STATE BOARD 
 
 EXAMINATION 
 
 QUESTIONS & ANSWERS 
 
 €>f flotty<ont ^>tate$ ana 
 Ctoo Canafcian ptofottueg 
 
 A PRACTICAL WORK, GIVING AUTHENTIC QUESTIONS 
 AND AUTHORITATIVE ANSWERS THAT WILL PROVE 
 HELPFUL IN PASSING STATE BOARD EXAMINA- 
 TIONS. REPRINTED FROM THE MEDICAL RECORD. 
 
 €l)ir& €&ition 
 
 Revised and Greatly Enlarged 
 
 NEW YORK 
 
 WILLIAM WOOD & COMPANY 
 
 MDCCCCX 
 
v<\ 
 
 
 Copyright 1910 
 
 By WILLIAM WOOD & COMPANY 
 
 First Edition, November, 1907 
 Second Printing, April, 1908 
 Second Edition, September, 1908 
 Third Edition, October, 1910 
 
 ©CLA275043 
 
CONTENTS 
 
 Pages 
 Questions Answers 
 
 Alabama 5 g 
 
 Arizona 21 26 
 
 Arkansas 41 44 
 
 California 49 54 
 
 Colorado 71 75 
 
 Connecticut 91 94 
 
 Delaware 109 113 
 
 Florida 126 129 
 
 Georgia 140 143 
 
 Idaho 155 159 
 
 Illinois 176 181 
 
 Indiana 195 200 
 
 Kansas 217 221 
 
 Kentucky 232 236 
 
 Maryland 258 262 
 
 Massachusetts 276 280 
 
 Michigan 294 299 
 
 Minnesota 315 319 
 
 Mississippi 340 342 
 
 Missouri 352 356 
 
 Montana 371 373 
 
 Nebraska...- 386 389 
 
 Nevada 401 405 
 
 New Hampshire 417 420 
 
 New Jersey 429 435 
 
 New York 458 463 
 
 North Carolina 480 483 
 
 North Dakota 500 504 
 
 Ohio 518 522 
 
 Oklahoma 534 538 
 
 Oregon 552 557 
 
 Pennsylvania 581 584 
 
 South Carolina 597 602 
 
 South Dakota 617 621 
 
 Tennessee 638 641 
 
 Texas '. 650 655 
 
 Vermont 678 682 
 
 Virginia 698 703 
 
 Washington 722 727 
 
 West Virginia 743 747 
 
 Wisconsin 761 764 
 
 British Columbia 776 77& 
 
 Ontario. 790 797 
 
 Requirements for Medical Licensure.... 818 
 
 Bulletin of Approaching Examinations . 819 
 
MEDICAL RECORD. 
 
 &iai* M&xtnl Wixtt ttatng Htmvba. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Alabama State Board of Medical Examiners. 
 
 ANATOMY. 
 
 (For graduates of less than five years' standing.) 
 
 1. Describe the upper third of the femur. 
 
 2. Give the class of joint, the articulation, and ligaments 
 of the shoulder joint. 
 
 3. Trace blood from the heart by way of the subclavian 
 artery to the circle of Willis, naming the arteries uniting 
 to form the circle. 
 
 4. Name the muscles of the anterior chest, and give origin 
 and insertion of the largest one of them. 
 
 5. Name the main superficial venous trunks of the upper 
 arm, describing one of them. 
 
 6. Describe the gall-bladder and the bile-ducts. 
 
 7. Describe the great sciatic nerve. 
 
 8. Describe the rectum. 
 
 (For graduates of more than five years' standing.) 
 
 1. Name the bones of the lower extremity. 
 
 2. Name and locate the valves of the heart. 
 
 3. Describe in full the sartorius muscle. 
 
 4. Locate the spleen and describe its gross anatomy. 
 
 5. Describe in full the pulmonary veins. 
 
 6. Describe the contents in Scarpa's triangle and give 
 their relations. 
 
 7. Name the lobes and ventricles of the brain. 
 
 8. Name the ligaments supporting the uterus and describe 
 its blood supply. 
 
 PHYSIOLOGY. 
 
 1. Explain the functions of the spinal cord. 
 
 2. What are the functions of the trifacial or fifth pair of 
 cranial nerves? 
 
 3. What is meant by cell action? Give examples. 
 
 4. What are the supposed functions of the spleen? 
 
 5. What are the supposed functions of the thyroid gland? 
 What symptoms sometimes follow its removal? 
 
 6. Explain the glycogenic function of the liver. 
 
 7. How is the equilibrium of the circulation of the blood 
 maintained in the body? 
 
 8. What are the functions of the skin? 
 
 CHEMISTRY. 
 
 (Answer eight.) 
 1. What is the difference between analytic and synthetic 
 methods in chemistry? Illustrate each. 
 
MEDICAL RECORD 
 
 2. Explain the reaction which occurs when the aqueous 
 solutions of the two parts of a Seidlitz powder arc mixed. 
 
 3. Write the equations which show the reaction occurring 
 when corrosive sublimate and potassium iodide in solution 
 are brought together. 
 
 4. What is the essential element of all acids? Differenti- 
 ate between hydracids and oxyacids? 
 
 5. Give a test for H 2 S0 4 when an adulterant in vinegar. 
 
 6. Give the technical names of (a) aqua regia, (b) oil 
 of vitriol, (c) green vitriol, and the formula of one of 
 them. 
 
 7. What is the chemical composition of ordinary alum? 
 
 8. Give the chemical reaction of (a) tears, (b) bile, (c) 
 blood, (d) saliva, (e) milk, and state what salt causes 
 acidity of urine. 
 
 9. Give a test for ferrous salts. 
 
 10. Explain the difference between a sulphate and a 
 fulphite. Give an example of each. 
 
 11. Give tests for albumin and sugar in urine. 
 
 12. Describe a chemical test for blood. 
 
 PHYSICAL DIAGNOSIS. 
 
 1. In what pathological conditions of the lungs is moder- 
 ate dullness found; in what is absolute dullness found? 
 
 2. Give differential diagnosis between acute bronchitis and 
 lobar pneumonia. 
 
 3. What are the principal points of difference between 
 pleuritic friction sounds and bronchial rales. 
 
 4. Give the diagnostic signs of aortic aneurysm. 
 
 5. What are the conditions most favorable for the pro- 
 duction of metallic tinkle? 
 
 6. Give the differential diagnosis between endocarditis 
 and pericarditis. 
 
 7. Give the diagnostic symptoms of emphysema of the 
 lungs. 
 
 8. Differentiate between aortic stenosis and mitral in- 
 sufficiency. 
 
 ETIOLOGY, PATHOLOGY, SYMPTOMATOLOGY, AND DIAGNOSIS. 
 
 i. Give the etiology of cirrhosis of the liver. 
 
 2. Give the etiology of pyelitis. 
 
 3. Give the pathology of arterial sclerosis. 
 
 4. Give the symptoms and diagnosis of hookworm disease. 
 
 5. Give the differential diagnosis between pericarditis and 
 acute pleurisy. 
 
 6. Give the pathology of cerebrospinal meningitis. 
 
 7. Give the etiology of erysipelas. 
 
 8. Give the pathology of pneumonia. 
 
 OBSTETRICS. 
 
 1. What is meant by the inclined planes of the pelvis? 
 
 6 
 
MEDICAL RECORD. 
 
 2. What are the forces by which the child is expelled? 
 
 3. Give operation for adherent placenta. 
 
 4. Give mechanism of left occipitoposterior position. 
 
 5. How would you manage a shoulder presentation? 
 
 6. Give 'causes and treatment of asphyxia in a new-born 
 child. 
 
 7. How would you apply forceps at the inferior strait 
 when the occiput has rotated to the pubic symphysis ? 
 
 8. Give the degrees of perineal laceration and manage- 
 ment of each. 
 
 GYNECOLOGY. 
 
 1. Give causes and treatment of hemorrhage of the uterus. 
 
 2. Give the cause and treatment of amenorrhea. 
 
 3. Define ectopic pregnancy and give varieties. 
 
 4. Give differential diagnosis between fluid and solid neo- 
 plasms in the abdominal cavity. 
 
 5. Under what conditions and why would you prefer 
 vaginal to abdominal hysterectomy? 
 
 6. Give symptoms of fibroid tumors of the uterus. 
 
 7. Give etiology of retrodisplacement of the uterus. 
 
 8. Describe the technique of a gynecologic examination. 
 
 SURGERY. 
 
 1. Give general rules for the treatment of wounds. 
 
 2. Give symptoms and treatment of traumatic spreading 
 gangrene. 
 
 3. Give general rules for the treatment of tubercular ab- 
 scesses. 
 
 4. Give differential diagnosis between chancre and chan- 
 croid. 
 
 5. Give treatment of a compound, comminuted fracture 
 of the femur. 
 
 6. Give symptoms and treatment of subcoracoid disloca- 
 tion of head of humerus. 
 
 7. Give symptoms and treatment of stone in the kidney. 
 
 8. Give treatment of penetrating gunshot wound of the 
 abdomen. 
 
 EYE, EAR, NOSE, AND THROAT. 
 
 1. Give symptoms and management of acute catarrhal 
 conjunctivitis. 
 
 2. Give the symptoms, dangers, and management of gon- 
 orrheal ophthalmia in the adult and in the new-born. 
 
 3. Give the management of ulcer of the cornea. 
 
 4. In what part of the ear does cerumen sometimes be- 
 come impacted, and how diagnosed and treated? 
 
 5. What is the seat of acute suppurative otitis media, and 
 what the symptoms, dangers, and management? 
 
 6. In the absence of the special instrument for the pur- 
 
MEDICAL RECORD. 
 
 pose how would you arrest an alarming hemorrhage from 
 the nose? 
 
 7. What is the most conclusive symptom of diphtheria, 
 and how ascertained ? What is the most generally accepted 
 treatment? Give in detail the method of administering the 
 treatment, and the dose. 
 
 8. Name three instances in which intubation of the larynx 
 would be indicated. Name three in which laryngotomy or 
 laryngotracheotomy would be required, and describe the 
 operation. 
 
 HYGIENE AND MEDICAL JURISPRUDENCE. 
 
 1. What is the period of incubation of smallpox? Of 
 measles? Give the differential diagnosis between these two 
 diseases. 
 
 2. What is immunity? What susceptibility? 
 
 3. How is typhoid fever disseminated! Give the hygienic 
 management of a case. 
 
 4. Describe briefly the proper location and construction 
 of a school building. 
 
 5. Define malpractice. 
 
 6. What are illusions? Delusions? 
 
 7. Give the differential diagnosis between strychnine poi- 
 soning and tetanic convulsions. 
 
 8. What are the symptoms of acute poisoning from coal 
 tar derivatives? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Alabama State Board of Medical Examiners. 
 
 ANATOMY. 
 
 (For graduates of less than five years' standing.) 
 
 1. See Cunningham's ''Anatomy" (1909), page 223; or 
 Gray's "Anatomy" (1908), page 223. 
 
 2. The shoulder joint is an enarthrodial variety of a 
 diarthrosis ; it is formed by the head of the humerus being 
 received into the glenoid cavity of the scapula; the liga- 
 ments are: Glenoid, capsular, coraco-humeral, and trans- 
 verse humeral. 
 
 3. Heart, aorta (innominate, on right side only), sub- 
 clavian, vertebral, basilar ; then to posterior cerebral (which 
 is part of Circle of Willis). This circle is formed: In 
 front by the two anterior cerebral arteries (branches of 
 the internal carotid), which are connected by the anterior 
 communicating artery; behind, by the two posterior cere- 
 brals (branches of the basilar artery), which are connected 
 to the internal carotid on each side by the posterior com- 
 municating artery. 
 
 8 
 
MEDICAL RECORD. 
 
 4. Muscles of anterior chest are: Pectoralis major, pec- 
 toralis minor, and subclavius. The largest of these is the 
 pectoralis major. Origin: Anterior surface of inner half 
 of clavicle, anterior surface of sternum, from the carti- 
 lages of the second to sixth ribs, and from the aponeurosis 
 of the external oblique of the abdomen. Insertion: Into 
 the outer bicipital ridge of the humerus. 
 
 5. See Cunningham's "Anatomy" (1909), page 891; or 
 Gray's "Anatomy" (1908), page 745. 
 
 6. The gall-bladder and bile-ducts. The gall-bladder 
 is a conical bag placed in a fossa on the under surface of 
 the right lobe of the liver. Its upper surface is attached 
 to the liver, and its fundus and posterior surfaces are in- 
 vested by peritoneum reflected from the adjacent surface 
 of the liver. The body is in relation in front with the 
 liver, and behind with the first part of duodenum, the 
 pylorus, and the hepatic flexure of colon. The fundus is 
 in contact with the parietes opposite the ninth right costal 
 cartilage. 
 
 The hepatic duct, formed by union of ducts from right 
 and left lobes, issues from the liver at the bottom of the 
 transverse fissure. It passes downward and to the right in 
 the layers of gastrohepatic omentum, having the vena porta 
 behind and the hepatic artery on the left. It joins the cystic 
 duct, the two forming the common bile-duct. 
 
 The cystic duct passes from the neck to the gall-bladder 
 downward, backward, and to the left, to join the preceding. 
 
 The ductus communis choledochus or common bile-duct 
 is the result of the union of the hepatic and cystic ducts. 
 It passes behind the first part of the duodenum, in front 
 of the vena portse, with the hepatic artery on the left, be- 
 tween the layers of the gastrohepatic omentum, and, pass- 
 ing between the pancreas and second part of the duodenum, 
 enters the small intestine obliquely a little below the middle 
 of the descending part of the duodenum by an opening 
 common to it and the pancreatic duct. — (From Aids to 
 Anatomy.) 
 
 7. See Cunningham's "Anatomy" (1909), page 648; or 
 Gray's Anatomy" (1908), page 1030. 
 
 8. See Cunningham's "Anatomy" (1909), page 1087; 01 
 Gray's "anatomy" (1908), page 1320. 
 
 (For graduates of more than five years' standing.) 
 
 1. Os innominatum (ilium, ischium, pubis), femur, pa- 
 tella, tibia, fibula, os calcis, astragalus, cuboid, scaphoid, 
 three cuneiforms, five metatarsals, and fourteen phalanges. 
 
 2. In the right auricle are the Eustachian and coronary 
 valves^ the former is situated between the anterior margin 
 of the inferior vena cava and the c.uriculo-ventricular ori- 
 
MEDICAL RECORD. 
 
 fice. In the right ventricle are the tricuspid and semilunar 
 valves. In the left ventricle are the mitral and semilunar 
 valves. Aortic valves, behind the third intercostal space, 
 close to the left side of the sternum. Pulmonary valves, 
 in front of the aortic, behind the junction of the third rib, 
 on the left side, with the sternum. Tricuspid valves, behind 
 the middle of the sternum, about the level of the fourth 
 costal cartilage. Mitral valves, behind the third intercostal 
 space, about one inch to the left of the sternum. 
 
 3. See Cunningham's "Anatomy" (1909), page 356; or 
 Gray's "Anatomy" (1908;, page 518. 
 
 4. The spleen is situated in the back part of the left hypo- 
 chondriac and epigastric regions, being covered by the 
 ninth, tenth, and eleventh ribs, on the left side. It is of 
 an oblong, flattened form, the external surface being con- 
 vex ; on the inner surface is a vertical ridge dividing it 
 into two parts, the posterior of which is applied to the 
 outer surface of the left kidney, while the anterior one 
 receives the tail of the pancreas and lies against the cardiac 
 end of the stomach. Near this ridge is a fissure, the hilum, 
 where the vessels enter. The anterior border is notched 
 and the lower end is pointed and rests on the costocolic 
 ligament, situated in the left hypochondriac region. It is 
 covered by peritoneum, except at the hilum, where it 
 passes forward and inward in a double line enclosing the 
 vessels, as the gastrosplenic omentum, to the fundus of 
 the stomach. It usually measures 5 by 3 by 1 or 1^ inches, 
 and weighs about 7 ounces. — (From Aids to Anatomy.) 
 
 5. See Cunningham's "Anatomy" (1909), page 870; or 
 Gray's "Anatomy" (1908), page 723. 
 
 6. Contents: The femoral vessels pass from about the 
 center of the base to the apex, the artery being on the 
 outer side of the vein; the artery gives off the superficial 
 and profunda branches, and the vein receives the deep 
 femoral and internal saphenous; the anterior crural nerve 
 lies to the outer side of the femoral artery; the external 
 cutaneous nerve is still further external, lying in the outer 
 corner of the space; just to the outer side of the femoral 
 artery, and in the sheath with it, is the crural branch of 
 the genitocrural nerve. At the apex the vein (which at the 
 base was internal to the artery) lies behind the artery. The 
 triangle also contains fat and lymphatics. 
 
 7. Lobes of brain: Frontal, parietal, occipital, temporal, 
 central (or island of Reil), limbic, olfactory, cuneate, orbi- 
 tal, precentral, postcentral, quadrate. Ventricles: Two 
 lateral, third, fourth, and fifth. 
 
 8. Ligaments of uterus: Anterior, posterior, two broad 
 (or lateral), two sacrouterine, and two round ligaments. 
 Blood supply: Uterine and ovarian arteries and veins of 
 same name. 
 
 10 
 
MEDICAL RECORD 
 
 PHYSIOLOGY. 
 
 i. The functions of the spinal cord are: (i) The con- 
 duction of nerve impulses; (2) reflex action; (3) co- 
 ordination ; it also contains special centers which preside 
 over definite functions. 
 
 In the spinal cord: (a) The white substance simply con- 
 ducts nerve impulses; (b) the gray substance contains 
 groups of cells which act as centers for and distributors of 
 nerve impulses, and are also concerned in reflexes; (c) the 
 anterior cornua have a motor and trophic function; (d) 
 the posterior cornua are sensory. 
 
 2. The functions of the fifth cranial nerve. First 
 ophthalmic branch supplies sensation to conjunctiva and 
 skin of upper eyelid, cornea, skin of forehead and nose, 
 lachrymal glands, mucous membrane of nose. Second, or 
 superior maxillary branch, supplies sensation to skin and 
 conjunctiva of lower lid, nose, cheek, upper lip, upper teeth 
 and alveolar processes, and palate. Third, or inferior 
 maxillary branch, supplies sensation to external auditory 
 meatus, side of head, mucous membrane of mouth, anterior 
 two-thirds of tongue, lower teeth, lower lip, and skin of 
 the lower part of the face. This branch, in addition, sup- 
 plies motion to the muscles of mastication (masseter, tem- 
 poral, external pterygoid, internal pterygoid), also to mylo- 
 hyoid and anterior belly of digastric. 
 
 3. By cell action is meant the function of cells, such as 
 power of movement, of growth, of ingestion, of egestion, 
 of reproduction, of secretion, of response to various 
 stimuli. 
 
 4. The function of the spleen: The following theories 
 have been held: (1) It is a source of production of the 
 white blood corpuscles ; (2) it is a source of production 
 of the red blood corpuscles during fetal life: (3) it is a 
 place where the red blood corpuscles are destroyed; (4) 
 uric acid is produced in the spleen; (5) an enzyme is pro- 
 duced in the spleen and is carried by the blood to the pan- 
 creas, where it converts the trypsinogen into trypsin. 
 
 5. The function of the thyroid is not definitely settled; 
 (1) it has some trophic function, regulating oxidation in 
 the body, and it is supposed to have also a special influence 
 on the vasomotor nerves, the skin, the bones, and on the 
 sexual functions; (2) it is supposed to antagonize toxic 
 substances, and (3) it produces an internal secretion. 
 
 Removal of the thyroid gland causes mental and bodily 
 dullness and apathy, tremors, twitchings, overgrowth of 
 the connective tissues, and development of fat; the hairs 
 fall out and the patient becomes unwieldy and clumsy in 
 
 II 
 
MEDICAL RECORD. 
 
 both body and mind. The complete removal causes death 
 in most animals, and it is not considered justifiable in man. 
 
 6. Glycogen is chiefly formed from the carbohydrates. 
 The liver cells act upon the dextrose into which the carbo- 
 hydrates have been converted by the action of the ptyalin 
 and amylopsin of the digestive juices. This may occur by 
 a simple process of dehydration : 
 
 C3H12U6 — H2O = CetlioOs 
 
 But the precise process by which it occurs in the liver cells 
 is not known. 
 
 At a subsequent period the glycogen is transformed into 
 dextrose and is returned to the circulation. Hence the 
 blood of the hepatic veins contains more sugar than the 
 blood of the arteries, and these latter more than the blood 
 in the veins (except the hepatic). This is the generally 
 accepted view, but it is denied by Pavy, and the whole sub- 
 ject is in a state of uncertainty. 
 
 7. The circulation of the blood is regulated in (a) the 
 arteries by: (1) The elasticity and tone of the arteries, 
 
 (2) the force and frequency of the cardiac contractions, 
 
 (3) the resistance in the capillaries; (b) in the capillaries 
 it is regulated by (1) the action of the heart, (2) the 
 action of the arteries ; (c) in the veins it is regulated by 
 (1) the action of the heart, (2) aspiration of the thorax, 
 (3) the contraction of the muscles, and (4) slightly by the 
 valves in the veins. 
 
 8. The functions of the skin are : Protection, sense of 
 touch, excretion, regulation of body temperature, absorp- 
 tion, and respiration. 
 
 CHEMISTRY. 
 
 1. Analytic methods consist in breaking up a compound 
 into its elements or into simpler compounds, as by acting 
 on a carbonate with an acid we get water and carbon 
 dioxide : CaC0 3 + H 2 S0 4 = CaS0 4 + H 2 + C0 2 . 
 
 Synthetic methods are the reverse of this, and consist in 
 building up compounds out of simpler compounds or out 
 of elements, as when 2H 2 -f- 2 = 2H2O. 
 
 2. The monosodic carbonate is decomposed by the tar- 
 taric acid ; sodium tartrate remains in the solution, and the 
 liberated C0 2 causes the effervescence. 
 
 3. HgCl 2 + 2KI = Hgl 2 + 2KCI. 
 
 4. Hydrogen is the essential element of all acids. 
 Hydracids contain no oxygen; oxyacids contain oxygen as 
 well as hydrogen. 
 
 5. Add cane sugar and evaporate; if the sugar turns 
 black H 2 S0 4 is piesent. 
 
 12 
 
MEDICAL RECORD. 
 
 (a) Aqua regia. 
 
 (b) Oil of vitriol. 
 
 (c) Green vitriol. 
 
 CHEMICAL NAME. 
 
 Nitrohydrochloric 
 
 acid. 
 Sulphuric acid. 
 Ferrous sulphate. 
 
 FORMULA. 
 
 HNO.+3HC1. 
 
 H 2 SO*. 
 FeS(X 
 
 7. Ordinary alum is aluminium ammonium sulphate. 
 
 8. They are all alkaline. The acidity of the urine is due 
 to monosodic phosphate. 
 
 9. Ferrous salts, on the addition of solution of potassium 
 hydroxide, give a greenish-white precipitate, changing to 
 green and then to reddish-brown, soluble in hydrochloric 
 acid, but insoluble in ammonium hydroxide. 
 
 10. A sulphate is a salt of sulphuric acid, and contains 
 more oxygen than a sulphite, which is a salt of sulphurous 
 acid: 
 
 H 2 S0 3 CaS0 3 
 
 Sulphurous acid Calcium sulphite 
 
 H 2 Sp 4 CaS0 4 
 
 Sulphuric acid Calcium sulphate 
 
 11. Test for albumin in the urine: "The urine must be 
 perfectly clear. If not so, it is to be filtered, and if this 
 does not render it transparent it is to be treated with a few 
 drops of magnesia mixture and again filtered. The reaction 
 is first observed. If it be acid, the urine is simply heated 
 to near the boiling point. If the urine be neutral or alka- 
 line^ it is rendered faintly acid by the addition of dilute 
 acetic acid and heated. If albumin be present a coagulum 
 is formed, varying in quantity from a faint cloudiness to 
 entire solidification, according to the quantity of albumin 
 present. The coagulum is not redissolved upon the addi- 
 tion of HNOs." 
 
 For sugar: Render the urine strongly alkaline by addi- 
 tion of Na 2 C0 3 . Divide about 6 c.c. of the alkaline liquid 
 in two test-tubes. To one test-tube add a very minute 
 quantity of powdered subnitrate of bismuth; to the other 
 as much powdered litharge. Boil the contents of both 
 tubes. The presence of glucose is indicated by a dark or 
 black color of the bismuth powder, the litharge retaining 
 its natural color. 
 
 12. Chemical test for blood: Boil a fragment of dried 
 blood with a drop of glacial acetic acid on a slide; on 
 cooling, hemin crystals separate out. If the blood stain 
 is not recent a crystal of sodium chloride should be added 
 with the acetic acid. 
 
 PHYSICAL DIAGNOSIS. 
 
 1. Moderate dullness is found in: Consolidation of lung 
 (in phthisis, pneumonia, gangrene, tumors), collapse of 
 
 13 
 
MEDICAL RECORD. 
 
 lung, congestion of lung, thickened pleura. Absolute dull- 
 ness is found in : Rydrothorax or pleurisy with effusion, 
 empyema. 
 
 2. Acute bronchitis begins with coryza; soreness and 
 tenderness may be behind the sternum ; pain may be caused 
 by coughing ; expectoration is abundant ; dyspnea is in pro- 
 portion to the extent of the disease; the pulse-respiration 
 ratio is not altered; fever is slight or absent; various rales 
 may be present; the condition is generally bilateral; ends 
 by lysis. 
 
 Lobar pneumonia begins with rigors, sometimes also 
 with vomiting; pain on affected side; expectoration is 
 rusty and tenacious; breathing is very rapid; the pulse- 
 respiration ratio is much disturbed; there is considerable 
 fever; crepitant rales are heard in first stage, also in third 
 stage (rale redux) ; usually only one side is affected; ends 
 by crisis. 
 
 3. Rales are produced within bronchi or lungs, while 
 friction sounds occur in the pleura and do not pass away 
 after coughing. The creaking or crackling pleuritic fric- 
 tion is often mistaken for a crepitant rale, and Tyson gives 
 the following distinguishing characteristics : The friction 
 so and does not pass away after coughing, while the crepi- 
 tant rale may do so; the friction sound is more superficial 
 and localized, while the crepitant rale is deep and more 
 diffuse; the friction sound has a to and fro movement 
 during inspiration and expiration, while the crepitant rale 
 is only heard at the end of inspiration; pleuritic friction 
 sounds are generally heard in the axilla or side of the chest, 
 while the crepitant rale is most frequently posterior, often 
 at the base of the lung. — (From Gould and Pyle's Cyclo- 
 pedia.) 
 
 4. See French's "Practice of Medicine" (1907), page 
 630; or Osier's "Practice of Medicine" (1909), page 857. 
 
 5. Pneumothorax, or cavity in the lung. 
 
 6. In endocarditis: The murmur is soft, not harsh; it is 
 systolic or diastolic; it may be transmitted; it is heard 
 loudest at definite points ; it is not followed by signs of 
 effusion ; the apex beat may be strong. 
 
 In Pericarditis: The murmur is harsh; is not in connec- 
 tion with the heart sounds: is heard loudest at the base of 
 the heart and over the precordium; is followed by (or 
 accompanied with) signs of effusion; the apex beat is gen- 
 erally feeble. 
 
 7. See French's "Practice of Medicine" (1907), page 
 681; or Osier's "Practice of Medicine" (1909), page 635. 
 
 8. See French's "Practice of Medicine" (1907), page 
 579; or Osier's "Practice of Medicine" (1909), pages 802 
 and 807. 
 
 14 
 
MEDICAL RECORD. 
 
 ETIOLOGY. PATHOLOGY, SYMPTOMATOLOGY.. AND DIAGNOSIS. 
 
 1. See French's "Practice of Medicine" (1907), page 824; 
 or Osier's "Practice of Medicine" (1909), pages 556, 557, 
 and 560. 
 
 2. See French's "Practice of Medicine" (1907), page 
 907; or Osier's "Practice of Medicine ' (1909), page 703. 
 
 3. See French's "Practice of Medicine" (1907), page 
 625; or Osier's "Practice of Medicine" (1909;, page 849. 
 
 4. See French's "Practice of Medicine" (1907), page 
 498; or Osier's "Practice of Medicine" (1909), page 45. 
 
 5. In pericarditis: The friction sound is not affected by 
 the patient holding his breath ; the pulse is feeble ; the pain 
 is slight and is not affected by respiration. In acute pleu- 
 risy: The friction sound ceases when the patient holds his 
 breath; the pulse is regular and strong; the pain is sharp 
 and cutting, and is worse on inspiration. 
 
 6. See French's "Practice of Medicine" (1907), page 141; 
 or Osier's "Practice of Medicine" (1909), page 159. 
 
 7. See French's "Practice of Medicine" (1907), page 
 218; or Osier's "Practice of Medicine" (1909), page 210. 
 
 8. See French's "Practice of Medicine" (1907), page 154; 
 or Osier's "Practice of Medicine" (1909), page 170. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), pages 3 and 262. 
 
 2. Forces by which the child is expelled: (1) Uterine 
 contractions; (2) contractions of the diaphragm; (3) con- 
 tractions of the abdominal muscles. 
 
 3. See Williams' "Obstetrics" (1909), page 478; or 
 Hirst's "Obstetrics" (1909), page 436. 
 
 4. See Williams' "Obstetrics" (1909), page 267; or 
 Hirst's "Obstetrics" (1909), page 404. 
 
 5. In cases of shoulder presentation, if seen before 
 labor, version should be performed to correct the mal- 
 presentation ; in case of impaction a cesarean section is 
 indicated ; sometimes decapitation or embryotomy has been 
 performed, but a cesarean section is preferable. Cases of 
 shoulder presentation have been known to terminate spon- 
 taneously, but it is not advisable to rely on this possi- 
 bility. 
 
 6. See Williams' "Obstetrics" (1909), page 846; or 
 Hirst's "Obstetrics" (1909), page 939. 
 
 7. See Williams' "Obstetrics" (1909), page 403. 
 
 8. See Williams' "Obstetrics" (1909), page 325; or 
 Hirst's "Obstetrics" (1909), pages 609 and 867. 
 
 GYNECOLOGY. 
 
 1. The following (from Gould and Pyle's Cyclopedia of 
 
MEDICAL RECORD, 
 
 Medicine and Surgery) is a useful classification of uterine 
 hemorrhages, and also give the causes of the same: 
 
 1. Hemorrhages complicating pregnancy, labor, or the 
 puerperium: 
 
 A. Hemorrhages of pregnancy : Caused by (i) placenta 
 praevia; (2) premature separation of a normally situated 
 placenta; (3) apoplexy of the decidua or placenta. 
 
 B. Hemorrhages of labor: Caused by (1) placenta 
 praevia; (2) premature separation of a normally situated 
 placenta; (3) relaxation of the uterus; (4) laceration of 
 the cervix;- (5) rupture or inversion of the uterus. 
 
 C. Hemorrhages of the puerperium: Caused by (1) re- 
 tained secundines; (2) displaced uterus; (3) displaced 
 thrombi; (4) fibroid tumors; (5) hypertrophied decidua; 
 (6) carcinoma. 
 
 II. Hemorrhages occurring in the non-pregnant woman: 
 
 A. In virgins before the age of thirty: Caused by (1) 
 uterine congestion, the result of cold or exposure; (2) 
 endometritis; (3) polypi and fibroid tumors. 
 
 B. In married women before the age of thirty: Caused 
 by (1) subinvolution; (2) laceration of the cervix; (3) 
 endometritis; (4) retrodisplacements of the uterus; (5) 
 polypi and fibroid tumors. 
 
 C. In women after the age of thirty: Caused by (1) 
 carcinoma of the cervix; (2) carcinoma of the body of the 
 uterus; (?) sarcoma of the uterus. 
 
 The treatment depends on the cause. For details see any 
 work on obstetrics or gynecology. 
 
 2. Amenorrhea may be due to : Absence or imperfect 
 development of the generative organs; also to stenosis, 
 obstructions, or atresia of the genital tract; also to oper- 
 ative removal of the uterus c r its appendages. Other 
 causative factors are: Acute infectious diseases, anemia, 
 chlorosis, obesity, drug habits, alcoholism, overstudy, lack 
 of exercise, exposure to cold, and various emotional causes. 
 Pregnancy or lactation may be the cause. 
 
 Treatment consists in : Removing or treating the cause. 
 
 3. Ectopic pregnancy is^ a pregnancy in which the product 
 of conception is not inside the uterine cavity. Varieties: 
 Tubal, ovarian, interstitial, abdominal. 
 
 4. "The consistency of a tumor is ascertained by palpa- 
 ting it in all directions between the fingers of both hands 
 and by tapping it to determine the absence or presence of 
 fluctuation. The left hand is placed firmly over the abdo- 
 men on one side of the tumor and the fingers of the other 
 hand strike or tap the abdominal wall on the opposite side; 
 if fluid is present a thrill or wave is detected. The fluctu- 
 ation wave, however, may be absent in multilocular cysts 
 and in tumors having thick, tense walls or viscid contents. 
 The length and intensity of the thrill over different parts 
 
 16 
 
MEDICAL RECORD. 
 
 of an abdominal enlargement are of great diagnostic value 
 in many instances. Thus, in ascites and unilocular cysts 
 there is no variation in the character of the wave, whereas 
 in a multilocular tumor it differs as to length and intensity 
 over different parts of the growth. In obese womei. the fat 
 contained in the belly walls causes false wave or thrill 
 when the abdomen is tapped, which may be mistaken at 
 times for the presence of fluid, lo eliminate this factor an 
 assistant places the ulnar edge of his hand firmly on the 
 abdominal wall in the median line, while the examiner taps 
 the abdomen in the usual manner/' — (From Ashton's 
 Gynecology.) 
 
 5. As to preference between the vaginal and abdominal 
 routes, the following is taken from Garrigues' Gynecology: 
 "If the vaginal route is available it should be preferred, 
 because it entails much less shock, requires a simple after- 
 treatment, does not leave any visible cicatrix, predisposes 
 less to hernia, and allows the patient to resume work in 
 shorter time. On the other hand, the vaginal route is more 
 difficult on account of the limited space. Hemorrhage is 
 more troublesome to check, adhesions are harder to sepa- 
 rate, and the bladder and intestine more exposed to injury 
 and less accessible for repair. The pelvic cavity cannot be 
 seen so well and the abdominal not at all. If tissue is left 
 to mortify it emits an offensive odor." 
 
 6. Symptoms of nbroids: Hemorrhage, leucorrhea, pain, 
 pressure symptoms (disturbances and displacements of 
 bladder, rectum, urethra, and uterus), backache, bearing- 
 down sensation, dysmenorrhea. 
 
 7. Retroversion. Etiology: Relaxation of uterine liga- 
 ments; increased weight of fundus; subinvolution; ovarian 
 or other tumor pressing on front of uterus ; distended 
 bladder; peritonitis or cystitis; prolonged dorsal decubitus 
 and tight bandaging in the puerperium. 
 
 Retroflexion. Etiology: Tight lacing and tight cloth- 
 ing ; congenital conditions ; pressure by tumors ; metrititis 
 and parametritis with adhesions ; atonic conditions of the 
 uterus following labor, and the conditions that cause retro- 
 version. 
 
 8. A complete gynecologica* examinaticn would include 
 (1) anamnesis, including family history; personal history, 
 with special reference to menstruation, labors, and mis- 
 carriages, and present illness. (2) Examination of the 
 abdomen (and breasts), including inspection, palpation, 
 percussion, auscultation, and mensuration. (3) Inspection 
 of the external genitals. (4) Vaginal examination, digital, 
 bimanual, and with speculum. (5) Bimanual examination 
 of uterus and appendages. (6) Sometimes the sound, or 
 curette, may be required. (7) Chemical and microscopical 
 examination of the urine. (8) Microscopical examination 
 
 17 
 
MEDICAL RECORD. 
 
 of discharges or uterine scrapings. (9) Rectal examina- 
 tion. (10) Cystoscopic examination and perhaps ureteral 
 catheterization. (11) In case of phantom tumor or pseudo- 
 cyesis, anesthetization would be required. 
 
 SURGERY. 
 
 1. The general rules for treatment of wounds: Stop the 
 bleeding; remove foreign bodies; make as aseptic as pos- 
 sible; coapt the edges; drain when necessary; dress, and 
 secure rest to the part; bring about reaction; ease pain. 
 
 2. See Rose and Carless' "Surgery" (1908), page 112; or 
 Da Costa's "Surgery" (1908), page 174. 
 
 3. See Rose and Carless' "Surgery" (1908), page 175; or 
 Da Costa's "Surgery" (1908), page 154. 
 
 4. 
 
 CHANCRE. 
 
 First lesion of a constitu- 
 tional disease, viz., syph- 
 ilis. 
 
 Due to syphilitic infection. 
 
 Generally a venereal infec- 
 tion. 
 
 May occur anywhere on the 
 body. 
 
 Period of incubation never 
 so short as ten days. 
 
 Generally single. 
 Not autoinoculable. 
 Secretion slight. 
 
 Slightly or not at all painful. 
 As a rule only occurs once 
 
 in any patient. 
 Buboes are painless and sel- 
 
 dom suppurate. 
 
 CHANCROID. 
 
 A local disease. 
 
 Due to contact with secre- 
 tion from chancroid. 
 
 Always a venereal infec- 
 tion. 
 
