
of other head prescntatious; the features of the face may be
detected. After rupture of the membranes the examining
finder can be introduced into the mouth, when, if the child'
be living, retlex closure of the gums will be noted.
How may a face presentation be converted into a vertex
presentation?
If labor have not yet begun, Schatz's method of c«phalie I
vereion, performed by external manipulation alone, may be '
attempted. With oue hand firm pressure is exerted against
the anterior portion of the fetal neck, while counter-pressure
is made with tlie opposite hand upon the occiput, at the same
time an assistant pushes liie breech in the direction in which
the face is looking; the head is thus flexed upon tlie body
and the vertex caused to present. If labor has already be-
gun, and the os is dilating, Baii'Iclocque's method of cephalic
version, the "ratchet method," may be attempted under .
anesthesia. One hand is placed against tbe face, and while ,
the thumb pushes the chin upward the fingers hook over the '
occiput and drag it down; an assistant at the same tin
carries the breech over to the side toward which the face
direelt-d.
What is the mechanism of
and what the compticationsV
A persistent menlo-poslerior positi
mento-posterior position.
* an absolutel'
OBSTETRICS AND GYNECOLOGY. 487
possible labor, and therefore there is no mechanism. For
labor to advance the ehin must strike the pelvic floor. The
lateral height of the pelvis is 3% inches (9 cm.), while the
length of the fetal neck is only iy2 inches. The posterior
height of the pelvis is 5 inches (12% cm.). In order for the
chin to reach the floor in these cases it would be necessary
for the thorax and occiput (18i/^ em. or 7 inches) to enter
the superior strait simultaneously. No diameter of this strait
could accommodate such a bulk. The uterus becomes tetanic
in action, the head and shoulders become impacted, the child
perishes, and the mother is exposed to the danger of uterine
rupture.
How should forceps be applied in a case of face pre-
sentation?
In the mento-occipital diameter, the chin being in apposi-
tion with the heel of the bladder ; the forceps should be used
only as rotators in men to-posterior positions.
How would you manage a brow presentation?
A brow presentation is an absolutely impossible case of
labor. The oceipito-mental diameter of the fetal head, 13%
cm., attempts to engage, but can find no accommodation in
the superior strait. The treatment consists in the perform-
ance of cephalic version, bringing down the occiput and apply-
ing forceps. If this be not possible, podalic version should
be tried. In impacted ca.ses with the child dead, craniotomy,
with perforation through the bregma, becomes necessary.
How would you treat a case of lateral presentation?
Lateral presentations of the head, including the parietal
eminence or the ear, should be treated by manual replacement,
converting the presentation into a true vertex presentation.
If this be impossible forceps may be applied or podalie ver-
sion performed.
Make a diagnosis of transverse presentation, and state
488 OBSTETRICS AND GYNECOLOGY.
haw it should be managed. Give the frequency, causes,
mechanism and management of such a case.
A traiisversc, shoulder or trunk pi-eseiitation occurs in
about Yz per cent, of aU cases of labor. The causes are over-
size of the feta! head, overgrowth of the entire fetus, fetal
monstrosities, mobility of the fetus, hydranmios, multiple
pregnancy, uterine deformities, undue obliquity of the uterus,
uterine and pelvic tumors, placenta prtevia, and traumatism,
such as falls or jars. Tliere is no mechanism for such a case,
the labor being absolutely impossible. The condition may be
recognized readily by external palpation, the child lying at
right angles to the long axis of the maternal body. Vaginal
examination reveals a high position of the presentation, and
the shoulder or elbow may be palpated through the mem-
branes. There is but one thing to do in all transverse pre-
sentations, namely, podalic version under full anesthesia.
How should a hand presentation be managed? What
course would you pursue if you found an arm projecting
from the vulvar orifice?
This would indicate a cross-birth. The ami should be left
alone, and podalic version performed. A tape may be tied
ai-ound the wrist in order to prevent extension of tlie extrem-
ity during the process of turning; if the tape he held taut
the arm is carried in front of the face and descends with the
should ere.
What are the causes of precipitate labor, what are its
dangers, and what is the treatment?
Precipitate labor may be caused by an excess in the expul-
sive power of labor or a deficiency in the resistant powers;
The dangers to the fetus are asphyxiation from rupture of
the cord or premature detachment of the placenta and injury
from a fall upon the floor or into a commode. The maternal
dangers are hemorrhage, fatal syncope from sudden evacua-
tion of the uterine contents, inversion of the uterus, lacera-
OBSTETRICS AND GYNECOLOGY. 489
tion of the cervix or perineum, and post-partum hemorrhage.
The treatment of precipitate labor consists in a retardation
of the advancing presentation in order to avoid the fore-
going accidents. When the head is on the floor short forceps
may be applied and the progress of the head arrested.
What are the causes of delay in labor (a) on the part
of the mother; (b) on the part of the child?
The maternal causes of delayed labor are uterine inertia
and obstruction in the birth-canal from any cause. The fetal
causes are malposition and malpresentation, oversize, hydro-
cephalus, fetal syphilis, fetal ascites, and other diseases caus-
ing overgrowth of organs or distension of cavities.
State the dangers and symptoms of a prolonged labor.
The symptoms of prolonged labor are those of uterine in-
ertia (see below). The dangers are, for the fetus, fatal com-
pression of the brain-centers and intra-utorine respiration,
with inspiration of liquor amnii or other substances. The
maternal dangers are pressure-necrosis, the development of
sepsis, exhaustion and death, and post-partum hemorrhage.
Give the causes, diagnosis and management of uterine
inertia.
Uterine inertia is that condition in which the uterine con-
tractions are irregular, weak and ineffectual, not sufficing to
induce dilatation of the os or expulsion of the fetus. The
causes are idiosyncrasy, advanced age of the woman, multi-
parity, emotion, temporary paralysis of the uterine muscles,
as from over-distension, weakness of the muscle, and any
cause preventing the hydraulic action of the liquor amnii.
The symptoms are weak, infrequent and irregular contrac-
tions, slight suffering, and slow or no advance of the fetal
presentation. In the first stage of labor quinine may be
administered in large doses and a firm abdominal binder
applied ; strychnine during the last weeks of pregnancy has a
tendency to increase the efficiency of the uterine contraction.
490 OBSTETRICS AND GYNECOLOGY.
In the second stage of labor forceps sliould be applied, &nd
after the delivery of the child ergot must be used in large
doees to preveut postpartum hemorrhage.
What is the proper management of rigidity of the os
uteri in labor?
Rigidity of the cervix is conimou in elderly primiparte and
in those suffering from uterine inertia; it may result from
cicatrices and from cancerous involvement o£ the cervis. The
treatment consists in the administration of large doses of
chloral, hot vaginal douches, anesthesia, cocaine to the cervii.
digital divulsion, or incision.
Qive the diagnosis and treatment of hour-glass contrac-
tion of the uterus.
Hour-glass contraction cf the uterus is an irregular con-
traction of the uterus, usually occurring before the escape of
the placenta, which is retained above the ring of Bandl. The
latter appears to be in an abnormal state of eontraction.
Digital exploration truces the cord up to the contracted ring.
Treatment consists in digital divulsion of the contracted por-
tion, followed by removal of the placenta and antisepsis of
the cavity.
Give the causes, symptoms, diagnosis and prognosis of
rupture of the uterus during labor, and state how such an
accident should be managed.
The exciting causes of uterine rupture during labor are
some insuperable obstruction to the delivery of the child, mi»-
directed or injudicious efforts at version, and tetanic action
of the muscle of the upper uterine segment from the admia-
istration of ergot. The predisposing causes are diminished
tonicity of the uterine walls, undue prolongation of labor,
fatty degeneration of the uterine muscle, or a previous opera- |
tion upon the uterus. The site of the rnpture is usually in (
the lower uterine segment. The symploms are sudden, acute.
lancinating pain, immediate collapse, signs of internal hemor-
L
OBSTETRICS AND GYNECOLOGY. 491
rhage, an anxious expreasion, pallor, rapid running pulse,
recession of the presenting part, the presence of two distinct
tumors, and the ability to detect the rent by the examining
finger. The prognosis is grave ; the maternal mortality is 55
to 60 per cent. The treatment consists in immediate evacua-
tion of the uterine contents, and if the tear has not com-
pletely perforated the uterus the patient may be watehed
carefully for the development of sepsis. In complete lacera-
tion an abdominal section must be performed and tlie tear
sutured aseptically.
Make a differential diagnosis of intra-uterine and extra-
uterine hemorrhage.
In the former there will be noted either a frc^ escape of
blood per vaginam or a rapidly distending uterine body,
associated wath the symptoms of hemorrhage. In the latter
the signs of concealed hemorrhage will be present, and vag-
inal examination will reveal the presence of a boggy mass in
the abdominal cavity and in Douglass* cul-de-sac.
Give the diagnosis, causes and treatment of pelvic hema-
tocele.
Pelvic hematocele results generally from rupture of an
extra-uterine pregnancy. It may result from rupture of
varicose veins in the broad ligament. It is recognized by the
signs of concealed hemorrhage and a rapidly increasing boggy
mass in Douglass' cul-de-sac. The only treatment is abdom-
inal section and ligation of the bleeding point.
Name three important forms of hemorrhage occurring:
in obstetric practice.
Antepartum hemorrhage, or that occurring in the last tri-
mester of pregnancy. This may be due to placenta pra?via
or premature separation of the placenta. Intrapartum hem-
orrhage is that occurring during the progress of labor, as in
the case of uterine rupture or invereion of the uterus. Post-
partum hemorrhage is that form occurring immediately after
labor.
492
OBSTETRICS AND GYNECOLOGY.
What is placenta praevia? Name its causes, varieties,
symptoms, dangers and management.
Placenta, praevia is that -condition in which the placenta is
attached to the lower uterine segment, and presents in front
of the fetus. It may be camplctc or central (placenta cen-
tralis), lateral, marginal and parietal. The cause of placenta
prffivia is unknown. It has been said to be due to uterine
subinvolution, low fixation of the ovum, and downward
growth of the decidua retiexa. There is but one symplom,
namely, free and painless hemorrhage, oaeurring at decreas-
ing intervals and in increasing quantity. The dangers are
fetal and maternal death from asphyxia, hemorrhage, air-
embolism, and septic infection. The treatment consists in
rapid dilatation of the os and delivery of the fetus by ver-
sion, or in the marginal form the application of the forceps
and rapid engagement of the head. In the central variety
the hand must bi- carried directly through the placenta.
Mention two distinct methods of dilatation of the cervix
uteri in obstetric practice.
Edgar's method consists in bimanual sti-etching and par-
alyzing of the cervical muscle. The index and middle fingers
of both hands are introduced into the cervix, which is grad-
ually but forcibly stretched in various directions. Another
method is the use of bags, such as Barnes' or those of Cham-
petier de Ribes and Voorhees.
What are the dangers of traction on the child and on
the placenta?
Traction on the cord may cause premature separation of
the placenta. It may cause rupture of the cord or avulsion
of the cord from the placenta, or it may result in inversion
of the uterus.
What is inversion of the uterus, what its causes and
symptoms, and how is it recognized?
By this term is meant a turning of the uterus inside out.
OBSTETRICS AND GYNECOLOGY. 495
either completely or in part. It may occur spontaneously,
the uterine fundus or placental site being temporarily par-
alyzed and sinking in; it may result from traction on the
cord, the placenta not yet having separated ; or it may follow
suction from close fitting of the detached placenta in the lower
uterine segment and traction being made upon the cord.
Other causes are vigorous Crede manipulations and violent
bearing down on the part of the woman. The symptoms are
acute pain, hemorrhage, shock, bearing down, and the appear-
ance of a tumor in the vagina. This may be mistaken for a
uterine polyp, but the surface of the latter will be covered
with the normal uterine mucosa, while the inverted uterus
will show decidual tissue and the site of the placental attach-
ment; the orifices of the Fallopian tubes may also be detected.
The treatment of acute inversion consists in immediate re-
placement, followed by the introduction of a strip of gauze
to prevent recurrence.
Give the causes, pathology, symptoms and prognosis of
eclampsia gravidarum, and state the relative frequency in
primiparae and multiparae. What is the treatment?
Puerperal eclampsia or puerperal convulsion is a convul-
sive or epileptiform seizure appearing suddenly in a woman
prior to, during or shortly after labor, and characterized by
tonic and then clonic convulsions of the muscles, with albu-
minuria, coma and death. Tlie gi-eat majority of cases occur
in primiparue — about 75 per cent. Other causes are heredity,
climatic influence, multiple pregnancy, extreme anemia, and
nervous excitability, all acting as predisposing influences.
The true cause is the presence in the blood of toxins, prob-
ably of hepatic origin, which cause a general arteriole con-
traction; as a consequence there follows an anemia of the base
of the brain and a corresponding cortical congestion. The
symptoms are fixing of the eyes, tonic contraction of the facial
muscles {sardonic grin), lividity, rapid involvement of all
the trunk muscles, distension of the superficial veins, and
494 OBSTETRICS AND GYNECOLOGY.
frothing at the mouth. The paroxysm lasts from ^ to 2
minutea. It is followed by increasing coma and a rise of
temperature. The urine becomes loaded with albumin. The
prognosis is grave; 30 per cent, of the women and 50 to 74
per cent, of the children perish. The causes of maternal
death are asphyxia, cerebral apoplexy, syncope, pulmonary
edema, and exhaustion. The fetus dies of asphyxia. The
prophylactic treatment is the treatment of the kidney of
pregnancy. During the attack chloroform must be admin-
istered. After the spasm, if the patient be plethoric, vene-
section to the amount of 20-25 ounces may be performed,
followed by the introduction of normal saline solution into
the tissues. Croton oil 1 to 3 drops, chloral hydrate 30 grains
by the rectum, and veratrum viride 15 drops of the fluid ex-
tract hypodermically may be administered. A hot pack aids
in the elimination of the poison. The uterus should be emp-
tied as soon as possible in order to still further relieve the
system.
Give the danger-signals of Impending eclampsia.
Rapidly lessening amount of urates in the urine; lessened
urinary toxicity, the development of eye-symptoms, including
musens volitantes, scintillations and blindness, and neuralgic
pains over the eyes, under the clavicles and in the epigastrium.
In case eclampsia gravidarum appears before the end of
the eighth month, how sliould it be managed?
By dilatation of the os and removal of the child by forceps
or version. The course of treatment already indicated should
be adopted.
What are the varieties of puerperal convulsions, and
how are they differentially diagnosed?
A puerperal woman may suffer from various coavulaive
seizures, including the true puerperal eclampsia. She may
have an anemia or an hj-sterie convulsion, or one due to
irritability. A true epileptic convulsion may occur.
L
^
OBSTETRICS AND OYNECOLOGY. 495
but this is not accompanied by albuminuria, has not the same
prodromata nor the rise of temperature, and there is, as a
rule, a definite history of previous attacks. Meningitis is
accompanied by vomiting, optic neuritis, opisthotonos, and a
rise of temperature before the onset of the convulsion.
When is curettage of the uterus justifiable in obstetric
practice, and how should it be performed?
Curettage is required whenever there has occurred a reten-
tion of some of the products of conception either after abor-
tion or labor. The best curet is the finger of the obstetrician,
but if this will not answer, the dull curet may be employed
or the placental forceps, under thorough asepsis and anti-
sepsis. In curetting the uterine cavity the walls should be
scraped systematically and without great pressure. The dan-
gers are hemorrhage and perforation.
Define puerperal mania. Give its etiology, symptoms
and treatment*
Puerperal rnania is the most common form of puerperal
insanity, or insanity occurring during the lying-in period.
It may result from heredity, primiparity, anxiety, dystocia,
and septic infection. Some authorities attribute all the cases
to septic infection. The disease appears with alarming ab-
ruptness. Without warning the patient becomes maniacal or
wildly delirious, and suffers from the most peculiar hallu-
cinations. A homicidal or suicidal tendency is common. 25
to 35 per cent, of the cases die from exhaustion or from sep-
ticemia, or remain permanently insane. The patient should
•be confined in a hospital and given nerve-sedatives, bromides,
hyoscine, trional, sulfonal and tonics. Ilest and mental diver-
sion are essential.
What hygienic precautions are necessary for a nursing
child if the mother has sore nipples?
If the nipples are fissured the child may suck in blood and
suflfer from hematemesis. It should temporarily be fed on the
496 OBSTETRICS AND GYNECOLOGY.
bottle or from a spoon, but retuiiied to tbe breast as soon as
the nipple will permit. An artificial nipple may also be used.
Give the management in a case of (a) flat or inverted
nipples, and (b) cracked nipples.
A /tat or inverted nipple requires g«utle traction and manip-
ulation during the last weeks of pregnancy, or more powerful
suction through a breast-pump. If this does not succeed an
artificial nipple must be employed. Fissured nipples should
be kept clean and dry, and anointed between the nursing with
sweet oil. In worse eases healing applications are necessary,
as ichthyol in lanolin or glycerin, or 1 dram each of bismuth
subnitrate and castor oil, compound tincture of benzoin, or a
4 to 8 per cent, solution of silver nitrate after cocainizatiou.
The child should not nurse from these nipples.
Give the varieties, pathology, symptoms and treatment
of puerperal mastitis.
Mastitis, or inflammation of the mammary gland, may be
suppurative or non-auppurative. It is almost always due to
septic infection occurring through a fissured nipple. Occa-
sionally it may result from caking of the breasts or milk-stasis.
The pathology consists essentially in an acute inflammation
of the cellular tissue of the gland. The symptoms are acute
pain, inflammation, reddening of the surface, induration, mal-
aise, elevation of temperature, and headache. The treatment
consists in hot compresses of lead-water and laudanum, thfr
ice-bag, the application of a mammarj- binder, and ichthyol
or belladonna locally ; the child should not nurse. The bowels
should be opened.
Give the symptoms and treatment of mammary abscess.
If mastitis advances to suppuration the symptoms will
change. This is most common in the third or fourth week of
the puerperiuni. The pain becomes dull and throbbing; rigor
or chills are noted; the fever becomes hectic in type; the-
indurated portion of the breast becomes softer at a certain
L
OBSTETRICS AND GYNECOLOGY. 497
pointj and fluctuation may be noted ; the surface of the gland
becomes edematous, livid and glazed. When the abscess is
situated deeply in the areolar tissue just above the pectoral
muscles a postmanimary or submammary abscess resuliB. In
this case the pus is very apt to burrow, and the gland is raised
from the chest and becomes protuberant. The treatment of
abscess is early incision, the line of incision radiating from
the nipple ; the wound should be bathed in mercuric chloride
(1:4000) and packed with sterile gauze.
What is the treatment of galactorrhea?
Galactorrhea is an excessive flow of milk from the engorged
breasts. It may be corrected by feeding the infant at regular
intervals, and between the feedings the breast-pump may be
employed to remove the excessive flow. Ergot may be admin-
istered in small amounts, potassium iodide given in doses of
10 grains three times daily, and belladonna ointment applied
locally, or a 5 per cent, solution of cocaine in equal parts of
glycerin and water.
To what dangers in pregnancy and labor does gonorrhea
of the mother expose her and her offspring?
During pregnancy a gonorrheal woman may develop a pus-
tube, which may rupture or eause an abortion and expose her
to the development of septic infection. A gonorrheal woman
is always in imminent danger of puerperal sepsis after the
delivery of her child. The child is exposed to the danger of
ophthalmia neonatorum.
Give the symptoms, treatment and prognosis of oph-
thalmia neonatorum. State its causes and the means of
prevention.
Ophthalmia neonatorum is a purulent inflammation of the
conjunctiva of the infant due to infection at birth by gonor-
rheal virus contained in the uterine and vaginal discharges.
It is very virulent, and frequently results in total loss of
sight from perforation of the cornea and destruction of the
32
498 OBSTETRICS AND GYNECOLOGY.
superficial tissues. The sifinptoms are reddening and edem* i
of the paipebne, aggluIinatJon of the lids, profuse purulent
discharge, a bright-red appearance of the conjunelivie, and
later ulceration and perforation of the cornea. The prognosis
is good unless corneal ulceration occurs. The treatment ia
mainly prophylactic, and this consists in frequent vaginal
douching during labor, and, immediately after the birth of
the head, cleansing of the eyes with warm sterilized water,
followed by the instillation of a few drops of a 2 per cent
solution of silver nitrate. After the disease has appeared the
cleaning must be done hourly {Crcde's method) with warm
water, followed in alternate hours by mercuric chloride 1 to i
5000 to 8000, and a saturated solution of boric acid. Twica
daily an application of silver nitrate 4 per cent, solution may ]
be used. The well eye should be protected with a cotlodian 1
dressing. I
Give the pathology of hydrocephalus. State how hy-
drocephalus may be recognized before delivery, and how
such a complication should be dealt with.
Hydrocephalus is a collecliou of serous fluid at some point |
within the cerebral substance {internal hydrocephalus) or I
outside the brain-substauee (external hydrocephalus), pre- j
venting closure of the fontanels and causing enlargement of ]
the skull. It is probably a sequel of some obscure form of I
inflammation of the cerebral meninges. The vaginal finger |
detects bulging fontanels and widely separated sutures, boti [
yielding the sensation of fluctuation. Occasionally crepita- J
tion may be noted. Abdominal palpation reveals an unusual J
size of the head. The treatment consists in aseptic puncture 1
through a fontanel or suture; if this fails craniotomy is ia- .
dicated.
How may multiple <twin) pregnancy be recognized? ]
State how it may complicate labor, and show how labor ]
should be managed when this condition exists.
A twin pregnancy may be recognized by the unusual sise I
OBSTETRICS AND OYNECOLOOY. 499
of the abdomen, by the presence of two distinct fetal heart-
beats, heard best at different points of the abdominal sur-
face ; there may be two distinct placental souiBes, irregularity
in the outline of the uterus, the presence of a number of fetal
extremities or parts, and the ability to outline two fetuses.
The dangers are uterine inertia, abnonnal presentations, im-
perfect development of the fetuses, the formation of mon-
strosities, and locking of the babies. The first child present-
ing normally, labor should proceed normally; after its birth
the second child should be made to present in a proper man-
ner, and then 1 dram of the fluid extract of ergot should
be administered. Not infrequently a forceps-delivery is re-
quired.
What complications may arise in a twin labor, and how
may they be overcome?
Malpresentation and malposition are frequent and must be
corrected. Locking of the heads requires separation of the
chins, the application of forceps or decapitation.
What is superfetation, and how does it take place?
Superfctatwn i& the supposed fertilization of an ovum when
there is another from a previous ovulation in uterogestation.
There is considerable doubt as to the possibility of such an
occurrence. If it does occur it wall probably take place
within the first few days after the primarj'- conception, i. e.,
before the formation of the decidua. The occurrence of
superfetation at a more advanced stage in the development of
the primarily fertilized ovum seems, however, to have been
proved by remarkable cases reported by eminent men.
What is meant by prolapse of the funis? When does it
occur? What are its dangers? How would you manage
such a case?
Prolapse of the cord consists in the descent of a loop of
the umbilical cord in advance of the presenting fetal portion.
It occurs in certain malpositions and malpresentations of the
500
OBSTETRICS AND GYNECOLOGY.
fetus, in multiple pregnancy, in hydramnios with sudden
escape of the liquor amnii, and in contracted pelvis when the
fetal head does not properly fit into the superior strait. The
danger is fetal deatli froni asphyxiation due to pressure on
the cord. The treatment consists in replacement of the cord,
the woman resting in the knee-ehest or Trendelenburg pos-
ture. This may he accomplislied by gravity, aided by the
hand or by a respositor. If this fails, podalic version may be
perfoi-med or the child hastily delivered by forceps.
What is premature respiration?
The establishment of the function of respiratiou before de-
livery of the child has been accomplished. This is due to the
entrance of air into the birth-canal, and occurs in eases of
dystocia or during the performance of version. The danger
is insufflation of liquor amnii or clots, with the development
of fetal pneumonia.
How does constitutional syphilis in the parents affect
the infant, and how can you detect its presence in the
infant?
The offspring of syphilitic parents is generally infected by
the disease. Congenital syphilis will be shown by the follow-
ing symptoms: TJndersize of the fetus, delivery at terra of a
still-bom baby, syphilitic pemphigus on the palms and soles,
enlargement of the liver and glands of the body, catarrhal or
white pneumonia, and a line of fatty tissue between the epi-
physis and diaphysis of the long bones. If the child be bom
alive and apparently healthy it will develop a coryza or
"snuffles" at the expiration of four or five weeks, followed
by the appeai-ance of emptions over the body and the devel-
opment of marasmus.
Give the causes and treatment of umbilical hemorrhage
of the new-born child.
Primary omphalorrhagia results from loose ligature or
laceration of the cord, and occurs immediately after birth.
OBSTETRICS AND GYNECOLOGY. 501
Secondary hemorrhage occurs at the time of separation of the
cord, and is due to a dislodgement of the clots or to the
hemorrhagic diathesis. The treaiment consists in religation of
the cord, the application of a firm compress with an astringent
solution, the application of a firm plaster of Paris dressing,
or of a figure-eight ligature applied over hare-lip pins.
How would you decide whether a dead infant had been
born alive?
By the presence of air in the lungs (hypostatic test).
What are the causes of still-birth, and how should a
still-born child be treated?
The causes of still-birth are various intra-uterine diseases,
asphyxia from pressure on the cord or interference with the
fetoplacental circulation, as in eclampsia or premature sepa-
ration of the placenta, and traumatism during some obstetric
operation. Such a child should be handled tenderly and be
given a decent burial. The term ** still-birth" should not be
confounded with asphyxia neonatorum.
Give the etymology and uses of the forceps, and name
the conditions for their application, together with the
rules therefor and precautions to be observed in the same.
The obstetric forceps (a Latin word) is an instrument with
two blades and handles for pulling, grasping or compressing
the fetus. Its use is indicated by the presence of uterine
inertia, minor degrees of pelvic contraction, threatened fetal
or maternal death, and to correct malpositions of the fetal head.
In order that the instrument may be applied the os must be
dilated, the membranes ruptured, there must not be too great
disproportion between the head and the birth-canal, the part
should be engaged, and the labor must be possible. The left
blade is always introduced first, and must be grasped in the
left hand and carried to the left side of the patient. It must
not be forcibly thrust in, but must be slightly rotated in order
to accommodate it to the pelvic and fetal curves. The blade
502
OBSTETRICS AND GJNECOlOGy.
I
that corresponds iu name to the pelvic diameter in which the
fetal presentation is lying must be pried forwnrd in order to
grasp Ihe fetal head on tho sides.
Describe the common varieties of obstetric forceps.
A short forceps is one in which the blades are attached
directly to the handles without the intervention of a shank;
it has the cephalic curve only, and is used only when the
head is on the pelvic floor {low forceps operation). The long
forceps is one in which a shank is placed between the handles
and the blades; it has a pelvic curve, as well as the cephalic.
It may he used at the superior 8ti*ait, but usually applied
to the head in the pelvic cavity (median forceps operatioii).
The axis IravtwH forceps is a long forceps, in which, by an
appliance or supplementary handle attached to the under
surface of the blades, the traction force is constantly exerted
in the line of the axis of the parturient canal. It is used at
the superior strait (high forceps operation).
Describe the position of patient and pliysician for the
readiest means of applying the forceps.
The patient lies upon her back iu the lithotomy position,
with the limbs tlexed and the buttocks over the side of the
l>ed. The physician sits on a chair between the thighs, which
are separated and held by assistants.
In what direction should traction be made when the
fetal head is in the cavity of the pelvis?
At first downnvard and outward, then upward and back-
ward.
What powers may be exerted by the forceps?
The forceps are generalty used as tractors. They may be
employed as levers, rotators, and com press ore.
What are the dangers in the use of forceps, and how
are such dangers to be avoided?
The dan-iers are slipping of the instrument, septic infec-
OBSTETRICS AND GYNECOLOGY. 503
tion, laceration of the cervix and soft tissues, and fatal com-
pression of the fetal head. If applied gently, without force,
and in the proper (less) diameters of the fetal skull, and if
thorough asepsis be employed, these dangers may be obviated.
Describe the technic of the high forceps operation.
The instrument (axis-traction forceps) must be introduced
through the cervix, and applied to the head in the best diam-
eter possible. The grip is a vicious one, because a large diam-
eter must be seized and there is danger of slipping. Traction
is made well down at first, and as the head descends and the
upper handles of the instrument rise the extra handles must
be raised in order to keep the two handles together. When
the head is low enough the instrument should be withdrawn
and reapplied in a better position, or a simple instrument
used.
Describe the occasion for the application of the forceps
in the inferior strait.
This is a low operation. The blades are introduced in the
manner already described, and traction made outward and
downward until the floor is reached. The head is then pulled
upward and outward and then upward and backward until
it emerges through the vulvar oriiiee. The instrument in the
last stage of delivery is grasped in the right hand only, as a
dagger would be held, and the left hand spans the perineum
in order to regulate the degree of distension.
Describe the use of the forceps in the occipito-posterior
position.
This is a double forceps-operation. The occiput generally
lies in the right oblique diameter (R. O. P.). After applying
the forceps in the manner already described traction is made
downward and outward until the head impinges upon the
pelvic floor. In the intervals of relaxation a certain amount
of anterior rotation will take place. This will carry the occi-
put through the transverse and into the left oblique diameter.
■
504 OBSTETRICS AND GYNECOLOGY.
The forceps must then be removed and reapplied in the new
diameter to prevent inversion of the instrument. The final
traction and delivery are as in the ordinary anterior forceps-
delivery.
What indications would lead you to insert a hand into
the uterus, and what precautions should you observe?
Pailiire of the placenta to descend, active post-partum
hemorrhage, and the necessity for the performance of version
are the indications for the introduction of the hand into the
uterus. Thorough asepsis and antisepsis must be observed,
and the hand must he anointed with an antiseptic ointment.
Define version. Give the varieties, indications and dan-
gers of version, together with the preliminaries and the
method of operating.
Vnrsion or turning is an obstetric operation whereby by
manual efforts the position of the fetus in utero is altered so
that one extremity of the fetal ellipse is made to take the
place occupied by the other extremity or by some portion of
the trunk. The varieties of version are ; 1, Cephalic, in which
the head is made to present; 2. Pelvic, in which the breech is
caused to present at the superior strait; and 3. Podaltc. in
which one or both feet are grasped and drawn doivn into the
parturient canal. The indications for version are malposition
of the head and malpresentations, minor degrees of pelvic
contraction, placenta prievia, anything indicatinp speedy de-
livery of the child, aa threatened fetal or maternal death,
The dangers of the operation are the introduction of septic
matter or of air, with the production of air-embolism, rupture
of the uterus, laceration of the cervix, and serious fetal in-
jury. The patient should be anesthetized, and every anti-
septic precaution observed. The membranes should not be
ruptured until the hand is ready to be introduced. One fool
should be grasped with the heel in the palmar surface and the
child gently turned to avoid undue distension of tbe lower
ut«rine segment, After the body is turned the case is treated
as a hreech presentation.
I
OBSTETRICS AND GYNECOLOGY. 505
Compare version with the employment of forceps, and
state when each is preferable.
Version is a shorter operation, and one that is to be pre-
ferred when haste is required. The dangers of sepsis are
greater than in the use of forceps, and also the danger of
uterine rupture. Version should be used when the forceps
fail to engage the head in minor degrees of pelvic contraction.
Version cannot be employed when engagement has occurred
or when there is a high position of Bandi's ring.
Describe symphyseotomy, and give the indications for
its performance.
Symphyseotomy or division of the pubic symphysis is an
extremely limited operation. It should be done, if done at
all, only in those cases of pelvic contraction in which the con-
jugate diameter of the superior strait measures from 7 to 8
cm. The operation of choice is the indirect method, in which
an incision li/^ to 2 inches long is made above the symphysis
in the median line, and after separation of the muscles the
Galbiati knife is passed down beneath the symphysis and the
bone divided from below upward and from within outward.
As the symphysis separates gauze is packed in to arrest hem-
orrhage. The forceps is then applied and the child extracted.
After delivery the wound is closed and the bones held in ap-
position by means of a firm pelvic binder.
Define embryotomy and craniotomy, and give the indi-
cations for and method of operating in each.
Emiryotomy is any mutilating operation upon the fetus.
It includes decapitation or beheading of the fetus, amputor
lions of the fetal extremities, evisceration y or removal of the
viscera piecemeal, and craniotomy, or opening of the fetal
skull, with evacuation of the brain. The technic of craniot-
omy is as follows: Vaginal asepsis, fixation of the head and
scalp with volsella-forceps, perforation through a suture or
fontanel, enlargement of the perforation, disorganization of
the brain-mass, decerebration by intra-cranial injections of
506 OBSTETRICS AND GYNECOLOGY.
warm carbolized water, crushing of the skull, and extraction
of the head by the eraniotraetor.
(live the various steps in embryotomy En the transverse
presentation.
If the fetus presents by the back, the operation of xptindy-
iotomy or division of the vertebi-a; is indicated, followed by
evisceration or by delivery of the fetal body doubled upon
itself. Spondylotomy or rachiotomy is performed by means
of scissors, as Is also evisceration. Oc>casionaIly in impacted
shoulder presentations the operation of decapitation will be
indicated. This can be accomplished by means of the blunt
or the sharp hook or by scissors. The body is readily re-
moved, and the head must then be ifrasped by forceps, crushed
and extracted.
Give the condition requiring Cesarean section or hys-
terectomy, and describe a modified form of the operation.
Cesarean section or delivery of the child through an ab-
dominal and ulerine incision is indicated in grave degrees of
pelvic contraction, in labor obstructed by tumors of the uterus
and pelvis, in irreducible vaginal tumors, in ruptni* of the
uterus, and in sudden maternal death. The original Ces
section, in which an incision was made into the uterine wall
and the child extracted, has been modified by Sanger as fol-
lows: The abdomen is opened in the median line, the utems
delivered and towels packed around it. Then while the uter-
ine arteries are controlled by an assistant an incision ii
into the uterus and the child and placenta extracted. The
uterine cavity is cleaned out and sutures introduced to close
the uterine incision, after which the abdominal wound ia
closed.
Detine Porro's operation, state when it is a
describe the method of its performance.
The Forro operation or ccUohysicrectomy consi.st
extirpatJOD of the utems and its appendages after the es-
OBSTETRICS AND GYNECOLOGY. 507
traction of the fetus, as in the simple Cesarean section. The
hidicatiafis for this operation are extreme degrees of pelvic
contraction, marked atresia of the cervix, vagina or vulva, the
presence of large bony growths in the pelvic canal, large
fibrous or myomatous tumors of the uterus, extensive rupture
of the uterus, with involvement of adjacent structures, a re-
laxed and flabby condition of the uterus after the section,
and a septic condition of the uterus, with threatened general
septic infection. The operation is the same up to extraction
of the child. The ovarian and uterine arteries are then ligated
and the uterus amputated at the cervical junction. The case
is then treated as an ordinary abdominal section.
What complications in labor justify abdominal section?
Give the technic of the operation.
The conditions that indicate Cesarean section, rupture of
the uterus, retrodisplacement of the uterus wnth incarceration,
extra-uterine pregnancy, labor complicated with tumors, grave
septic infection of the uterus, appendages or broad ligament,
all indicate abdominal section. The technic is that of Cesa-
rean section with or without the removal of the uterus.
Describe the malformations of the uterus.
Owing to failure of development of the ducts of Miiller we
have varying degrees of double uterus. The slightest degrees
are known as uterus incudiformis and uterus cordifonnis.
From these minor degrees the uterine deformity may advance
through the stages of uterus septus, suhscijtus, partitus, bi-
partitus, bilocularis and scmipariitus. In the uterus bicornis
the two tubes unite below, but are separated above. The
uterus unicornis results from a lack of development of one of
the Miillerian ducts, its fellow undergoing the normal process
of evolution.
Describe and differentiate anteversion, retroversion and
prolapsus of the uterus. State the obstetric significance
of each.
Anteversion of the uterus is a bending of that organ for-
508
OBSTETRICS AND GYNECOLOGY.
ward ; retroversion is a bending backward ; prolapsus is a fall-
ing down or descent of tlie organ. Auteversion may prevent
a rising of the uterus if the organ be (ixed, and so interfere
with pregnancy. Retroversion of a pregnant womb may re-
sult in incarceration with serious results. Prolapse does not
as a rule interfere wth gestation; the uterus returns to its
normal position as gestation advances.
Mention the symptoms and give the management of
long-retained excretions due to imperforate hymen.
In addition to menstrual suppression there will be noted
cramp-like pains and a steadily growing cystic tumor in the
median line of the abdomen. Palpation will elicit pain.
Vaginal examination will show the imperforate condition of
the hymen. The treatment consists o£ thorough asepsis, fol-
lowed by cervical incision into the hymen. As the tarry fluid
escapes a two-way catheter shoiald be introduced and an
antiseptic solution allowed to flow into the uterus in order to
prevent shock from sudden evacuation and to prevent septic
infection.
vaginismus? How may it be recognized and
What U
treated?
Vaginisnitis is painful spasm of the vagina and vulva. It
results from rigid hymen, fisaure, and other local conditions,
and appears at the time of coitus or digital exploration. It
is best treated by dilatation under anesthesia.
What method should be employed to dilate the non-
pregnant uterus, and under what circumstances is the
operation justifiable?
The best method of dilating the uterus is the use of the
dilator of Ooodell or Wathens, the glove-stretching apparatna.
This is required whenever there is stenosis of the cervical
canal, or as a preliminary step to the operation of euretlage.
OBSTETRICS AND GYNECOLOGY. 509
*Is ventrofixation of the uterus justifiable? If so, state
under what circumstances, and describe the operation.
It is a safe and proper operation for the correction of
retrodisplacement of the uterus in women past the child-
bearing period. An abdominal opening is made, the uterus
is brought forward, and a stitch is passed through the peri-
toneal and subperitoneal tissues on one side of the incision,
then through the fundus of the uterus on a line with the
Fallopian tubes and through the corresponding tissues on the
other side. A second suture must be passed a little back of
this and firmly secured. The abdominal wound is then closed.
Under what conditions may shortening of the round
ligament become justifiable, and how should the operation
be performed?
Shortening of the round ligament may be performed when
there is a retrodisplacement of the uterus. It is best per-
formed by Wylie's method or some other of the intraperi-
toneal methods, the ligaments being folded upon themselves
or implanted further back upon the uterus. Alexander's
operation is shortening of these ligaments in the inguinal
canals.
Define salpingitis, state its causes and pathology, and
give its management.
Salpingitis is inflammation of the Fallopian tubes. It may
be septic, gonorrheal, or tuberculous in origin, or merely a
catarrhal condition. The mucosa swells, secretes a fluid, and
if the edges of the firabriaB adhere a retension-cyst is formed.
The treatment may be derivative, and consist in purgation,
with local applications to the cervnx and vaginal vault, or
abdominal section may be performed and the appendages re-
moved.
Give the pathology of (a) hydrosalpinx, (b) hematosal-
pinx. Give the diagnosis and treatment of each.
Hydrosalpinx, or a watery collection in tlie tube, results
510
OBSTETRICS AND GYNECOLOGY.
from an old pyosaJpinx or purulent collection. The pyogenic
membrane has become destroyed, and the fluid slowly assumes
the watery nature. Hematosalpinx, or blood in the tube, re-
sults almost invariably from an extra-uterine pregnancy. The
treatment of each is exeision. The diagnosis is made by the
presence of a sensitive tumor in the situation of the tube, with
pain on the affected side.
Define endometritis, and give its causes, varieties and
treatment.
Eiiihnictrids, or iuflauimation of the lining membrane of
the uterus, may be septic, gonorrheal, traumatic, catarrhal or
tuberculous in origin, and occur as a glandular or as an inter-
stitial affection, or as Iwtli eombined. It may be treated by
local applications, depletion, curettemeut, iuti-a-uterine appli-
cations, or by excision of the uterus.
Give the causes of pelvic inflammation, and state its
relation to involvement of the ovary.
Pelvic inflammation is generally septic or gonorrheal in
origin. It may result from exposure to cold or wet or from
abrupt stopping of the menstrual discharge. If active and
virulent or long continued there follows a thickening and
chronic inflammation of the ovarian capsnle, which will re-
sult in follicular cysis forming in the ovarian stroma from
inability of the tlraafian follicles to rupture.
Give a differential diagnosis between ovaritis and ova-
ralgia.
Ovurilis. or inflammation of the ovary, is associated with
all the symptoms of pelvic inflammation, including pain, leu-
korrhea, hemorrhage, menstrual disturbance, and swelling of
the ovary or tumor-formation. There will also be general ■
symptoms, as fever and prostration. Ovaralgia is neuralgia
of the ovary, and may exist independently of any appreciable
local lesion. It is more apt !o occur at or near the menstrual
period.
OBSTETRICS AND GYNECOLOGY. 511
Give the pathology and treatment of an ovarian cyst.
An ovarian cyst may be follicular, as already described. It
may be a multilocular cyst arising from rudimentary Graafian
follicles, and consisting of two or more loculi or compart-
ments; it may be a unilocular cyst springing from the paro-
varium, or it may be a papillary growth arising in the vertical
tubules of the paroophoron. Whatever its origin and path-
ology, it should be removed by abdominal section.
Give a description of cystocele and rectoceie. State
how each may complicate labor, and what should be done
in the arising contingency.
Cystocele is a prolapse of the anterior vaginal wall and
posterior bladder wall; rectoceie is a prolapse of the pos-
terior vaginal wall and anterior rectal wall. Both cystocele
and rectoceie encroach upon the calibre of the vagina, and
may be caught by the advancing fetal head either arresting
its progress or being pushed before the head; in the latter
case the submucous tissue is torn and the vaginal prolapse
made worse. The treatment consists in applying forceps to
the head and drawing it over the relaxed vaginal walls.
How would you diagnose cystic degeneration of the
ovaries from other forms of disease which simulate it?
From ascites ovarian cyst may be distinguished by the cen-
trally situated tumor, the area of central dulness with coronal
resonance, the immovability of the tumor, and the protub-
erant abdomen when the woman assumes the dorsal position.
In ascites the abdomen flattens and the flanks bulge when the
woman lies upon her baek; a change of position causes a
corresponding change in the area of dulness; fluctuation is
marked; there is an area of central resonance with coronal
dulness, and an associated grave organic disea.se may be de-
tected. In phantom tumor the percussion-note is hyper-
resonant, and examination under an anesthetic reveals the
true condition.
512
OBSTETKICS AND GYNECOLOGY,
Give the early diagnosis and the treatment of cancer of
the uterus,
A reeurrecce of bleediag after the menopause; an angry-
appearance of the cervix, which bleeds on the slightest touch;
a peculiar hardness of the mucous membrane due to cellular
infiltration; an acid and irritating discharge, which may or
may not be fetid, and dull sacral pains would lead to the
suspicion of cancer. A microscopic examination would then
complete the diagnosis. The only treatment consists in total
extirpation of the uterus.
Qive the diagnosis and treatment of anemia and chio*
rosis.
Chlorosis is the "green sickness" of young girls. These
girls are generally stout and well nourished, but present a
peculiar green color; they sutfer from nosebleed not infre-
quently and attacks of vertigo and syncope. In true anemia
there is an extreme pallor, with marked diminution in the red
blood-corpuscles and hemoglobin and more or less wasting.
Anemia is generally associated with some grave organic dis-
ease. The treatment of both conditions consists in good food,
change of scene, rest and tonics, including iron, strychnine
and arsenic.
What are the symptoms and treatment of amenorrhea?
Amenorrhea is a total suppression of the menstrual flow.
It is generally associated with anemic conditions, and may
be accompanied by leukorrhea and vague pelvic pains. The
treatment consists in tonics, good food, and the use of iron,
oxalic acid, potassium permanganate, manganese, and the
other so-cailed emmenagogues.
What is the menopause, and in what manner would you
explain the theory that it is a critical period in a woman's
life?
The vienopause is the cessation of the phenomenon of men-
struation, occurring usually at the age of 43 to 45. At thia
OBSTETRICS AND GYNECOLOGY. 513
time the ovarian influence ceases, and because of the tendency
to the development of obesity and of uterine cancer at or
after this period it has long been regarded as a critical period
in the life of the woman. Various forms of insanity may
also develop at this time. The post-climacteric diseases may
assume a very serious aspect.
Enumerate the perils of premature parturition.
Premature labor subjects the woman to the dangers of
hemorrhage from partial detachment of the placenta, cervical
laceration because of rigidity of the parts, and sepsis from
retention of placental debris.
What are the conditions liable to produce sepsis after
abortion?
Imperfect expulsion of the product of conception and the
necessity in many cases of digital assistance.
Before the head engages, how would you convert an
L. O. P. into an L. O. A. position?
If possible by the position of the mother, who should lie
upon the left side. If this fails, the head may be rotated
forward by the hand or by forceps applied to the sides and
gently turned, not, however, reversing their normal position
in the pelvis. One blade of the forceps, the vectis, may be
employed for the purpose in suitable cases.
What injuries may happen to the vagina and rectum
during labor, and how may they be avoided?
The vaginal walls may be pushed or drawn ahead of the
advancing part and partially detached from their support;
they may be cut or torn by the blades of the forceps, which
may also cut through the rectovaginal septum and produce a
complete perineal laceration. These accidents may be pre-
vented largely by preservation of the bag of waters as long
as possible, by thorough lubrication of the parts, and by the
proper use of the forceps when these become necessary.
33
514
OBSTETRICS AND GYNECOLOGY.
Describe the method of applying forceps in R. O. A.
presentation.
The head lies in the left oblique pelvic diameter; therefore
the left blade first introduced is pried forward until the blade
rests over the upper fetal ear, the handle of the instrument
looking downward and outward to ibe operator's left. The
right blade is then introduced and depressed without rota-
tion until it fits into the slot of the other blade.
Describe the operation in detail for the immediate re*
pair of complete laceration of the perineum.
After cleansing the parts, the patient being under an anes-
thetie, a stitch is passed well behind the anal orifice and
toward the median line with an outward sweep, so as to
embrace the retracted sphincter fibers; it is then carried up
to the apex of the tear and caused to traverse a similar course
upon the other side of the fissure, emerging at the point of
introduction. A second stitch is then introduced at the point
of retraction of the outermost sphincter- fibers and carried in
and toward the apex of the tear, traversing a similar course
on the other side to emerge at the outermost retracted
sphincter-fibers of that side. These two stitcJies close llie
sphincter. The perineum above is tlien closed by transverse
sutures introduced in the usual manner. If the rectal septum
is torn, it must first be closed by a running catgut suture.
Give the mechanism of delivery of a R. 0. P. presen-
tation.
After great labor-pains the head descends until the occiput
strikes the pelvic floor high up pcsferiorly ; it is then rotated
anteriorly through % of a half circle until it rests under the
pubic sjTuphysis. While doing this the shoulders rotate high
up ip the false pelvis from right to left until they rest in the
right oblique diameter, having primarily rested in the line
of the left oblique diameter. The head is then delivered by
extension, rotation occurs toward the right, the anterior
OBSTETRICS AND GYNECOLOOY. 515
shoulder advances from the left side to the median line, and
the shoulders and body are then delivered.
What abnormal conditions in pregnant women are pre-
judicial to the life of mother or child?
Syphilis, tuberculosis, anemia, vomiting, zymotic diseases,
placenta praevia, pelvic deformities, renal disease, tumors, and
degenerations of the membranes.
Describe the method of delivery in a leg-presentation.
This is a modified breech-presentation. The leg should be
drawn down and the other made to engage. The labor may
proceed as a breech delivery, or the child may be rapidly ex-
tracted as after version.
State the conditions compelling artificial feeding, and
describe the proper method of modifying cow's milk for
the newly born.