 Nearly always on genitals. 
 
 Period of incubation always 
 less than ten days (gener- 
 ally about three). 
 
 Generally multiple. 
 
 Autoinoculable. 
 
 Secretion profuse and puru- 
 lent. 
 
 Generally painful. 
 
 May reoccur in same patient. 
 
 Buboes are painful and 
 usually suppurate. 
 
 5. See Rose and Carless' "Surgery" (1908), page 481; or 
 Da Costa's "Surgery" (1908), page 464. 
 
 6. See Rose and Carless' "Surgery" (1908), pages 620 
 621, and 622; or Da Costa's "Surgery" (1908), pages 588 
 and 590. 
 
 7. See Rose and Carless' "Surgery" (1908), pages 1175 
 and 1176; or Da Costa's "Surgery" (1908), pages 1110 and 
 
 mi. . 
 
 8. See Rose and Carless' "Surgery" (1908), page 909; or 
 Da Costa's "Surgery" (1908), page 821. 
 
 18 
 
MEDICAL RECORD. 
 
 EYE, EAR, NOSE, AND THROAT. 
 
 1. Acute catarrhal conjunctivitis. Symptoms: Hy- 
 peremia, profuse lacrymation, epiphora, a profuse discharge, 
 sensation of sand in the eye, and sometimes photophobia. 
 Treatment : Astringent and antiseptic washes are of value. 
 Ascertain the underlying cause, if possible, and remove it. 
 Anointing the lids with pure or medicated vaseline every 
 evening is necessary. Alum, tannic acid, silver nitrate, and 
 zinc sulphate are valuable as astringents. In intractable 
 cases a 50 per cent, solution of boroglycerid in glycerin 
 should be applied once daily. — (Gould and Pyle's Cyclo- 
 pedia.) 
 
 2. Gonorrheal ophthalmia. Symptoms: Swelling and 
 redness of the eyes, the presence of a discharge which 
 soon becomes purulent, the conjunctiva of the lids becomes 
 thickened, the eyelids are edematous, pain is severe, and 
 there is some fever. Dangers: Ulceration and sloughing 
 of the cornea, perforation of the anterior chamber, and 
 blindness. Management: Protect the sound eye. Wash 
 the eye carefully every half hour with a saturated solution 
 of boric acid; pus must not be allowed to accumulate. 
 Two drops of a 2 per cent, solution of nitrate of silver 
 must also be dropped onto the cornea every night and 
 morning. The eyes must be covered with a light, cold, 
 wet compress. The patient must be isolated, and all 
 cloths and compresses used must be burnt. In adults the 
 irrigation must be frequent, about every half hour or 
 hour. 
 
 3. Management of corneal ulcer: The treatment con- 
 sists in putting the eye at rest, instilling atropin, and the 
 application of a bandage. Leeches to the temple will re- 
 lieve the pain. Hot compresses have the same effect. The 
 eye should be douched with sublimate solution, 1 :5ooo, and 
 iodoform dusted upon the cornea. Stronger sublimate 
 solution, boroglycerid 50 per cent., and formalin 10 per 
 cent, are sometimes necessary. Cauterization is occa- 
 sionally indicated. If perforation seems probable, it should 
 be hastened by a puncture. — (Gould and Pyle's Cyclopedia.) 
 
 4. Cerumen may become impacted in the external au- 
 ditory canal. It may cause deafness, tinnitus, giddiness, 
 cough; it is diagnosed by being seen (with the aid of 
 an ear speculum). Syringing with warm water containing 
 sodium bicarbonate and glycerin ; if near the orifice, it 
 may be removed with a spud. 
 
 5. In acute suppurative otitis media: Pain (lessened 
 when drum perforates), fever (ioo° to 104 R), tinnitus, 
 deafness (usually partial only), and purulent discharge 
 (after perforation). Treatment: Dry heat allays the pain. 
 Wanned water or warmed carbolic acid solution (1:40) 
 
 19 
 
MEDICAL RECORD. 
 
 may be used. Inflations, aspirations, etc., should be 
 avoided. If the nares are filled with tough secretions, a 
 spray of Dobell's solution may be used. If the pain con- 
 tinues over six hours in a child or over twelve hours in 
 an adult without spontaneous perforation of the tympanic 
 membrane, paracentesis of that structure should be per- 
 formed. The concha and meatus should be smeared with 
 petrolatum to avoid chapping, and the secretions should be 
 gently mopped off as they appear. Under this treatment 
 the ear usually returns to normal in two to three weeks." — 
 (Gould and Pyle's Pocket Cyclopedia of Medicine and 
 Surgery. ) 
 
 6. To arrest epistaxis: (i) Try to cauterize the bleeding 
 point; (2) plug the nasal cavity with gauze soaked in 
 adrenalin; (3) inject into the nares a solution of peroxide 
 of hydrogen; (4) plug the nares, anteriorly and poste- 
 riorly; (5) an inflating plug may be used. 
 
 7. The most conclusive evidence of diphtheria is the 
 finding of the Klebs-Loeffler bacillus. See French's "Prac- 
 tice of Medicine" (1907), pages 192 and 196; or Osier's 
 "Practice" (1909), pages 205 and 209. 
 
 8. Intubation is indicated in : Diphtheria, edema of glot- 
 tis, and laryngeal obstruction. Laryngotomy in : Spasm of 
 glottis, foreign body in the larynx, and dyspnea due to 
 some sudden obstruction. See Rose and Carless' "Sur- 
 gery" (1908), page 914; or Da Costa's "Surgery" (1908), 
 page 770. 
 
 HYGIENE AND MEDICAL JURISPRUDENCE. 
 
 i. See French's "Practice of Medicine" (1907), pages 
 301, 326, and 307; or Osier's "Practice of Medicine" (1909), 
 pages 115, 141, 120, and 144. 
 
 2. Immunity is the ability of a tissue or organism to 
 resist infection. The absence or loss of this defensive 
 power against infection is called susceptibility. 
 
 3. See French's "Practice of Medicine" (1907), page 
 107; or Osier's "Practice of Medicine" (1909), pages 97 
 and 99. 
 
 4. The school building should be as near as possible to 
 the center of the area which it is to serve; the site should 
 be airy and open, of sufficient size, and somewhat ele- 
 vated; it should not be too near factories, busy streets, 
 or railways; the soil should be as free as possible from 
 organic matter. The building should be so planned that 
 the corners < look towards the four points of the com- 
 pass. In this way the sun will have access to each side 
 and to every room during some part of the day. The 
 building should have as few stories as possible. The 
 walls should be of brick or stone, and should be pointed 
 with cement; the inner surface of the wall should be 
 
 20 
 
MEDICAL RECORD, 
 
 cemented smooth. The foundations must be solid. The 
 general arrangement will depend upon size of site, number 
 of scholars, and number of required rooms. Fifteen 
 square feet per child should be allowed. Details will have 
 to be considered on : plans, accommodations to be pro- 
 vided, shape and size of class rooms, distribution of 
 rooms, teachers' rooms, corridors, entrances and stair- 
 cases, playground, ventilation, heating, lighting, and plac- 
 ing of windows, sanitation, lavatories, water supply, drink- 
 ing water, sewage disposal, removal of refuse, sanitary 
 appliances, and drainage. 
 
 5. Malpractice is a failure on the part of a medical prac- 
 titioner to use such skill, care, and judgment in the treat- 
 ment of a patient as the law requires ; and thereby the 
 patient suffers damage. If due to negligence only, it is civil 
 malpractice. But if done deliberately, or wrongfully, or 
 if gross carelessness or neglect have been shown, or if 
 some illegal operation (such as criminal abortion) be per- 
 formed, it is criminal malpractice. 
 
 6. A delusion is a belief in something which has no real 
 existence, but is purely imaginary; and o"ut of which the 
 person cannot be reasoned. An illusion is a false or per- 
 verted impression, received through one of the senses. 
 
 7. In tetanus, the onset is gradual, is apt to begin with 
 trismus, swallowing is difficult or impossible, the condition 
 is persistent, consciousness is dulled or lost, and there is 
 history of a wound or injury. In strychnine poisoning the 
 onset is more sudden, the muscles of the jaw and neck 
 are generally the last to be affected, there are marked re- 
 missions with muscular relaxation, consciousness is re- 
 tained, and there is no history of a wound or injury. 
 
 8. The symptoms of acute poisoning by coal tar deriva- 
 tives are given by Riley as follows : After a full toxic 
 dose there soon follows a sense of chilliness and, especially 
 in the case of antipyrin, nausea, and vomiting. The skin 
 becomes cyanosed and covered with cold perspiration. The 
 pulse becomes soft, slow, and weak, and the respirations 
 slow and shallow, death usually resulting from respiratory 
 paralysis. Occasionally paroxysms of sneezing have been 
 observed. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Board of Medical Examiners, Territory of Arizona. 
 
 ANATOMY. 
 
 1. Give a description of the general lymphatic system. 
 
 2. Give the histology of compact bone. 
 
 3. Give the structure of the spinal cord. 
 
 21 
 
MEDICAL RECORD. 
 
 4. Name the muscles of the back, grouping them in 
 their different layers. 
 
 5. Give the origin, insertion, action, blood and nerve 
 supply of the following muscles; occipitofrontalis, pector- 
 alis major, deltoid, adductor longus, rectus abdominis, and 
 sternomastoid. 
 
 6. Name the lobes and fissure of the brain. 
 
 7. Describe the peritoneum. 
 
 8. Name the anatomical structures derived from the 
 epiblast, mesoblast, hypoblast. 
 
 9. Give the gross and minute anatomy of the kidney. 
 
 10. Describe the brachial plexus and give its distribu- 
 tion. 
 
 MATERIA MEDICA. 
 
 i. Explain the distinction between the physiological 
 action and the therapeutic use of drugs; between rational 
 and empirical therapeutics. 
 
 2. What ratios do hypodermic and rectal dosage bear 
 to that by the mouth? Give rule for children's dosage. 
 
 3. What are alkaloids ? Give the four official alkaloids 
 of cinchona bark. 
 
 4. Give a safe and efficient dose for an adult of mor- 
 phine sulphate ; strychnine sulphate, cocaine hydrobromide ; 
 hyoscine hydrobromate ; tr. digitalis ; tr. aconite. 
 
 5. Give the active principles of digitalis ; give indica- 
 tions and contraindications for the use of the drug in 
 diseases of the heart. 
 
 6. Name five potassium salts commonly used in medi- 
 cine. State dose. 
 
 7. Give source and action of ergot. 
 
 8. Name some of the chief alkaloids of opium and state 
 the therapeutic differences in the use of opium and mor- 
 phine. 
 
 9. What hypnotic should be avoided if patient has a 
 weak heart? 
 
 10. What anesthetic do you use, and why do you pre- 
 fer it? 
 
 PHYSIOLOGY. 
 
 1. Upon what theory is physiology founded? What is 
 the structural basis of all organisms? 
 
 2. Life is in its ultimate analysis the metabolism of 
 plasm; define plasm and metabolism. Give chemical con- 
 stituents of plasm. 
 
 3. Lymph : where elaborated ; how conveyed ; compo- 
 sition and function. 
 
 4. Give source and function of adrenalin, thyroidin, and 
 opsonin. 
 
 5. Describe the local peculiarities of the circulation of 
 the blood in the brain, lungs, liver, and erectile organs. 
 
 22 
 
MEDICAL RECORD. 
 
 6. Give mechanism of respiratory movements; ratio of 
 respiration to pulse ; effects of atmospheric pressure on 
 respiration; influence of respiratory movements on heart 
 and circulation of the blood and lymph. 
 
 7. Give the source and action of the various secretions 
 concerned in the process of digestion. 
 
 8. Where are the following centers: (a) Parturition, 
 (b) auditory, (c) respiratory, (d) visual, (e) micturition? 
 
 9. Define: (a) Amnion, (b) corpus luteum, (c) leucin, 
 
 (d) erythrocyte, (e) neuron, (/) hemolysin. 
 
 10. Distinguish between cerebral and spinal paralysis in 
 
 (a) muscle-tonus, (b) nutrition of muscles, (c) electrical 
 reactions of muscles. 
 
 CHEMISTRY. 
 
 1. Define decomposition. Name three physical decom- 
 posing agents. 
 
 2. Sulphur: (a) occurrence in nature, (&) physical and 
 chemical properties, (c) what compound of sulphur is lib- 
 erated in decomposing organic matter? 
 
 3. Give chemical formula for (a) hydrochloric acid, 
 
 (b) sulphuric acid, (c) Epsom salts, (d) Rochelle salts, 
 
 (e) Glauber salts. 
 
 4. What is an alkaloid? Name five important ones and 
 give derivation of same. 
 
 5. What are ptomains ? Give usual symptoms present in 
 ptomain poisoning. 
 
 6. Name the general properties of carbohydrates and 
 mention the occurrences in nature. 
 
 7. Describe in detail (a) a chemical test for blood; (b) 
 for pus in the urine, (c) What urinary test is considered 
 most important from a diagnostic and prognostic stand- 
 point in pulmonary tuberculosis? (d) How may the 
 amount of total solids passed in the urine in 24 hours 
 be approximated? (e) How many grains of total solids 
 should a man weighing 160 pounds pass in 24 hours? 
 (/) Give normal sp. gr. of human urine, (g) Give test 
 for albumin in urine; (h) for sugar in urine. (1) What 
 is the normal amount of urea passed by man in 24 hours, 
 and give a method of estimating the amount excreted. 
 
 8. (a) Name a test by which arsenic may be detected 
 with certainty, (b) Give antidote for arsenic poisoning. 
 
 9. Name some drugs which combined in a prescription 
 would be chemically incompatible. Give chemical formulae. 
 
 10. Give chemistry of pancreatic ferment in digestion. 
 
 PATHOLOGY. 
 
 1. In what diseases does hypertrophy of the heart most 
 commonly result? Why? 
 
 2. What are the commonest underlying conditions in 
 angina pectoris? 
 
 23 
 
MEDICAL RECORD. 
 
 3. What are the microscopic characteristics of the ex- 
 udate in croupous pneumonia? In catarrhal pneumonia? 
 
 4. What pathological conditions are productive of icterus? 
 
 5. Differentiate, pathologically, between a typhoid ulcer 
 and a tuberculous ulcer of the intestine. 
 
 6. ^ Give the usual methods of metastatic extension of 
 carcinoma and of sarcoma. 
 
 7. In what locations in the body is the typhoid bacillus 
 found in typhoid fever? 
 
 8. Name the parasite of malaria and describe its develop- 
 ment in the blood. 
 
 9. Describe briefly lesions in the cord in tabes dorsalis. 
 
 10. What is pathological leucocytosis ? 
 
 PRACTICE. 
 
 1. Give differential diagnosis between measles, scarlet 
 fever, and smallpox. 
 
 2. Give treatment of acute gastrointestinal catarrh in 
 children. 
 
 3. Give predisposing cause and treatment of pulmonary 
 hemorrhage. 
 
 4. Describe the etiology and pathology of typhoid fever. 
 
 5. Give diagnosis and treatment of pneumonia. 
 
 6. W r hat is the prognosis as to the cure of epilepsy? 
 Treatment of epilepsy? 
 
 7. Give treatment of acute bronchitis. 
 
 8. What are the complications and sequelae of scarlet 
 fever? 
 
 9. Give varieties of erysipelas, with treatment. 
 
 10. Give treatment of asthma. 
 
 SURGERY. 
 
 i< What is the point of election for ligation of the 
 subclavian artery? Describe fully the technique. 
 
 2. Give differential diagnosis of osteosarcoma and tuber- 
 culous knee-joint. 
 
 3. Differential diagnosis of renal and cystic calculi. 
 Give treatment of each. 
 
 4. How does the Halstead differ from the Bassini opera- 
 tion for inguinal hernia? 
 
 5. Symptoms, diagnosis, and treatment of prostatic 
 hypertrophy. 
 
 6. Etiology, diagnosis, and treatment of fistula in ano. 
 
 7. Diagnosis and treatment of embolism of the mesen- 
 teric vessels. 
 
 8. Diagnosis and treatment of ulcerative perforation of 
 the intestine. 
 
 9. Differential diagnosis and treatment of hydrothorax 
 and pyothorax. <* 
 
 24 
 
MEDICAL RECORD. 
 
 io. Describe minutely the operation for enucleation of 
 the eye. 
 
 OBSTETRICS. 
 
 i. Describe the changes that take place in the mucous 
 lining of the uterus preparing it for the reception of the 
 fertilized ovum. If it becomes attached, what further 
 changes take place? If it passes without becoming at- 
 tached, what further changes? 
 
 2. Describe the conditions most likely to result in 
 laceration of the cervix and perineum and what remedies 
 would you use and what treatment would you employ to 
 reduce the danger as much as possible? 
 
 3. Describe fully how you would conduct a face presen- 
 tation. 
 
 4. Describe how you would conduct a breech presenta- 
 tion to decrease the danger to both mother and child as 
 much as possible. 
 
 5. Classify, give symptoms, and treatment of extra- 
 uterine pregnancy. 
 
 6. Give classifications, symptoms, and treatment of pla- 
 centa prsevia. 
 
 7. Give technique of obstetric asepsis and antisepsis dur- 
 ing pregnancy, parturition, and the puerperium. 
 
 8. Mention four important causes of active uterine con- 
 tractions of normal labor. 
 
 9. Give the cause and treatment of puerperal sepsis. 
 
 10. Give the three important diameters of the fetal head 
 at term; the diameters of the normal female pelvis. 
 
 GYNECOLOGY. 
 
 1. What are the most common causes of pelvic cellulitis? 
 
 2. State how chronic purulent salpingitis may cause 
 sterility. 
 
 3. Give differential diagnosis between acute non- 
 puerperal ovaritis and appendicitis. 
 
 4. Describe urethral caruncle and give treatment. 
 
 5. When is ventral fixation contraindicated? 
 
 6. What is vaginismus? Give its causes and treatment. 
 
 7. Give treatment in detail of retroversion of less than 
 one year's standing. 
 
 8. Explain how fibroid tumors may cause ascites. 
 
 9. When would you perform trachelorrhaphy and when 
 amputation of cervix in cervical lacerations? Give tech- 
 nique of trachelorrhaphy. 
 
 10. What is the cause of chronic inflammation of Skene's 
 glands? Give treatment. 
 
 25 
 
MEDICAL RECORD, 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Board of Medical Examiners, Territory of Arizona. 
 
 ANATOMY. 
 
 i. See Cunningham's "Anatomy" (1909), page 904; or 
 Gray's "Anatomy" (1908), page 772. 
 
 2. See Cunningham's "Anatomy" (1909), page 72; or 
 Gray's "Anatomy" (1908), page 38. 
 
 3. See Cunningham's "Anatomy" (1909), page 456; or 
 Gray's "Anatomy" (1*908), page 843. 
 
 4. Muscles of the Back. First layer: Trapezius, and 
 Latissimus dorsi. 
 
 Second layer: Levator anguli scapulae, Rhomboideus 
 major and Rhomboideus minor. 
 
 Third layer: Serratus posticus superior, Serratus pos- 
 ticus inferior, Splenius capitis et colli. 
 
 Fourth layer: Erector spinae, Iliocostalis, Longissimus 
 dorsi, Spinalis dorsi, Cervicalis ascendens, Transversalis 
 cervicis, Trachelomastoid, Complexus, Biventer cervicis, 
 and Spinalis colli. 
 
 Fifth layer: Semispinalis dorsi, Semispinalis colli, Mul- 
 tifidus spinae, Rotatores spinae, Supraspinales, Interspinals, 
 Extensor coccygis, Intertransversalis, Rectus capit'is 
 posticus major, Rectus capitis posticus minor, Obliquus 
 capitis superior, and Obliquus capitis inferior. 
 
 5. See Cunningham's "Anatomy" (1909). pages 395, 323, 
 328, 362, 426, and 405; or Gray's "Anatomy" (1908), pages 
 369, 466, 472, 522, 444, and 391. 
 
 6. Lobes of the brain: Frontal, parietal, occipital, tem- 
 poral, central, limbic, and olfactory. 
 
 Fissures of the brain: Longitudinal, transverse, Sylvian, 
 of Rolando, calcarine, parietal, and parieto-occipital. 
 
 7. See Cunningham's "Anatomy" (1909), pages 1048 and 
 1097; or Gray's "Anatomy" (1908), page 1255. 
 
 8. From the epiblast are derived: The skin, and its 
 appendages (hair, nails), and glands (including the mam- 
 mary glands) ; the nervous system (brain, spinal cord, 
 ganglia and nerves) ; the epithelial parts of the organs of 
 special sense. 
 
 From the mesoblast are derived: The skeleton; con- 
 nective tissues ; muscles and bones ; heart, blood-vessels, 
 lymphatics, and spleen; the urinary and generative organs. 
 
 From the hypoblast are derived: The epithelial lining^ of 
 the alimentary canal and its glands; the epithelial^ lining 
 of the respiratory tract, Eustachian tube, thyroid and 
 thymus. 
 
 9. See Cunningham's "Anatomy" (1909), page 1130; or 
 Gray's "Anatomy" (1908), page 1419. 
 
 26 
 
MEDICAL RECORD. 
 
 io. See Cunningham's "Anatomy" (1909), page 622; or 
 Gray's "Anatomy" (1908), page 994. 
 
 MATERIA MEDICA. 
 
 1. The physiological action of a drug is the influence 
 which the drug exerts upon the various bodily organs or 
 tissues in a state of health. The therapeutic use signifies 
 the use of drugs in accordance with "rational" or "em- 
 pirical" usage as defined below. 
 
 Rational therapeutics is the use of remedies based on a 
 combined knowledge of their physiological action and of 
 the pathological condition present in the patient. 
 
 Empirical therapeutics is the use of remedies based on 
 no other "reason" but that some one has found them use- 
 ful or beneficial in conditions similar to the one under 
 treatment. 
 
 2. If the dose by mouth, is one grain, the hypodermic 
 dose would be about one-half grain, and the dose by rec- 
 tum about one and a half grains. 
 
 Rule for children's dosage: x 
 
 Let x = the age of a patient ; then = the 
 
 x + 12 
 
 fraction of the adult dose which the patient should receive. 
 
 Thus, a patient of four years old should receive 
 
 4 4 1 
 
 = — = — of an adult dose. 
 
 4 + 12 16 4 
 
 3. Alkaloids are organic nitrogenized substances, alka- 
 line in reaction, and capable of combining with acids to 
 form salts in the same way that ammonia does. 
 
 The four official alkaloids of cinchona bark, are : Quinine, 
 quinidine, cinchonine, and cinchonidine. 
 
 4. Morphine sulphate, dose, gr. X A ; strychnine sulphate, 
 dose, gr. 1/64; cocaine hydrobromide, not used, the dose 
 of cocaine hydrochloride is gr. % ; hyoscine hydrobromate, 
 dose, gr. 1/128; tr. digitalis, dose TT£xv; tr. aconite, dose 
 TT£viij. 
 
 5. Digitalis. Active principles: Digitalin, digitalein, 
 digitin, digitoxin, and digitonin. 
 
 Digitalis is indicated in diseases of the heart, (1) when 
 the heart action is rapid and feeble, with low arterial ten- 
 sion ; (2) in mitral lesions when compensation has begun to 
 fail; (3) in non-valvular cardiac affections; (4) in irritable 
 heart, due to nerve exhaustion. Digitalis is contraindicated 
 in diseases of the heart (1) in aortic lesions when uncom- 
 bined with mitral lesions ; (2) when the heart action is 
 strong, and arterial tension high. 
 
 6. Five potassium salts: Potassium bromide, dose, 
 gr. xv : potassium iodide, dose, gr. vijss; potassium acet- 
 ate, dose, gr. xxx; potassium citrate, dose, gr. xv; potas- 
 sium chlorate, dose, gr. iv. 
 
 27 
 
MEDICAL RECORD 
 
 7. Ergot. Source: The sclerotium of the claviceps pur- 
 purea. 
 
 Physiological action: Ergot stimulates and causes con- 
 traction of involuntary muscle fibers, hence it is a vaso- 
 constrictor, hemostatic, and oxytocic. It is also a cardiac 
 sedative, it raises the blood pressure, it increases peristal- 
 sis, and is an emmenagogue. 
 
 8. The chief alkaloids of opium, are: Morphine, codeine, 
 thebaine, narceine, narcotine, papaverine, and pseudomor- 
 phine. 
 
 Therapeutic differences in the use of opium wnd mor- 
 phine: Opium is more slowly absorbed, acts more slowly, 
 the effect lasts longer, and its immediate local effect on 
 the intestines is more marked. Morphine is less irritating, 
 less constipating, less, diaphoretic, less stimulating to the 
 heart and nervous system, and affects the secretions less 
 than opium. Morphine is more liable to cause skin 
 eruption and itching, it is more certain and rapid as 
 an anodyne and hypnotic, and is also more quickly elim- 
 inated. 
 
 9. If a patient has a weak heart, chloral should not be 
 used as a hypnotic. 
 
 10. Ether; because it is safer (as shown by statistics). 
 And see Rose and Carless' "Surgery" (1908), page 1323; 
 or Da Costa's "Surgery" (1908), page 1026. 
 
 PHYSIOLOGY. 
 
 1. Physiology is not founded upon any theory; it is 
 rather based upon a knowledge of anatomy, histology, 
 chemistry and physics. 
 
 Perhaps the examiner wants "Virchow's cellular theory ." 
 Cells are the structural basis of all organisms. 
 
 2. Plasm (or protoplasm) is the physiological basis of 
 life, being the substance of which the cells are made. 
 
 Metabolism is the name given to the entire series of 
 changes which occur in ja cell or organism during the 
 processes of nutrition. It is of two kinds: (1) Assimila- 
 tive, or constructive, called anabolism; and (2) destruc- 
 tive, called katabolism. 
 
 The chemical constituents of protoplasm, are: Water, 
 and solids; the chief of the latter are proteids (which con- 
 tain carbon, hydrogen, oxygen, nitrogen, sulphur, phos- 
 phorus) ; lecithin; cholesterin; and chlorides and phos- 
 phates of calcium, sodium, and potassium. 
 
 3. Lymph. Elaboration: There are two theories as to 
 the formation of lymph: (1) That it is formed from the 
 blood plasma by the processes of filtration, diffusion, and 
 osmosis. (2) That, in addition to these, the endothelial 
 cells of the capillaries exercise some influence. 
 
 It is conveyed by the lymphatic circulation, which is, 
 
 28 
 
MEDICAL RECORD. 
 
 strictly speaking, not a circulation at all ; since the lymph 
 flows only in one direction, namely, toward the heart. 
 The lvmph capillaries take up any excess of the blood 
 plasma which is not required for the nutrition of the tis- 
 sues. These capillaries consist of a single layer of epithe- 
 lium, and empty themselves into vessels very like the 
 veins. The lymph vessels are well provided with valves, 
 which are so closely approximated as to give the vessels 
 a beaded appearance. All the lymphatic vessels, except 
 those of the right upper half of ti* : body empty into the 
 thoracic duct, which terminates in the left subclavian vein, 
 where the left internal jugular vein also enters. Those 
 from the right upper half of the body discharge into the 
 right lymphatic duct, which, in turn, empties into the right 
 subclavian vein at its junction with the right internal jugu- 
 lar vein. 
 
 Composition: Lymph plasma (fibrinogen, serum globu- 
 lin, and serum albumin) and lymphocytes. 
 
 Function: Nutrition of tissues. 
 
 4. Adrenalin is obtained from the medulla of the 
 suprarenal gland. It is supposed to maintain the tonicity 
 of the muscles, also to maintain the blood pressure, and 
 to stimulate the muscle fibers of the heart and arteries. 
 
 Thyroidin is found in the thyroid gland. It is supposed 
 to have some favorable influence on general metabolism, 
 and to antagonize certain toxic substances. 
 
 Opsonin has its origin in the blood serum. It is said 
 to increase the phagocytic action of the leucocytes. 
 
 5. In the brain: This organ requires a large supply of 
 blood, which is supplied by the two internal carotids and 
 the two vertebrals. To lessen the pressure the arteries are 
 very tortuous and anastomose freely in the circle of Willis. 
 These two factors ensure a uniform supply of blood to the 
 brain. The venous trunks or sinuses are so arranged as 
 to allow little or no change in size, and are neither com- 
 pressible nor distensible. 
 
 In the lungs: "The lungs receive blood from two 
 sources, (a) the pulmonary artery, (b) the bronchial ar- 
 teries. The former conveys venous blood to the lungs for 
 its arterialization, and this blood takes no share in the 
 nutrition of the pulmonary tissues through which it passes. 
 (b) The branches of the bronchial arteries ramify for 
 nutrition's sake in the walls of the bronchi, of the larger 
 pulmonarv vessels, in the interlobular connective tissue, 
 etc. ; the blood of the bronchial vessels being returned 
 chiefly through the bronchial and partly through the pul- 
 monary veins." 
 
 In the liver: The portal vein, the hepatic artery, and 
 the hepatic duct run together through the substance of the 
 liver. "To take the distribution of the portal vein first: 
 
 29 
 
MEDICAL RECORD, 
 
 In its course through the liver this vessel gives off small 
 branches which divide and subdivide between the lobules 
 surrounding them and limiting them, and from this cir- 
 cumstance called inter-lobular veins. From these small 
 vessels a dense capillary network is prolonged into the 
 substance of the lobule, and this network, gradually gather- 
 ing itself up, so to speak, into larger vessels, converges 
 finally to a single small vein, occupying the center of the 
 lobule, and hence called in^ra-lobular. The small intra- 
 lobular veins discharge their contents into veins called sub- 
 lobular, while these again, by their union, form the main 
 branches of the hepatic veins, which leave the posterior 
 border of the liver to end by two or three principal trunks 
 in the inferior vena cava, just before its passage through 
 the diaphragm. The hepatic artery, the chief function of 
 which is to distribute blood for nutrition to Glisson's 
 capsule, the walls of the ducts and blood-vessels, and 
 other parts of the liver, is distributed in a very similar 
 manner to the portal vein, its blood being returned by 
 smaller branches either into the ramifications of the portal 
 vein, or into the capillary plexus of the lobules which con- 
 nect the inter- and intra-lobular veins. The hepatic duct 
 divides and subdivides in a manner very like that of the 
 portal vein and hepatic artery, the larger branches being 
 lined by cylindrical, and the smaller by small polygonal 
 epithelium. The bile capillaries commence between the 
 hepatic cells, and are bounded by a delicate membranous 
 wall of their own. They appear to be always bounded by 
 hepatic cells on all sides, and are thus separated from the 
 nearest blood capillary by at least the breadth of one cell." 
 — (From Kirkes' Physiology.) 
 
 The erectile tissues are susceptible of turgescence and 
 increase in size; they contain a collection of arteries and 
 veins, the latter being tortuous and varicose and contained 
 in spaces formed by trabecular of fibrous tissue. 
 
 6. Mechanism of respiratory movements: See Cunning- 
 ham's "Anatomy" (1909), pages 415 and 419; or Gray's 
 "Anatomy" (1908), pages 289 and 433. Ratio of respira- 
 tion to pulse is about 1 '.4. Effects of atmospheric pressure 
 on respiration: Decrease of pressure causes nose bleed, 
 dyspnea, convulsions ; increase of pressure may cause 
 dyspnea or tetanic convulsions. Influence t of respiratory 
 movements on heart and circulation: Inspiration aids the 
 circulation and so increases the arterial tension; expira- 
 tion does not materially aid or hinder circulation; violent 
 extirpation may obstruct circulation. 
 
 7. The various secretions concerned in the process of 
 digestion, are the saliva, gastric juice, pancreatic juice, 
 bile, and succus entericus. 
 
 The source of the saliva is the salivary glands; of the 
 
 30 
 
MEDICAL RECORD 
 
 gastric juice, the glands of the stomach; of the pan- 
 creatic juice, the pancreas; of the bile, the liver; and of 
 the succus entericus, the glands of the small intestine. 
 
 The functions of the saliva are: (i) To moisten the 
 mouth, (2) to assist in the solution of the soluble portions 
 of the food, and thus (3) to administer to the sense of 
 taste, (4) to lubricate the bolus of food, and thus (5) to 
 facilitate the acts of mastication and deglutition, and (6) 
 to change starches into dextrin and sugar. 
 
 The functions of the gastric juice are: (1) To change 
 proteids into proteoses and peptones, and (2) to curdle the 
 casein of milk. 
 
 The functions of the pancreatic juice are: (1) To change 
 proteids into proteoses and peptones, and afterwards de- 
 compose them into leucin and tyrosin; (2) to convert 
 starch into maltose; (3) to emulsify and saponify fats; 
 and (4) to cause milk to curdle. 
 
 The functions of the bile are: (1) To assist in the 
 emulsification and saponification of fats; (2) to aid in the 
 absorption of fats; (3) to stimulate the cells of the intes- 
 tine to increased secretory activity, and so promote peris- 
 talsis, and at the same time tend to keep the feces moist; 
 (4) to eliminate waste products of metabolism, such as 
 lecithin and cholesterin; (5) it has a slight action in con- 
 verting starch into sugar; (6) it neutralizes the acid 
 chyme from the stomach and thus inhibits peptic digestion; 
 (7) it has a very feeble antiseptic action. 
 
 The functions of the succus entericus are : The secre- 
 tion of enterokinase, secretin, and crepsin, which assist the 
 pancreatic juice in digestion. 
 
 8. The center for (a) parturition is in the lumbar en- 
 largement of the spinal cord; (b) auditory, is in the first 
 and second convolutions of the temporal lobes of the 
 brain ; (c) respiratory, is in the floor of the fourth ven- 
 tricle ; (d) visual, is in the occipital lobes of the brain; 
 (e) micturition, is in the lumbar enlargement of the spinal 
 cord. 
 
 9. (a) Amnion, is the innermost of the fetal mem- 
 branes, it secretes and contains the liquor amnii. 
 
 (b) Corpus luteum is the scar or yellow body left on 
 the ovary at the site where a Graafian follicle has dis- 
 charged its ovum. 
 
 (c) Leucin is amidocaproic acid; it is found in the pan- 
 creas, spleen, liver, kidneys, thymus, lymphatic and sali- 
 vary glands ; it is due to the decomposition of proteins by 
 acids or alkaloids, and during putrefaction. 
 
 (d) Erythrocyte is a red blood-corpuscle. 
 
 (e) Neuron is a nerve cell with all its processes. 
 
 (/) Hemolysin is "a substance produced in the body of 
 one species of animal by the introduction of red blood 
 
 31 
 
MEDICAL RECORD. 
 
 corpuscles derived from the body of another species; it is 
 capable of dissolving the red blood corpuscles of the ani- 
 mal species from which the blood was obtained." — Gould. 
 10. 
 
 
 Cerebral Paralysis. 
 
 Spinal Paralysis. 
 
 (a) Muscle tonus. 
 
 Spastic ; may be 
 contractures. 
 
 Flaccid. 
 
 (b) Nutrition of 
 
 Normal, or slight 
 
 Marked atrophy. 
 
 muscle 
 
 atrophy. 
 
 
 (c) Electrical re- 
 
 Normal. 
 
 Little or no re- 
 
 action 
 
 
 sponse to fara- 
 dic current ; par- 
 tial or complete 
 reaction of de- 
 generation t 
 galvanic current. 
 
 CHEMISTRY. 
 
 1. Decomposition is the splitting up of a compound 
 into simpler compounds or into its constituent element's. 
 
 Three physical decomposing agents : Heat, light, and 
 electricity. 
 
 2. Sulphur, (a) Occurrence in nature: It is found 
 free, also in combination in the sulphides and sulphates, 
 and in proteids, especially the keratins. 
 
 (b) Physical and chemical properties: Yellow crystal- 
 line solid, slight odor and taste which are characteristic, 
 insoluble in water, soluble in carbon disulphide, it is di- 
 morphous; on being heated, it first fuses to a thin yellow 
 liquid, on further heating it becomes thick and brown, at 
 a still higher temperature it again becomes thin and 
 lighter in color, and at a higher temperature again it 
 boils, at the same time giving off a brownish-yellow vapor. 
 Suphur has a valence of two or six, atomic weight of 32, 
 molecular weight of 64; it readily combines with other 
 elements ; heated in air or oxygen, sulphur dioxide is pro- 
 duced; if burnt in hydrogen, hydrogen sulphide is pro- 
 duced. The compounds of sulphur are similar in consti- 
 tution and (to some extent) in chemical properties to the 
 compounds of oxygen. 
 
 (c) In decomposing organic matter, sulphuretted hydro- 
 gen H 2 S is liberated. 
 
 3. («) Hydrochloric acid, HC1; (b) sulphuric acid, 
 HsjSCX; (c) Epsom salts, MgS0 4 ; (d) Rochelle salts, 
 NaKCJLOa; (e) Glauber salts, Na 2 S0 4 . 
 
 4. An alkaloid is a basic nitrogenous substance of alka- 
 line reaction and capable of acting with an acid to form 
 salts in the same way that ammonia does. 
 
 32 
 
MEDICAL RECORD 
 
 Five important alkaloids: (i) Strychnine, from 
 strychnos nux vomica; (2) Atropine, from atropa bella- 
 donna; (3) Coniine, from Conium maculatum; (4) Nico- 
 tine, from tobacco; (5) Cocaine, from coca erythroxylon. 
 
 5. Ptomains are basic, nitrogenous compounds, pro- 
 duced from protein material by the bacteria which cause 
 putrefaction. 
 