Lack of milk-f ormation ; refusal of the child to nurse;
tuberculosis or other grave maternal disease; high fever.
Normal cow's milk should be diluted by 10 or 12 parts of
water, some sugar of milk added, lime-water 1 or 2 drams to
the mixture, and the whole subjected to Pasteurization before
being administered in sterile bottles.
Give the relations of the cephalic and pelvic diameter
at 3 points during the birth of a L. O. A. presentation.
At the beginning of the labor the suboccipito-bregmatic and
bitemporal diameters of the head are concerned, the sagittal
suture running in the right oblique pelvic diameter. After
engagement perfect flexion causes the trachelobregmatic and
biparietal diameters to engage. After anterior rotation the
head rests in the conjugate pelvic diameter and the head is
delivered by extending under the subpubic ligament.
Diagnose pregnancy in the sixth month from phantom
tumor.
In phantom tumor there is general tympany over the dis-
OBSTETRICS AND OYNECOLOOY.
tended abdomen, there are no hard parts to be felt, and under
ether the entire condition clears up. The pregnancy at six
aiontbs will give all the absolute signs of pregnancy, includ-
ing movements, heart-beats, and ability to. outline the fetal
parla.
Differentiate an ovarian cyst, a uterine fibroid, and
pregnancy at the fifth month.
At the fifth month of pregnancy there will be found a
pyramidal tumor almost reaching to the umbilieus, eystic upon
one side and firm upon the other, alternately hardening and
contracting. The fetal outlines may be determined indis-
■tinetly, ballottement is present, and the soft signs of preg-
nancy may be found.
An ovarian cyst is of slower growth, is entirely cystic to
the feel, fluctuation will be present, the tumor will be more
or less to one side of the median line; none of the signs of
pregnancy will esist; menstruation may persist.
A uterine fibroid will be much harder, irregular in outline,
without the signs of pregnancy. Menstruation will be fre-
quent and irregular, and increased in amount.
Give the management of a pregnancy and labor compli-
cated by a fibroid tumor of the uterits.
If the tumor is large and tlie pregnancy early, abortion
may be induced. In later pregnancies, the tumor being situ-
ated on the anterior uterine wall, the patient may be allowed
to go to term and may spontaneously deliver herself. If not,
Cesarean section is indicated. If the tumor is lodged in the
pelvis or is in tlie posterior uterine wall, elective Cesarean
section'with the Porro operation may he performed.
DeBne multiple pregnancy.
Pregnancy in which more than one fetus is present in the
uterine cavity or in the maternal abdomen.
r
OBSTETRICS AND GYNECOLOGY. 517
Give the management of delay in the second stage of
labor.
If due to inertia, rest, firm abdominal binder, quinine,
friction over the uterine fundus. If due to obstruction, as
from rigid perineum, rigid cervix, tumor, or pelvic contrac-
tion, correct the existing cause and deliver wth forceps or by
some other operative procedure.
To what diseases is the puerperal breast liable?
Fissure of the nipple, mastitis, abscess, septic infection,
caking of the milk.
Describe the vulva. Differentiate the vulva of a parous
woman and the vulva of a non-parous woman.
The vulva consists of the mons veneris and the two rolls of
fatty tissue known as the labia majora. These parts are cov-
ered with hair. In a non-parous woman the labia are in close
contact, even when the thighs are separated; in a woman
who has given birth to children the labia are either lightly
in contact or the orifice is patulous and relaxed.
Descrtbe pelvimetry and state its obstetric uses and
value.
By pelvimetry is meant the measurement of the dimensions
and capacity of the pelvis. It is employed to determine the
degree of pelvic contraction that may be present, and the re-
lationship existing between the respective sizes of fetus and
pelvis. By its use grave major obstetric operations may be
avoided by the premature induction of labor, or the operation
of choice may be selected and both fetal and maternal life
saved.
Describe the genupectoral posture and mention some of
its important uses.
The genupectoral or knee-chest posture is tliat in which
the patient, resting upon her knees with the thighs vertical,
inclines her body forward until she rests upon the upper
518 OBSTETRICS AND GYNECOLOGY.
portion of the chest with the head turned to the side and the
arms resting above the head. This position favors gravita-
tion of the viscera out of the pelvis, permits a replacement
of a retro-displaced uterus, the return of a hernia through
the ring, and the replacement of a prolapsed funis.
Describe the causes and management of a ** head-last **
labor.
This is a breech-labor, and results from a reversal of the
shape of the fetal ellipse, the cephalic extremity of the child
becoming the larger; it may also depend upon a deformed
uterus or a mild degree of pelvic contraction. The treatment
consists in efforts at version before labor, if this be deemed
best ; inaction during the first and second stages of labor until
the child is delivered as far as the umbilicus, and then a rapid
delivery of the shoulders and head.
THERAPEUTICS AND MATERIA MEDICA
Mention the salts of lithium and describe their medic-
inal uses.
Benzoate, bromide, carbonate, citrate, and salicylate.
The carbonate and citrate are used extensively in gout and
the lithemic diathesis. The lithium salts have strong alkaline
qualities, and act on the system as other alkalies. Lithium
bromide is prescribed for the effects of bromide.
What are the therapeutic uses of lobelia?
It is used as an expectorant, diaphoretic, emetic, purgative,
and anti-spasmodic.
Mention the official preparations of copper. Give the
dose of each.
There is but one ofBcial preparation, the sulphate, which is
given as an emetic in doses of 0.250 6m. (4 grains), and as a
tonic in dose of 0.010 Gm. (% grain).
What are the therapeutic uses of oleum tiglii or Croton
oil?
Externally it is applied as a counter-irritant in bronchitis,
neuritis, rheumatism, and ovaritis. Internally it is used as a
prompt hydragogue cathartic and revulsant in acute cerebral
congestion, apoplexy and uremia. In these cases it not only
causes general depletion, but also a rapid efflux of blood from
the brain.
What are the uses of the bromides?
The bromides are used as sedatives io the nervous system,
to lower reflex activity, to produce sleep, to subdue excite-
(519)
520 TnERAFEUTlCS AKD MATERIA MEDICA.
ment of ifae genital apparatus, and to antagonize congestion
of tile brain.
Give the indications for the use of corrosive sublimate
internally.
As an antisyphilitio, as a hematinic, in gastric ulcer and
early sta)?es of hepatic cirrhosis and in dysentery.
What remedies are employed to correct anemic condi-
tions and how are they used?
^'ux vomica, stimulates the blood-making organs, and is
used as an adjunct to restorative remedies. Iron, the chief
value of which is to improve digestion and to furnish hematin
to the blood. The astringent preparations are the best, and
should be given after meals. Arsmu: as an adjunct to iron.
.\rsenic increases the number of blood cells, while the iron
increases the hemoglobin contained in each. Bichloride of
tnercury, qmnitie and manganese increase the number of red
blood cells. In the treatment of anemia it is of importance
to determine the cause when possible. This will frequently
be found to be due to gastro-intestinal irritation or constipa-
tion, (ieneral tonic treatment, with the proper diet and
hygienic surroundings, are often more valuable than dnig
treatment.
Describe the therapeutic uses of the preparations of
phosphorus.
Phosphoms is chiefly used to promote the nutrition of
osseous and nervous tissue. Very small doses of the drug
have been found of excellent service in functional impotence,
in certain skin diseases, in pernicious anemia and in neuralgia.
C^alcium phosphate and the hypo phosphites are used with
benefit in all diseases of malnutrition and where the repair
or development of the bones is required. They are particu-
larly useful in protracted suppuration, osteomalacia, rachitis,
caries, chronic phthisis, and in the anemia and bone-softening
of lactation. Sodium phosphate is a well-known purgative.
I
I
THERAPEUTICS AND MATERIA MEDICA. 521
Indicate the manner in which ethylic ether (sulphuric
ether?) should be applied to produce general anesthesia.
As an anesthetic it may be administered from a sponge, a
folded towel surrounded by a cone of pasteboard, or from an
inhaler made especially for the purpose. At first the inhaler
should be held some distance from the nose, to accustom the
patient to the irritant effects of the ether, but soon it should
be brought close to the nose, so that the anesthetic may be
taken in concentrated form. Insensibility of the conjunctiva
and muscular relaxation are the indications that the patient
is properly prepared for the operation. Many surgeons now
employ preliminary anesthesia with nitrous oxide gas. This
greatly shortens the first stage and allows the patient to be
anesthetized with a comparatively small amount of ether.
In what manner is the system affected by an overdose
of chloral hydrate?
The ingestion of a toxic dose produces sleep, which soon
deepens into coma; the pulse becomes feeble and thready, the
respiration embarrassed, the surface cold and clammy, the
pupils at first contracted and then dilated, and finally death
results from cardiac and respiratory paralysis.
Name three general anodynes and give the dose of some
official preparation of each.
Opium, belladonna, cannabis indica. Morphine sulphate,
0.015 Gm. (14 grain). Sulphate of atropine, 0.0004 Gm.
(*/i6o grain). Extract cannabis, 0.010 Gm. (Y^ grain).
State the precautions which should ordinarily be ob-
served in administering medicines by the hypodermic
method.
The medicine must be in solution, and the latter should be
neutral in reaction and freshly prepared. The skin of the
patient should be rendered aseptic at the place selected for
the injection. The solution is to be injected beneath the skin
and not into it, and the blood-vessels and nerve points are to
he especially avoided.
522 TUERAPEVTiaS AND MATERIA MEDIVA.
Give the physiological effects of cinchona.
Cinchona is aii astringeut bitter and a stomach tonic. At
first it promotes appetite, digestion, the flow of saliva and
gastric juice; long continued it sets up a. gastric catarrh, im-
peding digestion and causing constipation. Its action is more
astringent aud irritating than that of its alkaloid, quinine.
Its active principles are more slowly a'bsorbed by reason of
its bulk. In large doses quinine causes headache, ringing in
the ears and some deafness. It is antipyretic and a heart
depressant. On the nervous system it causes congestion of
the brain and acts as a cerebral excitant; moderate doses
lessen reflex activity by stimulating Setsehenow's inhibitory
center. Toxic doses permanently abolish the reflexes by de-
pressing the spinal cord and peripheral nerves. Small doses
exert no influence on the respiratory system, but large doses
paralyze the respiratory center.
Mention the conditions that contra-indicate the admin-
istration of aconite.
It is eontra-iudiealed when there is adynamic action of the
heart, cardiac degeneration or dilatation, and gastro-intestinal
irritation or inflammation.
Mention the ailcaioids of nux vomica.
It contains two alkaloids, strychnine and brucine. "Kie ]
latter i-esembles the former in its action, but ia less powerful.
For what pathologic conditions is salicylic acid admin*
istered? What symptoms indicate the discontinuance of
the use of salicylic acid?
Externally it is used as an antiseptic in the dressing of
wounds. Dissolved in collodion it is a valuable application
for the removal of corns. The ointment is of service
chronic eczema. Internally, salicylic acid is of the greatest 1
value in acute rheumatism. In neuralgia and neuritis of |
rheumatic origin it is of service, as it is in tonsiJitis, pleurisy j
with serous effu.'sion and in diabetes of goutj' origin.
THERAPEUTICS AND MATERIA MEDICA. 523
should be discontinued if the patient suffers from headache,
ringing in the ears, deafness, paralysis of the ocular muscles,
great fall of temperature, excessive sweating, difBcult respi-
ration, weak pulse, convulsions, and olive-green urine. These
are the symptoms resulting from a poisonous dose.
For what conditions should (a) tincture of digitalis be
given, (b) infusion of digitalis be given? Mention the
dose of each.
When the cardiac action of digitalis is desired the tincture
should be employed, and no fluid should be taken within
twenty minutes either before or after swallowing. If the
diuretic action is required the proper preparation is the in-
fusion. The dose of the tincture is 1 Cc. (15 minims). The
dose of the infusion is 8 Cc. (2 fluidrachms).
Write a prescription illustrating chemical incompati-
bility.
Salicylic acid is incompatible with the salts of iron ; a pre-
scription containing tincture of iron and salicylic acid would
furnish an example of such incompatibility.
Mention the principal physiologic effects of jaborandi.
Give the alkaloids of jaborandi.
Jaborandi is a powerful diaphoretic and sialogogue, a car-
diac depressant, by stimulation of the vagus-ends; it is also
myotic, emetic, and under some circumstances abortifacient.
Jaborandi contains four alkaloids, pilocarpine, jaborine, pilo-
carpidine, and jaboridine.
•
What are the earliest signs of poisoning from the ex-
ternal use of carbolic acid?
Early symptoms are smoky color of the urine, lumbar pain,
slight cerebral disturbance, after which develops impairment
of respiration and stupor. Applied in concentrated form it
is irritant and superficially escharotic, and produces at the
point of application a white spot, changing to red if the
acid is soon removed. If the application is prolonged a white
Sai THEBAPEUTICS AND MATERIA MEDICA.
aloQ^ resnltB from eqagolatioii of the albumin of the tissue;
this is bordered by a red zone of inflammation.
Mcatioa the ingredients and the dose of puivis glycyr-
CtMupound liquoriee powder contains senna 18, glycyrrhiza
oil of fennel 0.4, washed sulphur 8, sugar 50 ; the dose
is 4 Gm. (60 grains).
Far wiMt conditions should blisters be applied? De-
scribe the application of blisters.
Blisters are applied for the purpose of producing counter-
irrttatton. The proper manner of employing a counter-irri-
tant to affect inflammation is not to apply it directly to an
actually inflamed area* but a little to one side of it, at a spot
kui^wu to be connected intimately with the diseased area by
ttcrvc fibers.
B>' wImI other name is liquor potassU hydroxidi Icnown?
Slate the dose.
la^u^>r |H>tassai hydroxidi is also called solution of potas-
sium h^'dix^xide. Its dose is 1 Cc. (15 minims), well diluted
Mention the antagonist of cocaine.
V»umv>titii Hiul aimi nitrite combat the earliest symptoms
s»!" oaixitsHo vlopr\*ssi\>u pnKhiced by cocaine. The most direct
auia>:i»irst is chU>nil: then follow chloroform, ether and mor-
ph:Mv*
III ^hat conditions is gallic acid useful?
vij4i!to tioid and its convener, tannic acid, are astringrents,
\\w Uwmor IviniT the feebler of the two. They constringe
•Iw iiiuxvular tissue in the walls of tJie minute vessels, thus
viuvk^Ui;: NWivtion and hemorrhage and cutting short local
lultuiwiiaiion. (Jallic acid is useful in hematuria, passive
*is':»io: rhas;os, ohixHiie cystitis, chronic diarrhea, bronchorrhea.
i;ui 'uiihl sweats.
THERAPEUTICS AND MATERIA MEDICA. 525
Describe the treatment of night sweats.
The following drugs are found useful in the treatment of
night sweats : Sulphate of atropine, in doses of l-75th gr. at
bed-time; gallic acid, in 15 gr. doses; camphoric acid, in 10
gr. doses ; and agaricine, in doses of y^ to ^ gr. Sponge baths
with weak solutions of alum and other astringents are some-
times employed.
For what purposes are diuretics employed?
Diuretics are administered with the object of increasing
the quantity of urine excreted: to promote the elimination of
waste products and other poisons from the blood: to dilute
the urine and to alter morbid conditions of the urine.
Give the source, the common name and the principal
therapeutic uses of oleum theobromatis.
Oil of theobroma is commonly called cacao-butter. It is a
fixed oil expressed from the seech of theobrama cacao, the
chocolate tree, which is found in Mexico, the West Indies,
and South America. Oil of theobroma consists chiefly of
stearin with a little olein. It has a demulcent action. Its
chief use is as a base for making suppositories.
What are the varieties of sinapis used in medicine?
How are they used and for what purpose?
There are two varieties of sinapis (mustard), sinapis alha
and sinapis nigra. It is directed, however, that pharmaco-
poeial preparations be made from black mustard only. Lo-
cally used, mustard is rubefacient, counter-irritant, and a
nerve stimulant, causing heat, redness and severe burning
pain. Its prolonged application pi*oduces vesication by in-
ducing local inflammation. Internally it is a local emetic in
full doses; in smaller doses it has a carminative action. On
the gastric mucous membrane its irritant effect is much less
powerful than on the skin. ^lustard is commonly used as
an application to relieve local pain and to produce counter-
irritation. Internally it may be employed as an emetic in
526 THERAPEUTICS AND MATERIA MEDICA.
indigestion or naTcotic poisoning. Its use as a condiment is
general. The oil of mustard is one of the most irritant of
the volatile oils, producing severe gastro-enteritis.
What are the causes and treatment of urticaria?
Urticaria is an inflammatory affection, characterized by the
eruption of pale-red, evaiie«cent wheals, which are associated
with severe itching. It is due to gas tro-in test ina! disturb-
ances and emotional excitement. Chronic visceral diseases
predispose. It is produced in susceptible individuals by cer-
tain articles of food, as well as the bites of insects, and by
certain drugs. Treatment: Remove lie cause when possible.
Especial attention should be paid to removing gastric irrita-
tion and securing a free movement of the bowels with a saline
laxative. The special remedies i-ecommended are the alkalies,
salicylate of sodium, quinine, iodide of potassium, atropine,
and antipyrine. Tjocally, lotions of water and alcohol, car-
bolic acid, boric acid or hydrocyanic acid are vei-y useful.
Name three drugs belonging to each of the following
classes: narcotics, diaphoretics, ecbolics.
Narcotics: opinra, hyoscyamus and alcohol. Diaphoretics;
pilocarpine, aconite and cocaine. Ecbolics: er^ot, oil of rue,
and savin.
What are the physiological effects and the therapeutic
uses of Phytolacca?
Phytolacca is an eme to-cathartic possessing slow hut per-
sistent action, with great nausea and considerable depression.
It lowers the rate of respiration and of cardiac action, and is
a motor depressant, paralyzing the spinal cord and the me-
dulla. Death occurs from paralysis of respiration preceded
by tetanic convulsions. The drug is said to possess alterative
properties, and has been used internally and externally in
chronic rheumatism and chronic skin affection. It produces
the absorption of adipose tissue, and has been used as a
remedy in obesity. Considering its physiologic aetion its em-
ployment is not justifiable.
THERAPEUTICS AND MATERIA MEDICA. 527
From what source besides nux vomica is strychnine
obtained? What other allcaloid is obtained from the same
source?
Strychnine is derived from Ignatia, St. Ignatius' Bean,
which contains the alkaloids, strychnine and brucine, about
1 per cent, of each.
How do borax and boric acid differ chemically and thera-
peutically?
Boric acid, H3BO3, is a weak acid occurring in transparent,
colorless, six-sided plates. It is odorless, of a slightly bitter
taste, and is soluble in 18 parts of water, in 15.3 of alcohol
and in 4.6 of glycerine at 25° C. Borax is the sodium borate
NajB^Oj + lOHjO ; it occurs in colorless, transparent prisms
of cooling and sweetish taste and alkaline reaction. It is
soluble in 20.4 parts of water at 25° C, and is insoluble in
alcohol. Boric acid may be produced from borax by the
action of sulphuric acid. The action of borax differs from
that of boric acid in being a more powerful antiseptic and
disinfectant, as well as being far more irritating when locally
applied.
Name the official preparations of gold and describe its
therapeutic uses.
Gold, aurum, has but one official salt, the gold and sodium
chloride, but triturations of the metal itself may be prepared
according to the general pharmacopajial formulre for such
preparations. Gold has been recommended in certain forms
of gastric disturbance, in chronic Bright *s disease, in certain
nervous disorders, in impotence, and in pertussis. It is not
generally employed.
What is the adult dose of (a) sulphate of atropine, (b)
tincture of cantharides, (c) tincture of colchicum?
(a) 0.0004 Gm. (V.^^ grain), (b) 0.3 C<;. (5 minims),
(c) 2 Cc. (30 minims).
528 THERAPEUTICS AND MATERIA MEDICA.
yviention three alkaloids which are chemically alike and
almost identical in physiologic effect.
CinchoniuEe Sulphas, Cinchonidinie Sulphas and Quiniditin;
Sulphas.
State the cause and give the treatment of trichinosis.
TriclihiotiiM is a typhoid coudition resulting from the en-
trance of a parasite, the trichinn spiralis, into the intestinal
canal and the subsequent mij^ration of these parasites into
the muscular structure. Tho trichina: are introduced into the
human body by eating infected hog's flesh, either raw or im-
perfectly cooked. The preventive treatment cousisis in eatiny
no pork that has not been perfectly cooked. If the parasites
have been recently talten. emetics and purgatives are indi-
cated. After migration has begun the powers of life should
be sustained by nourishing food, stimulants and tonics.
What drug is antagonistic to pilocarpine?
Atropine in dose of 1-100 gr. for each '/i gr. of pilocarpine.
Where is the habitat of belladonna?
It is indigenous in the moimtainous districts of central
and southern Europe and A«a, and is cultivated in Europe
and in the United States.
What are the sources of sulphur?
Sulphur is Obtained native in several volcanic districts or
from the native sulphides of iron and copper by roasting, as
it sublimes at about 238" F.
In what dose may the oil of winlergreen be adminis*
tered to an adult for rheumatism?
Averjige dose, 1 Ce. (15 miiiims).
How is nitrite of amyl administered and for what pur*
pose?
Nitrite of amyl is indicated for the same general conditions
as nitro-glycerin. It is generally prescribed in glass pearia
containing 3-5 minims, and these are broken in a handker-
THERAPEUTICS AND MATERIA MEDICA. 529
chief and inhaled. It is a valuable heart stimulant, checks
spasms and dilates peripheral vessels. It is especially em-
ployed for the relief of attacks of angina pectoris.
Describe the therapeutic uses of sparteine and state the
dose of the sulphate for hypodermic uses.
Sparteine is the alkaloid of Scoparius, Broom, and is a
valuable diuretic and heart stimulant. Its dose hypoder-
mically is 0.010 Gm. (l^ grain).
What are the physiologic effects and the thereapeutic
uses of the balsam of Peru?
Balsam of Peru is employed locally as a sedative and para-
siticide. Internally it is of value as an expectorant in chronic
bronchitis. This balsam is antiseptic, disinfectant, stimulant
to the circulation and sedative to the nervous system, acting
chiefly on the mucous membrane; it is a tonic and expec-
torant, diuretic and diaphoretic.
Give the common name, therapeutic uses and dose of
sodium sulphate.
Glauber's salt; it is a powerful purgative; average dose,
16 Gm. (240 grains).
Describe the therapeutic uses of sodium chloride.
A bath may be made more stimulating for debilitated
patients by the addition of a few ounces of salt to the water.
An enema containing one or two tablespoonfuls of salt to the
pint of water is sometimes used effectively against thread-
worms. The subcutaneous or intravenous injection of a
three-tenth per cent, solution of sodium chloride has proven
of marked benefit in cholera, uremia and acute anemia from
hemorrhages.
State the composition and therapeutic uses of pulvis
jalapae compositus.
Compound powder of jalap contains of jalap 35 parts, of
potassium bitartrate 65 parts, rubbed together until thor-
34
530 THERAPEUTICS AJiD MATERIA MEDICA.
oughly mixed. It is much employed to produce free watery i
evacuations in ascites and anasarca. Since it is nearly taste-
less, it is a useful cathartic for children.
What is a physiologic action of camphor in medicinal
doses on (a) the skin, (b) the circulation?
(a) Rubefacient; (b) increases the pulse-rate and raises
arterial tension.
Describe the forms of poisoning by ergot.
There are two forms, the acut« ergotism and chronic ergot-
ism. The symptoms of the acute form are nausea, vomiting,
colic, diflieult micturition, and purging. The drug slows the
heart, raises arterial tension, dilates the pupil, and produces
vertigo. It stimulates the contraction of unstriped muscle
fiber, especially affecting the sphincters and uterus. In very
large dose it produces cerebral and spinal anemia and violent i
convulsions. There are two varieties of the chronic ergot i
poisoning, the convulsive and the gangrenous. The convul- i
sions are tetanoid spasms of the flexor muscles, the uterus, the i
intestinal fibers and muscles of respiration, ending in coma ,
and death by asphyxia. The gangrenous form begins with .
coldness and numbness of the limbs, formication of the skin,
loss of sensibility and abolishment of the special senses, bullie
of blood and ichor, followed by dry or moist gangrene of the
lower extremities, buttocks and other parts, epileptiform con-
vulsions, coma and death.
In what pathologic condition is veratrum viride useful?
Locally, veratrum is of value in neuralgia. Internally thft
di^g is advised by some in the early stages of sthenic pneu-
monia and in puerperal eclampsia.
Mention the therapeutic uses of phenacetine.
It is antipyretic, analgesic, and hypnotic. It is useful in J
■whooping-cough and in rheumatic and other fevers.
\
I
%
THERAPEUTICS AND MATERIA MEDICA. 531
Give the name of the alkaloid of Calabar and state its
4lose.
Physostigmine (or eserine). The dcxse of the sulphate is
0.001 Gm. (Ve4 grain).
Mention three vegetable emmenagogues and state the
dose of each.
Ergot, the dose of the fluid extract is 2 Ce. (30 minims) ;
fiavin, the dose of the fluid extract is 0.3 Cc. (5 minims) ;
tansy, the dose of the oil is 1 to 3 drops.
Define therapeutic incompatibility, chemical incompati-
bility.
Therapeutic incompatibility arises when two agents are
administered together which oppose each other in their physi-
ologic actions. Chemical incompatibility is due to the union
■of two or more substances in combination whereby chemical
change results.
Write a prescription containing dilute hydrochloric acid,
syrup of wild cherry and camphor water for a cough.
Write on this prescription the dose for an adult.
Jan. 1, 1903. Mr. John Smith.
B . Acidi hydrochlorid dil f 3 ▼
Aquee camphone f ,^ i
Syr. Pruni virginianse q. s. ad f 3 1^
M. Sig. — Teaspoonful every four hours.
Wm. Jones, M. D.
State the dose of (a) fluid extract of belladonna, (b)
-extract of conium.
(a) 0.05 Cc. (1 minim), (b) 0.2 Cc. (3 minims).
In what pathologic conditions is uva ursae used?
Uva ursae is employed as an antiseptic and stimulating diu-
retic in chronic inflammatory affections of the genito-urinary
Iract, such as pyelitis, cystitis, and urethritis.
532 THERAPEUTICS AND MATERIA MEDICA.
State the name and the dose of each of five ofHciaf
preparations of opium.
Opii pulvis, 0.065 Om. (1 grain) ; extract of opium, 0.030
Gm, {1/2 grain) ; tincture of opium, 0.5 Cc. (8 minims) ; cam-
phorated tincture of opium (paregoric), 8 Ce. (2 fluid-
drachms) ; wine of opium. 0.5 (..'c. (8 minims).
In what diseases are preparations of arsenic useful?
Ixwally, arsenic is useful in lupus and epithelioma. It is
a valuable alterative in diabetes, chronic rheumatism, phthisis
aud asthma. In malaria it ranks next to quinine; in the
simple chorea of childhood it is almost a speeiftc. It is of
great value in anemic conditions.
Slate the name and dose of a drug belonging to each of
the following classes: (a) emetics, <b) diuretics, (c) dia*
phorelics, (d) cathartics.
(a) Ipecac, the emetic dose of the fluid extract iii 1 Cc.
(15 miuinis) ; (b) digitalis, the dose of the infusion is S Cc.
(2 Hiiidrachms) : (e) pilocarpus, dose of fluid extract is 2
Co. (30 minims) ; (d) jalap, the dose of the compound jalap-
powder is 2 Om. (30 grains).
State the name and the alterative dose of a preparation
of mercury capable of producing acute poisoning. Men-
tion the chemical antidote for this preparation.
Bichloride of mercury; dose. 0.00.3 Gni. ('/oj grain). In
oases of poisoning by corrosrive sublimate the stomach should
be evacuated, the body temperature maintained, and egg
nihumin given in Ixrge quantities as an antidote.
How should asthma of cardiac origin be treated?
The term cardiac asthma is applied to any shortness of
bn'utli which is the result of deranged cardiac action. The
treatment is, of course, the treatment of the diseases which
are responsible for it. Rest in bed in most important. The
oardiac condition may indicate the need of digitalis if, for
inNtance, mitral regurgitation exists with loss of compensa^
THERAPEUTICS AND MATERIA MEDICA. 533
tion; strychnine should be given if the heart muscle is weak;
nitro-glycerine may be given in the early stages of arterial
sclerosis. The particular treatment will depend upon the
condition of the circulation.
Outline the treatment of uremia.
The name uremia is applied to a group of symptoms result-
ing from the retention of toxic materials in the blood which
should have been eliminated by the kidneys. Sweating should
be encouraged by the use of hot-air or vapor baths. Cath-
arsis should be induced by croton oil in one-drop doses or
by elaterium in % grain doses. The renal engorgement may
be relieved by a dry or wet cup to the loins. Venesection is
indicated if the patient is robust find the pulse is strong. If
the pulse is weak, heart stimulants should be administered.
If convulsions occur, 30 to 40-grain doses of chloral may be
given by the rectum, or nitrite of amyl inhaled.
Describe the treatment of apoplexy due to cerebral
hemorrhage.
During the attack the head and shoulders should be slightly
elevated and an ice-bag applied to the head. Prompt cath-
arsis should be produced by croton oil, in a little glycerin,
placed on the back of the tongue. If the pulse be strong,
bleeding is indicated; if the pulse is feeble, hypodermic
injection of such stimulants as strychnine should be em-
ployed. Bed sores must be prevented by frequently chang-
ing the patient's position and sponging with alcohol the
parts exposed to pressure. During convalescence those pre-
disposed to such attacks should lead a quiet life and avoid
excitement. Iodide of potash should be administered over a
long period. After the primary rigidity has appeared in the
affected muscles galvanism and massage may assist in restor-
ing lost functions.
State the official name and the minimum poisoning dose
JSD MATERIA MEDIC A.
(b) moffphlne sulpliatet (c>
The fatal dose of atrydmine
TaQrlor at ^ to 2 giains for an adult,
after maeh larger doaea. The
kydnle^ tannic add and animal ehar-
b/ IkapbiDK aid^ikaa. Tozie doae dependa on per-
i f gnin of morphine aolpfaate has killed
iganate la the beat antidote if
*3» amrpmum i»m Aa atanadi; blaek c<^ee and atropine are
4i. viWMk e.> Chifimt hydrate haa cauaed death in aeveral in-
i^S* ^ i^-grabi doae. Atropine ia its antidote.
c—taiiring the tincture of the chlor-
of potaaht with the proper doae
JoHH Smith.
• gr. XTi.
f3«
3i
\Hi>Mi»» «i.al fJiT
S(- ^ A :iwpouoful in wmter eveiy three hours.
John Jones, M. D.
ilh( following prescription:
.^ UMitm^jU f ^ ii
N^. .V ««»(MOUiuI ev«rT fonr hours.
. •«< Dr. J.
'•^5^ ^ vij Aiiiu^ut* of pharmaceutical incompatibility. An
.ivi'.t V siKmld not be prescribed with aqueous solu-
x<,vi4i^ vsitK»us tinctures be combined with aqueous
. V -»'-»■
>..iiif ^tf4«r<^ ^t carbo ligni? What are the thera-
x^«v •^•r«<^* vi«r^ S^ni?
1^ V S'** "^ *Ui:\v<iI Jt*rived from soft wood. It is em-
,i vi.v^vrVttc v»f foul gases and as a deodorant and
-. 'S^
THERAPEUTICS AND MATERIA MEDICA. 535
disinfectant. Internally it is useful in aflfeetions of the
gastro-intestinal tract associated with hyperacidity and flat-
ulent distension.
Give the dose of (a) caffeine, (b) wine of ipecac.
(a) 0.065 Gm. (1 grain) ; (b) 1 CJc. (15 minims).
What are the therapeutic uses of convallaria majalis?
Lily-of-the-valley possesses actions analogous to digitalis,
strengthening the heart and increasing the flow of urine; it
does not disturb the stomach and is not cumulative in its
effects.
Define a general anesthetic. Mention three general
anesthetics in common use.
A general anesthetic is a drug which when inhaled suflS-
ciently produces complete unconsciousness and loss of sen-
sation, also lessened motor power. The general anesthetics
mostly belong to the alcohols and ethers. Ether, chloroform
and nitrous oxide are three examples of such drugs.
Mention three principal salts of potassium nised in medi-
cine and give the dose of each.
Potassium bromide, dose 1 Gm. (15 grains) ; potassium
acetate, dose 2 Gm. (30 grains) ; potassium bicarbonate, dose
2 Gm. (30 grains).
Of what is duboisine an alkaloid? What are the physio-
logic effects of duboisine?
Duboisine is the alkaloid of duboisia; it is believed to be
identical with hyoscyamine, and strongly resembles atropine.
It is a prompt mydriatic. In moderate doses it induces quiet
and refreshing sleep, and is not dangerous. When given in
large doses it may produce vertigo, nausea or syncope. It is
less irritating to mucous membranes than atropine.
What are the therapeutic uses of nitro-glycerin? By
what other names is nitro-glycerin known?
Nitro-glycerin is also known as glonoin and trinitrin. It
536 THEHAl'EUTWS AND MATERIA MEDICA.
is valuable in flertain forms of cardiac disease, especially in
sudden heart failure, angina, pectoris and fatty degeneration
of the heart. It relieves the high arterial tension and the
dyspnea of chronic nephritis.
Define materia medica, therapeutics.
Materia medica treats of the substances used as medicines
and describes their origin, composition, chemical properties,
modes of preparation and administration, also their physio-
logic and toxicologic actions. Therapeutics comprises all the
science and art of healing, including the use of medicines and
all other agents given with the object of curing disease.
What are the therapeutic uses of sulphur?
Externally it is of value aa a stimulant and parasiticide in
diseases of the skin of chronic type. Internally it is a mild
laxative. It is of use both internally and externally in
chronic articular rheumatism.
Outline the general treatment of acute articular rheu-
matism. Write a prescription containing at least two
ingredients fbr an adult to relieve pain in acute articular
rheumatism.
Rest in bed is essential. The joints should be wrapped in
cotton-wool. The nourishment should consist of milk, beef
tea, bralhs and gruel. The free use of lemonade or mineral
waters is advisable. The best remedies are the salicylates
and the alkaline salts of potassium. The following is a use-
ful combination:
B. SodiisalicyUt. 3>i
Pol&ga. citrat. • . ■ • ,^ in
Gl^cerini.
TincL cardamom, comp an C^ts
Aqtuc, q. a. sd f ,^ t. M.
Sig.— A [flbleepoonful everv two lumrs.
What are the therapeutic uses of strophanthusV Men-
tion the dose of the tincture of strophanthus.
StrophanlbiLS is a valuable cardiac tonic, and may be em-
THERAPEUTICS AND MATERIA MEDICA. 537
ployed in the class of cases in which digitalis is indicated.
The dose of the tincture is 0.5 Cc. (8 minims).
Define official preparations as applied to preparations of
medicinal agents.
All of those drugs which have gained entrance to the Phar-
macopoeia are termed official preparations.
What are the therapeutic uses of cardamom?
It is used as an agreeable aromatic for disguising the taste
of other drugs and as a carminative.
Describe gelsemium. State the dose of the preparations
of gelsemium.
Yellow jasmine is the rhizome and roots of gelsemium sem-
pervirens, a climbing plant of the natural order TiOganiceae,
with showy yellow flowers. It grows in the forests of the
southern United States. It contains a volatile oil, a resin
and an alkaloid, gelsemine, in combination with gelsemic acid.
Preparations are the fluid extract, dose 0.05 Cc. (1 minim) ;
the tincture, dose 0.5 Cc. (8 minims). Gelsemium itself is
given in, dose of 0.065 Om. (1 grain).
Mention the therapeutic uses of iodine.
Iodine is a useful counter-irritant. Internally it is used
chiefly for its alterative effect. In the form of Lugol's solu-
tion (2 or 3 drops) it will sometimes control obstinate vom-
iting.
State the physiologic effects of physostigma on the res-
piration, the heart and the pupil of the eye.
Small doses do not affect the circulation or respiration, but
toxic doses kill by paralyzing the respiratory center. The
arterial pressure is raised by the drug stimulating the heart
or its contained ganglia, and probably also by stimulating the
vasomotor center. Toxic doses paralyze the heart. Physo-
stigmine powerfully contracts the pupil. This results from
stimulation of the peripheral fibers of the oculo-motor nerve
538 THERAPEUTICS AND MATERIA MEDIC A.
filaments of thi; aympa-
and from paralysis of the periplierji
thetic nerve.
Describe the physiologic action of phosphorus.
In small doses phosphorus stiumlates the brain and circu-
lation, the functions of the stomach and the genital organs
auu the growth of bones. It aids digestion by irritating the
end organs of the gastric nerve, but produces eructations of
hydrogen phosphide.
Outline the therapeutic uses of atropine.
Atropine is used in poisoning by opium, physostigma and
hydrocyanic acid. In ptyaliara from mercury, pregnancy,
etc., in the sweats of phthisis, in sudden cardiac failure, and
as a mydriatic. It is very useful in lead -poisoning, combined
with potassium iodide. It is useful as hemostatic in profuse
metrorrhagia after abortion, in metrorrhagia of obscure
origin, and in the hemoptysis of phthisis.
Define sialagogue. Give an example of (a) topical siala-
gogue, (b) general sialagogue.
Sialagogues are agents which increase the secretion and
flow of saliva and buccal mucus. Topical sialagogues act by
reflex stimulation, as tobacco and mustard. General siala-
gogues act through their influence on the glands or their
secretorj- nerves, as pilocarpine and the mercurials.
For what pathologic conditions is camphor used?
Camphor may be employed in diarrhea, cholera, vomiting,
cardiac depression, nervousness and nervous headache, the in-
fectious fevei-s, dysmenorrhea, after-pains, and catarrhal con-
ditions. Locally it is of u-sc wherever counter- irritation or a
local anodyne is required.
Give the official name and the composition of (a) Fow
ler's solution, (b) Donovan's solution.
Solution of potassium arsenite is a 1 per cent, solution pre-
pared by boiling together arscnous acid 1, potassium bicar-
bonate 2, compound tincture of lavender 3, and distillecf
I
THERAPEUTICS AND MATERIA MEDICA. 539
water to 100 parts. The solution of arsenous and mercuric
iodides (Donovan's solution) contains arsenous iodide and
mercuric iodide, of each 1 part in 100 of distilled water.
State the dose of (a) spirit of nitro-glycerin, (b) wine
of colchicum (sein.)f (c) extract of colocynth.
(a) 0.05 Cc. (1 minim) ; (b) 2 Cc. (30 minims) ; (c) 0.030
Gm. (V^ grain).
Describe the therapeutic applications of sulphate of
copper.
It is a prompt and efQcient emetic, and is so used in croup
and narcotic poisoning. In phosphorus poisoning it forms a
comparatively insoluble phosphide of copper, besides produc-
ing emesis. It is of value in acute diarrhea and chronic
dysentery combined with opium. Locally it is employed in
throat aflfections, gonorrhea, granular lids, corneal ulcers,
and chronic inflammation of mucous membranes.
Mention (a) a hydrogogue, (b) a cholagogue. State the
dose of each.
(a) Elaterium, the active principle, elaterin, is given in
doses of 0.005 Gm. (V,„ grain) ; (b) podophyllum, dose 0.500
Qm. (71^ grains).
Mention four remedies used to control vomiting and
state the dose of each.
Cerium oxalate, 0.065 Gm. (1 grain) ; subnitrate of bis-
muth, 0.500 Gm. (71/^ grains) ; cocaine hydrochloride, 0.030
Gm. (1/^ grain) ; acid carbolic, 0.065 Gm. (1 grain).
Write a compound prescription for an adult suffering
from insomnia.
Jan. 1, 1903. Mr. John Smith.
B . Potaf«8ii bromidi ^ iv
Chloralis hydratis. ,:; iii
Tincturae assafoetidse f .? iv
Synipi f ;5 vi
Aquae, q. s. ad ^.^ ^i
M. Sig. — Tablespoonfiil every two hours until sleep is induced.
Jos. Jones, M. D.
540 TBEHAFEVTlCii AND MATElilA MEDICA.
What are the uses of apomorphine?
In narcotic poisoning, such as from opium or alcohol, apo-
morpliine is a. valuable emetic. When the eireulation is weak
it must be given cautiously. It is of service a^ an expectorant
in the dry stage of acute bronchitis and in chronic brouchilis
■when the expectoration is viscid and scanty. The emetic doise
of apomorphine hydrochloride is 0.005 Om. ('/,o grain) in
alcohol. As an expectorant by the mouth the dose is 0.002
Gm, ('/,„ grain).
State the effect of amyl nitrite on the vascular system.
The inhalation of nitrite of amyl is speedily followed by
flushing of the face, fulness in the head, quickening of the
pulse and a fall of the Wood -pressure. The flushing is due
to dilatation of the arterioles, brought about partly by de-
pression of the vasomotor centers and partly by direct action
on the blood-vessel walls. The quickening of the pulse re-
sults from a depression of the cardiac inhibitory centers in
the medulla. The fall of blood- pressure is mainly due to dila-
tation of the vessels. Upon the heart the drug acta primarily
as a stimulant, but in large amounts it soon acts as a cardiac
depressant.
Describe asafetJda and outline its physiologic effects.
Asafetida is e gum-resin obtained by incision from the
living root of ferula fetida, a perennial herb of the natural
order Umbelliferffi, native of Persia and Afghanistan. It*
principal constituent is a sulphuretted volatile oil; it also
contains a gum and a resin. It is a powerful anti-spasraodic,
a stimulant to the brain and nervoita system, a stimulant ex-
pectorant; also tonic, laxative, diuretic, diaphoretic, emmena-
gogue, aphrodisiac and anthelmintic in action.
State the effect of the bromides on the respiration and
on the action of the heart. What effect is the long con-
tinued use of the bromides liable to produce on the mental
faculties?
The bromides reduce the number of the respirations,
THERAPEUTICS AND MATERIA MEDICA. 541
the heart's action and force, and lower the arterial tension.
The continued use lessens the activity of the brain-cells, pro-
ducing weakness of mind and somnolence.
In what diseases is conium used?
It is especially indicated in diseases characterized by exces-
sive motor activity. It is useful in chorea, paralysis agitans,
in acute mania, and delirium tremens ; it is also employed in
tetanus, asthma, whooping-cough, and other spasmodic affec-
tions.
Define diaphoresis. Mention three diaphoretics and
state the dose of each.
Diaphoresis is a condition of sweating. Aconite, veratrum
viride, and the salicylate of sodium. The dose of aconitine is
0.00015 Gm. (V400 grain). The tincture of veratrum, 1 Cc.
(15 minims). Salicylate of sodium, 1 Gm. (15 grains).
Mention ten drugs, the use of any one of which may
cause slcin eruption.
Aconite, antimony, antipyrine, atropine, quinine, tar, tur-
pentine, salicylic acid, mercury, opium.
Write a prescription containing a stomachic to be used
in alcoholism.
B . Tinct. Nucis V^oniica? f 3 ii
Tinct. Gentianse Co f S iv
M. Sig. — Teaspoon ful before meals.
What is the alkaloid of hyoscyamus? What is the dose
of hyoscine hydrobromide for hypodermic use?
It contains an alkaloid, hyoscyamino. The dose of hyos-
cine hydrobromide for hypodermic use is 0.0005 Gm. (^/ijg
grain) .
In what form is iodine most frequently administered in-
ternally? What is the antidote for free iodine?
Potassium iodide. Starch is the antidote to free iodine, but
THERAPEVTlC.
the stomach must be immediately evacuated, as the iodide of
starch is not inactive.
Mention three commonly used myotics.
Eserine is the only myotic generally employed in ophthal-
mic practice. Opium and pilocarpine are two other drugs
possessing myotic effects.
State tlie effects of alcohol and strychnine on the arte-
rioles.
Alcohol causes a dilatation of the arterioles, while strych-
nine contracts tie arterioles, except in very large doses, when
it produces i-elaxation of tl)e smaller vessels.
and give the treatment of gastro-
Describe the symptom
duodenitis.
The symptoms of gastro-duodeniLis partake of gastritis
with an enteritis added, fever, gastric pain and vomiting, in
addition to which there may be colic and diarrhea. Simple
catarrhal jaundice will result from an extension of a gastro-
duodenitis into the common duct. The general symptoms of
this condition arc jaundice, loss of appetite, nausea, vomiting.
a sense of fulness and constipation or irregular action of the
Imwels; there may also be slight fever. The treatment con-
sists in saline aperients, which reduce the catarrhal inflam-
mation; and second, the use of such foods as do not require
the bile to facilitate digestion. Skimmed milk, animal broths
and e^g albumen and copious drinking of water are advised.
Mention the chief alkaloids and the therapeutic class of
belladonna and of Calabar bean.
Belladonna contains two alkaloids, the official atropine
and hyoscyamine. Belladonna is a deli rifac lent. Calabar
bi'iin contains physostigmine (eserine). It is a depreaso-
miilor.
I
THERAPEUTICS AND MATERIA MEDICA. 543
Mention a soluble salt of lead. To what therapeutic
class does bismuth subnitrate belong?
Lead acetate. Bismuth subnitrate is classed with astrin-
gents.
What is the physiologic action of Indian hemp?
Cannabis indica, Indian hemp, produces in full doses a con-
dition of mental exhilaration associated with liallucinations
and disordered consciousness of time, locality and personality.
This stage of excitement finally gives way to sleep, which may
last for several hours. Sensation is perverted and benumbed,
and before sleep is induced there is often more or less general
anesthesia. The drug has little influence upon circulation
and respiration.
What is the physiologic action of veratrum viride on the
circulation?
It lessens greatly the force and rate of cardiac pulsation
and reduces arterial tension by depression of the vasomotor
center and of the heart itself.
Give the physiologic action of senna and state what part
of it is used in medicine. Where does senna grow most
abundantly?
The leaflets of Cassia acutifolia and of Cassia angu^tifolia ;
the former grows in Egypt and the latter in southern India.
Senna is a brisk cathartic, producing in three or four hours
after its ingestion copious watery stools. It acts by increas-
ing both peristalsis and the intestinal secretion. It is ab-
sorbed by the circulation.
Describe bromism and state how it is produced.
Bromism is produced by the continuous administration of
bromides. The condition is characterized by anemia, fetor
of the breath, gastric disturbance, diminution of the reflexes,
unsteady gait, impairment of tactile sensibility, abolition of
sexual function, mental depression, failure of memory, som-
nolence, and a general eruption of acne.
544 THERAPEUTICS AND MATERIA MEDICA.
What are the therapeutic uses of sodium salicylate?
It is of value as an antipyretic, as an auti-rheumaUc and
an ti- neuralgic. It is of the greatest service in pleurisy with
nerous effusion, and is often useful in diabetes. When given
early it will often abort toiisilitis. It is of service as a
Kastro-intealinal disinfectant.
Give the dose of pilocarpine.
The dtise of pilocarpine hydrochloride is l.).01 Gin. {1,5
grain ) .
Describe the therapeutic uses of hydrochloric acid.
It is employed internally in the treatment of dyspepsia
associated with subaeidity. It is useful as a refrigerant and
digestant in the continued fevers. In conjunction with
strychnia it is of value in intestinal indigestion. The strong
acid is also an escharotie.
What are the principal uses of calcium chloride? To
which ingredient does it owe its energy?
Calcium chloride is of value as an interna! remedy in the
various manifestationa of the strumous diathesis and to arrest
bleeding. It often causes the resolution of glandular enlarge-
ment, and is of value in chorea, lupus and eczema. It owes
its energy to the calcium contained.
What are the symptoms of opium poisoning?