 Ptomain poisoning. Symptoms: Chilliness, headache, 
 vertigo, muscular twitchings, hallucinations, imperfect 
 vision, weak and rapid pulse, nausea, vomiting, diarrhea, 
 cyanosis, early dyspnea, often subnormal temperature, and 
 occasionally cutaneous eruptions. The prognosis is guard- 
 edly favorable. 
 
 6. Carbohydrates. "The carbohydrates are bodies com- 
 posed of C, H, and O, as aldehydes and ketols. They 
 are classified as monosaccharides, dextrose, galactose, etc. 
 These are the simplest molecules of the hexoses. They 
 are sweet, odorless, soluble in water, and oxidize readily, 
 hence their reducing power. They form crystalline osa- 
 zones. They rotate polarized hVht. Their formula is 
 CeH^Oe. Disaccharides, maltose, saccharose, lactose, etc. 
 They are formed by the union of two simpler molecules 
 and the elimination of a molecule of water. They have 
 the formula G2H22O11. And polysaccharides, glycogen, 
 starch, dextrin, gum, etc. They are much less soluble, 
 can be hydrolyzed into the simpler forms, and have the 
 formula (CeHioC^n. 
 
 "Monosaccharides are especially soluble and polysaccha- 
 rides are especially insoluble; monosaccharides and disac- 
 charides do not give colored solutions with iodine, while 
 polysaccharides do; monosaccharides and (except sac- 
 charose) disaccharides reduce Fehling's solution, while 
 polysaccharides do not." — (Kirkes' Physiology.) 
 
 Occurrences: Starch, cellulose, plants, seeds, roots, 
 fruits, sugar. 
 
 7. (a) Chemical test for blood in the urine: To the 
 urine add a solution of potassium hydroxide to distinct 
 alkaline reaction; heat nearly to boiling (do not boil). A 
 red precipitate is produced. 
 
 (b) For pus in the urine: Acidify the urine with acetic 
 acid, then filter it, and treat the filter with a few drops 
 of freshly prepared tincture of guaiacum ; a deep blue color 
 denotes the presence of pus. 
 
 (c) Ehrlich's diazo reaction. 
 
 (d) and (e) The average amount of solids in the urine 
 is about 850 to 950 grains in twenty-four hours. It can be 
 estimated as follows : Take the specific gravity of the 
 twenty-four hours' output ; multiply the two last figures of 
 this specific gravity by the number of ounces of urine 
 
 33 
 
MEDICAL RECORD. 
 
 passed in the twenty-four hours ; multiply this product by 
 i.i; this represents the total urinary solids in grains. 
 
 (/) The normal specific gravity of the urine is about 
 1015 to 1025. 
 
 (g) Test for albumin: "The urine must be perfectly 
 clear. If not so, it is to be filtered, and, if this does 
 not render it transparent, it is to be treated with a few 
 drops of magnesia mixture, and again filtered. 
 
 "The reaction is then observed. If it be acid, the urine 
 is simply heated to near the boiling point. If the urine 
 be neutral or alkaline, it is rendered faintly acid by the 
 addition of dilute acetic acid, and heated. If albumin be 
 present, a coagulum is formed, varying in quantity from 
 a faint cloudiness to entire solidification, according to the 
 quantity of albumin present. The coagulum is not redis- 
 solved upon the addition of nitric acid." 
 
 (h) Test for sugar: First remove any albumin that may 
 be present, then "render the liquid strongly alkaline by 
 addition of sodium carbonate. Divide about 6 c.c of the 
 alkaline liquid in two test-tubes. To one test-tube add a. 
 very minute quantity of powdered subnitrate of bismuth, to 
 the other as much powdered litharge. Boil the contents 
 of both tubes. The presence of glucose is indicated by a 
 dark or black color of the bismuth powder, the litharge 
 retaining its natural color." 
 
 (i) The normal amount of urea passed by a man in 
 twenty-four hours is about five hundred and twenty grains. 
 
 A comparatively easy test for Urea is that of Fowler, 
 based upon the loss of the specific gravity of the urine 
 after the decomposition of the urea by hypochlorite. "To 
 apply this method the specific gravity of the urine is care- 
 fully determined, as well as that of the liquor sodse 
 chlorinatse (Squibb's). One volume of the urine is then 
 mixed with exactly seven volumes of the liquor sodae 
 chlorinatse, and, after the first violence of the reaction has 
 subsided, the mixture is shaken from time to time during 
 an hour, when the decomposition is complete ; the specific 
 gravity of the mixture is then determined. As the reaction 
 begins instantaneously when the urine and reagent are 
 mixed, the specific gravity of the mixture must be calcu- 
 lated by adding together once the specific gravity of the 
 urine and seven times the specific gravity of the liquor 
 sodse chlorinatse, and dividing the sum by eight. From 
 the quotient so obtained the specific gravity of the mix- 
 ture after decomposition is subtracted; every degree of 
 loss in specific gravity indicates 0.7791 gram of urea in 100 
 c.c. of urine. The specific gravity determinations must all 
 be made at the same temperature ; and that of the mixture 
 only when the evolution of gas has ceased entirely." — 
 (Witthaus' Manual of Chemistry.) 
 
 34 
 
MEDICAL RECORD. 
 
 8. {a) Test for arsenic: Reinsch's test is as follows : To 
 the suspected fluid add a little pure HC1 ; suspend in the 
 fluid a small strip of bright copper foil, and boil. If a 
 deposit forms on the copper, remove the copper, wash it 
 with pure water, dry on filter paper, but be careful not to 
 rub off the deposit. Coil up the copper, and put it into a 
 clean dry glass tube, open at both ends, and apply heat 
 at the part where the copper is. If arsenic is present there 
 will appear in the cold part of the tube a mirror, which 
 will be found on microscopical examination to consist of 
 octahedral crystals of arsenic trioxide. 
 
 (b) The chemical antidote for arsenic poisoning is 
 freshly prepared ferric hydroxide. The ferric hydroxide 
 changes the arsenic into ferrous arsenate, which is non- 
 poisonous. 
 
 9. Lead acetate, Pb (C2H.3O2), and Potassium iodide, 
 KI, are chemically incompatible in a prescription. 
 
 10. The pancreatic juice contains three ferments: (1) 
 Trypsin, which changes proteids into proteoses and pep- 
 tones, and afterwards decomposes them into leucin and 
 tyrosin ; it only acts in an alkaline or faintly acid me- 
 dium. (2) Amylopsin, which converts starches into mal- 
 tose. (3) Sieapsin, which emulsifies and saponifies fats. 
 
 PATHOLOGY. 
 
 i. Hypertrophy of the heart most commonly results 
 from the following diseases : Arteriosclerosis, chronic in- 
 terstitial nephritis, exophthalmic goiter, valvular disease 
 (particularly aortic), pulmonary emphysema, adherent peri- 
 cardium. 
 
 2. The commonest underlying conditions in angina pec- 
 toris, are : Arteriosclerosis (either general, or of the 
 aorta) ; obstruction of the coronary arteries, from ather- 
 oma, embolism or thrombosis ; degeneration of the myo- 
 cardium. 
 
 3. See French's "Practice of Medicine" (1907), pages 
 155 and 671; or Osier's "Practice of Medicine" (1909).. 
 pages 170 and 620. 
 
 4. Pathological conditions productive of icterus, are: 
 Catarrh of the duodenum and common bile duct, pancre- 
 atic disease, gallstones, cirrhosis of the liver, obstruction 
 of the bile ducts, septicemia, acute yellow atrophy of the 
 liver, tumors of liver, pancreas, stomach, or kidney. 
 
 5. In the typhoid ulcer: (1) The main axis of the 
 ulcer lies parallel with that of the intestine ; (2) it lies 
 opposite to the mesenteric attachment; (3) it has smooth 
 floor and undermined edges ; (4) it commonly leads to 
 perforation. 
 
 In tuberculous ulcer: (1) The long axis of the ulcer 
 lies at right angles to that of the intestine ; (2) it is not 
 
 35 
 
MEDICAL RECORD. 
 
 necessarily situated opposite the mesenteric attachment; 
 (3) its floor is not smooth nor are its edges undermined, 
 but rather funnel-shaped and irregular; (4) it is not apt 
 to perforate, but it does not tend to heal, rather to spread. 
 
 6. The usual method of metastatic extension of carci- 
 noma, is by the lymphatics, occasionally by the blood-ves- 
 sels ; of sarcoma, by the blood-vessels. 
 
 7. In typhoid fever, the typhoid bacillus may be found 
 in : The intestinal lesions, intestinal contents, spleen, liver, 
 kidneys, urine, blood of the macular spots in the skin, 
 lungs, parotid glands. 
 
 8. See French's " Practice of Medicine" (1907), page 
 233; or Osier's "Practice of Medicine" (1909), page 12. 
 
 9. In locomotor ataxia, the posterior columns of the 
 spinal cord are gray and shrunken and show considerable 
 overgrowth of connective tissue in the columns of Goll, 
 B.urdach, and Lissauer; this process extends upward from 
 the lumbrosacral region; the posterior nerve roots degen- 
 erate and become atrophic. The meninges over the af- 
 fected parts become opaque and adherent. 
 
 10. Pathological leucocytosis is an increase in the num- 
 ber of the white blood corpuscles when associated with 
 diseased conditions, or when not accompanying mere physi- 
 ological processes, such as pregnancy, lactation, exercise, 
 digestion, etc. 
 
 PRACTICE. 
 
 1. Scarlet fever: Period of incubation, from a few 
 hours to seven days. Stage of invasion, twenty-four hours. 
 Character of eruption, a scarlet punctate rash, beginning 
 on neck and chest, then covering face and body; desqua- 
 mation is scaly or in flakes. The eruption is brighter, is 
 on a red background, punctiform, and is more uniform; 
 the temperature is higher, the pulse quicker; the tongue 
 is of the "strawberry" type, the lymphatics in the neck may 
 be swollen, and there is sore throat; Koplik's spots are 
 absent. Smallpox: The eruption usually appears first on 
 the forehead and wrists, and on the third or fourth day; 
 it is first mascular, then papular, then vesicular, and finally 
 pustular; it does not appear in successive crops; the spots 
 are multilocular, and do not collapse on being punctured; 
 the papule is hard and shotty, and does not disappear on 
 stretching the skin. Period of incubation is from eight to 
 fourteen days. Measles: Period of incubation, ten to 
 twelve days. Stage of invasion, four days. Character of 
 eruption, small, dark red papules with crescentic borders, 
 beginning on face and rapidly spreading oyer the entire 
 body; desquamation is branny. The eruption is darker, 
 less uniform; more shotty; the temperature is lower, pulse 
 slower, the tongue is not of the "strawberry" type ; coryza, 
 
 36 
 
MEDICAL RECORD. 
 
 coughing, and sneezing may be present; Koplik's spots are 
 present. 
 
 2. See French's "Practice of Medicine" (1907), page 781 ; 
 or Osier's "Practice of Medicine" (1909), page 509. 
 
 3. See French's "Practice of Medicine" (1907), page 666; 
 or Osier's "Practice of Medicine" (1909), page 617. 
 
 4. See French's "Practice of Medicine" (1907), pages 65 
 and 70; or Osier's "Practice of Medicine" (1909), pages 
 57 and 65. 
 
 5. See French's "Practiceof Medicine" (1907), pages 171 
 and 174; or Osier's "Practice of Medicine" (1909), pages 
 172 and 189. 
 
 6. See s French's "Practice of Medicine" (1907), page 
 1 132; or Osier's "Practice of Medicine" (1909), page 1064. 
 
 7. See French's "Practice of Medicine" (1907), page 650; 
 or Osier's "Practice of Medicine" (1909), page 603. 
 
 8. See French's "Practice of Medicine" (1907), page 320; 
 or Osier's "Practice of Medicine" (1909), page 134. 
 
 9. See French's "Practice of Medicine" (1907), pages 218 
 and 221; or Osier's "Practice of Medicine" (1909), page 
 213. 
 
 10. See French's "Practice of Medicine" (1907), page 
 661; or Osier's "Practice of Medicine" (1909), page 612. 
 
 SURGERY. 
 
 1. See Rose and Carless' "Surgery" (1908), page 333; or 
 Da Costa's "Surgery" (1908), page 410. 
 
 2. See Da Costa's "Surgery" (1908), page 558; and Rose 
 and Carless' "Surgery" (1908), page 604. 
 
 3. See Rose and Carless' "Surgery" (1908), pages 1175 
 and 1212; or Da Costa's "Surgery" (1908), pages 11 10 and 
 1 132. 
 
 4. The Halstead differs from the Bassini operation for 
 inguinal hernia, in that in the Halstead operation: (1) A 
 new and closely fitting internal ring is made; (2) the 
 internal oblique and transversalis muscles are incised as 
 well as the external oblique; (3) the spermatic cord is left 
 between the skin and the aponeurosis of the external 
 oblique ; and (4) most of the veins of the spermatic cord 
 are excised. 
 
 5. Symptoms of hypertrophy of the prostate gland: 
 Slowness in starting urination; difficult micturition; fre- 
 quency of micturition, particularly at night; the presence 
 of residual urine; dull, aching pain in the perineum and 
 above the pubes ; enlargement of the lateral lobes of the 
 prostate; there may be cystitis and retention of urine. 
 
 Treatment consists in : Catheterization, under proper pre- 
 cautions ; prostatectomy may be required ; formerly less 
 radical measures were occasionally employed, such as cas- 
 tration, vasectomy, and Bottini's operation. 
 
 37 
 
MEDICAL RECORD. 
 
 6. See Rose and Carless' "Surgery" (1908), page 1134; 
 or Da Costa's "Surgery" (1908), page 1010. 
 
 7. Embolism of the mesenteric vessels is diagnosed by 
 the sudden onset of intense pain, which is sometimes per- 
 sistent and sometimes has paroxysms of extra intensity, 
 rapid pulse, subnormal temperature, abdominal rigidity, 
 exhaustion, nausea, vomiting, and in about half the cases 
 bloody diarrhea ; meteorism may be present, and a mass 
 may be palpated over the affected region. 
 
 Treatment: Exploratory laparotomy, and if the affected 
 area is small, resection of the part of the intestine involved 
 is indicated. If a large portion of the intestine is gan- 
 grenous, little or nothing can be done. 
 
 8. See Rose and Carless' "Surgery" (1908), page 1009; 
 or Da Costa's "Surgery" (1908), page 845. 
 
 9. See French's "Practice of Medicine" (1907), pages 702 
 and 696; and Da Costa's "Surgery" (1908), page 774. 
 
 - 10. Enucleation of the eyeball is performed as follows : 
 "A general anesthetic is generally given. After introduc- 
 tion of the speculum, the conjunctiva is divided all around 
 the cornea, as close to its border as possible, and dissected 
 back as far as the insertions of the recti muscles. A squint 
 hook is passed beneath the tendon of the internal rectus, 
 and the latter is divided with the strabismus scissors close 
 to its insertion; then the other straight muscles are cut 
 in the same way, together with the subconjunctival con- 
 nective tissue for some distance beyond the equator. The 
 points of the scissors must always be directed toward the 
 eyeball and the latter stripped as clean as possible to avoid 
 any unnecessary removal of orbital tissue. Instead of 
 commencing with a circumcorneal division of the conjunc- 
 tiva, we may begin with a tenotomy of tfie internal rectus 
 and then divide the conjuctiva as we pass from tendon to 
 tendon. The hook is passed around the globe to make 
 sure that the attachments of the muscles have been com- 
 pletely divided. The eyeball is then dislocated forward 
 by pressing the speculum backward, and thus the optic nerve 
 is put on the stretch. A pair of enucleation scissors, 
 closed, are passed between sclera and conjunctiva, feeling 
 for the optic nerve ; they are withdrawn, slightly opened, 
 and the nerve is divided close to the sclera. The eyeball 
 is held between the thumb and index finger of the left 
 hand, and the oblique muscles, and other unsevered attach- 
 ments are divided. The orbit is plugged for a few minutes 
 to control hemorrhage, and the conjunctiva is usually closed 
 with a single suture, which is passed through its edge at 
 intervals and tied like the string of a pouch. The eye is 
 bandaged and the patient kept in bed for a day." — (May, 
 Diseases of the Eye.) 
 
 38 
 
MEDICAL RECORD. 
 
 OBSTETRICS. 
 
 i. See Williams' "Obstetrics" (1909), pages 81 and 119; 
 or Hirst's ''Obstetrics" (1909), pages 58 and 143. 
 
 2. See Williams' "Obstetrics" (1909), pages 830, 316, and 
 419; or Hirst's "Obstetrics" (1909), pages 898, 333, 607, 
 and 86j. 
 
 3. If the chin is presenting anteriorly, expectant treat- 
 ment may suffice ; but care must be taken to observe that 
 the chin does not rotate backwards. Spontaneous version 
 may occur, and the presentation become a vertex one. 
 Failing this, or as a means of favoring this, postural 
 treatment, such as Walcher's position, has been recom- 
 mended. If, in spite of this, engagement has not occurred, 
 cephalic version is indicated, care being taken not to rup- 
 ture the membranes. If this is not successful, podalic 
 version should be tried. If, after all these manipulations, 
 the child is still alive and the head is engaged, symphyse- 
 otomy is indicated; if the child is dead, craniotomy should 
 be performed. 
 
 4. See Williams' "Obstetrics" (1909), page 289; or 
 Hirst's "Obstetrics" (1909), page 425. 
 
 5. The varieties of ectopic pregnancy are: (1) Tubal, 
 (2) interstitial, (3) ovarian, and (4) abdominal. 
 
 In differentiating this condition from a normal preg- 
 nancy, the following signs and symptoms are of most reli- 
 ance : "When extrauterine pregnancy exists, there are: (1) 
 The general and reflex symptoms of pregnancy; thev have 
 often come on after an uncertain period of sterility. Nau- 
 sea and vomiting appear aggravated. (2) Then comes a 
 disordered menstruation, especially metrorrhagia, accom- 
 panied with gushes of blood, and with pelvic pain coinci- 
 dent with the above symptoms of pregnancy. Pains are 
 often very severe, with marked tenderness within the 
 pelvis. Such symptoms are highly suggestive. (3) There 
 is the presence of a pelvic tumor characterized as a tense 
 cyst, sensitive to the touch, actively pulsating. This tumor 
 has a steady and progressive growth. In the first two 
 months it has the size of a pigeon's egg; in the third 
 month it has the size of a hen's egg ; in the fourth month 
 it has the size of two fists. (4) The os uteri is patulous : 
 the uterus is displaced, but is slightly enlarged and empty. 
 (5) Symptoms No. 2 may be absent until the end of the 
 third month, when suddenly they become severe, with 
 spasmodic pains, followed by the general symptoms of col- 
 lapse. (6) Expulsion of the decidua, in part or whole. 
 Xos. 1 and 2 are presumptive signs; Xos. 3 and 4 are 
 probable signs; Xos. 5 and 6 are positive signs." — (Amer- 
 ican Text-Book of Obstetrics.) 
 
 Treatment consists in removal of the product of con- 
 
 39 
 
MEDICAL RECORD. 
 
 ception, by a laparotomy, as soon as the diagnosis is made. 
 
 6. See Williams' "Obstetrics" (1909), page 809; or 
 Hirst's "Obstetrics" (1909), page 574. 
 
 7. See Hirst's "Obstetrics" (1909), pages 773, etc. 
 
 8. (1) Increased muscular irritability of the walls of the 
 uterus; (2) exaggerated reflex excitability of the spinal 
 cord; (3) distention of the uterus; (4) movements of the 
 child. 
 
 9. See Williams' "Obstetrics" (1909), page 852; or 
 Hirst's "Obstetrics" (1909), page 712. 
 
 10. Fetal head: Occipito-mental, about 5^2 inches; oc- 
 cipitofrontal, about 4^ inches ; sub-occipito-bregmatic, 
 about 3J/2 inches. 
 
 The pelvic diameters: 
 
 Antero-posterior. Oblique. Transverse. 
 
 Inlet 4 inches 4 T A inches 5 inches 
 
 Outlet 5 inches 4^2 inches 4 inches 
 
 GYNECOLOGY. 
 
 1. The most common causes of pelvic cellulitis, are : 
 Traumatism during labor or the puerperium, abortions, 
 sepsis, gonorrhea, an ill-fitting pessary, spread of inflam- 
 mation from any part of the genital tract. 
 
 2. Chronic purulent salpingitis may cause sterility, by : 
 Destroying the cilia in the tube, and so hindering the 
 transmission of the ovum ; causing adhesions, thickening, 
 stenosis, kinking, or atresia of the tube, and thus hinder- 
 ing the transmission of the ovum ; pathological secretions 
 may also destroy the ovum. 
 
 3. In appendicitis the pain is of sudden onset -and is 
 localized in the right iliac fossa; there is abdominal rigi- 
 dity, chiefly of the right rectus muscle, and tenderness at 
 McBurney's point; there are usually fever, nausea, vomit- 
 ing, and constipation. 
 
 In inflammation of the right ovary the pain is not local- 
 ized, but may be bilateral, and spreads to the vagina and 
 rectum; there is no tenderness at McBurney's point; it 
 is usually worse just before the menstrual period, which 
 sometimes affords relief ; on vaginal examination the ovary 
 is found to be tender. 
 
 4. Urethral caruncle is a small red fleshy growth gener- 
 ally situated on the posterior part of the meatus of the 
 urethra. There are local pain and tenderness, which may 
 be excessive ; a burning sensation is experienced on urina- 
 tion ; it may bleed. The proper treatment is to excise it 
 or destroy it with the thermocautery. 
 
 5. Ventral -fixation is contraindicated when there is any 
 possibility of a future pregnancy. 
 
 6. Vaginismus is a condition of painful and spasmodic 
 contraction of the vaginal orifice, which renders coitus 
 
 40 
 
MEDICAL RECORD. 
 
 either painful or altogether impossible. Its causes are 
 irritable hymen, ulcer, or fissure anywhere in the immedi- 
 ate vicinity, urethral caruncle, carunculae myrtiformes, a 
 long perineum with vaginal orifice placed too anteriorly. 
 The treatment consists in removing the cause when pos- 
 sible, tonics and general constitutional treatment, dilatation 
 of the vaginal orifice ; local application of a 5 per cent, 
 solution of cocaine will relieve the hyperesthesia and allow 
 coitus. The condition is sometimes incurable. 
 
 7. The palliative treatment of retroversion of the uterus 
 consists in: (1) Removing the cause, if possible; (2) re- 
 placing the uterus; (3) keeping the uterus in position by 
 means of pessaries, tampons, and knee-chest position; (4) 
 tampons, ichthyol, pelvic massage, and vaginal douches; 
 (5) the enforcing of proper hygiene, particular attention 
 being paid to the bowels, clothing, and exercise. 
 
 Curative treatment is operative, and the choice lies be- 
 tween ventral suspension of the uterus and shortening of 
 the round ligament. 
 
 8. Fibroid tumors cause ascites by pressure on the 
 large vessels which thus induces an effusion of liquid 
 through the walls of these vessels. 
 
 9. Trachelorrhaphy should be done : When the lesion 
 is slight, and there is not much loss of tissue or erosion; 
 or in uncomplicated cases. 
 
 Amputation should be done: When the lesion is greater, 
 or stellate, or where there is much loss of tissue, or when 
 complications are present. 
 
 10. Generally gonorrhea, or maybe tuberculosis. 
 Treatment: The tubules should be slit open and cauter- 
 ized with pure carbolic acid, or excised. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Arkansas State Board of Medical Examiners. 
 
 anatomy. 
 
 1. At what time in the development of the fetus is 
 the hair formed? 
 
 2. Give the general classification of bones. 
 
 3. Name the bones of the upper extremity. 
 
 4. Describe the diaphragm, giving origin, insertion, 
 nerve supply, and action. 
 
 5. Name the superficial group of the muscles of the 
 abdomen. 
 
 6. Name the openings of the heart. 
 
 7. Name the branches of the anterior tibial artery. 
 
 8. Describe the pia-mater. 
 
 9. Describe the uterus. 
 
 10. Describe the gall-bladder. 
 
 4i 
 
MEDICAL RECORD. 
 
 PHYSIOLOGY. 
 
 1. Name and describe the glands of the intestines and 
 tell in which portion of the intestine each kind is situated. 
 
 2. Describe the glycogenic function of the liver and tell 
 the destination of glycogen. 
 
 3. Give origin, distribution, and function of the fifth 
 pair of cranial nerves. 
 
 4. (a) How is the nervous system arranged anatomi- 
 cally? (b) Give a short sketch of each system. 
 
 5. How many .pairs of spinal nerves are there? De- 
 scribe them. 
 
 CHEMISTRY. 
 
 1. What is albumin? 
 
 2. In what form in nature do we find albumin in its 
 purest form? 
 
 3. In what case of poisoning do we use albumin as an 
 antidote? 
 
 4. Name a metallic poison for which albumin is espe- 
 cially recommended. 
 
 5. What is meant by toxicology? 
 
 6. What causes the decay of animal or vegetable matter 
 when deprived of life? 
 
 7. What is meant by ptomain poison? 
 
 8. What is the origin of ptomain poison, or, in other 
 words, how and from what are ptomains derived? 
 
 9. When the atmosphere we live in becomes charged 
 with an excess of carbonic acid, how is it purified and 
 made fit for the support of animal life? 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. What is an alkaloid, a tincture, a fluid extract? 
 
 2. Name four different classes of medicine, with an ex- 
 ample of each class. Give dose of example. 
 
 3. What drugs would you use hypodermatically to meet 
 the following requirements? (3.) To stimulate the heart's 
 action; (b) to produce emesis ; (c) to control hemorrhage. 
 
 4. What is the strength of normal salt solution? Give 
 indications for its use and mode of administration. 
 
 5. Give principal alkaloid of belladonna and indications 
 Cor its use ; also dose. 
 
 6. Name the three (3) most used preparations of opium, 
 and how much of each contains one grain of opium. 
 
 7. Give hypodermatic dose of the following: Sulphate 
 of strychnine, sulphate of atropine, sulphate of morphine, 
 apomorphin hydrochlorate, nitroglycerin, and pilocarpine 
 hydrochlorate. 
 
 8. Write a complete prescription for a diuretic contain- 
 ing not less than three ingredients. 
 
 42 
 
MEDICAL RECORD 
 
 9. How are the cathartic effects produced by salines? 
 
 10. How is nitrite of amyl used, and for what purpose? 
 
 PRACTICE. 
 
 1. Differentiate between acute alcoholism and apoplexy. 
 
 2. Give etiology, physical signs, and treatment of peri- 
 carditis. 
 
 3. Give physical signs of acute lobar pneumonia. 
 
 4. Give etiology, diagnosis, and treatment of biliary colic. 
 
 5. What are the two common complications of typhoid 
 fever during the second or third week? and give treat- 
 ment. 
 
 6. Describe a case of acute catarrhal dysentery and give 
 treatment. 
 
 7. Give etiology, diagnosis, and treatment of gon- 
 orrhea. 
 
 8. Give diagnosis and treatment of acute articular rheu- 
 matism. 
 
 9. Give etiology, morbid anatomy, period of measles in- 
 cubation, common complications and their treatment. 
 
 10. Describe three stages of malarial paroxysm and 
 give treatment in each stage. 
 
 SURGERY. 
 
 1. Describe symptoms and operation for gallstones. 
 
 2. Through what would you pass, in the open method 
 of operating for hydrocele? 
 
 3. What are the contraindications for hemorrhoidal 
 operation? 
 
 4. How would you differentiate between gallstones, gas- 
 tric ulcer, and appendicitis? 
 
 5. Give surgical treatment for Bright's disease. 
 
 OBSTETRICS. 
 
 1. Describe the Fallopian tubes. 
 
 2. Describe the placenta and give its functions. 
 
 3. Give differential diagnosis of pregnancy from ovar- 
 ian cystoma. 
 
 4. Give treatment for threatened abortion. 
 
 5. Write prescription for vaginitis. 
 
 6. Give treatment for placenta prsevia. 
 
 7. What are the indications for vaginal tamponing? 
 
 8. Give method of performmg Gephalic version. 
 
 9. Give treatment of uterine inertia. 
 
 10. Give management of normal labor. 
 
 43 
 
MEDICAL RECORD, 
 
 ANSWERS TO S'TATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Arkansas State Board of Medical Examiners. 
 
 anatomy. 
 
 i. Hair begins to develop at about the third month of 
 fetal life. 
 
 2. Bones are classified as: (i) Long, (2) short, (3) 
 flat, and (4) irregular bones. 
 
 3. -Scapula, clavicle, humerus, ulna, radius, carpal (scaph- 
 oid, semilunar, cuneiform, pisiform, trapezium, trapezoid, 
 os magnum, unciform), five metacarpals, and fourteen 
 phalanges. 
 
 4. The diaphragm is a musculofibrous septum which di- 
 vides the thoracic from the abdominal cavity; it is fan- 
 shaped; the broad, elliptical portion is horizontal, and the 
 crura are vertical. It is attached to the ensiform, to the 
 internal surfaces of the lower six costal cartilages, to 
 bodies and intervertebral substances of first, scond, and 
 third lumbar vertebrae. Its openings are: (1) The aortic, 
 (2) the esophageal, (3) the opening for the vena cava, (4) 
 the right crural, (5) the left crural. Nerve supply: Phre- 
 nic, lower intercostal, and sympathetic. Action: It is the 
 chief inspiratory muscle; also used in all expulsive ef- 
 forts (laughing, sneezing, coughing, crying, vomiting, urin- 
 ation, defecation, and parturition). 
 
 5. External oblique, internal oblique, transversalis, rec- 
 tus, pyramidalis. 
 
 6. Openings of superior vena cava, of inferior vena cava, 
 of coronary sinus, of foramina of Thebesius, right auriculo- 
 ventricular, of pulmonary veins, left auriculo-ventricular, 
 of pulmonary artery, and of aorta. 
 
 7. Anterior and posterior recurrent tibial, superior 
 fibular, muscular, external, and internal malleolar. 
 
 8. See Cunningham's "Anatomy" (1909), page 603; or 
 Gray's "Anatomy" (1908), page 980. 
 
 9. See Cunningham's "Anatomy" (1909), page 1187; or 
 Gray's "Anatomy" (1908), page 1498. 
 
 10. See Cunningham's "Anatomy" (1909), page 11 18; or 
 Gray's "Anatomy" (1908), page 1350. 
 
 PHYSIOLOGY. 
 
 1. Lieberkiihn's glands are found throughout the small 
 and large intestine; Brunner's glands are found in the 
 duodenum; the solitary glands are found throughout the 
 entire intestine, but are most abundant in the lower part of 
 the ileum and the upper part of the large intestine; Peyer's 
 patches are found in the lower two-thirds of the small 
 intestine, chiefly in the ileum. 
 
 44 
 
MEDICAL RECORD. 
 
 2. Glycogen is chiefly formed from the carbohydrates. 
 The liver cells act upon the dextrose into which the carbo- 
 hydrates have been converted by the action of the ptyalin 
 and amylopsin. This may occur by dehydration, but the 
 exact process is not known. At a subsequent period the 
 glycogen is transformed into dextrose and is returned to 
 the circulation. Hence the blood of the hepatic veins 
 contains more sugar than the blood of the arteries, and 
 these latter more than the blood in the veins (except the 
 hepatic). It is the generally accepted view, but it is de- 
 nied by Pavy, and the whole subject is in a state of un- 
 certainty. 
 
 The destination of glycogen: It is converted into 
 sugar (dextrose), is given off to the blood, and is finally 
 oxidized in the tissues. 
 
 3. Fifth pair of cranial nerves. Origin: Superficial, 
 from side of pons Varolii ; deep, from medulla, and floor 
 of fourth ventricle. Distribution and Functions: First, 
 ophthalmic; sensory to anterior half of scalp, conjunctiva, 
 and skin of upper eyelid, cornea, skin of nose, mucous 
 membrane of nose, lacrymal gland. Second, superior max- 
 illary; sensory to conjunctiva and skin of lower eyelid, 
 nose, cheek, upper lip, palate, upper teeth, and alveolar 
 processes. Third, inferior maxillary; sensory to external 
 auditory meatus, side of head, mucous membrane of mouth, 
 anterior two-thirds of tongue, lower lip, teeth and alveolar 
 processes of lower jaw. It is also motor to the muscles of 
 mastication (temporal, masseter, two pterygoids), mylo- 
 hyoid, and anterior belly of the digastric. 
 
 4. See Cunningham's "Anatomy" (1909)* page 443; or 
 Gray's "Anatomy" (1908), page 815- 
 
 5. See Cunningham's "Anatomy" (1909), page 607; or 
 Gray's "Anatomy" (1908), page 982. 
 
 CHEMISTRY. 
 
 1. Albumin is a protein substance, found in most ani- 
 mal tissues, and consisting of carbon, hydrogen, oxygen, 
 nitrogen, and sulphur. It is soluble in pure water, and is 
 coagulated by heat. 
 
 2. In the white of hen's egg. 
 
 3. and 4. In mercurial poisoning (by corrosive sub- 
 limate), also in poisoning by nitrate of silver. 
 
 5. By toxicology is meant that branch of medical 
 science which appertains to poisons ; it includes their char- 
 acter, origin, actions, symptoms produced, antidotes, treat 
 ment, and detection. 
 
 6. The process of slow oxidation. 
 
 7. By ptomain poison is meant the poisonous products 
 of putrefaction of dead animal tissues and fluids. 
 
 8. Ptomains are derived from dead animal matter. 
 
 45 
 
 3 
 
MEDICAL RECORD. 
 
 9. By the action of plants : the chlorophyl of which, 
 under the influence. of sunlight, decomposes the C0 2 into C 
 and Oi. The plants retain the carbon in organic combina- 
 tion, and return the oxygen to the air. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 1. An alkaloid is an organic, nitrogenized substance, 
 alkaline in reaction, and capable of combining with acids 
 to form salts in the same way that ammonia does. A 
 tincture is an alcoholic solution of a nonvolatile substance. 
 A fluid extract is a permanent solution of a vegetable drug, 
 in which one cubic centimeter of the solution represents 
 one gram of the drug. 
 
 2. (1) Emetics, as tartar emetic, dose one to two grains; 
 (2) diuretics, as potassium acetate, dose five to sixty 
 grains; (3) hypnotics, as chloral hydrate, dose five to 
 twenty grains; (4) mydriatics, as atropine sulphate, dose 
 one one-hundred-and-twentieth to one-twentieth of a grain. 
 
 3. To stimulate the heart's action, strychnine; to pro- 
 duce emesis, apomorphine; to control hemorrhage, ergot. 
 
 4. Normal salt solution is of the strength of 0.7 of 1 per 
 cent. It is indicated in shock or hemorrhage, as an irri- 
 gating fluid, and for intravenous infusion. For method 
 see Rose and Carless' "Surgery" (1907), pages 260, 977, 
 and 2J7 ; or Da Costa's "Surgery" (1908), pages 241 and 
 242. 
 
 5. Principal alkaloid of belladonna is atropine; dose, 
 gr. 1/160. Indications : To relieve pain, relax spasms, to 
 check secretions, to dilate the pupil, to prevent the griping 
 of purgatives, in urinary incontinence, in inflammatory 
 conditions, in asthma, whooping cough, and for the night 
 sweats of phthisis. 
 
 6. Pulvis ipecacuanhse et opii, ten grains; tinctura opii, 
 about ten minims ; tinctura opii camphorata, about half 
 an ounce. 
 
 7. Sulphate of strychnine, gr. 1/90; sulphate of atropine, 
 gr. 1/200; sulphate of morphine, gr. 1/6; apomorphine 
 hydrochloride, gr. 1/12 ; nitroglycerin, Tl# % ; pilocarpine 
 hydrochloride, gr. 1/6. 
 
 8. 5 Potassii acetatis 
 
 Potassii bitartratis 
 
 Potassii citratis a a 3ij 
 
 Aquae destillatae q.s ad Sviij. Misce. 
 
 Signa : One tablespoonful three times a day, in half a 
 glass of water. 
 
 9. Salines cause a great increase in the amount of fluid 
 secreted by the intestinal glands; they also hinder the re- 
 absorption of this fluid. The result is an accumulation of 
 
 46 
 
MEDICAL RECORD 
 
 fluid in the intestine, which, by distention, excites peri- 
 stalsis. 
 
 \g) Xitrite of amyl is inhaled; it is kept in pedes, which 
 are crushed when required. It is used to dilate the blood- 
 vessels in angina pectoris, epilepsy, cardiac dyspnea. 
 
 PRACTICE. 
 
 i. See French's "Practice of Medicine" (1907), pages 
 954 and 1076. 
 
 2. See French's "Practice of Medicine" (1907), page 557; 
 or Osier's "Practice of Medicine" (1909), page 775. 
 
 3. See French's "Practice of Medicine" (1907), page 158; 
 or Osier's "Practice of Medicine" (1909), page 175. 
 
 4. See French's "Practice of Medicine" (1907), page 850; 
 or Osier's "Practice of Medicine" (1909), page 550. 
 
 5. Hemorrhage and perforation of intestines. See 
 French's "Practice of Medicine" (1907), pages 117 and 
 118; or Osier's "Practice of Medicine" (1909), page 103. 
 
 6. See French's "Practice of Medicine" (1907), page 
 225; or Osier's "Practice of Medicine" (1909), page 244. 
 
 7. See French's "Practice of Medicine" (1907), page 
 214; or Osier's "Practice of Medicine" (1909), page 281. 
 
 8. See French's "Practice of Medicine" (1907), page 
 228] or Osier's "Practice of Medicine" (1909), page 225. 
 
 9. See French's "Practice of Medicine" (1907), page 
 326: or Osier's "Practice of Medicine" (1909), page 141. 
 
 10. See French's "Practice of Medicine" (1907), pages 
 242 and 248; or Osier's "Practice of Medicine" (1909), 
 pages 16 and 24. 
 
 SURGERY. 
 
 i. See Rose and Carless' "Surgery" (1908), pages 1059 
 and 1061 ; or Da Costa's "Surgery" (1908), pages 891, 894, 
 and 965. 
 
 2. Skin, dartos, intercolumnar fascia, cremasteric fascia, 
 infundibuliform fascia, and the parietal layer of the tunica 
 vaginalis. 
 
 3. Contraindications for hemorrhoidal operation: Can- 
 cer, or other serious rectal disease; hepatic or cardiac dis- 
 ease, as the cause of the hemorrhoids. 
 
 4. In gallstones there is excruciating pain in the right 
 hypochondrium and epigastrium, muscular rigidity, vomit- 
 ing, jaundice, and fever. In gastric nicer the pain is not 
 so severe, is in the epigastrium, begins soon after eating ; 
 there is no rigidity and no fever. 
 
 In appendicitis: "There is no initial rise of temperature, 
 the latter usually appearing after a few hours. The vomit- 
 ing in biliary colic immediately follows the onset, and not 
 after a few hours, as in appendicitis. It is also more fre- 
 quent during the continuance of the pain in biliary colic. 
 
 47 
 
MEDICAL RECORD. 
 
 The pain in the latter is more severe than in appendicitis, 
 is located higher in the abdomen, as a rule, and radiates 
 to the right shoulder. The muscular rigidity and tender- 
 ness are also higher, being most marked just beneath the 
 costal arch. Appendicitis and chol lithiasis at times co- 
 exist, so that the clinical picture is a most confusing one." — 
 (Eisendrath.) 
 
 5. See Rose and Carless' "Surgery" (1908), page 1166; 
 or Da Costa's "Surgery" (1908), page 11 16. 
 
 OBSTETRICS. 
 
 1. See Cunningham's "Anatomy" (1909), page n85; or 
 Gray's "Anatomy" (1908), page 15 10. 
 
 2. At full term the placenta is a soft, spongy mass, 
 roughly saucer-shaped, from six to nine inches in diameter, 
 about three-quarters of an inch in thickness at the central 
 point, and weighs about one pound. Its functions are: (1) 
 To supply nourishment to the fetus; (2) to act as a 
 respiratory organ for the fetus; (3) to act as an excretory 
 organ for the fetus. 
 
 3. Differential diagnosis— Pregnancy: The tumor is 
 hard and does not fluctuate, is situated in the median line, 
 and may give fetal heart sounds and movements; the cer- 
 vix is soft, and the other signs of pregnancy are present. 
 The rate of growth of the tumor, and the general condition 
 of the patient's health may also help in arriving at a 
 diagnosis. 
 
 Ovarian cystoma: Absence of the chief signs of preg- 
 nancy; there may be the characteristic facies, the tumor is 
 soft, fluctuating, is more to one side, and does not show 
 fetal signs. 
 
 4. See Williams' "Obstetrics" (1909), page 618; or 
 Hirst's "Obstetrics" (1909), page 280. 
 
 5. I£. Acidi borici. 
 
 Sodii bicarbonatis aa, Jj. M. 
 Signa : Put two teaspoonf uls in douche bag of hot 
 water and use as douche morning and evening. 
 
 6. See Williams' "Obstetrics" (1909), page 815; or 
 Hirst's "Obstetrics" (1909), page 577- 
 
 7. For controlling hemorrhage, either vaginal or uterine ; 
 to exert pressure ; to support the uterus ; as a means of 
 applying medication locally; and for depleting inflamma- 
 tory conditions. 
 
 8. See Williams' "Obstetrics" (1909), page 434; or 
 Hirst's "Obstetrics" (1909), page 414. 
 
 9. See Williams' "Obstetrics" (1909). page 661; or 
 Hirst's "Obstetrics" (1909), page 442. 
 
 10. See Williams' "Obstetrics" (1909), page 225; or 
 Hirst's "Obstetrics" (1909), page 324. 
 
 48 
 
MEDICAL RECORD. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 California State Board of Medical Examiners. 
 
 ANATOMY. 
 
 (Answer ten questions only.) 
 
 1. Trace cerebrospinal fluid from the lateral ventricles 
 to the spinal canal. 
 
 2. Describe the rami communicantes. 
 
 3. Name the bones of the tarsus ; use diagram. 
 
 4. Indicate, on the diagram, the points of exit from the 
 pelvis of the following nerves; external cutaneous, an- 
 terior crural, genitocrural, obturator, sciatic, pudic, superior 
 gluteal. 
 
 5. Indicate, on the diagram, the course of the common, 
 internal, and external iliac arteries. 
 
 6. What veins are without valves? 
 
 7. What cranial nerves are distributed to muscles only, 
 i.e. are motor? 
 
 8. Give topographical outline of the lungs and bronchi 
 on the anterior chest wall ; use the diagram. 
 
 9. Give origin and course of the eleventh cranial nerve 
 as far as its exit from the skull. 
 
 10. What are the characteristics of arthrodial joints? 
 Give five examples of this class of joints. 
 
 11. What is the ischiorectal fossa, how bounded, and 
 what does it contain? 
 
 12. When the arm is hanging with palm forward, what 
 bony prominences at shoulder, elbow, and wrist are nor- 
 mally in line? 
 
 HISTOLOGY. 
 
 (Answer eight written questions and identify slides.) 
 
 1. (a) Name the structures found in red bone marrow; 
 (b) give the function of red bone marrow. 
 
 2. Draw diagram illustrating long tissue, naming differ- 
 ent structures. 
 
 3. Explain the difference between the mucosa of the 
 endometrium and that of the vaginal portion of the cervix. 
 Also make drawing. 
 
 4. Give structure of the tonsil. 
 
 5. From which germ layers are the following derived? 
 Pancreas, spleen, large intestine, salivary glands, fat. 
 
 6. Draw a transverse section of the brain, at a point just 
 anterior to the pons varolii. Name most important parts. 
 
 7. Draw diagram illustrating a cell and name all the 
 necessary constituents. 
 
 8. Describe the structure of the liver. 
 
 49 
 
MEDICAL RECORD. 
 
 9. Explain the difference between the white and gray 
 matter of the brain. 
 
 10. What are terminal arteries? Name organs which 
 are so supplied. 
 
 11. Identify slides. 
 
 12. Identify slides. 
 
 PHYSIOLOGY. 
 
 (Answer ten questions only.) 
 
 1. How and where is lymph formed? 
 
 2. Discuss sleep and its causation. 
 
 3. Discuss briefly the influence of the nervous system on 
 the digestive secretions. 
 
 4. Describe the movements of the intestines during diges- 
 tion. 
 
 5. Explain the effect of (a) expiration on the volume 
 of the brain, (b) inspiration. 
 
 6. Discuss the formation, function, and fate of glycogen. 
 
 7. What is the physiological difference between the brain 
 of man and that of lower animals? 
 
 8. Under what circumstances may functional union be 
 made between fibers of different nerve trunks? What 
 practical value has this operation? 
 
 9. Give nerve supply and action of muscles concerned in 
 the movements of the eyeball. 
 
 10. Do we determine the function of a nerve by the 
 location or function of the center from which it comes 
 or by its peripheral connections? Give your reasons. 
 
 11. What is the effect of a destructive lesion in the 
 posterior limb of the internal capsule? 
 
 12. To what extent is the secretion of sweat under (a) 
 nervous control; (b) vascular control? 
 
 BACTERIOLOGY. 
 
 (Answer eight questions only.) 
 
 1. What are the differences in structure, methods of 
 multiplication sporulation, etc., between the blastomycetes 
 or yeasts and bacteria? 
 
 2. What changes are produced on the culture media when 
 Bacillus Coli Communis is grown: (a) upon gelatin, (b) 
 in milk, (c) in dextrose, (d) in lactose? 
 
 3. Describe the conditions necessary to successfully grow 
 Bacillus tetani and the appearance of a stab culture in 
 agar or gelatin about the sixth day. 
 
 4. What is the difference between an antitoxin and a 
 bacterial vaccine? 
 
 5. Name four (4) pathogenic anerobic bacteria. 
 
 50 
 
MEDICAL RECORD. 
 
 6. Differentiate between bacillus tuberculosis and bacillus 
 leprae, taking into consideration staining, culture peculiari- 
 ties, effect on tissues, and relation to tissue cells of the 
 host. 
 
 7. Describe briefly how you would make gelatin plate 
 cultures, using material from a furuncle as the source 
 from which to obtain the germ. 
 
 8. Name ten (10) pathogenic bacteria that are Gram 
 positive. 
 
 9. What do you understand by the opsonic index? 
 
 10. How would you sterilize: (a) a culture tube of 
 gelatin, (b) a p"lass container with rubber stopper, (c) 
 a platinum needle in a glass handle? 
 
 11. Identification of cultures. 
 
 12. Identification of slides. 
 
 CHEMISTRY. 
 
 (Answer ten questions only.) 
 
 1. What is the poison in most headache powders? Its 
 effect? Antidote. 
 
 2. Mention six elementary substances commonly used in 
 their pure state in medicine. 
 
 3. What does the presence of an abnormal quantity of 
 chlorine in drinking water indicate? 
 
 4. How would you detect the presence of bile in the 
 urine? Give two tests. 
 
 5. Give the reaction, specific gravity, and percentage of 
 fats in normal cow's and woman's milk. 
 
 6. Mention a secretion in the body that contains choles- 
 terin; one that contains pepsin, and one that contains 
 trypsin. 
 
 7. What antidotes should be used in phosphorus poison- 
 ing? Explain the action of each. 
 
 8. Define and illustrate (a) capillary attraction, (b) 
 absorption, (c) diffusion, (d) osmosis, (e) endosmosis. 
 
 9. In what principal form is nitrogen eliminated from 
 the body? Give the chemical properties of nitrogen. 
 
 10. What is the -chemical composition of the various 
 renal calculi? 
 
 11. Mention one chemical antidote for each of the fol- 
 lowing: (a) Phenol, (b) arsenious oxide, (c) sulphuric 
 acid, (d) mercuric chloride, (e) oxalic acid. 
 
 12. What are the distinguishing characteristics of urates 
 and uric acid as found in the urine? Give test for uric acid. 
 
 GENERAL DIAGNOSIS. 
 
 (Answer ten questions only.) 
 
 1. Give the physical signs of a pleurisy with effusion. 
 
 2. Give the symptoms of bubonic plague. 
 
 51 
 
MEDICAL RECORD. 
 
 3. Give the symptoms and physical signs of aortic in- 
 sufficiency in the stage of failing compensation. 
 
 4. Give varieties, etiology, and symptoms of chorea. 
 
 5. Give the symptoms of tabes dorsalis. 
 
 6. Describe a Colles' fracture. 
 
 7. Give the points upon which you would make a diag- 
 nosis of cancer of the stomach. 
 
 8. Describe diabetes mellitus, and differentiate it from 
 diabetes insioidus. 
 
 9. Differentiate rubeola from scarlet fever. 
 
 10. Describe the secondary lesions of syphilis. 
 
 11. Give the symptoms of a transverse myelitis. 
 
 12. Give the symptoms of cholelithiasis. 
 
 PATHOLOGY. 
 
 (Answer eight of the written questions and identify four 
 
 slides. ) 
 
 1. Describe the difference in the pathological changes 
 which take place in degeneration of the tissues and those 
 which take place in atrophy. 
 
 2. Give the pathology of tabes dorsalis. 
 
 3. Describe the gross and microscopic changes which 
 take place in the spleen, liver, and kidneys as a result of 
 prolonged exposure to malarial infection. 
 
 4. What are the postmortem changes usually found in 
 diabetes mellitus in (a) children, (b) adults of middle age, 
 (r) adults of advanced age? 
 
 5. What is the average blood pressure in adults fifty to 
 sixty years of age measured in millimeters of mercury? 
 Describe the results if this pressure is exceeded for a con- 
 siderable time. 
 
 6. In bony tissue what variety of malignant growths 
 usually occur, and why? 
 
 7. Under what conditions is cerebral embolism most 
 likely to occur? What blood-vessels are most likely to be 
 affected, and why? 
 
 8. Describe the local lesion caused by infection by 
 anthrax bacilli; the general or systemic effects, and state 
 how infection usually occurs. 
 
 9. Describe the condition present in acute dilatation of 
 the heart. Give the immediate and predisposing causes and 
 the usual final result. 
 
 10. State fully why urinary bladder disorders are so fre- 
 quent and so resistant to treatment in both elderly men 
 and elderly women. 
 
 11. Identify two slides. 
 
 12. Identify two slides. 
 
 52 
 
MEDICAL RECORD 
 
 OBSTETRICS. 
 
 (Answer ten questions only.) 
 
 i. What zymotic diseases are liable to affect the pregnant 
 and puerperal woman, and how? 
 
 2. How soon after the completion of the second stage 
 of labor should the umbilical cord be ligated? How 
 dressed? What are the dangers of improper dressing? 
 
 3. What injuries are liable to occur to the birth canal 
 during labor? 
 
 4. Under what circumstances are anesthetics indicated in 
 labor? What are the dangers? 
 
 5. What are the causes of premature rupture of the 
 membranes? How does it influence the progress of labor? 
 
 6. How would you determine if a child is premature at 
 birth? _ 
 
 7. Differentiate between retained and adherent placenta; 
 the management of each. 
 
 8. What can be determined by external palpitation of the 
 pregnant woman at the eighth month? How should it be 
 performed? 
 
 9. What are the so-called false pains of labor? Differen- 
 tiate from true pains. 
 
 10. Rupture of the uterus ; etiology and symptoms. 
 
 11. Give the physiology of menstruation; of ovulation; 
 relation, if any. 
 
 12. What is inversion of the uterus? Diagnosis and 
 management. 
 
 GYNECOLOGY. 
 
 (Answer ten questions only.) 
 
 1. Give the conditions justifying operative measures in 
 fixed retrodisplacement of the uterus. 
 
 2. Describe a pelvic hematocele, and give the usual 
 cause. 
 
 3. What is the pathology of pelvic cellulitis, and what are 
 the physical signs? 
 
 4. Name the most important causes of sterility. 
 
 5. Differentiate between a pudendal hernia and pudendal 
 hematocele. 
 
 6. What do you understand by the operation for peri- 
 neorrhaphy? 
 
 7. Give the etiology and pathology of chronic endocer- 
 vicitis? 
 
 8. Describe a case of carcinoma uteri, and give some of 
 the most prominent physical signs. 
 
 9. Discuss the matter of relative protmosis^ of cancer of 
 che body of the uterus and cancer of the cervix. 
 
 53 
 
MEDICAL RECORD. 
 
 io. Describe the mode of use and purpose of a vaginal 
 tampon. 
 
 ii. Differentiate between herpes of the vulva and chancre. 
 
 12. Name the muscles of the perineum, and give the 
 functions or the perineal body. 
 
 HYGIENE. 
 
 (Answer ten questions only.) 
 
 i. Describe in detail the method of transmission of 
 yellow fever. 
 
 2. What measures would you adopt to prevent the spread 
 of typhoid fever during an epidemic? 
 
 3. What is a septic tank? Describe construction and 
 explain how it acts. 
 
 4. What sanitary measures should be adopted in caring 
 for tuberculous patients? 
 
 5. Name five of the most common intestinal parasites, 
 and give a short description of each. 
 
 6. Give three ways of fumigating a room with formalin ; 
 also two methods with other disinfectants. 
 
 7. What effect have venereal diseases on the propagation 
 of the human species? Explain. 
 
 8. How does the hookworm usually enter the human 
 body? What means would you adopt to prevent its spread? 
 
 9. Describe the technique of vaccination, and give the 
 course of a successful case. 
 
 10. What is the period of incubation of the following 
 diseases: Plague, smallpox, diphtheria, scarlatina, measles? 
 
 11. What is the object of placing traps on all waste 
 pipes? What danger to health would arise if there were 
 no traps? 
 
 12. Describe two types of water filter. What should be 
 accomplished by a good filter? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 California State Board of Medical Examiners. 
 
 ANATOMY. 
 
 i. The cerebrospinal fluid passes from the lateral ventri- 
 cles through the foramen of Monro into the third ventri- 
 cle; then through the aqueduct of Sylvius (or iter a tertio 
 ad quartum ventriculum) into the fourth ventricle, through 
 the latter, and into the central canal of the spinal cord. 
 
 2. See Cunningham's "Anatomy" (1909), pages 615, 616, 
 
 54 
 
MEDICAL RECORD. 
 
 and 609; or Gray's "Anatomy" (1908), pages 1078 and 
 1079. 
 
 3. The bones of the tarsus are: Calcaneus, astragalus, 
 cuboid, scaphoid, internal cuneiform, middle cuneiform, 
 and external cuneiform. For diagram, see Cunningham's 
 "Anatomy" (1909), page 239; or Gray's "Anatomy" (1908), 
 page 242. 
 
 4. See Cunningham's "Anatomy" (1909), page 641; or 
 Gray's "Anatomy" (1908), pages 1017 and 1029. 
 
 5. See Cunningham's "Anatomy" (1909), pages 840 and 
 857; or Gray's "Anatomy" (1908), pages 671 and 686. 
 
 6. The veins without valves are : The venae cavse, hepatic 
 veins, portal vein and its branches, renal, uterine, ovarian, 
 pulmonary, cerebral, spinal, and umbilical veins. The sinuses 
 of the skull and very small veins are also without valves. 
 
 7. The cranial nerves exclusively motor are: Oculomotor 
 (3) ; Trochlear (4) ; Abducens (6) ; Facial (7) ; Spinal ac- 
 cessory (11) ; and Hypoglossal (12). 
 
 8. See Cunningham's "Anatomy" (1909), page 1257. 
 
 9. See Cunningham's "Anatomy" (1909), page 695; or 
 Gray's "Anatomy" (1908), page 1073. 
 
 10. See Cunningham's "Anatomy" (1909), page 257; or 
 Gray's "Anatomy" (1908), page 268. 
 
 11. See Cunningham's "Anatomy" (1909), page 1281 ; or 
 Gray's "Anatomy" (1908), page 1548. 
 
 12. When the arm is hanging with palm forward the 
 acromion process of the shoulder, the external condyle 
 of the humerus, and the styloid process of the radius are 
 normally in line. 
 
 HISTOLOGY. 
 
 1. (a) See Cunningham's "Anatomy" (1909), page 71; 
 or Gray's "Anatomy" (1908), page s^> ( ] °) The function 
 of red bone marrow is to form red blood corpuscles; also 
 to help in the formation of bone. 
 
 2. See Cunningham's "Anatomy" (1909), page 990; or 
 Gray's "Anatomy" (1908), page 1403. 
 
 3. See Cunningham's "Anatomy" (1909), page 1191; or 
 Gray's "Anatomy" (1908), page 1504. 
 
 4. See Cunningham's "Anatomy" (1909), page 1035; or 
 Gray's "Anatomy" (1908), page 1223. 
 
 5. Pancreas is derived from entoderm; spleen, from 
 mesoderm; Large intestine, from entoderm; Salivary 
 glands, from ectoderm ; Fat, from mesoderm. 
 
 7. See Cunningham's "Anatomy" (1909), page 8. 
 
 8. See Cunningham's "Anatomy" (1909) page 1121; or 
 Gray's "Anatomy" (1908), page 1345. 
 
 9. See Cunningham's "Anatomy" (1909), page 443; or 
 Gray's "Anatomy" (1908), page 833. 
 
 55 
 
MEDICAL RECORD. 
 
 io. Terminal arteries are such as do not anastomose 
 with other arteries, either directly or by branches. Organs 
 supplied with terminal arteries: Retina, brain, kidneys, 
 spleen, lungs. 
 
 PHYSIOLOGY. 
 
 i. There are two theories as to the formation of lymph: 
 (i) That it is formed from the blood plasma by the 
 processes of filtration, diffusion, and osmosis. (2) That 
 in addition to these -the endothelial cells of the capillaries 
 exercise some influence. 
 
 2. Sleep is a condition of partial or complete uncon- 
 sciousness, during which the brain and body can recuperate. 
 Metabolism in general is diminished, anabolism is (rela- 
 tively) in excess of katabolism. During sleep the respira- 
 tions are slower and deeper, most of the secretions are 
 diminished, the pulse is slower, the eyeballs roll inward 
 and upward, and oxidation in the tissues is decreased. 
 The cause of sleep is not known. Bradbury (in Allbutt's 
 "System of Medicine") gives the following as hypotheses 
 as to the causation of sleep: (1) Cerebral anemia; (2) 
 chemical changes in the brain cells or neurons, such as an 
 exhaustion of their intramolecular oxygen, or an accumula- 
 tion of fatigue products; (3) contraction of the dendritic 
 processes and a consequent break in the transmission of 
 nerve impulses ; (4) expansion of the neuroglial cell proc- 
 esses, insulating the nerve processes and producing the 
 same effect; (5) loss of consciousness apart from any 
 physical or chemical change ; (6) the most probable hypoth- 
 esis is that of an altered metabolism of the cerebral^ cells 
 dependent upon exhaustion and diminished influx of stimuli. 
 Quite recently two new theories have been promulgated; 
 one attributes the causation of sleep to an internal secre- 
 tion of the pituitary body; the other makes it due to 
 osmosis. 
 
 3. "The secretion of the digestive fluids is governed by 
 the action of the nervous system, so that they are poured 
 into the alimentary canal during the digestive process as 
 they are required. The saliva is continuously secreted in 
 sufficient quantities to keep the mouth moist, but _ the 
 quantity formed is greatly increased by the sight or idea 
 of food, as well as by the actual presence of food in the 
 mouth, or the savory smell of food acting on the olfactory 
 nerve. 
 
 "Stimulation of the mucous membrane of the stomach 
 gives rise to increased vascularity, also to a copious secre- 
 tion of gastric juice. It is probable that the food acts 
 directly upon a local nervous mechanism in the wall of 
 the stomach, possibly Meissner's plexus, yet it is certain 
 
 56 
 
MEDICAL RECORD. 
 
 that the secretion of the gastric fluid is more or less 
 under the influence of the central nervous system. ^ This 
 is seen in the manner in which the digestive function is 
 arrested by fear, anger, and other mental conditions. 
 Moreover, the secretion of the gastric juice commences 
 before food is actually introduced into the stomach, as 
 the smell, taste, or idea of food stimulates its glands to 
 activity. As division of the vagus below the origin of the 
 recurrent branch during digestion causes the gastric mucous 
 membrane to become pale, and diminishes the secretion of 
 gastric juice, it may be inferred that this nerve is an 
 efferent nerve, the action of which normally inhibits the 
 vasoconstrictor action of the sympathetic. 
 
 "The secretion of the pancreas, like that of the salivary 
 glands, is undoubtedly under the control of the nervous 
 system, and a large flow of pancreatic juice occurs imme- 
 diately food is taken; and a second but less copious flow 
 takes place about four hours afterwards, probably when 
 the principal discharge of chyme from the stomach into 
 the duodenum takes place. 
 
 "In the intestine the rich nervous plexus of Meissner, 
 which is found in the submucous tissue, is concerned in 
 regulating the secretion of the glands in the intestinal wall. 
 Similar plexuses are found in the esophagus and stomach, 
 and in the latter, it has been already stated, a local nerv- 
 ous mechanism probably regulates the act of secretion." — 
 (Aids to Physiology.) 
 
 4. See Gray's "Anatomy" (1908), page 1330. 
 
 5. The volume of the brain is increased during expira- 
 tion, and is diminished in inspiration. This can be ob- 
 served in infants before the fontanelles are closed, and in 
 adults when the brain is exposed. "With the act of ex- 
 piration the flow of blood in the arteries is favored and 
 the current in the veins is retarded. If the effort be vio- 
 lent, the valve at the opening of the internal jugular maybe 
 closed. This act would produce an expansion of the 
 brain, not from reflux by the veins, but from the fact that 
 the flow into the chest is impeded, and the blood, while 
 passing in more freely by the arteries, is momentarily 
 confined. With inspiration the flow into the thorax is 
 materially aided, and the brain is in some degree relieved 
 of this expanding force."— (Flint's Physiology.) 
 
 6. Glycogen is chiefly formed from the carbohydrates. 
 The liver cells act upon the dextrose into which the carbo- 
 hydrates have been converted by the action of the ptyalin 
 and amylopsin of the digestive juices. This may occur by 
 a simple process of dehydration : 
 
 C6H12U6 — H 2 = CsHioOs 
 57 
 
MEDICAL RECORD. 
 
 But the precise process by which it occurs in the liver 
 cells is not known. At a subsequent period the glycogen 
 is transformed into dextrose and is returned to the cir- 
 culation. Hence the blood of the hepatic veins contains 
 more sugar than the blood of the arteries, and these latter 
 more than the blood in the veins (except the hepatic). 
 This is the generally accepted view, but it is denied by 
 Pavy, and the whole subject is in a state of uncertainty. 
 The function of glycogen is to form a temporary re- 
 serve supply of carbohydrate material that is stored up in 
 the liver during digestion, and made use of between meals ; 
 at the same time the percentage of sugar in the systemic 
 blood is kept nearly constant. 
 
 7. The brain of man, as compared with that of lower 
 animals: (1) Is greater in size and weight; (2) shows a 
 greater complexity of the convolutions; (3) has frontal 
 lobes relatively greater in size and complexity; (4) has 
 temporo-sphenoidal lobes less prominent; (5) the fissure 
 of Sylvius is nearly horizontal; and (6) the fissure of 
 Rolando is more distinct. — (From Kirkes' Physiology.) 
 
 8. This procedure is of very limited application because 
 of the necessity of finding large nerves in the neighbor- 
 hood; it is utilized nearly exclusively in the upper extrem- 
 ity; it seems to make no difference whether a sensory nerve 
 be grafted to a motor or to a mixed nerve — or vice versa. 
 The object is to switch an interrupted nerve impulse into 
 a neighboring sound nerve, and then have it returned to 
 the original nerve (lower down), and so transmitted to its 
 final distribution as though there had been no interruption. 
 
 9. See Cunningham's "Anatomy" (1909), page 401; or 
 Gray's "Anatomy" (1908), page 376. 
 
 10. The function of a nerve is determined by dividing 
 the nerve and then observing whether there is any loss of 
 sensation, or muscular paralysis, or absence of secretory 
 function, or degeneration of tissue. 
 
 11. A destructive lesion in the posterior limb of the in- 
 ternal capsule will cause hemiplegia of the opposite side, 
 followed by contractures ; and also hemianesthesia, in 
 which the special senses may be included. 
 
 12. (a) The secretion of sweat is chiefly under nervous 
 control; and (b) but slightly under vascular control. "The 
 relation of the secretion of perspiration to the temperature 
 of the body, and the amount formed, is under the control 
 of the nervous system. An increased supply of blood to 
 the skin, the result of vasomotor inhibition, acts only in- 
 directly in increasing the secretion, which is under the 
 direct control of special secretory nerves. This can be 
 shown by the stimulation of a cutaneous nerve even after 
 
 58 
 
MEDICAL RECORD. 
 
 the blood supply has been cut off. Stimulation of the 
 sciatic of the amputated limb of an animal will produce 
 a discharge of sweat upon the foot. The copious sweat 
 produced on the pale, cold, anemic skin by fear and in 
 some forms of death are evidence that sweat, like saliva, 
 may be secreted in considerable quantity without any in- 
 creased, and, indeed, with a greatly diminished, blood sup- 
 ply." — (Aids to Physiology.) 
 
 BACTERIOLOGY. 
 
 i. Blastomycetes. Structure: A protoplasmic body sur- 
 rounded by a double-contoured capsule. Sometimes drops 
 of fat, granules, and vacuoles are seen ; the presence of a 
 nucleus is doubtful. Sometimes they appear as long, cylin- 
 drical hyphce. Multiplication is by budding; sometimes also 
 by sporulation. 
 
 Bacteria. Structure: A protoplasmic body surrounded 
 by a cell wall and nucleated, often flagellated, and some- 
 times granular. Multiplication is by fission, sometimes 
 also by sporulation. 
 
 2. Bacillus coli communis (a) shows colonies in twenty- 
 four hours on gelatin. The deeper colonies are round and 
 brownish ; the more superficial ones are larger and more 
 diffuse ; the edges are dentate ; the gelatin is not liquefied. 
 (b) The milk coagulates, becomes acid, gas is given off, 
 and a fecal odor is observed, (c) Dextrose is fermented, 
 and gases are formed (mainly C0 2 and H 2 , generally two 
 parts of H 2 to one of CO2). (d) Lactose is fermented, and 
 gases are formed (mainly C0 2 and H, but in less constant 
 proportion than in dextrose). 
 
 3. Absence of oxygen is necessary for the growth of the 
 tetanus bacillus ; otherwise the conditions are much the 
 same as for other bacilli. The appearance of a stab cul- 
 ture, in gelatin, about the sixth day, is that of a fir tree. 
 
 4. Difference between an antitoxin and a bacterial vac- 
 cine: ''The antitoxic sera act directly upon the poison 
 secreted by the living bacterial cell and neutralize its toxic 
 property, while the bacteriolytic sera affect the bacteria 
 themselves and destroy them or paralyze their action. 
 Since the antibacterial sera are without effect upon the 
 formed toxin, they are mainly useful in practice as a 
 means of protecting against the bacterial invasion, while 
 the antitoxic sera {e.g. diphtheria) may be employed to 
 combat an infection already in progress. Broadly speak- 
 ing, the latter are curative, the former protective." — (Jor- 
 dan's Bacteriology.) 
 
 5. Four pathogenic anaerobic bacteria: Bacillus tetani, 
 Bacillus cedematis maligni, Bacillus cerogenes capsulatus, 
 and Bacillus botulinus. 
 
 59 
 
MEDICAL RECORD 
 
 6. Differentiation between Bacillus tuberculosis and Bacil- 
 lus leprae: (i) It is claimed that the leprosy bacillus is 
 stained by an exposure of six or seven minutes to a cold, 
 saturated, watery solution of fuchsin, and retains the stain 
 when subsequently treated with acid alcohol (nitric acid 
 i part to alcohol 10 parts). When treated for the same 
 length of time the Bacillus tuberculosis does not ordinarily 
 become stained. (2) The leprosy bacilli are found in 
 enormous numbers, especially in large vacuolated cells 
 (lepra cells), and lie in the lymph spaces. They are fre- 
 quently beaded and lie in masses which have been likened 
 to a bundle of cigars tied together. It is necessary to 
 examine for long periods of time smears made from 
 tuberculous lesions of skin before finding a single organ- 
 ism. (3) Leprosy bacilli have not surely been cultivated. 
 (4) Injected into guinea-pigs, they do not produce lesions. 
 
 7. To make a gelatin plate culture : Melt three tubes of 
 gelatin, and let them cool in a water bath to about 30 C. 
 Sterilize the platinum wire. Inoculate tube 1 with a 
 platinum loopful of the material to be plated (pus from 
 the furuncle) and mix thoroughly. Replace the cotton 
 plug, and take care that it does not get soiled. From tube 
 1 transfer two loopfuls to tube 2, and mix, and replace 
 plug as before. From tube 2 similarly transfer two loop- 
 fuls to tube 3, and mix, and replace plug as at first. Then 
 pour the contents of each tube into a sterile Petri dish; 
 heat the neck of the tube as soon as the plug is removed, 
 insert it under the edge of the lifted Petri di§h cover and 
 pour quickly. 
 
 8. Ten pathogenic bacteria that are Gram positive: 
 Staphylococcus pyogenes aureus, Staphylococcus pyogenes 
 albus, Streptococcus pyogenes, Pneumococcus, Bacillus 
 anthracis, Bacillus tuberculosis, Bacillus leprce, Bacillus 
 diphtheria, Bacillus tetani, Micrococcus tetragenus. 
 
 9. The opsonic index is the relative amount of opsonins 
 in a serum, as compared with the normal standard. It is 
 obtained by dividing the average number of bacteria taken 
 up by a leucocyte under the influence of a given serum by 
 the average number taken up by a leucocyte under the in- 
 fluence of a standard normal serum. 
 
 10. To sterilize (a) a culture tube of gelatin: Put it 
 in an Arnold sterilizer on three successive days, or in the 
 autoclave at about 8 or 9 pounds' pressure for ten minutes. 
 (b) A glass container with rubber stopper: Take out the 
 stopper, clean it with soap and water, and let it stand 
 for an hour in a solution of bichloride of mercury 1 :iooo, 
 and then wash with sterile water ; plug the glass with non- 
 absorbent cotton and put it in a hot-air sterilizer at 170 C. 
 for one hour, (c) A platinum needle in a glass handle: 
 
 60 
 
MEDICAL RECORD 
 
 Heat the needle in an alcohol flame till red hot, and then 
 allow to cool. 
 
 CHEMISTRY. 
 
 i. The poison in most headache powders is Acetanilid. 
 It produces a sense of chilliness, cold perspiration, cyanosis, 
 pulse soft and slow, respirations slow and shallow, dizzi- 
 ness, dyspnea, collapse, and coma. Antidote, strychnine. 
 
 2. Sulphur, mercury, phosphorus, oxygen, carbon, and 
 iodine. 
 
 3. The presence of an abnormal quantity of chlorine in 
 drinking water generally indicates sewage contamination. 
 
 4. Gmelin's test for bile pigments: Put 3 c.c. HN0 3 in 
 a test tube, add a piece of wood, and heat until the acid 
 is yellow; cool. When cold, float some of the urine to be 
 tested upon the surface of the acid. A green band is 
 formed at the junction of the liquids, which gradually rises, 
 and is succeeded from below by blue, reddish-violet, and 
 yellow. 
 
 The Pettenkofer test: Dissolve one or two drops of a 
 solution of cane sugar 1:4 in the liquid to be examined; 
 shake the mixture and float it carefully upon concentrated 
 H2SO4. In the presence of bile acids the solution becomes 
 turbid at the zone of junction of the two layers; this is 
 soon replaced by a deep reddish purple zone, which extends 
 upward and downward. 
 
 5- 
 
 Reaction 
 
 Specific gravity — 
 Percentage of fats. 
 
 cow's MILK. 
 
 Alkaline or ampho- 
 teric. 
 1028 to 1034. 
 3 to 4. 
 
 woman's milk. 
 
 Alkaline or ampho- 
 teric. 
 1026 to 1036. 
 3 to 4. 
 
 6. Cholesterin is found in the bile ; pepsin, in the gastric 
 juice; trypsin, in the pancreatic juice. 
 
 7. In phosphorus poisoning the antidotes are: (1) Solu- 
 tion of potassium permanganate (1 per cent.) ; this oxi- 
 dizes the phosphorus, forming phosphoric acid and phos- 
 phates; the potassium permanganate itself becoming man- 
 ganese dioxide. (2) Old, acid, oil of turpentine; this is 
 said to combine with the phosphorus to produce a non- 
 poisonous substance. 
 
 8. (a) Capillary attraction is the force which attracts 
 fluids in contact with small tubes thrust into them, so that 
 the fluid is drawn up above the surface of the liquid in the 
 containing vessel. 
 
 (&) Absorption is the process by which one substance 
 is taken up or into another by molecular action. 
 
 61 
 
MEDICAL RECORD. 
 
 (c) Diffusion is the gradual and spontaneous passage of 
 one gas into another gas, or of one liquid or dissolved sub- 
 stance into another liquid. 
 
 (d) and (e) If two liquids be separated from each other 
 by a membrane each will pass through the membrane into 
 the other; this process is called osmosis; they do not pass 
 with equal rapidity. Endosmosis is the term used to de- 
 note the more rapid osmosis, and exosmosis, the slower. 
 These terms are also used to denote the direction (inward 
 or outward osmosis, respectively). 
 
 9. Nitrogen is chiefly eliminated from the body as urea. 
 Chemical properties of nitrogen: It is a gas, colorless, 
 odorless, tasteless; it is not combustible, and does not 
 support combustion; is but slightly soluble in water; it is 
 very slow to enter into combination ; it is not poisonous, 
 but it is incapable of supporting respiration. 
 
 10. Chemical composition of various renal calculi: Uric 
 acid, sodium urate, ammonium urate, calcium oxalate, cal- 
 cium phosphate, ammonium magnesium phosphate; occa- 
 sionally, cystin, xanthin, and urates of potassium, calcium, 
 and magnesium. 
 
 11. Chemical antidote for (a) Phenol, sodium sulphate; 
 (b) arsenious oxide, freshly prepared solution of ferric 
 hydroxide; (c) sulphuric acid, magnesia; (d) mercuric 
 chloride, white of egg; (e) oxalic acid, lime water. 
 
 12. Urates show a pinkish color, and dissolve on warm- 
 ing the urine. Uric acid is recognized by its crystalline 
 form, and by the murexide reaction. The murexide test 
 is : Add a little dilute nitric acid to the urine, evaporate to 
 dryness, a yellowish-red residue is left, add a few drops 
 of ammonia, the residue turns to violet. This is due to 
 the formation of murexide (or purpurate of ammonia). 
 