Unless the dose has been very large there is at first a stage
of excitement, in which the imagination is stimulated and
the feelings exalted. This stage is soon followed by depres-
sion ; the patient becomes stupid and drowsy, and finally falls
asleep. The sleep deepens into coma, the pulse becomes slow
and full, the pupils contracted, the respiration slow and heavy
and the face suffused. At this time it is still possible to
arouse the patient by a loud noise, flagellation or shaking.
In the third stage the coma becomes absolute, the pulse rapid
and feeble, the breathing shallow and irregular, the skin
THERAPEUTICS AND MATERIA MEDICA. 545
moist, the muscles relaxed, the pupils dilated, and finally
death- results from paralysis of the respiration.
Mention the remedy which will arrest the secretion of
milk and state how it should be employed.
Camphor used locally by inunction in saturated solution of
olive oil is efficient in checking the secretion of milk, as is
belladonna.
Give the methods and the therapy 9f cold water treat-
ment applied externally.
Cold water may be applied in the form of cloths saturated
with it, by sponging, bathing or packing with ice. The cold
bath is the most frequently employed. A bath-tub half full
of water at 70° P. is kept in readiness at the bedside of the
patient, and whenever the temperature rises above 102.4° P.
the patient is wrapped in a sheet and carefully lifted into the
tub. While in the bath cold aflfusions should be applied to the
head, and the body should be constantly subjected to gentle
friction and massage, so as to bring new relays of blood to
the surface. A stimulant is often necessary to counteract the
shock. After remaining in the water 15 to 20 minutes he is
placed in a dry sheet and covered with a light blanket.
What are the therapeutic uses of alchohol?
The question of the advisability of employing alcohol in
medicine has given rise to never-ending controversy. Many
give it a high place, while others do not employ it at all. The
external and local use of alcohol includes many applications
of its antiseptic, refrigerant and rubefacient qualities. In
the form of champagne it is especially valuable in controlling
vomiting. A single dose of whisky or brandy is an efficient
combatant of fainting or of collapse. In fevers it acts as an
antipyi*etic, a food, and promotes sleep. It is well to with-
hold it until the first sound of the heart becomes feeble and
dull, and then to use it boldly. It is of especial value in the
treatment of pneumonia, typhoid fever and snake-bite.
35
546 THEKAPEVTIl
Mention the physiologic effects of bryonia. What is the
dose of the tincture of bryonia?
Bryonia is a pure irritant, setting up local inflammation
wherever it is applied. It has a vesicant action on the skin,
and is violently irritant to the serous and mucous membranes.
It produces cerebral congestion, wit!i frontal headache and
vertigo. It is a drastic purgative and a powerful diuretic
It causes in full dose hepatic and renal congestion, vesical
tenesmus, and depri^ion of the heart's action. The dose of
the tincture is 5 drops to ^ ounce.
State the dose of aconitine.
0.00015 Gm. (V.oo grain).
Give the composition and state the uses of lotio hydrar*
gyri flava.
Yellow wash is a favorite application for syphililic sores.
It is prepared by adding 18 grains of corrosive sublimate to
10 ounces of lime-water, producing the yellow oxide.
Give indications for the internal use of bichloride of
mercury. State the dose of bichloride of mercury for in>
ternal use.
It is of \'alue in anemia, as an absorbent in diphtheria, as
a general alterative, and is highly prized as an an ti -syphilitic
remedy in the secondary and tertiary stages. The dose is
0.003 Gm. (V„ grain).
What are the principal therapeutic uses of the salt of
lead?
Lead salts are chiefly used as astringenta and hemostatica.
The acetate is an efficient internal styptic. The nitrate is of
value locally in epithelioma and unhealthy grauulations. The
iodide is employed locally to enlarged lymphatic glands and
in chronic skin affections. The carbonate is only used exter-
nally to protect irritated surfaces, such as intertrigo, etc.
I
THERAPEUTICS AND MATERIA MEDICA. 547
Explain the constipating action of opium.
Opium arrests all the secretions except the milk and the
sweat, and retards the digestive juices. The biliary €ind
glycogenic functions of the liver are affected and metabolism
greatly reduced. Its constipating action is produced chiefly
by stimulation of the inhibitory nerves of the intestines
through the splanchnics.
Mention tlie symptoms of poisoning by phospliorus.
Toxic doses of phosphorus produce, after the lapse of a few
hours, a garlicky taste in the mouth, thirst, intense abdominal
pain, obstinate vomiting, restlessness and prostration. The
ejected materials contain mucus, bile, and occasionally dis-
integrated blood, and are luminous in the dark. At the end
of 24 or 36 hours the symptoms gradually subside and the
patient feels comparatively comfortable, but soon jaundice
develops, the vomiting and pain return, the liver becomes
enlarged and painful, the urine contains albumin, bile, hypo-
phosphoric acid and crystals of leucin and tyrosin. The
tongue is coated, the breath offensive, the belly distended, the
bowels either constipated or loose, and the stools clay-colored.
Death is generally preceded by grave nervous symptoms, such
as headache, delirium, convulsions, stupor and coma. When
recovery follows, convalescence is protracted.
Write a prescription containing a sedative and an ex-
pectorant for a bronchia! cough in a three-year-old child.
Jan. 1, 1903. For Walter Smith.
H • Tinctura opii camphoratse gtt. Iziv
Potassii citratis ,!^ ii
Synipi pnini virginiana?, q. s. ad f 5 iv.
M. Sig. — Teaspoonfnl every four hours.
Wm. Jones, M. D.
In what patholos:ic condition is jaborandi useful?
It is of use in dropsy, especially of renal origin, in uremia,
Inflammation of the serous membranes, in diabetes insipidus,
548 TEERAPEUTICS AND MATERIA MEDWA.
but is contra- indicated when the heart's action is weak. It
is useful in the form of a lotion for alopecia.
What is the dose of carbolic acid for internal adminis-
tration?
Dose 0.065 Gni. (1 grain), -well diluted.
What is the common name of lactucarium? State the
physiologic action of lactucarium.
Lettuue, Laetucarium is feebly hynotic and somewhat
sedative and diuretic. The syrup is a good vehicle for ex-
pectorants and anti-spasmodies.
What is the physiologic action of colchicum?
Emetic, diuretic, diaphoretic, a drastic purgative and car-
diac depressant, gas tro- intestinal irritant. In small doses it
is an emeto-eathartie.
What serious results may ensue from indiscriminate use
of acetanilide?
A toxic dose destroys the oxygeu-earrj'ing function of the
blood and forms methyl-hemoglobin, causes fatty degenera-
tion of the heart, liver and kidneys in animals poisoned by it.
When administered continuously or in too great dose it is apt
to cause subnormal temperature, cyanosis and collapse.
What is cascara sagrada? State the dose of the fluid
extract of cascara sagrads.
It is the bnrk of Rliannius pnrshitina, California buckthorn.
The dose nf the fluid extract is 1 Cc. (15 minims).
What are the therapeutic uses of tincture of capsicum
internally administered? State the dose of the tincture
of capsicum.
It is employed chiefly as a stomachic and carminative. A
weak solution of the tincture is also a much used gargle in
Bore throat with relaxed uvula. The drug is especially vain-
THERAPEUTICS AND MATERIA MEDICA. 549
able in alcoholic gastritis and obstinate constipation. The
dose of the tincture is 0.5 Cc. (8 minims).
What part of aconite is used in medicine? What is the
alkaloid of aconite?
Aconite is derived from the root of the aconitum napellus.
Its most important alkaloid is aconitine.
Write a prescription for corrosive sublimate to be used
as a parasiticide.
Jan. 1, 1903. For John Jones.
Hydrargyri bichloridi gr. ii
Unguenti petrolati f 5 i.
M. et Sig. — Use locally. John Smith, M. D.
How is liquor ammonii acetatis prepared? In what
conditions is this preparation useful?
Spirit of Mindererus is prepared by neutralizing dilute
acetic acid with ammonium carbonate; it should be freshly
made, as it soon deteriorates. It is an active diuretic if the
body be cool, and a diaphoretic if the body be warm. In
wineglassful doses it will counteract many of the immediate
effects of alcohol.
What is the common name of staphisagria? What are
the therapeutic uses of staphisagria?
Staphisagria, commonly known as stavesacre, is a violent
emetic, cathartic and parasiticide.
Mention the preparations of ammonia. What effect has
ammonia on the heart?
The oflBcial preparations are aqua ammonia?, aqua ammonise
fortior, linimentum ammoniaB, spiritus ammoniaB, spiritus am-
moniaB aromaticus. Moderate doses of anmionia increase the
strength and rapidity of the heart, and Uiis effect is produced
by a direct stimulation of the heart and its accelerator nerves.
550 rUERAI'EUTICS AND MATERIA MEDICA.
Write a compound prescription for an adult containing
iron, quinine and opium in pill form for neuralgia.
Jab. 1, 1B03. John^mith-
ii. Pulverifl opii gr. x
Ferri sulphatis eiaiccaia:,
QuininiB sulpbalU aa gr. ix.
M. et fiant in pilula; No. 20.
Sig. — Onu everj four hours. ■ JoBN Jokes. M. U.
De6ne tincture and spirits.
Tinctures are alcoholie solutions of medicinal substaDces.
Spirits are alcoholie solutions of volatile substances, which
may be solids, liquids or gases. Tinctures, with the exception
of the tincture of iodine, are made from non-volatile bodies.
Mention three drugs used to accelerate the action of the
heart and give the dose of some preparation of each.
Atropine; dose of atropine sulphate, 0.0004 Gm. ('/,„
grain). Nitro-glycerin ; dose of spirit, 0.05 Ce. (1 minim).
Ammonia; dose of the aromatic spirits, 2 Ce. (30 minims).
Give the treatment of obstinate hiccough,
Bhythmi* traction of the tongue will often arrest obstinate
hiccough. Ether as a spray to the epigastrium for ten min-
utes, then to the site of the phrenic in the neck, is also ad-
vised. Morphine hypodermatically, either alone or in combi-
nation with atropine, has sometimes proven effective.
What is the physiologic effect of cocaine on the ocular
conjunctiva, the pupil of the eye and the salivary and
sweat glands.
Cocaine dropped upon the conjunctiva causes dilatation of
the pupil and profound anesthesia of that membrane; it also
produces partial paralysis of accommodation, slight laehry-
matjon, and sometimes temporary ptosis. It lessens the
secretion of the salivary glands and the sweat glands.
THERAPEUTICS AND MATERIA MEDICA. 551
I
Write a prescription for a syphilitic adult containing
corrosive sublimate and iodide of potassium in solution.
Jan. 1, 1903. For John Jones.
H . Hydrargyri chloridi corrosivi gr. i
PotaRsii iodidi 55 ii
Tinctune gentianse comp f S ^^*
M. et Sig. — A teaspoonful thrice daily after meals.
John Smith, M. D.
What are the therapeutic uses of tar?
Tar is used as a stimulating expectorant and as a stimulant
to the skin in certain chronic inflammatory diseases.
What are the physiologic effects and therapeutic uses of
chromic acid?
Chromic acid exerts a powerful caustic effect upon all ani-
mal tissue. It has a destructive action upon micro-organisms,
and from the readiness with which it parts with its oxygen it
rapidly decomposes organic matter, and so serves as a disin-
fectant. It is not employed internally. It is a useful escha-
rotic for destroying corns, warts, syphilitic vegetations, and
the like.
Give the source and state the uses of thymol.
Thymol is a phenol obtained from the volatile oil of thyme
and certain other volatile oils. Thymol is used as a disin-
fectant in the form of a wash, as an ointment in chronic skin
diseases, and internally as an efficient antiseptic.
What is the dose of croton oil as a cathartic? What are
the contra-indications to its use?
The dose is 0.05 Cc. (1 minim), given in glycerin or olive
oil. It is contra-indicated when either debility, organic ob-
struction, or inflammatory conditions of the stomach or
bowels exist.
What are the physiologic effects and therapeutic uses of
cubebs?
Cubebs is an aromatic stomachic and a stimulant diuretic
552 THERAPEUTICS A^'D MATERIA MEDICA.
in small or mediuiu dose, but l^i-ge ajnounts derange digestios
and may act as a gastro-intestiual irritant. Its constitneuts
are eliminated by the bronchial mucous membranes, the skin
and the kidneys, stimulating and disinfecUng the genilo-
urinary passages, increasing the bronchial mucus, sweat ami
urine, and frequently causing an urticarial or vesicular erup-
tion. It increases the action of the heart and the vascular
system and promotes tlie menstrual discharge. Cubebs is
used in the acute stage of gonorrhea, in chronic cystitis and
chronic bronchitis. It is applied in powder form in hay
fever, chronic nasal catarrh and follicular pharyngitis.
Mention the therapeutic uses of carbolic acid except as
an antiseptic.
It is used as a caustic, local anesthetic, as an auti-emelie
and carminative.
What is the treatment of scabies?
Sulphur, styrax and naphthol are efficient local applica-
tions as ointments.
An excellent formula is the following:
Sulphar Bublimat .5J
Bnbiam PerufianBe 3 ss
Adipifl si
M. et Sig, — Bub in thoroughly twite a Hay.
How does an antagonist differ from an antidote?
Antagonists are agents which oppose each other in their
physiologic action, and may be employed against each other
as counter poisons to neutralize their effects upon the organ-
ism. They do their work in the blood and tissues after ab-
sorption, and are especially available against poisons admin-
istered hypodermic idly, in which case antidotes are useless.
Antidotes affect a poison so as to remove it from the body or
alter its character before absorption, and thereby prevent its
tosic action on the organism. They do their work in the ali-
mentary canal or in the respiratory passages. (Potter.)
THERAPEUTICS AND MATERIA MEDICA. 553
Name and describe the methods of introducing medicines
into the circulation.
Medicines may be introdueed into the circulation by vari-
ous routes, including the mouth, the stomach, the rectum, the
respiratory tract, the veins and arteries, the subcutaneous
cellular tissues, and the skin. Intravenous medication is only
used in emergencies where immediate action is desired.
Saline solution is the usual remedy introduced by this route.
The rectum will absorb any substances applied in the form
of enemata or suppositories. The hypodermic method is the
introduction of medicines into the organism by injecting them
into the subcutaneous tissue, from which they are quickly
absorbed by the lymphatic and capillary vessels. The respi-
ratory tract admits of the rapid absorption of medicinal
substances through its extensive blood supply, especially by
inhalation. The stomach is the most convenient organ for
the absorption of medicine. The remedies find their way into
the current of the circulation through the walls of the gastro-
intestinal blood-vessels and the lacteals.
How do strophanthus and digitalis differ in physiologic
action?
Compared with digitalis, strophanthus is a powerful car-
diac stimulant, differing from digitalis in not producing
vasomotor constriction of the arterioles. It reduces the pulse,
lowers body temperature somewhat, is not cumulative in
action, and does not cause any gastro-intestinal disturbance.
It is a diuretic by direct stimulation of the renal circulation,
and has power over rigors by its rapid cardiac action, stop-
ping them and preventing their recurrence.
Mention the official turpentines. State from whence
they are obtained.
There are two official turpentines, terebinthina, a concrete
oleoresin from Pinus palustris, the yellow pine, and other
species of Pinus, natural order Conif eree ; Terebinthina cana-
554 THEltAPEVTlCS AND MATERIA MEDICA.
deDsis, a liquid ol'eoresin obtained from Abies balsaiuie, the
balm of Gilead.
Compare opium and belladonna as to action on the heart
Mediciiial doses of belladonna quiiiktn ihe pulse and raise
the arterial pressure; the quickening of the pulse results
from depression of the inhibitory nerves and stimulation of
the accelerators. The increased blood pressure is due to stim-
ulation of the vasomotor centers and the heart Itself. Tosie
doses paralyze the heart. Opium in moderate doses has little
effect upon the circulation. Large doses, however, stimulate
the inhibitory nerves, centrally and peripherally, and thus
slow the pulse; at the same time the latter becomes full and
strong from stimulation of the heart or its contained ganglia,
and possibly also from stimulation of the vasomotor centers
in the medulla, Tosie doses finally paralyze bolh the heart
and vagi and produce a i-apid, feeble pulse.
What are the therapeutic uses of ammonium carbonate?
It is used principally as a stimulant in low fevers, like
typhoid, and in acute pulmonary diseases associated with
cardiac and respiratory weakness, such as croupous pneii-
. monia, catarrhal pneumonia and eapillary bronchitis.
Define solvent. Mention three principal solvents.
Solvent is tile term applied to the liquid before the sub-
stance is added to it, by which addition after the operation is
completed the combined preparation is called a solution. The
chief solvents are water, alcohol and glycerin.
What is the source of aloes? By what part of the intes-
tinal tract is it eliminated?
Aloes is the inspissated juice of the leaves of the Aloe soco-
Imva and other species of aloe. It acts chiefly on the lower
half of the lar^'c intestine.
Describe the physiologic action of alum. In what patho-
logic conditions is alum useful?
Alum is an astringent, coagulating the albumin and stim-
I
THERAPEUTICS AND MATERIA MEDICA. 555
ulating muscular contraction. At first it excites the flow
of saliva and then diminishes it. It coagulates pepsin and
arrests digesrtion, stops peristalsis and usually causes consti-
pation, although sometimes it produces diarrhea. Although
coagulating albumin even in weak solution, it enters the
blood, arrests secretion, especially those of mucous surfaces,
and stops capillary hemorrhages. It is used locally as an
astringent in chronic catarrh, leucorrhea, gonorrhea, hemor-
rhoids, bed sores, colliquative sweats, etc. The dried powder
is escharotic, destroying granulation and warty growths.
Alum is used as an emetic in smaller doses in gastric catarrh,
gastralgia, lead colic, etc.
Mention the ingredients of (a) Tully*s powder, (b>
Dover's powder.
(a) Tully's powder is the compound powder of morphine.
It is composed of morphine sulphate 1 part, to 19 of camphor
and 20 each of liquorice and calcium carbonate, (b) Dover's
powder contains 10 parts ipecac, 10 parts of powdered opium
and 80 parts of sugar of milk.
Why is atropine combined with morphine when the
latter is administered? What is the dose of atropine
when combined with morphine?
Atropine has long been regarded as the physiological an-
tagonist of opium. It especially combats the depressing
effect of opium on the circulation. The hypodermic dose of
atropine sulphate w^hen combined with morphine is 1-150
grain.
Give the therapeutic uses of sodium phosphate.
In doses of y^ ounce it is a mild purgative. It has been
recommended in catarrhal jaundice and cholelithiasis.
State the ingredients and uses of sulphur ointment.
Sulphur ointment is made up of 15 parts of washed sul-
phur and 85 parts of benzoinated lard thoroughly mixed.
Sulphur ointment is used in certain forms of skin diseases
I
556 THERAPEUTICS AND MATERIA MEDICA.
and as a means of administering sulphur when it is not well
borne by the stomach.
Give the composition and the chief use of lotio hydrar-
gyri nigra.
Blaok-wasb is prepared by adding 30 grains of calomel to
10 ounces of lime-water, tbereby producing the black oxide,
and is used as an application to syphilitic sores.
What are the therapeutic uses of Pulsatilla?
Some therapeutists regard the drug as of no value what-
ever; others claim good effects from its employment as an
emmeuagogue, a diuretic and diaphoretic; it is also a cardJat;
and vascular sedative, and possesses some antipyretic action.
Where is quassia indigenous? What part of the plant
is used in medicine?
The West Iu(iit's, The wood is used.
What is the common name of ferrous sulphate? Give
the chief uses of ferrous sulphate.
Copperas; it is impure ferrous sulphate. It is chiefly
used to make the dry sulphate and other preparations. It is
sometimes employed as a tonic astringent.
Describe the physiologic action and the therapeutic use
of guarana.
(hiaraiia has similar actions to those of coffee, the active
principle of botli plants being perhaps identical. It may be
used in migraine, in convalescence in acute diseases, in diar-
rhea of phthisis, etc.
Give the composition of Vienna paste (pasta caustics
Viennensis).
It is a grayish-white deliquescent powder consisting of
equal parts of potassa and lime rubbed together.
Explain the distinction between physiologic action and
the therapeutic use of medicinal agents.
The physiologic action of a drug is its effect upon the
I
THERAPEUTICS AND MATERIA MEDICA. 55T
economy in health, and includes its action upon the nervoua
centers, respiration, circulation and metabolism. Prom its
physiologic action is deduced its therapeutic indication or
employment in certain diseased states.
Define a mydriatic. Give three examples, with the dose
for the local application in each case.
Mydriatics are agents which produce dilatation of the
pupils. Atropine is used locally in solutions of 8 grains to
the ounce. Homatropine, in strength of 4 grains to the ounce.
Cocaine locally in a 5 per cent, solution.
Define germicides, parasiticides.
Germicides are agents that destroy germs, as solutions of
bichloride of mercury, permanganate of potash, carbolic acid,
etc. Parasiticides are agents which are destructive to para-
sites; the principal parasiticides are mercurial ointment, sul-
phur and acetic acid.
What results from combining silver nitrate and creo-
sote?
An explosive compound, which is white in color, without
odor, and has the appearance of an emulsion.
What symptoms are produced by toxic doses of tartar
emetic?
Pain, vomiting, diarrhea, with watery stools and collapse,,
motor and sensory paralysis and suppression of the urine.
Mention two remedies commonly used to increase in-
testinal peristalsis.
Senna and rhubarb.
What are the therapeutic uses of buchu?
Chronic affections of the genito-urinary mucous membranes,
lithiasis, prostatic affections, atonic dyspepsia and chronie
rheumatism.
ND MATERIA MEDWA.
What is the ultimate effect on the heart's action of
medicinal doses of belladonna?
Following the ingestion of belladonna the heart rate ia at
first slowed, but soon becomes rapid and vigoroos, and the
artei-ial tension is increased; this is accomplished by stimula-
tion of the cardiac sympathetic and paralysis of the pneumo-
gastric, thus stimulating the accelerator apparatus while
lessening the iuhibitoiy.
Compare the strength of dilute hydrochloric acid with
that of the absolute acid. What is the dose of the former?
Dilute hydrochloric acid is a 10 per cent, solution of the
absolute acid in water. Its dose is 1 Cc. (15 minims).
How do styptics and hemostatics differ? Give an ex-
ample of each.
These are agents which arrest bleeding, styptics being those
which are applied locally, as alum, and hemostatics those
which are administered internally, as gallic acid.
What part of zingiber is used in medicine? What are
its therapeutic uses?
The rhizome. The official preparations are fluid extract.
tincture, syrup, and the oleoresin. It is employed as a car-
minative and as an adjunct to purgative medicine to prevent
griping; the syrup is commonly employed as a flavoring ad-
juvant.
Define pharmacy.
Pharmacy is the art of selecting and preserving medicines
and preparing fhem for administration.
How do therapeutic agents act to promote waste?
Destructive metamorphosis of the tissues is promoted by
alteratives and astringents. The manner in which alteratives
act has never been determined. We know that of such drugs
as mercury and iodine, the former being endowed with the
power of breaking up newly-deposited fibrin and disorganit-
THERAPEUTICS AND MATERIA MEDICA. 559
ing syphilitic deposits, and the latter acts energetically upon
the lymphatic system €ind promotes absorption.
Mention the principal therapeutic application of anti-
pyrine.
Antipyretic, analgesic, antiseptic, as a local anesthetic and
to diminish secretion, as an anti-galactagogue.
What is the dose of curare for hypodermic use? What
are the antagonists of curare?
Dose V20 to Yq grain. Strychnine, atropine, and more ef-
fective still, artificial respiration.
What is codeine? State the dose of codeine. What are
the advantages of codeine over opium?
Codeine is an alkaloid of opium, differing from morphine
in having the radical CHs replacing an atom of hydrogen. It
is less irritating to the digestive tract than opium. Its dose
is 0.030 Gm. (1/2 grain).
Mention the therapeutic uses of creosote.
Locally as an anesthetic and antiseptic. Internally as an
antiseptic, in chronic gastric catarrh, in diarrhea, dysentery
and phthisis.
What is the common name of hamamelis? State the
dose of the fluid extract of hamamelis.
Witch-hazel. The dose of the fluid extract is 2 Cc. (30
minims) .
What part of buchu is used in medicine? State the dose
of the fluid extract of buchu.
The leaves. Dose of the fluid extract 2 Cc. (30 minims).
What is the official name of tartar emetic? State the
dose of tartar emetic.
Antimonii et potassii tartras. Dose as expectorant, 0.005
Ora. ( Vjo grain) ; as emetic, 0.030 Gm. (i/^ grain).
560 THERAPEUTICS AND MATERIA MEDICA.
What are the uses of cantharis (a> externally applied,
(b) internally administered?
Externally it is employed as a vesicant and internally as a
stimulant to the genito-urinary tract.
What is pepo? State its therapeutic use.
Puiiipkiu-seed. It is used as an anthelmintic against tape-
and the therapeutic uses
Describe the physiologic action
of scatntnoniutn.
Scaniniony is a powerful irritating hydragogue cathartic.
It may be used in combination with other cathartics in obsti-
nate constipation.
Mention the preparations of ergot and give the dose of
each preparation.
The extract of ergot, dose 0.250 Gm. (4 grains) ; the fluid
extract, dose 2 Cc. (30 minims) ; the wine, dose 8 Cc. (2 fluid-
drachms) .
Define hematics. Mention two principal hematics.
These are medicines which increase the quantity of bematin
in the blood. They consist chiefly of iron and manganese
and tlii'ir compounds.
What are the physiologic effects of iodoform internally
administered? State the therapeutic uses of iodoform
when externally applied.
In small doses internally iodoform is considered to be a
tonic and alterative. If taken over a protracted period it may
cause profuse salivation. In toxic doses it causes pyrexia,
then headache, quick and feeble pulse, marked anxiety and
retftlessness ; collapse and death may suddenly supervene.
Locally its action is anesthetic and powerfully antiseptie. It
is one of the best agents to prevent decomposition, and it
destroys the germs of putrefaction and of disease, but must
be carefully employed.
THERAPEUTICS AND MATERIA MEDICA. 561
Give the dose of (a) liquor potassii arsenitis, (b) liquor
sodii arsenatis.
(a) 0.2 Cc. (3 minims), (b) 0.2 Cc. (3 minims).
Define emulsion.
Emulsions are liquid preparations containing an insoluble
medicinal substance, as an oil or a resin, in a state of minute
subdivision, and suspended by the aid of some viscid excip-
ient, as gum, which may be contained in the medicinal ingre-
dient itself or be added by the pharmaceutist.
Where is the habitat and what are the physiologic
effects of digitalis?
It grows wild in Europe and is cultivated in this country.
The dominant action of digitalis is on the circulation. In
therapeutic doses it slows the pulse and raises the blood pres-
sure. The slowing of the pulse results from a prolongation
of the diastole, and this in turn is due to stimulation of the
vagi or inhibitory nerves. The increased blood pressure is
due to a powerful stimulant effect on the heart and to a con-
traction of the arterioles resulting indirectly from stimula-
tion of the vasomotor center and directly from the action of
the drug on the vessel wall. Toxic doses quicken the pulse
by paralyzing the vagi and lower the arterial pressure by
causing a powerful systolic contraction so that the diastole
becomes too imperfect to permit the ventricles to be completely
filled. Therapeutic doses have no effect on the nervous sys-
tem, but toxic doses lessen the reflexes, first by stimulating
Setschenow's inhibitory centers, and later by depressing the
spinal cord. It requires toxic doses to influence the respira-
tion, and then slowing occurs. Large doses occasionally pro-
duce nausea, vomiting and diarrhea. In health, digitalis has
little or no diuretic action. When the urine is diminished
from embarrassment of the circulation it produces free diur-
esis, which is attributed to its effect on the heart and vessels,
and not to a direct influence on the secreting structure of
the kidney.
36
562 THERAFEVTICS AND MATERIA MEPWA.
State the source of ichthyol and give its uses in medi-
cine.
Ichthyol is prepared from the product of the distillation of
bituminous rocks from the Tyrol, which contain fossil fishes.
It is useful in certain chronic skin diseases, particularly
eczema and psoriasis. It is extensively used externally for
its antiseptic and alterative properties in rheumatism, erysip-
elas and lymphatic enlargements. Combined with glycerin,
it is valuable, locally applied, in the various inflammatory
affections of the female genital organs.
What are the therapeutic uses of aconite? Give the
dose of the fluid extract of this drug.
Aconite is used locally in neuralgia; internally in hyper-
emesis, in acute inflammation, such as tonsillitis, bronchitis
and pneumonia, in eseessive hypertrophy of the heart, in
nervous palpation, in the tachycardia of exophthalmic goiter
and in active cerebral congestion with high arterial tension.
Dose of fluid extract is 0.05 Ce. (1 minim).
What part of scoparius is used in medicine? What
alkaloid is derived from scoparius?
The tops of CI/''"'*'*' SCO pari IIS. Its alkaloid i
s sparteine.
I and state wh
Give the common name of taraxacur
part of this plant is used in medicine.
Dandelion. The root is used in medicine.
What is the physiologic action of tincture of the chlor*
Ide of iron upon the kidneys?
The tincture of the chloride is considered diuretic.
Give the chief source and the dose of gallic acid.
It is prepared from a paste of powdered galls by ferment-
ing for six weeks, boiling and reboiling in water, filtering
and crystAllizing. Dose, 1 Gni. (15 ^
THERAPEUTICS AND MATERIA MEDICA. 563
Give the dose of hyoscine for hypodermic use. For what
purpose is hyoscine used?
The dose of hyoscine hydrobromide hypodermically is
0.0005 6m. (Vi28 grain). Hyoscine is a cerebral and spinal
sedative, a powerful hypnotic. It is employed as anodyne
when opium is contra-indicated.
What is an excipient? Give examples.
Excipients are substances which give form and consistence
to prescriptions, and serve as vehicles for the exhibition of
the other ingredients. Examples are syrups, acacia and the
various flavoring agents, such as syrup of lemon.
Describe the technique of venesection.
The patient having been placed in a semi-recumbent posi-
tion, the arm should be constricted three or four inches
above the elbow by a few turns of a roller or a twisted hand-
kerchief; if this is not sufficient to render the veins prom-
inent, the arm may be rubbed for a few minutes from below
upwards. A large vein having been selected, it should be
incised by a thumb-lancet or a spring-lancet in a direction
oblique to the long axis of the vessel. The amount of blood
abstracted will depend entirely upon the pulse, which should
be carefully observed during the operation, and when it les-
sens in force and becomes more compressible the bleeding
must be suspended.
Define glucosides and give two examples.
Glucosides form a group of organic principles existing in
plants, and are generally neutral in character. Examples
are salicin, obtained from willow and other barks, and glycyr-
rhizin, from liquorice root.
What is the most active laxative ingredient in pulvis
i^lycyrrhizae compositus?
Senna.
564 TEERAFEUTICS AND MATERIA MEDICA.
By what methods do antipyretics act? Give an example
of one that acts by each method.
Antipyretics reduce the body temperature in fever: (a)
by lessening the production of heat — (1) by diminishing
tissue change, (2) reducing the circulation; or (b) promot-
ing tlie loss of heat — by (3) dilating the cutaneous vessels-,,
(4) producing perspiration, and (5) abetraetiug heat from
the body. Examples of antipyretics acting in the order
named are as follows: Quinine (1), digitalis (2), carbolic
acid (1 and 3). antipyrine (1 and 4), cold sponging (5).
Indicate the common name and give the preparations of
serpentaria.
Virginia suake-root. The preparations ere the liuid ex-
tract and the tincture. It also is oae of the components of
compound tincture of cinchona.
What are the therapeutic uses and the official prepara*
tions of oleic acid?
Oleic acid is used only in making the oleates. Three prep-
arations are official, the oleate of mercury, the oleate of vera-
trine and the oleate of zinc.
What is the antidote for strychnine?
Chloral hydrate.
Describe the manner of making barley '
for the patient.
It may be made as follows : Grind ^^ ounce of pearl barley
in a coffee-mill, add 6 ounces of water, boil 20 minutes, add
salt and strain.
What are the therapeutic uses of the preparations of
silver?
The nitrate is the most soluble of the silver salts ; it is anti-
septic, astringent, hemostatic, irritant, and a limited escha-
rotic. also anti-phlogistic, anti-spasmodic and tonic. The
oxide is the least irritant, and does not discolor the skin so
THERAPEUTICS AND MATERIA MEDICA. 565
quickly. Internally it has been used in gastric neuralgia, irri-
table dyspepsia, pyrosis, gastric and pulmonary hemorrhages,
dysmenorrhea, menorrhagia, to check profuse sweating, to
control vomiting, and in diarrhea depending on reflex nervous
irritation. The iodide is similarly employed.
How would you distinguish ciiemically between ether
und chloroform?
Ether is ethyl oxide (C2Hb)20. Chloroform is trichlor-
methane, CllCla.
Name four drugs used in the treatment of chronic inter-
stitial nephritis.
Nitroglycerin, Basham's mixture, caffeine, and magnesium
sulphate.
Give the therapeutic uses of caffeine.
Cardiac stimulant in cardiac and renal dropsy, and alone
or in combination with antipyrine or the bromides in nervous
headache and migraine.
Describe the physiologic action of aconite.
It is a powerful depressant of the sensory nerve ends, the
nervous and muscular apparatus of the heart and respiration,
and the spinal nervous system. It is also antipyretic, dia-
phoretic and diuretic.
Name the official preparations and doses of digitalis,
cascara sagrada and ipecacuanha.
Digitalis, the extract, dose 0.010 Gm. (I/5 grain) ; the fluid
extract, 0.05 Cc. (1 minim) ; the infusion, 8 Cc. (2 fluid-
rachms) ; the tincture, 1 Cc. (15 minims). Cascara sagrada,
the fluid extract, dose 1 Cc. (15 minims). Ipecacuanha, the
fluid extract, emetic dose 1 Cc. (15 minims) ; expectorant
dose 0.05 Cc. (1 minim) ; Dover's powder, 0.500 Gm. (7V^
grains) ; the syrup, emetic dose 15 Cc. (4 fltiidrachms) , ex-
pectorant dose 1 Cc. (15 minims) ; wine of ipecac, dose 1
Cc. (15 minims).
» r^zsj^m'zici} ±n> materia medic a.
give the source and
awrrinat ii»rtveti frcHn opium, dose 0.015 Gm.
,r---: I ^^T^i«!sr, ui likaluiii of hvoscyamos, dose of the
r^ii.'. r^ie. '.■.♦••>J fm. ^ --» grain) ; chloral hydrate ob-
?ti ^*««iE 31^ icciMi •!£ '!flHTriiie OH aldehyde, dose 1 6m.
^--ti^z»- -^a:nB#aat**Tiam*. or solphonal, a synthetic prod-
jvs -g^i^ ^ 2fr 'Xiuacrua of a mixture of ethyl-mercaptan
•cr-»:Lrr. -UBS* "1 tol ^5 £rains .
4. Tffcscn^QMt nr la^ a coll>Tium, (b) a supposi-
t . >.;«»i vtfw:t gr. X
^.1* .ck«^:aftar la c. ii. la fjj
^<^. ■ i.'''tU«««t in>|ik> ji Tvcii «▼«» thrice d&ilv.
X. "^i.'^r*- ini* •-• 8T* j
w.t*.tmt- gr. j
"v.A9«w '!vi':»i:'!^ gr. Ixxx
^ •• • • •
• ' ^^ Vllj
^ ^ > -■ ■.: J Vice,.
a..4«v *«^ .•lo^c^KTc^i' x»J tell in what proportions each
«i«u«.c%«. vr s^irirical purposes.
1 ::• liXXX Permanganate of po-
. ::: Boric acid, 15 grrains to the
• ■ • 7 r>vnt. solution in glycerin and
■•- c r.. the full strength of the offi-
vr«i**^
* 1
»
;c*^ cv *^ »a> >*^>*0}:iv: action of hyoscine and name a
.... *•■ V -'i' st'dative and powerful hypnotic,
. ,?^ ^ '^^ * -:'K-r function of the brain and
u rr *.* Tannin and morphine.
« k
THERAPEUTICS AND MATERIA MEDICA. 567
Give the composition of the official compound cathartic
pill.
Compound extract of oolocynth, 80 parts; resin of jalap,
20 parts; mild chloride of mercury, 60 parts; gamboge, 15
parts.
Describe two escharotics and tell how you would apply
them.
Nitrate of silver applied in the form of lunar caustic is an
efficient superficial escharotic; carbolic acid is escharotic, and
should be used in strong solution, 1 to 10.
Write a correct prescription containing nitrate of silver.
Argcnti nitratis gr. iij
Gum Tragacanth, q 8.
Ft. — In pil. no. xii.
Sig.— One before meals. John Jones, M. D.
State the direct and indirect effect of pilocarpine in
dropsical effusion.
It causes prompt and profuse perepiration and salivation,
increases the bronchial and lachrymal secretion, and some-
times causes serous diarrhea. Full doses cause a decrease in
arterial tension. The elimination of urea is greatly increased,
but not the quantity of the urine.
What are the physiological effects of nux vomica on the
nerves and circulatory system?
It is a powerful stimulant of the spinal cord, especially the
motor columns. In toxic doses it produces spinal convul-
sions. Small amounts stimulate the brain and increase the
mental powera. In moderate doses the heart is stimulated and
the arterial pressure raised by stimulation of the vasomotor
center in the medulla.
What is wrong with the following prescription?
B . ArgentK* nitratis drams, one.
Sodi chloridum drams, four.
Syrnpus lemonis, q. 8 ounces, four.
Sig. — Take a tablespoonful after meals in water.
568 THERAPEUTICS AXD MATERIA MEDICA.
ArgeniiE should read arg/enti; sodi chloridum shuuld read
sodii chloridi; syrupus lemcnis should read syrupus limonis.
This prescriptiOD atfords the example of a pharmaceutical
incompatibility. Nitrate of silver should not be compounded
with sodium chloride, for there results the insoluble chloride
of silver.
Write for an adult a complete prescription for a diarrhea
mixture containing three remedies and the excipient.
B . CreliE preparatie 3 ii
Tincturtc uulecliu • ^aa
Tiuctune opii ■ n)_1iii
Aqua uinnnniomi ad ■ f^.S ^''>i
M. Sig.— Two leaspoonful* erety four hours.
Name the official preparations of belladonna and the
dose of those used internally.
Estraiituiii be Undo una' foliorum, dose 0.010 Gm. (J grain) ;
tinctura belhidouuse foliorum, dose 0.5 Cc. (8 minims) ; fiuid-
extractum belladonniB raditis, dose 0.05 Co. (1 minim) ; em-
plastrum belladonnie; unguentum belladonnEe.
Write a prescription containing oil of sandal wood and
at least one other constituent for chronic cystitis.
Jan. 1. 1UU3. Fok Willum Smith.
B. OleisaiiUli f.^i
Silol 3i
Fl. in CapsulcH no. xii.
Sig — One iificr menls. Wm. Jones, M. D.
Define narcotics, anesthetics and sedatives, and give an
example of each.
Narcotics are agents which lessen pain and produce sleep
or stupor; example, opium. Anesthetics are agents which
temporarily destroy sensation ; they are both general and
local; example, ether as a general anesthetic and chloride of
«thyl as a local anesthetic. Sedatives are agents which exert
a soothing influence on the system by lessening functional
activity, depressing motility and diminishing pain; example,
the bromides.
THERAPEUTICS AND MATERIA MEDICA. 569
Treat a case of opium poisoning; also give the tiiera-
peutic uses of opium.
The stomach should be emptied by the stomach-pump or a
stimulating emetic, like sulphate of zinc or mustard. Pre-
vious to this, however, if the opium is in the stomach, solution
of permanganate of potash should be administered freely ; as
a chemical antidote strong coflfee should be given, and the
patient should be aroused by flagellation, douching, or forced
walking. Atropine and strychnine should be given hypo-
dermically. The temperature should be maintained by the
external application of heat. In therapeutics opium is used
internally to produce sleep, to relieve pain, to lessen nervous
excitement, to promote diaphoresis, to check hemorrhage, and
to support the system. Externally it is used as a sedative.
Name five emetics and give the dose of each.
Alum, dose 1 to 4 drams; mustard, dose 1 to 4 drams;
ipecac, dose of the fluid extract 15 minims; apomorphine,
dose Vjo grain; sulphate of zinc, dose 15 grains.
What are the advantages and disadvantages in the use
of choloroform as an anesthetic and what are the signs in-
dicative of danger in the patient?
Inhalations of chloroform produce sensations which are
rather agreeable than otherwise, while the first stage of ether
anesthesia is decidedly unpleasant. Chloroform produces
anesthesia more quickly than ether, and in certain cases this
is an advantage. It is, however, much more dangerous than
ether. Its dangerous symptoms are: (1) i^espi rati on becomes
stertorous or shallow; (2) sudden dilatation of the pupils;
(3) signs of cardiac failure. Chloroform produces much less
subsequent vomiting.
Define briefly but clearly serum therapy.
Serum therapy properly means the prophylactic and cur-
ative treatment of certain acute infectious diseases by the
subcutaneous injection of a blood serum containing an anti-
I
570 THERAPEUTICS AND MATERIA MEDJCA.
toxin specific to the particular disease. As generally used,
however, this term includes the treatment of the same dis-
orders by the toxins produced by attenuated cultures of their
respective microbes; but these toxins, though sometimes
grown on blood serum, may be cultivated on other media,
and arc never administered in a serum, as the antitoxins in-
variably are. The antitoxins at present employed in serum
therapy are those of diphtheria, tetanus, tuberculosis, erysip-
elas, pneumonia, cholera, syphilis, plague, and typhoid fever,
but only the first three have come into anything like general
use. (Potter.)
What official preparations are derived from the willow?
8alicinum or salicin, a glueoside, ia obtained from several
species of the willow. Salicylic acid and the various sah-
cylates might be prepared from salicin by synthetic processes
but practically this is never done.
What active principles are found in di};itaiis? What
are the official preparations of petroleum?
Digitalin, digitoxin, digitalein, digltonin, and digitin.
trolatum is a mixture of the hydrocarbons obtained from
petroleum. The official preparations are petrolatum, petro-
latum album, and petrolatum liquidum.
Give the physiologic action and therapy of saline pur-
gatives.
This group includes the neutral salts of metals of the alk*- 1
line or alkaline earths. They stimulate the intestinal glanda J
to increased secretion, and by their low diffnsibility impede 1
re- absorption, causing an. accumulation of fluid in the intea-f
tinal tract. This, partly from the effect of gravity and partly!
by gentle stimulation of peristalsis excited by dlsteosioQ, I
reaches the rectum and produces a copious evaeuation. Mag-T
nesium sulphate and sodium sulphate are the typical salines. 1
They should be given in plenty of water and during aetivefl
THERAPEUTICS AND MATERIA MEDICA. 571
movement (as in walking) in order to produce their best
effects.
Name three drugs used in the treatment of intermittent
fever. State how each controls this disease.
Quinine exerts a specific influence in all malarial infections
by reason of its power to prevent the development of the
Plasmodium to which malaria is due. A 10-grain dose of the
sulphate should be given in the sweating stage, and again
five horn's before the expected time of the next paroxysm. In
the intervals arsenic is of more value; its therapeutic action
is due to the fact that it is a valuable anti-periodic, as well
as tonic and alterative. Mercurv is also of value for its
hematinic and alterative properties.
Describe the treatment of intestinal indigestion.
Under this term a variety of conditions have been described
dependent upon various causes, but it is usually restricted to
acute or chronic intestinal catarrh. When this is dependent
upon causes residing in the stomach the existing gastritis
must be first treated. A course of calomel and soda is of
value; this may be followed by the administration of pan-
creatin, which will aid digestion. Proper measures of diet
and exercise are important. Charcoal in 10-20- grain doses is
useful.
Name four drugs incompatible with tannic acid. Name
two incompatible with hyoscyamus.
Tartar emetic, lead acetate, silver nitrate and hydrochloric
acid are incompatible. The hydroxide of potassium and
tannin with hyoscyamus.
What doses of antitoxin are used for a child five years
old ill with diphtheria? What would be the prophylactic
dose for the same child?
1500 units. 500 units.
i
572 THERAPEUTICS AiiD MATERIA MEDICA.
Correct the following prescription:
K ■ Atropine Suipliuli - grs. iss
Potoa. lodidi ■ i az.
Infusae Digitalis • ^ d. oz.
Elix, Simpl. q. H. nd 2 fl. ox.
M. 8, — Ttaspoonful in water four times a day.
Potassium iodide is best given aJone. The dose of atropine
is much too great. It sliould be about '/,„„ grain to each
dram. Atropia sidpkati should read AtroptntE sulpkatis.
Infuse should read Infusi.
What parts of sossypium are used in medicine?
The bark of the root is official as gossypii cortex, aud the
hairs ol" the seed as gossypium puriiiuatum.
What is the important allcaloid of erytfaroxylon and
what is its principal therapeutic use?
Its alkaloid, coeaiue. is allied to caffeine, but h more pow-
erful, and its proportion in the leaves of the plant varies
greatly in the different samples which occur iu eommerce.
Us chief use is that of a local anesthetic.
Name the official preparation of bismuth and give the
dose of each.
Bismuth citrate, 0.125 Um. (2 grains) ; bismuth and am-
monium citrate, 0.125 Gm. (2 grains) ; bismuth subcarbonate,
0.500 Gm. (71/2 grains) ; bismuth subgallate, 0.250 Gm. [i
grains) ; bismuth subnitrate, 0.500 Gm. HYs grains) ; bis-
muth subsalicylate, 0.250 Gm. (i grains).
What Is the physiologic action of iris?
Iris when fresh is actively purgative, emetic aud diuretic,
producing severe nausea and prostration.
What is the dose of (a) potassium iodide, (b) ammo*
nium iodide, (c) sodium iodide?
(a) 0.500 Gm. (71A grains); (b) 0.250 Gm. (4 grains);
<c) 0.500 Gm. iiyz graina).
THERAPEUTICS AND MATERIA MEDICA. 575
From what is koumiss made and wiiat are its thera-
peutic uses?
Koumiss is an effervescing fermented liquor originally pre-
pared by the Tartars from mares* milk, but now imitated
with cows' milk by adding sugar of milk, fermenting in an
open tank, skimming off the casein and butter, then bottling
during active fermentation. Koumiss is an invaluable article
of diet in many wasting diseases, especially tuberculosis. It
is of great benefit in dyspepsia, the diarrheas of children,
convalescence from acute maladies, chronic affections of the
kidneys, chronic bronchitis and other cachexias.
What is the proportion of mercury in hydrargyrum cum
creta? What is the dose^
38% mercury. Dose, 0.250 Gm. (4 grains).
Compare the therapeutic uses of pepsin and pancreatin.
How are these remedies prepared?
Pepsin is the digestive principle of gastric juice. Pan-
creatin is a mixture of the enzymes naturally existing in the
pancreas of warm-blooded animals. Pepsin is usually ob-
tained fi-om a solution prepared by digesting the mucus
scraped from the rennet-bags of sheep or the stomach of the
pig in acidulated water for several days. It is theft precipi-
tated by sodium chloride, lead acetate or alcohol. Pancreatin
is usually obtained from the fresli pancreas of the hog. Pep-
sin is employed in cases of gastric indigestion, while pancre-
atin is indicated in intestinal indigestion.
Describe the therapeutic action of spigelia. What are
its therapeutic uses?
Spigelia, pink root, is anthelmintic against the round-worm
and is usually administered with senna. In large doses it ia
an uni'ertain cathartic, and may produce serious symptoms,
including vertigo, dimness of vision, dilated pupils, and con-
vulsions.
I
ri74 THERAPEUTICS AND MATERIA MEDICA.
What are the therapeutic uses of cannabis and what is
the dose of the tincture of cannibas indica?