 GENERAL DIAGNOSIS. 
 
 i. See French's "Practice of Medicine" (1907), page 701 ; 
 or Osier's "Practice of Medicine" (1909), page 646. 
 
 2. See French's "Practice of Medicine (1907), page 284; 
 or Osier's "Practice of Medicine" (1909), page 240. 
 
 3. See French's "Practice of Medicine" (1907), page 585; 
 or Osier's "Practice of Medicine" (1909), page 799. 
 
 4. See French's "Practice of Medicine" (1907), page 
 1 1 17; or Osier's "Practice of Medicine" (1909), page 1045. 
 
 5. See French's "Practice of Medicine" (1907), page 
 1047; or Osier's "Practice of Medicine" (1909), page 889. 
 
 6. See Rose and Carless' "Surgery" (1908), page 521; or 
 Da Costa's "Surgery" (1908), page 506. 
 
 62 
 
MEDICAL RECORD. 
 
 7. See French's "Practice of Medicine" (1907), page 759; 
 or Osiers "Practice of Medicine" (1909)* page 485. 
 
 8. See French's "Practice of Medicine" (1907), pages 
 935, 943, and 947; or Osier's "Practice of Medicine" (1909), 
 pages 408, 419, and 425. 
 
 9. See French's "Practice of Medicine (1907), pages 322, 
 323, and 330; or Osier's "Practice of Medicine" (1909)* 
 pages 136, 137, and 144. 
 
 10. See French's "Practice of Medicine" (1907), page 
 421 ; or Osier's "Practice of Medicine" (1909), page 267. 
 
 11. See French's "Practice of Medicine" (1907), page 
 1030; or Osier's "Practice of Medicine" (1909), page 946. 
 
 12. See French's "Practice of Medicine" (1907), page 
 852; or Osier's "Practice of Medicine" (1909)* page 550. 
 
 PATHOLOGY. 
 
 1. Degeneration is a pathological process in which ab- 
 normal substances are formed within living cells, or the 
 entire cells are transformed into abnormal material. 
 
 Atrophy is decrease in the amount of a tissue, owing to 
 diminution in size (simple atrophy) or number (numerical 
 atrophy) of the histological elements of which it is com- 
 posed. There are also loss of weight and impairment of 
 function. There is no definite disease of the cells or tis- 
 sues ; frequently the two conditions (degeneration and 
 atrophy) merge, and it may be difficult to draw a dividing 
 line between them. 
 
 2. In tabes dorsalis the posterior columns of the spinal 
 cord and the posterior nerve roots are involved. The 
 posterior columns of the spinal cord are gray and shrunken, 
 and show considerable overgrowth of connective tissue 
 in the columns of Goll, Burdach, and Lissauer; this process 
 extends upward from the lumbosacral region ; the posterior 
 nerve roots degenerate and become atrophic. The meninges 
 over the affected parts become opaque and adherent. Some 
 of the cranial nerves may also atrophy, notably the optic, 
 but also the motor oculi and vagus. The process is de- 
 structive and progressive ; it is not a simple wasting, 
 although the nerve fibers are atrophied, but it is character- 
 ized by irritation, changes in the axis cylinders, overgrowth 
 of the connective tissue, and sometimes congestion; the 
 spinal ganglia may be affected. 
 
 3. See French's "Practice of Medicine" (1907), page 
 239; or Osier's "Practice of Medicine" (1909), page 15. 
 
 4. For the changes, in general, see French's "Practice of 
 Medicine" (1907), page 939; or Osier's "Practice of Medi- 
 cine" (1909), page 412. As to the distinction asked in the 
 question, we can find no information. 
 
 63 
 
MEDICAL RECORD. 
 
 5. The average blood pressure in adults fifty to sixty 
 years of age is about 100 to 145 mm. mercury. If this pres- 
 sure is exceeded for a considerable time there will be 
 hypertrophy and dilatation of the heart; possibly, also, 
 bursting of a blood-vessel, with its consequences. 
 
 6. Sarcoma is the most usual malignant growth in bone; 
 the reason is that bone is a connective tissue, and sarcoma 
 is the only malignant tumor of the connective tissue type. 
 
 7. Cerebral embolism most frequently occurs as a result 
 of vegetations of an endocarditis. The artery of the Syl- 
 vian fissure is most likely to be affected, owing to anatom- 
 ical conditions by which the embolus takes the most direct 
 route from the left side of the heart to the brain (through 
 the aorta, left common carotid, internal carotid, middle 
 cerebral, and so to artery of Sylvian fissure). The anterior 
 cerebral artery may also be obstructed; or the posterior 
 cerebral (in which case the embolus travels along the 
 vertebral and through the basilar). 
 
 8. See French's "Practice of Medicine" (1907), page 
 454; or Osier's "Practice of Medicine" (1909), page 252. 
 
 9. See French's "Practice of Medicine" (1907), page 
 599; or Osier's "Practice of Medicine" (1909), page 820. 
 
 10. In old age the walls of the bladder grow thicker, and 
 the capacity becomes smaller; in men the prostate gland 
 enlarges; urinary troubles follow, caused partly by the 
 above and partly by diseases of the kidneys or other organs. 
 All the resisting and recuperative powers of the body are 
 diminished, the reparative processes no longer act, or act 
 feebly and slowly; the nutrition of the tissues is enfeebled; 
 hence diseases tend to become chronic. Degenerative proc- 
 esses are also common. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), pages 480 and 916; 
 or Hirst's "Obstetrics" (1909), pages 263 and 674. 
 
 2. There is no fixed time for the ligation of the cord; 
 as a rule it should not be ligated till it has ceased to pul- 
 sate, unless there is some urgent reason to the contrary. 
 Dry, aseptic cotton or gauze (borated or salicylated) makes 
 the best dressing. It should be kept dry and aseptic, and, 
 if possible, be touched by no one but the physician. The 
 dangers of improper dressing are : Infection, peritonitis, 
 and death of the child. 
 
 3. Injuries which may occur to the birth canal during 
 labor: Lacerated perineum, tears and abrasions of labia, 
 injuries of blood-vessels, laceration of vagina, laceration 
 of vulva, injuries to levator ani muscle, lacerations of 
 
 64 
 
MEDICAL RECORD. 
 
 cervix, rupture of uterus, instrumental perforation of 
 uterus, inversion of the uterus. 
 
 4. Anesthetics are used in labor to lessen suffering 
 produced by labor pains; to lessen the pain attending ob- 
 stetric operations ; to relax the uterus when its rigid con- 
 traction interferes with version; to promote dilatation of 
 the os uteri; to reduce excessive nervous excitement which 
 may interfere with progress of early stage of labor; to 
 relieve eclamptic convulsions and mania ; in cases of uterine 
 inversion to relax the constricting cervix and so facilitate 
 replacement; in bipolar version to lessen pain of introduc- 
 ing the hand into vagina ; in precipitate labor to suspend 
 action of voluntary muscles and retard delivery; in all 
 cutting operations upon the abdomen; and sometimes in 
 sewing up a lacerated perineum when many sutures are 
 required. — (From King's Obstetrics.) 
 
 Dangers: It lessens the efficiency of the uterine con- 
 tractions ; it predisposes to postpartum hemorrhage ; and, 
 if given too freely, may be followed by headache, nausea, 
 and vomiting. 
 
 5. Premature rupture of the membranes. Causes: 
 Deformed pelvis, shoulder presentation, unusual friability 
 of the membranes, endometritis. The progress of labor is 
 lengthened and rendered more difficult; hence infection is 
 more likely. It conduces to laceration of the cervix, rup- 
 ture of cervix, prolapse of funis, maternal exhaustion and 
 shock, and fetal death. 
 
 6. See Williams' "Obstetrics" (1909), page 146; or Hirst's 
 "Obstetrics" (1909), page 86. 
 
 7. Adherent placenta is not common. It cannot be ex- 
 pressed. There is no descent of the cord. Pressure on 
 the fundus causes a thrill of the cord; there is hemorrhage. 
 
 In retained placenta the opposite of the above will be 
 observed. For treatment see Williams' "Obstetrics" (1909), 
 page 301; or Hirst's "Obstetrics" (1909), pages 434 and 
 436. 
 
 8. See Williams' "Obstetrics" (1909), page 211 ; or Hirst's 
 "Obstetrics" (1909), pages 200 and 389. 
 
 9. False pains are irregular uterine contractions which 
 occur before the beginning of labor, and which may be 
 either painful or painless, and which do not cause the 
 "show," nor yet dilate the os. 
 
 True pains are uterine contractions occurring at the be- 
 ginning and lasting through the first two stages of labor. 
 They are usually very painful; they advance labor, dilate 
 the os, and cause the "show." 
 
 10. See Williams' "Obstetrics" (1909), pages 833 and 
 836; or Hirst's "Obstetrics" (1909), pages 593 and 597. 
 
 65 
 
MEDICAL RECORD. 
 
 ii. See Williams 5 "Obstetrics" (1909), page 81; or 
 Hirst's "Obstetrics" (1909), pages 57 and 61. 
 
 The relation existing between ovulation and menstrua- 
 tion is not known. The two processes are usually coexist- 
 ent, but they may be independent of each other. The fol= 
 lowing theories have been held*: (1) Menstruation is de- 
 pendent upon ovulation; (2) ovulation is dependent upon 
 menstruation; (3) they are independent of each other; (4) 
 they both depend upon some other (at present unknown) 
 cause. 
 
 12. See Williams' "Obstetrics" (1909), page 824; or 
 Hirst's "Obstetrics" (1909), pages 614 and 616. 
 
 GYNECOLOGY. 
 
 1. "Many cases of displacements are so complicated by 
 prolapsed and adherent^ ovaries, by advanced disease of 
 the ovaries and Fallopian tubes, by tumors, by inflam- 
 matory exudates, or by peritoneal adhesions that replace- 
 ment is impossible, or, replacement being possible, the 
 pessary is either intolerable from pain or proves inadequate 
 to sustain the uterus. Such cases, unless relievable by non- 
 surgical measures, furnish a definite indication for sur- 
 gical treatment." — (Dudley's Gynecology.) 
 
 2. Pelvic hematocele is an accumulation of blood in the 
 pelvis, due to rupture of a blood-vessel ; it is generally due 
 to rupture of a tubal pregnancy, or to a tubal abortion. 
 Symptoms: Pain, which is sudden and severe, over abdo- 
 men and pelvis ; nausea, cold perspiration, cold extremities, 
 pulse rapid and weak, pinched features, and shock. 
 
 3. Pelvic cellulitis. Pathology: "Pelvic cellulitis is 
 the inflammation of the connective tissue in the pelvis, 
 above the pelvic diaphragm. It is particularly found in 
 the broad ligaments, the surroundings of the cervix, and 
 the sacro-uterine ligaments. It may be acute or chronic. 
 The former may arise from a tear in the cervix extending 
 into the parametrium, spread from the interior of the 
 uterus, or originate in the depth of bruised tissue. Gener- 
 ally it is combined with peritonitis, lymphangitis, or phle- 
 bitis. It is as a rule unilateral. It may be traumatic or 
 septic. Both are caused by germs, but the former is due 
 to simple saprophytes, the latter to pathogenic microbes. 
 Either of them may be puerperal or non-puerperal. The 
 traumatic spreads in the loose connective tissue lying 
 between the denser membranes ; the septic does not respect 
 any boundary. First, there is a stage of infiltration, which 
 may end in resolution, induration, or suppuration. Of all 
 pelvic inflammations, cellulitis is the one most prone to 
 end in suppuration. The pus spreads, and the abscess may 
 open in a way similar to that followed by an intraperitoneal 
 
 66 
 
xMEDICAL RECORD. 
 
 one ; but while the puerperal form has a tendency to break 
 through the skin, the non-puerperal form usually opens 
 into one of the hollow organs. Rupture into the peritoneal 
 cavity is rare. Cellulitis may end in cicatricial retraction, 
 causing uterine displacement. Indurated tissue is apt to 
 suppurate after a long time. Physical signs: The patient 
 may have a chill, there is a rise in temperature; the pulse 
 is accelerated ; she has pain in the lower part of the 
 abdomen, and perhaps vesical and rectal tenesmus; she 
 has no appetite; and her tongue is furred. But the pain 
 does not come on so suddenly as in peritonitis, and is not 
 so severe. There is less tendency to vomiting, and no 
 meteorismus. By vaginal examination we find the vagina 
 hot, swollen, and tender. If the seat of inflammation is 
 in the broad ligament, we find at the side of the uterus a 
 tumor that is sensitive on pressure and crowds the uterus 
 to the opposite side. If both ligaments are inflamed 
 the uterus is lifted up. If the sacro-uterine ligaments are 
 inflamed we feel one or, both folds at the top of Douglas' 
 pouch swollen and sensitive. More rarely the swelling 
 is situated behind or in front of the uterus. If the affec- 
 tion extends into the iliac fossa the corresponding leg is 
 drawn up. If the tissue suppurates the swelling becomes 
 softer, but rarely distinctly fluctuating, and there is an in- 
 crease in the fever." — (Garrigues' Gynecology.) 
 
 4. The most common causes of sterility in woman are: 
 Gonorrhea, absence or errors in development of any part 
 of the genital tract, malformations of genitals, fistulse, 
 lacerations, obesity, alcoholism, pelvic inflammations, 
 dyspareunia, inflammations of uterus, tubes, or ovaries, 
 elongated cervix. The cause may not be in the woman, 
 but in the man. 
 
 5. In pudendal hernia: There is a tumor which is 
 soft, insensitive, and rounded ; and which is apt to disap- 
 pear with a gurgling sound on pressure or if the patient 
 is put in the knee chest position ; it is tympanitic on per- 
 cussion, and may give an impulse on coughing. In puden- 
 dal hematocele: There is generally a history of trauma, 
 no impulse on coughing, no resonance on percussion, and 
 it is not reducible. 
 
 6. By perineorrhaphy is meant the various operations 
 that are performed for the repair of lacerations of the 
 perineum in the female. 
 
 7. Chronic endocervicitis. Etiology: Bacteria, especial- 
 ly gonococci; lacerations of the cervix, tumors^ polypi, 
 and excessive coitus. Pathology. The inflammation may 
 spread, causing endometritis, salpingitis, ovaritis and peri- 
 tonitis ; the body of the uterus is very apt to become in- 
 volved. The mucous membrane becomes congested, thick- 
 
 67 
 
MEDICAL RECORD. 
 
 ened, and everted, and the cervix appears hypertrophied ; 
 the secretion is increased and is thick, ropy, viscid and 
 profuse. The cervical epithelium becomes eroded and the 
 glands become enlarged. 
 
 8. See Rose and Carless' "Surgery" (1907), page 1285. 
 
 9. In both cases the prognosis is bad, a fatal result being 
 inevitable unless timely and thorough operation is per- 
 formed. Cancer of the body of the uterus progresses much 
 slower than cancer of the cervix, and therefore in the 
 former the disease will last longer. In cancer of the cer- 
 vix the only hope lies in an early diagnosis, followed by 
 operation. Hysterectomy gives much better results in 
 cancer of the body of the uterus than it does in cancer of 
 the cervix ; the ratio of cures being about 60 per cent. : 5 
 per cent. So the prognosis may be said to be better in 
 cancer of the body of the uterus. 
 
 10. A tampon is a small roll of absorbent cotton, about 
 2Y2 x 1 inches, and is inserted into the vagina either with 
 or without some medicinal substance. Around the center 
 of the tampon is a strong string, long enough to hang out 
 from the vulva, and by which the tampon can be removed. 
 The details of the mode of use will depend upon the con- 
 dition for which the tampon is used. In any case the pa- 
 tient's bowels should be empty, and as a rule she is placed 
 in either the dorsal or knee-chest position. The tampons 
 are removed after about 36 hours, and a douche is then 
 taken. The purposes of a vaginal tampon are: For con- 
 trolling hemorrhage, either vaginal or uterine; to exert 
 pressure; to support the uterus; as a means of applying 
 medication locally; and for depleting inflammatory condi- 
 tions. 
 
 11. Chancre of vulva is the first lesion of syphilis, is 
 due to infection, has a long period of incubation, is gen- 
 erally single, is not as a rule painful, only occurs once in 
 a patient, buboes are apt to follow. Herpes of vulva is a 
 local neurosis, is due to irritation, has no incubation pe- 
 riod, consists of multiple vesicles appearing in crops, 
 tingles and itches, has no lymphatic involvement. 
 
 12. Muscles of perineum : Transversus perinei, 
 sphincter vaginae, erector clitoridis, compressor urethrae 
 (and levator ani). Functions of perineal body: It holds 
 in position the lower end of the rectum, vagina, and urethra 
 and enables them to perform the functions of defecation, 
 coitus, parturition, and urination; it strengthens the pelvic 
 floor. 
 
 HYGIENE. 
 
 1. See French's "Practice of Medicine" (1907), page 
 267; or Osier's "Practice of Medicine" (1909), page 234. 
 
 68 
 
MEDICAL RECORD. 
 
 2. See French's "Practice of Medicine" (1907), page 
 107; or Osier's "Practice of Medicine" (1909), page 96. 
 
 3. A septic tank is a specially constructed tank for the 
 treatment of sewage ; in it the sewage as such is destroyed, 
 and new substances are built up in its place. In Cameron's 
 septic tank system "the sewage is first led into a tank 
 from which air and light are excluded. Digestive changes 
 take place in the sewage within this tank as the result of 
 anaerobic bacterial action, which is favored by the dark- 
 ness, the absence of air, and the perfect stillness at which 
 the sewage is maintained. Under these circumstances 
 much of the solid matter is rendered soluble and dis- 
 solved." — (Notter and Firth's Hygiene.) 
 
 4. Hygienic precautions to be taken in treating a case 
 of tuberculosis: "The patient's quarters should be free 
 from dust and admit of his spending many hours daily in 
 the open air in all weathers, properly sheltered, and, if very 
 ill, lying wrapped in a hammock or reclining chair. His 
 bedroom should be well aired at night, draughts being 
 avoided. The room should be uncarpeted and free from 
 hangings. It should be often cleaned and periodically dis- 
 infected. All sputum should be collected in paper spit- 
 cups, which should be burned daily. Smoking should be 
 forbidden. Harm is done by any exercise which results 
 in fatigue, and while fever exists it should not be at- 
 tempted at all. Patients should be taught the necessity 
 of practicing lung gymnastics and breathing only through 
 the nose, which should be kept clear and free from oc- 
 clusion by secretions, or an hypertrophied catarrhal mu- 
 cosa. * * * The clothing should be woolen, but not 
 too heavy, or sweating is increased; and a flannel night- 
 gown and loosely knit leggings should be worn at night 
 in cool weather. The skin should be cleansed daily with 
 alcohol and water." — (Thompson's Practical Medicine.) 
 
 5. See French's "Practice of Medicine" (1907), page 
 474; or Osier's "Practice of Medicine" (1909), page 28. 
 
 6. The best means of fumigating by formaldehyde gas 
 are: (1) By Trillat's apparatus, which "allows the solu- 
 tion of formalin to flow in a fine stream through a copper 
 coil heated to redness by a flame beneath, and the gas 
 and vapor passing directly into the room. The apparatus 
 may be operated outside of a room, and the amount of 
 gas liberated depends directly upon the strength and quan- 
 tity of the solution evaporated. (2) In Schering's method 
 the solid paraform is heated in a receptacle over an alcohol 
 lamp, and is especially valuable in disinfecting small 
 rooms, closets, etc. (3) The cheapest and most common 
 form develops the gas directly by the oxidation of methyl 
 
 69 
 
MEDICAL RECORD 
 
 alcohol, the vapors of the latter passing over or through 
 tubes or coils of heated metal. — (Gould and Pyle.) 
 
 To fumigate by chlorine: For 1,000 cubic feet of space 
 pour two ounces of H 2 S0 4 and three ounces of water, 
 previously mixed and cooled, upon eight ounces of Nad 
 and two ounces of Mn0 2 . The fluids must be mixed 
 slowly and with care, and the salts should be in an earthen 
 vessel upon a bed of sand. The generating apparatus 
 should be high because chlorine gas is heavy. 
 
 To fumigate by sulphur dioxide: For each i,ooo cubic 
 feet of space, three pounds of sulphur are burned, care 
 being taken to prevent accidents. In all cases, all aper- 
 tures and crevices of the room should be closed, all closets, 
 drawers, or other receptacles opened; and after the fumi- 
 gation the room should be well ventilated and thoroughly 
 cleansed with a solution of corrosive sublimate. 
 
 7. Gonorrhea exerts an inhibitory influence upon the 
 procreative capacity of both man and woman; in the 
 man it may cause oligospermia, azoospermia, spermatozoa 
 without power of movement, epididymitis, stricture, etc. ; 
 in the woman it may cause vaginitis, endocervicitis, endo- 
 metritis, salpingitis, ovaritis. Each of these may inter- 
 fere with propagation. Syphilis may cause disease or 
 death of the fetus. Hence both gonorrhea and syphilis 
 tend to prevent the propagation of the human specie?. 
 
 8. See French's "Practice of Medicine" (1907), page 
 499; or Osier's "Practice of Medicine" (1909), page 45. 
 
 9. See French's "Practice of Medicine" (1907), page 
 311; or Osier's "Practice of Medicine" (1909), page 127. 
 
 10. Incubation period of: Plague, is about 2 to 7 days; 
 Smallpox, about 12 days; Diphtheria, about 2 to 7 days; 
 Scarlatina, about 1 to 8 days; Measles, about 7 to 14 days. 
 
 11. The object of traps is to prevent the passage of 
 sewer air into houses. If there were no traps sewer 
 air would enter the houses, and there would follow symp- 
 toms such as : Vomiting, diarrhea, headache, prostration, 
 pallor, languor, loss of appetite, and susceptibility or liabil- 
 ity to certain infectious diseases would be increased. 
 
 12. Two types of water filter: 1. The first has a filtering 
 medium of carbon (charcoal), or iron. Such filters strain 
 off the grosser suspended impurities and make the water 
 more palatable through aeration. The best, when new, 
 slowly oxidize organic matter, lessen hardness, diminish 
 nitrites and ammonia, and increase nitrates. They do 
 not remove disease germs; but may, after a few days' 
 use, increase the number of bacteria. 2. The second type 
 provides bacteriologically pure water, but has no effect 
 on the chemical constituents in solution ; its pores are so 
 
 70 
 
MEDICAL RECORD. 
 
 tine as to strain off all microorganisms. Of this class are 
 the Pasteur-Chamberland filter of unglazed porcelain, and 
 the Berkefeld filter of infusorial earth. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Colorado State Board of Medical Examiners. 
 
 anatomy. 
 
 i. Describe the clavicle, naming the muscles and liga- 
 ments attached to it. 
 
 2. Name the muscles attached to the tibia. 
 
 3. Describe the hip joint. 
 
 4. Give the boundaries and contents of the popliteal 
 space. 
 
 5. Give the origin, insertion, and nerve supply of the 
 following muscles: Sartorius, triceps (in arm), gastroc- 
 nemius, pectoral muscles. 
 
 6. Give the relations of the heart to the chest wall, and 
 name the valves of the heart. 
 
 7. Describe the brachial plexus. 
 
 8. Describe the diaphragm ; mention its attachments and 
 openings and tell what they transmit. 
 
 9. Give the relations of the prostate gland. 
 
 10. Name the structures seen in a cross-section of the 
 thigh at its middle. 
 
 physiology. 
 
 1. Give a physical description of the blood, together 
 with its functions. 
 
 2. Give (a) origin, function, number per c.m.m. of red 
 blood corpuscles, (b) origin, classification, function, and 
 number per c.m.m. white blood corpuscles. 
 
 3. Give the forces which cause the blood to circulate in 
 its vessels. 
 
 4. Give a physical description of lymph, together with 
 its functions. 
 
 5. Define respiration, its function, and tell how per- 
 formed. 
 
 6. Name the digestive ferments, tell the origin and 
 function of each. 
 
 7. Name the organs of elimination and tell the function 
 of each. 
 
 8. Give the function of (a) the liver, (b) spleen, 
 (c) thyroid gland. 
 
MEDICAL RECORD. 
 
 9. Give the distribution and functions of the first five 
 cranial nerves. 
 
 10. Give a short description of the vasomotor nervous 
 system, with its functions. 
 
 CHEMISTRY. 
 
 1. What is the chemistry of Fehling's test for glyco- 
 suria? 
 
 2. Give a test for chlorides in water. 
 
 3. Name the principal chemical constituents and their 
 average percentage in the stomach three hours after a meal 
 of mixed food. 
 
 4. What is the significance of nitrites in drinking water? 
 
 5. Name the principal chemical constituents, and their 
 average percentage, of normal urine. 
 
 6. What chemical reaction takes place when solutions 
 of ammonia and acetic acid are mixed? 
 
 7. What is the chemical composition of the various renal 
 calculi ? 
 
 8. What is percentage of albumin in normal blood 
 serum? 
 
 9. Name tests^ for albumin in urine other than nitric 
 acid and the application of heat. 
 
 10. What is a base? an acid? an alkali? an acohol? an 
 ether? 
 
 TOXICOLOGY. 
 
 1. Define toxicology. 
 
 2. Give symptoms of an overdose of chloroform, and 
 treatment. 
 
 3. Give post-mortem appearance in a case of death from 
 chloroform. 
 
 4. Give symptoms of poisoning by oxalic acid, and 
 treatment. 
 
 5. Post-mortem appearance in death from an overdose 
 of oxalic acid. 
 
 6. Give symptoms of poisoning by acetate of lead, and 
 treatment. 
 
 7. Post-mortem appearance in death from acetate of 
 lead. 
 
 8. Give signs of death by drowning. 
 
 9. Give symptoms of one asphyxiated by vapor from 
 burning charcoal. 
 
 10. Post-mortem appearance of one asphyxiated by 
 charcoal vapors. 
 
 72 
 
MEDICAL RECORD 
 
 SYMPTOMATOLOGY. 
 
 i. What is pseudoleukemia and what are its principal 
 symptoms and prognosis? 
 
 2. Differentiate bronchopneumonia from acute lobar 
 pneumonia and capillary bronchitis. 
 
 3. What is exophthalmic goiter? Give its principal 
 symptoms. 
 
 4. Give the etiology, symptomatology, and prognosis of 
 tabes dorsalis. 
 
 5. What conditions commonly cause icterus? 
 
 6. What are the general classes of diabetes and how is 
 each diagnosed? 
 
 7. Define variola ; describe the stages of this disease. 
 
 8. Name the exanthematous diseases of children and 
 give the symptoms and differential diagnosis of each. 
 
 9. Name the different forms of nephritis ; give the 
 symptoms and differential diagnosis of each. 
 
 10. Discuss the diagnosis of the following case : The 
 patient is a married woman, age 34, large and fat in 
 person. She has had two children and three miscarriages, 
 the last six weeks ago. Otherwise she says her health has 
 always been good until within three or four months; has 
 been in the habit of drinking beer freely, but has not been 
 intemperate. For two weeks there has been pronounced 
 jaundice, anorexia, and bilious vomiting soon after eating; 
 dizziness, flatulence, occasional diarrhea, with pain at 
 epigastrium ; slight edema of feet and ankles. These 
 symptoms have been increasing. There has been no head- 
 ache and no hemorrhages or chills. The tongue was clean, 
 the pulse 80, temperature 97-8°. The heart and lungs were 
 normal. The liver was much enlarged and smooth. The 
 spleen was felt below the ribs. There was no ascites. The 
 urine had a sp. gr. of 1017, was of a deep yellow color, 
 and contained a trace of albumen and much bile; sediment 
 normal. The blood was negative. 
 
 PATHOLOGY. 
 
 1. Name the system diseases of the afferent or sensory 
 nervous system. 
 
 2. How is malaria propagated? 
 
 3. Enumerate the causes of sudden death in children. 
 
 4. What is the pathology of diabetes? 
 
 5. Describe the bacillus of diphtheria. 
 
 6. What are the causes of fatty liver? 
 
 73 
 
MEDICAL RECORD. 
 
 ;. Describe the blood in leucemia. 
 
 8. Discuss the relationship between arterial disease and 
 chronic nephritis. 
 
 9. What are the microscopic findings of simple chronic 
 gastritis? 
 
 10. Define : Vaccine, opsonin, bacterin, agglutinin, lysin. 
 
 OBSTETRICS. 
 
 1. Give the various diameters of the inlet and outlet of 
 the pelvis. 
 
 2. Give a good description of the anatomy of the 
 uterus. 
 
 3. What are the different stages of labor? Describe 
 each. 
 
 4. Give the various diameters of the fetal head. 
 
 5. Describe the sutures, fontanelles, and protuberances 
 of the fetal head. 
 
 6. What is the mechanism of delivery in the R. O. P. 
 
 position? 
 
 7. What are the indications and contraindications for 
 the use of the obstetric forceps? 
 
 8. Give the indications for the induction of premature 
 labor and describe the best method. 
 
 9. What is post-partum hemorrhage? How prevented? 
 
 10. What is puerperal sepsis? Give treatment. 
 
 surgery. 
 
 1. Give the symptoms and prognosis of fracture of the 
 olecranon process of the ulna. 
 
 2. Give the causes of non-union of fractures. 
 
 3. Give the causes and symptoms of compression of the 
 brain. 
 
 4. Describe the different forms of dislocation of the 
 shoulder-joint, and state which is the most frequent. 
 
 5. Give the symptoms and diagnosis of tuberculosis of 
 the knee-joint. 
 
 6. Give the symptoms and diagnosis of hydrocele. 
 
 7. Give symptoms and diagnosis of stone in the common 
 duct. 
 
 8. Give some of the causes of vesical hemorrhage. 
 
 9. Describe acute osteomyelitis. 
 
 10. What are the early symptoms of carcinoma of the 
 breast? 
 
 74 
 
MEDICAL RECORD 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 Colorado State Board of "Medical Examiners. 
 
 ANATOMY. 
 
 i. The clavicle forms the anterior part of the shouldei 
 girdle; it articulates internally with the first part of the 
 sternum, and externally with the acromion process of the 
 scapula. It is broad and flattened at its outer end, and 
 thick and rounded at the inner end. It consists of a double 
 curve, the outer part is concave forward, the inner part 
 convex forward. The bone has two surfaces, superior and 
 inferior; and two borders, anterior and posterior. On the 
 under surface are the conoid tubercle, a groove for the 
 subclavius, a rough impression for the rhomboid ligament. 
 Muscles attached to it are: Deltoid, trapezius, pectoralis 
 major, subclavius, sternomastoid, and sternohyoid. Liga- 
 ments attached to it are: Interclavicular, rhomboid, conoid, 
 trapezoid, and capsular (of sternoclavicular and acromio- 
 clavicular articulations ) . 
 
 2. Muscles attached to the tibia are : Semimembranosus, 
 semitendinosus, biceps, gracilis, sartorius, tibialis anticus, 
 extensor longus digitorum, tibialis posticus, soleus, poplit- 
 eus, flexor longus digitorum, quadriceps extensor. 
 
 3. The hip- joint is an enarthrodial joint, formed by the 
 head of the femur and the acetabulum. The articular sur- 
 faces are covered with cartilage. Near the center of the 
 head of the femur is attached the ligamentum teres. The 
 ligaments are: (1) The capsular, which embraces the mar- 
 gin of the acetabulum above, and the neck of the femur 
 below. (2) The ileofemoral or Y ligament,, which passes 
 obliquely across the front of the joint, and is attached above 
 to the anterior inferior spine of the ileum, and below to 
 the anterior intertrochanteric line. (3) The ligamentum 
 teres. (4) The cotyloid ligament, which deepens the aceta- 
 bulum, and bridges over the cotyloid notch, being there 
 called (5) the transverse ligament. The joint has a very 
 extensive synovial membrane. It is capable of the follow- 
 ing movements: Flexion, extension, abduction, adduction, 
 circumduction, and rotation. 
 
 4. The Popliteal Space is bounded: Above, and ex- 
 ternally by the Biceps; above, and internally by the Semi- 
 membranosus and Semitendinosus; below, and externally 
 by the Plantaris and external head of the Gastrocnemius; 
 below, and internally by the inner head of the Gastroc- 
 nemius. 
 
 Contents: Popliteal vessels with branches, external 
 
 75 
 
MEDICAL RECORD. 
 
 saphenous vein, external and internal popliteal nerves, small 
 sciatic nerve, lymphatic glands, and loose areolar tissue. 
 
 5. Sartorius. Origin: Anterior superior spine of ilium, 
 and part of notch below. Insertion: Inner side of tibia 
 near tubercle. Nerve supply: Middle cutaneous, or branch 
 from anterior crural. 
 
 Triceps : The long, or middle, head arises from a de- 
 pression on the axillary border of the scapula immediately 
 below the glenoid cavity; the external head from the root 
 of the great tuberosity on the posterior surface of the 
 humerus, and the upper part of the musculospiral groove ; 
 the internal head from the posterior surface of shaft of 
 humerus, below musculospiral groove, and the internal and 
 external muscular septa. It is inserted into the back part 
 of the upper surface of the olecranon process of the ulna. 
 Nerve supply: Musculospiral. 
 
 Gastrocnemius : The inner head arises from a depres- 
 sion on the upper and back part of the inner condyle of the 
 femur and the adjacent part of the femur; the outer head 
 from an impression on the external surface of the outer 
 condyle ; and from the posterior surface of the femur im- 
 mediately above the condyle. It unites with the tendon of 
 the soleus to form the tendo Achillis, which is inserted into 
 the lower part of the posterior surface of the os calcis. 
 Nerve supply: Internal popliteal. 
 
 Pectoralis major. Origin: Anterior surface of inner 
 half of clavicle, anterior surface of sternum, from the 
 cartilages of the second to sixth ribs, and from the aponeu- 
 rosis of the external oblique of the abdomen. Insertion: 
 Into the outer bicipital ridge of the humerus. Nerve sup- 
 ply: External and internal anterior thoracic. 
 
 Pectoralis minor. Origin: From third and fourth and 
 fifth ribs, just external to the cartilages, and from aponeu- 
 rosis over intercostal muscles. Insertion: Into coracoid 
 process of scapula. Nerve supply: Internal anterior 
 thoracic. 
 
 6. A line from the lower border of the second left costal 
 cartilage (one inch from sternum) to upper border of 
 third right costal cartilage represents the base line; the 
 right side will be a line drawn from right side of 
 upper limit to seventh right chondrosternal articulation; 
 the lower limit is a line from this last point to the apex (in 
 fifth intercostal space, three and one-half inches from mid- 
 line) ; the left side, from left end of upper border to left 
 of apex. The valves are : Aortic, mitral, tricuspid, pul- 
 monary (and Eustachian and coronary). 
 
 7. The brachial plexus is formed by the union and subse- 
 quent division of the anterior divisions of the fifth, sixth, 
 seventh, and eighth cervical and the first dorsal nerves. 
 The union of the fifth and sixth makes the upper trunk; 
 
 76 
 
MEDICAL RECORD. 
 
 the seventh forms the middle trunk, and the eighth cervical 
 and first dorsal make the lower trunk. Each of these trunks 
 is divided into an anterior and a posterior branch. The 
 anterior branches, from the upper and middle trunks, make 
 the upper or outer cord of the plexus; the anterior branch 
 of the lower trunk becomes the lower or inner cord; the 
 three posterior branches unite to form the posterior or 
 middle cord. The plexus lies between the Scalenus anticus 
 and medius. The branches are: (r) Above the clavicle; 
 communicating, muscular, posterior thoracic, and supra- 
 scapular. (2) From outer cord: External anterior thoracic, 
 musculocutaneous, and outer head of median. (3) From 
 inner cord: Internal anterior thoracic, lesser internal cuta- 
 neous, ulnar, and inner head of median. (4) From pos- 
 terior cord: Subscapular, circumflex, and musculospiral. 
 
 8. The diaphragm is a musculofibrous septum which di- 
 vides the thoracic from the abdominal cavity; it is fan- 
 shaped; the broad, eliptical portion is horizontal, and the 
 crura are vertical. It is attached to the ensiform, to the 
 internal surfaces of the lower six costal cartilages, to 
 bodies and intervertebral substances of first, second, and 
 third lumbar vertebrae. Its openings are: (1) The aortic, 
 transmitting the aorta, vena azygos major, and the thoracic 
 duct; (2) the esophageal, transmitting the esophagus, 
 pneumogastric nerves, and some small esophageal arteries ; 
 
 (3) the opening for the vena cava, transmitting the inferior 
 vena cava, and small branches of the right phrenic nerve ; 
 
 (4) the right crural, transmitting the right splanchnic 
 nerves; (5) the left crural, transmitting the left splanchnic 
 nerves and the vena azygos minor. 
 
 9. Relations of prostate. Anteriorly: Symphysis pubis, 
 anterior ligaments of bladder, branches of dorsal vein of 
 penis. Posteriorly: Rectum. Laterally: Levator ani. Base: 
 Surrounds neck of bladder, seminal vesicles, and vasa 
 deferentia. The apex rests on triangular ligament. 
 
 10. At middle of thigh would be cut: Skin; fascia; 
 muscles, adductor longus, sartorius, gracilis, rectus femoris, 
 adductor brevis, adductor magnus, semimembranosus, semi- 
 tendinosus, vastus internus, crureus, vastus externus, 
 biceps ; vessels : profunda, femoral, external circumflex, 
 internal saphenous vein ; nerves : external cutaneous, super- 
 ficial obturator, anterior crural, sciatic, small sciatic ; bone : 
 femur. 
 