It is used as a sedative aud soporific as a substitute for
opium in such conditious as chronic bronchitis, phthisis, in
the dyspnea of asthma, aud in the restlessness of chronic
nephritis. As an analgesic it is useful in neuralgia and mi-
graine. It is also employed in mania, delirium tremens, and
in some forma of dysmenorrhea and menorrhagia. The dose
of the tincture is 0.6 Cc. {10 minims).
What is the composition of hydrargyri iodidum mbrum?
It is a red crystalline powder prepared by the double de-
composition of potassium iodide, 5 parts, ajid mercurie
chloride, 4 parts.
Where is the cinchona tree indigenous? What part of
the tree is used in medicine?
It is a nalivi; of tlie easlcni slope of the Andes. The bark.
Name three drugs used to retard the heart's action and
state the dose of some preparation of each.
Aconite, dose of the tincture, 0.6 Ce. (10 minims); anti-
mony, dose of tartar emetic 0.005 Om. ('/„ grain) ; vera-
trum, dose of the tincture 1 Cc. (15 minims).
Describe the symptoms of hydrargyrism.
The first symptoms of chronic mercurial poisoning are fetid
breath, swollen and spongy gums having a bluish line along
their margin, stomatitis, sore and loosened teeth, salivation.
Anorexia, diarrhea and fever follow, also ulceration, and in
some eases even gangrene of the lips and tongue. There is
destruction of tissue and various nervous disturbances. The
patient becomes emaciated, suffers from headache, insomnia.
neuralgia and tremor, a vesicular or pustular eruption ap-
pears, and finally there follow coma and convulsions.
Give the common name and state the physiologic effects
of mentha piperita.
Peppermint. It is an aromatic stiitiiilaut, also carminative
THERAPEUTICS AND MATERIA MEDICA. 575
and anti-spasmodic. It is used in the form of menthol, as
an antiseptic and local anesthetic. Peppermint is employed
internally for the relief of nausea and colic and as a car-
minative. It is an agreeable corrigent for combination with
purgatives to prevent griping.
Of what is iodoform a preparation and what is the dose
for internal administration?
Iodoform contains from 94 to 97 per cent, of iodine. Dose,
0.250 Gm. (4 grains).
What are the sources of salicylic acid?
Salicylic acid is an organic acid existing naturally in com-
bination in various plants, but generally prepared synthet-
ically from carbolic acid.
Give the source and describe the uses of lanolin.
Lanolin is the purified fat of the wool of sheep mixed with
not more than 30 per cent, of water. It is useful in chronic
skin diseases where there is infiltration and where a penetra-
tive action is required for medicaments locally applied.
How do oleates and ointments differ?
Oleates are liquid solutions of metallic salts, or alkaloids in
oleic acid intended for external administration. Ointments
are soft, fatty mixtures of medicinal agents with a basis of
lard, petrolatum, etc. They are intended for application to
the skin by inunction, and have a melting point which is
below the ordinaiy temperature of the human body.
What are the therapeutic uses of acetanilide adminis-
tered internally? Has it any uses when locally applied?
If so, what are they?
It is used internally as an antipyretic and an analgesic and
antispasmodic. It is extensively employed in surgical prac-
tice as a dry dressing for wounds, etc.
576 THERAPEUTICS AM) MATERIA MEDICA.
Describe linum anJ give its medical preparations and
uses.
Flaxseed is tbe seed of liimm usitatissimum. It contains
15 per cent, of mucilage in tbe epitheliiini, also 30 to 40
per cent, of fixed oil in the embryo. Linseed oil is official.
Linseed tea is in common u.se, but is not official. Carron oil,
a favorite application for burns, consists of equal parts of
linseed oil and iime-water. Linseed is demulcent, emollient.
expeet«rant and diuretic. The oil is laxative in doses of 1
ounce. The ground seed is used in making tbe linseed
poultice.
What are the symptoms of iodism? How may it be
prevented while the use of the iodide is continued?
The symptonm of iodistn are anemia, emaciation and mental
depression. There is frontal headache, ptyalism, a saline taste
in the mouth, dysphagia, temporary impotence, and an erup-
tion of acne on the face and limbs. The iodide of potash
may be prescribed in combination with tincture of cinchona
or with Fowler's »»lutiou. which prevents the iodic eruption
to some extent. If the iodides are given freely diluted in .
water the toxic effects arc less likely to be produced.
Give the common name of hydrastis and describe its |
therapeutic uses.
The I'omuion name is goldenseal. It is used chiefly as a i
stomaehie tonic and antiperiodic, a mild laxative and an I
antiseptic. It is of value in catarrhal inflammation of tl»'J
gastro-intestinal and genito-urinary tract and ns a local alter-
ative and antiseptic application.
Write the following prescription by the metric system:
Polaaaii bicarb 3) dr.
Acidisceiici 7 11. dr.
Aquae 3fl. Of.
Pntaasii bicarb 136
Acidiacelici
Aquae
P
THERAPEUTICS AND MATERIA MEDIC A. 577
What are the po.ssible dangers from the use of salol in
large doses?
Salol breaks up in the body into salicylic acid and carbolic
acid. It is apt to produce the symptoms of carbolic acid
poisoning.
Give the medical name and the official preparation of
lignum vitae.
Guaiacum. The oflScial preparations are the tincture of
guaiac and the ammoniated tincture.
What are the therapeutic uses of manganese?
The salts of manganese, especially the permanganate of
potash, are used in anemia, in irregularities of menstruation,
as an antidote against opium or morphine in the stomach and
locally, as an antiseptic and oxidizing agent. The dioxide
is a good remedy in amenorrhea, gastrodyuia and pyrosis, and
in the form of an ointment for many skin diseases.
How is the peroxide of hydrogen prepared? What are
its therapeutic uses?
By passing COo through water containing BaOo in suspen-
sion, or by action of an acid on BaOo. The U. S. P. solution
contains, when freshly prepared, 3 per cent, of the pure
dioxide, corresponding to about 10 volumes of available
oxygen. This preparation is a non-toxic antiseptic. It is
employed as a gargle or spray in quinsy, croup, diphtheria,
scarlet fever, ozena, and for the purpose of cleansing wounds.
It may possess some value as an intestinal antiseptic on ac-
count of the fact that it is a valuable oxidizing agent.
What are the therapeutic uses of uva ursae? What part
of this plant is used in medicine?
Bearberrj' is an astringent tonic, and is feebly diuretic.
The leaves are employed.
What is the common name of oleum morrhuae? On
what physiologic effect does its therapeutic use depend?
Cod-liver oil. The action of cod-liver oil is like that of
37
578 THERAPEUTICS AND MATERIA MEDICA.
any other fat except that it is more easily assimilated than
any member of the class. Its beneficial effects, therefore, are
derived solely from its food value.
What is the composition of linimentum calcis? For
what is it principally used?
Carron oil consists of equal parts of lime-water and linseed
, oil, and is employed chiefly in burns.
Wliat action on the heart has valerian in full doses?
State the therapeutic uses of valerian.
In full doses it inereases the action of the heart and raises
the temperature. The oil in large doses lowers the blood
pressure and slows the pulse. Valerian is used in hysteria,
for the flatulence of infants and nervous subjects, also for
coughs of nervous type, in whooping cough, diabetes insipi-
dus and in delirium with vital depression.
Where is jalap indigenous? What part of it is used in
medicine?
Jalap is a Jlexican plant. The root is used.
Mention the salts of silver used in medicine and give
the dose of each.
i^ilver nitrate, dose 0,010 Gm. (% grain). Silver cyanide;
this is not used iu medicine except in the preparation of
hydrocyanic acid. Silver oxide, dose 0.065 Gm. (1 grain).
Describe the therapeutic uses of (a) water and (b) min>
eral water.
Cold water or ice has many exl^rnal applications of value
in the treatment of disease. As a wet pack it is used in ton-
sillitis and diphtheria. The cold baths and the cold wet pack
are the best methods of obtaining an antipyretic effect in
fevers. Cold or ice water is applied to the head in acute
cerebral congestion. Ixically in orchitis, the uterus in post-
partum hemorrhage. Hot water externally is most e£Eecti»«
in reducing local congestion and
I
I
externally is most enectivs ^h
1 setting up resolution of^^H
I ^^^^^H
THERAPEUTICS AND MATERIA MEDICA. 579
local inflammation. The hot wet pack is highly esteemed in
inflammations of. the chest The vaginal hot- water douche is
serviceable in catarrhal conditions of the vaginal and cervical
mucous membrane and congestive, swollen or neuralgic con-
ditions of the ovaries, tubes and adjacent tissues. Vapor and
Turkish baths are used in chronic kidney disease and • as
diaphoretics generally wherever a diuretic effect is desired.
Internally, water is of value as a diuretic, and if hot as a
diaphoretic. Mineral waters are esteemed most hij^rhly when
they are of the class possessing aperient and purgative prop-
erties. Depending upon the composition of these waters, they
may be of value in chronic rheumatism, diabetes, obesity,
syphilis, metallic poisoning, constipation, etc.
Where is the cinnamon tree indigenous? Mention the
active principle of cinnamon and give its dose.
Ceylon. The active principle is a volatile oil, the dose of
which is 0.05 Cc. (1 minim).
What therapeutic uses has chloroform other than an
anesthetic?
It is used in int^tinal colic and serous diarrhea, as a car-
minative and as a sedative in cases of obstinate cough.
What is the dose of tincture of belladonna and what
indications show that its physiologic effect has been ob-
tained?
Dose, 0.5 Cc. (8 minims). Medicinal doses quicken the
pulse and large doses stimulate respiration. Dryness of the
mucous membrane and skin and dilatation of the pupil will
indicate the physiologic effect has been reached.
For what purposes and effects is strychnia frequently
used in formulae for cathartics?
Strychnia stinuilates the muscular coat of the intestine,
increasing peristalsis, and thus acts as a purgative, but it re-
strains the frequent discharges due to atony of the bowels.
580 TSEEAPEUTICS AND MATERIA MEDICA.
What effect has pilocarpus on (a) the heart, (b) the
skin, (c) the salivary glands?
(a) Pilocarpus aels as a cardiac depressant by stimulation of
the vagus ends; (b) it causes prompt and profuse perspira-
tion, and (e) salivation.
What is the source from which eserine is obtained?
How and for what purpose is eserine principally used?
Eserine is one of the alkaloids of physostigina. It is
need locally in solution of 2 grains to the ounce in tbe eye
to contract the pupil and reduce intra-ocular tension. Inter-
nally it is efficient in constipation due to torpor of the bowel,
in which condition it is usually combined with belladonna
and mix vomica.
Describe the therapeutic uses and the dangers of chloral
hydrate. How does a toxic dose of chloral hydrate affect
body temperature?
Chloral is chiefly used to promote sleep and to cheek
spasms. It must be administered with care on account ot the-
danger of the patient becoming addicted to the chloral habit.
It is a distinctly dangerous drug, as it lowers the blood pres-
sure and body temperature. Cardiac and respiratory weak-
ness are contra-indicationa to its use. Toxic doses lower body
temperature.
What is the common name of guaiacum? What are the
therapeutic uses of guaiacum?
Its common name is (igjium vittr. Guaiacum is diaphor-
etic, expeeioraut and alterative, also laxative and purgative,
according to the dose administered.
What are the therapeutic uses of limonis succus?
Lemon juice is used as a refrigerant and diuretic mixture
in fever. For acidity of the stomach and as a common
remedy in obesity. Locally it is used as an antipyretic, anti-
pruritic, and as a gargle. It is also used for flavoring pur-
THERAPEUTICS AND MATERIA MEDICA. 581
Define anthelmintic and name the remedies of this class.
Anthelmintics are agents which destroy or expel worms
inhabiting the intestinal canal. They are classed according
to the worm against which they are each most efficient. For
thread worms the principal remedies are quassia, alum, sod-
ium chloride, lime-water, and the vegetable astringents. For
round worm, santonin, spigelia, chenopodium. For tape
worm, filix mas, kamala, kousso, pepo, and granatum. The
principal vermifuges are the purgatives, castor oil, jalap,
and scammony.
What are the therapeutic uses of resorcin?
Resorcin is employed as an antipyretic and antiseptic. A
3 per cent, solution gives good results in ulcer of the stom-
ach, cancer and other morbid conditions. It is also used
locally as a remedy in skin diseases.
Name the official preparation and state the therapeutic
uses of santalum album.
Oil of santal is official. It is extensively used in chronic
bronchitis and catarrhal conditions of the genito-urinary
tract.
How is collodium made? What are the preparations of
collodium?
Collodium is made by dissolving 4 parts of pyroxylin in 75
parts of ether and 25 parts of alcohol. Preparations are flex-
ible collodium, styptic collodium and cantharidal collodium.
Collodium is used as a protective covering for superficial
burns, ulcers, wounds and slight cuts. Styptic collodium has
many uses as a hemostatic and protective, while the cantha-
ridal form is a convenient epispastic.
Give the common name and the therapeutic uses of
hematoxylon.
Log- wood. Ijog-wood is mildly astringent, its properties
depending upon the tannin contained in it. It is not irritat-
ing, and is u.seful in diarrhea and hemorrhages in young
582 THERAPEUTICS AND MATERIA MEDICA.
childreD. It has been employed as a hemostatic in bleediiiK
of the lungs and hemorrhages from the uterus and intestines,
also as au astriugent injection.
On what physiologic action does the therapeutic use of
elaterin depend?
Elaterin is the most powerful of the hydragogae cathar-
tics, causing profuse watery stools, and when given in large
doses great prostration and gastro-iutestinal irritation, nausea
and vomiting.
Name three drugs incompatible with belladonna and two
incompatible with pilocarpine.
Tannin and the hydroxides of potassium and sodium are
incompatible with belladonna, and are also incompatible
with pilocarpine, as are the salts of the metals generally.
Give the usual dose of creosote and tell how it Is best
administered.
It is prescribed in doses of 0.2 Cc. (3 minims), well diluted
in wine or whiskey.
Name four official pills and give the principal ingre-
dients of each.
Pills with aloes contain purified aloes and powdered soap;
pills of asafetida contain asafetida and powdered soap; com-
pound pills of iron contain myrrh, carbonate of sodium, sul-
phate of ii'on and syrup; compound rhubarb pills contain
rhubarb, aloes, myrrh and oil of peppermint.
Define tinctures, extracts and ointments and tell as a
rule how many drops of a tincture are in a fluid dram.
Tinctures are alcoholic solutions of medicinal substances,
and with the exception of tincture of iodine are made from
non-volatile bodies. Extracts are solid or semi-solid prepa-
rations obtained by evaporating solutions of vegetable prio-
ciples. Ointments are soft, fatty mixtures of drugs with a
basis of lard, petroleum or fixed oils. The number of dropa \
THERAPEUTICS AND MATERIA MEDICA. 583
to a fluid dram of tinctures varies widely; 110 may be con-
sidered an average.
Write a complete prescription containing at least three
drugs for acute bronchitis in an adult. Use no abbrevia-
tions.
Jan. 1, 1903. For Mrs, Watson.
B . Tinctune opii camphorata. f 3 v
Tincture niicis Tomicffi f ,^ ii
Misturse glvcyrrhizae compooita* ^S'^^
M. S. — Teaspoonful every four hours. John Jones, M. D.
In the treatment of syphilitic node or gumma state
which should be used, a mercurial or an iodide, and give
the reason thereof.
In the treatment of the tertiary lesions of syphilis the
iodides and mercury, the so-called mixed treatment, is often
employed, the object being to get the greatest possible alter-
ative effect. The appearance of a gumma, especially of the
nervous system, demands energetic drug treatment. Iodides
should be given in the largest possible doses, and mercury
should be administered by inunction.
Give the reason which would determine the employment
of a vegetable or a mineral astringent in acute inflam-
matory conditions.
Vegetable astringents check secretion and hemorrhages and
cut short local inflammation. They are practically non-toxic.
Differentiate the conditions in which opium and hyoscine
should be used to promote sleep.
Hyoscine is useful as a hypnotic in children, and in general
in conditions in which opium is contra-indicated. Children
are particularly susceptible to opium, and an opium habitue
would require a different hynotic.
State when calomel or podophyllum should be given and
give the reason for the selection.
Calomel is unirritating, and has also a diuretic effect.
584 thehapeutws a\d materia medica.
Podopliyliuin is more irritating and causes more griping,
and is to be selected in cases o£ habitual constipation.
Name the coal-tar products used to reduce temperature.
Their name is legion. Those in general use are autipyrine,
pheoaeetine, acetanllide.
Describe the alkaloid, strychnia, and give a test for de-
termining its presence.
Strychnia is an alkaloid derived from the seed of strychnoa
nus-vomica, a tree of tiie natural order Loganiacea. growing
in India and China. Strychnia and its salts dissolve without
color in concentrated sulphuric acid, but on adding to the
solution lead peroxide a beautiful blue color results, jiassinn
into violet, then red, and finally yellow.
What are the derivatives of cinchona and their doses?
Cinchona bark contains many natural alkaloids, of which -1
are official, quinine, cinchonine and cinchonidine. The sul-
phates of these alkaloids may be administered in doses of
0.250 Cm. f4 grains).
Describe four diuretics and give the dose of each.
Potassium citrate occura in transparent crystals, is odor-
less, of cooling saline taste and a neutral reaction, dose 1 Gm.
(15 grains). Sparteine sulphate, the alkaloid of scoparins,
occurs in white prismatic crystals of slightly saline and bitter
taste, dose 0.010 Gm. (Vs grain). Digitalis (elsewhere de-
scribed), dose of the infusion, 8 Cc. (2 fluidrachms). Calo-
mel, the mild chloride of mercury, is efficient ns a diuretic in
0.010 Cm. (Vf, grain) doses every hour.
How does a lethal dose of gelsemium affect the system?
In toxic doses It pi-odnces vertigo, diplopia, drooped eye-
lids, dilated pupils, labored respiration, slow and feeble
heart, dropped jaw, staggering gait, extreme nmsele weak-
ness, almost complete anesthesia, and death hy asphyxia.
THERAPEUTICS AND MATERIA MEDICA. 585
Name three indications for the use of opium.
To relieve pain, to produce sleep, to check excessive secre-
tion, as in dysentery.
How does opium act when used as in the last question?
The principal action of opium is on the nervous system,
first affecting the cerebral convolutions, which are briefly
stimulated and soon depressed; next the perceptive and sen-
sory centers in the higher brain are blunted and the con-
ductivity of the afferent nerves is impaired. The hypnotic
action of opium is believed to be due to the lessened activity
produced by the drug on the nerve cells and the consequently
lessened demand for blood. Its constipating aetion is pro-
duced by stimulation of the inhibitory nerves of the intestine
through the splanchnic.
What are the therapeutic uses of the preparations of
bismuth?
Locally the insoluble bismuth salts are used in acne rosa-
cea, stomatitis, coryza, gonorrhea and leucorrhea. The sub-
nitrate is regarded as of great value in diarrhea and dysen-
tery, in disordered digestion, vomiting, gastralgia, and gastric
ulcer. The bismuth nitrate is soluble and toxic, and is not
generally used. The subcarbonate and the subgallate are used
in the same class of cases as the subnitrate.
How would you distinguish quinine from the other cin-
chona ailcaloids?
The slight solubility of the sulphate of quinine in water
distinguishes this alkaloid from other cinchona alkaloids.
Give the adult dose of phosphorus, solution of arsenous
acid, and tincture of aconite.
0.0005 Gm. ( T^T grain) ; 0.2 Cc. (3 minims) ; 0.6 Cc.
(10 minims).
What condition of the eye contra-indicates the use of
mydriatics?
All diseases increasing intra-ocular tension.
58G THERAPEUTICS AND MATERIA MEDWA.
Describe the physiologic action of arsenic and name
three indications for its use.
In therapeutic dose, with the exception of a slight increase
in the pulse, arsenic exerts very little influence on the circu-
lation. In toxic dose it causes the fall of blood-pressure. In
medicinal dose it ia a eei-ebro-spinal stimulant, but in toxic
doses it paralyzes the spiaal cord, especially the sensory side.
Small doses increase the appetite and stimulate digestion.
Toxic doses pi-oduee violent gaatro-intestinal inflammation.
In small doses it diminishes and in large doses increases tissue
waste. In concentrated form it is a powerful irritant and
escharotic. It is indicated in anemia, malaria and diabetes.
For what medicinal purposes is senna used?
It is used as a laxative in habitual constipation, and in
larger doses as a cathartic.
Write a prescription for an ointment containing a rube-
facient and at least one other constituent.
Jan. 1, 190;i. Fob John S-Mirn.
B . Ungiiciiti hydrargyri nilmlin ,^ iv
Si'lpl'u™ 3"
Creosoti gtt. x
Adipis fgi
Pr. iinguenLum f,^ i
S. Eub in well. Jamke iosm, M. D.
What is the usual physiologic action of an astringent
administered internally?
Astringents are agents which produce contraction of muscle
fiber and condensation of other tissues. They lessen secre- '
tions fram mucous membranes.
What are the medical uses of ammonia?
Ammonia is employed in medicine when a quickly-acting
heart and respiratory stimulant is required. It
as an antacid and a counter-irritant.
What are the therapeutic uses of lime (calcium)?
Lime in its unslaked form acts u|X)n the skin as an irri-
THERAPEUTICS AND MATERIA MEDIC A. 587
tant and caustic ; if inhaled or swallowed it may produce dan-
gerous inflammation, followed by ulceration. In weak solu-
tion it has a sedative and an astringent effect, both locally
and internally, and acts as an absorbent and antacid.
For what pathologic conditions may capsicum be used?
It is an excellent stomachic tonic in atonic dyspepsia and
in that of chronic alcoholism with tremor and insomnia. In
acute dipsomania large doses are effective in producing sleep
and promoting appetite. Ijocally, capsicum plaster is a mild
counter-irritant.
•
What is the ordinary relative strength of a tincture to
a fluid extract of the same drug?
With fluid extracts a cubic centimeter represents the medi-
cinal powers of 1 gramme of the drug. Tinctures are divided
into two classes. A uniform strength of 10 per cent, has been
adopted by the new pharmacopoeia for the tinctures of potent
drugs. Other tinctures have a strength of 20 per cent.
Name three agents which are used to promote menstru-
ation.
Potassium permanganate, purgatives, as castor oil, and
ergot.
How do the preparations of gentian affect the human
system and in what conditions are they indicated?
Gentian is used exclusivelv as a bitter tonic. In atonic
dyspepsia it increases the appetite and stimulates digestion.
The dose of medicine given by the mouth being i grain,
what would be the equivalent dose for hypodermic use and
what for administration by the rectum?
For hypodermic injection the dose should be % or % of
that used by the mouth. By the rectum J of the same.
How should a case of poisoning with chloral hydrate be
treated?
The patient should be aroused by friction, douches, etc..
588 TUERAPEVTlCii AND MATERIA MEDICA.
but must not be made to walk, as in opium poisoning, on ae-
count of heart failure. Cardiac and respiratory stimulauts
should be given freely, as ammonia, atropine and Btrychnine.
Artificial respiration should be resorted to early, hetore the
development of asphyxia.
In what conditions may cathartics be useful in the (real-
ment of diarrhea or dysentery?
Cathartics are useful in the treatment of diarrhea and dys-
entery, especially early in the course of this condition, in the
case of diarrhea for the purpose of removing offending mate-
Hal, as iudij^estilile food, discharges, bacteria, etc.
Define a laxative, a saline purgative, a drastic purgative,
a hydragogue purgative and a cholagogue purgative, with
an example of each.
Laxatives are drugs which excite moderate peristalsis and
produce soft stools without irritation, as sulphur. Saline
purgatives include the neutral salts of metals, of the alkalies
or alkaline earths; they stimulate the intestinal glands to
increased secretions and produce a copious evacuation, hs
Epsom salts. A drastic purgative produces violent peri-
stalsis and watery stools, with much griping pain and tenes-
mus; in large doses irritant poisoning results, as .ialap. Hy-
dragogue purgatives are those which remove a large quantity
of water from the vessels, as elaterium. Cholagogue purga-
tives stimulate the diseharfre of bile and produce free purga-
tion, as podophyllin.
Would you administer charcoal internally, and if so in
what dose and for what purpose?
It may be given with advantage in chronic gastric catarrh,
cancer, intestinal dyspepsia and diarrhea when flatulence is t
prominent symptom. IK«e is 1 Gm. (15 grains).
What are the physiologic effects of gelsemium?
Medicinal doses do not affect the circulation. Toxic doses
depress the heart. It is a marked depressant to the spinal
THERAPEUTICS AND MATERIA MEDICA. 589
cord, and in toxic doses produces paralysis. The drug kills
by paralyzing the respiratory center. Locally the drug
causes dilatation of the pupil, probably from paralysis of the
oculo-motor nerve.
Describe the therapeutic uses of jalap and state how it
differs in effect from aloes.
In moderate dose jalap acts as a hydragogue cathartic, pro-
ducing copious watery discharges. It is best given in the
form of compound jalap powder in conditions of general
dropsy, and should never be employed in simple constipation.
Aloes is a cholagogue cathartic, stimulating the discharge of
bile.
Name two remedies which are commonly used to pro-
mote intestinal peristalsis.
Belladonna and nux vomica.
What are the therapeutic uses of guaiac?
Used locally and internally in acute bronchitis; often pro-
scribed in chronic rheumatism, gout, sciatica and lumbago.
Name the official bromides.
The bromides of potassium, sodium, lithium, ammonium,
strontium and zinc.
Describe the therapeutic uses of ox-gall.
It is a tonic, antiseptic and purgative, stimulating the ab-
sorptive powers of the mucous membrane. It is frequently
used as a laxative in constipation.
Where does buckthorn grow? Give the official prepara-
tion and dose.
In Europe. Flnidextract of frangula. Dose 1 Cc. (15
minims).
What are the therapeutic uses of gelsemium?
It is indicated in all conditions of exalted nerve function,
and contra-indicated whenever the heart is weak. It is espe-
ind therapeutic use of
590 THERAPEUTICS AND MATERIA MEDICA.
cially useful in cerebro-spinal meningitis, mania, persistent
insomnia, neuralgia, dysmenorrhea, incontinence of urine,
irritation of the bladder, spasmodic coughs and remittent or
typho-malaria! fevers.
What is the purgative dose of acetate of potassium?
Two to four drac-hniH.
What is the common name
plumbi acetatis?
Sugar of lead. It is a component of the mixture of lead
water and laudanum, which is employed in bruises and in-
flammatory swellings where the skin is not broken. It is
used in solution as a lotion in skin diseases and pruritus, and
is employed as an astringent in diarrhea.
How do official waters, e. g. aqua camphorae, differ
from solutions, e. g. liquor calcts?
Wafcre arc aqueous solutions of volatile substances; liqu(
are all atjueous solutions of non-volatile substances.
How do potassium acetate and potassium bitartrate
compare as diuretics and purgatives?
The acetate is the more certain diuretic; the bitartrate is
the more active cathartic.
Give the common name and the official preparations of
prunus Virginiana.
"Wild cherry. The official preparations are tlie fluid ex-
tract, infusion and syrup.
On what chemical change in the intestinal tract does
the purgative action of castor oil depend?
The oil is decomposed by the pancreatic juice, setting free
ricinoleic acid, which produces purgation by a mildly irritant
action on the bowels, stimulating the glands and muscular
coat, but not the liver.
What are the therapeutic uses of acetic acid?
Used internally as a nnild refrigerant and antiscorbutic,
F
THERAPEUTICS AND MATERIA MEDICA. 591
and as an antidote in poisoning by alkalies, such as ammonia.
Locally it is used to check hemorrhages and as an escharotic.
What is the proportion of mercury in blue pill? What
is the dose of blue pill?
It contains 33 per cent, of mercury. Dose 1 to 20 grains.
What effect has benzoin on the urine? • Name the prep-
arations of benzoin.
It renders the urine acid and increases its quantity. The
preparations of benzoin are adeps benzoinatus, tinctura ben-
zoini, tinct. benzoini composita, acidum benzoicum, ammonii
benzoas, lithii benzoas, sodii benzoas.
What are the alkaloids of pilocarpus and how do they
compare in physiologic effect?
The alkalies of pilocarpus are pilocarpine, jaborine, antag-
onistic to pilocarpine in action; pilocarpidine, analogous to
pilocarpine, and jaboridine, which is analogous to jaborine.
What is the source of camphor and what is the dose of
spiritus camphorae?
Camphor is a stearopten obtained from the cinnamomum
camphora, a tree of the natural order Lauracece (indigenous
to China and Japan), purified by sublimation. Dose of the
spirit 1 Cc. (15 minims).
Give the common name and the therapeutic uses of
potassium bi tartrate.
Cream of tartar. It is an agreeable laxative, and also is
used as a diuretic in infusion of juniper in general cardiac
dropsy.
Give the source and preparations of gum arable.
Acacia, gum arabic, is a gummy exudation of Acacia Sen-
egal, a small tree native in Africa. Its preparations are the
syrups and mucilage. It enters also into the composition of
official troches, etc.
592 THEHAPEVTICS AND MATERIA MEDICA.
Mention the therapeutic uses of nitric acid.
It is locally a powerful escharotic, and internally in dilute
form in bilious affections. It lessens phosphatic deposits and
sets as an astringent to the system, diminishing expectora-
tion in bronchorrhea and phthisis.
Oive the physiological action and the therapeutic uses of
sarsaparilla.
It is doubtful if it possesses any physiologic action. Some,
however, claim it to be diurectic, diaphoretic, tonic and alter-
ative. Its chief value is as an excipient for administering
potassium iodide and inereiiric chloride in syphilis.
Describe and give the indications for the uses of cardiac
sedatives, with an example.
Cardiac sedatives are drugs which are used to decrease the
activity of the circulation. The indications for their use are
increased arterial excitement, sthenic fevers and severe local
inflammation. Aconite is an example of such a drug. It
reduces very markedly the rate of the pulse and the arterial
pre.ssn re.
Describe the physiologic action of antipyrine in medicinal
doses on the circulation and temperature.
After the ingestion of a full medicinal dose there is a stim-
ulant stage, in which the heart's activity is increased; this is
soon followed by profuse sweating, coolness of the surface,
slowed pulse, considerable depression, and if fever be present
by lowered temperature. In health it has very slight anti-
pyretic effect. It raises the arterial tension and blood pres-
sure.
How do digitalis and belladonna act in increasing blood
pressure?
Digitalis increases blood pressure by its powerful stimu-
lating effect on the heart by contraction of the arterioles,
resulting indirectly from stimulation of the vasomotor center,
and directly from the action of the drug on the vessel walL
I
THERAPEUTICS AND MATERIA MEDICA. 593
The increased blood-pressure produced by belladonna is due
to stimulation of the vasomotor centers and the heart itself.
Name a vasomotor stimulant, a vasomotor depressant
and describe tiie physiologic action of eacii.
Belladonna is a vasomotor stimulant; it quickens the pulse
and raises arterial pressure. The increased blood-pressure
is due to stimulation of the vasomotor center and the heart
itself. Toxic doses paralyze the heart; large doses stimulate
the respiratory center; toxic doses paralyze it; large doses
stimulate the brain and spinal cord and act as a depressant
to the motor and sensory nerves; it lessens nearly all of the
secretions except that of the kidney; it dilates the pupil by
paralyzing the peripheral ends of the oculo-motor nerves
and by stimulating the ends of the sympathetie. Veratruni
viride is a vasomotor depressant; it lessens in a marked de-
gree the force and rate of the cardiac pulsation ; the lowered
arterial tension results from depression of the vasomotor cen-
ter and of the heart itself; the slowing of the pulse from
stimulation of the inhibitory nerves of the heart and from
v^xakening of the cardiac muscles. Large doses depress the
respiratory center, the spinal cord and peripheral nerves and
muscles.
Give tiie theory of the alkaline treatment of rheuma-
tism.
The alkaline treatment of rheumatism by the administra-
tion of potassium acetate, citrate, etc., was in general use
before the introduction of the salicylates. Wood states that
the alkalies do good in rheumatism by lowering arterial ac-
tion, by favoring oxidation and elimination of partially effete
products, and by neutralizing excessive acidity.
What is incompatibility in medicine, and v^hat are the
different kinds of incompatibles? Give an example of
each.
Incompatibility in medicine signifies that a combination is
38
594 TSEliAl'EUTWS AND MATERIA MEDICA.
not suitable for administration. Incompatibility may be
chemical, pharmaceutical and therapeutic, according as the
prescribed combination results in cbcmieal decomposition,
physical diaassociation or antagonistic action. An example
of chemical incompatibility is seen in the prescribing of qui-
nine sulphat* with potassium acetate, resulting in a volu-
minous precipitate of quinine acetate. An instance of phar-
maceutical incompatibility is the addition of an acid to a
quinine and liquorice mixture, resulting in precipitation of
the glycyrrhizin, relied on to cover the taste of the quinine.
Therapeutic incompatibilitj arises when two agents mixed to-
gether oppose each other in their action, for instance bella-
donna and physostigma.
Describe the physiologic action of salicylic acid.
Salicylic acid is a powerful antipyretic and antiseptic. In
small doses it stimulates the stomach, heart and respiration,
but moderate quantities derange the stomach, causing nausea
and vomiting, while large doses depress the heart's action
and the respiration, lower the arterial tension, relax the ves-
sels and produce free perspiration.
Name the therapeutic uses of apomorphia and state how
codeia differs in its physiologic action from morphia.
Apomorphia is a valuable emetic and a useful expectorant
in the dry stage of acute bronchitis, and in chronic bronchitis
when the expectoration is viscid and scanty. "While codeia
possesses but feeble hypnotic powers, it exerls a sedative influ-
ence similar to morphine; it is at times much better borne by
patients than morphine, but is regarded as less reliable.
Enumerate the symptoms arising from a toxic dose of
digitalis.
Digita]i.s poisoning is characterized by obstinate vomiling,
diarrhea, headache, severe pain in the back and limbs and a
very slow, full pulse, which, when the patient sits up, may
become rapid and feeble. Later, even in recumbency, the
pulse becomes rapid, thready and irregular, the surface cold,
I
THERAPEUTICS AND MATERIA MEDICA. 595
the urine suppressed and the mind stuporous. Intelligence,
however, is not lost until shortly before death. Occasionally
convulsions develop during the last stage.
What are the therapeutic uses of tartar emetic?
It is employed as an emetic, diaphoretic, sedative, expecto-
rant, cardiac depressant and counter-irritant.
Describe cantharis and name three official preparations.
Cantharis is the dried body of the beetle, Cantharis vesica-
toria, found chiefly in the south of Europe. The active prin-
•ciple is cantharidin. Ceratum cantharidis, collodium can-
tharidatum, tinctura cantharidis.
By what rule would you determine the dose of any medi-
cine for a child?
Young's rule will be found the most convenient. Add 12
to the age and divide by the age, to get the denominator of a
fraction, the numerator of which is 1 ; thus, for a child 2
^ears old, 2 plus 12 divided by 2 equals 7, and the dose is 1-7
of that for an adult.
Name ten official preparations of mercury. Name four
alkaloids of opium.
Hydrargyrum cum creta,^ massa hydrargyri, unguentum
hydrarygri, emplastrum hydrargyri, hydrargyri chloridum
mite, hydrargyrum ammoniatum, unguentum hydrargyri
ammoniati, hydrargyri oxidum flavum, unguentum hydrar-
gyri oxidi flavi, hydrargyri oxidum rubrum. Four alka-
loids of opium are morphine, codeine, thebaine and narcotine.
Give the source and dose of picrotoxin, creosote and pix
liquida.
Picrotoxin is a neutral principle derived from cocculus
indicus, dose 1-100 to 1-20 grain. Creosote is a product ob-
tained from distillation of wood-tar, dose 0.2 Cc. (3 minims).
Pix liquida, tar, is an oleoresin obtained from the destructive
<iistillation of certain species of Pinus; the dose is 0.500 Ghn.
<7y2 grains). •
596 TBEUAPEVTICS AND MATERIA MEDICA.
What are the principal therapeutic uses of the prepara-
tions of mercury?
The plaster of mercury is used as an absorbent and oounter-
irritaut over chronic inflammatory swelling, glandular en-
largements, syphilitic nodes, etc. Mercurial ointment and
the oleate of mercury are used for the same purposes as the
plaster; they are also extensively employed in the treatment
of syphilis by inunction. Blue mass is used as a cholago^e.
laxative and diiiretio. Ammouiated mercury is used exter-
nally as a stimulant or parasitieide. The chloride of mer-
cury is an antiseptic, an ti- parasitic, anti-syphilitic ab-
sorbent, and tonic. The mild chloride, calomel, is used
internally as an anti-syphilitic, as a laxative, as a gastric
sedative, a cholap'ogue aLid a diuretic, and externally as a
stimulant and desiccant. Mercuiy and chalk is used in the
same class of eases as calomel. The yellow iodide is fre-
quently used as a substitute for the chloride, as is the red
iodide. The nitrate is used externally as a powerful caustic.
The oxide is used externally for its stimulant and aJterati^-e
effect. The yellow sulphate, lurpefh mineral, is sometimes
employed as a stimulating emetic for children, but it is dis-
tinctly poisonous.
State the contra-indications to the use of quinine.
It is contra-indicated in acnte inflammatory affections of
the brain, eyes and ears.
In what form would you prescribe eucalyptus and in
what doses? Whence is eucalyptus obtained.
Eucalyptus is derived from the leaves of the tree Euca-
lyptus globulus, a native of Australia. It may be prescribed ]
in doses of 2 Cc. (30 minims) of the fluid extract or in doses. 1
of 0.5 f'c. (S minims) of the oil in elastic capsules or pmulsioD.. |
In what strength would you use solutions of nitrate of
silver, borax, permanganate of potash, bichloride of mer>
cury and creolin for injection into the bladder?
Silver nitrate, 1 grain in 4 ounces of water; borax, tO grain*
THERAPEUTICS AND MATERIA MEDICA. 597
to the ounce; permanganate of potassium, 20 grains to the
pint; bichloride of mercury, 1 to 3000; creolin, i/^ to 1 per-
cent.
Name six drugs containing large quantities of tannic
acid.
Galla, catechu, hamamelis, kino, granatum, hematoxylon.
Name four drugs incompatible with iodide of potassium,
two with atropine and one with antipyrine.
Potassium iodide decomposes most of the metallic salts.
The following four drugs are examples of this incompati-
bility: Sulphate of quinine, sulphate of iron, acetate of lead,
oxide of zinc. Physostigmine and aconite are incompatible
with atropine. Tannic acid is incompatible with antipyrine.
Give the physiologic action of ergot and mention its
therapeutic uses.
Ergot is a motor excitant and a vascular contractor. It is
also hemostatic and anhydrotic, emmenagogue and oxytocic.
It increases the functional activity of the spinal cord, it stim-
ulates the vasomotor center, raises the blood-pressure, pro-
duces contraction of unstriped muscle fiber, reduces the cali-
ber of the arterioles, depresses the motor ganglia of the heart
and causes a slower and weaker pulsation.
Ergot is used to promote uterine contractions in labor, in
amenorrhea due to plethora and in the atonic form of sper-
matorrhea. It is useful in catarrhal inflammations of the
mucous membranes generally. It is an excellent remedy in
chronic diarrhea and dysentery, in hemorrhages of arterial
type, in headache and migraine of congestive form, in mye-
litis and tabes and chronic nervous diseases. It is also used
locally in hemorrhages.
Name four drugs used in the treatment of bronchorrhea
and explain their action.
Eucalyptus for its expectorant effect. Lead acetate for its
astringent effect to restrict secretions. Quinine and arsenic
iis valuable tonics and restoratives.
598 TUERAPEUTICS AXD MATElilA MEDICA.
What is the physiologic action of rhubarb in dose of i
to 5 grains? In dose of jo to 60 grains?
In small doses its action is that of a gastric tonic and an
intestiual astringent. In larger doses its cathartic action
prevails, producing in G to 8 hours copious yellow stools ivith
some griping and considerable hepatic stimulation.
For what purposes is diaphoresis produced? Name
three diaphoretics.
Diaphoretics are employed in medicine to fulfil the follow-
ing indications: (1) to arrest forming diseases of not very
severe type, as in general cold and suppressed menstruation;
(2) to favor absorption, as in dropsy; (3) to aid in the sub-
sidence of diseases which naturally pass off in a sweat, as.
malaria; (4) lo eliminate noxious materials from the blood.
Three excellent diaphoretics are pilocarpus, spirit of nitroii»
ether and Dover's powder.
What is the source and what are the therapeutic uses of
picrotoxin?
Picrotoxiu is a poisonous neutral principle obtained from
the seeds of cocculus indieus, used in the night sweats of
phthisis and in the form of an ointment as an an ti- parasitic.
Give the chemical name and the dose of (a) Epsom salts,
(b) Rochelle salts, <c) Glauber's salts.
(a) Magnesium sulphate, dose 16 Gm. (240 grains); (b)
potassium and sodium tartrate, dose 8 Gm. (120 grains) ; (c) 1
sodium sulphate, dose .IG Gm. (240 grains).
Describe hypodermoclysis and state the circumstances
under which it is practiced as a therapeutic measure.
Hypodermoclysis is the inti-oduetion into the subcutaneous I
tissue of fluids in large cLuaotity. It is indicated to replace
the fluid lost through excessive purging or hemorrhage. It
may also be used to wash from the body certain impurities
circulating in the blood and lymph; in other instances it may
be used to supply the botly with lif|uid when the atomaeh will \
THERAPEUTICS AND MATERIA MEDICA. 599
not permit drinks to be swallowed, as in gastric ulcer or
abdominal operations. Normal saline solution is used for
such injections. The sterilized liquid is placed in a proper
vessel which is absolutely aseptic, and to which air gains ac-
cess only by means of a glass tube filled with sterilized cotton ;
from the lower part of the vessel a rubber tube leads, to
which is attached a canula carefully sterilized. The skin
over the place where the liquid is to enter is to be rendered
sterile. The trocar is then inserted into the subcutaneous
tissue of the abdomen or thigh and the solution allowed to flow
at the rate of 1 dram to each pound of body weight in 15
minutes. The pressure is obtained by raising the container a
few feet.
Define galactagogue and sialagogue and give an example
of each.
A galactagogue is an agent which increases the secretion of
milk, example pilocarpus. A sialagogue increases the secre-
tion and flow of saliva and buccal mucus, example mercury.
By what process and from what source is sugar of milk
principally obtained?
It is a crystalline sugar obtained from the whey of cows'
milk by evaporation and recrystallization.
State the source and give the uses of saccharin.
It is derived from coal tar. It is about 500 times sweeter
than sugar and is used as a substitute for sugar in the food of
diabetics and subjects of liver disease and corpulence.
Describe the preparation of lime water. Give the offi-
cial name and the adult dose.
Liquor calcis may be given to an adult in average doses of
16 Cc. (4 fluidrachms). It may be prepared by pouring 2
quarts of hot water over fresh unslaked lime the size of a
walnut: stir till slaked, let it stand until clear and bottle.
600 THERAPEUTICS AAD MATERIA MEDICA.
Give the source, the physiologic action and the thera-
peutic uses of oleum ricini.
Castor oil Js a fixed oil expressed from the seeds of rleinua
oommunis. It acts as a mild, but rattier slow purgative, pro-
ducing witiiout ii'ritation copious aemi-liquid stools. It does
not increase the flow of bile nor to a great extent the secre-
tions of the intestinal canal, but excites catharsis by stimu-
lating the muscular coat of the bowel. It is useful in acute
inflammatory affection of the bowel and as a laxative in preg-
nancy, anal fissure and painful bemorrhoids.
What are the medicinal uses of potassium chlorate?
It is an excellent local application in inflammatory condi-
tions of the mouth and throat, being valuable in tlie various
forms of stomatitis, in acute pharyngitis, in diphtheria and
scariet fever.
How should poisoning by coal gas be treated?
Antidotes, chlorine water as a spray, inhaled. Antago-
nists, oxygen by inhalation 4 or 5 quarts. Ammonia vapor
inhaled. Galvanism, by iuterrupled current to extremities.
Artificial respiration, to be maintained steadily for hours.
Rhythmic traction of the tonsue. Fresh air in plenty; open
all doore and windows. Coffee, black, a pint as enema.
Venesection may be of service. Douche, alternately cold and
warm, to head and chest. Horizontal position, elothing re-
moved. Alcohol moderately by mouth or rectum. Catheter
may be required in prolonged cases. Subsequently a warm
bed, heat applied to the body and limbs, open windows, perfect
quiet, Condy's fluid about the room, stimulants sparingly.
cold acid drinks freely.
Write a prescription for a cough mixture containing
muriate of ammonia and an opiate, giving adult dose.
Jan. 1, 1903. Fob Jorbpb Wilsoji.
B ■ AmiDonii cliloridi 3 »
Tr. opii camph f S '
Sjr, pruni 7irg f,?iv
M. S.— f^ I every four hoiirB.
Joseph Jones, U> D.
THERAPEUTICS AND MATERIA MEDICA. 601
What are the therapeutic uses of podophyllin?
It is an excellent laxative in constipation associated with
hepatic congestion. It tends to produce griping and is usu-
ally given with small doses of belladonna or hyoscyamus.
What is the dose of Fowler's solution and what precau-
tions should be observed in its administration?
The dose is 0.2 Cc. (3 minims). Potter advises that full
doses of the solution should be taken at first, and always im-
mediately aft^r food; the dose should then be gradually re-
duced. Susceptible persons often tolerate it better if a few
drops of laudanum are administered with each dose. Swell-
ing beneath the eyes is an indication of the physiologic limit
for the emplo>Tnent of the drug.
From what part of the colchicum plant is the active
principle obtained?
From the corm and seed.
What injurious effect is liable to follow the prolonged
internal use of the preparations of silver?
Argyria. The first sign of this condition is a slate-colored
line along the margin of the gum with some inflammatory
swelling. Subsequently grayish patches appear on various
parts of the skin and mucous membrane and gradually extend
over the whole body. As a rule, arg>'ria does not produce
serious effects on the health of the subject. The pigmenta-
tion is due to a deposit of silver in the connective tissues. In
the skin it is found in the corium. The discolorization is per-
manent.
Name a vesicant derived from (a) the animal kingdom,
(b) the vegetable kingdom, (c) the mineral kingdom.
(a) Cantharides, (b) mustard, (c) iodine.
602 THEEAPEVTICS AND MATEEIA MEDICA.
Write a prescription for diarrhea containing an alkali
and an astringent suitable for a child of ten years.
Jan. ], 1903. Walteb.
B. Sod i i bi carbon atU gii
Bisniulhis subcarbonHtis ■ ■ 5ii
TragacSiiiCha^ 31
SpU. chlorofonni f 3 i
Aquae cinnamomi f 3 (t
M. S.— TeBPimonfiil every four hours.
Joseph Jokes, M. D.
What is the vulgar name for veratrum viridc? What is
its active principle and the dose of the principle?
American hellebore. It coDtaina several active principles,
of which the most important is jervine. The dose of the
tincture is 1 (>. [1.5 minims).
Name three drugs which are administered internally to
arrest bleeding.
Ergot, gallic acid and hcmatoxyloQ.
What are the therapeutic uses of magnesia?
It is used as an antacid and lasative in acidity, sick head-
ache, colic, etc., and as an antidote in poisoning by acids,
arsenic, phosphorus and the mercuric and copper salts.
Mention the medical uses of the oil of turpentine.
The oil of turpentine is employed externally as a rubefa-
cient and counter-irritant in many conditions causing pain
and inflammation. The liniment is in constant use for sprain,
neuralgia and other sliffht local affections. Internally it i
best employed in ulceration and hemorrhage of the intestines,
and in passive hemorrhage from other organs. It is also used
as an anthelmintic against tape-worm, and is of value in flatu-
lent eolic. It is employed in chronic bronchitis and ehronie
inflammations of the mucous membranes generally.