 PHYSIOLOGY. 
 
 i. Physical properties of blood: Fluid, somewhat viscid, 
 red, specific gravity from 1055 to 1062, alkaline reaction, 
 saltish taste, characteristic odor, variable temperature 
 (average about ioo° F.). Functions: For red and white 
 corpuscles, see Question 2. 
 
 77 
 
MEDICAL RECORD. 
 
 Plasm conveys nutriment to the tissue; it holds in solu- 
 tion the carbon dioxide and water which it receives from 
 the tissues, and takes them to be eliminated by the lungs, 
 kidneys, and skin ; it also holds in solution urea and other 
 nitrogenous substances that are taken to and excreted by 
 the liver or kidneys. 
 
 2. (a) Red Corpuscles. Origin: From red marrow of 
 bones (and during fetal life from spleen, liver, and con- 
 nective tissue cells). Function: To carry oxygen from the 
 lungs to the tissues. Number: About 4,500,000 to 5,000,000 
 per cubic millimeter,. 
 
 (b) White Corpuscles. Origin: From spleen, lymphatic 
 glands, and lymphoid tissue. Classification: (1) Small 
 mononuclears; (2) large mononuclears ; (3) transitionals ; 
 (4) polynuclears; (5) eosinophils; and (6) mast cells. 
 Function: (1) To serve as a protection to the body from 
 the incursions of pathogenic microorganisms; (2) they 
 take some part in the process of the coagulation of the 
 blood; (3) they aid in the absorption of fats and peptones 
 from the intestine, and (4) they help to maintain the proper 
 proteid content of the blood plasma. Number: Normally 
 between 7,000 and 10,000 or 12,000 in each cubic millimeter 
 of blood. 
 
 3. The forces concerned in the circulation of the blood 
 are : The force and frequency of the contractions of the 
 heart, the elasticity and tone of the arterial walls, the 
 resistance in the capillaries and tissues, the valves in the 
 veins, the contraction of the muscles, the aspiration of the 
 thorax. 
 
 4. Lymph is a colorless, albuminous fluid, alkaline in 
 reaction, specific gravity of about 1015. Function: (1) It 
 conveys nutriment to all cells not directly reached by the 
 blood ; (2) in the intestines, it absorbs nutrient material 
 (chiefly fat) and pours it into the blood stream for distri- 
 bution; (3) it takes certain waste matters to the blood to 
 be later eliminated by the lungs, kidneys, and skin. 
 
 5. Respiration is the act by which air is taken into and 
 expelled from the lungs. Function: (1) To introduce 
 oxygen into the system; (2) to excrete carbon dioxide. It 
 is performed by inspiration and expiration. 
 
 6. 
 
 DIGESTIVE 
 FERMENTS 
 
 ORIGIN 
 
 Ptyalin. 
 Pepsin 
 
 Saliva. 
 Gastric juice. 
 
 FUNCTION 
 
 Changes starches into 
 dextrin and sugar. 
 
 Changes proteids into 
 proteoses and peptones 
 in an acid medium. 
 
 7S 
 
MEDICAL RECORD 
 
 DIGESTIVE 
 FERMENTS 
 
 ORIGIN 
 
 FUNCTION 
 
 Trypsin, 
 
 
 Changes proteids into 
 proteoses and peptones, 
 and afterward decom- 
 
 •- 
 
 Pancreatic juice. 
 
 poses them into leucin 
 and tyrosin ; in an alka- 
 line medium. 
 
 Amylopsin. 
 Steapsin. 
 
 
 Converts starches into 
 
 maltose. 
 Emulsifies and saponifies 
 
 fats. 
 
 Invertin. 
 
 Intestinal juice. 
 
 Converts maltose into 
 glucose. 
 
 7. The organs of elimination are: (1) Skin, for sweat 
 (urea, water, salts) ; (2) lungs (for carbon dioxide, 
 water) ; (3) kidneys, for urine (water, urea, salts), and 
 
 (4) intestines (feces). 
 
 8. (a) The functions of the liver are: (1) The secretion 
 of bile; (2) the formation of glycogen; (3) the formation 
 of urea and uric acid; (4) the manufacture of heat, and 
 
 (5) the conversion of poisonous and harmful into inert 
 material. 
 
 (b)The function of the spleen: The following theories 
 have been held: (1) It is a source of production of the 
 white blood corpuscles; (2) it is a source of production of 
 the red blood corpuscles during fetal life; (3) it is a place 
 where the red blood corpuscles are destroyed; (4) uric 
 acid is produced in the spleen; (5) an enzyme is produced 
 in the spleen and is carried by the blood to the pancreas, 
 where it converts the trypsinogen into trypsin. 
 
 (c) The function of the thyroid is not definitely settled; 
 (1) it has some trophic function, regulating oxidation in 
 the body, and it is supposed to have also a special influence 
 on the vasomotor nerves, the skin, the bones, and on the 
 sexual functions; (2) it is supposed to antagonize toxic 
 substances, and (3) it produces an internal secretion. 
 
 9. I. Olfactory. Distributed to the Schneiderian mem- 
 brane of nose. Function, sense of smell. 
 
 - II. Optic. Distributed to retina. Function, sense of 
 sight. 
 
 III. Motor oculi. Distributed to: Superior rectus, in- 
 ferior rectus, internal rectus, inferior oblique, and levator 
 palDebrarum muscles. Function, motor to these muscles. 
 
 IV. Trochlear. Distributed to superior oblique muscle. 
 Function, motor to this muscle. 
 
 V. Trifacial. First, or ophthalmic branch, supplies sen- 
 sation to conjunctiva and skin of upper eyelid, cornea, skin 
 
 79 
 
MEDICAL RECORD. 
 
 of forehead and nose, lachrymal gland, and skin of nose. 
 Second, or superior maxillary branch, supplies sensation to 
 skin and conjunctiva of lower eyelid, nose, cheek, upper 
 lip, upper teeth,, and palate. Third, or inferior maxillary 
 branch, supplies sensation to external auditory meatus, side 
 of head, mucous membrane of mouth, anterior two-thirds 
 of tongue, lower teeth, and skin of lower part of face. 
 This branch, in addition, supplies motion to the muscles of 
 mastication (Masseter, temporal, external, and internal 
 pterygoids), and the mylohyoid and anterior belly of the 
 digastric. 
 
 10. The vasomotor nervous system consists of a center in 
 the medulla, subsidiary centers in the spinal cord and vaso- 
 motor nerves. The nerves are: (i) Vasodilator (which 
 increase the caliber of the arterioles), and (2) vasocon- 
 strictors (which diminish the caliber of the arterioles). 
 Functions: (1) To dilate arterioles; (2) to constrict 
 arterioles; (3) to maintain tonicity of blood vessels; (4) 
 to maintain peripheral resistance; (5) to regulate the 
 amount of blood supplied to a part. 
 
 CHEMISTRY. 
 
 1. The glucose in the urine reduces the cupric sulphate of 
 Fehling's solution to copper oxide. 
 
 2. Add a small amount of solution of nitrate of silver; 
 in the presence of chlorides there will be a white precipi- 
 tate insoluble in dilute HN0 3 , but soluble in dilute NH 8 . 
 
 3. Hydrochloric acid, pepsin, proteoses, peptones, etc. 
 The relative and absolute amounts will necessarily vary 
 according to the kind and quantity of food ingested. 
 
 4. Nitrites in drinking water denote contamination by 
 sewage. 
 
 5. Normal urine consists of : Water, 95 per cent. ; solids, 
 5 per cent. The latter are : Urea, 2.8 per cent. ; uric acid, 
 0.06 per cent. ; hippuric acid, 0.03 per cent. ; creatinin, 0.06 
 per cent. ; extractives, 0.8 per cent. ; sodium chloride, 0.8 
 per cent.; phosphates, 0.2 per cent; sulphates, 0.1 per cent.; 
 oxides of calcium, magnesium, sodium, and potassium, 0.1 
 per cent. 
 
 6. Ammonium acetate is formed. 
 
 7. Calculi are composed of: (1) Most frequently, uric 
 acid, sodium or ammonium urate, calcium oxalate, calcium 
 phosphate, and ammonio-magnesium phosphate. (2) More 
 rarely, cystin, xanthin, potassium or magnesium or calcium 
 urate, and calcium carbonate. 
 
 8. About 8 per cent. 
 
 9. Trichloracetic acid, salicyl-sulphonic acid, picric acid, 
 potassium ferrocyanide, Spiegler's test, Tanret's test, 
 Jolle's reagent. 
 
 80 
 
MEDICAL RECORD. 
 
 io. A base is a ternary compound capable of entering 
 into double decomposition with an acid and producing a 
 salt and water. 
 
 An acid is a compound of an electro-negative element or 
 radicle with hydrogen, part or all of which hydrogen it can 
 part with in exchange for an electro-positive element with- 
 out the formation of a base. 
 
 An alkali is a substance which is basic in character, alka- 
 line in reaction, is caustic in action, and can saponify fats. 
 
 An alcohol is the hydroxide of a hydrocarbon radicle. 
 
 An ether is the oxide of a hydrocarbon radicle. 
 
 TOXICOLOGY. 
 
 i. Toxicology is that branch of medical science which 
 appertains to poisons; it includes their character, origin, 
 actions, symptoms produced, antidotes, treatment, and de- 
 tection. 
 
 2. Overdose of chloroform. Symptoms: I. Flushed face, 
 contracted pupils, rapid and full pulse. II. Slow respira- 
 tion, lowered temperature, dilated pupils, relaxed muscles, 
 slow and full pulse. III. Irregular pulse, superficial respi- 
 ration, dilated pupils, blue skin and lips, stertorous breath- 
 ing, skin cool and covered with perspiration. Treatment : 
 If the chloroform has been swallowed : Wash out the 
 stomach, keep the patient warm, give hypodermic of strych- 
 nine. If during inhalation, stop further administration, 
 start artificial respiration, give oxygen, and faradic current. 
 
 3. Post-mortem appearances: Cerebral and meningeal 
 vessels are engorged ; the lungs, liver, and kidneys are con- 
 gested; the blood is dark and fluid; if the chloroform has 
 been swallowed, the mucous membrane of mouth, stomach, 
 and intestines is inflamed. The odor of chloroform may be 
 present. 
 
 4. Symptoms of poisoning by oxalic acid: "The sour 
 taste of the acid is rapidly followed by a burning pain, 
 increasing in intensity, in the mouth, throat, and stomach, 
 and persistent vomiting of a dark, 'coffee-ground' material. 
 The pulse becomes small and imperceptible, and the patient 
 dies in collapse, preceded frequently by convulsions, within 
 half an hour. If the case be prolonged, swallowing becomes 
 very difficult and painful ; there are numbness and tingling 
 of the skin; twitchings of the facial muscles; convulsions, 
 frequently tetanic ; delirium, and lumbar pain. Death occurs 
 in some cases within three to ten minutes, sometimes almost 
 immediately, and in some cases it is delayed for several 
 days." 
 
 Treatment: "Magnesia (magnesia usta) or slaked lime 
 suspended in a small quantity of water, or mucilaginous 
 liquid, should be given as soon as possible. If vomiting do 
 not occur, and if the symptoms of corrosion be not marked, 
 
 81 
 
MEDICAL RECORD. 
 
 an emetic. The stomach pump should not be used, nor 
 should the alkaline carbonates be depended upon as anti- 
 dotes." 
 
 5. Post-mortem appearances: The mucous membrane of 
 mouth, esophagus, and stomach is whitish, easily detached, 
 and looks as if it had been scalded; the muscular coat is 
 red and thick; the stomach contains a pultaceous material, 
 acid, and like "coffee-ground" vomitus; the kidneys may 
 show crystals of calcium oxalate; the urine may contain 
 oxalates. 
 
 6. The symptoms of acute lead poisoning are : "Metallic 
 taste; dryness of the throat; thirst; severe colicky abdom- 
 inal pains, referred particularly to the umbilical region, 
 and relieved by pressure ; pulse very feeble and slow ; great 
 prostration; constipation; urine scanty and red; violent 
 cramps ; paralysis of the lower extremities ; convulsions, 
 and tetanic spasms." 
 
 The treatment consists in administering "magnesium 
 sulphate, which brings about the formation of the insoluble 
 lead sulphate, while the purgative action of the magnesia is 
 also useful. It should be preceded by an emetic, or by the 
 use of the stomach tube." 
 
 7. Post-mortem appearances: Not always characteristic; 
 mucous membrane of stomach may be red or gray; there 
 is a blue line on the gums ; the colon may be constricted. 
 
 8. Signs of death by drowning: Froth at nostrils and 
 mouth; pallor and goose-skin; maceration of epidermis of 
 palms of hands and soles of feet; sand or mud may be 
 under the nails or in the hands ; water and foreign matter 
 are generally in the stomach and also in bronchi ; lungs are 
 swollen and emphysematous; the right side of the heart is 
 engorged and the left side is empty; the liver is engorged. 
 
 9. Symptoms of asphyxiation by charcoal vapor: Head- 
 ache, drowsiness, vertigo, tinnitus aurium, vomiting, dysp- 
 nea, pain and oppression in chest, irregular heart, stertorous 
 breathing. 
 
 10. Post-mortem appearances: The blood is of a bright 
 red color and the skin shows bright reddish spots on face, 
 chest, and abdomen ; the brain is congested ; all the internal 
 organs are colored by the bright red blood. 
 
 SYMPTOMATOLOGY. 
 
 i. Pseudoleukemia is a disease characterized by hyper- 
 plasia of the lymphatic glands and progressive anemia; 
 there is no great excess of white corpuscles. It is also 
 known as Hodgkin's disease. Symptoms: Glands of neck, 
 axilla, and groin are enlarged ; anemia is present ; the 
 swellings are painless and do not, as a rule, suppurate; 
 dyspnea may ensue; spleen and thyroid are apt to become 
 enlarged; palpitation, shortness of breath, and hemic mur- 
 
 82 
 
MEDICAL RECORD 
 
 murs may be found. Prognosis is unfavorable; recovery is 
 rare; cases may last from six months to three or four 
 years. 
 
 2. Bronchopneumonia and capillary bronchitis are the 
 same. 
 
 LOBAR PNEUMONIA 
 
 Generally a primary disease. 
 
 Age has little influence. 
 
 Sudden onset. 
 
 Fever is high and regular. 
 
 Ends by crisis between sixth 
 and tenth day. 
 
 Generally only one lung af- 
 fected. 
 
 The physical signs are dis- 
 tinct, and there is a large 
 area of consolidation. 
 
 Sputum is rusty. 
 
 BRONCHOPNEUMONIA 
 
 Generally secondary (to 
 bronchitis or an infectious 
 disease). 
 
 Generally found in very 
 young or very old. 
 
 Gradual onset. 
 
 Fever is not so high, and is 
 irregular. 
 
 Ends by lysis, at no partic- 
 ular date. 
 
 Generally both lungs af- 
 fected. 
 
 Physical signs indistinct, 
 and the evidences of con- 
 solidation are indefinite. 
 
 Sputum is rather streaked 
 with blood. 
 
 3. Exophthalmic goiter is a disease characterized by: 
 Exophthalmos, enlarged thyroid, tachycardia, and tremors. 
 The principal symptoms are the four just mentioned, with 
 sometimes anemia, fever, emaciation, diarrhea, pigmenta- 
 tion, and profuse perspiration. 
 
 4. Tabes dorsalis. Etiology: Tabes dorsalis is a disease 
 of adult life; is more common in men than in women; is 
 more common in cities than in the country; syphilis is 
 believed to be the most frequent direct cause; alcoholism, 
 injury, exposure to cold and wet, have all been urged as 
 causes, but they are not now assigned so important a place 
 as etiological factors as was formerly the case. 
 
 Symptoms: Loss of coordination; characteristic and 
 unsteady gait; tendency to stagger when standing up with 
 feet together and eyes closed ; sharp and paroxysmal pain, 
 called crises; girdle sensation ; loss of knee-jerk and other 
 reflexes ; Argyll-Robertson pupil. 
 
 Prognosis: The disease is probably never cured; it may 
 be arrested, and some of the symptoms may be ameliorated. 
 It may last from four to twenty years. 
 
 5. Icterus may be caused by: Catarrh of the duodenum 
 and common bile duct, pancreatic disease, gallstones, cir- 
 rhosis of the liver, obstruction of the bile ducts, septicemia, 
 
 83 
 
MEDICAL RECORD. 
 
 acute yellow atrophy of the liver, tumors of liver, pancreas, 
 stomach, or kidney, certain infections and poisons. 
 
 6. Diabetes mellitus and diabetes insipidus. 
 
 In diabetes mellitus the urine has a high specific gravity 
 and contains glucose ; complications are many and frequent. 
 
 In diabetes insipidus the urine has a low specific gravity 
 and does not contain glucose ; complications are rare. 
 
 7. Variola is an acute infectious and contagious disease, 
 of unknown origin, and characterized by rapid onset and 
 fever, pains in head and back, and a rash which appears on 
 the third or fourth day and passes through the stages of 
 macule, papule, vesicle, and pustule. 
 
 For description of the stages of the disease, see French's 
 "Practice of Medicine" (1907), pages 301 et seq., or Osier's 
 "Practice of Medicine" (1909), pages 115 et seq. 
 
 8. The exanthematous diseases of children are: Variola, 
 varicella, scarlet fever, measles, and German measles. 
 
 Variola: The eruption usually appears first on the fore- 
 head and wrists, and on the third or four day; it is first 
 macular, then papular, then vesicular, and, finally, pustu- 
 lar; it does not appear in successive crops; the spots are 
 multilocular, and do not collapse on being punctured; the 
 papule is hard and shotty, and does not disappear on 
 stretching the skin. Varicella: The eruption usually ap- 
 pears first on the trunk, is evident on the first day, comes 
 in successive crops, is not shotty, and disappears on stretch- 
 ing the skin ; the spots are unilocular, and collapse on being 
 punctured. Scarlet fever: Period of incubation, from a 
 few hours to seven days. Stage of invasion, twenty-four 
 hours. Character of eruption, a scarlet punctate rash, 
 beginning on neck and chest, then covering face and 
 body; deesquamation is scaly or in flakes. The eruption is 
 brighter, is on a red background, punctiform, and is more 
 uniform; the temperature is higher, the pulse quicker; the 
 tongue is of the "strawberry" type; the lymphatics in the 
 neck may be swollen, and there is sore throat; Koplik's 
 spots are absent. Measles: Period of incubation, ten to 
 twelve days. Stage of invasion, four days. Character of 
 eruption, small, dark red papules with crescentic borders, 
 beginning on face and rapidly spreading over the entire 
 body ; desquamation is branny. The eruption is darker, less 
 uniform, more shotty; the temperature is lower, pulse 
 slower, the tongue is not of the "strawberry" type ; coryza, 
 coughing, and sneezing may be present; Koplik's spots are 
 present. German measles: Period of incubation, ten to 
 seventeen days. Stage of invasion, one day. Eruption ap- 
 pears on first day, is most intense on second day, consists 
 of red papules, often fades from face before it is seen on 
 the limbs. The pulse is not much accelerated, all the symp- 
 toms are slight. Desquamation is very slight. There may 
 
 84 
 
MEDICAL RECORD. 
 
 be slight sore throat and swollen cervical glands. Koplik's 
 spots are absent. 
 
 9. The different forms of nephritis are: (1) Acute 
 parenchymatous; (2) chronic parenchymatous ; (3) chronic 
 interstitial. The following table is from Gould & Pyle's 
 Cyclopedia : 
 
 ACUTE PAREN- 
 CHYMATOUS 
 NEPHRITIS 
 
 1. Most common 
 in children, from 
 exposure or infec- 
 tious fevers. 
 
 2. Edema of 
 lower eyelids ; then 
 of upper extremi- 
 ties, trunk, and, 
 lastly, lower ex- 
 tremities. 
 
 3. Urine scanty, 
 dark or smoky 
 color, high specific 
 gravity, 1025 or 
 over. 
 
 4. Large amount 
 of albumin. 
 
 5. Variety of 
 casts, such as hya- 
 line, blood, epithe- 
 lial, and waxy 
 casts, also free red 
 blood globules, and 
 epithelial cells. 
 
 6. Urea dimin- 
 ished. 
 
 7. R e c o v e ries 
 frequent. 
 
 CHRONIC PAREN- 
 CHYMATOUS 
 NEPHRITIS 
 
 i. Later life; 
 
 often the conse- 
 quence of acute at- 
 tack. 
 
 2. In early stage 
 same as acute 
 form; later, drop- 
 sy may diminish. 
 
 3. Urine normal 
 or increased 
 amount; specific 
 gravity may fall to 
 1010; urine pale. 
 
 4. Late in at- 
 tack, greatly di- 
 minished ; occa- 
 sionally absent. 
 
 5. Large and 
 small granular 
 casts ; compound 
 granule cells, and 
 fatty epithelium. 
 
 6. Urea dimin- 
 ished. 
 
 7. R e c o v e ries 
 rare. 
 
 CHRONIC INTER- 
 STITIAL 
 NEPHRITIS 
 
 i. Late life; of- 
 ten results from 
 alcoholism, gout, 
 lead poisoning. 
 
 2. Dropsy slight 
 or entirely absent. 
 
 3. Urine greatly 
 increased ; specific 
 gravity low, 1005; 
 urine pale in color. 
 
 4. Albumin 
 greatly diminished, 
 often absent. 
 
 5. Hyaline or 
 finely granular 
 casts, occasionally 
 dark in color; in- 
 frequently blood 
 casts and oil drop- 
 lets. 
 
 6. Urea dimin- 
 ished. 
 
 7. Indefinite du- 
 ration, but never 
 cured. 
 
 10. ''Gallstone in the common duct is possible, but un- 
 likely, owing to the presence of splenic tumor, the lack of 
 any intermission in the symptoms, and the absence of pain, 
 fever, or chills. Catarrhal jaundice cannot be excluded, 
 though it rarely leads to much enlargement of the liver or 
 spleen. The points against cancer are the absence of pain, 
 cachexia, or irregularities on the liver surface. Syphilis 
 might produce all these symptoms, and can be positively 
 
 85 
 
MEDICAL RECORD. 
 
 excluded only by the therapeutic test. Cirrhosis, or the 
 combination of cirrhosis and fatty infiltration, is the most 
 likely diagnosis. This accounts better than any other 
 hypothesis for the splenic enlargement, the large, smooth 
 liver, and the jaundice. The gastric symptoms would then 
 result from passive congestion of the stomach. The course 
 of the case confirmed the diagnosis of cirrhosis.'* — (Cabot's 
 Case Teaching in Medicine, from which the question is 
 taken.) 
 
 PATHOLOGY. 
 
 i. Locomotor ataxia; general paralysis of the insane; 
 herpes zoster. 
 
 2. Malaria is propagated by the bite of a mosquito (ano- 
 pheles), which harbors the plasmodium malarise. 
 
 3. Causes of sudden death in children: Asphyxia, mal- 
 formations, status lymphaticus, atelectasis, marasmus, in- 
 ternal hemorrrhages, convulsions, and heart failure after 
 diphtheria. 
 
 4. For pathology of diabetes, see French's "Practice of 
 Medicine" (1907), pages 935 et seq.; or Osier's "Practice 
 of Medicine" (1909), pages 412 et seq. 
 
 5. The characteristics of the bacillus of diphtheria: The 
 bacilli are from 2 to 6 mikrons in length and from 0.2 to 1.0 
 mikron in breadth; are slightly curved, and often have 
 clubbed and rounded ends; occur either singly or in pairs, 
 or in irregular groups, but do not form chains; they have 
 no flagella, are non-motile, and aerobic; they are noted for 
 their pleomorphism; they do not stain uniformly, but stain 
 well by Gram's method and very beautifully with Loefiler's 
 alkaline-methylene blue. 
 
 6. The causes of fatty liver are : Anemia, phthisis, ca- 
 chetic conditions, obesity, phosphorus poisoning, pulmonary 
 diseases, infectious diseases (as yellow fever, pyemia). 
 
 7. In leukemia the blood is light in color, specific gravity 
 is lowered, coagulation is slow, the white corpuscles are 
 much increased in number (there may be from 150,000 to 
 500,000 per c. mm., or even more) ; myelocytes are present 
 in large numbers in the splenomedullary type; red cells 
 may be moderately diminished, and some may be nucleated. 
 
 8. Chronic nephritis is often secondary to anterioscle- 
 rosis ; in other cases the arteries are sclerotic even if there 
 is no causal relation between the two conditions ; sometimes 
 it is hard to say which condition was primary. In many 
 cases one or more of the coats of the arteries are thickened ; 
 this thickening is not evenly distributed, and is apt to be 
 most marked in the renal vessels. Aneurysm, atheroma- 
 tous or hyaline changes are often present in the blood- 
 vessels in nephritis. 
 
 9. In simple chronic gastritis, the cells of the glands are 
 
 86 
 
MEDICAL RECORD. 
 
 eroded, or atrophied, or show cloudy swelling; round cell 
 infiltration is present in the tubules; the glands are dilated 
 and filled with an exudate and desquamated cells ; new 
 connective tissue forms between the glands. 
 
 10. Vaccine is an attenuated virus which, when intro- 
 duced into the body of an animal, enables it to withstand 
 the development of an infectious disease. Opsonin is that 
 quality of a serum which makes a microorganism more 
 susceptible to phagocytosis. Bacterin "is a preparation of 
 killed bacteria suspended in normal solution which is 
 injected for the purpose of raising the opsonic index of 
 patients suffering from infection by that organism. Agglu- 
 tinin is something in the blood serum of an animal affected 
 with a bacterial disease which is capable of causing the 
 clumping of the bacteria which caused the disease. Lysins 
 are bacterial products which are capable of destroying 
 alexins, and so promote the growth of the bacteria. 
 
 OBSTETRICS. 
 
 i. The pelvic diameters : 
 
 Anterio-posterior. Oblique. Transverse. 
 
 Inlet 4 inches. 4^2 inches. 5 inches. 
 
 Outlet 5 inches. 4^ inches. 4 inches. 
 
 2. In the nulliparous adult the uterus is about three 
 inches long, about two inches wide at the upper part, and 
 about one inch thick. The uterus lies between the rectum 
 behind and the bladder in front; it is below the abdominal 
 cavity and above the vagina. Its position is one of slight 
 anteflexion, with its long axis at right angles to the long 
 axis of the vagina. The anterior surface of its body rests 
 on the bladder, and the cervix points backward toward the 
 coccyx. The uterus is not fixed, but moves freely within 
 certain limits. It is held in place by ligaments — broad liga- 
 ments, round ligaments, vesicouterine, and rectouterine. 
 The arteries are the uterine and ovarian ; the nerves are 
 from the uterovaginal plexus, the hypogastric plexus, and 
 the vesical plexus. 
 
 3. Labor is divided into three stages : The first stage 
 begins with the commencement of labor and ends with the 
 complete dilatation of the os uteri. The second stage begins 
 with the complete dilatation of the os uteri and ends with 
 the birth of the child. The third stage immediately follows 
 the second, and ends with the expulsion of the placenta and 
 the beginning contraction of the uterus. 
 
 For description of each, see Williams' "Obstetrics" 
 (1909), pages 226 et seq.; or Hirst's "Obstetrics" (1909), 
 pages 317 et seq. 
 
 4. The fetal head has the following diameters : Occipito- 
 frontal, occipitomental, bitemporal, biparietal, suboccipito- 
 bregmatic, trachelobregmatic, and mentobregmatic. Of 
 
 87 
 
MEDICAL RECORD. 
 
 these, the occipitofrontal is 4^2 inches, the occipitomental 
 is 5J4 inches, and all the others are approximately ^A 
 inches. 
 
 5. See Williams' "Obstetrics" (1909), page 152. 
 
 6. See Williams' "Obstetrics" (1909), pages 267 et seq.; 
 or Hirst's "Obstetrics" (1909), page 404. 
 
 7. Indications for the use of forceps are: (1) Forces at 
 fault: Inertia uteri in the presence of conditions likely to 
 jeopardize the interests of mother or child, (a) Impending 
 exhaustion; (b) arrest of head, from feeble pains. (2) 
 Passages at fault: Moderate narrowing, 3% to 2> Z A inches, 
 true conjugate; moderate obstruction in the soft parts. (3) 
 Passenger at fault: A. Dystocia due to (a) occipito-poste- 
 rior; (b) mentoanterior face; (c) breech arrested in cavity. 
 B. Evidence of fetal exhaustion (pulse above 160 or below 
 100 per minute). (4) Accidental complications: Hemor- 
 rhage ; prolapse funis ; eclampsia. All acute or chronic dis- 
 eases or complications in which immediate delivery is 
 required in the interest of mother or child, or both. 
 
 Contraindications for the use of the forceps are: Me- 
 chanical obstruction of any nature in the parturient canal ; 
 incomplete dilatation of the os ; non-rupture of membranes ; 
 non-engagement of the presenting part; the fact that the 
 fetal head is either too large or too small ; distended blad- 
 der or rectum. 
 
 8. Conditions that justify the induction of premature 
 labor: (1) Certain pelvic deformities; (2) placenta prsevia; 
 (3) pernicious anemia; (4) toxemia of pregnancy; (5) 
 habitual death of a fetus toward the end of pregnancy; 
 (6) the presence of a hydatidiform mole; (7) habitually 
 large fetal head. 
 
 The methods that may be employed are : Partial dilata- 
 tion of the cervix and the introduction within the cervix 
 (and vagina) of a tamponade of sterile gauze; (2) dilata- 
 tion of the cervix; (3) puncturing the membranes; (4) 
 introduction of a soft rubber bougie into the uterus; (5) 
 intrauterine injection of glycerin, water, or some other 
 fluid. For description of method, see Williams' "Obstet- 
 rics" (1909), pages 381 et seq.; or Hirst's "Obstetrics" 
 (1909), page 799- 
 
 9. Postpartum hemorrhage is hemorrhage from the par- 
 turient canal occurring after the birth of the child ; it may 
 occur immediately after the birth of the child, or at any 
 time within several hours. 
 
 Prevention: Exert gentle pressure on the fundus of the 
 uterus during birth of fetus and secundines ; prevent too 
 rapid delivery; after birth of head, give a dram of fluid 
 extract of ergot; after complete delivery, give vaginal 
 douche of creolin and water, and apply a uterine pad (ex- 
 
 88 
 
MEDICAL RECORD. 
 
 ternally) and abdominal binder; the patient should be kept 
 quiet, both mentally and physically. 
 
 io. Puerperal sepsis is a condition beginning within a 
 week after labor, generally about the third or fourth day, 
 and characterized by fever, inflammation of one ormore of 
 the reproductive organs, and general septic infection. For 
 treatment, see Williams' "Obstetrics" (1909), pages 883, 
 et seq.; or Hirst's "Obstetrics" (1909), pages 732, 737, 
 et seq. 
 
 SURGERY. 
 
 1. Symptoms of fracture of the olecranon process of the 
 ulna are: The upper fragment is drawn upward; swelling; 
 the forearm is partly flexed and cannot be extended read- 
 ily; flexion of elbow increases the distance between the 
 fragments; crepitation is present. The prognosis is fair; 
 fibrous union is common, and ankylosis, or joint stiffness 
 may occur. 
 
 2. Causes of non-union of fractures: 111 health, want of 
 approximation of the ends of the bone, want of blood 
 supply in the bone, defective innervation of the bone, dis- 
 ease of the bone, lack of rest, and immobility. 
 
 3. Causes of compression of brain: Hemorrhages, ab- 
 scess, tumor, depressed fractures, edema, new growths of 
 bone. Symptoms: Unconsciousness, slow and stertorous 
 breathing, full and slow pulse, later becoming rapid, tem- 
 perature raised, pupils unequal and fixed, hemiplegia, 
 sphincters paralyzed, reflexes increased on paralyzed side. 
 
 4. The various dislocations of the shoulder-joint are: 
 (1) Subcoracoid — forward, inward, and downward. (2) 
 Subglenoid — downward, forward, and inward. (3) Sub- 
 spinous — backward, inward, and downward. (4) Subclav- 
 icular — forward, inward, and upward. 
 
 The special diagnostic signs are : 
 
 (1) Subcoracoid: The head of the humerus is felt below 
 the outer end of the clavicle ; there is little or no shortening 
 of the limb ; the elbow is directed outward and backward. 
 
 (2) Subglenoid: The head of the humerus can be felt 
 in the axilla ; the arm is decidedly lengthened ; the elbow 
 is flexed, and there are signs of pressure on vessels and 
 nerves. 
 
 (3) Subspinous: The head of the humerus is felt below 
 the acromion process and behind ; the arm is rotated in- 
 ward and the elbow is displaced outward. 
 
 (4) Subclavicular: The head of the humerus is felt 
 below the clavicle ; the elbow is far from the side, and the 
 limb may be shortened. 
 
 The most frequent of these dislocations of the shoulder 
 joint is the subcoracoid. 
 
 89 
 
MEDICAL RECORD. 
 
 5. In tuberculosis of the knee-joint there are : Swelling 
 at sides of and above patella; joint is semiflexed; skin is 
 edematous; there is a doughy feel round patella; foot 
 is everted ; muscles of thigh and calf are wasted ; pain is 
 variable; tibia displaced outward and backward, is flexed 
 and externally rotated; the limb shortened; abscesses may 
 form. 
 
 6. Hydrocele is diagnosed by its translucency. Further, 
 it is a tumor which grows from below upward, is tense and 
 fluctuating, is generally situated in front of the testicle, and 
 gives no impulse on coughing. 
 
 7. Stone in the common duct is characterized by: Jaun- 
 dice, colic, clay-colored stools, collapse, nausea, vomiting; 
 the liver is enlarged and tender, and the gall-bladder is 
 shrunken. 
 
 8. Causes of vesical hemorrhage: Traumatism, stone, 
 inflammation, tumors, tuberculosis, and filaria. 
 
 9. Acute osteomyelitis is inflammation of the bone and 
 marrow; the term is often used now for inflammation of 
 the bone. It is caused by infection, the bacteria gaining 
 entrance either through a wound or by extension from 
 neighboring tissues, or they may be brought by the blood. 
 Pathological changes: "The area of the medulla affected 
 becomes hyperemic; exudation occurs in the cancellous 
 spaces, Haversian canals, and under the periosteum. Pus 
 soon forms in these three situations. If the disease begins 
 in the superficial part of the bone the pus may only be 
 subperiosteal, the deeper part of the bone escaping, though 
 large areas of the superficial portion may die from the 
 combined action of (1) stripping up of the periosteum by 
 the pus ; (2) strangulation of the vessels in the bone by the 
 pressure of the exudation, and (3) the toxic action of the 
 bacterial products. . . . When the disease begins in the 
 deeper layers of the bone the pus may reach the periosteum, 
 or extend along the medullary cavity, so that the veins 
 become filled with septic thrombus, which may be disinte- 
 grated and carried off as septic emboli (pyemia). There is 
 profound toxemia, and necrosis of the whole diaphysis may 
 occur. ... If the infection is mild, a chronic abscess 
 may be formed in the cancellous tissue. The usual course 
 of an acute case, if a patient survives, is that there is some 
 necrosis of the shaft of the bone. The abscess bursts ex- 
 ternally, and there are numerous openings in the skin lead- 
 ing through openings (cloacae) in the periosteum and in- 
 volucrum down to the sequestrum. The sequestrum be- 
 comes loose in six weeks to six months. Symptoms: Sud- 
 den onset; pain, tenderness, fever, chills, swelling of soft 
 parts ; sometimes the joint can be moved gently ^without 
 pain ; septicemia or pyemia may be present. It is to be 
 diagnosed from three conditions: (1) Rheumatism, in 
 
 90 
 
MEDICAL RECORD. 
 
 which more than one joint is affected and the tenderness 
 is in the joint, and not near it. (2) Tubular arthritis, in 
 which the onset is slow and the trouble starts in the epiphy- 
 sis rather than in the diaphysis. (3) Cellulitis, in which 
 the bone and periosteum are not affected, and in which 
 there is always a wound. 
 
 10. Early symptoms of carcinoma of breast: Hard no- 
 dule, painless, fixed to gland, slowly but steadily increases 
 in size; later it becomes harder and is fixed to skin; the 
 skin is dimpled and may ulcerate ; the nipple may be re- 
 tracted ; pain is present, and the breast cannot be freely 
 moved. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Connecticut State Medical Examining Board. 
 
 anatomy. 
 
 1. Give (a) the number of bones in the human body; 
 (b) classify them by regions of body; (c) classify by 
 variety and give examples of each. Give briefly the macro- 
 scopical and the microscopical structure of bone. 
 
 2. Describe the bony relationship and landmarks of the 
 elbow joint. 
 
 3. Describe (a) the anatomical relations and the struc- 
 ture of the mammary gland; (b) its nerve supply, and (c) 
 its lymphatic drainage. 
 
 4. Of what does the sympathetic nervous system con- 
 sist? What does the cerebrospinal system comprise? 
 
 5. State the origin and mention three branches of the 
 ophthalmic nerve. To which system does this nerve belong, 
 and what is its function? 
 
 6. Give the surface topography of (a) the appendix 
 vermiformis; (b) the apex of the heart; (c) the apices 
 of the lungs; (d) the two kidneys posteriorly. 
 
 7. What vessels unite to form (a) the basilar artery? 
 O) What its course. 
 
 8. Define epigastric region and tell what organs or parts 
 of organs are found in the same. Diagram. 
 
 9. What is (a) the stomach? (b) Give its gross anat- 
 omy, (c) Give the minute anatomy of its mucosa. 
 
 10. Write briefly on (a) the decidual teeth; (b) the 
 permanent teeth. 
 
 PHYSIOLOGY. 
 
 1. What is the relation of the red and white corpuscles 
 as to (a) size, (b) numbers, (c) function? What causes 
 the variation in the color of the blood? 
 
 2. State the source and describe the function of the 
 
 9i 
 
MEDICAL RECORD. 
 
 saliva. Explain the importance of thorough mastication 
 as related to digestion. 
 
 3. Describe the muscular movements of the large intes- 
 tine and explain their function. 
 
 4. Give a physiological explanation of the rapid respi- 
 ration of pneumonitis. 
 
 5. Give the localization in the cerebral cortex of the 
 motor function of (a) the left side of the face; (b) the 
 right arm; (c) the left leg. Also illustrate the external 
 cranial topography of the same. 
 
 6. Describe the .physical and nervous mechanism in 
 normal urine evacuation. 
 
 7. How is the cornea nourished? 
 
 8. Define secretion and excretion. What organs of the 
 body are purely excretory? 
 
 9. What part of the retina is most sensitive to visual 
 impressions? Explain this. 
 
 10. Explain the condition causing muscle fatigue. 
 
 CHEMISTRY AND HYGIENE. 
 
 i. (a) How dangerous is impure air? (b) How tested? 
 And what would be index of impurity? (c) What hygienic 
 measures should be observed in our public schools? 
 
 2. Give chemical name and formula for the following: 
 (a) blue vitriol; (b) common salt; (c) plaster of paris; 
 (d) paris green; (e) sugar of lead; (/) corrosive subli- 
 mate. 
 
 3. (a) What are peptones? (b) How evolved? (c) 
 What are proteoses? (d) What are ptomaines? 
 
 4. (a) What is urea? (b) What is the pathological sig- 
 nificance of urea in the urine? (r) How estimated? 
 
 5. (a) Given a neutral or faintly acid urine, and on 
 heating it a precipitate forms. What is this precipitate, 
 and how do you determine it? (b) Given an alkaline 
 urine, and on heating no precipitate is seen; is albumen 
 present? 
 
 6. (a) What are ferments? (b) Classify them, (c) 
 Name three. 
 
 7. Name the chief constituents of the bile. 
 
 8. (a) Discuss the influence of alcohol on the race. Is 
 it food or poison? 
 
 9. Is sanatorium treatment of tuberculosis worth while? 
 
 10. What are the symptoms of (a) acute poisoning of 
 phosphorus? (b) Treatment and antidote, (c) Test. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 1. What is the physiological action and therapeutics of 
 phenacetin ? 
 
 2. What are the secondary effects of alcohol upon (a) 
 
 92 
 
MEDICAL RECORD. 
 
 stomach; (b) liver; (c) vasomotor system; (d) nervous 
 system ? 
 
 3. What are emetics? In what way do they act? When 
 indicated? When contraindicated? 
 
 4. What changes take place in the blood when illumi- 
 nating gas is inhaled? Give treatment. 
 
 5. What is the action and dose of pilocarpine? Of apo- 
 morphine? 
 
 6. What is the physiological action and what are the 
 uses of potassium acetate? 
 
 7. Name three heart depressants and tell how they act. 
 
 8. How and upon what portion of the alimentary tract 
 do the following drugs act: cascara, phosphate of soda, 
 aloes, jalap and calomel? 
 
 9. Write a prescription in Latin, unabbreviated, for 
 acute bronchitis, containing four ingredients, and give the 
 action of each. 
 
 10. Treat a case of infantile convulsions. 
 
 PRACTICE, PATHOLOGY AND DIAGNOSIS. 
 
 1. Describe the varieties of stomatitis : (a) simple, 
 (b) aphthous, (c) mycotic, (d) ulcerative. Give the causes 
 and treatment. 
 
 2. Give the etiology of congestion of the liver, active 
 and passive. 
 
 3. Differentiate cardiac asthma from bronchial or spas- 
 modic asthma — symptomatically and pathologically. 
 
 4. What are the causes of albuminuria, renal and extra- 
 renal ? 
 
 5. Describe a case of acute inflammatory rheumatism; 
 state its complications and sequels. 
 
 6. What are the varieties of influenza? Give the promi- 
 nent symptoms of each variety. 
 
 7. Diagnosis of scarlet fever, smallpox, measles, and 
 chickenpox; (a) period of incubation; (b) eruption; (c) 
 course of each disease. 
 
 8. Differentiate between cerebrospinal fever and tuber- 
 cular meningitis, pathologically. 
 
 9. Give the symptoms and treatment of chorea. 
 
 10. When is the eye ametropic, and what are the forms 
 of ametropia? 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 1. (a) Describe the relation between ovulation and 
 menstruation; (b) what is the present belief as regards 
 migration of the ovum? 
 
 2. (a) State the cause of the premature detachment of 
 the placenta; (b) what are the dangers? (c) Treatment. 
 
 3. (a) Give all the causes of prolonged first stage labor; 
 (b) the dangers; (c) management. 
 
 93 
 
MEDICAL RECORD. 
 
 4. (a) What are the indications for the use of forceps? 
 (b) What condition necessitates version rather than for- 
 ceps? (c) What cesarean section rather than version? 
 
 5. (a) What are the changes that occur in the uterus 
 during pregnancy? (b) After delivery? 
 
 6. Differentiate an ovarian cyst from (a) ascites; (b) 
 hydramnios; (c) fibroid tumor; (d) distended bladder; 
 (e) hematometra. 
 
 7. (a) What is sapremia? (b) How does it differ from 
 septicemia? (c) Should treatment differ? 
 
 8. (a) What pathological conditions require curettage? 
 (b) Give the operative technique. 
 
 9. (a) Give three causes for post-partum hemorrhage. 
 
 (b) Your treatment for each. 
 
 10. What are the operative procedures in the treatment 
 of prolapsus uteri? Give indications for each. 
 
 SURGERY. 
 
 1. Aneurysm: (a) causation; (b) varieties; (c) diag- 
 nosis. 
 
 2. Carbuncle: (a) defined; (b) predisposing causes; 
 
 (c) diagnosis; (d) treatment. 
 
 3. Local anesthesia. Technique of^ its application in 
 hernis, removal of appendix, or thyroidectomy? 
 
 4. Practical demonstration of the use of Janeway's 
 manometer. 
 
 5. State your views as to the scope and value of blood 
 pressure determinations in operative surgery under gen- 
 eral anesthesia. 
 
 6. Describe or depict the arrangement of the synovial 
 sheaths of the palm and fingers. 
 
 7. Give the differential diagnosis between a fracture and 
 dislocation at the hip. 
 
 8. Diagnosis and treatment of fractured clavicle. 
 
 9. What do you consider the best operation for internal 
 hemorrhoids? Describe your technique. 
 
 10. Carcinoma: (a) varieties; (b) location in order of 
 frequency; (c) metastasis; (d) differentiation? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Connecticut State Medical Examining Board. 
 
 anatomy. 
 
 1. (a) There are 206 named bones in the human body. 
 
 (b) By regions: The spine, with sacrum and coccyx; 
 cranium, and face, with ossicles of the ear; hyoid, sternum, 
 and ribs; upper extremities; and lower extremities. 
 
 94 
 
MEDICAL RECORD 
 
 (c) By variety: Long bones, as femur and humerus; 
 short bones, as carpal and tarsal ; flat bones, as parietal 
 and scapula ; irregular bones, as vertebrae and sphenoid. 
 
 For structure, see Cunningham's "Anatomy" (1909), 
 pages 71 and J2\ or, Gray's "Anatomy" (1908), pages 
 34 to 40. 
 
 2. There are three bony points : The external condyle 
 of the humerus, the internal condyle of the humerus, and 
 the olecranon process of the ulna. When the forearm is 
 extended these three points are in a straight line; when 
 the forearm is flexed, the olecranon is a little below the 
 line joining the two condyles. The head of the radius can 
 be felt from behind, nearly one inch below the external 
 condyle. The internal condyle is more prominent than the 
 external condyle ; the olecranon is nearer to the inner than 
 to the outer condyle. 
 
 3. See Cunningham's "Anatomy" (1909), pages 1207 and 
 923; or, Gray's "Anatomy" (1908), pages 1516 and 810. 
 
 4. "The sympathetic nervous system consists of (1) a 
 series of ganglia connected together by a great ganglionic 
 cord, the gangliated cord, extending from the base of the 
 skull to the coccyx, one gangliated cord on each side of 
 the middle line of the body, partly in front and partly on 
 each side of the vertebral column ; (2) of three great 
 gangliated plexuses or aggregations of nerves and ganglia, 
 situated in front of the spine in the thoracic, abdominal, 
 and pelvic cavities respectively; (3) of smaller or terminal 
 ganglia, situated in relation with the abdominal viscera ; 
 and (4) of numerous fibers." 
 
 The cerebrospinal system comprises the central nervous 
 axis (brain and spinal cord) and the peripheral nerves 
 (cranial and spinal). 
 
 5. The ophthalmic nerve is a branch of the trigeminal 
 (fifth cranial) nerve. Its three branches are the Lacrymal, 
 Frontal, and Nasal. It is a sensory nerve belonging to the 
 cerebrospinal system. Its function is to supply sensation 
 to the anterior half of the scalp, conjunctiva and skin of 
 upper eyelid, cornea, skin of nose, mucous membrane of 
 nose, and lacrymal gland. 
 
 6. See Gray's "Anatomy" (1908), (a) page 1331 ; (b) 
 page 580; (c) page 1405; (d) page 1434. 
 
 7. (a) The two vertebral arteries, (b) It is situated in 
 the center of a groove on the under surface or front of 
 the pons, extending from the posterior to the anterior 
 border. It lies between the sixth pair of cranial nerves. 
 
 8. See Cunningham's "Anatomy" (1909), pages 1046 and 
 1047; or, Gray's "Anatomy" (1908), pages 1243, 1244, and 
 1246. 
 
 9. See Cunningham's "Anatomy" (1909), pages 1050 to 
 1060; or, Gray's "Anatomy" (1908), pages 1277 to 1285. 
 
 95 
 
MEDICAL RECORD. 
 
 io. See Cunningham's "Anatomy" (1909), pages 1016 
 and 1022; or, Gray's "Anatomy" (1908), page 1206. 
 
 PHYSIOLOGY. 
 
 1. (a) Red corpuscles are about 1/3200 of an inch in 
 diameter; white corpuscles are about 1/2500 of an inch in 
 diameter. 
 
 (b) There are about 4,500,000 to 5,000,000 red corpuscles 
 in each cubic millimeter of blood, and about 7,000 to 
 10,000 or 12,000 white corpuscles in each cubic millimeter 
 of blood. 
 
 (c) The function of the red corpuscles is to carry oxy- 
 gen from the lungs to the tissues. Function of the white 
 corpuscles: (1) To serve as a protection to the body from 
 the incursions of pathogenic microorganisms; (2) they 
 take some part in the process of the coagulation of the 
 blood; (3) they aid in the absorption of fats and peptones 
 from the intestine, and (4) they help to maintain the 
 proper proteid content of the blood plasma. The variation 
 in the color of the blood is due to the presence of oxygen 
 in combination with hemoglobin, giving to arterial blood 
 its red color, and the presence of carbon dioxide (with 
 lessened oxygen), giving to venous blood its bluish color. 
 
 2. Source of saliva: The parotid, submaxillary, and sub- 
 lingual glands (and the small mucous and serous glands of 
 the mouth). 
 
 The functions of the saliva are: (1) To moisten the 
 mouth, (2) to assist in the solution of the soluble portions 
 of the food, and thus (3) to administer to the sense of 
 taste; (4) to lubricate the bolus of food, and thus (5) to 
 facilitate the acts of mastication and deglutition, and (6) to 
 change starches into dextrin and sugar. Thorough masti- 
 cation prepares the solid and fibrous foods for the more 
 ready and speedy action of the various digestive juices; it 
 enables these foods to present also a larger surface to the 
 action of these juices. Food that is imperfectly masticated 
 may cause suffocation; it is also a well-known cause of 
 indigestion. 
 
 3. The muscular movements of the large intestine are 
 chiefly of the peristaltic or vermicular kind. This is a 
 wave-like motion, characterized by a contraction of the 
 circular fibers behind a bolus and a relaxation of the fibers 
 in advance of it. The result is a movement forward of the 
 bolus, and as it moves it is followed by a ring of constric- 
 tion and preceded by a ring of relaxation or inhibition. 
 Under the influence of this peristaltic movement the con- 
 tents of the large intestine (food residues and excrementi- 
 tious matter) are gradually carried downward toward the 
 sigmoid flexure, where they accumulate prior to their ex- 
 trusion from the body. The effects of the peristaltic waves 
 are to some extent interfered with by antiperistaltic waves, 
 
 96 
 
MEDICAL RECORD. 
 
 which, beginning in the transverse colon, run toward and to 
 the cecum. The intestinal contents are thereby driven back 
 toward the cecum. The effect is a still further admixture 
 with the secretions and exposure to the absorbing mucosa. 
 There is some evidence also that the antiperistaltic wave 
 may force some of the liquefied contents through the ileo- 
 colic opening into the small intestine because of the relax- 
 ation of the sphincter muscle. (From Brubaker's Physi- 
 ology.) 
 
 4. The rapid respiration in pneumonia is due to: (1) 
 Toxemia, which affects the respiratory center; (2) the 
 amount of lung involved; (3) the limited air space left for 
 use; (4) pain, 
 
 5. See Cunningham's "Anatomy" (1909), pages 1224 and 
 1227; or, Gray's "Anatomy" (1908), pages 966 and 970. 
 
 6. "The urine trickles drop by drop down the ureters, 
 into the bladder, where it collects and gradually distends 
 it. The exit from the bladder is opposed by the sphincter 
 vesicae, or, as some believe, by the elastic and muscular 
 fibers of the urethra. The urine is expelled by the con- 
 traction of the walls of the bladder, more especially by the 
 detrusor vesicae, and is assisted when much distended by 
 the contraction of the abdominal walls. Micturition is a 
 reflex act, but one which (with the exception of infants) 
 is under the influence, if not under the control of the will. 
 The mechanism appears to consist of an automatic center 
 in the lumbar part of the cord, maintaining the constant 
 contraction of the sphincter, a second center, which, when 
 stimulated, excites contraction in the detrusor. These 
 centers are antagonistic, so that an afferent impulse from 
 the bladder excites the detrusor center, at the same time 
 inhibiting the sphincter center. These centers are nor- 
 mally under the control of the will, so that, although an 
 afferent impulse may ascend from the bladder to the centers 
 of the cord and up to the sensorium, yet by an effort of 
 will the sphincter center may be assisted and the detrusor 
 inhibited, or vice versa. Thus when the bladder becomes 
 distended an afferent impulse from the bladder reaches 
 both lumbar center and the brain; if the opportunity is 
 favorable for micturition the controlling influence of the 
 will is removed, the reflex contraction of the detrusor 
 taking place, assisted, perhaps by the voluntary abdominal 
 muscles." (Ashby's Physiology.) 
 
 7. The cornea is nourished chiefly by the lymph in the 
 corneal spaces or lacunae and canaliculi. At its border, for 
 a very short distance, there are also capillary loops from 
 the sclera and conjunctiva. 
 
 8. Secretion is the process by which certain organs 
 (glands and membranes) separate from the blood certain 
 constituents which are further elaborated and serve some 
 further office in the economy. 
 
 97 
 
MEDICAL RECORD 
 
 Excretion is a similar process by which there are re- 
 moved from the blood waste materials, and products of 
 no further use to the body, and which, if retained, would 
 be injurious. 
 
 The purely excretory organs are : Kidneys and skin. 
 
 9. The fovea centralis in the macula lutea is the part of 
 the retina most sensitive to visual impressions. Here the 
 end organs of the optic nerve are most highly developed; 
 the cones are here increased both in number and in size. 
 
 10. Causes of fatigue in muscle: Presence of sarcolactic 
 acid and acid potassium phosphate in the muscle; using up 
 of the material from which the energy is obtained; and 
 accumulation of carbon dioxide and other waste products. 
 
 CHEMISTRY AND HYGIENE. 
 
 i. (a) The danger of impure air depends upon: (1) 
 The amount of oxygen present; (2) the amount and 
 nature of impurities present (the chief being carbon diox- 
 ide, organic matters, crowd poison, disease germs, com- 
 bustion products, emanations from sewers or marshes, con- 
 taminations from trade and manufacturing processes, and 
 decomposition products). 
 
 (b) Pettenkofer's method of determining the percentage 
 of carbon dioxide in the air: A large cylindrical container 
 of known capacity, say, 15 liters, is filled with the air to be 
 examined; a known volume of barium hydroxide is then 
 added and shaken up with the air. The carbon dioxide 
 combines with the barium hydroxide to form a barium car- 
 bonate, which is insoluble, and also incapable of acting 
 upon an indicator. The barium hydroxide employed is of 
 known strength, e.g. it may be of such strength that 1 c.c. 
 of the solution neutralizes 1 c.c. of carbon dioxide at nor- 
 mal temperature and pressure. If then we find that 10 c.c. 
 of the barium hydroxide has been neutralized by the carbon 
 dioxide present in the air, we know that 10 c.c. of carbon 
 dioxide is present in 15 liters or 15,000 c.c. of the air 
 examined. 
 
 2. 
 
 
 
 
 
 CHEMICAL NAME. 
 
 FORMULA 
 
 (a) 
 
 Blue vitriol. 
 
 Cupric sulphate. 
 
 CuS0 4 . 
 
 (b) 
 
 Common salt. 
 
 Sodium chloride. 
 
 NaCl. 
 
 (c) 
 
 Plaster of 
 Paris. 
 
 Calcium sulphate. 
 
 CaS0 4 . 
 
 (d) 
 
 Paris green. 
 
 Cupric aceto - met 
 
 Cu(C 2 H 3 2 ) 2 + 3 
 
 
 
 arsenite. 
 
 CuAs 2 4 . 
 
 (e) 
 
 S ug a r of 
 lead. 
 
 Lead acetate. 
 
 Pb(C,H,O0* 
 
 (f) 
 
 Corrosive 
 sublimate. 
 
 Mercuric chloride. 
 
 HgCl 2 . 
 
 98 
 
MEDICAL RECORD 
 
 3. (a) Peptones are the final products of the action of 
 proteolytic ferments on proteids. 
 
 (b) By the action of proteolytic ferment (pepsin and 
 trypsin) on proteids. 
 
 (c) Proteoses are the intermediate products in the con- 
 version of proteids into peptones. 
 
 (d) Ptomaines are basic, nitrogenous compounds, pro- 
 duced from protein material by the bacteria which cause 
 putrefaction. 
 
 4. (a) Urea is the end product of the proteid metabol- 
 ism of the body. It is a crystalline solid, soluble in water, 
 colorless, odorless, with a slightly bitter taste ; it is neu- 
 tral in reaction, but basic in character ; dilute aqueous 
 solutions are not decomposed by boiling, but by prolonged 
 boiling urea is hydrolized to ammonia and carbon dioxide ; 
 urea forms compounds with acids and also with certain 
 salts and oxides. Formula is CON 2 H 4 . 
 
 (b) Urea is always present in the urine, a healthy man 
 excreting about 500 grains of urea daily. Pathologically, 
 the amount of urea excreted may be diminished or in- 
 creased, as follows : 
 
 A diminution may be due to some condition interfering 
 with the normal transformation of proteins in the body, 
 as in certain chronic diseases. More frequently, however, 
 a diminished proportion of urea in the urine is not due to 
 a diminution in the production, but to the fact that the 
 urea formed has not been separated by the kidneys as in 
 uremia, and in diseases attended with dropsical effusions. 
 Pathologically it is increased in the early stages of all 
 acute febrile diseases, except when these are attended by 
 the formation of dropsical deposits or by diarrhea; during 
 reabsorption of dropsical fluids; in both forms of dia- 
 betes, and in chronic interstitial nephritis. 
 
 (c) "The specific gravity of the urine is carefully de- 
 termined, as well as that of the liquor sodae chlorinatse. 
 One volume of the urine is then mixed with exactly seven 
 volumes of the liquor sodse chlorinatse, and, after the first 
 violence of the reaction has subsided, the mixture is shaken 
 from time to time during an hour, when the decomposi- 
 tion is complete ; the specific gravity of the mixture is 
 then determined. As the reaction begins instantaneously 
 when the urine and reagent are mixed, the specific gravity 
 of the mixture must be calculated by adding together once 
 the specific gravity of the urine and seven times the spe- 
 cific gravity of the liquor sodae chlorinatae, and dividing the 
 sum by eight. From the quotient so obtained the specific 
 gravity of the mixture after decomposition is subtracted; 
 every degree of loss in specific gravity indicates 0.7791 
 gram of urea in 100 c.c. of urine. The specific gravity de- 
 terminations must all be made at the same temperature, 
 
 99 
 
MEDICAL RECORD 
 
 and that of the mixture only when the evolution of gas 
 has ceased entirely." (Witthaus' Manual of Chemistry.) ^ 
 
 5. (a) Albumin or phosphates. Add HN0 3 ; this will 
 dissolve the phosphates, but not the albumin. 
 
 (b) Albumin may or may not be present. 
 
 6. Ferments are certain microorganisms (bacteria, mould 
 and yeast fungi) which, by their growth, cause definite 
 chemical changes in certain substances contained in the 
 media in which they develop. They are classified as: (1) 
 Proteolytic, e.g. trypsin; (2) amylolytic, e.g. ptyalin; (3) 
 steatolytic, e.g. steapsin; (4) inverting, e.g. invertin; (5) 
 coagulating, e.g. milk curdling ferment. 
 
 7. Water, sodium glycocholate, sodium taurocholate, 
 bilirubin, biliverdin, fats, soaps, cholesterin, lecithin, urea, 
 sodium chloride. 
 
 8. The influence of alcohol on the race cannot be dis- 
 cussed in the space at our disposal. Most of what is 
 written on the subject has absolutely no scientific value, 
 being characterized by prejudices and diatribes rather 
 than by logic and science. Probably most races would 
 benefit if some of the individuals of these races consumed 
 less alcohol. That alcohol is abused or misused is true; so 
 are money and many other things, and the abuse of a thing 
 is no argument against its legitimate use. As to whether 
 alcohol is a food or a poison, there is also much difference 
 of opinion. Taken in excess, it may be a poison ; but many 
 scientists believe that it has also a food value. Much 
 depends on the conditions under which it is used and the 
 quantity in which it is taken. The student (and examiner) 
 will easily find any quantity of "literature" which will 
 favor his own particular views or prejudices in the matter, 
 but very little of it is of scientific value. 
 
 9. See French's "Practice of Medicine" (1907), page 
 394; or, Osier's "Practice of Medicine" (1909), page 354. 
 
 10. (a) Eructation of gas having the odor of garlic. 
 The mouth, when observed in the dark, is frequently 
 faintly luminous (phosphorescent). After several hours, 
 pain in the throat, a sense of heat in the epigastrium, 
 nausea, and vomiting. The vomited matters are sometimes 
 bloody, and frequently luminous when agitated in the dark. 
 The abdomen is tender, and there are diarrhea and colicky 
 pains. After one or two days these symptoms cease, there 
 remaining only pain in the back and limbs and a feeble 
 pulse. Death sometimes occurs suddenly in from two to 
 four days. Usually about the fourth day the patient be- 
 comes^ jaundiced, suffers from headache, insomnia, and 
 retention of urine, rapidly becomes delirious and coma- 
 tose, and dies. 
 
 (b) The unabsorbed^ portion is to be removed as speedily 
 as possible by an emetic of copper sulphate or apomorphin. 
 
 100 
 
MEDICAL RECORD. 
 
 No chemical antidote is known. French oil of turpentine 
 (the older the better) should be given as a physiological 
 antidote. The food should be free from oils and fats. 
 
 (c) The matters supposed to contain phosphorus are 
 rendered fluid by dilution with water and acidulated with 
 sulphuric acid. They are placed in a flask upon a sand 
 bath and the flask connected with a Liebig's condenser, 
 which is placed in absolute darkness. Upon heating the 
 flask any phosphorus present is volatilized, and, condensing 
 in the tube, forms a luminous ring. This reaction is very 
 delicate, and the appearance of the ring is proof positive 
 of the presence of unoxidized phosphorus. (From Witt- 
 haus' Essentials of Chemistry and Toxicology.) 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. Phenacetin. Physiological Action: Lowers body 
 temperature, and is an analgesic; it is also a cardiac de- 
 pressant. Therapeutics: In fevers, as an antipyretic, and 
 to relieve pain; also used in epilepsy. 
 
 2. The stomach is overstimulated and congested, the gas- 
 tric glands are similarly affected, gastric catarrh ensues, 
 digestion is impaired, and morning vomiting may occur. 
 The liver and hepatic cells suffer in a similar way. De- 
 generative changes may follow. It is a vasodilator, and 
 lowers arterial tension. The nervous system is specially 
 affected, and eventually paralysis or epilepsy may result 
 from the long continued use of alcohol. 
 
 3. Emetics are agents which produce vomiting. They 
 act: (1) By irritating the nerves of the stomach, esopha- 
 gus, or pharynx; (2) through the circulation; (3) by irri- 
 tation of the vomiting center in the medulla. Indications: 
 To produce vomiting or nausea; in catarrhal conditions of 
 the respiratory tract; to remove poisons or foreign bodies 
 from stomach, esophagus, etc. ; to empty the stomach. 
 Contraindications: Severe cardiac lesions and aortic 
 aneurysm ; atheroma ; when the patient is so weak that 
 there is danger of collapse; in poisoning by caustics; in 
 hernia or peritonitis, or in cases of high arterial tension. 
 
 4. When illuminating gas is inhaled, the color of the 
 blood is a very bright red, much brighter than normal ; 
 the cells are not altered in appearance, but the red corpuscles 
 are incapable of carrying oxygen to the tissues, as the 
 carbon monoxide forms with the hemoglobin a compound 
 which is very much more stable than oxyhemoglobin. The 
 spectroscope shows, also, a characteristic absorption spec- 
 trum. Treatment: Stimulants, fresh air, bleeding, and 
 hypodermocleisis, or infusion of normal salt solution. 
 
 5. Pilocarpine: Dose, gr. 1/5. Action: Stimulant of 
 secretory nerves and of involuntary muscles, myotic, nerv- 
 ous depressant, sudorific. 
 
 101 
 
MEDICAL RECORD. 
 
 Apomorphine hydrochloride. Dose: As an emetic, gr. 
 i/io subcutaneously ; as an expectorant, gr. 1/30. Physio- 
 logical action: It acts on the vomiting center in the 
 medulla, hence is emetic; it increases pulse, blood pressure, 
 and rate of respiration; it is also an expectorant. 
 
 6. Potassium acetate. Physiological action: Antacid, 
 increases alkalinity of the blood and of the urine, is a 
 diuretic, and a diaphonetic. Uses: In rheumatism, gout, 
 fevers, dropsy, nephritis, cystitis, and irritation of the 
 urinary tract. 
 
 7. Three cardiac depressants: (1) Antimony, which de- 
 presses the motor ganglia; (2) pilocarpine, which stimu- 
 lates the inhibitory ganglia and depresses the heart muscle 
 and also the motor ganglia; (3) hydrocyanic acid, which 
 is a direct cardiac poison, depressing the heart muscle and 
 the motor ganglia. , 
 
 8. Cascara is a stomachic and laxative, and acts on the 
 stomach and small intestine. Phosphate of sodium is a 
 saline, hepatic stimulant, and cholagogue; it acts on liver 
 and colon. Aloes is a purgative, hepatic stimulant, and 
 cholagogue, and acts on the large intestine (chiefly de- 
 scending colon and rectum) and liver. Jalap is a drastic 
 purgative, and acts on the small intestine. Calomel is a 
 simple purgative, and acts on the small intestine. 
 
 9. 5- Ammonii carbonatis, 3j. 
 
 Spiritus chloroformi, 3j. 
 Syrupi pruni virginianse, Jj. 
 
 Misturse glycyrrhizse composite, q.s. ad. Jviij. 
 Miscc. 
 Signa : One tablespoonful every three hours. 
 The ammonium carbonate is a respiratory stimulant 
 and a stimulating expectorant. The chloroform disguises 
 the taste of the ammonium. The prunus virginiana is a 
 sedative and expectorant. The glycyrrhiza is an expecto- 
 rant. 
 
 10. See French's "Practice of Medicine" (1907), page 
 1 124; or Osier's "Practice of Medicine" (1909), page 1058. 
 
 practice, pathology, and diagnosis. 
 
 1. See French's "Practice of Medicine" (1907), pages 
 707 to 710; or Osier's "Practice" (1909), pages 434 to 437. 
 
 2. See French's "Practice of Medicine" (1907), page 
 817; or Osier's "Practice of Medicine" (1909), page 541. 
 
 3. See French's "Practice of Medicine" (1907), page 
 659; and Osier's "Practice of Medicine" (1909), page 610. 
 
 4. Albuminuria is found: "(1) In fevers, as typhoid and 
 pneumonia. (2) In valvular heart lesions, degeneration of 
 the heart muscles, diseases of the coronary arteries, im- 
 peded pulmonary circulation, in pregnancy by pressure upon 
 the renal veins, in intestinal catarrh, and in Asiatic cholera. 
 
 102 
 
MEDICAL RECORD. 
 
 (3) In purpura, scurvy, leukemia, pernicious anemia, jaun- 
 dice, diabetes, and syphilis. (4) After taking lead, mer- 
 cury, iodine, phosphorus, arsenic, antimony, chloroform, 
 cantharides, oxalic, carbolic, salicylic, or the mineral acids, 
 turpentine and nitrates. (5) In large amounts in acute 
 nephritis and chronic parenchymatous nephritis; in small 
 amounts in chronic interstitial nephritis, and amyloid kid- 
 ney." — (Witthaus' Essentials of Chemistry.) 
 
 5. See French's "Practice of Medicine" (1907), pages 
 222 to 230; or Osier's "Practice of Medicine" (1909), pages 
 219 to 226. 
 
 6. See French's "Practice of Medicine" (1907), pages 
 132 to 136; or Osier's "Practice of Medicine" (1909), 
 pages 153 and 154. 
 
 7. Scarlet fever: Period of incubation, from a few 
 hours to seven days. Stage of invasion, twenty-four hours. 
 Character of eruption, a scarlet punctate rash, beginning 
 on neck and chest, then covering face and body ; desqua- 
 mation is scaly or in flakes. The eruption is brighter, is 
 on a red background, punctiform, and is more uniform; 
 the temperature is higher, the pulse quicker; the tongue 
 is of the "strawberry" type, the lymphatics in the neck may 
 be swollen, and there is sore throat; Koplik's spots are 
 absent. Smallpox: The eruption usually appears first on 
 the forehead and wrists, and on the third or fourth day; 
 it is first mascular, then papular, then vesicular, and finally 
 pustular ; it does not appear in successive crops ; the spots 
 are multilocular, and do not collapse on being punctured; 
 the papule is hard and shotty, and does not disappear on 
 stretching the skin. Period of incubation is from eight to 
 fourteen days. Measles: Period of incubation, ten to 
 twelve days. Stage of invasion, four days. Character of 
 eruption, small, dark red papules with crescentic borders, 
 beginning on face and rapidly spreading over the entire 
 body; desquamation is branny. The eruption is darker, 
 less uniform, more shotty; the temperature is lower, pulse 
 slower, the tongue is not of the "strawberry" type ; coryza, 
 coughing, and sneezing may be present ; Koplik's spots are 
 present. Chickenpox: The eruption usually appears first 
 on the trunk, is evident on the first day, comes in suc- 
 cessive crops, is not shotty, and disappears on stretching 
 the skin ; the spots are unilocular, and collapse on being 
 punctured. The period of incubation is from four to 
 fourteen days. 
 
 8. See Osier's "Practice of Medicine" (1909), pages 159 
 and 301. 
 
 9. See French's "Practice of Medicine" (1907), pages 
 1 1 18 and 1 120; or Osier's "Practice of Medicine" (1909), 
 pages 1048 and 1052. 
 
 10. The eye is ametropic when, in a condition of rest, 
 
 103 
 
MEDICAL RECORD. 
 
 parallel rays of light are focussed either behind or in 
 front of the retina, and not on it. The forms of ametropia 
 are: Hyperopia, myopia, and astigmatism. 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 i. See Williams' "Obstetrics" (1909), pages 83 and 85; 
 or Hirst's "Obstetrics" (1909), pages 65 and 62. 
 
 2. See Williams' "Obstetrics" (1909), pages 805, 808, and 
 810; or Hirst's "Obstetrics" (1909), pages 583 and 585. 
 
 3. See Williams' "Obstetrics" (1909), pages 658 to 663; 
 or Hirst's "Obstetrics" (1909), pages 439 to 444. 
 
 4. (a) Indications for the use of forceps are : "1. Forces 
 at fault: Inertia uteri in the presence of conditions likely 
 to jeopardize the interests of mother or child, (a) Im- 
 pending exhaustion; (b) arrest of head, from feeble pains. 
 2. Passages at fault: Moderate narrowing, 3% to zYa 
 inches, true conjugate; moderate obstruction in the soft 
 parts. 3. Passenger at fault: A. — Dystocia due to (a) oc- 
 cipitoposterior, (b) mentoanterior face, (c) breech ar- 
 rested in cavity. B. — Evidence of fetal exhaustion (pulse 
 above 160 or below 100 per minute). 4. Accidental com- 
 plications: Hemorrhage; prolapsus funis; eclampsia. All 
 acute or chronic diseases or complications in which imme- 
 diate delivery is required in the interest of mother or child, 
 or both." (b) Indications for version are: (1) In trans- 
 verse presentations: (2) in placenta prsevia; (3) in mal- 
 presentations of the head; (4) in simple flattened pelvis, 
 and in minor degrees of pelvic contraction; (5) in pro- 
 lapsed funis; (6) in sudden death of the mother, and (7) 
 in any case where speedy delivery is imperative, (c) Indi- 
 cations for cesarean section are : Extreme pelvic contrac- 
 tion or deformity in which delivery by forceps or version 
 or symphyseotomy is impossible, and in which craniotomy 
 is either impossible or would be more dangerous to the 
 mother; the presence of extreme atresia of the vagina; 
 rupture of the uterus ; sudden maternal death. 
 
 5. See Williams' "Obstetrics" (1909), pages 165 to 169, 
 185, and 332 to 334; or Hirst's "Obstetrics" (1909), pages 
 182 and 348 to 353- 
 
 6. 
 
 ASCITES. 
 
 
 OVARIAN CYST. 
 
 
 I. Previous history of 
 
 1. 
 
 No such history. 
 
 
 visceral disease. 
 
 
 
 
 2. Enlargement compara- 
 
 2. 
 
 Gradual. 
 
 
 tively sudden. 
 
 
 
 
 3. Face puffy; color 
 
 3. 
 
 Facies ovariana. 
 
 Ane- 
 
 waxy; early anemia. 
 
 mia 
 
 absent, or later. 
 
 
 104 
 
MEDICAL RECORD 
 
 ASCITES. 
 
 OVARIAN CYST. 
 
 4. Patient on back, en- 
 largement symmetrical; flat 
 in front. 
 
 5. Sitting up, abdomen 
 bulges below. 
 
 6. Navel prominent and 
 thinned. 
 
 7. Fluctuation decidedly 
 clear, diffuse throughout 
 abdomen, but avoids highest 
 parts in all positions, and al- 
 ways has a hydrostatic level. 
 
 8. Intestines float on top 
 of fluid; hence percussion 
 gives clear tympanitic note 
 over the highest parts of 
 abdominal cavity, and dull- 
 ness in lowest parts for all 
 positions, i.e. areas of res- 
 onance and dullness change 
 with position. 
 
 9. Vaginal touch detects 
 fluctuation, bulging into va- 
 gina. 
 
 10. Uterus in prolapsed 
 location, but position un- 
 changed. Size and mobility 
 unchanged. 
 
 11. Hydragogues and diu- 
 retics temporarily remove 
 the fluid. 
 
 12. Fluid light straw color 
 and thin. Coagulates spon- 
 taneously. 
 
 4. Asymmetrical until tu- 
 mor is quite large; promi- 
 nent in front. 
 
 5. No appreciable change. 
 
 6. Navel usually un- 
 changed. 
 
 7. Less clear; limited to 
 cyst ; not modified by change 
 of position. No hydrostatic 
 level. 
 
 8. No change in areas of 
 dullness and resonance with 
 change of position. Dull- 
 ness over cyst. Clear reso- 
 nant note in all parts beyond 
 cyst limits, i.e. in flanks and 
 toward the diaphragm. 
 
 9. Vaginal fluctuation less 
 I clear or absent. 
 
 10. Uterus displaced for- 
 | ward or backward, or later- 
 j ally by pressure of cyst. 
 
 11. Medicines have no ef- 
 fect. 
 
 12. Fluid light or dark 
 I and of varying consistency; 
 ! albuminous, but does not 
 I coagulate spontaneously; 
 
 may contain colloid matter. 
 
 HYDRAMNIOS. 
 