For what are the preparations of juniper used in r
cines?
Juniper is a stomachic tonic, diaphoretic, diuretic and |
THERAPEUTICS AND MATERIA MEDICA. 603
aphrodisiac. The oil acts therapeutically like the oil of tur-
pentine, and may be used in chronic cystitis, etc., but is
contra-indicated where acute inflammations of the kidney
exist.
How should a case of poisoning with atropine be treated?
Tannic acid should be given freely and the stomach emptied
by an emetic or the stomach-pump. Collapse must be met by
the use of heart stimulants, such as ammonia, alcohol and
nitroglycerin.
What is the vulgar name of physostigma?
Calabar bean.
What are the therapeutic uses of the preparations of
zinc?
The acetate is used as an astringent application in conjunc-
tivitis and subacute gonorrhea. The precipitated zinc car-
bonate is used as a sedative astringent in acute inflammatory
affections of the skin, such as erythema and eczema. The
chloride is used as an astringent antiseptic and caustic. It
is also used in chronic inflammation of the mucous mem-
branes. The oxide is employed in the form of an ointment
or powder externally as a mild astringent and sedative in
burns, acute ulcers, etc. Internally it is of doubtful value
as an anti-spasmodic and anti-hydrotic. The phosphide of
zinc is employed in the same class of cases in which phos-
phorus is indicated. The sulphate of zinc is employed locally
as an astringent, and internally is used in chronic dysentery
and diarrhea, as well as an emetic in large doses in narcotic
poisoning.
Name three official preparations of camphor.
Aqua camphone, linimentum camphora? and spiritus cam-
phor®.
F
604 TEERAPEI-TICS AND MATERIA MEDICA.
Write a prescription containing some preparation of
iron in a delectable form.
Jan. 1, 1D03. PoH Wm. Jones.
U. Tinctuneferrichloridi. fgii
AcidiphiKiplioricidiliili T^iii
Spiritos limoniB Tj i
Sjrapi rjiiwi
Aqoam ad f 5 vi
M. S.-'rnbleE[io.mful nfler meals.
John Smith. M- It-
Wliat preparations of copper are used in medicine and
for wliat purposes?
The only official salt of copper is the sulphate; it is useful
in phosphorus poisoning both as an emetic and a uheiuical
antidote. Tlie application of the solid crystal is often useful
for its astringent and stimulating qualities. It is also useful
in gonorrhea in the subacute stage. Internally il is some-
times employed in chronic diarrhea.
What are the therapeutic uses of borax?
Borax is sodium borate, which is a powerful antiseptic and
disinfectant. It has been nsed internally in amenorrhea,
dysmenorrhea and puerperal convoilsions and epilepsy. In
thp form of a wa.sh it is of value as an anti-pruritie.
With what remedies should spasmodic croup be treated?
Name three suitable ones.
With emetics, as ipecac, and with anti-spasmodies, such as
the bromides. Lobelia is a useful remedy.
Describe the medicinal uses of hydrocyanic acid.
Hydrocyanic acid is used solely to allay irritation of the
peripheral nerves. Thus it is employed internally for the
cough of phthisis and chronic bronchitis, for gastralgia in
obstinate vomiting, and externally to subdue the itching in
pruritia, eczema and urticaria.
THERAPEUTICS AND MATERIA MEDICA. 605
Mention the conditions which affect the dosage of medi-
cines.
The age of the patient, the personal idiosyncrasy, the con-
dition of the heart, kidneys, nervous and respiratory system.
What class of acids would you use to acidify alkaline
urine?
Benzoic acid and its derivatives, as benzoate of sodium and
ammonium.
What is the dose of phenacetine as an antipyretic?
Dose 0.500 Gm. (7Vi» grains) every 4 to 6 hours.
What is the composition of the so-called green soap?
Green soap is prepared from potassa and linseed oil.
Where does arnica grow most abundantly? What part
of the plant is used in medicine?
In the mountains of northern Europe and Siberia. Both
the flowers and the roots are official.
What is glycerin and what are its therapeutic uses?
Glycerin is obtained by the decomposition of vegetable or
animal fats or fixed oils. It is a triatomic alcohol, existing
in fats and fixed oils in combination with the fatty acids.
Externally it is used in various forms as an emollient. In
the various acute inflammations of the fauces, it makes an
excellent vehicle for carryiug other drugs. Being hygro-
scopic, it not only depletes the turgid vessels, but it spreads
the medicant over the entire surface. It is especially useful
in tampons in such conditions as uterine congestion. It may
be employed in suppository in obstinate constipation. It is
sometimes used as a substitute for sugar in diabetes.
How many grains of the hydrochloride of cocaine are
contained in one ounce of a ten per cent, solution?
Forty-eight grains.
What is the dose of the fluid extract of senna?
Dose, 2 Cc. (30 minims).
I
I
606 TREKAFEVTICS AND MATEIUA MEDICA.
What injury may result from large doses or long con-
tinued use of potassium chlorate?
The chlorate is distinctly irritant to the kidneys. An in-
flammation of these organs may follow its use.
Give tlie habitat of squills and state which of its prep-
arations are used in medicine.
It is native to southern Europe, The preparations an-
vinegar of sriuills, fluid extract, syrup, compound syrup and
tincture.
Describe the therapeutic uses of olive oil and state
where it is principally produced.
It is produced principally in southera Europe, California
and Australia. Externally used it is a good protective from
the air, and if rubbed into the skin is absorbed by the lym-
phatics and is directly nutritive. Internally it is a food and
a mild laxative, and in quantitj' protects the mucous mem-
branes against the action of poisonous aubstanees.
How should phosphorus poisoning be treated?
Immediate full dose of sulphate of copper, which is an
emetic as well as a chemical antidote. Potassium perman-
ganate and French oil of turpentine are also of value.
What is the dose of oleum erigerontis?
Dose 1 Cc. (15 minims).
Write the following prescription in the metric system:
B . Amnionii bromidi. .
Sp.
A,,
B . Ammonii bromidi
Sp. iminonis nroniBt
Aqn«. 120|
HiMse.
What is the dose of oleum sabinae?
Dose 0.05 Cc. (1 minim).
THERAPEUTICS AND MATERIA MEDICA. 607
What medicine would you give to promote bone growth?
One of the preparations of lime, as lime water, or the
carbonate or phosphate.
What is the allcaloid of pomegranate and for what is it
used?
Pellatierine; it is a teniafuge.
By what other name is saltpetre Icnown?
Potassium nitrate and nitre.
In what dose may sulphonal be administered to an adult
to produce a soporific effect?
It may be given in average dose of 1 Gm. (15 grains), best
in hot milk about 2 hours before retiring.
To what chemical change does sulphur ointment owe its
efficiency as a parasiticide?
Sulphur ointment contains an alkaline ingredient and de-
velops sulphides which are powerful anti-parasitics.
What are the uses of lactic acid in medical practice and
what pathologic conditions may its administration pro-
duce?
It is employed as a mild caustic, a digestant and intestinal
antiseptic. It is a valuable local remedy in laryngeal tuber-
culosis, and internally in cholera, typhoid fever, simple diar-
rhea and the diarrhea of infants. It is supposed to cause
acute rheumatism when in excess and free in the blood.
Write the following prescription in the metric system:
B . Morphinae Hulphatis grains 6
Sodii boratis drams 4
Aquse camphorse. ... fl. ounces 6
B . Morphina* 8ulphatis 4
Sodii boratis 16
Aqu£e camphorse 180
What is the effect of full doses of opium on respiration
608 TFIERAPEUTICS AND MATERIA MEDICA.
and to what extent may this effect be safely carried in
treatment?
In full dose there is irregular aud slow respiration. It
should not be used when there is profuse expectoration, as
the lowering of excitability of the respiratory center which it
produces would be dangerous in such a ease. Morphine is
combined with atropine to overcome the effect of Uie former
i>n the circulation. It should be avoided in all organic dis-
eases of the lungs associated with weak respiration.
Where is colocynth obtained and for what is it used?
Coloeynth is the fruit of eitruUus coloeyntliis deprived
of its rind. The plant is a native of Spain and ^Vsiatic
Turkey. It is classed among the tonic, astringent and resin-
bearing purgatives. In moderate doses it increases peristal-
sis and the intestinal glandular secretion : watery evacuations
ivith griping pain.
What is the comparative action of strychnine and alco-
hol on the arterioles?
Strychnine raises the arterial pressui'e by stimulating t
vasomotor center in the medulla. Alcohol inhibits the vaso-
motor syatem, causing dilatation of all the vessels of the body,
especially those of the periphery. The blood pressure is
raised, however, owing to the great increase of cardiac action,
which overcomes the results of the arteriole dilatation.
How may carbolic acid poisoning be produced and bow
treated?
Carbolic acid poisoning may be induced by the local use,
especially of weak solutions, of the acid, as well as by tiie
internal ingestion of carbolic acid or its derivatives. The
treatment of the poisoning consists of the administration of
the antidote, which is a soluble sulphate, as sulphate of
sodium : this unites with the acid, forming an insoluble sulpho-
carbolate. Evacuation of the stomach, the application of
external heat and slimulanls and the use of mucilaginons.
drinks are indicated.
THERAPEUTICS AND MATERIA MEDICA. 609
Would you write for potassium chlorate and tannin in
the same prescription? Give reason for your answer.
No. There would be danger of explosion.
Mention the therapeutic uses of gamboge.
Gamboge is an irritant purgative, decidedly diaphoretic;
its catharsis is accompanied by vomiting and colic. It has
no cholagogue action. Its use, for the most part, is limited
to the compound cathartic pill, of which it is a constituent.
Where is Icousso obtained? What preparation is used
and for what purpose?
Kousso is a native of Abyssinia ; it is used in the form of the
fluid extract as an anthelmintic against tape-worm.
What remedies should be used for hemorrhages from
mucous surfaces?
The astringents and vaso-contractors ; the extract of supra-
renal gland is probably of greatest value; ergot, gallic acid
and opium are employed internally.
On what theory can the use of salol in diarrheal diseases
be advocated?
In the intestine it is separated into carbolic and salicylic
acids and acts as an antiseptic. It is free from irritating
properties.
For what is copaiba used in medical practice?
Copaiba is used in subacute or chronic inflammations of the
genito-urinary tract.
Name a drug commonly used which affects the color of
the stools without altering the constituency, and explain
the cause.
The organic salts of iron blacken the feces by conversion
into the sulphide.
Describe the three stages of chloroform narcosis.
1st stage: This stage is very short and the symptoms are
very similar to those of alcoholic intoxication. Consciousness
39
610 THERAFEUTICS AND MATERIA MEDICA.
is uot lost but the sensibility is generally dulled. Pupils of
eyes dilated.
2d stage: This is the stage of anesthesia, consciousness and
sensibility are abolished, the museles are relaxed and the pa-
tient is quiet. The pulse is generally normal in frequency,
but soraCT^'hat weakened. Pupils of eyes contracted.
3d stage: This stage is one of profound narcosis with ster-
torous breathing, intense muscular relaxation, abolition of the
ordinary reflexes and fall of bodily temperature. Pulse is
weak and rapid. Pupils of eyes dilated.
Describe the three stages of anesthesia under ether.
1st stflge: Burning in the fauces, feeling of strangulation,
sense of exhilaration, lightness in the head with a buzzing or
roaring in the ears. These symptoms are soon followed by a
senii-unc4)nsciousnes8 with visions and illusions. Pupils of
eyes dilated.
2-d stage : This stage begins with a complete loss of con-
sciousness. Muscular rigidity soon passes off and the patient
is quiet. Respiration is slow and regular. Pupils of eyea ■
contracted.
3d stage ; Same as the third stage under chloroform narcosis, i
Give the contra-indicBtions to the use of anesthetics.
Organic brain disease, including tumors, atheromatous cott-
ditions of the blood vessels, organic affections of the heart, |
lungs and kidneys (Wood). Some authorities add diabetes 1
mellitus, chronic alcoholism and enlarged tonsils.
Why is the use of ether as an anesthetic contra-indicatetf ,1
in diseases of the lungs and kidneys?
Because it is eliminated by the lungs and kidneys, and e
account of its irritating qualities it would aggravate the I
diseased condition.
What is meant by cataphoric application of a remedy? I
By cataphoric application of a remedy is meant the in-
filtrating of the tissue with some drug by electrical osmosis.
THERAPEUTICS AND MATERIA MEDICA. 611
Give the indications for the use in producing sleep of
(a) morphine, (b) chloral, (c) potassium bromide.
(a) Morphine is used when sleeplessness is due to pain.
(b) Chloral is indicated when sleeplessness is due to mental
ovenvork and where a more powerful hypnotic than potassium
bromide is required. If the heart or stomach are in bad con-
dition it should not be ^ven. (c) Potassium bromide is given
when insomnia is caused by cerebral excitement, nervous ex-
citement (especially when connected with the genital function)
and motor activity. According to Wood it is contra-indicated
by an excessive irritability of the gastro-intestinal mucous
membrane and great exhaustion.
(a) What systemic conditions contra-indicate the use of
nitrous oxide gas? (b) State why.
(a) Atheromatous vessels, fatty heart and pulmonary em-
physema. (Burchard). (b) Nitrous oxide gas increases blood
pressure and in atheromatous degeneration of the arteries this
may result in rupture of these vessels and if in the brain,
apoplexy or early death may ensue.
In fatty heart the muscles are weakened, and on account of
the increased resistance in the blood-vessels there may be
sudden dilatation of this organ.
In pulmonary emphysema the danger is in the engorgement
of the blood vessels of the lungs which causes an increased re-
sistance to the right heart, which may result in the sudde|l
dilatation of this organ, or there may be pulmonary edema
or hemorrhage.
(a) What are topical remedies? (b) Mention two
classes, (c) Give two examples of each.
(a) Topical remedies are those which are applied locally.
(b) Plasters and liniments, (c) Belladonna plaster and cap-
sicum plaster — turpentine liniment and chloroform liniment.
Give the signs of danger in chloroform anesthesia and
tell what should be done.
Lividity of the face, irregular or stertorous breathing
r
612 THERAPEUTICS AND MATERIA MEDICA.
or feebleness of the pulse. Withdraw the anesthetic, lower
the head, use artificial respiration and give a hypodermic
injection of strychnine, digitalis, or atropine.
When is chloroform preferred to ether as an anesthetic?
In acute intiammation of the bronchi or lungs, aneurism,
atheroma and nephritis.
Name the accidents that may happen during the admin-
istration of ether, and give the treatment in each case.
In the early part of Uie administratJou of ether we may
have failure of respiration, which is due to reflex spasm of
the laryngeal muscles excited by the ether. By giving more
air with the ether we can correct this trouble.
Embarrassed respiration may be due to the accumulation
of mucus in the upper air passages. In this condition we sim-
ply turn the head to one side.
Respiratory failure may be caused by the action of the
ether on the respiratory centre. In this case we withdraw
the ether; push the jaw forward by pressing on its angles,
draw the tongue forward by means of a tenaculum or for-
ceps and make rhythmic traction of the tongue. Pour ether
on the abdomen or chest in order to stimulate inspiration by
reflex action, give strychnine and atropine hypodermienlly.
Practice artificial respiration.
Name the most common after-effects of the administra*
tion of ether.
Nausea and vomiting.
Under what conditions is ether contra-indicated as an
anesthetic?
In acute inflammatory infections of the respiratory tract,
advanced arteriosclerosis, severe nephritis, especially when
associated with cardiovascular lesions and anemia when the
hemoglobin is less than 30%. Diabetes mellitus, especially
when well established and associated with aeelonuria
(Stevens).
I
PRACTICE OF MEDICINE.
Give the prophylactic treatment of gout.
As nearly as possible a vegetable diet should be adhered to,
as animal food gives rise to uric acid. Water should be par-
taken of plentifully. Alcoholic and malt liquors, especiaUy
the rich, sweet wines, such as port, sherry, champagne, should
be particularly prohibited. Systematic bathing, regular ex-
ercise in the open air, avoidance of exposure to cold and damp-
ness are important.
At what age is spasmodic croup most common? Give
the symptoms and treatment of spasmodic croup.
The disease is most common in children before the age of
puberty. The attack begins suddenly, most often at night.
The first indication is usually a hoarse metallic cough, fol-
lowed by dyspnea. In severe cases the dyspnea is so extreme
that cyanosis of the face and extremities occurs. There is
some elevation of temperature. The cougli is unproductive
at first, but at the close of the attack free expectoration may
occur. The child should at once be immersed in a warm bath,
and an emetic promptly given. Inhalations of steam are also
useful. Between the attacks the child should have tonic
treatment.
Give the etiology, duration and prognosis of pertussis.
It is an infectious disease of early childhood, and common
betw-een the second and seventh year. The disease usually
lasts from four to six weeks. The i)rognosis, as a rule, is
favorable, the danger being due to complications.
(G13)
614
PRACTICE OF MEDICINE.
Describe the treatment of biliary lithiasis.
The prophylaxis consists in appropriate diet, exercise and
general favorable hygiene. In women tight lacing should be
avoided. Warm baths, reg^ular exercise in the fresh air, ete„
should be reeomtnended. The patient should avoid indul-
gence in sweet and starchy foods. Constipation should be
corrected. Massage has been strongly advised. For the
treatment of the attack hot fomentations should be applied
over the liver. For the pain hypodermic injections of mor-
phine give relief. If the condition is not relieved by medical
means, if the jaundice persist, and especially if symptoms of
Charcot's fever appear, surtfical interference should be re-
sorted to.
Give the etiology and treatment of St. Vitus' dance.
Chorea is a disease of childhood, although it may occur at
any age. Females are most often attacked, and the disease is
more common in the temperate climate. It is most prevalent
in the spring months. Acute rheumatic fever has been noted
as an exciting cause in a large number of cases. Fright,
shock and worry are predisposing causes. It may be due to
reflex causes, such as intestinal worms, eye-strain, nasal di&
ease and sexual disorders. The treatment consists in long
hours of rest, especially iu bed. If the child be attending
school it had better discontinue and remain at home. The
diet should be simple, meats and highly-seasoned foods should
be excluded. Arsenic, antipyrine. bromide of zinc and qui-
nine are the most useful drugs.
Give the etiology, symptoms and treatment of cirrhosis
of the liver.
The disease occurs most often in the male sex, and ia very
frequently due to alcohol. In the newborn the affection is
due to hereditary syphilis. The next most important causes
are acquired syphilis, malaria and other infectious diseases,
such as cholera, enteric fever and scarlet fever. (Jout and
rickets also give rise to it. The disease may begin without
PRACTICE OF MEDICINE. 615
prodromes, except in the ease of topers who present a long
history of gastro-intestinal catarrh. Early in the course of
the affection there may be some slight enlargement of the
liver. In the fully established disease the organ is dimin-
ished in size. Of decided diagnostic import is an early atro-
phic change in the right lobe of the liver, which in some cases
can scarcely be felt in the abdomen. Jaundice is absent as a
rule. The most characteristic symptoms relate to the disturb-
ance of the circulation in the portal vein, or to the diminished
function in the atrophied cells of the liver, or they depend
upon a combination of these two conditions. One of the most
prominent signs is ascites. Even before this the effect of
congestion of the nmcous membranes of the stomach and
bowels may be noted by hematemesis and enterorrhagia, which
occur in the course of this affection. Hemorrhoids occur.
The spleen is enlarged. The cutaneous veins of the abdomen
are often greatly enlarged. The urine is diminished in
amount and is of low specific gravity, frequently reddish in
color. The temperature is normal or subnormal. The gen-
eral nutrition suffers greatly, and the patient loses flesh. The
treatment consists in abstaining from alcohol. Potassium
iodide and mercnrj- are of use in the syphilitic form. The
Ijowels should be carefully regulated, and when ascites be-
comes prominent, paracentesis abdominis becomes necessary.
Give the etiology of tetanus.
The disease occurs in either sex and at any age. It may
result from a wound in any part of the body, and sometimes
without apparent trauma. It occurs most often from wounds
that are exposed to dirt and filth. The exciting cause is the
bacillus of tetanus described by Kitasato.
Give the treatment of sciatica.
Rest by means of splinting the limb is important. Atten-
tion must be directed to the cause of the diwsease. If of rheu-
matic origin the salicylates are of value. Phenacetine, anti-
pyrine and other members of the coal-tar group are of value;
r
616 PRACTICE OF MEDICINE.
in severe cases, however, morphine is necessary. 8urgieal
measures should only be resorted to after all forais of medical
relief have failed.
State the varieties, causes and prognosis of angina pec-
toris.
True angina pectoris and pseudo angina pectoris. Occlu-
sion of the coronary (\rteries and sclerosis are import-ant fac-
tors. The true form occurs after middle life, and in the male
sex ; the pseudo form occurs most frequently in young women,
in connection with hysteria and ueuraslhenia. The prog-
nosis in tho true form is very unfavorable: in the pseudo form
it is favorable.
How should insolation (sunstroke) be treated?
The treatment of thermic fever consists in the application
of cold to the surface of the body, preferably in the form of
an ice bath or ice rubbing. The cold pack is sometimes sub-
stituted. The bath is commonly continued until the temper-
ature reaches the normal point. Ice water enemata may also
be employed. Measures should also be taken to guard the
heart. For this purpose strychnine, digitalis and alcohol
are useful.
Oive the treatment and prognosis of erysipelas.
Cold waler should be liberally adminiatered Jo the patient,
and cold sponging, especially if the temperature is high, is of
distinct advantage. Ice cloths are also the best treatment
for the eruption. They should be frequently renewed. An
ointment of ichthyol and lanolin is also used for this purpose.
The administration of tincture of the chloride of iron in full
doses is the general method of treating erysipelas. "VThon
the nervous symptoms become prominent, or if in the aged or
cachectic, bold stimulation is necessary; alcohol is best for
this purpose. If the paia be severe morphine should be re-
sorted to. Anti-streptococcic serum may be beneficial, and
should always be resorted to in malignant cases.
PRACTICE OF MEDICINE. 617
In simple, uncomplicated cases occurring in those in pre-
vious good health the prognosis is favorable. The prognosis
should be regarded as serious when erysipelas occurs as a
complication of any other malady, or when it results from
surgical accidents or occurs in the puerperal state. It is
always serious in alcoholics and cachectics.
State the etiology and prophylaxis of biliary calculi.
In a majority of cases they are found in persons of thirty
and over, and they occur more frequently in the female than
in the male sex. Catarrh of the bile-ducts and gall-bladder
may lead to stagnation of bile and to an increase in the amount
of cholesterin. Farinaceous foods may give rise to the for-
mation of gall-stones; in diseases in which nitrogenous food
is largely partaken of, as in diabetes, gall-stones are rarely
found. They are formed most frequently in the gall-bladder.
They may occur in the larger gall-ducts, and, rarely, even in
the smaller biliary passages of the liver. The prophylaxis
consists in appropriate diet, exercise and general favorable
hygiene. In women tight lacing should be avoided. Warm
baths, regular exercise in the fresh air, etc., should be recom-
mended. The patient should avoid indulgence in sweets and
starchy foods. Constipation should be corrected. This may
best be done by the use of waters, such as Carlsbad. Massage
has been strongly advised.
What is chronic hydrocephalus?
As a rule the child's head begins to increase in size soon
after birth, or it may even be greatly enlarged at birth. There
is irritability and restlessness, and much impairment of the
general nutrition; the child does not grow as is usual with
normal children, even though the appetite be good. Mental
development is tardy, and as a rule the child does not learn
to walk. Ocular phenomena are present, such as strabismus,
and occasionally optic atrophy. Within a few years vomiting,
coma and convulsions appear. Death usually takes place
from exhaustion.
618
PKACTWE OF MEDWISE.
Give the etiology and treatment of anthrax.
This is a widespread disease in animals, occurring all over
the world. The affection is conveyed to man as the result of
the handling of wool or hides, rarely by direct inoculation
from the bites of insects that have fed on animals that have
died of the disease. It is a very rare affection in man. Cer-
tain occupations predispose to it, such as those of stablemen,
tanners, butchers, shepherds and wool-sorters. The exciting
cause is the bacillus of ajithrax. It is important that tiie
pustules should be treated surgically, the site of Inoculation
being destroyed by bichloride of mercury, carbolic acid or the
actual cautery. Constitutional treatment consists in the use
of quinine, ii-on, strychnine and alcohol.
Give the treatment of catarrhal pneumonitis.
When the temperature becomes high, cyanosis shows itself
and somnolence is threatened, and a warm bath with cold effu-
sion to the head is useful. Alcohol is valuable as a circulatory
stimulant. Inhalations of steam are of value. In strong
children in whom there is great secretion in the bronchial
tubes which is brought up with difficulty, emetics may be used
from time to time, but these should not be continued through-
out the course of the disease. It is dangerous to administer
narcotics to young children. Stimulating expectorants, such
as the salts of ammonia, are often useful. Minute doses of
strychnine and inhalations of oxygen are of benefit. A mild ■
purge at the onset frequently gives great relief. The diet
should be a light and nutritious one.
What is the prognosis as to the cure of epilepsy? Give
the treatment of epilepsy.
True epilepsy is an incurable affection. Much may be done
to diminish the number and severity of the attacks, but a true
cure is rarely met with. In the treatment it is important to
relieve the cause if possible. It is best to endeavor to treat
the epileptic in a colony, in which he may have an out-door
occupation. The bowels should be regulated, the diet should
PRACTICE OF MEDICINE. 619
consist of meat sparingly, fruit, cereals and vegetables. The
best results have been obtained from the use of the bromides.
What cutaneous diseases may occur as complications of
saccharine diabetes?
Boils, earbuneles, erythema, eczema, especially of the geni-
tals, purpura, cellulitis and gangrene.
What is hemophilia? How should it be treated?
This is a disease characterized by a tendency to hemorrhage,
which is often uncontrollable, and it is due to a deficiency in
the coagulability of the blood. The coagulation is retarded,
and frequently in this condition the blood does not coagulate
in less than from thirty to fifty minutes. The prophylaxis is
important : wounds and operations should be avoided in a per-
son suspected to be a bleeder. When the blei»ding is from a
free surface and easy of access, compression and rest should
be tried. Ice, locally, is of value. Calcium chloride and per-
chloride of iron are recommended by many. Gelatine, collo-
dion and extract of the suprarenal capsule may be found
useful when applied to the bleeding surface. Freshly drawn
blood from a healthy i)erson may be employed as an appli-
cation.
Describe the treatment of purulent pleurisy.
The aspirator should be used, and drainage should be as
free as possible. If the pus does not flow through the needle
a surgical operation is necessary.
Describe the treatment and prophylaxis of nephrolith-
iasis.
The treatment consists in rt^lieving the pain during an
attack of renal colic, which is best accomplished by a hypo-
dermic of morphine or by the inhalation of chlorofonn. Hot
baths and hot fomentations to the loins are useful. Fluids
should be freely i)artaken of. For uric acid calculi, piper-
azin, urotropin, and the salts of lithia are of value. The
waters of various mineral springs are valuable, such as Carls-
620 PRACTICE OF MEDICINE.
bad. Ems. Kissingen. Surgical lulerferenee is sonieliinee
necessary.
How should cholera morbus be treated?
Absolute rest in bed is necessary. Pood should be given
sparingly, and it had bettor be withheld for some time if
vomiting be frequent. Sterilized milk and animal broths may
be administered sparingly. Local sinapisms and hot turpen-
tine stupes are of benefit to allay vomiting. At the onset of
tbe disease it is good practice to give a purge. The remedy
for the condition is opium in some form. Later in the course
of the affection bismuth and antiseptics which act on the
inlcstiuiil tract are of value.
What is the treatment of spasmodic stricture of the
esophagus?
Dilatation with the e.sophageal bougie is of value. Uemedics
to act upon the nervous system and tonies are of use. The
general hygiene of the patient should be carefully looked
after.
Give the treatment of hematemesis.
Absolute rest in bed. Food and drink should be stopped.
For the thirst small pellets of ice may be taken in the mouth.
Opium and ergot hyporlermically are the Iicst remedies.
Describe the treatment of rachitis.
The child should have the best of food, and if the mother
cannot nui-se it a wet-nurse should be procured. Abundance
of fresh air and sunshine are essential. Daily warm bathing
is necessary. The child should not be encouraged to walk-
The remedies that have proven most etfeclive are phosphonw.
cod-liver oil and the syrup of the iodide of iron.
Give the treatment of ulcer of the stomach.
Rest in bed is most importanl, even in the mildest eases.
Pood should he withheld from the stomach for some time, rec-
tal alimentation being resorfed to. Milk is the best food, and
PRACTICE OF MEDICINE. 621
may be given either hot or cold. External applications over
the stomach, such as hot poultices frequently renewed, are of
value. Among the most useful of the many drugs that have
been recommended is bismuth; this remedy should be em-
ployed in large doses. Salol, oxide of silver, carbonate of
soda, carbolic acid and cocaine are also highly recommended.
If there be great pain opium, and sometimes cannabis indica
are useful.
Give the symptoms of (a) acute lead poisoning, (b)
chronic lead poisoning.
In acute lead poisoning the symptoms may come on in a few
weeks. Rapid and marked anemia is usually the earliest
symptom. Constipation, which is followed by excessive diar-
rhea, vomiting, abdominal tenderness and distension are pres-
ent. The abdomen, as a rule, is hard and distended. There
is colic of the severest type over the entire abdomen. The
paroxysms are of gradual onset and increase in severity. The
pain is relieved by deep pressure. The temperature, as a rule,
is subnormal. The symptoms of chronic lead poisoning are
due to the prolonged absorption of lead in small quantities.
The anemia may be profound, showing a marked decrease in
the red blood-cells, with a corresponding decrease in the hem-
oglobin. There is wasting of the muscles and a peculiar yel-
low conij)h'xi()n, which, however, is not due to the deposit of
bile pigment. Along the ])order of the gums, usually most
marked under the incisor teeth, is a bluish-black line. Tre-
mors occur from time to time. There is a metallic taste in the
mouth, coated tongue, fetid breath, marked dyspepsia and
obstinate constipation. liea<l colic is particularly marked.
The pain, as a rule, is more sovcm-c in the afternoon and at
night. Occasionally paroxysmal pains occur in the joints
without swelling, redness or fever. An important symptom
is lead paralysis. This most frequently occui's as wrist-drop,
tlie extensors being particularly atVected. Occasionally cere-
bral symptoms develop, this condition being known as lead
encephalopathy.
(522
PRACTICE OF MEDICISE.
Give the treatment of suppurative hepatitis.
The treatment consists in the early evacuation of the ab-
scess in suitable cases. Purging with calomel or salts is
recommended. Opium is best to relieve pain. When the
septic phenomena are marked, free stimulation should be re-
sorted to, whiskey and strychnine giving good results. Qui-
nine is often of use. For the anemia, iron and arsenic should
be administered. The diet should be light and nutritions.
What is uremia and how should it be treated?
Uremia is a clinical condition due to acute or chronic dis-
ease of the kidney or of its conducting apparatus. Depend-
ing upon whether the symptoms arise rapidly or suddenly or
whether they are more insidious, the condition is known as
acute or chronic uremia. In young subjects with slow pulse
and high arterial tension bleeding is indicated, and should be
followed by hypodermoclysis of a normal salt solution. In-
travenous injections of a normal salt solution are often indi-
cated. Purging by croton oil and broken doses of calomel
is useful. Por the convulsions, chloral and morphine hypo-
dermieally are the most reliable agents. Sweating should be
induced by a hot pack or by some similar method. The ad-
ministration of pilocarpine is accompanied with danger on
account of its depressing cfFect upon the heart.
How should acute nephritis accompanying or following
scarlet fever be treated?
Absolute rest in bed is important. It is well to put the
patient on an absolute milk diet. Some of the alkaline min-
eral waters, such as Seltzer and Vichy, may be mixed with
the milk. Daily sponging with warm water and gentle fric-
tion of the skin are of use. Calomel in fractional doses is
useful, which may be followed by a saline, even if there be no
tendency to constipation. Some of the diuretics may be used,
such as citrate of potash or benzoate of soda. Iron in some
form is useful, and Basham's mixture is often administeretl.
PRACTICE OF MEDICINE. 623
How should edema of the glottis be treated?
The treatment is that of dropsy occurring in other parts of
the body. Surgical treatment, such as scarification, intuba-
tion, tracheotomy, etc., is often necessary.
Name one important complication and one important
sequel of typhoid fever.
An important complication of typhoid fever is hemorrhage
from the bowels. An important sequel is phlebitis, which
most frequently occurs in the left leg.
What is dysphagia, and with what pathological condi-
tion is it associated?
Dysphagia is difficulty or pain in swallowing. It may be
due to causes in the mouth and fauces, such as glossitis, cancer
of the tongue, to various forms of stomatitis, tonsillitis and
pharyngitis. Some of the exanthemata, such as scarlet fever
and variola, give rise to lesions of the throat, diphtheria,
spasm or paralysis of the pharynx, disease of the larynx, dis-
ease of the esophagus, such as stricture, cancer, etc. Finally,
from pressure from the outside, such as from an enlarged
thyroid gland, thoracic aneurysm, mediastinal tumor, etc.,
and from pleural and pericardial effusion.
How would aneurysm of the abdominal aorta affect the
dorsalis pedis artery pulse as compared with the radial
pulse?
The pulse of the dorsalis pedis artery compared with the
ladial pulse would be small and delayed.
What conditions predispose to cerebral hemorrhage?
Heredity is important; many individuals inherit the ajx)-
plectic constitution. It is a disease of middle life, and more
common in the male sex. Diseases of the blood vessels are
important factors. It may follow the infectious fevers and
diseases producing disturbances of the blood. Embolism is
an important factor. Hypertrophy of the heart, exertion or
excitement frequently cause rupture of the diseased blood
vessels.
624
PRACTICE OF MEDICIXE.
I
What are the causes of endocarditis?
The greatest niiiuber ol' cases are the result of rhcumalic
fever. Chorea is also a cause. The acute exanthemata also
give rise to it, also pneumonia, erysipelas, sepsis, puer-
peral diseases, and sometiines gonorrhea. Tuherculosis, gout.
renal disease and diabetes are etiological factors. Trauma
has also been given as a cause. It occurs in fetal life. It
may sometimes be secondary, from extension of the disease
from the myocardium or aorta.
Differentiate between cerebral vomiting and gastric
vomiting.
Cerebral vomiting occurs without nausea, often with a clean
tongue, and is not related to the taking of food. In gastric
vomiting there is the histojy of some gas tro- intestinal affec-
tion. The tongue is coated, and there is always considerable
nausea and much retching.
Give the characteristic differences between diabetes
insipidus and diabetes mellitus.
In diabetes insipidus the urine is of low specific gravity,
never over 1010; there is no sugar present, no itching of the
skin and genitalia, no hunger, no tendency to the formation
of earhuneles or boils. In diabetes mellitus the urine is of
high specific gravity, 1030 and over, sugar is present in the
urine, there is itching of the skin, great hunger, tendency to
formation of boils, loss of weight, and frequently an etherial
odor o£ the breolh.
Give the cause of vertigo.
Vertigo occurs in the course of neurasthenia and lithemia,
from gastric disorders, from arteriosclerosis, vah^llar disease
of the bcHrt and aneurysm, from Meniere's disease, from
reflex causes, such as disease of the eye, nose and larynx. It
also occurs in many nervous diseases, such as epilepsy, etc.
Describe pyuria and state its import.
Pyuria is pus in the urine, and is an important symptom
PRACTICE OF MEDICINE. 625
in many diseases of the urinary tract, from the kidney to the
end of the urethra. It is present in urethritis, cystitis, ure-
teritis, pyelitis and pyelonephritis. Pus may be caused by
rupture of an abscess in the urinary tract (especially the
bladder) ; this may occur in salpingitis, abscess of the ovary,
extra-uterine pregnancy, cysts of various kinds, psoas and
other forms of abscess, etc.
Describe leukemia and mention the pathological changes
occuring in this disease.
Leukemia is a disease in which the white blood corpuscles
are greatly increased in number ; the percentage of the various
forms also differ greatly from the normal. It is character-
ized anatomically by changes in the spleen, lymphatie glands
or bone marrow, singly or combined. In the splenomedullary
form the spleen is greatly enlarged, and it may weigh ten
pounds or more. The capsule is thickened, and the surface
of the organ somewhat irregular. On seetion it is quite firm.
The color of the pulp is reddish-brown. Infarcts are common.
The gross appearance of the blood is altered, occasionally
being milky in character, the specific gravity is decreased, the
alkalinity is somewhat diminished, and coagulation is slightly
retarded. The leukocytes show a great increase in number,
from 250,000-500,000 or more per cmm. In the lymphatic
variety groups of lymph glands are enlarged, owing to hyper-
plasia of the lymphoid cells, and the spleen is slightly increased
in size. The gross appearance of the blood may show very
slight change or resemble the variety just described. The leu-
kocytes are also greatly increased in number, but not to the
extent that they are in the splenomedullary form. Exami-
nation of the stained films shows an enormous increase in the
lymphocytes.
Give the symptoms indicative of impacted gallstone.
When the gallstone has become impacted there is an arrest
of the pain. Jaundice is marked, the urine shows bile pig-
ments, and the stools are clay-eolored. There is hepatic inter-
40
626 PRACTICE OF MEDICINE.
mittent fever, eometinies called Charcot's fever. This con-
sists of high temperature, chills and sweating. While this :
fever is paroxysmal, it does not show the regularity of ft i
malarial attack.
Give the treatment of yellow fever.
Disinfection of the person and all effects. Strict quaraa* I
tine. A mild cathartic may he given at the onset with advan- j
tage. Vomiting and gastric irritability may he treated hy 1
the adniiiiis [ration of cai-bolic acid, cocaine or broken doses
of calomel. The fever should be treated by cold applications
to the head and cold sponging. For the pain opium in some
form is useful. Strychnine is valuable as a cardiac tonic
For the hemorrhage, opium, ergot and suprarenal e.xtract
may be administered.
Outline appropriate treatment for Asiatic cholera.
Complete isolation of the sick and thorough disinfection of i
all discharges and all articles of elothing are absolutel;'!
necessary. Efficient quarantine must be establkhed.
milk and water should be boiled, and no raw fruit or vegfr-J
table should be eaten. In the stage of premonitory diarrhei J
it is considered good practice to administer a prompt laxative.]
If there be great pain opium may be given hypoilcrmieally. 1
Salol and guaiacol carbonate may be given from time to timel
as intestinal antiseptics. In the stage of serous diarrhea thtl
patient should be wrapped in flannels and esternal heat ap-l
plied to the body. If there be cramp, friction of the musclofa
is useful. Fluids should only be allowed in veiy small quan*
titles. Enteroctysis should be used in this stage. When co^
lapse sets in, hypodermoclysis of a normal salt solution should!
be given. Strychnine may he given by the skin, but it muatl
be remembered that as a'bsorption is slow, accumulation inftyl
occur.
What are the causes and treatment of palpitation of thel
heart?
This may be due to reflex causes, such as disease of thel
PRACTICE OF MEDICINE, . 627
stomach, disease of the genito-urinary apparatus, and sexual
excesses. Toxic causes may give rise to it, such as the abuse
of alcohol, tobacco, t<ja and coffee. Gout and anemia are
productive features, and the condition occurs in inanition and
marasmus. Finally, it is due to disease of the heart itself,
such as organic disease, and it is an important symptom of
exophthalmic goitre. The treatment consists in removing the
cause, if possible, and is then symptomatic. Rest in the re-
cumbent posture and an icebag over the heart are useful.
What are the causes and symptoms of dilatation of the
stomach?
The dilatation may be acute or chronic. It may be due to
obstruction of the pyloric end of the stomach, such as con-
genital stenosis, the cicatrices resulting from gastric ulcer,
and from tumors, the most common being malignant. Motor
insufficiency of the stomach may give rise to dilatation; this
may result from overeating or drinking, and frequently occurs
in beer drinkers. The symptoms are general feebleness, ane-
mia, emaciation, thirst, scanty urine, sallow and hollowed face,
tlabby coated tongut\ pyrosis, chilliness, cyanosis, subnormal
temperature and nervous symptoms. Pain and vomiting are
always present. The outline of the stomach may be demon-
strated bv means of the X-rav.
What is scurvy, how should it be prevented and treated?
Scurvy is an affection characterized by anemia, by swollen,
tender and bleeding gums, by manifestations of puri)ura and
by great prostration due to improper fond. The prevention
of the condition is accomplished ])y the use of anti-scorbutic
food. In the tn^atment, antiseptic mouth washes are of use.
Fresh vegetables should be administered. Lemon-juice is very
valuable, as are also bitter tonics.
Give in detail the treatment of diphtheria.
The prophylaxis is highly important, the disease being very
contagious and easily transmitted. The patient should be
strictly isolated. Efficient disinfection is also necessary.
628 PRACTICE OF MEDICINE.
The food must "be nutritious and easily digested. If the
patient cannot swallow, rectal alimentation must be resorted
to. Alcohol is necessary, and must be given freely, even in
mild cases. The membrane must not be removed. Antiseptic
and soothing applications are employed; inhalations of quick-
lime and steam iu all cases in which there is danger of invasion
of the larynx are useful. Hydrogen dioxide in solution is
serviceable as a mouth wash. Internally, the tincture of
chloride of iron may be given in medium doses. Calomel or
corrosive sublimate in appropriate doses are useful. The
antitoxin treatment, however, is the most important. The
dose in individual eases varies; 3,000 antitoxin units may
be given at a dose, hut this may he increased in severe
eases and repeated. In laryngeal cases intubation and tra-
cheotomy may have to be resorted to.
What is the prognosis of suppurative nephritis secondary
to cystitis? Outline the treatment of the condition.
The prognosis is unfavorable, and the treatment is surgical.
Give the etiology of tubercular peritonitis and the treat-
ment.
The disease appears at all ages, but it is most common id
childhootl. Males are more frequently attacked than females,
and it is more often met with in the negro than in the while
race. It is also found associated with intestinal or roeseuteric
tuberculosis. The condition may be primary in the perito-
neum, and may he confined solely to this membrane. A com- ,
mon mode of iufeclion in through the intestines; this may ala* J
occur through the lymphatics or by extension from the pleura [
or the pericardium. It is often of the miliary variety, but
also of the chronic ulcerative and chronic fibroid forms. The I
modern treatment of this condition is surgical, the best results 1
having been obtained by opening the abdomen and producing
adhesions.
Outline a plan of treatment of typhus fever.
The prophylaxis is of the greatest importance. An abuud-
PRACTICE OF MEDICINE. 629
ant supply of good food, fresh air and free ventilation are
important. Stimulation is necessary on account of the severe
prostration. If hyperpyrexia occur the cold bath should be
resorted to. Strychnine may be necessary as a respiratory
and cardiac stimulant. Complications are treated as they
arise. The constipation must be relieved by enemata, and in
convalescence tonics should be administered.
Give the treatment of pyelitis.
The patient must be kept in bed and protected against cold.
A bland diet should be given and the alkaline mineral waters
freely used. Application of heat to the renal region should
be resorted to. Warm baths are grateful to the patient.
Opium in some form to relieve the pain is necessary. In
chronic pyelitis astringents are indicated, such as acetate of
lead. Salol and methylene blue are sometimes found of ben-
efit. Surgical interference is necessary if hydronephrosis or
pyelonephrosis is present.
Mention the most reliable remedy for pulmonary hem-
orrhage.
Rest in bed, abstaining from food and drink, an ice-bag
applied to the chest, and opium and ergot.
What remedies should be used in hemorrhage from
mucous surfaces?
Opium, ergot and suprarenal capsule.
What are the complications and sequelae of whooping
cough?
Hemorrhages occur, such as i)etechiff, about the face and
neck; epistaxis and hemoptysis may occur; broncho-pneumonia
is a complication which adds greatly to the gravity of the
case. Pulmonary tuberculosis is comparatively frequent in
a considerable proportion of the cases, especially in adoles-
cents.
Describe the treatment of paralysis agitans.
The treatment is purely symptomatic. Occasionally hyos-
PRACTICE OF MEDICINE.
cyamine or hyoscine control the tremor. The general hygiene
of the patient is to be looked after; tonics, such as arsenic
strychnia, are of use.
What are the causes of peritonitis?
The most frequent mode of infection is through the intea-
tinea and from the female generative organs. Various forma
of ulcer may produce peritonitis, such as the typhoid or tuber-
cular ulcer. Malignant disease of the intestine may give rise
to it. It also arises from forma of intestinal obstruction, such
as volvulus «nd stricture. The gall-bladder and liver may
be the sources of infection, and particularly abscesses, and
syphilitic disease may give rise to it. Obstruction of the
biliary passages by gall-stones may produee it. The affection
may arise from the spleen, through an infected embolus. It
may occur from infective disease of the kidney, from disease
of the bladder wall, from the prostate and from the urethra. '
Peritonitis occasionally occurs in the course of some of the I
acute infectious diseases, such as erysipelas, acute rheumatic j
fever and septicemia.
Name the places where yellow fever is endemic.
The disease is endemic in the West Indies, parts of the
Mediterranean coast. South America and Africa.
What treatment would you recommend for diphtheritic |
paralysis? What is the prognosis?
Rest, tonics, strychnia, and. later, electricity are useful, j
The prognosis in all forms of diphtheritic paralysis is favor- J
able as a rule, except in paralysis of the heart.
What are the causes and treatment of acute myelitis?
Exposure to variations of temperature, especially to cold, is i
important. Thus certain occupations predispose, such as e
neers, cabmen, drivers, etc. Gout, rheumatism and certain I
metallic poisons, such as lead, mercury and arsenic, have been I
recognized as etiologic factors. Alcohol may also be a cause. I
Syphilis usually gives rise to the chronic form. Occasionally!
PRACTICE OF MEDICINE, 631
acute myelitis may be secondary, resulting from extension, as
in abscess, caries or cancer of the spine. Traumatism is per-
haps the most common cause. The puerperal period and the
existence of septic conditions have also been noted as causes of
the disease. In the treatment, counter-irritation by blisters or
the application of cold are of use in the acute stage, but they
are contra-indicated after this stage. Precaution should be
taken not to interfere with the nutrition of the skin on account
of the great liability to trophic changes. Absolute i^est is
important. Great care must be taken of the bladder. The
catheter should be carefully sterilized. Electricity is benefi-
cial late in the course of the disease, and at this time massage
is also valuable. A warm climate favors improvement. Hy-
drotherapy has been highly recommended, (jleneral tonics
are of use; the bowels may be moved by, enemata. In syphi-
litic cases anti-syphilitie treatment is indicated.
What are the complications and sequelae of scarlet
fever?
Diphtheria and nephritis are the most important complica-
tions, and occur in nearly all severe cases. Endocarditis
occurs; less commonly pericarditis. Meningitis, peritonitis,
pleurisy, with and without effusion, also occur. Among the
most common sequels are enlarged lymphatic glands, chronic
joint affection, the hemorrhagic diathesis, monoplegia, hemi-
plegia, peripheral neuritis, hysteria and auemia.
On what symptoms would you base a diagnosis of ty-
phoid fever?
Ui)on the slow onset, with a gradual rise in temperature,
nose-bleed, headache, diarrhea, the occurrence on or about the
seventh day of the typical eruption, enlargement of the spleen,
dilated pupils, the AVidal reaction, and the dicrotic pulse.
How should scarlatina be treated?
Strict isolation is important. The scales during the period
of desquamation should be carefully collected and burned.
The diet should he nutritious and easily assimilated. Pure
632
FBACTICE OF MEDICINE.
i
drinking water or the alkaline mineral waters may be freely
administered. Milk is a aeeeasary article of diet. There is
no specific treatment. A mild laxative should be given at the
onset Tepid sponging, at least twice daily, is necessary in
severe eases. Warm bathing is usually very grateful to the
patient. During Ihe period of eruption an animal fat, used
as an inunction to the skin, prevents itching and hastens des-
quamation. A mild diuretic may be used, and it is important
to keep the kidneys active. Complieations must be treated
upon general principles.
What should be done for a patient during the passage of
a biliary calculus?
Hot fomentations should be applied over the lower part of,
the liver. If the pain is severe, whiffs of ehlorofomi may be
inhaled. However, in the majority of the cases relief of the
pain only follows the hypodermic use of morphine. If the
condition is not relieved by medical means surgicsl interfer-
ence must be resorted to.
How should small-pox be treated?
Vaccination should be practiced as a prophylaxis. Com-
plete isolation and disinfection are absolutely necessary.
There is no specific treatment. Food is not well borne at first,
and there may he much vomiting and diarrhea. Usually acid
drinks or small particles of ice are grateful to the patient.
From the onset of the disease detergent washes containing
antiseptic solutions should be used for the mouth. The room
should be darkened; the solar light being rigidly eseluded.
This prevents pitting. Warm baths two or three times
daily are of decided benefit to the patient. During the
time of secondary fever bold .stimulation is necessary. At
the onset a laxative is useful. Pain should be overcome by
small doses of opium, but great care must be exercised with
this drug, as it tends to lock up the secretions.
and insomnia should be treated by trional and sulpht
convalescence tonics are useful.
PRACTICE OF MEDICINE. 633
What is the treatment for angina pectoris?
For the attack, hypodermics of morphia are necessary. In-
halations of amyl nitrite or nitroglycerin in full doses may
prove beneficial. In the interval between the attacks the
patient must lead a quiet life. The functions of the body
should be well looked after, and the administration of the
nitrite of sodium with strychnine is of use.
What should be done to give relief in intestinal obstruc-
tion?
The treatment is largely surgical. Opium should be given
to relieve the pain. If vomiting be persistent the stomach
tube may be used. Purgatives should be avoided. Hot tur-
pentine stupes may be applied to the abdomen. Rectal feed-
ing may be resorted to, but surgical interference sooner or
later becomes imperative. Atropine in large doses hypoder-
mically has been advised.
What causes cerebro-spinal meningitis, and how should
it be treated?
The exciting cause is the diplococcus intracellularis menin-
gitidis, described by Weichselbaum in 1887. The treatment
is purely symptomatic. Cold applications to the head and to
the spinal cord are useful. On the other hand, heat to the
head and spine may be preferred by some patients. A laxa-
tive dose of calomel early in the course of the disease and
mercury throughout the entire affection has many advocates.
Opium perhaps offere the best mode of treatment, and there
is a remarkable tolerance for this drug even in the very
young. If vomiting be a prominent symptom morphine
should be given hypodermically. Chloral, the bromides and
cannabis indica have been used, but in effect cannot be com-
pared with the systematic use of opium. Alcohol is necessary
when depression shows itself and asthenia is marked.
Describe the treatment of pericarditis.
In the first stage ice-bags applied over the precordium are
LAr RY. SIA.WWS^\Sm^Q8^
634
PRACTICE OF MEDICINE.
of use ill relieving pain and quieting the cardiac action.
Small blisters at some distance from the precordiom are of
benefit, especially when there is an effusion. If pain be
severe opium in some form is neeessary. In very lar^ effu-
sion paracentesis is necessary, especially so if the effusion be
punilent, in which condition surgical interference is impera-
tive, (jentle purges fi-om time to time are useful, A mild,
non-stimulaling diet is indicated.
How should apoplexy due to cerebral hemorrhage be
treated?
The patient must be placed in bed with the head elevated.
If arterial tension be high venesection should be perfonoed
immediately. Ice-bags are applied to the head. Croton oil
or calomel is of great value in inducing free purgation. If
the patient be unconscioiis for a considerable length of time
the bladder must be evacuated with a catheter.
What is the treatment of diarrhea occurring in typhoid
fever?
Large doses of bismuth, salol and some of the intestinal
antiseptics are of value in this condition. Opium rnusi be
administered with great caution.
Qive the treatment of whooping-cough.
Pood sliould be abundant and nutritious, and if the child
vomits during a parosj'sm nourishment should be immediately
readministered. Antipyrine in doses proportionate to the
age of the patient has some influence on the paroxysms.
Bramoform is of use, but is very likely to give rise to nausea.
(lood hypriene is es.senlial in the treatment of the case.
What measures should be adopted in the treatment of
pulmonary edema?
The treatment is largely that of the primary disease which
causes the edema. There shoidd be active purging, especially
if cyanosis be absent. Hypodennics of atropia in large doses
frequently repeated have been found of use in some c
PRACTICE OF MEDICINE. 635
How should endocarditis be treated?
The treatment consists in absolute rest in the recumbent
posture. Digitalis should only be given for definite and fixed
indications, and is not required unless the pulse becomes quick
and small or irregular, or the signs of failing compensation
occur. Strychnia is of benefit in this condition. If anemia
persists, iron with quinine and arsenic will be found valuable.
What measures should be employed to rid the system of
tape-worm.
The most reliable anthelmintics are the male fern, the pome-
granate root, bark and its alkaloid pelletierin, kousso, pump-
kin seed, turpentine and chloroform. Thymol is also highly
recommended by some authorities. Before the administration
of any of these drugs the patient should be put upon a milk
diet for at least twenty-four hours. It is then desirable the
night before the vermifuge is administered to give a brisk
cathartic, preferably calomel. Early the following morning
the anthelmintic is administered, and a few hours afterward
another purgative.
What are the ordinary age limits of typhoid fever, and
what conditions are essential to its production?
The age at which enteric fever most frequently occurs is
from 15 to 30. The predisposing causes are temperate cli-
mate, autumn months, unfavorable hygienic surroundings,
such as infected drinking water, food, sewage and poor drain-
age. The exciting cause is the bacillus of Eberth or the ba-
cillus typhosus.
How does the cause of typhoid fever principally gain
entrance to the human body? Outline the prophylaxis.
Most frequently through the digestive tract in the form of
infected drinking water or milk. The prophylaxis consists
in the absolute destruction of the discharges and disinfection
of the soiled linen. The drinking water .should be boiled, and
suspected milk should also be boiled.
t «< iacnbation and the treatmc
1 U about two weeks. It ma;
wva. In ibe treatment the patient sho'
miii laxative given at the onset. Best
kiteation should be given to tlie aUe\
its treatment.
■tcv ^xvap» <i£ small resides seated upon a
;^MU!U by oeur&l^e. burning pain, occurring
1. tw ->r mon branches of a nerve, is kno
v, rtw iirof«s is acute and self-limited.
-riHiiif* ^»ny eonstitutional treatment. I
iwKB- rrBi«iies »-hich invigorate the nervou
*,?r. intf phosphide every three or four
1. -er*nw. dnd in some cases quiniue and s
t^ u, ustf dTsenio. If the pain be very ;
^» ■te'n. * laseful. Antipyrine, phenacetin
lavK N?*n highly recommended. A
i-'ajc •}{ oxide of zinc, boric aeid am
ivtfr the vesiele.s. This may be ch
> iays.
. and treatment of exophth;
PRACTICE OF MEDICINE. 637
tachycardia and tremor. Hydrotherapy is often valuable;
rest in bed and ice-bags applied to the precordium give much
relief to the patient. Digitalis, aconite, veratrum viride,
tincture of strophanthus and potassium bromide have been
employed in this disease. Thyroid extract has also been lately
recommended. Removal of the thyroid gland has been prac-
ticed with but little benefit.
Name five diseases caused by a known germ.
Tul>erculosis, enteric fever, cholera, plague and diphtheria.
Describe the treatment of neurasthenia.
The study of the individual ease is important. The rest
cure is applicable in many eases, while in others a change of
climate is of great benefit. Hydrotherapy, electricity, mas-
sage and hypnotism have all been of value in the treatment.
The diet must be easy of digestion. In the cerebral vanety
the bromides are valuable. In the gastric variety ai*senic in
the form of Fowler's solution is of service. Syrup of the
hypophosphites and valerian, eaireine, hyoscine and phenace-
tine are of benefit in suitable cases. Opium and other hyp-
notics must be used with great caution. Iron and cod-liver
oil are useful. Systematic exercise is of great benefit.
Give the morbid anatomy and physical signs of acute
endocarditis.
The lesions are usuallv situated in the left side of the heart.
The endocardium lining the valves is most frequently affected.
The lesions are small vegetations varvins; in size from one to
four millimett^rs in diameter. Usually micro-organisms are
associated with simple endocarditis. ^Mieroscopically the first
change noted in the endocardium is the irranular degeneration
of the epitlielial cells. In the sub-endotlielial tissues blood-
vessel changes that ape()m|)any intlannnation are noted. Co-
agulation necrosis and th(" proliferation of the fixed cells
are found. TIk* inllannnatory exudate, the sub-endothelial
tissues and the fibrin upon the free surface cause the bulging^
PRACTICE OF MEDICINE.
^Jtcresceiipes. Upon Ihin projection, fibrin from llu'
oca ^am is also deposit(?d. Intermingled with the exu-
te tne various miero-organisms may be present. E-ariy on
pection no change is ii«iia!l,v noted, and thp iniporlanl
^s can only be discovered upon auscultation. An
valve is most frequently involved, a systolic mnr-
1 has its luaxiinuiti intcDsily at or near the apex.
L lo I lamitted to the left axilla, and often to the angle
the sL-^pnla, shows that mitral refairgitation has taken
piace. The umrmi ' ■" ■ '■ ay,3 blowing in character.
When other valv . ntea murmurs related to them
Mention the causes and symploms of gastralgia.
The condition consists in severe boring, rumbling, painful
contraction in the epigastric region extending from the
xiphoid cartilage and radiating to the back, accompanied by
syncope and signs of collapse. The condition may appear
suddenly without apparent cam or may be due to slight
pressure in the epigastrium. It ay be accompanied by the
sensation of the globus hystericus, bulimia, frequent micturi-
tion nnd vomiting. It disappears after having lasted a tev
moments. The attacks occur with marked irregularity, occa-
sionally several taking place in one day, upon alternate days,
or not recurring for months. It is a neurosis of the stomach.
Describe the treatment of leukemia.
Rest in bed is desirable, and a nutritious diet should be
given. Arsenic should be administered early, and the dose
increa,sed to the point of tolerance. This drug seems to have
a marked beneficial effect. Ergot has been recommended;
bone marrow and iron are also found to be useful, especially
when arsenic is not well borne. Oxygen inhalations may be
beneficial.
Describe the symptoms and treatment of multiple
sclerosis.
The first symptoms may appear after some mental or phys-
PRACTICE OF MEDICINE. 63S)
ical strain, the patient behaving as if affected by hy&teria.
There may be temporary aphonia, from which there may be
speedy recovery, or numbness may occur in some part of the
body. These symptoms may disappear for a time and re-
appear with increased severity. Charcot has given the fol-
lowing description: The patient develops spastic paraplegia
with exaggerated reflexes, with ankle clonus and limited
movements. An irregular jerky tension tremor occurs, nys-
tagmus being a prominent symptom. Diplopia and paralysis
of the ocular muscles are common. Scanning speech is prom-
inent. There are parasthesia, tinnitus aurium and vertigo.
The mental faculties are blunted, and in some few cases apo-
plectiform and epileptiform convulsions occur. Trophic
changes arise late in the disease, the sphincters, however,
remaining normal. The treatment is the same as in other
fonns of sclerosis. The salts of gold, silver and arsenic have
been recommended.
Describe the eruptions in the eruptive fevers. State
where they first appear and the time of their appearance.
In scarlet fever the eruption occurs at the end of the first
day or beginning of the second day. It consists of pin-head
points appearing first upon the neck and chest and spreading
rapidly all over the body, except certain parts of the face, the
mouth and chin. These red points, which are close together,
soon coalesce, giving a diffuse pinkish or reddish appearance
to the entire skin, which presents a boiled lobster color. Some
slight edema may also be noted. Throughout the entire erup-
tion raised papules are found. The eruption lasts about four
or five days, and disappears by desquamation.
The eruption in measles occurs upon the fourth day. It
appears first upon the face and neck, and spreads rapidly
over the entire body. The eruption consists of rose- red or
brownish maculo-papular points raised above the skin, with
intervening healthy skin, often arranged in a crescentic shape,
especially upon the forehead and wrists. The eruption re-
mains at its height for about four days.
640
PRACTICE OF MEDICINE.
The eruption in rubella appears upon the first day, and
occurs irregularly over tie face, neek, chest, body and limbs,
varying in individual cases and in different epidemics. The
multiform eruption may resemble erythema, urticaria, and
in some cases that of true measles or scarlet fever. It may
be confluent or diffuse, lasting from two to four days.
The eruption in sraall-pox occurs upon the third day. The
temperature falls as the eruption occurs. The eruption may
be discrete or confluent. At first the rash is about the size
of a pin-head, and soon becomes bard, feeling like a shot
under the skin. The macular eruption is rapidly converted
into a papule of a reddish color. There may be itching and
burning attending these early eruptive symptoms. In from
twenty-four to forty-eight hours the rash has invaded the en-
tire body, the earlier papules soon become vesicular, this
change taking place about the sixth or seventh day froiri
the onset of the attack. In a day or so the fluid becomes
turbid and purulent, the top being held down (primary um-
bilieation). In from twenly-four to forty-eight hours this
umbilieation has disappeared, the top now being conic in
shape. About this time an intense red inflammatory areola
is noticed about the base of the pock, and the eruption is now
exceedinply painful. On or about the ninth day from the
beginniug of the disease suppuration begins in the pock, last-
ing about three days, when the apes of the cone drops in, due
to the absorption of the contents of the pock (secondary um-
bilieation). "When absorption has been completed a crust
forms that may remain for some days, these crusts falling off
on or about the sixteenth day from the beginning of the dis-
ease, leaving depressed striated scars.
The eruption in varicella occurs upon the first day, and
marks the beginning of the disease. The exanthem shows ifa-
self as a small reddish point or papule, which in a very few-
hours becomes a vesicle. It is slightly elevated above the
skin rather thflu having the appearance of bein^ under the
skin; the vesicles are thin and transparent, and from one-
PRACTICE OF MEDICINE. 641
eighth to one-quarter of an inch in diameter. There is usually
no areola. In the course of a few hours the vesicle becomes
milky and begins to shrivel, with depression at the top from
absorption of its contents. This results as a yellowish-brown
crust that in about ten days from the beginning of the at-
tack, and even before this, separates, leaving a more or less
well-defined scar, which in some cases, especially upon the
face, remains permanently. The pocks may appear upon the
face, neck, scalp, wrist and some parts of the body.
Give the symptoms of acute pericarditis.
It is impossible to diagnosticate a true pericarditis by
symptoms without a careful physical examination. The dis-
ease commonly begins with severe pain in the region of the
precordium. The pulse rate increases, and may be from 90
to 160 per minute. In some cases it may be normal, or when
effusion occurs the pulsus paradoxus occurs. Fever of some
degree is usually present. The most important sign is a fric-
tion sound, which varies greatly in intensity. It is limited
to the precordial area, and is heard most frequently at the
base of the heart. It is increased by pressure with the stetho-
scope. If an effusion develops the friction sound disappears,
apd returns again as absorption takes place.
What are the complications and sequelae of cerebro-
spinal fever?
The important complications are broncho-pneumonia, bron-
chitis, croupous pneumonia, endocarditis and pericarditis.
The sequels are exceedingly common. They consists in affec-
tions of the special senses. There may be loss of sight, per-
manent deafness, loss of smell, loss of taste, various forms of
paralysis and neuralgia.
Describe the eruption of typhus fever.
The characteristic eruption of typhus appears upon the
fifth day of the disease, and in its early stages closely resem-
bles measles. Macular spots of irregular size and outline,
41
642
PRACTICE OF MEDICINE.
P
and of a dirty pinkish or reddish color, characterize the e
anthem. It appears first upon the chest and abdomen, and
extends to the extremities, the face being rarely affected. It
is particularly copious upon the extremities, where later in
the disease it becomes darker or petechial. Another erup-
tion is also characteristic, and consists of marbling or mottling
of the skin. This rash lasts throughout the disease, and does
not disappear in death.
Describe the treatment of measles.
There is not specific treatment, and in uncomplicated cases
medicines are unnecessary. A mild laxative at the onset is
useful. The entire treatment should he directed to the pre-
vention of complications, eepecially broncho-pneumonia. "When
complications occur they must be treated upon general prin-
ciples.
Give the physical signs of a cavity of tlie lung in pul-
monary tuberculosis.
If the cavity he large and superficially situated there will
be depression upon inspection. Upon palpation, if the cavity
be empty, there will be increased vocal fremitus. Upon per-
cussion, if the cavity is empty, a tympanitic note may be elic-
ited. If the cavity communicate with the bronchus a cracked-
pot sound may occur. If the cavity be filled dulness will be i
noted upon percussion. On auscultation, if the cavity be I
empty, increased vocal resonance and cavernous breatliing I
will be heard. If fluid be present in the cavity bubbling ralee I
are heard. Around the cavity a friction sound is frequently I
noted.
Give the etiology and treatment of hemothorax.
Hemothorax may result from traumatism, caused by frac- 1
ture of a rib or wounding of a lung. It may also result from j
rupture of an aneurysm, from malignant disease of the lung, j
and in the hemorrhagic diathesis. If the hemothorax be mod* i
erate in size it should not be interfered with, as subsequent I
PRACTICE OF MEDICINE, 643
absorption and clotting will take place. Best and the free
administration of opium are necessary. Avoid stimulation,
for it will interfere with the formation of a clot.
Describe the characteristics and significance of the
several icinds of arterial pulse.
The normal radial pulse is characterized by regularity, fair
volume, and, in the healthy adult, is from 70 to 80 per minute
in the erect posture. The pulse of aortic regurgitation is
known as the water-hammer or Corrigan pulse. It makes
itself known by an apparent fulness, which, however, soon
passes, and it recedes from the finger, hence it is also known
as the receding pulse. The pulse of mitral stenosis is*a small,
irregular, rapid pulse. The dicrotic pulse conveys to tho
finger a double beat.
Diagnosticate diabetes mellitus.
The diagnosis of diabetes mellitus consists in the continuous
presence of glucase in the urine. The amount of urine passed
by the patient may be from 3 to 5 quarts in the 24 hours ; its
specific gravity is high, 1030 or over. The color is usually
straw-colored, and the urine is clear. The patient has great
thirst, large appetite, as a rule loses weight, and an etherial
odor may often be detected in the breath ; there is pruritus,
especially of the genitals, and boils and carbuncles are apt to
form.
Differentiate gastric cancer from gastric ulcer.
Gastric cancer occurs after the age of 40, most frequently
in the male sex; gastric ulcer is a disease most frequently
occurring in young females in whom chlorosis is often present.
Gastric caneer is characterized by loss of weight, marked
cachexia, and often by the presence of a tumor in the region
of the pylorus. There is pain which, as a rule, is dull in char-
acter and not particularly aggravated by food. Vomiting
occurs after a longer period, 24 hours or more, of food which
is but partially digested. The Oppler-Boas bacillus may be
644
PRACTICE OF MEDICINE.
present in the vomited material, and there may also be tinges
of blood. In ulcer there is pain and marked tenderness in
the region of the ensifonu cartilage. This pain is greatly
aggravated by the taking of food; vomiting occurs soon after
a meal; there is frequently hematemesis. In the examination
of the gastric contents it will be found that in cancer there is
an absence of free HCI and the presence of lactic acid, while
in ulcer there is an escess of free HCI.
Differentiate scarlatina, measles and roseola.
In scarlatina the eruption appeare late on the first day or
early on the second day of the disease, while in measles il
appears on the fourth day, and in roseola the eruption is the
first symptom of the disease. The onset in scarlet fever is
abrupt, with a chill or convulsion, high temperature, rapid
pulse, 140-160 per minute or more, sore throat, etc. In measles
the onset is characterized by marked catarrhal symptoms, sucli
as sneezing, coughing, lachrymation, etc.; the temperature
moderate, there is slight sore throat and mild gastric dis-
turbance.
How would you diagnose pneumonia?
The direct diagnosis of pneumonia depends upon the sudden
onset with chill, temperature which, as a rule, is high, severe
pain in the side, cough, at first with scanty expectoration, later
the expectoration becomiag very tenacious and containing
blood (rusty sputum), and upon the physical signs. These
consist of the crepitant rale in the first stage, dulness on per-
cussion in the second stage- with bronchial breathing, and the
occurrence of the crepitus redux in the third stage.
Differentiate peritonitis and enteritis.
In peritonitis there are present marked abdominal pain,
tenderness on pressure, abdominal distension, after which
effnsion is apt to occur, vomiting, which becomes persistent,
fever and perhaps the occurrence of collapse; marked consti-
pation is an important symptom. In enteritis there is diar-
k
PRACTICE OF MEDICINE, 645
rhea, there is rarely marked distension, no abdominal rigidity ;
ss a rule, there is the history of some dietary error.
Differentiate organic and functional heart murmur.
Organic murmurs may be systolic, presystolic or diastolic in
time. There is evidence of cardiac hypertrophy, dilatation, or
both. The murmur is conducted in certain definite direc-
tions (except the presystolic murmur). A thrill is sometimes
present. A functional murmur is always systolic in time; it
is heard at the base, particularly at the left base (whereas
the organic murmur is heard at the punctum maximum), it is
not transmitted, there is no evidence of hypertrophy or dila-
tation, and it is present in anemic conditions.
Describe three pathological pulmonary sounds heard on
auscultation, and give their significance in diagnosis.
The friction sound which may be heard in inspiration, expi-
ration or both, which indicates a fibrinous pleurisy. A crep-
itant rale, which usually indicates fluid in the vesicular struc-
ture of the lung. Amphoric breathing, showing a cavity.
Differentiate aortic stenosis and aortic insufficiency.
In aortic stenosis the murmur is systolic in time, transmitted
to the arteries of the neck ; a systolic thrill is also often pres-
ent, there is some evidence of hypertrophy of the left ventri-
cle, the pulse is full and, as a rule, not rapid. In aortic
regurgitation the murmur is diastolic in time, heard at the
left base, conducted down the sternum. The water-hammer
or Corrigan pulse is present. There is marked evidence of
hypertrophy of the left ventricle. Occasionally the ** Flint
murmur^' may be heard.
Differentiate typhoid fever and remittent fever.
In typhoid fever prodromes are present, such as loss of
appetite, headache, diarrhea, evening fever, becoming more
marked each succeeding night. On or about the 7th day the
characteristic eruption appears, the typical tongue makes its
appearance, the spleen is enlarged, and the dicrotic pulse is
646
PRACTICE OF MEDICINE.
I
found during the second week. The Widal and diazo reac-
tions are present. Remittent fever may be present in many
of these* cases; there is, however, no Widal or diazo reac-
tion, no dicrotic pnlse, and the presence in the blood of the
Plasmodium malaria.' will in all eases lead to a correct diag-
nosis.
[)escribe four peculiar appearances of the tongue and
give their significance in diagnosis.
A flabby, indented, swollen tongue, covered with a yellowish
fur shows eatasrhal gastritis. This tongue is also seen in
smokers and drinkers, and occurs often in moderate fevers,
A tongue which is red at the edges and tips and is coated pos-
teriorly occurs in enteric fever. The "strawberry" or cat
tongue, in which the papillie are elevated and a slight grayish
fur is seen, occurs in scarlet fever. Furrings which are small
and limited indicate irritation from a rough tooth or inflam-
mation of a tonsil.
Differentiate acute rheumatism and periostitis.
Acute rheumatism is charaeferized by redness, swelling and
pain in the joints, by fever of a moderate range, by aeid
sweats and a constant tendency to inflammation of the serous
membranes of the heart. Periostitis, as a rule, follows an
injury; the pain is more localize<l and does not refer to the
joints; there are no aeid sweats, aad pus formation may occur,
which is exceedingly rare in acute rheumatism.
Differentiate neuritis from myalgia.
In neuritis Ihe pain is, as a rule, along the nerve trunks:
trophic changes may occur. In myalgia pain is over the mus-
cles; there is no constitutional disturbauee; fever is entirely
absent; pressure upon the affected area in myalgia gives re-
lief; in neuralgia the paiu is aggravated by pressure.
Describe the symptoms of yellow fever.
For convenience of description the disease is divided into
three stages: The stage of onset, which generally lasts three |
PRACTICE OF MEDICINE, 647
days ; the period of calm, which lasts from 12 to 24 hours ; and
the period of collapse, the duration of which is indefinite. In
the first stage there is headache, pain in the bones, nausea and
vomiting, moderate fever, the pulse may be 80 to 100 in a min-
ute, and becomes progressively slower as the disease advances,
the urine is albuminous ; there may be even in this stage slight
jaundice. These symptoms disappear more or less abruptly
and give place to the stage of calm, in which all the previous
symptoms disappear; and recovery from this stage may be
uninterrupted. If this favorable event should not occur, the
third stage is ushered in, with the appearance of marked jaun-
dice, from which the disease receives its name. There may be
hemorrhage from any of the internal organs, most frequently,
however, from the stomach, the characteristic black vomit.
The symptoms of the first stage are added to this.
Give the diagnosis of gastric ulcer.
The disease is most frequent in young anemic females.
There is pain and tenderness on pressure in the region of the
ensiform cartilage; there is hematemesis and obstinate con-
stipation. Examination of the gastric contents shows an
excess of HCl.
Give the symptoms resulting from paralysis of the
phrenic nerve.
This is a paralysis of the diaphragm, if the condition is bi-
lateral; no movement is noted on the abdomen and epigas-
trium; the hypochondrium is drawn in; marked dyspnea
occurs upon the slightest exertion. There may be enlarge-
ment of the chest.
What is the significance of the patellar reflex as a sign
of disease?
Absence of the knee-jerk is caused by a lesion affecting any
region of the reflex arc ; it is, therefore, lost in disease affect-
ing either motor or sensory fibers or both, as in neuritis, in
disease of the posterior roots or columns, as in Friedreich's
ataxia. It may be absent in apoplexy, epilepsy, injury to the
648
PRACTICE OF MEDICINE.
cord and in meniugitiB ; it is sometimes absent in diabetes,
diphtheria and chorea. It is exaggerated in hemiplegia fol-
lowing apoplexy, in the cerebral palsies of children, in general
paralysis of the insane, also in hysteria, neurasthenia aud
strychnine poisoning.
Differentiate epilepsy from hysteria.
Epilepsy is often preceded by an aura, followed by complete
loss of conaeionsness. There are at fii-st tonic, followed by
clonic, convulsions; during the attack the pupils are dilated;
the patients often bite their tongue. In hysteria there is never
complete loss of consciousness; there is no regularity with
regard to the con^iilsion; it is most common in females be-
tween the ages of 15 and 25; the pupils are irregular, hystero-
genic zones are present, the patient never falls so that she
may be injured.
Differentiate neuritis and rheumatism.
In neuritis the pain is commonly along the nerve trunks;
trophic changes occur; there may be foot-drop or wrist-drop;
fever is slight. In rheumatism there is redness, swelling and
pain in the joints, acid sweats, frequent implication of the
membranes of the heart, marked deposits of urates in the
urine.
Differentiate acute phthisis and capillary bronchitis.
There is a form of acute pulmonary phthisis which is knottTi
as the broncho-pneumonic form, which can with the greatest
difficulty only be differentiated from so-called capillary bron-
chitis. The main points of difference would consist in the
progressive emaciation, a family history of tuberculosis, the
finding of tubercle bacilli in the sputum, and the appearance
of the physical signs in the lungs.
What are the clinical manifestations of biliary calculi?
As long as the enlcnli remain quiescent in the gall-bladder
no symptoms arise. It is only upon the passage of the gall-
stones into the duct that the symptoms of hepatic colic arise,
PRACTICE OF MEDICINE. 649
which consist in great pain in the region of the liver, radiating
toward the umbilicus and right shoulder-blade, nausea and
vomiting and, after the passage of stones, jaundice, clay-
colored stools and the appearance of biliary pigments in the
urine.
Differentiate empyema from pulmonary abscess.
In pulmonary abscess there is a fever of a septic type, the
physical signs of a cavity are commonly present, frequently
expectoration of foul-smelling pus, which under the micro-
scope shows elastic fibers. In such cases leukocytosis is pres-
ent. In empyema there are the usual signs of pleural eflFusion.
the temperature may range from 102° to 105°, displacement of
the heart and the adjacent organs is common, local edema
and redness of the skin are often present.
Describe the diagnostic characteristics of the eruption
of typhoid fever, smallpox and chicken-pox.
The eruption of typhoid fever appears about the seventh
day, consisting of slightly elevated, rose-colored spots, which
disappear on pressure and appear again after the pressure is
removed; they occur in crops, having a duration of from two
to three days; they appear commonly on the abdomen, chest,
between the shoulder-blades, extremely rarely upon the face.
The eruption of smallpox appears on the third day in the form
of a macula, passing through the successive stages of vesicle,
pustule, crust and scar. The pustule is umbilieated and has
an inflammatory areola; the eruption appears all over the
body, especially on the exposed parts. The eruption of
chicken-pox appears on the first day; it appears as a small
reddish papule, which in a very few hours becomes a vesicle;
the vesicle is thin and transparent.
Differentiate diphtheria from follicular tonsillitis.
In diphtheria the exudate is found upon all parts of the
posterior pharynx, uvula and tonsils. Around the exudate
there is an inflamed areola. The exudate is removed with
great difficulty, leaving a bleeding surface, the false mem-
rmAoncM of medicikb.
In f ollienlar tonsiHitis the exudate
eryptBof the tonmLi; it is wiped away
learoig a bleeding aorf aoe, and it does net
Imeilltis k found cmly in the dipb*
orterlCia from acute dysentery.
liie inpwtant qrmptoma to be eoxuddered are
and abxfls ecmipoeed of muciia and blood.
IB aente enteritis do not oeeur in anything
at'taii^ and eonstani^ that they do in dysentery.
app^MUdtls from enteric fever.
Jto^ % nkt^ ^ppendiettis begins abruptly, with marked pain
OTer MeBumey's xH>int There is eon-
board-like rigidity, all this occurring,
% cdta^ wittiua a few days. The onset of enteric fever is
Willi prodromes of diarrhea, headache, characteristic
of the eruption about the seventh day^
ef the qileen, dicrotic pulse, Widal reaction.
aorte pericarditis from acute endocarditis.
tn pericarditis there is pain in the perieardium. This, as
.i rtiie. K absent in endocarditis. In pericarditis there is a
rrtociou :$oiuid, which may be either systolic or diastolic, but
,itf^ 4 rtile. i:> not related to either. In endocarditis there is a
iturtuur which is either systolic, diastolic or presystolic ; the
ifcunuur is transmitted, the friction sound is localized. The
tturtuur is heard at the punctum maximum ; the friction sound
s.:K*i4m x^ver the body of the heart and is nearer the ear.
H:uw» wvoid you diagnose a case of rickets?
SoitKSitue between the seventh month and second year of life
tK iKitieiit :$hv>ws irritability, restlessness and some fever
v»^<iivi oveuiu^. dentition is delayed and gastro-intestinal
iis^iiiiviiiv^.*^ follow; there is profuse sweating. The shape
»i. IK' 'kW is characteristic; it is rectangular, the face ap-
^;^i,n^ >4tiall in proportion to the skull, bone changes are
'iv>v^ vUiU the rachitic rosary appears.
PRACTICE OF MEDICINE. 651
Differeittiate variola and varicella.
In variola the eruption appears on the third day, preceded
by marked constitutional symptoms. The eruption goes
through the successive stages of macule, papule, vesicle, pus-
tule, which is umbilicated and surrounded by an inflammatory
areola, crust and scar. The eruption in varicella appears on
the first day and is vesicular almost from the beginning.
There are rarely marked constitutional plienomena, and the
disease is essentially one of childhood.
Differentiate apoplexy from uremic coma.
This is often very difficult; however, the following points
favor apoplexy: Profound coma, the face may be pale and
cyanotic or flushed; respiration is stertorous and slow and
may be of the Cheyne-Stokes type; hard arteries, with a slow,
hard, irregular, full pulse ; the pupils are dilated or unequal
and do not react to light ; conjugate deviation of the head may
be present; there is evidence of paralysis; the skin is hot and
dry; the coma in uremia may be preceded by, or accompanied
with, convulsions; the face may be pale and edematous; the
pulse is slow and of high tension, showing either hypertrophy
of the heart or sclerosis of the vessels; there may be a urinous
odor exhaling from the patient; frecjuently there is edema of
the feet; albumin and easts are found in the urine; albumi-
nuric retinitis may be present.
Differentiate unconsciousness from apoplexy, syncope
and alcoholic intoxication.
(Apoplexy see above.) In syncope the face is \ery pallid,
the pulse is very weak, and the pupils are markedly dilated.
In alcoholic coma the unconsciousness is rarely complete. The
alcoholic odor of the breath is not diagnostic, as apoplexy and
uremia may occur in persons that have been drinking. The
pulse is at first rapid and full, later becoming small and fee-
ble. The pupils are equal and often dilated. The skin is
cool and moist and the temperature subnormal.
52 PRACTICE OF MEDICINE.
Differentiate cardiac hypertrophy from cardiac dilata-
In cardiac hypertrophy the apes-beat is displaced down-
ward and to the left The first sound of the heart is strong
and booming. The pulse is slow and strong. In cardiac dUa-
tatioD the apex-beat is displaced to the right. It is diffused
and feeble, the first sound being weak. The pulse is often
rapid, irregular and weak.
Differentiate Asiatic cholera from cholera morbus.
This often presents great difficulties, especially in limes of
an epidemic of cholera; however, the finding of the comma
bacillus will in all eases clear up the diagnosis. Rice water
discharges are much more common in true cholera. In cholera
morbus there is usually the history of an indiscretion in diet.
Differentiate heat exhaustion from sunstroke.
In heat exhaustion premonitory symptoms occur, such as
dizziness, headache, nausea and vomiting. The respirations
are increased in number, and the pulse is very rapid, 130-liO
per minute. Unconsciousness is not profound. The temper-
ature may be normal or sub normal, or slight fever may be pres-
ent. In sunstroke there may or may not be prodromes. The
temperature is very high, from 106°-115°, or even higher.
Dyspnea is marked, and the skin of the body is red and some-
times even livid. The pupils are contracted and the pulse is
very rapid. There ia complete unconsciousness in which con-
vulsions may occur. Cheyne-Stokes breathing may be present.
Diagnosticate parenchymatous nephritis.
The face is pale and edematous. The pulse ia fidl and
strong, showing some hypertrophy of the heart at first, al-
though this is not nearly as common as in the interstitial
variety. The urine is decreased in amount, of high specific
gravity, high-colored, and contains large amounts of albumin
and casts. Often there is also edema of the lower extremity.
Differentiate aortic and mitral valvular diseases.
In aortic disease the murmur is heard with the greatest in-
PRACTICE OF MEDICINE. 65^
tensity at the aortic cartilage (second right costal cartilage) ;
it is either transmitted to the neck, if it be systolic, or it is
transmitted down the sternum, if the murmurs be diastolic in
time. In aortic valvular disease there is always hypertrophy
of the left ventricle. In mitral disease the murmur is heard
at the apex. It is transmitted to the axilla and the angle of
the scapula if the murmur be systolic in time. The presys-
tolic murmur is not transmitted and is accompanied with a
presystolic thrill.
When is perforation in typhoid fever most likely to
occur?
Sometime in the course of the third week.
Describe the essentially different sounds given by the
thorax on percussion.
Tympany is elicited over the trachea, resonance over the
lungs, dulness over the heart.
In what cases would the ophthalmoscope aid in diag-
nosis?
In disease of the arteries (retinal hemorrhages). In dis-
ease of the kidney, in disease of the nervous system, syphilis,
tobacco-poisoning, lead-poisoning, tubercular meningitis, dia-
betes, etc.
Differentiate in a general way between cerebrospinal
fever and tubercular meningitis.
The onset of tuberculosis is not so sudden as in cerebro-
spinal meningitis; the pains, hyperesthesia and retraction are
less, and there are no eruptions. Ketraction of the abdomen,
irregular pulse and Cheyne-Stokes respiration are much more
frequent. A pre-existii\g tuberculous lesion may be found,
and the ophthalmoscope may reveal tubercles in the choroid.
What does bronchial breathing indicate?
This is heard normally when listening over the trachea. It
is encountered over airless spaces in the lung tissue and over
cavities.
1
«4 PRACTICE OF MEDICINE.
In what diseases can we employ the microscope to ad-
vwtaKC as an aiJ in diagnosis?
Priiieipall; in diseases of the blood and kidney. It is also
VK^aaxy in the examination of all secretions and excretion:*
for palbogenic organisms aJid parasites.
Describe the physical signs of simple ascites and those
•f ovarian dropsy.
In ascites, if the patient be lying upon the back, tho center
I «f the abdomen is flat (provided the amount of fluid is not
L'essive), the lateral and dependent portions bulge. There
will be tympany over the region of the umbilicus and flatness
I lo the flanks. Fluctuation will be obtained. In dropsy due
to ovarian disease the accumulation of the fluid is local (in
Ihe region of the ovary) ; it does not change with positioo
of the patient. If the accumulation be great, the differential
I diagnosis is verj- difSeult; vaginal examination must be made.
«nd sometimes the character of the dropsy can only be delcr-
mined from the fluid withdrawn.
Differentiate the early eruption of syphilis and measles.
In syphilis there is the hitstory of tho chanon?. and quite a
period (six weeks) before the eruption appears. Coincident
with the eruption there is inflammation of the throat (mucous
patches). There is rarely any fever. The eruption is copper-
colored, and is not particularly prominent on the face. In
measles there is marked fever from the onset, with severe
(.■atarrhal symptoms. The eruption does not appear before
the fourth day, it occurs prominently on the face and rapidly
spreads all over the body, the catarrhal symptoms continuing.
What are the methods of physical diagnosis or explora-
tion?
Inspection, palpation, mensuration, percussion, auscultation
and siiccnssion.
Describe the symptoms of acute inflammatory arti-
cular rheumatism.
The disease, as a rule, begins with pain, swelling and red-
PRACTICE OF MEDICINE. 655
ness of one or more of the large joints. The joints implicated
are symmetrical. There is moderate fever, 102°-103°, acid
sweats and marked urates in the urine. There is a tendency
to implication of the serous membranes of the heart.
Give the etiology and describe the symptoms of idio-
pathic erysipelas.
It occurs at all seasons of the year and in all climates. It
is most liable to occur in debilitated and cachectic persons
and in the course of chronic pulmonaiy tuberculosis. The
disease may occur in the puerperal state. The exciting
cause is the streptococcus erysipelatis of Fehlcisen. The dis-
ease begins with a chill or chilliness, and is followed by the
development of the eruption. There are gastro-intestinal
symptoms or fever. The skin becomes irritated, itchy and
swollen. There is heat, tension and burning in the part.
The eruption shows decided elevation with a distinct, promi-
nent margin, it is red or puffy in the center and glossy in
appearance. Uncomplicated cases last from two to three
weeks.
Mention the causes and describe the treatment of pri-
mary lobar pneumonia.
The exciting cause is the diplococcus or pneumococcus of
Frankel. Exposure to cold and wet, alcohol, are said to be
predisposing causes. The treatment of the disease consists
in giving the preliminary purge, preferably calomel. Dover's
powder or a hypodermic injection of morphine to relieve the
pleural pain, remedies to sustain the heart and respiration,
such as alcohol and strvchnine, are useful. Ammonium car-
•■ -
bonate and ammonium chloride are also of value.
Describe the treatment of hydrothorax.
Purges, diaphoretics and diuretics are of value. If these
remedies do not relieve the condition the aspirator must be
resorted to.
656
PRACTICE OF MEDICINE.
State your treatment, including diet, of typhoid fever.
If the patient be seen before the tenth day of the disease,
a calomel purge should be administered. The systematic cold
bath of Brand Is a favorite method of treatment. Alcohol
and strychnine are valuable adjuncts to sustain the circula-
tion. The diet should be absolutely liquid. Water plenti-
fully, milk. li<|nid peplonoids are commonly employed. No
solid nor semi-solid food should be administered before Ihe
evening temperature has been normal for at least one week.
Describe the treatment of diabetes mellJtus.
Diet is most important. No starches or sugars should be
given. The diet should consist iu the fresh green vegetables,
meat, fish. No alcoholic or malt liquoi-s should bo em-
ployed. The generally accepted treatment is by some form
of opium, codeine being most often employed.
Give the symptoms and treatment of tetanus.
The prominent symptoms are the occurrence and recurrence,
at varying intervals, of tonic spasm of greater or lesser inten-
sity in the voluntary muscles. The spasm is usually first
noticed in the neck, which is soon followed by spasm of the
muscles of the jaw. with inability to open the mouth. There
is pain, which, however, is not severe. Occasionally the body
arches backward, a condition known as opisthotonos. There
is usually fever of about 101°, but after prolonged spasm
hyperpyrexia may occur. The urine is scanty, extremelj^
toxic aad often contains albumin. Profuse sweating is a
prominent symptom. The treatment consists in the endeavor
to administer nutriment, and rectal injections should be re-
sorted to. Chloral is of value because it produces sleep and
sometimes relaxes spasm. Antitetanic serum is of value in
some cases. The wound should be tborouprhly <
treated antiseptically.
What is the most
Syphilis,
L
PRACTICE OF MEDICINE. 657
How should acute coryza be treated?
Acute coryza should be treated by cleansing the nose with a
mild antiseptic solution ; a weak solution of cocaine is also of
value. Dover ^s powder is also recommended internally.
Describe the treatment of pleurisy with effusion.
The common measures administered to absorb fluid, such as
purges, diaphoretics and diurectis, should be resorted to. If
these fail the aspirator may be used.
What is the period of incubation in variola and vaccinia?
The period of incubation of variola is from ten to thirteen
days. The period of ineubation in vaccina varies from three
to seven days, depending upon whether humanized or bovine
virus is used.
What are the symptoms of hepatic abscess? In what
climate is hepatic abscess most likely to occur?
The symptoms of hepatic abscess are an enlarged and tender
liver, with jaundice, anemia and wasting. The clinical mani-
festations vary, and large abscesses may be present without
marked disturbance. Occasionally fluctuation may be de-
tected in the liver. There may be pain of a throbbing char-
acter. Occasionally all the phenomena of sepsis are present,
chilLs, fever and sweating. The disease is most common in
hot climates.
How may pleuritis in its early stages be differentiated
from intercostal neuralgia?
In pleuritis there is pain, which is especially aggravated by
breathing. In intercostal neuralgia the pain is over the exit
of the intercastal nerves. It is increased by i)ressure. In
pleuritis the pain is diminished by pressure. The pain is not
aggravated in intercostal neuralgia by deep breathing. In
pleurisy there is a friction sound, wliicli does not occur in
intercostal neuralgia. Fre(iuently intercostal neuralgia is
accompanied by the development of herpes zoster.
42
658 PRACTICE OF MEDICINE.
How many and what are the stages of malarial inter*
mittent fever?
There are tliree stages : The stage of chill, the stage of fever, I
and the sweating stage-
Mention the eruptive fevers.
Scarlet fever, measles, German or Fi-ench measles or rubella,
variola, varicella and erysipelas.
Describe the treatment of intermittent fever.
The treatment of intermittent fever consists in the admin- 1
istration of quinine in sufficient doses to destroy the Plasmo-
dium of malaria. From 10 to 20 grains a day for an adult is
sufficient for this purpose.
Give the etiology and outline the treatment for acute
gastritis.
If the majority of instances the condition is due to irritants,
either thermic or chemical, that come in contact with the
mucous membrane of the stomach, producing an acute infiam-
raation. Food either too hot or too cold, spices, drugs and
poisons may have this influence on the mucous iDerabrane.
The treatment consists in the administration of a purge, such
as calomel or castor oil. The diet should be restricted for a
while. In severe eases it is necessary to produce vomiting.
Lavage is useful. Drugs are scarcely ever nece&sary.
Describe the symptoms and treatment of chronic hydro*
cephalus in children.
The symptoms of congenital hydrocephalus are difficulty in
the movements of the child on account of the weight of the
head. As a rule there is impairment of intellect. The head
is often enormous in size. There may be headache and dim-
ness of vision, and the gait may become irregular. The polae.—
is usually slow. Medical treatment is of no avail in this coi
dition. Operative methods are advised by some authoritiei
Define rubeola and describe its symptoms.
Rubeola is an acute, infectious, contagious disease chai
PRACTICE OF MEDICINE. 659
terized by marked catarrhal symptoms, especially of the res-
piratory tract, with a characteristic eruption occurring on the
fourth day. The disease may begin with a chill, followed by
fever that may reach 103° F. or higher, with marked catarrhal
symptoms from the onset. There is injected conjunctiva,
lachrymation, photophobia, corj-za, and some cough. Rales
are heard in the chest. Koplik's sign may appear about this
time. On the fourth day the eruption appears, which consists
of rose-red or brownish maculo-papular points raised above
the skin, with intervening healthy skin, often arranged in
crescentic shape. The eruption remains at its height for about
four days. The catarrhal symptoms continue. About the
eighth day of the disease the eruption begins to fade. A fine
desquamation occurs. In the absence of complications the
disease lasts about twelve days.
Describe the symptoms and treatment of gangrene of
the lung.
Cough accompanied by expectoration, which is abundant,
thin and foul-smelling, should call attention to gangrene of
the lung. Fever is always present. There is often hemop-
tysis. Microscopically the sputum contains leukocytes, shreds
of lung tissue, especially elastic fibers, fat crystals and bac-
teria. Upon percussion over the affected area dulness is pres-
ent. Upon auscultation, bronchial breathing and, if excava-
tion occurs, signs of a cavity are present. The treatment is
supportive.
Describe the symptoms of tubercular meningitis.
The coui'se of the disease is usually divided into a pro-
dromal stage, a period of excitement and a period of paralysis.
In the prodromal stage the child becomes irritable and rest-
less, there is anorexia, heachache, pain in the limbs, accom-
panied by nausea and obstinate vomiting. The second
stage is marked by an aggravation of the symptoms just
enumerated, with fever. The headache becomes intense, and
is usually general. The hydrocephalic cry is usually present.
660 FRACrWE OF MEDICINE.
Obstinate coustipatiou is characteristic. There is a rapid
pulse, which may be from 120 to 160 per miuut*?; the abdomen
is prominent; nervous symptoms are present, most frequently
delirium. The pupils are contracted, and strabismus may
occur. There is marked cuteneous hyperesthesia. Convul-
sive movements are common. This period lasts for a week or
ten days and is followed by the stage of paralysis. The fever
becomes higher, often reaching 103° or 106°. Spasmodic
eontractioDB, with tremor and twitching of the tendons and
muscles, with local paralysis occur. The third nerve is most
frequently involved, causing ptosis. The duration of the dis-
ease is variable, lasting about three weeks. When the disease
occurs in adults it may he prolonged to three or four months.
Ijeukocytosis is present throughout the course of the disease.
What should be done for hemoptysis occurrin}; in the
course of phthisis?
Absolute quiet is essential ; food and drink should be stopped
for a while; ice-bags may be applied over the cheat; the ad-
ministration of opium in some form is generally advised.
Give the symptoms of epidemic influenza.
The disease occurs suddenly, usually with a chill and marki'd
fever, 103°-105°, with catarrhal symptoms, such as sneezing,
coughing, etc. There is headache, usually frontal or behind
the eyes, or at the root of the nose, pain in the limbs and in
the bones. Thei-e is marked prostration, out of proportion Ui
all tJie other phenomena. There is a constant tendency to
complications resulting from inflammatjon of the respiratory
or gastro-intestinal mucous membrane. There may be nau-
sea and diarrhea. Unoomplioated cases last from a week to
ten days.
Wliat is hemoptysis?
Bleeding from the lungs.
Give the physical signs of pleuritic effusion.
On inspection there )uay be slight bulging. The apex-beat
PRACTICE OF MEDICINE, 661
of the heart is seen to be displaced. Upon palpation there is
decreased vocal fremitus. Upon percussion there is flatness
over the afl:ected area. Upon auscultation the breath-sounds
are absent, and vocal resonance cannot be obtained over the
affected area.
Describe the natural heart sounds.
Two distinct sounds are encountered: The systolic or first
sound, and the diastolic or second sound. They are separated
from each other by a short pause, a long pause occurring
between the second and first sound. The first sound is due to
the contraction of the ventricle, the rush of blood and the
closure of the auriculo-ventricular valve. It is long, low and
booming in character. The second sound is due to the closure
of the semilunar valve, and is short and valvular. The first
sound is best heard at the apex, the second sound at the base
of the heart.
On what day does the rash usually appear in scarlatina?
At the end of the first or beginning of the second day.
What are the symptoms of delirium tremens?
The prodromes consist of nervousness, restlessness and ano-
rexia. As a rule there is insomnia. A tremor occurs which
affects the lips, tongue and limbs. Delirium soon develops,
which is active and constantly changing. The skin is moist
and the expression is anxious. The pupils are dilated. The
temperature is subfebrile, the pulse soft and rapid. The
tongue is covered with a thick fur, and there is sometimes
nausea and vomiting.
What are the clinical features of cerebrospinal fever?
The onset is sudden, beginning with intense headache, stiff-
ness in the muscles of the back of the neck, nausea and vomit-
ing. The attack may begin with a chill. Delirium and stupor
commonly occur. There is marked alteration of sensation.
The fever varies from 101°-105° or more. Kernig's sign is
present. Herpes is very common. Other eruptions also
PRACTICE OF MEDICINE.
occur, 8ueh as erythema, urticaria and petechise. Arthritis
may be present. The urine is scanty and may contain
albumin.
Diagnose varioloid.
The disease begins with a chill, followed by fever of about
103°. There is nausea and vomiting, pain in ihe head and
hack. The eruption occurs earlier than in variola, usually in
the course of the second day. It is never so copious. The
I evolution of the pox is arrested in the vesicular stage. There
is no secondary fever, as there is no pus to absorb.
Give the symptoms of acute myelitis.
Paralysis of motion, which comes on rapidly, with complete
OSS of sensation below the site of the lesion, and paralysis of
the sphincters are the important symptoms. Bed-sores usually
occur. There is some rise in temperature. Convulsions may
occur. Reactions of degeneration are not present. The re-
flexes are exaggerated when the lesion is above the lumbar
region, and ankle eionus may be elicited. Loss of sensation
is complete.
What diseases produce conditions of the sicin which are
of general diagnostic value?
The eruptive diseases, yellow fever, diseases of the liver,
purpura, Addison's disease and melanotic cancer.
What would auscultation and percussion reveal in a case
of congestion of the lung?
Auscultation would reveal small moist rales, with broncho-
vesicular breathing; percussion may reveal impairment of
What are the physical signs of stenosis of the mitral
valve?
A presystolic murmur heard at or near the apex, which is
not transmitted, a presystolic thrill and a rapid, irregular,
feeble pulse.
PRACTICE OF MEDICINE. 663
Describe the features of a case which would lead you to
diagnose acute appendicitis.
Marked tenderness and pain in the right iliac fossa, espe-
cially over McBurney's point; rigidity upon the affected side;
nausea and vomiting, and marked constipation.
What does the urine reveal as to color, specific gravity,
quantity voided, abnormal constituents, etc., in a typical
case of diabetes mellitus?
The color is pale yellow with a slight greenish cast; the spe-
cific gravity is high, 1030 or over; the quantity voided is usu-
ally large, five quarts or more in twenty- four hours; the
abnormal constituents consist in the presence of glucose;
occasionally there is also albumin.
State the sex and period of life to which chlorosis is
confined.
It is common in the female sex, rarely occuring in the male.
It is usually at the age of puberty.
What are the grades of temperature which come under
observation in the sick?
The temperature of collapse is below 96° ; subnormal tem-
perature is from 96°-97.5'^ ; normal temperature is 98.6° ; a
subfebrile temperature is from 99.5° to 101° ; moderate fever
from 101° to 103°; high fever from 103° to 105°; hyper-
pyrexia above 105.5°.
Give the most frequent causes of pericarditis.
The most frequent causes are rheumatic fever, scarlet fever,
diphtheria, septicemia and trauma.
Give the symptoms of an ordinary case of scarlet fever.
The disease begins suddenly, with chill or a convulsion.
There is nausea and vomiting, liigh temperature, rapid pulse
and marked angina. There is enlargement of the lymphatics
at the angle of the jaw. At the end of the first or beginning
of the second day an eruption appears all over the body, which
664
PRACTICE OF MEDICINE.
has the color of a boiled lobster. The eruption last* four to I
five days and disappears by desquamation. Postscarlatinal
nephritis is a frequent complication.
Describe an attack of acute articular rheumatism.
The disease begins suddenly, with fever of about 102°-103°.
There is pain, tenderness, swelling and redness in one or more
of the large joints. Occasionally prodromes are present.
There may be a preceding tonsillitis or pharyngitis. The
involvement of the joints is symmetrical. The pulse is accel-
erated from 100 to 110 per minute, the urine is high-colored, '
scanty in amount, specific gravity from 1025 to 1040. contain-
ing au abnndance of phosphates and urates, albumin being
rarely present. The saliva is strongly acid. Copious acid
sweats occur. Skin eruptions are flommon, such as urticaria
and erythema.
Give the differential diagnosis between cerebrospinal
meningitis and typhoid fever.
In the tirst week of the disease the diagnosis is often diffi-
cult. Later in enteric fever the characteristic eruption ap- |
pears, the spleen enlarges, the pulse beeomes dicrotic, the ,
nervous symptoms are not prominent until the beginning or |
toward the end of the second week, the headache disappears i
at the end of t-he first week, the Widal i-eaction is present.
In enteric fever the onset is rarely sudden; there are marked I
prodromes, such as headache, epistasis; vomiting is very in-
frequent; the temperature cuitc in enteric fever is charac- I
teristie, rising step-like in the first week, being subertnlinuoiM I
in the second, remittent in the third and intermittent in the I
fourth week. The onset in cerebrospinal fever is sudden, J
with chill or convulsion ; marked rigidity of the muscles of the I
back of the neck; violent headache and marked vomiting of j
the cerebral type. Herpes is common. The temperature is l
not characteristic, and the nervous symptoms are much more |
prominent than in enteric fever.
What are the physical signs of pulmonary solidification? |
Upon palpation there is increased vocal fremitus. Upon [
L
PRACTICE OF MEDICINE, 6G5
percussion there is dulness, and upon auscultation there is
bronchial breathing. There may be rales.
Differentiate catarrhal from croupous pneumonia.
Catarrhal pneumonia is a disease secondary to bronchitis.
Croupous pneumonia occurs suddenly, with marked chill, high
temperature. In croupous pneumonia there is marked pain
in the side, cough, anxious expression of the face, flush upon
the cheeks, herpes, rusty sputum, and the disease terminates
by crisis, usually upon one of the odd days of the disease,
fifth, seventh or ninth day. Broncho-pneumonia occurs most
commonly at the extremes of age. The disease is longer in
duration, terminating by lysis. Upon physical examination
in broncho-pneumonia there are scattered areas through both
lungs, over which may be detected subcrepitant rales and
dulness. Croupous pneumonia is, as a rule, a unilateral disr
ease affecting the base of the lung. The crepitant rale, which
occurs in the first stage, disappears in the second stage and
reappears in the third stage as crepitus redux, is charac-
teristic.
Give the general symptoms of cerebral hemorrhage.
The onset is sudden, with loss of consciousness, a rapid
development of hemiplegia, conjugate deviation of the head
and eyes, usually normal temperature, full, bounding pulse
and irregular pupils. There may be Cheyne-Stokes respi-
ration.
What condition of the blood is generally prominent in
all forms of rheumatism?
There is marked anemia. The red bloodcells may be re-
duced one-half or more in number. The hemoglobin may be
reduced to fifty per cent., and leukocytosis occurs.
What adventitious sounds are usually discovered by
auscultation in catarrhal pneuinonia?
Kales, usually of the subcrepitant variety, large mucous
rales and broncho-vesicular breathing.
666 PRACTICE OF MEDICINE.
How are the lymphatic glands involved in scarlatina?
The lymphatic glands at the angle of the jaw and of tie
I neck are usually enlarged, sotiietimes greatly, so that they
form what is known as the collar of brawn.
Give the physical signs of the second stage of acute
lobar pneumonia.
Thei-e is dulness on pereussion, bronchial breathing on aus-
cultation.
Give the topographical outlines of the liver as revealed
by percussion when the patient is in the recumbent posi-
, tion.
Anteriorly liver dulness begins in the mam miliary line at
I the sixth rib, in the axillary line at the eighth rib, and in the
8ea5)ular line posteriorly at the tenth rib. It extends from
all these points to the lowest border of the eoslal eartilages.
At what point does auscultation best reveal the sound
of the mitral valves and of the aortic valves?
The sound of the mitral valve is best heard at the apes of
the heart. The sound of the aortic valve is beat heard at the
second right costal cartilage near the sternum.
Make a diagnosis of locomotor ataxia.
The disease is commonly divided into three stages : The pre-
ataxic, the ataxic and the paralytic stage. The pre-ataiic
stage is characterized by lightning pains, most often in the
lower extremities, by ocular phenomena such as the Argyll-
Robertson pupil, which is a contracted pupil reacting to
accommodation but not to light, and by the use of the patellar
tendon -reflex. In the second stage the ataxic gait occurs ; the
patient cannot stand with his feet in juxtaposition with his
eyes closed. The symptoms of the pre-ataxie stage continue
in this st-age. The paralytic stage is characterized at first by
loss of control of the sphincters and by paralysis.
Give the symptoms of acute spinal meningitis.
The disease usually begins with chill and a temperature of
PRACTICE OF MEDICINE. 667
the aseptic type. There is severe pain in the back, increased
by motion, radiating into the extremities ; rigidity of the mus-
cles occurs. Hyperesthesia is general. The reflexes are ex-
aggerated, and ankle clonus is pronounced. There may be
retention of urine and feces from paralysis of the sphincters.
What is the period of desquamation in scarlet fever?
The period of desquamation in scarlet fever usually occurs
after the appearance of the eruption, or when the eruption
has been prominent for about four or five days. It may last
from several da}^ to several weeks or more. The desquama-
tion is usually in large scales.
Define lithemia.
A condition due to a disturbance of metabolism, character-
ized by an excess of uric acid in the blood, and clinically by
various digestive, nervous and circulatory phenomena.
What are hemic murmurs as applied to the heart, and
what is their cause?
It is commonly believed that hemic munnurs are due to an
alteration in the constituents of the blood, such as occurs in
chlorosis or in other forms of anemia. These murmurs are
systolic in time, soft, and heard at the left base of the heart.
Make a general diagnosis of icterus.
Jaundice is characterized by a yellowish discoloration of
the skin and of the conjunctiva. There is itching of the skin,
slow pulse, the appearance of bile pigment in the urine and
clay-colored stools.
Why is dyspnea caused by disorganization of the mitral
valves?
This is due largely to the fact that, when rupture of com-
pensation occui's, the right heart, and hence the pulmonary
circuit, is interfered with.
Describe a typical case of laryngismus stridulus.
The disease comes on abruptly, the child being attacked
PRACTICE OF MEDICINE.
most often at night with shortness of breath, followed by clos-
ure of the glottis, which may rem'aiu closed from several sec-
onds to twenty or thirty. During this time cyBnosis may be
a. prominent feature. This is followed by relaxation of the
spasm giving rise to high-pitched inspiration. Convulsions
may occur, and are apt to be very severe.
Describe a typical case of typhus fever.
The disease begins suddenly, «-ith marked chill and high
temperature. There is nausea, vomiting and epigaatrii; pain.
The pulse is rapid, hard and not easily compressible. Ver-
, tigo and delirium soon set in. The face is reddened, the pupils
are contracted and the conjunctiva injected. The lonfnie is
\ <oated. The liver and spleen are painful upon palpaliou
and are somewhat enlarged. Delirium and convulsions are
common. Constipation is marked throughout the course of
the disease. On or about the fifth day an eruption occurs,
which, in its early appearance, closelj' resembles measles. It
I occurs all over the body except the face. This eruption after-
ward becomes petechial. Another eruption is characteristic,
which oon-sists of marbling or mottling of the skin. On or
about the fourteenth day of the disease cri.sis occurs.
What is the significance of prolonged expiration?
When inflammatory exudates occur in the bronchial tubes
the expiratory murmur equals and occasionally is longer than
the inspiratory murmur. When this sign is localized to the
apices it is indicative of incipient tubercular disease. It fur-
ther occurs in bronchial a.sthma and in chronic pulmonary
emphysema.
What age and sex are most subject to chorea?
It is a disease of childhood, most common between the fifth
and fifteenth years: much more common in the female than in
the male sex.
What is understood by an exanthematous fever?
A fever in which a characteristic eruption occurs.
PRACTICE OF MEDICINE. G69
What parts of the brain are most liable to hemorrhage?
The parts supplied by the middle cerebral artery.
Describe the morbid states associated with asthma.
They are chronic bronchitis and chronic pulmonary emphy-
sema.
What are the general or constitutional symptoms of
diphtheria?
The onset of the disease is rapid, the early symptoms being
discomfort and weakness, with headache. There is moderate
fever. Pain on swallowing is often the first symptom. Upon
examination of the throat the characteristic exudate is seen.
What are the physical signs of aortic regurgitation?
Upon inspection the apex of the heart is found displaced
downward and to the left. The impulse is seen to be forcible,
indicating great hypertrophy of the left ventricle. Palpation
confirms this. Upon auscultation a diastolic murmur is noted
at the second right costal cartilage, transmitted down the
sternum. The Flint murmur may be present. The pulse is
characteristic, being known as Corrigan, receding or water-
hammer pulse.
On what day does the rash usually appear in measles?
On the fourth day.
What is progressive pernicious anemia?
This is a primary anemia, characterized by a marked de-
crease in the number of red bloodcells, by fatty degeneration
of the heart, liver and kidneys, and by a peculiar lemon-yellow
discoloration of the skin.
What is Asiatic cholera?
A specific disease, due to the comma bacillus of Koch, pre-
vailing endemically in some parts of the world, and occasion-
ally becoming epidemic, characterized by vomiting, purging*
muscular cramp and high mortality.
i
FSACTWE OF MEDICISE.
Enumerate the points of diagnostic value in a case of
chronic interstitial nephritis.
Hypertrophy of the heart aud artcrioscSerosis. albuminuriii
retinitis, headache, the passage of large amounts of urine of
low speeific gravity, 1004 to 1006, traces of albumin and often
without alhumin, and the presence of tube casts.
Name a medicine which affects the urine as to color and
odor.
Turpentine.
What cardiac lesions are lil<ely to accompany or to fol-
low acute articular rheumatism? And how may the}' be
recognized by the aid of the stethoscope?
Pericarditis and eudocardilis. In enciocarditis a murmur
will be developed; in pericarditiK a friction sound is heard.
How may rheumatism affect the respiratory organs?
Pleurisy witli or without effusiou may occur in the eourw
of rheumatic fever.
What is the usual reaction of the urine in (b) chronic
cystitis, (b) acute articular rheumatism?
In chronic cystitis the reaction is usually alkaline; in acute
articular rheumatism markedly acid.
What is the diagnostic significance of dropsy?
Dropsy is an accumulation of watery fluid in one or more
of the serous cavities or in the subcutaneous tissues. It is due
to venous obstruction, to a toxemic condition of the blood, to
the effects of inflammation upon the neighboring circulation,
to vasomotor causes relating to disease of the nervous system.
to lymphatic obstruction, and it occurs in a condition known
as idiopathic or essential edema.
Define a puerile murmur and give its causes.
This form of breathing is normal in infants and children.
It diminishes in intensity up to the age of twelve years. It
closely resembles broneho-vesieular breathing. However, the
PRACTICE OF MEDICINE, 671
ratio between the length of inspiration and expiration is
always longer. It is occasionally heard in dyspnea, especially
from disease of the heart. It also occurs in what is known
as compensatory breathing over one lung when there is disease
of the opposite lung, or in tbe portion of one lung when it is
affected by disease in another part.
Differentiate between sibilant and sonorous rales.
Sibilant rales are high-pitched, whistling rales, and occur
in the smaller bronchial tubes. Sonorous Y'ales are low-
pitched, snoring in character, and they occur in the larger
bronchial tubes.
Name the leading rational and physical signs of chronic
bronchitis.
The important sign of chronic bronchitis is cough, with or
without expectoration. After chronic bronchitis has existed
for some time, emphysema frequently occurs, and also bronchi-
ectasis. The physical signs which belong to chronic bron-
chitis are, particularly, rales, which are dry rales if there be
no expectoration, and moist rales if expectoration be profuse.
Differentiate between pulmonary edema and pneumo-
nitis.
Pulmonary edema is usually a secondaiy disease. There is
marked dyspnea, urgent and troublesome cough, large num-
bers of moist rales of all sizes are heard, particularly at the
base. In pneumonitis there is the onset, with chill, high tem-
perature, rusty sputum, and the important physical signs,
which consists in crepitant rales, followed by bronchial breath-
ing, and the crepitus redux. .The termination is by crisis.
In what conditions does bronchial breathing take the
place of vesicular breathing?
Bronchial breathing is encountered over airless spaces in
the lung tissues and over cavities. Only pulmonary tissues
containing air have the property of changing into the vesi-
cular murmur the bronchial sound as it passes through the
trachea and bronchi.
I
672 PIlACriCE OF MEDICINE.
What is the character of the fever curve in chronic
tuberculosis?
As a rule it is intermittent in character. Occasionally,
liowi.'ver, the inverse temperature curve is seen.
What are the physical signs in the first stage of pneu-
monic fever?
On inspection there is increased breathing; palliation may
detect friction fremitus from the associated pleurisy. On
percussion there is impairment of resonance, and on susenl-
tation the crepitant rale is found to he present.
Relate the history of a case of progressive muscular
atrophy.
The early symptoms are pain in the arm and shoulder, with
numbness and a feeling of exhaustion; next atrophy is no-
ticed, as a rule, in one hand. The wasting usually extends
and the muscles supplied by the ulnar nerve are, as a rule,
most affected. The motion of the fingei-s becomes impaired,
and the wasting gradually passes up from the forearm to the
arm and shoulder. Both flexors and extensors are affected.
The other hand usually shows the same process within two to
ten montlis. Sometimes the muscles of the shoulder are first
affected, next the nniscles of the back, hip and thigh are in-
volved. It is rare for the muscles of t-he legs to be attacked.
There is paralysis and fibrillary twitching. The reflexes are
lost early. Reactions of degeneration set in later. One or
both sides of the face may be affected. The sphincters do
not share in this process.
Describe alcoholism and some of its effects.
As a rule, the onset is insidious, tlie symptoms consisting in
fatigue, unwillingness to work and loss of energy. There is
malaise, headache, general and mental depression, loss of sleep
and tremor of the hands, lips and tongue. The tremor at first
may be controlled. As the eondition advances these eymptotuB
become more manifest. The skin becomes Sahby, the face shows-
PRACTICE OF MEDICINE. 673
venous congestion, and acne may show itself about the nose.
Symptoms of gastric catarrh are present as a rule. The
tongue is flabby and furred, and the tremor is marked when
the tongue is protruded. Leukoplakia may occur, especially
in males. The breath is fetid, and there is great thirst.
Often there is disgust for food, especially in the morning, and
this is aggravate by the early morning nausea and vomiting.
Insomnia is an early and almost constant symptom, and if the
patient sleep at all, he is disturbed by bad dreams. Peri-
pheral neuritis may develop. The will and intellectual facul-
ties are greatly impaired, and there is perversion of the moral
tendencies. The resistance of the body becomes lessened, so
that drinkers readily succumb to the acute infectious diseases.
What is the diagnostic significance of Cheyne-Stokes
respiration?
This form of respiration is very likely to be observed in
disease of the brain, from disturbances of the circulation or
from toxic conditions.
State where topographically mitral and tricuspid mur-
murs are most distinctly heard.
The mitral murmur is heard at or near the apex. The tri-
cuspid murmur is heard a little to the right of the ensiform
cartilage.
Enumerate the diagnostic sounds in a diseased respi-
ratory apparatus.
There may be moist or dry rales, crepitant rales, friction
sounds, bronchial breathing, broncho-vesicular breathing or
cavernous breathing.
In what conditions does sub-normal temperature occur?
This occura in diabetes, myxedema, chronic cardiac, renal
and hepatic disease, and in many forms of insanity. It is
also common in internal malignant growth. It frequently
occurs after the defervescence in some of the specific fevers.
It occurs in the stage of collapse in cholera.
4:]
674
PRACTICE OF MEDICINE.
How does paralysis of the third nerve affect the eye? I
THere may oe ptosis, slight esopthalmus, external stva- j
bisinus, diplopia and a dilated pupil which reacts neither to
aecommodation nor to light.
Give the causes and clinical features of purpura sim-
plex.
This condition occurs in many diseases. It is characterized I
by the extravasation of blood into the skin, mucous membraueg 1
and internal organs, and sometimes by free hemorrhage from J
mucous membranes. The alterations in the composition of J
the blood in purpura are usually those of symptomatic ane- I
mia from hemorrhage. Purpura simplex is most usually I
met with in children. It is a mild condition, accompanied I
with purpuric spots upon the extremities, and sometime J
upon the trunk and arms, with impairment of tbe appetite I
and diarrhea.
Make a diagnosis of cerebral tumor.
The characteristic symptoms consist in headache, optie 1
atrophy, sensory disturbances, convulsions, vomiting, vertigo
and bradycardia. The headache is almost constant, and in-
creases in severiiy as the disease advances. It may often be
diffuse, occupying the entire akuU. Double optic neuritis is J
very frequent. The temperature is usually normal or sub- 1
norma). If, however, the tumor be situated in the pons or n
medulla there may be hyperpyrexia. Occasionally there is
dyspnea, and also Cheyne-Stokes respiration. Yawning and
hiccough occur.
Describe the skin appearances in (a) rubeola, (b) ru*
bella, (c) scarlatina and (d) vericella.
(a) In rubeola the eruption appears upon Ihe fourth day. ■
It is macule -papular and coai-se. It appears all over the body,.B
and is particularly marked upon the face. It is sometime*^
arranged in erescentic form. It disappears by fine desqua-
mation, (b) In rubella the eruption occurs upon the first day
■
PRACTICE OF MEDICINE. 61 d
irregularly over the face, neck, chest, body and limbs. It is
a multiform eruption, and may resemble erythema, urticaria,
and in some cases even measles and scarlet fever. It may be
confluent or diffuse, and usually lasts from two to four days.
Desquamation occurs in fine scales, (c) In scarlatina the
eruption appears at the end of the first day or beginning of
the second day. It is a bright scarlet eruption, being a true
inflammation of the skin. It disappears by desquamation,
which is often in large scales, an entire cast of a hand or foot
coming away, (d) The eruption in varicella appears upon
the first day, the exanthem showing itself as small reddish
points or papules, which in a few hours become vesicles. The
eruption is slightly elevated above the skin, rather than hav-
ing the appearance of being under the skin. The vesicles are
thin and transparent, and from Vs ^^ Vi of an inch in diam-
eter. The contents are at first clear and transparent. As a
rule there is no areola. In the course of a few hours the vesi-
cle becomes milky, and begins to shrivel. The pox may appear
upon the face, neck, scalp, and some parts of the trunk.
In what diseases may blood be expectorated?
As a rule it occurs in chronic pulmonary tuberculosis. It
sometimes occurs in croupous pneumonia. It may result from
cancer of the lungs, from abscess of the lung, from bronchi-
ectasis, ulcerative lesions of the bronchi and frequently in dis-
ease of the mitral valve. It may occur from aortic aneurysm.
Malignant disease and parasites of the lung also give rise to
it. Vicarious hemorrhage. It may occur in the hemorrhagic
diathesis, in purpura and trauma of the chest wall.
Give the period of incubation and of eruption of the
exanthemata.
The period of incubation in scarlet fever is from four to
seven days. The eruption occurs at the end of the first or
beginning of the second day. The period of incubation in
measles is about ten days. The eruption occurs on the fourth
day. The period of incubation of rubella is about eighteen
676 PRACTICE OF MEDICINE.
days. The eruption appears upon the first day. The period
of incubation in variola is from ten to thirteen days. The
eruption appears upon the third day. The period of incu-
bation of varicella is from ten to fifteen days. The eruption
appears upon the first day.
Make a differential diagnosis between renal colic and
hepatic colic.
The pain in biliary colic radiates over the upper half of the
abdomen toward the right shoulder. There is tenderness over
the gall-bladder. The pain in renal colic radiates less over
the abdomen, but is marked down the ureter to the testicles
and to the head of the penis, often irritating the rectum.
There is tenderness over the kidney and in the lumbar region.
In biliary colic the vomiting is pronounced and persistent.
In renal colic vomiting may be present, but is never persistent.
In biliary colic there are no symptoms relating to the bladder
or testicle. In renal colic these symptoms are marked. The
urine may contain bile in biliary colic. In renal colic the
urine may contain blood and mucus. Jaundice is present in
bliary colic, and entirely absent in renal colic.
Mention and describe, in regard to the feces, abnormal
conditions that are of diagnostic value.
Large quantities of mucus may be present in the evacua-
tions, showing a catarrhal condition of the mucous membrane
of the intestine. Fat may occur in the stools, and be due to
disease of the pancreas. Blood occurs from hemorrhage in
the intestine. Pus may occur from the rupture of an abscess
situated anvwhere in the intestinal tract. Gall-stones and
enteroliths are also diagnostic. Shreds of tissue and fibrinous
casts from necrosis occasionally occur. They may be due to
carcinoma of the bowel. Fibrinous casts occur particularly
in the course of dysentery. Various forms of animal para-
sites may also be found in the stools.
Give the symptomatology of epilepsy.
As a rule the attack comes on suddenly, the patient falling
PRACTICE OF MEDICINE, 677
to the ground unconscious. This may or may not be preceded
by an aura. At first there are tonic spasms, the patient often
biting his tongue and bloody foam appearing at the mouth.
This is followed by clonic spasm, and this in turn is succeeded
by epileptic coma. During the attack the pupils are markedly
dilated. After the attack the patient usually falls into a
deep, profound sleep lasting for several hours.
Make a diagnosis of infantile spinal paralysis.
The disease begins suddenly, often with convulsions, de-
lirium and fever. The temperature rises suddenly, usually to
about 103° F., there is pain in the back and limbs, and some-
times diarrhea. Paralysis, as a rule, occurs suddenly. Th^
paralysis is more extensive early and the muscles of the par-
alyzed limb soon undergo atrophy. Reaetions of degenera-
tion are marked. The legs are most often attacked. Later,
as a rule, marked improvement takes place.
How may pleuritic friction sounds be distinguished from
rales occurring in the bronchial tubes?
A friction sound is close to the ear ; it is distinctly localized,
and accompanied by pain on respiration. It may occur in
inspiration or in expiration or be heard in both. As a rule
there is no pain with rales; they are further from the ear and
are more diffused over the chest.
What complication should be guarded against in inflam-
matory conditions of the ear?
The most important complication relates to an affection of
the meninges. This is more apt to result from disease of the
middle ear.
Define cyanosis and give its causes.
This is a blue-red condition of the skin, showing itself most
prominently upon those parts that are normally bright red,
such as the lips, cheeks, mucous membranes and the finger
nails. Canosis is due to the accumulation of carbonic acid
in the blood and a deficient amount of oxygen, the blood hav-
ing a venous or hypervenous character.
678
PRACTICE OF MEDICINE.
What aids to diagnosis are utilized in the treatment of
persons affected with stomach lesions?
Inflation of the stomach may be practiced so as to determine
the size and position of the st-oraaeh. The X-ray may be used.
A test meal may be given, and the contents of the stomach
withdrawn after a certain time. The contents are then tested
for free IT CI, pepsin, lactic acid, etc.
State possible causes of dropsical conditions of the
abdomen and lower extremities.
This is most often due lo disease of the lieart, kidneys and
liver. It occasionally occui-s from profound anemia, and may
be due to pressure in tbe abdomen, as from malignant disease
or aneurysm.
diagnosis of
What causes general anemia? Make
general anemia.
By the term anemia is meant a deficiency of the blood,
either in its bulk or in certain of its constituents. It is usually
divided into primary and secondary anemia. By the term
prmary — also called essential, idiopathic or cryptogenetic—
anemia is meant a disturbance of the blood or blood-making
organs, so tliat the anemia seems the distinctive feature of the
disease, while other symptoms appear mainly dependent upon
this change. Secondary anemia is due to some disease acting
upon the blood or blood-making organs, the anemia not being
the prime feature, but a SJ^nptomatic manifestation. The
diagnosis depends upon a change in the blood itself, either in
a diminution in the hemoglobin or in the number of blood
corpuscles, or a change in both these constituents. There are
also constitutional symptoms, such as pallor, shortness of
breath, especially upon exertion, digestive disturbances and
nervous symptoms.
Mention and differentiate the species of tenia.
In man three species of tapeworm which are fully developed i
mnininnly npcnr. The tenia echinococcus occurs only in its J
PRACTICE OF MEDICINE. 679
larval form. The three varieties are tenia solium, tenia
saginata and the bothrioeephalus latns or tenia latus. The
tenia solium is sometimes called the armed tapeworm, as the
rostellum is supplied with two rows of hooklets, each row
containing from twelve to fourteen hooklets. The head is
(luadrilateral, being supplied with four suctorial discs. The
worm is about four meters long. The segments are from 6-8
mm. in breadth and from 10-12 mm. length. In the tenia
saginata the head is surrounded by four suckers, with a rudi-
mentary sucker in the middle. The segments measure from
8-10 mm. in width and are about 18 mm. in length. In the
tenia lata the worm varies from 5-16 meters in length. The
head is elongated, and supplied with two grooved suckers, one
on each side. The breadth (1.8 cm.) of the joints is greater
than the length. The mature segments show a rosette ar-
rangement of the uterus which is characteristic.
Describe the Brand method of treatment in typhoid
fever.
When the temperature in the axilla reaches 102.6° F. a cold
bath is given, and repeated every three hours, the water being
at a temperature of about 70° F. The patient should be
immersed in the tub, the water covering all but the head ; then
water of a lower temperature should be poured upon the
patient's head or a wet ice pack used. Gentle friction should
be applied constantly by the attendants, and the patient
should be encouraged to do likewise. The abdomen should
not be rubbed. The duration of the bath is 15 minutes.
Some alcoholic stimulant should be administered to the pa-
tient before and after the bath. When the bath is finished
the patient should be lifted baek to his bed and covered with
woolen blankets. The temperature should be taken one-half
hour afterward to note the fall produced by the bath.
Give the symptoms and treatment of myocarditis.
The symptoms may be entirely latent, and the condition in
mild grades is not likely to be recognized. In the advanced
680 PRACTICE OF MEDICINE.
stages pain in the precordium, especially upon slight exertion,
becomes prominent. It radiates and shoots down the lefl
arm, and tingling may occur in the fingers. Shortness of
breath is a prominent symptom. The apex beat is weak and
diffused, the pulse is feeble, and often intermittent Marked
arrhythmia occurs. Constipation and pastric disturbanc-s
are common. In advanced stages edema of the skin may
occur. The treatment consists in cai-eful regulation of thi"
diet, attention to the functions of the body, and the systemic
use of such drugs as alcohol, strj'ehnia. iodide of potassium
and arsenic.
What is the practical import of hematuria, and how can
Its source be diagnosed?
Blood in the urine may be frani the kidneys, in uancrt-
acute nephritis, after powerful diuretics, etc. ; from the blad-
der, in diphtheritic and acute cystitis, calculi, cancer, congi-s-
tion, etc.; from the prostate and as a result of mechanical in-
jury. When blood is derived from the bladder the first Ihat
is passed will contain a smaller amount of blood ihau the last.
Blood from the bladder may be copious in amount, and thin
uriue ii] contrast to thai conlaiiiin^ b!<x)d from the kidoL'y.
upon standing, will show fibrin. Blood from the kidney is
more likely to be intimately mixed with the urine, and if
eoagula be present they are apt to be washed out. From the
urethra only the last drops are likely to be bloody.
Give the etiology of scarlet lever.
Age is an important predisposing caune. It rarely occurs
after the tenth year of life. Neither sex nor occupation pre-
dispose to it. The disease is more common in cold and tem-
perate regions. Epidemics are more prevalent in the winter.
In this disease there is a marked personal predisposition.
One attack confers immunity as a rule. The exciting cause
is not known.
Give the treatment of tic douloureux.
It is especially important to treat the underlying condition.
PRACTICE OF MEDICINE, 681
If the disease be reflex it is important to give attention to the
affection giving rise to it. Hygienic treatment is of import-
ance. Change of seene and residence, with good, nourishing
diet, are necessary. Many drugs have been recommended for
the treatment of the paroxysm, such as quinine, the coal-tar
analygesics, the salicylates, caffeine, aconite, gelsemium and
belladonna. Morphine should be avoided if possible, as there
is great danger of the patient acquiring the opium habit.
Local treatment is sometimes of use, thus hot and cold appli-
cations, liniments containing menthol, and occasionally elec-
tricity may be tried. In protracted cases surgical interfer-
ence should be thought of.
Give the symptoms of appendicitis.
The onset is sudden ; there is pain in the abdomen, which at
first may be general or centered around the umbilicus, and
occasionally in the epigastrium and in the left or right iliac
fossa. In many cases the pain is confined to the right iliac
fossa, and directly in the region of the appendix (McBurney 's
point). If the pain is general it soon localizes itself to the
right iliac fossa, usually within the course of twenty-four
hours. It is paroxysmal or intermittent, and colic-like. This
pain may be preceded by chilliness. Frequently nausea and
vomiting mark the beginning of the attack. Fever rapidly
follows the onset of the disease, and is usually moderate,
from 100°-103° F. Occasionally it may be absent. The fre-
quency of the pulse generally corresponds to the degree of
the fever. Constipation is commonly present. The tongue
is coated posteriorly. The facial expression of the patient
shows anxiety and suffering. The position of the patient is
often characteristic. The right thigh is frequently partially
flexed upon the abdomen, while the left leg is extended.
Examination of the abdomen shows slight distension. On
palpating the abdomen the right rectus musele will be found
rigid. Tenderness is as constant as pain. Pressure upon
the opposite side produces pain in the region of the appendix.
682 PRACTICE OF MEDICINE.
In some instances the appendix may be clearly made out, and
occasionally a tumor is palpable.
Define aphasia and give its etiology.
Aphasia embraces a variety of defects' in the use or the
comprehension of language, either spoken or written. In the
majority of eases aphasia is one of the symptoms of organic
local cerebral disease, occurring in the left hemisphere in the
right-handed, and vice versa. It occurs in cerebral hemor-
rhage, thrombosis, embolism, abscess, tumor, and depressed
fracture of the skull. Rarely it has been noted in hysteria
and neurasthenia.
Give the diagnosis and treatment of acute follicular
tonsillitis.
The diagnosis depends upon great pain in swallowing. This
may be preceded by lassitude, malaise, headache, pain in tbe
bones, vomiting, and marked fever. Examination of the
throat shows redness and swelling of one or both tonsils, with
yellowish-white patches upon them, varying in size from a
pin-head to a split pea. These may be sti-ipped off without
leavintr a bleeding surface, lea\ing an intact mucous mem-
brane beneath. The breath is usually fetid. The patient
should be put to bed and a laxative administered. The coal-
tar products, especially phenacetine, in small doses, guardedlv
given, promptly relieve the pain. Ice bandages and small
particles of ice in the mouth are useful. If pain and sleep-
lessness persists, opium, especially Dover's powder, may be
administered.
Give the treatment of intestinal hemorrhage in typhoid
fever.
Food and drink should be withdrawn ; one or more ice-bags
applied to the right iliac fossa, and opium given for efifeel.
The head of the bed may be lowered and the foot of the bed
elevated. The opium should be pushed so as to produce
mild somnolence. If thirst becomes excessive, small pellets
of ice may be placed in the mouth from time to time.
^
PRACTICE OF MEDICINE. 683
Give the treatment of delirium tremens.
One of the most important features in the treatment is care-
ful feeding. Little food should be given at a time, but it
should be frequently administered. If vomiting is persistent,
rectal alimentation may be resorted to. If there are signs of
heart failure stimulants must be administered. Strychnine
hypodermically is of great value. Every effort should be
made to induce sleep. The most useful agents are morphine
hypodermically, or hyoscine. Chloral is also useful, but it has
a depressing effect upon the heart.
Give the treatment and prognosis of progressive perni-
cious anemia.
Rest in bed is essential, and easily digested, nutritious foods
should be given. Arsenic has been found of most value, given
in the form of Fowler's solution in ascending doses. If this
drug is not well borne iron may be substituted. Bone marrow
is also useful. Stimulants, such as strj-chnine and alcohol,
and inhalations of oxygen, are of advantage. The prognosis
is always grave. Death results in from a few months to a few
years. Apparent recovery followed by relapse is common.
Give the symptoms of acute exudative nephritis.
The disease may begin suddenly or gradually. Edema
develops rapidly. The urine becomes scanty and high col-
ored, and uremic symptoms, such as vomiting and convulsions,
occur. The edema at first is most marked in the face, partic-
ularly about the eyelids. There is dull headache, with pain
in the back and loins, dryness of the skin and dyspnea. The
temperature is sub-febrile. The urine upon examination
shows that it is decreased in amount, the color is dark red and
is turbid, blood being present. The specific gravity is from
1020 to 1030, and upon testing the urine large quantities of
serum albumin are found. The quantity of urea is usually
less than normal. Under the microscope hyaline, granular
and epithelial casts are noted, with renal epithelium, red blood
cells and granular matter.
€84 PRACTICE OF MEDICINE,
Define and describe bronchorrhea.
This is a rare form of bronchitis, characterized by an exces-
sive amount of secretion, which is very foul. It is sometimes
called purulent bronchorrhea. The quantity of expectoration
varies from one to three pints. The character may be either
thin or watery or it may be transparent or ropy. Dyspnea
and cough are always present often being persistent and
paroxysmal.
Define hydro-nephrosis. State its causes and describe
its treatment.
Obstruction to some part of the ureter, bladder or urethra
may give rise to dilatation of the pelvis and tubules of the
kidney from accumulation of urine. It may be due to the
twisting of the ureter, it may result from congenital narrow-
ing of the ureter or urethra, from pressure. The treatment
is largely surgical. i\Iassage may be practiced with favorable
results. However, if the condition persists, aspiration and
drainage are necessary.
Give the symptoms and treatment of migraine.
The principal symptom is the headache, which shows greater
or less periodicity. This symptom is followed by pallor and
some vasomotor spasm. As a rule the disease is unilateral,
the left side being oftener affected than the right. The pupil
upcm the affected side is often smaller, and the eye may be
retracted. Often there is disturbance of vision, the duration,
however, being temporary. Oeeasionally, tinnitus auriuin
occurs, which may be associated with vertigo. These symp-
toms are accompanied in the majority of cases by marked
gastric disturbances, such as nausea, with frequent vomitinjr.
The treatment consists in relieving the pain and the preven-
tion of its recurrence. The following drugs have been recom-
mended: Krgot, the coal-tar i)roducts. salicylate of sodium,
the bromides, caffeine and gelsemium. As a ])rophylactic.
, nitroglycerin taken after meals with bismuth and pepsin has
been said to be of value. Mild purging with calomel from
time to time often prevents attacks.
PRACTICE OF MEDICINE. 685
Mention a disease of the nervous system in which the
patella reflex usually disappears; one in which it is usually
exaggerated.
In locomotor ataxia the knee-jerk usually disappears; in
spastic paraplegia, as a rule, the knee-jerk is exaggerated.
Define myxedema and give its treatment.
This is a disease characterized by a myxomatous change in
the subcutaneous tissues due to pathologic lesions in the thy-
roid gland causing diminished or absent secretion. Thyroid
extract should be administered as early as i>ossible, and should
be continued until all the symptoms disappear, and then a
prophylactic dose must be given regularly. General tonics,
such as iron, quinine and strychnia, are of value.
Define simple acute stomatitis; at what age is it most
common and what is its treatment?
This is an inflammation of the mucous membrane of the
mouth. The disease is most frequent in children, but may
also occur in adults. The treatment consists in cleanliness,
careful feeding, and the use of a mild alkaline mouth wash.
A mild purge is often advantageous.
Give the causes and treatment of bronchial asthma.
The disease is sometimes hereditary. It is more common
in males than in females. It mav follow an attack of bron-
chitis, and is commonly associated with chronic bronchitis
and emphysema. The inhalation of dust, the pollen of
certain plants, fog, fumes, vapors, odors that emanate from
certain animals may produce an attack of asthma. Reflex
causes, as irritation from nasal polypi, causes relating to the
gastro-intestinal tract, skin or «reni to-urinary center may act
in a like manner. For the treatment of the paroxysm nar-
cotics and anti-s])asmodies are usually employed. Chloral,
whiffs of chloroform or ether, amyl nitrite by inhalation, or
morphia and atropia hypodermically are useful drugs. Re-
lief sometimes follows the inhalation of nitre-paper cigarettes,
PRACTICE OF MEDICINE.
which also contain lobelia and stramonium. Sinapisms and
turpentine stupes to the chest may be of value.
Give the treatment of an acute attack of gout.
A mild laxative at the onset is useful. The affected joint
should be kept at rest, and a diet of milk and farinaceous
articles, with plenty of water, should be insisted upon. If
the pain become severe opium in some form must be adminis-
tered. For tlie attack itself colehieum is the remedy. Iodide
' and bromide of potassium are also usefid. as are also tfae
salicylates and the salts of lithia.
State the prognosis in aneurysm of the thoracic aorta.
The prognosis is always gvavi.', death invariably resulting
Differentiate broncho-pneumonia and incipient phthisis.
This is very frequently difficult, incipient phthisis often
occurring as a localized broncho-pneumonia. Bi-oncho-i>nen-
monia follows an acute bronchitis, making itself known by a
rise in temperature over 103° P., by an increase in the respi-
ratory and pulse rate, the pnlae commonly running from llitl-
160 per minute, while lli:- rcspirnlory rate may be from 40-80
per minute. Broncho-pneumonia occurs at the extremes of
age. The physical signs of well-developed broneho-pneumoEia
are, upon inspection, an increased respiratory rate; on palpa-
tion, increased vocal fremitus in areas over both lungs; upon
percussion, localized areas of dulness over both lungs (more
marked posteriorly) surrounded by a tympanitic area; on
auscnltation, broncho- vesicular breathing subcrepitant rales
mixed with large and small mucous rales. The physical signs
are all more marked posteriorly, and are usually well marked
at the bases.
Incipient phthisis has a gradual onset with loss of appetite,
gastric disturbance, slight evening rise of temperature (100°
or thereabouts) , anemia and general malaise. There is, as a
rule, slight cough with scanty expectoration (the tubercle
bacillus may be found in the expectorated material). Ocea-
PRACTICE OF MEDICINE, 687
sionally there is slight hemotysis or the sputum may be blood-
tinged; there is a progressive loss of weight. The physical
signs relate principally to the apices. There is a slight im-
pairment of resonance at one or both apices on percussion,
and upon auscultation there may be heard slight friction
sounds, harsh breathing and some fine moist rales.
What are the diagnostic signs of retro-pharyngeal
abscess?
This may follow the infectious fevers, such as scarlet fever
or diphtheria, usually in young children, ocasionally due to
caries of bone. There is pain on swallowing (dysphagia),
difficulty in breathing, occasionally hoarseness, cough and
stiffness of the neck. Upon examination of the throat by
inspection and palpation there is discovered a fluctuating
tumor which projects from the posterior wall of the pharynx.
Differentiate tonic and clonic spasms.
A tonic spasm is a continuous spasm ; a clonic spasm is an
interrupted one with contraction and relaxation.
Describe the symptoms of a case of apoplexy due to
cerebral hemorrhage.
Prodromes may precede the attack, such as nausea, vomit-
ing, vertigo. As a rule, the attack comes on suddenly, the
patient becoming comatose. The face is flushed or pale. There
is stertorous breathing, occasionally of the Cheyne-Stokes
type. There is conjugate deviation of the head and eyes ; the
pupils are irregular, and there is evidence of hemiplegia.
Differentiate acute bronchitis from lobar pneumonia.
In acute bronchitis there is cough, at first without, later
with mucopurulent expectoration; subfebrile temperature,
and slight pain under the sternum. There are no changes
from the normal on percussion, but upon auscultation there
are at first dry rales, followed by moist rales. Lobar pneu-
monia is characterized by sudden onset with marked chill, high
temperature, * 'stitches in the side,'' cough, a sputum which
688 PRACTICE OF MEDICINE.
is very tenacious and often rusty; full pulse at first, later
becoming rapid. The physical signs are quite characteristic.
There is, in the first stage, the crepitant rale, in the second
stage dulness on percussion with bronchial breathing and, in
the last stage, ** crepitus redux."
Differentiate hemoptysis and hematemesis.
Hemoptysis. Ileniatemesis,
Blood 18 bright red and frothy ; often Blood is dark, clotted and often
coughed up. mixed with food ; is vomited. Stools
may be tarry.
Alkaline in reaction. Acid in reaction.
Containing air bubbles. Air bubbles absent.
Tubercle bacilli may be present in the No tubercle bacilli in the blood,
blood.
Differentiate rheumatism from ^ut.
Gout occurs suddenly and shows a special preference for
the smaller joints, especially the great toe. Rheumatism
comes on more gradually and attacks principally the large
joints. The appearance of the joint in gout is swollen, glossy,
tense and bluish. There is less sweating and less fever than
in rheumatism ; gastric and nervous symptoms are never
prominent. Implication of the membranes of the heart in
gout is decidedly less freciuent than in rheumatism.
Differentiate intestinal colic, uterine colic and renal
colic.
Intestinal Colic. — Diffuse [>ain, which may be localized,
very severe in character; usually of sudden onset, relieved by
pressure: lasting, as a rule, a few hours. A free discharge of
flatus relieves the attack.
Vtirinc Colic. — The pain is in the pelvis, there is some his;
tory of uterine discharge and disease.
Renal Colic. — The pain starts from the region of the kidney,
shooting down the ureter. There is retraction of the testicle;
often nausea and sometimes vomitinjr.
PRACTICE OF MEDICINE. 689
Give the physical sis:n8 of the most usual valvular lesion
of the heart.
Mitral insufficiency is the most common valvular lesion of
the heart. The physical sign is a murmur at the apex, systolic
in time and transmitted to the left axilla and the angle of the
scapula.
Differentiate pleurisy and pneumonia.
In pleurisy there is a friction sound heard commonly both
in inspiration and expiration ; fever is slight, there is marked
pain in breathing. There may be slight cough. In the first
stage of pneumonia there is a pleurisy, especially when the
inflammatory exudate reaches the periphery of the lung.
There is high fever, which is preceded by a marked chill,
cough, rusty sputum and the physical signs (crepitant rale,
dulness on percussion, bronchial breathing and crepitus
redux).
What conditions might cause alvine discharge contain-
ing fat?
In obstructive jaundice fatty stools are sometimes noted;
they occur occasionally in overfed infants. Patty stools are
often indicative of disease of the pancreas, such as cancer or
pancreatic calculi.
Give the characteristic symptoms of purpura hemor-
rhagica.
Hemorrhages from the mucous membranes and extravasa-
tion in the cutaneous surfaces ; great weakness, anemia due to
loss of blood. Fever is present, as a rule.
What conditions increase the amount of uric acid voided
with the urine?
Increased by diet (fat and sugar), muscular exercise. In
the acute fevers (pneumonia and rheumatic fever), in leuke-
mia and in disease of the spleen generally; in diabetes and in
lithemia. It is decreased in amount under strict milk diet, in
44
PRACTICE OF MEDICINE.
anemia, cbroDic Icad-poisouing and chronic interstitial neph-
ritis.
Differentiate thrombosis and embolism.
''—'tnh isis. — Prodromes are common, drowsiness and head-
nset of the attack is insidious. Hemiplegia gradual
onset. Ocular and other nerve palsies.
Embolism- — Loss of consciousness rapid, hemiplegia and
rtnrbancea of the pulse and respiration. Embolism is more
irequent in the left side of '■'-- brain, hence valvular disease
favors embolism.
What diseases are liable to occur in the right inguinal
region?
Appendicitis, floating kidney, disease of the liver and of the
bladder.
Distinguish between the terms illusion, delusion and
hallucination as used in diagnosis.
An illusion is a wrong conception of an object which really
exists. A delusion is an absurd and unfounded belief. A
hallucination is a sense perception without a phj'sical basis.
Give the- physical and rational signs of pericarditis be-
fore and after effusion.
There i» slight fever, marked pain in the precordial region,
dyspnea and irregular, usually quickened, pulse. There is
pericardial friction on auscultation. When effusion occurs
the friction disappears; there is dulness in the precordial area,
the base of dulness being at the apex of the heart, quite the
reverse from the usual condition.
Define vocal fremitus and state its significance In pul-
monary disease.
Vocal fremitus means the vibrations of the voice which
are transmitted to the chest wall. These are conducted from
the larynx by the trachea and bronchi to the smaller tubes
within the lungs, and thence through the lung tissue to the
PRACTICE OF MEDICINE, 691
surface. Vocal fremitus is increased by consolidated lung
tissue ; it is increased from an empty pulmonary cavity super-
ficially situated, and is diminished or lost on accumulation of
fluid in the pleural cavity.
Differentiate between sunstroke (coup de soleil) and
apoplexy.
In sunstroke there is the history of exp<^ure to the sun.
The temperature is very high, 105°-115° or over, but no evi-
dence of hemiplegia. In apoplexy there is conjugate devia-
tion of the head and eyes, hemiplegia, irregular pupils, never
so high a temperature, and full, bounding pulse.
What casts are frequently found in albuminous urine
and what do they denote?
Hyaline, granular, epithelial and blood casts. Hyaline
<jasts probably result from the exudation or secretion of a
material from the epithelial cells lining the tubules. They
are sometimes found in healthy individuals. Granular casts
indicate nephritis. Epithelial easts are always indicative of
A renal lesion. Blood casts are found in acute parenchyma-
tous nephritis or in a condition in which the renal tubules
become filled with red blood corpuscles.
Of what import is the spleen in the diagnosis of febrile
conditions? Give the topography of the spleen.
As a rule, the spleen is enlarged in all febrile conditions.
The spleen extends from the ninth rib to the margin of the
twelfth rib in the midaxillary line of the left side.
Differentiate the crepitant rales and the subcrepitant
rales and give the clinical significance of each.
The crepitant rale is a fine moist rale and is heard only at
the end of inspiration. It is found in the vesicular structure
of the lung. The subcrepitant rale is also a fine moist rale,
somewhat coarser than the crepitant rale, found in the finer
bronchi and heard both in inspiration and in expiration.
The crepitant rale is heard in croupous pneumonia, broncho-
poimonary iufarcta, edema of the
a mberculosis. The subcrepitant rule
and edema of the luaga, io hemorrli&ge
wbidi duid is present in the finer bron-
tabtnolofiis. ill the third stage of croupous
IB heam ho-p penmo ni a.
I of hereditary syphilis?
T feeble, and the eruption may be
; dRfliifiil aasflks, the mouth is fissured, and the lips
aaA hinx lad spleen are enlarged, and Ifone ttymp-
If the symptoms do not appear at birth.
racor abont the third month. There is then
. viEb ft «roptirulent discharge. Neurosis of
[ tine nose undergoes a charaeterislio de-
ft «/ the skin also appear. When the teeth
1 (Hutchinson's teeth).
•( aneurysm of the descending aorta.
TSmw ~» madcnl pain, especially in the back, aud a largp
■ ■■.<■ •.r>:"-:\7 :-.i>-;TLi->i-Iy ill IJK' scapulai' reffion. Para-
•jitgfA mny uecur troni pressure on the cord, dysphagia from
;.r»MMirv '« tiie esophagus, and pulmonary symptoms from
Tjprmitr- >Ju dte left bronchus. There are, besides, all the
^MijisuHi. ^ij^K o£ aaeuiysm in any other locality, such as ex-
:tmti'-frH ^mibitiitiQ. tniDor, bruit and thrill.
diagnosis of pleuritic and pericardial
U :i*w fwriennJial effusion be very great, it may much
0 .1 !eft-dided pleural effusion. In pericardia) effusion.
t i$. pulmonary resonance at the base, Skodaic
. :q ^Ih iii'«'H>«. and the heart is not displaced to the
^^}ttt^ ciM ^wttum. The dyspnea is greater in pericarditis
-vtK i:J»>tnMiL iw»«t tfa« paradoxical pulse may be present. An
■ lliswy of rheumatic fever may help the diagnosis
PRACTICE OF MEDICINE. 693
Describe the treatment of hay fever.
A change of residence before the annual attack is the only
prophylaxis ; a correction of the neurotic and gouty tendency
of the individual should be attempted. A spray to keep the
nasal passages clean is important. A weak solution of cocaine
for this purpose is valuable. Suprarenal extract appears to
give the best results both locally and internally.
Define epidemic parotitis. What complications may
arise in the course of this disease?
There is abrupt development of fever and an enlarged par-
otid gland on one side. Inflammatory edema of the surround-
ing tissue is common, the ear may be pushed upward. The
mouth is displaced and the face disfigured. The fever is
usually about 102°. In some cases the opposite gland becomes
affected after a few days. Suppuration does not occur.
Occasionally other glands, such as the testicles, ovaries and
mammary glands, are affected.
Define chlorosis.
Chlorosis is a form of primary anemia, affecting chiefly
females at the time of puberty, and characterized by marked
diminution of the hemoglobin.
INDEX.
Abdomen, regions of, 39
Abdominal aorta, 32, 71
muscles, 10
viscera, 27
Abortion, 456, 457, 458, 459
Abscess, 326, 370, 387, 389
Absorption, 104
Accomodation, 82, 108
Acetabulum, 14
Acetanilide, 548, 575
Acetic acid, 184, 208, 590
Acetone, test for, 303
Acetous fermentation, 196
Acids, definition of, 203
corrosion by, 181
antidote for, 248
Aconite, 522, 549, 562, 565
Aconitine, dose of, 546
Acromegaly, 366
Adenoma, 387
Adipose tissue, 317
After pains, 474
Agglutinins, 326
Air, analysis of, 260
Albuminoids, 185
Albumin, test for, 188, 192, 233, 246
Albuminuria of pregnancy, 454
Albumose, 303
Alcohol, 183, 269, 545, 608
drinking of, 90, 141, 142,
166, 330, 416, 541, 651,
672
methyl, 288
percentage in wines, 183
Alcoholic fermentation, 235
liquors, 201, 210, 231, 239
Aldehydes, 300
Alimentary canal, 50
Alkali, 204
group, 268
Alkaloids, 182, 271, 290
Allantois, 438
Allotropism, 217
Alloy, 224
Aloes, 554
Altitude, effect of, 169
Alum, 251, 261, 554
Aluminum, 207, 228
Amalgam, 224
Amenorrhea, 512
Amid, 179
Amins, 254
Amnion, 438
Amorphous, definitions of, 175, 265
Ammonia, 204, 281, 286, 299, 549
Ammonium, 279
Ammonium compounds, 178, 231,
262, 549,
554, 572
source of, 178
Amphiarthrosis, 19
Amputations, 364, 390, 425
Amyl nitrite, 528, 540
Amyloid degeneration, 308, 325, 335
Anatomy, 9
Anemia, 308, 311, 315, 335, 512,
520, 678
pernicious, 315, 669, 683
Anesthetics, 197, 221, 385, 535, 609,
610, 611, 612
Aneurysm, 321, 352, 366, 388
Angina pectoris, 616, 633
Angioleucitis, 336
Angiomata, 319, 386
Anhydride, 211
Anilid, 179
Anilin, 299
Ankle joint, 16, 38, 41, 389
Ankylosis of jaw, 340
of joints, 344
varieties of, 402
Anodynes, 521
Anospinal center, 112
Antagonist, 552
Anthelmintics, 581
Anthrax, 618
Antidotes, 254, 552
Antimony, 265. 302
Antipyretics, 564
Antipyrine, 559, 592
(695)
696
INDEX,
Antiseptics, 566
Antitoxin, 145, 571
Antrum maxillae, 430
Aortic aneurysm, 623, 686, 692
insufficiency, 86, 645, 669
stenosis, 645
valve, 102
Aphasia, 125, 682
Aphonia^ 125
Apnoea, 92
Apomorphine, 540, 594
Aponeurosis, 14
Apoplexy, 416, 533, 634, 651, 687,
691
Appendicitis, 36, 362, 650, 663, 681
Appendix vermif ormis, 22, 46
Arnica, 605
Arsenic, 177, 194, 197, 217, 243, 283,
302, 532, 586
Arterial pulse, 643
Arteries, aorta, 32, 48
axillary, 20
basilar, 44
brachial, 18, 29
carotid, 11, 45
celiac axis, 65
degeneration of, 323, 324,
335
femoral, 23, 27
intercostal, 29
internal carotid, 40
internal iliac, 67
ligation of, 348, 356, 382,
384, 385, 390, 391, 392,
399, 402
meningeal, 38, 354
of bladder, 41
of forearm, 41
of hand, 52
of heart, 30
palmar arch, 36
popliteal, 65
post-tibial, 60
pulmonary, 70
structure of, 105
subclavian, 26
ulnar, 68
Arthritis deformans, 327
Arytenoid cartilages, 67
Asafetida, 540
Ascites, 321, 420, 654
Asphyxia, 74, 121
Asthma, 532, 685
Astigmatism, 131
Atavism, 91
Atheroma, 320
Atmosphere, composition of, 198
Atom, definition of, 189
Atomic theory, 216
weight, 174, 199, 211
Attraction, forces of, 192
Atrophy, 318, 401
Atropine, 261, 527, 538, 603
Auditory apparatus, 17
vertigo, 117
Aural labrynth, 65
Axilla, 32
Bacteria, 308, 335, 336
Baking powder, 282, 294
Ballottement, 446
Balsam of Peru, 529
Barley water, 564
Barometer, 264
Base, definition of, 209
Basic radical, 209
Bassini's operation, 369
Bathing, 155
Baths, 137, 153, 169
Belladonna, 528, 531, 542, 554, 558,
568, 579
Benzene, 270
Benzoin, 591
BUe, 108, 109, 134, 207
duct, occlusion of, 337
test for, 246
Biliarv calculi, 238, 614, 617, 625,
632* 648
Bilirubin, 303
Binarv compounds, 203
Bisnuith, 263, 298, 572. 585
Bladder, 27, 28, 58, 425
injections for, 596
Blisters, 524
Blood, circulation of, 93
coagulation of, 74, 97
composition of, 104
corpuscles, 105, 110. 114,
116, 124
description of, 128
expectoration of, 675
function of, 78, 104
plasma, 333
pressure, 93, 98
quantity of, 76
reaction of, 133
stains, 120
tests for, 246, 302
vessels, 81
Blow-pipe, 201, 271
INDEX,
697
Blue piU, 591
Blushing, 92
Body, composition of, 94
Bones, clavicle, 28
frontal, 36
humerus, 12
inflammation of, 324
malar, 41
occipital, 16
of foot, 16
of hand, 44
of head, 14
of heel, 30
of pelvis, 31
ossa innominata, 57
parietal, 78
patella, 31
radius, 32
sternum, 58
superior maxilla, 59
Borax, 527, 604
Boric acid, 527
Boroglycerid, 230
Boron, 255
Brachial plexus, 9
Brain, anemia of, 320
convolutions of, 52
corpus callosum, 71
cortex cerebri, 80
fissure of Rolando, 69
Sylvius, 29, 69
fourth ventricle, 41
function of, 73
gray matter of, 134
lobes of, 23, 45
medulla oblongata, 63, 89
membranes of, 25, 120
motor area of, 118
pia mater, 44
pons varolii, 26
tumor, 422
ventricles of, 41, 43
Brand treatment, 679
Breasts, removal of, 343
Bright 's disease, see Nephritis
Bromides, 519, 540, 589
Bromine, 216
Bromism, 543
Bryonia, 546
Bubonic plague, 139, 333
Buchu, 557, 559
Buckthorn, 589
Bunions, 364
Bunsen burner, 202
Bums, 342, 389
Bursitis, 364
Butter, 137, 186
Butyric acid, 298
Caffeine, 535, 565
Calabar bean, 531, 542
Calcific metamorphosis, 334
Calcium chloride, 544
Calculi, bmary, 238, 614, 617, 625,
632, 648
urinary, 187, 304
Calculus formation, 225
Calomel, 216
Camphor, 530, 538, 591, 603
Camp hospital, 150
Cannabis Indica, 543, 574
Cantharides, 527, 560, 595
Capillaries, 83
Capillary attraction, 254, 290
Capsicum, 548, 587
Caput succedanum, 463
Carbohydrates, 220, 223, 241, 264
Carbolic acid, 184, 291, 523, 548,
552, 608
Carbo ligni, 534, 588
Carbon, 259
oxides of, 220, 273, 280
Carbuncle, 387
Carcinoma, 310, 313, 314, 367, 427,
428
Cardaraon, 537
Cardio-inhibitory centers, 127
Caries, 317
Cartilage, 87, 124
Cascara sagrada, 548, 565
Castration, 396
Casts in urine, 691
Cataphoresis, 610
Cathartics, 532, 588
Cecum, 39
Celiac axis, 65
Cell growth, 121
Cells of body, 114, 124
Cemeteries, 155
Cerebellum, 73
Cerebral hemorrhage, 307, 332
softening, 316
tumor, 674
veins, 61
C^rebro-spinal fever, 314, 661
Cerebrum, removal of, 76
Cerumen, impacted, 408
Cervical caries, 397
vertebrae, 14
Cervix uteri, 70, 492
698
INDEX.
Cesarian section, 506
Chancre, 430
Chancroid, 426, 430
Chemical action, 196, 213
affinity, 173
Chemistry, 240
Chest in respiration, 116
Cheyne-Stokes respiration, 673
Chicken-pox, see Varicella
Chloral, 229, 238, 521, 580, 587
Chlorides, 196
Chlorinated lime, 219
Chlorine, 178, 206, 224, 248
Chloroform, 183, 229, 248, 256, 274,
569, 579, 609, 611
Chlorosis, 512, 663, 693
Cholagogue, 539
Cholera, Asiatic, 160, 626, 652, 669
morbus, 620, 652
CJholesterin, 114
Chorda tympani, 75
Chorea, 614, 668
Chyle, 74, 103
Chyme, 74
Chromic acid, 551
Chromium, 301
Cicatricial changes, 323
Ciliary processes, 72
Cinchona, 522, 574, 584
Cinnamon, 579
Circumcision, 406
Cirrhosis of liver, 310, 314
Citric acid, 293
Clavicle, 28
Climate, 146, 153
Clubfoot, 403
Coal gas, 600
oil, 289
Cocaine, 524, 550, 605
Codeine, 559
Coffee, 165
Colchicum, 527, 539, 548, 601
Colic, 688
Collodion, 181, 581
Colloid degeneration, 311
CoUyrium, 566
Colocynth, 539, 608
Color blindness, 120
sensation, 95
Colostomy, 365
Columnae carneae, 133
Coma, 416
Combustion, 201
Comma bacillus, 309
Complimental air, 126
Compounds, 240
Congestion, 350, 363
Conium, 531, 541
Connective tissue, 9, 113
Constipation, 144
ConvaUaria majalis, 535
Cooking, effect of, 157
Copaiba, 609
Copper, 177
sulphate, 242, 519, 539, 604
Corpus luteum, 119
Corrosive sublimate, see Mercuric
chloride
Coryza, 657
Cough, prescriptions for, 531, 547,
600
Craniotomy, 505
Cream of tartar, 262
Cremation, 167
Creosote, 559, 582
Cretinism, 315
Croton oil, 519, 551
Croup, 604, 613
Crystalline, definition of, 175
lens, 24
Crystals, formation of, 197
Cubebs, 551
Curare, 559
Cyanogen, 227
Cyanosis, 677
Cystocele, 571
Cysts, 308
Death-rate, average, 138
Death, changes in body after, 209
Decay, 266
Defecation, 112
Degeneration, 311
Deglutition, 74
Delirium tremens, 661, 683
Dermoid cysts, 418
Destructive distillation, 195
Diabetes insipidus, 624
mellitus, 619, 624, 643,
656, 663
Diacetic acid, 303
Dialvsis ^^44
Diaphoretics, 532, 541, 598
Diaphragm, 23, 77, 110
Diarrhea, 568
Diarthrosis, 19
Diet, 73, 98, 121, 133, 144, 163, 237
Digestion, 77, 82, 96, 101, 104, 106,
126
Digestive secretions, 79, 84, 86
INDEX.
699
Digitalis, 523, 553, 561, 565, 570,
592 594
Diphtheria, 143, 150, 158, 165, 309,
315, 627, 630, 649, 669
Disinfectants, 155, 157, 159, 215
Dislocations, 389, 396, 427, 429
elbow, 374
forearm, 431
head of femur, 373
hip, 391, 415
inferior maxilla, 394
knee, 419
shoulder, 350, 376, 394,
413
Diuretics, 525, 532, 584
Donovan's solution, 538
Dosage for children, 595
Dover's powders, 555
Dropsy, 670, 678
Ductus communis choledochus, 9
Duodenum, absorption from, 93
Dura mater, 37
Dysentery, 650
Dysphagia, 92, 366, 623
Dyspnoea, 92
Dystocia, 480
Ear, diseases of, 385, 396
Eclampsia, 493, 494
Ectopic pregnancy, 459, 460
Eczema, 315, 333
Edema, 308
Effervescence, 234
Efflorescence, 234
Elastic tissue, 112
Elaterin, 582
Elbow, 27, 47
resection of, 422
Electric battery, 285
light, 256
Electricity, 271
Element, definition of, 206, 240
Embolism, 320, 690
Embryotomy, 505, 506
Embryo, human, 443
Emetics, 532, 569
Emmenagogue, 531
Emulsification, 109, 561
Emulsion, 270
Encephalon, 88
Endemic diseases, 135
Endocarditis, 624, 635, 637, 650
Endocardium, 26
Endometrium, diseases of, 456, 510
Endosmosis, 229
Endothelium, 11
Enteric fever, see Typhoid
Enteritis, 319, 644, 650
Enzymes, 223
Epidemic diseases, 135
Epiglottis, 88
Epilepsy, 618, 648, 676
Episiotomy, 470
Epistaxis, 413
Epithelioma, 308
Epithelium, 65, 73, 122
Epsom salts, 598
Equations, chemical, 196, 199, 204,
210, 213, 217, 218, 223, 226, 227,
229, 242, 244, 250, 251, 256, 258,
263, 266, 267, 269, 274, 279, 285,
286, 287, 289, 296, 297, 298, 300.
302
Erectile tissue, 106
Ergot, 530, 560, 597
Eruptive fevers, 639, 658
Erysipelas, 410, 616, 655
Erythroi^lon, 572
Escharotics, 567
Eserine, 580
Esophageal stricture, 386, 620
Esophagus, 42, 46
Ether, 245, 270, 521, 610, 612
Ethers, compound, 208
Eucalyptus, 596
Eustachian tube, 23, 119
Eutocia, 483
Evaporation, 198
Exanthemata, 675
Excipient, 563
Excreta, disposal of, 162
Exophthalmic goitre, 636
Exophthalmos, 396
Eye, 40, 42, 59, 65, 66
enucleation of, 403, 412
movements of, 110
pupil of, 89
refractory media of, 99
Factory hygiene, 139
Fallopian tubes, 36
Faradic current, 258
Fats, 80, 186, 287
Fatty degeneration, 318
infiltration, 318
metamorphosis, 312
Favus, 335
Feces, 89, 147, 676
Fecundation, 437
Fehling's test, 249, 262, 304
700
INDEX,
Female reproductive organs, 433
Femoral hernia, 46
Fermentation, 277
Fetal heart sounds, 446
Fetus, 444, 445, 474
Fibrinous degeneration, 314
Fibromata, 318
Fibrous tissue, 112, 310
Filth diseases, 140
FUtration, 198
Fire damp, 235
Fissure of Rolando, 69
Sylvius, 29, 69
Fistula, 403
in ano, 351, 352
Flame, chemistry of, 279
Fluid extracts, 587
Fluorine, 230, 301
Fontanels, 445
Foods, 73, 75, 76, 83, 87, 98, 108,
111, 147, 159
Foramen ovale, 71
Foramina of skull, 15
Forceps, use of, 501, 502, 503, 514
Forests, effect of, 148
Formulae, 193, 212
Fowler's solution, 273, 538, 601
Fractures, 347, 393, 395, 409, 421,
425, 428, 429
clavicle, 400
femur, 373, 380, 421
forearm, 363
inferior maxilla, 412
humerus, 350
nasal bones, 355
patella, 379
Pott's, 340
ribs, 415
skull, 343, 347, 349, 37S,
409
Fruit acids, 256
Funis, prolapse of, 499
Furuncle, 387
Galactogogue, 599
Galactorrhea, 497
Gall bladder, 41
stones, see Biliary calculi
Gallic acid, 524, 562
Galvanic cell, 213
definition of, 175, 176
Gamboge, 609
Gangrene, 313, 318
Gas, definition of, 200
illuminating, 214
Gaseous elements, 240
Gastralgia, 638
Gastric juice, 120
Gastritis, 658
Gastrocnemius, 12
Gastro-duodenitis, 542
Gastrotomy, 398
Gelsemium, 537, 584, 588, 589
Genitalia, 352
Gentian, 587
Genu valgam, 397
Germicide, 557
Germ theory, 149
Giant cell, 317
Glands, ductless, 115
excretory, 132
of small intestine, 34
Glauber's salt, 598
Glaucoma, 424
Gliomata, 396
Globulins, 210
Glottis, edema of, 623
Glucose, 204, 210
Glucosides, 563
Glycerin, 208, 271, 605
Glycogen, 212
Gold, 527
Gonorrhea in obstetrics, 497
Gossypium, 572
Gout, 320, 321, 613, 686, 688
Gravitation, 211
(iroin, 384
Guaiacuni, 580, 589
Guarana, 556
Gum arabic, 591
Gun-cotton, 181, 252
Gunshot wounds, 377
Hair folUcle, 62
Halogens, 177, 198, 206
Hamamelis, 559
Hammer-toe, 418
Hamstring muscle, 29
Hare-lip, 414
Haversian system, 66
Hav- fever, 693
Hearing, organs of, 99
; Heart, arteries of, 30
apex beat of. 111
columnae carneae, 133
description of, 652
dilatation of, 652
fattv changes in, 313
hypertrophy of, 312, 652
palpitation of, 626
INDEX,
701
Heart, rate of, 91, 109
remedies, 550, 592
revolution of, 80
sounds, 120, 125, (545, 661,
662, 667, 673
valvular diseases of, 312,
328, 652, 689
ventricles of, 11, 16
weak, training for, 141
Heating of houses, 147
Heat production, 114
prostration, 151, 652
Hectic fever, 334
Heel, bones of, 30
Hematemesis. 620, 688
Hematics, 560
Hematocele, 491
Hematosalpinx, 509
Hematoxylon, 581
Hematuria, 680
Hemoglobin, 92, 187, 257
Hemophylia, 619
Hemoptysis, 660, 680
Hemorrhages, 323, 371, 385, 427
cerebral, 623, 665, 669
in obstetrics, 491
pulmonary, 629
Hemostatic, 558
Hemothorax, 642
Hepatitis, 622
Hernia, 352, 353, 369, 375, 376,
386, 388, 398
Herpes progenitalis, 430
zoster, 636
Hiccough, 550
Hip joint, 45
Humerus, 12, 18
Humidity, effect of, 170
Hunger, 77
Hydatid pregnancy, 439
Hydrargyri iodidum rubrum, 574
Hydrargyrism, 574
Hydrarygrum cum erota, 573
Hydrastis, 576
Hydrate, 203
Hydrogen, 201, 205, 206, 280
dioxide, 220, 285, 577
sulphide, 177, 224, 265
Hydrobromic acid, 293
Hydrocarbon, 258
Hydrocele, 388, 407
Hydrocephalus, 498, 617, 658
Hydrochloric acid, 262, 303, 544, 558
Hydrocyanic acid, 284, 295, 299, 604
Hydrogogue, 539
' Hydronephrosis, 684
I Hydrophobia, 345
; Hydrosalpinx, 509
Hydrothorax, 655
Hydride, 278
Hydriodic acid, 293
! Hygrometer, 264
Hyoscine, 541, 563, 566
I Hyoscyamus, 541, 571
I Hyperemesis, 449
Hyperemia, 311, 334
Hypermetropia, 131
Hypertrophy, 427
Hypnotics, 566
Hypochondriac region, 16, 38
Hypodermic medication, 521
! Hypodermoclysis, 598
Hypospadias, 397
Hypostatic inflammation, 334
Hysterectomy, 481, 506
Hysteria, 648
Ice, artificial, 151 •
Ichthyol, 562
Icterus, 321, 667
Ileocecal valve, 40, 88
Illuminating gas, 233
Immigrant inspection, 168
Immunity from disease, 136, 307, 309
Incompatibility, 523, 531, 593
Indian hemp, see Cannabis Indica
Indican, 304
Infant, care of, 475, 477, 478, 500,
515
feeding, 154
Infantile paralysis, 677
Infarct, 320
Infectious diseases, 136
Infiltration, 311
Inflammation, 314, 316, 318, 321,
325, 332, 381, 414, 415. 430
Inflammatory fever, 372
Influenza, 660
Inguinal canal, 26, 30
Insemination, 436
Insolation, 616
Insomnia, 539
Intercostal neuralgia, 657
■' Intermittent fever, 571. 658
Intervertebral substance, 72
Intestinal bacteria, 97
colic, 688
glands, 34, 113
indigestion, 571
obstruction, 383, 419, 635
702
INDEX.
Intestinal villi, 113
Intestine, large, use of, 125
Intussusception, 388
Involution, 473
Iodine, 237, 537, 541
lodism, 576
Iodoform, 216, 560, 575
Ions, 300
Ipicacuanha, 535, 565
Iris (of eye), 515
versicolor, 572
Iron, 276
compounds of, 176, 179, 217,
260, 556
group, 289
reduced, 270
tests for, 178
Ischio-rectal abscess, 339, 377
fossa, 11
Isomerism, 209, 226
Isomorphous, 175, 265
Jaborandi, 523, 547
Jalap, 578, 589
Jaw, excision of, 391
Juniper, 602
Kidney, 11, 33, 37, 82
circulation of, 16
degeneration, 331
Koumis, 573
Kousso, 609
Knee joint, 64, 343
Labor, delayed, 489
diagnosis of, 461
management of, 467, 469,
470, 471, 472, 473, 477,
479, 483, 484, 48r>, 486,
487, 488, 490, 513, 518
mechanism of, 462, 403, 464,
465, 486, 514, 515
pains, 462
precipitate, 4S8
preparation for, 460, 46S, 471
stages of, 461, 466
Lachrymal duct, 339
gland, 64
T^actic acid. 298, 607
Lactose, 599
Lactucarium, 548
Lanolin, 575
Lardaceous degeneration, 325
Laryngismus stridulus, 667
Larynx, 25
Larynx, stenosis of, 409
ventricles of, 27
Latent heat, 211
Lateral sinus, 51
Laws of combination, 203
Lead, 180, 231, 546
antidote for, 212
poisoning, 621
test for, 222
Leontiasis ossia, 366
Leucomaines, 119
Leukemia, 311, 625, 638
Lignum vitae, 577
Lime, 586
water, 599
Limonis sulcus, 580
Linamentum calcis, 578
Linea alba, 61
Linum, 576
Lipomata, 319
Liquor amnii, 438
Lithium, 191, 261, 519
Litholapaxy, 392
Lithotomy, 419
Litmus, 200, 229
Liver, 9, 36, 73, 87, 132
abscess of, 657
amyloid, 330
atrophy of, 324, 336
cirrhosis of, 614
hemorrhage of, 340
hj'peremia of, 326
percussion of, 066
Lobelia, 519
Locomotor ataxia, 319, 666
Lotio hydrargyri flava, 546
nigra, 556
Lunar caustic, 176
Lungs, 37, 64, 132
gangrene of, 659
Lupus, 403
Lymph, 103, 108
Lymphadenitis, 334
Lymphangitis, 336
Lymphatic glands, 10, 69, 71, 325,
331
system, 122
Lj-mphorrhagia, 323, 325
Magnesia, 602
Malaria, hvgiene of, 135
Malleability, 229
Malleolus, external, 35
Mammary abscess, 496
glands, 59, 451
Manganese, 577
Manare, diaposition of, 156
Marah 's test, 194
Moatication, 32
Mastitis, 496
Materia medica, ileflnition of, 53i
ilaidllary siuiis, 48
Measles, aee Riibeiib
Meat inspection, 170
Meeonium, 446
MBdiHstinum, 69, 72
HeduUa oblongata, 63, 89
Meibomian glands, 18
Melanoaartoma, 3 OB
Mem bran H tympani, 344
lUcnibranes, mueolM, serous i
eyaovial, IIG
Meniere's disease. 117
Meningitis, 309, 633. 653, 659, 6
666
Menapanse, SIS
Menstrual ion. 434, 435
Mentba piperita, 574
Merfnry, 193, 266, S95, 596
ebloridcs of, 216, 245, 2
291. 520, 532, 546
iodides of, 293
Metabolism. 75
MetHls, 211
Methane, 162
Metric system, 239. 265, 2B7
Micturition, SS
Milium,
Milk, adulteration of, 157
composition of, 237
cow's, 186, 291
diseases conveved bv. 167
human, 94, 1S6, 291
ingpertioa nf, 170
modified, 1.16
souring of. 238
steriliieii. 151, 170, 278
Mineral mnler, see Water
M iseairiafre. 456
Mixture, definition of, 240
Molecule, definition of, 189
Morbus cOxne, 345, 399
Morphine, 226, 534
Mortification, 368
Mouth, hyjriene of, 158
Mucin, 246
Mucoid defreneration, 311
Mnmps, see Parotitis
Muscles, 260
DEX. 703
I Muscles, abdominal, 10
affections of, 399
atrophy of, 672
, biceps, 45
I classes of, 13
compressor uretbrae, 14
contraction of, 117, 125, 130
deltoid, 44
fatigue, 127
gluteus maximns, 38, 72
internal oblique, 10
of back,' 70
of calf of leg, 12, 40
of forearm, 13
of neck, 51
of orbit, 14
ipf male [leriin
40(1
of li
inti, 32
shoulder and arm, 45
sphincter ani. 61
structure, 106
tibialis anticus, 61, 72
tissue, 65
trapezius. 20
quadriceps, 41, 348
Myalgia, 640
Mydriatics. 557
Myelitis, 630, 662
Myocardial degeneration, 331
Myocarditis, C79
Myomata, 319
Myopia, 124. 162
Myotics, 542
Myxedema, 685
eotics, 611
Jinsal fossae. 54
NllRcent etRte, 204
Necrosis, 420
Negroes, diseases common with, 168
.Xephrcctoniv, 390, 393
.Nephritis. 314, 315, 328, 565, 622,
6.^.2, 670, 0SI3
iNephrolitbiflsis, ftlB
INephrorrhaphy, 390
j Nephrotainy, 390
Nerves, afferent, 113
cranial, 23
efferent, 113
I facial, 47, 92, 356, 401
704
INDEX.
Nerves, fibre, 37, 87
fifth cranial, 26, 33, 66, 111
fourth cranial, 78
glossopharyngeal, 39, 60
median, 29, 341
motor oculi, 66, 109, 119
of eye, 65
of optic commissure, 20
of palm of hand, 56
olfactory, 59
optic, 14, 75
pharyngeal plexus, 68
phrenic, 68, 647
pneumogastric, 50, 57, 95
radial, 61, 393
sciatic, 21
sclerosis of, 324
sixth, 11, 78
spinal accessory, 413
spinal cord, 58
superior laryngeal, 97
sympathetic, 43, 85
ulnar, 398
Neuralgia of fifth nerve, 400
prescription for, 550
Neurasthenia, 637
Neuritis, 646, 648
Neuromata, 319
Nevus, 423
New-horn, hygiene of, 153
Night -sweats, 525
Nij)ples, (-nro of, 495, 496
Nitrates, 2o7
Nitric acid, 190, 215, 236, 592
Nitrites, 257
Nitrogen, 272
acids, 263
oxides of, 221, 268, 611
Nitroglycerin, 254, 263, 535, 539
Nomonciaturo, chemical, 189, 203,
210, 224, 226, 227. 2G8, 277, 292,
298
Non-metals, 179. 211
Normal salt solution, 394
Nuisances, ir)4, 166
Nursing women, liygienc of, 158
Nux vomica, 522. 567
Obesity, 100. 133, 337
Oil of turj)entine, 602
winter^reen, 528
Ointments, 575
Oieates, 575
Olefiant g;is. 195
Oleic acid, 564
Oleomargarin, 137
Oleum erigirontis, 606
morrhuae, 577
ricini, 600
sabinae, 606
theobromatis, 525
tiglii, 519
Olfactory apparatus, 123
Olive oil, 186, 606
Omentum, 21
Opium, 185, 416, 532, 544, 547, 554,.
569, 585, 607
Opthalmia, gonorrheal, 320, 497
Organic chemistry, 200
compounds, 176
Osmosis, 83, 274
Ossa innominata, 57
Ostitis deformans, 366
Ovaralgia, 510
Ovarian cyst, 511, 516
dropsy, 654
Ovaries, 52
Ovaritis, 510
Ovule, 437
Ovulation, 437
Ovum, 83, 437, 438
Oxalic acid, 242, 300
Ox-gall, 589
Oxvgon. 194, 205, 223, 234, 242, 275,.
288, 295
Ozone, 189, 230, 251
T*aget 's disease, 343
Pain, lOO
Pallor, 92
Palmar arch, 3()
fascia, 53
Pancreas, 21, 93
Pancrcatin, 573
Papillomata, 312
Paracentesis, 38(5
Parnciticide, 557
Paralysis agitans, 629
Paraphimosis, 349, 397
Paresis, 321
Paris green, 249
Paronychia, 364, 402
Parotid duct, 10
Parotitis, 144, 636, 693
Patellar reflex, ()47, 685
Pelvic inllammation, 510
Pelvimetry, 517
Pelvis, liones of. 31
female. 439, 440, 441, 442
male, 439
Pepo, S60
PepHin, 251, 573
Pef-tones, 211
PericBTilinl effusion, C92
fericarditis, li3:i, C41, G50, 66:
Pericardium. 21
Perineum, JO, 469, 470, 514
Periosteum, 61
FerioBtitis, 646
Peritonitis, 322, 330, 628, 630,
Peritoneum, 25, 62
PerapirBtiou, M, 118
PertusaiB, 144, 613, 629, 634
FetToleum products, ISO
Peyer'a glands, CQ
Pharj-nx. 30, 30
Phcn
I, Ii30, (
Phenol, see Carbolic aeiH
prodiieta of, 272
Phimosis, 36S, 397
PhlebitiH, 307. 404, 426
Phlegmaaift alb& dotens, 481
Phosphorus. 144, 181, 182, 206. :
221, 253. 284. S20, 538, 547, C
Photography, IBS
Phthisis, see TuberenloHiB
Pbjsical nctioD, £13
Physics, 340
Physoatigmine, 5.11, 537, 603
Phytolacca, G26
Pia mater, 44
Pierotoxin, 505, 598
Pilocarpine, 528, 644. 567, 580,
Pix liquids, 595
Placenta, 435, 4C8, 477
Plaster of Paris) 2fi2
Plastic operations, 409
Pleura, 30
Pleurisy, 619, 657, 6S9
Pleuritic effusion, 602
PleuritiB, 657
PlumhiDg, 160
Pneutnoain, 316, 618, 644, 655, (
672, 686, 687, 689
Pneumonitis, 671
Podophyllin, 601
PoIariiBfinn, 575
Pomegranate, 507
Pons varolii, 26
Popliteal apace, G4
Porosity, 254
Porro's operation. 506
Portal circulation. 95
Poat-mortemB, 86, 337
45
EX. 705
Postpartum hemorrhage, 482
Potassium, 218, 266
compounds, 179, 181, 243,
252, 299, 524, S35, 572,
590, 591, 600, 606
Poupart 'b ligament, 22
Precipitate, definition of, 240
Pregnancy, 442, 443, 450
;i>l>m>i;Liiria in, 454, 455
ill:.i:iii'.-i-< iif, -147 448,
452, 515, 516
hygiene of, 163, 453
multiple, 408, 499, 516
pathology of, 454
prosentations in, 452, 453,
463, 464
Premature birth, 474
Prescriptions, 531, 534, 539, 541,
547, 549, 550, 551,
566, 567, 568, 572,
583, 586, 600, 602,
604
metric, 576. 606, 607
Preventiblc diseases, 139
Productive inflammation, 312
I. 495
convulsions, 404
Pulmonnrv al>apesB, 649
edema, 634, 671
sotidiflcation, 664
sounds, 645, 671, 673,
677, 690, 691
Pulsatilla, 556
Pulse, 79, 93
Pulvis glycyrrbizae comp., 524, 663
jfjapae comp., 529
Purgativea, 570
Purpura hemorrhagica, 689
simplex, 674
Pus, 163, ;llfl, 334
Pustalc, malignant, 408
Putrefaction, 261
Pvelitia, 629
I'yemia. 305, 39S
Pyroxylin, 181, 252
Pyuria, 624
706
INDEX.
Qualitative analysis, 209, 240
Quantitative analysis, 209
Quarantine, 148
Quassia, 556
Quickening in pregnancy, 449
Quinine, 596
Rachitis, 620, 650
Radical, 179, 253, 275
Ramus of jaw, 67
Rattlesnake bite, 425
Reagent, 174, 203
Rectal feeding, 102
Reotocele, 511
Rectum, 32, 42, 70
stricture of, 390
Reflex action, 78, 107, 129
Reflexes, the, 102
Remittent fever, 645
Renal circulation, 95
colic, 676, 688
Reserve air, 126
Residual air, 126
Resorcin, 581
Respiration, 81, 89, 124, 128, 156
Respiratory sounds, 81, 131
Retina, 107, 116
Retropharyngeal abscess, 687
Rheumatism, 536, 593, 646, 648, 654,
664, 665, 670, 688
Rhubarb, 598
Rigor mortis, H5, 117
Rochclle salt, 50S
Roentgen ray, 265
Roseola, 644, 674
Rotheln, 144
Rubella, 644, 674
Rubeola, 138, 642, 644, 654, 658,
674
Saccharin, 599
Sacroiliac disease, 349, 399
Safety lamps, 250
Sal ammoniac, 178
Salicylic acid, 204, 522, 575, 594
Salivary glands, 17
Salol, 577, 609
Salpingitis, 509
Saltpetre, 607
Salts, definition of, 173, 203
Santalum, 581
Saponification, 109, 287
Sarcoma, 310
Sarsaparilla, 592
Scabies, 552
Scalp wounds, 344
Scammonium, 560
Scarlatina, 162, 316, 631, 644, 663,
666, 667, 674, 680
Scarpa's triangle, 33
School houses, 148
life, diseases of, 149
rooms, 157, 161
Sciatica, 615
Sclerosis, multiple, 638
Sooparius, 562
Scrotum, affections of, 383
Scurvy, 627
Sebaceous glands, 89
Secretion, 89
Seidlitz powder, 250
Selenium, 301
Semen, 436
Seminal fluid, 121
Senile changes, 328
Senna, 543, 586, 605
Septicemia, 398
Serpentaria, 564
Serum therapy, 569
Sewage disposal, 164
Sewer gas, 137, 166
Shock, 410, 420
Shoulder joint, 19
Sialagogue, 538, 599
Sigmoid flexure, 4, 6
Sinapis, 525
Sinus, 395
Sinuses of face, 55
Skin, 49. 115, 131, 158
Sleep, 121, 134, 153
Small-pox, see Variola
Smell, sense of, 77, 123
Soap, 270, 300
Sodium compounds, 529, 544, 555,
572
Solar plexus, 15
Solvent, definition of, 554
Sound, sensation of, 115
Sparteine, 529
Spasms, 687
Special senses, 100, 117
Specific gravity, 174, 200, 218, 235,
240
Spectroscoj)e, 175
Speech center, 99
Sjxrmatic cord, 29
Spermatozoa, 436
Sphincter ani, 61
Sphygmograph, 107
Spigelia, 573
INDEX.
707
Spina bifida, 319
Spinal column, 38, 49
cord, 58, 86, 100, 126, 128
Spleen, 31
in fevers, 691
in leucocythemia, 126
Sprain, 411
Sputum disinfection, 149
SquUls, 606
Stammering, 131
Staphisagria, 549
Starch, 180
Static electricity, 176
Stenson's duet, 36, 90
Sterility, 456
Still-birth, 501
Stoichiomeitrical problems, 205, 236^
239, 287, 290
Stomach, 36
absorption from, 93
cancer of, 636, 643
distension of, 91, 627
foreign body in, 359
ulcer of, 620, 643, 647
Stomatitis, 685
Strabismus, 394
Stramonium, 247
Strophanthus, 536, 553
Strychnine, 258, 278, 534, 564, 579,
584, 608
St. Vitus' dance, see Chorea
Styptic, 558
Subinvolution, 473, 478
Sublimination, 176, 214
Sublingual duct, 10
Submaxillary duct, 10
Sudoriferous glands, 89
Sugar, tests for, 188, 247, 262
classes of, 195, 215
Sulphonal, 607
Sulphur, 194, 214, 234, 255, 282,
528, 536, 555, 607
Sulphuretted hydrogen, 236
Sulphuric acid, 211, 222, 245, 282
Sulphurous acid, 202
Sulphur, oxides of, 194, 269
Sunstroke, 616, 652, 691
Superfetation, 499
Suprarenal capsule, 63
Surgical fever, 347
Symbiosis, 326
Sympathetic nerve, 43
Symphysiotomy, 505
Synarthrosis, 19
Syncope, 121
Synovial bursae, 394
Synthesis, 258
Syphilis, 312, 430, 500, 583, 654, 692
Syphilitic gummata, 324
Tabes dorsalis, 656
Talipes calcaneus, 348
equino-varus, 358, 407
equinus, 359
Tallow, 186
Tampon, 482
Tannic acid; 571, 597
Tape worms, 635, 678
Tar, 551
Tartar emetic, 219, 236, 557, 559,
595
Tartaric acid, 277, 284, 299
Tea drinking, 167
Tears, 92, 133
Teeth, 46, 88, 97, 123, 129
Tendo Achillis, 16
Tendons, 14
Temperature of body, 86, 101, 126,
127, 130, 663, 673
Temporo-maxillary articulation, 47
Testes, 28, 57, 123
Tetanus, 85, 615, 656
Therapeutics, definition of, 536
Thermometers, 228, 232, 264
Thigh amputation, 374
Thirst, 77
Thoracic duct, 30
Thrombosis, 311, 690
Thrombus, 426
Thymol, 551
Thymus, 63
Thyroid, 12, 119
Tie douloureux, 680
Tidal air, 126
Tinctures, 582, 587
Tinnitus aurium, 432
Tobacco, evils of, 151, 162
Tongue, 44, 646
excision of, 339
TonsilUtis, 649, 682
Tonsils, 69
Torticollis, 397
Trachea, 49
foreign body in, 357
Tracheotomy, 68, 346
Trichinosis, 528
Tubal pregnancy, 460
Tubercle bacilli, 315, 328
Tubercles, 310, 332, 335
Tubercula quadrigeminay 18
nrbsx.
'\}p, ns, 332, 335, 642,
^ ISL iSS, 347, 3S1, 3S!
4QB, 124
5S3. 002
it end, 439
hemorThage, &00
f UdHWHC, nwteruJ of, J67
ia oriiw, £78
"V 1ST, 222. 262, 283, 333
. *M, 333, 6S2, 651
«.«7
15. ro
tTterpa, invenion of, 40S
liganuinta of, 24
ruptaro of, 490
Uva nraae, 531, 377
^>:. ;4i.
I■a^• <
VltriM bntt. 45
tfbn'iO. 516
ViteUib, 4,19
iMttis. 489
tftwnM. K. 4». 43«; 442, 507
*t*ir viVKBADcj, 91
casMr of, 512
<hliU»:ii>n of, SOS
ioL-lMinMBt of, 435, 607
-^'-» of, SW
Taccioation, 140, 142, 144, 165 IOC
170, 057 ' I .
Vagina, 19
Vaginismus, 508
Vaginitia, 403
Valence, 253
Valerian, 578
Varicella, 144, 649, 651, 674
Varicocele, 361
Varicose veins, 432
Variola, 138, 632, 651, 657
Varioloid, 662
Varix, 426
Vascular syBtem of new-born 71
Vaseline, 228
Vasomotor remedies, 593
Veins, cerebral, 61
oiternal jugular, 67
internal jngular, 32
pulmonarj, 49
Baphenons, 68 *
subclavian, 13
Vena cava, 40, 47
Veaaaeistioa, 563
Venona Wood current, 112
Ventilation, 152, 153, 161
Vcratnim, 530, 543, 602
Vflraion, 504, 505
Vertebrae, 14, 35
Vertigo, 624
Veaicantfl, 601 '
Vesicnlae aeminales, 60
Vienna paste, 556
Vinegar, 181
Vitellus, 438
Vocal cords, 10, SO, 90
Voice, 112
Volvulus, 386
Vomiting, 96, 539, 624
Vulva, 517
Volvo- vaginal abscess, 351
ir, 200
CDntamioation of, 161, 16S
decomposition of, 192, 234
detection of impurities in
164, LM7, 273, 301
diseaaes convoyed by, 164
hard and soft, Ifm
J
INDEX.
709
Water, mineral, 190, 228, 250, 283,
296
natural, 230
of crystallization, 174
uses of, 545, 578
Webbed fingers, 422
Wet pack, 159
Willow, preparations from, 570
WiUes, circle of, 42
Wine, adulteration of, 140
Wolffian bodies, 94
Wormian bones, 62
Wounds, classificatioji of, 384
infection of, 395
Wrist, amputation, 368
joint, 31
Wry-neck, 365
Yellow-fever, 167, 626, 630, 646
Zinc, preparations of, 603
salts of, 179, 207, 252
Zingiber, 558
LANE MEDICAL UBRAl^l
: .u PAbi'EUR DUVE
BALO ALIO, CALffORNlA »
L79 Ludy, Robert B.
L96 Answers to questions
1907 „ prescribed by medical
sbBite boards.
i