 1. Evidence of pregnancy. 
 
 2. Rapid development. 
 
 3. Ballottement. 
 
 4. Distention symmetrical. 
 
 1. 
 2. 
 3- 
 
 4- 
 side. 
 
 OVARIAN CYST. 
 
 Not usual. 
 
 Less rapid. 
 
 Absent. 
 
 Distention more on one 
 
 105 
 
MEDICAL RECORD. 
 
 FIBROID TUMOR. 
 
 i. Slow growth. 
 
 2. Facial expression un- 
 changed. Face may be full 
 and flushed ; later pale from 
 hemorrhage. 
 
 3. General health usually- 
 unimpaired except from loss 
 of blood, if submucous or 
 mural ; may be painful. 
 
 4. Abdomen usually very 
 asymmetrical from irregu- 
 lar shape of tumor. 
 
 5. Abdominal veins not 
 usually enlarged. 
 
 6. Action of kidneys nor- 
 mal. 
 
 7. Usual menorrhagia. 
 
 8. Elasticity, not fluctua- 
 tion. No percussion wave. 
 
 9. Surface firm and usual- 
 ly lobulated. 
 
 10. Vaginal touch and con- 
 joined examination show tu- 
 mor dense and firm, and, 
 unless pedunculated, contin- 
 uous with uterus. Uterus 
 large and heavy. 
 
 11. Uterine cavity much 
 elongated. 
 
 12. Uterus moves with tu- 
 mor. 
 
 OVARIAN CYST. 
 
 1. Usually more 
 growth. 
 
 2. Facies ovariana. 
 
 rapid 
 
 3. General health early 
 impaired from emaciation. 
 Not painful. 
 
 4. Abdomen more sym- 
 metrical, especially when tu- 
 mor is large. 
 
 5. Usually enlarged, espe- 
 cially in large polycysts. 
 
 6. Kidneys less active. 
 
 7. Menstruation unchanged 
 or diminished. 
 
 8. Fluctuation marked. 
 Percussion wave marked. 
 
 9. Surface yielding; in 
 monocysts, regular; in poly- 
 cysts, irregular. 
 
 10. Uterus normal, except 
 displacement from pressure. 
 Tumor compressible, fluctu- 
 ating, detached from uterus. 
 
 11. Not materially elon- 
 gated. (This is a most im- 
 portant diagnostic point.) 
 
 12. Does not move with 
 tumor. 
 
 Distended bladder: The use of a catheter will absolutely 
 settle the diagnosis. 
 
 Hematometra: The enlargement is perfectly symmet- 
 rical, and external os or cervix will be found completely 
 closed. — (Tables from Dudley's Gynecology.) 
 
 7. See Williams' "Obstetrics" (1909), pages 852 and 856; 
 or Hirst's "Obstetrics" (1909), page 764. 
 
 8. Curettage. Pathological Indications: To remove 
 pieces of retained placenta or decidua, endometritis, mucous 
 polypi, hemorrhage, dysmenorrhea, endocervicitis. Dangers: 
 Sepsis, perforation of uterus, hemorrhage, abortion, inflam- 
 mation of uterus, or adnexa. Procedure: All antiseptic and 
 
 106 
 
MEDICAL RECORD. 
 
 aseptic precautions are necessary, the patient should be in 
 the dorsal position, the vagina is to be disinfected, and the 
 cervical canal dilated ; a speculum is introduced into the 
 vagina and the cervix is drawn down with volsella ; the 
 uterine cavity is irrigated with creolin or lysol ; a curette 
 is inserted to the fundus and moved down to the internal 
 os; the operator should begin at one cornu and go in the 
 same direction all around till he reaches the starting point, 
 and if necessary repeat till no more spongy or hyperplastic 
 tissue appears ; the fundus should be scraped separately by 
 moving the curette along it from side to side; in going 
 towards the fundus no scraping should be done, and care 
 must be taken not to perforate the uterus; should this hap- 
 pen no fluid must be injected; otherwise the uterus and 
 vagina are again irrigated, and one or more strips of iodo- 
 form gauze are inserted into the cavity to act either as a 
 hemostatic plug or as a drain, which is diminished with 
 two days' interval and withdrawn on the sixth day. A 
 hemostatic tampon should be placed in the vagina and 
 withdrawn the following day. If any fever arises, the 
 tampon is at once removed and the vagina douched with 
 antiseptic fluid every three hours. If not, the vagina is 
 only swabbed with the same every day, and packed loosely 
 with iodoform gauze. After the final removal of the gauze 
 the antiseptic douche is given twice a day until there is no 
 more discharge. The patient should remain in bed for a 
 week. 
 
 9. See Williams' "Obstetrics" (1909), pages 818 and 821; 
 or Hirst's "Obstetrics" (1909), pages 585 and 587. 
 
 10. "A prolapsed uterus must first be placed in proper 
 position, or a procidentia reduced. In many cases the 
 introduction of a rubber ring pessary will then suffice to 
 prevent recurrence. But it will often be found necessary 
 to repair a torn perineum, removing at the same time 
 redundant portions of the vaginal walls, before the ring 
 will remain in the vagina. When such an operation is con- 
 traindicated, and the vaginal orifice is so wide that a ring 
 cannot be kept in, some form of pessary with a vaginal 
 stem and perineal bands will be required. In cases of pro- 
 cidentia, where the exposed surface is much ulcerated, the 
 patient should be kept in bed, emollient applications made 
 to the ulcers, and vaginal douches given. When the ulcers 
 have healed, a pessary may be introduced. Procidentia due 
 to supravaginal elongation of the cervix must be differently 
 dealt with. Amputation of a portion of the cervix must 
 therefore form the first step in the treatment, and it may 
 be required also when the hyperplasia is secondary to 
 descent. Cases of prolapse and procidentia which resist 
 milder measures require further operative procedures, such 
 as ventrofixation of the uterus or the shortening of the 
 
 107 
 
MEDICAL RECORD. 
 
 round ligaments. It is in cases of this kind that hys- 
 teropexy has often given satisfactory results. Total ex- 
 tirpation of the uterus has been advised and practised for 
 the treatment of procidentia." — (Sutton and Giles' Dis- 
 eases of Women.) 
 
 SURGERY. 
 
 i. See Rose and Carless' "Surgery" (1908), pages 307, 
 308, 310, and 311; or Da Costa's "Surgery" (1908), pages 
 359, 356, and 361. 
 
 2. See Rose and Carless' "Surgery" (1908), pages 399 
 and 400; or Da Costa's "Surgery" (1908), page 1057. 
 
 3. See Rose and' Carless' "Surgery" (1908), page 1318; 
 or Da Costa's "Surgery" (190&), page 1047. 
 
 4. "The portable instrument of Janeway is accurate and 
 practical because of its broad arm piece, which excludes the 
 errors (high readings) inherent in the narrow compression 
 bands when applied to unusually fat or muscular arms, and 
 because of its accurate regulation of pressure by a stop- 
 cock. Technique: The hollow armlet applied midway be- 
 tween shoulder and elbow is inflated by the hand bulb 
 until the radial pulse is lost, then by the outlet thumb- 
 screw the pressure is lowered until the pulse return is just 
 perceptible. As the pressure is equal in all parts of the 
 closed system, the height of the mercury column in the 
 manometer tube is an exact index, and the reading repre- 
 sents the 'maximum' or 'systolic' pressure. 'Diastolic' or 
 'minimum' pressure is determined by noting for ten or 
 twelve pulsations the increasing amplitude of the pulse 
 wave registered by the mercury column as the pressure is 
 reduced in 5-mm. series. The point causing maximum 
 excursion is the index of diastolic pressure. Below that 
 is a limited pressure area of equal amplitudes. The 'mean' 
 pressure represents the average of systolic and diastolic 
 readings. Diastolic readings run about 25 to 40 below 
 systolic, and in low tension vary 50 to 80, and in regurgita- 
 tion up to 100 mm. A loose band or a rapid or excessively 
 small pulse makes diastolic pressure determination im- 
 possible, and in every case the arm band should be closely 
 adjusted, the arm supported at the heart level and the 
 same position taken for a series of tests. The limit of 
 error in calcareous arteries is but 5 to 10 mm., and is 
 negligible or easily estimated. The same figures represent 
 the difference between females and <males and the stand- 
 ing> and sitting posture. In normal pressure four factors 
 are concerned, viz., the initial heart energy, peripheral 
 resistance, blood volume, and the elasticity of the vessels. 
 The normal readings, according to Janeway, are : For 
 young adults, 100 to 130; older adults, 100 to 145; children, 
 90 to no; infants under two years, 75 to 90. Excitement 
 
 108 
 
MEDICAL RECORD. 
 
 may cause a rise of 40 mm., and concentrated physical 
 effort a slight increase.'' — (Greene's Diagnosis.) 
 
 5. The blood pressure is an indication of the degree of 
 shock; in severe operations it is generally lowered below 
 100 mm. ; and below 80 mm. is supposed to be indicative 
 of danger. It is not in general use but is (theoretically) 
 of value. 
 
 6. See Gray's "Anatomy" (1908), page 494; or Rose and 
 Carless' "Surgery" (1908), page 247. 
 
 7. In fracture of the neck of the femur, the head of the 
 femur will be found in the acetabulum; in dislocation, the 
 acetabulum will be empty, and the head of the femur will 
 be found elsewhere, e.g. on the dorsum of the ilium. In 
 the fracture, crepitus may be elicited; in the dislocation, 
 never. In the dislocation there is inversion and a fixed 
 position of the limb, both of which are absent in fracture. 
 
 8. See Rose and Carless' "Surgery" (1908), pages 494 
 and 495 ; or Da Costa's "Surgery" (1908), page 482. 
 
 9. See Rose and Carless' "Surgery" (1908), pages 1152 
 and 1153; or Da Costa's "Surgery" (1908), page 1015. 
 
 10. (a) Varieties of carcinoma: (1) Glandular or spher- 
 oid carcinoma. (2) Squamous carcinoma. Synonyms, 
 epithelioma; squamous epithelioma. (3) Rodent cancer or 
 rodent ulcer. (4) Columnar carcinoma. Synonyms, col- 
 umnar epithelioma; adenoid cancer. (5) Thyroid carcino- 
 ma (resembling in structure the thyroid gland). — (From 
 Gould and Pyle's Cyclopedia.) (c) By the lymphatics. 
 For (b) and (</), see Rose and Carless' "Surgery" (1908), 
 pages 209 to 217; or Da Costa's "Surgery" (1908), pages 
 333 to 336. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Delaware Board of Medical Examiners. 
 
 anatomy. 
 
 1. Give shape and number of segments forming os 
 hyoides. 
 
 2. Give form, location, and attachments of ethmoid 
 bone. 
 
 3. Give shape, size, origin, and insertion of latissimus 
 dorsi muscle. 
 
 4. Give shape, size, origin, and insertion of trapezius 
 muscle. 
 
 5. Describe vermiform appendix — location, attachment, 
 structure, ,shape, and size. 
 
 6. Explain origin, course, and distribution of brachial 
 artery. 
 
 7. The stomach is supplied by what arteries? 
 
 109 
 
MEDICAL RECORD. 
 
 8. Explain 'course and distribution of cephalic vein. 
 
 9. Give formation and distribution of deep cervical 
 plexus of nerves. 
 
 10. Explain anatomical formation of mammary gland. 
 
 PHYSIOLOGY. 
 
 1. What special centers have we in the spinal cord? 
 
 2. Name the special centers existing in the medulla 
 oblongata and give their respective functions. 
 
 3. What is the function of the Eustachian tube? 
 
 4. What is the difference between aphasia and aphonia? 
 
 5. At what time of life does menstruation begin and 
 end in the temperate zone? 
 
 6. In what way can you prove, physiologically, that the 
 anterior columns of the cord are motor and the posterior 
 sensory? 
 
 7. What are the chief functions of the skin? 
 
 8. What is the origin of urea, and the average quantity 
 excreted in 24 hours? 
 
 9. What is the object of boiling starchy foods? 
 
 10. What are the functions of the liver? 
 
 CHEMISTRY. 
 
 1. Define specific gravity. What relation does the 
 amount of solid matter in urine bear to the specific grav- 
 ity of urine? 
 
 2. How are the compounds containing two, three or 
 four elements distinguished by name? Illustrate. 
 
 3. What is (a) an acid, (b) an alkaloid? Illustrate. 
 
 4. How may the presence in urine of each of the 
 following be detected: (a) albumin (b) sugar? 
 
 5. How may the presence of mercury be detected 
 in a solution? 
 
 6. Define combustion. State the result of combustion. 
 
 7. During respiration what chemical changes take 
 place in (a) air, (b) blood? 
 
 8. Give the symbol, valence and a principal compound 
 of each of 10 elements. 
 
 9. Define and illustrate (a) mixture, (b) compound, 
 (c) radical, (d) salt. 
 
 10. Mention the chemical reason for the use of lithia 
 and its salts in cases of uric acid diathesis. 
 
 MATERIA MEDICA. 
 
 i. Give the common name, preparations, and doses of 
 colchicum. 
 
 2. What are the physiological actions of gelsemium? 
 
 3. Name the preparations and doses of benzoin. 
 
 4. State some general rules to be observed in prescrip- 
 tion writing. 
 
 no 
 
MEDICAL RECORD. 
 
 5. Write a prescription for acute cystitis with alkaline 
 urine ; two for acute dysentery. 
 
 6. What is salol? What are its physiological actions? 
 Why should care be exercised in its administration? 
 
 7. What are anthelmintics? Name three drugs of this 
 class, stating the dose of each. 
 
 8. Give the common name, the active principles, the 
 preparations and doses of mix vomica. 
 
 9. How does strophanthus differ in its physiological 
 action from digitalis? 
 
 10. Make a list of the lithium salts with dose of each. 
 
 THERAPEUTICS. 
 
 1. Name three digestive ferments and state the indica- 
 tions for the use of each. 
 
 2. W'hat are the therapeutic uses of sodium phosphate? 
 
 3. State what you know about the uses of potassium 
 iodide. 
 
 4. Veratrum viride. What are its medical uses? 
 
 5. What is aqua hydrogen dioxide? What are its ther- 
 apeutic uses? 
 
 6. Name the preparation, and doses of codeine. For 
 what is it used? 
 
 7. What is the chemical antidote for arsenic? Iodine? 
 Corrosive sublimate? Chlorine water? Nux vomica and 
 its alkaloids? 
 
 8. What are the therapeutic uses 'of bismuth? 
 
 9. What are the therapeutic uses of hydrargyri chlor- 
 idum mite? 
 
 10. Write a short essay on "hydrotherapy." 
 
 PATHOLOGY. 
 
 1. Give the causes and process of cerebral softening. 
 
 2. How does calcareous degeneration of the arteries 
 influence the circulation, and to what diseases does it pre- 
 dispose? 
 
 3. Describe the protective agencies by which the body 
 guards itself against the entrance and harmful effects of 
 pathogenic bacteria. 
 
 4. What are some of the phenomena attending pus- 
 formation? 
 
 5. What structural changes take place in chronic gout? 
 
 6. Differentiate a tuberculous joint from one enlarged 
 by chronic rheumatism. 
 
 7. Name some of the principal bacteria of the staphy- 
 lococci and the streptococci groups. 
 
 8. Describe the rash and give the morbid anatomy of 
 scarlatina. 
 
 9. What changes take place in hypertrophy of the 
 heart? 
 
 Ill 
 
MEDICAL RECORD. 
 
 io. What are the pathological conditions in gonorrheal 
 ophthalmia? 
 
 PRACTICE OF^ MEDICINE. 
 
 i. Differentiate primary lobar pneumonia from acute 
 pneumonic phthisis. 
 
 2. Give the treatment of erysipelas: (a) dietetic, (b) 
 constitutional, (c) local, (d) prophylactic. 
 
 3. Give treatment and symptoms of acute articular rheu- 
 matism, 
 
 4. Give period of incubation, character of eruption, and 
 complications of each of the following diseases : (a) 
 measles, (b) variola, (c) scarlet fever. 
 
 5. Define hydrophobia ; give clinical history and treat- 
 ment. 
 
 6. Give symptoms and treatment of acute congestion of 
 the lungs. 
 
 7. Give the etiology and symptoms of acute cardiac dila- 
 tation. 
 
 8. Etiology and symptoms of arteriosclerosis. 
 
 9. Make a differential diagnosis of follicular tonsillitis 
 and diphtheria. 
 
 10. Name four diseases for which you consider there is 
 a specific treatment. Write prescriptions for each. 
 
 OBSTETRICS. 
 
 1. Define obstetrics. Give a rule for determining the 
 date of labor. 
 
 2. What is the placenta? Describe its formation and 
 development. 
 
 3. Name, under separate headings, the positive and 
 doubtful signs of pregnancy. 
 
 4. Into how many stages is labor divided? Define each 
 stage. 
 
 5. Define puerperal eclampsia. Give the causes and 
 treatment of same. 
 
 6. Name three important abnormal presentations and 
 your management of each. 
 
 7. What are the symptoms, varieties, and dangers of 
 placenta prsevia? 
 
 8. Give the causes, symptoms, and treatment of simple 
 chronic endometritis. 
 
 9. Name two conditions requiring the use of an anes- 
 thetic during labor. State the kind of anesthetic preferred 
 and give the method of administering it. 
 
 10. Describe in full the application of forceps. 
 
 SURGERY. 
 
 1. Give minute directions for antiseptic surgical dress- 
 ings applied to surface wounds. 
 
 112 
 
MEDICAL RECORD. 
 
 2. What tendons are severed and what mechanical de- 
 vice is necessary for correcting congenital talipes varus? 
 
 3. Give diagnostic symptoms, reasons for, and methods 
 of ligating aneurysmal arteries. 
 
 4. Differentiate chronic cystitis and chronic prostatitis. 
 
 5. Differentiate phimosis and paraphimosis. 
 
 6. Explain the formation of an orifice, sinus, and fistu- 
 lous openings — with method of drainage and treatment. 
 
 7. In what particular do the diagnostic symptoms of 
 appendicitis differ from those of acute peritonitis? 
 
 8. Differentiate traumatic and hospital gangrene. 
 
 9. Explain necessary structural changes in reuniting 
 fractured bones. 
 
 10. Classify the method of reducing dislocations by 
 manipulation. 
 
 HYGIENE. 
 
 1. What precautions should be taken in school rooms 
 to protect the sight of scholars? 
 
 2. What are the chief sources of contamination to 
 drinking water? 
 
 3. What physical conditions would render the taking of 
 a Turkish bath unsafe? 
 
 4. What care should be employed in exhumations? 
 
 5. Name causes for greater prevalence of diphtheria and 
 smallpox in cold than in warm weather. 
 
 6. State the advantage of cremation over earth burial. 
 
 7. What is milk sterilization? How is it performed? 
 
 8. How do forests benefit public health? 
 
 9. Mention some of the diseases to which artisans are 
 especially liable. 
 
 10. Is green wall paper objectionable? If so, why? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Delaware Board of Medical Examiners. 
 
 ' ANATOMY. 
 
 1. See Cunningham's " Anatomy" (1909), page 145; or 
 Gray's "Anatomy" (1908), page 155. 
 
 2. See Cunningham's "Anatomy" (1909), page 127; or 
 Gray's "Anatomy" (1908), page 98. 
 
 3. See Cunningham's "Anatomy" (1909), page 320; or 
 Gray's "Anatomy" (1908), page 415. 
 
 4- See Cunningham's "Anatomy" (1909), page 319; or 
 Gray's "Anatomy" (1908), page 413. 
 
 5. See Cunningham's "Anatomy" (1909), page 1079; or 
 Gray's "Anatomy" (1908), page 1311. 
 
 113 
 
MEDICAL RECORD. 
 
 6. See Cunningham's "Anatomy" (1909), page 830; or 
 Gray's "Anatomy" (1908), page 654. 
 
 7. The stomach is supplied by the following arteries : 
 Gastric, pyloric, right and left gastro-epiploics, and vasa 
 brevia. 
 
 8. See Cunningham's "Anatomy" (1909), page 891; or 
 Gray's "Anatomy" (1908), page 747. 
 
 9. See Cunningham's "Anatomy" (1909), page 619; or 
 Gray's "Anatomy" (1908), page 993. 
 
 10. See Cunningham's "Anatomy" (1909), page 1207; or 
 Gray's "Anatomy" (1908), page 1516. 
 
 PHYSIOLOGY. 
 
 1. The special centers in the spinal cord are: the cilio- 
 spinal, secretory, vasomotor, genital, vesical, and rectal 
 centers. 
 
 2. The special centers in the medulla oblongata are : 
 (1) center for mastication, (2) for secretion of saliva, 
 (3) for sucking, (4) for deglutition, (5) for vomiting, 
 (6) for voice, (7) center for expression, (8) cardiac cen- 
 ters, (9) respiratory centers, (10) vasomotor centers. 
 
 3. The function of the Eustachian tube is to keep the 
 atmospheric pressure within the tympanic cavity the same 
 as that on the outside. 
 
 4. Aphasia is a condition in which the patient is unable 
 either to receive ideas or to communicate them by the 
 ordinary means of speech or writing. 
 
 Aphonia is simply loss of voice, due to some interfer- 
 ence with the function of the vocal cords. 
 
 5. In the temperate zone, menstruation begins at about 
 fourteen or fifteen years of age, and ends at about forty- 
 five or fifty. 
 
 6. Transverse section of the anterior root of a spinal 
 nerve causes loss of motion and degeneration of the periph- 
 eral portion of the anterior root fibers; and stimulation 
 of the anterior root is followed by tetanic contraction 
 of the muscles supplied by the nerves concerned. 
 
 Transverse section of the posterior root of a spinal 
 nerve causes loss of sensation and degeneration; and 
 stimulation of the dorsal root is followed by sensations 
 of pain, or pressure, or temperature. 
 
 7. The functions of the skin are : Protection, sense of 
 touch, excretion, regulation of body temperature, absorp- 
 tion, and respiration. 
 
 8. Urea is chiefly made in the liver; it is the end prod- 
 uct of the metabolism of the proteids. The average quant- 
 ity of urea excreted in twenty-four hours is about five 
 hundred grains. 
 
 9. The object of boiling starchy foods is : To burst the 
 
 1 14 
 
MEDICAL RECORD. 
 
 cellulose envelope and thus allow the digestive juices to 
 come into contact with the granules. 
 
 10. The functions of the liver are: (i) The secretion 
 of bile, (2) the formation of glycogen, (3) the forma- 
 tion of urea and uric acid, (4) the manufacture of heat, 
 and (5) the conversion of poisonous and harmful into inert 
 material. 
 
 CHEMISTRY. 
 
 1. Specific gravity is the weight of a given volume of a 
 substance as compared with the weight of a similar volume 
 of some other substance taken as a standard, under like 
 conditions of temperature and pressure. 
 
 In normal urine, the last two figures of the specific 
 gravity, multiplied by 2.33, will give approximately the 
 number of grams of solids to the liter of urine. 
 
 2. A compound whose molecule contains two elements 
 is called a binary compound, e.g. H 2 ; one containing 
 three elements is called a ternary compound, e.g. H 2 S0 4 ; 
 and one containing four elements is called a quaternary 
 compound, e.g. KHSO4. 
 
 3. An acid is a compound of an electro-negative ele- 
 ment or residue with hydrogen, part or all of which hydro- 
 gen it can part with in exchange for an electro-positive ele- 
 ment, without the formation of a base. 
 
 Examples : Sulphuric acid : H 2 S0 4 Nitric acid : HN0 3 . 
 
 An alkaloid is a basic nitrogenous substance, alkaline in 
 reaction, and capable of uniting with an acid to form a 
 salt in the same way that ammonium does. Examples: 
 Morphine and strychnine. 
 
 4. To examine for albumin : "The urine must be per- 
 fectly clear. If not so, it is to be filtered, and, if this 
 does not render it transparent, it is to be treated with a 
 few drops of magnesia mixture, and again filtered. 
 
 "The reaction is then observed. If it be acid, the urine 
 is simply heated to near the boiling point. If the urine be 
 neutral or alkaline, it is rendered faintly acid by the ad- 
 dition of dilute acetic acid, and heated. If albumin be pres- 
 ent, a coagulum is formed, varying in quantity from a 
 faint cloudiness to entire solidification, according to the 
 quantity of albumin present. The coagulum is not re- 
 dissolved upon the addition of nitric acid." 
 
 To examine for sugar: First remove any albumin that 
 may be present, then "render the liquid strongly alkaline 
 by addition of sodium carbonate. Divide about 6 c.c. of 
 the alkaline liquid in two test-tubes. To one test-tube 
 add a very minute quantity of powdered subnitrate of 
 bismuth, to the other as much powdered litharge. Boil the 
 contents of both tubes. The presence of glucose is indi- 
 
 115 
 
MEDICAL RECORD. 
 
 cated by a dark or black color of the bismuth powder, the 
 litharge retaining its natural color/' 
 
 5. The presence of mercury in a solution may be de- 
 tected by the Reinsch test, as follows : To the suspected 
 fluid add a little pure HC1; suspend in the fluid a small 
 strip of bright copper foil, and boil. If a deposit forms 
 on the copper, remove the copper, wash it with pure water, 
 dry on filter paper, but be careful not to rub off the deposit. 
 Coil up the copper, and put in into a clean dry, glass tube, 
 open at both ends, and apply heat at the part where the 
 copper is. If mercury is present there will appear in the 
 cold part of the tube a mirror, which will be found on 
 microscopical examination to consist of metallic globules 
 of mercury. 
 
 6. Combustion is rapid oxidation, with the giving off 
 of light and heat. The products of combustion are light 
 and heat. 
 
 7. (a) The chemical changes produced in the air by 
 respiration are : 
 
 Oxvfifen 
 
 Inspired Air. 
 
 21 per cent. 
 79 per cent. 
 0.04 per cent. 
 Rare. 
 Variable. 
 
 Expired Air. 
 
 16.6 per cent. 
 79 per cent. 
 4.4 per cent. 
 Often present. 
 Saturated. 
 
 Nitrogen 
 
 Carbon dioxide . . . 
 
 Other gases 
 
 Watery vapor . . . 
 
 (b) In the blood the chemical changes are: (1) The 
 giving up of the C0 2 by the venous blood, (2) the ab- 
 sorption of oxygen during inspiration and (3) the blood 
 loses a small amount of watery vapor. 
 
 8. 
 
 Ten Elements. 
 
 Symbol. 
 
 Valence. 
 
 A Principal Compound. 
 
 1. Hydrogen. 
 
 H. 
 
 1. 
 
 Hydrogen monoxide (or 
 water), H 2 
 
 2. Oxygen. 
 
 0. 
 
 2. 
 
 Hydrogen dioxide, 
 H 2 2 
 
 3. Carbon. 
 
 C. 
 
 4- 
 
 Carbon dioxide, CO a 
 
 4. Nitrogen. 
 
 N. 
 
 3 or 5. 
 
 Ammonia, NH.? 
 
 5. Chlorine. 
 
 CI. 
 
 1. 
 
 Sodium chloride NaCl 
 
 6. Sulphur. 
 
 S. 
 
 2. 
 
 Sulphuretted hydrogen, 
 
 H 2 S < 
 Potassium iodide, Kl 
 
 7. Potassium. 
 
 K. 
 
 1. 
 
 8. Sodium 
 
 Na. 
 
 1. 
 
 Sodium carbonate, 
 Na a C0 8 
 
 9. Silver. 
 
 Ag. 
 
 1. 
 
 Silver nitrate, AgNOi 
 
 10. Boron. 
 
 B. 
 
 3. 
 
 Borax, Na 2 B*0T 
 
 116 
 
MEDICAL RECORD 
 
 9. (a) A mixture is the product obtained by uniting 
 into a more or less homogeneous whole two or more sub- 
 stances, whether elements or compounds. There is no 
 chemical union, and the amounts of the component parts 
 are not definite. Examples : Air, milk and water. 
 
 (b) A compound is a substance made up of two or more 
 elements, chemically united with each other in definite pro- 
 portions. Examples : Ammonia, NH 3 ; borax, Na 2 B 4 07. 
 
 (c) A radical is a group of atoms which can enter or 
 leave a chemical reaction like a single atom. Examples : 
 Ammonium, NH 4 ; ethyl, C 2 H 8 . 
 
 (d) Salts are substances formed by the substitution of 
 an electropositive element for part or all of the replaceable 
 hydrogen of an acid. Examples: Sodium nitrate, NaN0 8 ; 
 monopotassic sulphate, KHSO4. 
 
 10. Lithia and the salts of lithium are used in cases 
 of uric acid diathesis, because: (1) They diminish the 
 acidity of the urine; (2) they have a diuretic action; (3) 
 they hasten the excretion of the urates ; (4) and so pre- 
 vent the accumulation of gravel and the formation of 
 calculi; (5) the lithium salt of uric acid is the most soluble 
 of all the urates. 
 
 MATERIA MEDICA. 
 
 1. Colchicum. Common Name: Meadow Saffron. 
 Preparations and Doses: Colchici cormus, gr. iv; ex- 
 
 tractum colchici cormi, gr. j ; colchici semen, gr. iij ; fluidex- 
 tractum colchici seminis, Tl^jss; tinctura colchici seminis, 
 n#xxx; vinum colchici seminis, TTJJxxx; colchicine, gr. 
 1/128. 
 
 2. The physiological actions of gelsemhtm: "When 
 given internally gelsemium acts as a powerful depressant 
 to the respiratory, circulatory, and nervous systems. It 
 acts as a depressant to the heart muscle and vagus nerves, 
 and under its influence there is a diminution in the pulse 
 force and blood pressure. It primarily depresses the sen- 
 sory side of the spinal cord; but later, if given in large 
 amount, depresses the motor side. The drug has no effect 
 upon the spinal nerves, but the motor cranial nerves are 
 paralyzed by large doses. In moderate amounts it causes 
 the respiration to become slow and feeble, and in lethal 
 quantities paralyzes the respiratory centers. — U. S. Dis- 
 pensatory. 
 
 3. Preparations and Doses of Benzoin: Adeps benzo- 
 inatus ; tinctura benzoini, TTjjxv ; tinctura benzoini com- 
 posita, TTRxxx; acidum benzoicum, gr. vijss; ammonii ben- 
 zoas, gr. xv ; sodii benzoas, gr. xv ; lithii benzoas, gr. xv. 
 
 4. Gould and Pyle give the following: "Altfiough pre- 
 scriptions in good English are preferable to those written 
 in incorrect or badly abbrevated Latin, those written in the 
 
 117 
 
MEDICAL RECORD. 
 
 classic style should be governed by the following rules: 
 The name of the patient and the date should be placed at 
 the top. The sign fy, which is the abbreviation of the 
 Latin word Recipe, and signifies Take' or 'Take thou,' 
 should be placed in the upper left corner. The names and 
 quantities of the ingredients then follow, and the names 
 should be written in Latin, in the genitive case usually. 
 The directions to the compounder should be in Latin, but 
 the directions to the patient should be written in English. 
 The prescription is completed by the name and address of 
 the prescriber. The quantities of the drugs may be ex- 
 pressed in apothecaries' weights or in the metric system. 
 Each dose in the- former system is equal to fifteen doses in 
 the latter if the terms 'gram' and 'cubic centimeter' are 
 substituted for grains and minims." To these we would 
 add : Beware of incompatibility, be careful of dosage, and 
 avoid polypharmacy. 
 
 5. For acute cystitis with alkaline urine: 
 ]J. Sodii benzoatis, 5vj. 
 
 Aquae menthae piperita, q.s. ad Jiij- M. 
 Signa : One teaspoonf ul in water every four hours. 
 For acute dysentery (amebic): 
 5. Amyli, 3j. 
 
 Tincturae opii, 3ss. 
 Aquae destillatae, Jiv. M. 
 Signa: For rectal injection. 
 For acute dysentery (bacillary) : 
 
 1$.. Hydrargyri chloridi corrosivi, gr. ss. 
 Aquae destillatae, 3" J- 
 
 Tincturae cinchonae compositae, q.s. ad 3 V J. M. 
 Signa: One teaspoon ful in water every two hours. 
 
 6. Salol is phenyl salicylate ; and is composed of 60 
 parts of salicylic acid, and 40 of carbolic acid. Its physi- 
 ological action is : antiseptic, antipyretic, and germicidal. 
 Care should be exercised in its administration, because in 
 the small intestine it is decomposed into its constituent 
 parts, and symptoms of carbolic acid poisoning may de- 
 velop. 
 
 7. Anthelmintics are agents which kill or expel worms. 
 Examples: Oleoresina aspidii, gr. xxx; Pelletierine tannate, 
 gr. x; santonin, gr. j. 
 
 8. Nux Vomica. Common name: Dog button, or 
 poison nut; Active principles: Strychnine and brucine. 
 
 Preparations and Doses: Extractum nucis vomicae, gr. 
 Y A ; fluidextractum nucis vomicae, tt#j ; tinctura nucis vomi- 
 cae, TTRx; strychnine, gr. 1/64; strychninae sulphas, gr. 1/64; 
 strychninae nitras, gr. 1/64. 
 
 9. As compared with digitalis, strophanthus acts quick- 
 er, is less enduring in its effects, is less certain, is not 
 cumulative, has less marked vasoconstrictor effects, has 
 
 118 
 
MEDICAL RECORD. 
 
 greater diuretic power, and is said to be safer for aged 
 patients. 
 
 10. Lithium Salts, with Doses: Lithium benzoate, 
 gr. xv ; lithium bromide, gr. xv; lithium carbonate, gr. 
 vijss; lithium citrate, gr. vijss; effervescent lithium citrate, 
 3ij ; lithium salicylate, gr. xv. 
 
 THERAPEUTICS. 
 
 i. There are only two official digestive ferments, viz., 
 pepsin and pancreatin. Trypsin is also a digestive fer- 
 ment. 
 
 Pepsin is indicated as an aid to gastric digestion in gas- 
 tralgia, gastric cancer and ulcer, atonic dyspepsia, and the 
 vomiting of pregnancy. 
 
 Pancreatin is indicated as an aid to digestion, and for 
 the predigestion of food, in convalescence, in wasting 
 diseases, and in intestinal dyspepsia. 
 
 2. Sodium phosphate is used as a saline purgative and 
 cholagogue. 
 
 3. Potassium iodide would be useful in the following 
 conditions : Tertiary syphilis, chronic rheumatism, pleurisy, 
 arteriosclerosis, asthma, mercurial poisoning, chronic in- 
 flammations, aneurysms. 
 
 4. Veratrum viride. Medical uses: "As a circulatory 
 depressant, given early, in croupous pneumonia, pleurisy, 
 hepatitis, maniacal delirium, etc., with strong, bounding 
 pulse and other esthenic conditions ; in puerperal convul- 
 sions and the early stage of peritonitis, phlebitis, and other 
 inflammatory affections of the puerperal state; also acute 
 rheumatism, tonsillitis, aneurysm, and wounds of the 
 head, pericardium and peritoneum." — (Wilcox, Materia 
 Medica. ) 
 
 5. Aqua hydrogen dioxide is a solution of hydrogen 
 dioxide containing, when freshly prepared, about 3 per 
 cent, by weight of pure dioxide, or about 10 volumes of 
 available oxygen. It is used: To cleanse ulcers, fistulous 
 tracts, wounds ; as an antiseptic wash in empyema, cystitis, 
 gonorrhea ; in ear, eye, nose, and throat troubles ; on 
 diphtheritic membranes. 
 
 6. Preparations and- doses of codeine: Codeine, gr. y 2 ; 
 codeine phosphate, gr. Y 2 ; codeine sulphate, gr. y 2 . 
 
 Codeine is used to allay cough, and also in diabetes ; 
 sometimes it is employed as an anodyne in cases of some 
 duration, such as cancer. 
 
 7. Chemical Antidotes. For Arsenic: Freshly pre- 
 pared ferric hydroxide. For iodine, starch, or sodium 
 carbonate or bicarbonate. For corrosive sublimate, 
 white of egg or milk in moderate amount. For chlorine 
 water, ammonia, cautiously. For nux vomica and its alka- 
 loids, potassium permanganate, or tannic acid. 
 
 119 
 
MEDICAL RECORD. 
 
 8. Preparations of bismuth are used: (i) Externally, 
 as dusting powders for wounds, sores, some skin diseases; 
 (2) internally, in vomiting, diarrhea, gastritis, gastralgia, 
 and as an intestinal antiseptic; (3) also in sore mouth, 
 conjunctivitis, granular lids, coryza, mercurial ptyalism. 
 
 9. Calomel is used externally in eczema, and for venereal 
 ulcers ; internally, in diarrhea, ilia-colitis, as a purgative in 
 bilious attacks, congested or cirrhotic liver, inflammations 
 of pericardium, liver, or meninges, in bronchitis, pneumo- 
 nia, chlorosis, in Asiatic cholera, and for marasmic in- 
 fants. 
 
 10. See French's "Practice of Medicine" (1907), page 
 u3. 
 
 PATHOLOGY. 
 
 i. See French's "Practice of Medicine" (1907), page 
 1079; or Osier's "Practice of Medicine" (1909), page 977- 
 
 2. See French's "Practice of Medicine" (1907). page 623; 
 or Osier's "Practice of Medicine" (1909), page 847- 
 
 3. The chief protective agencies by which the body 
 guards itself against the entrance and harmful effects of 
 pathogenic microorganisms are: The acidity of the gastric 
 juice, urine, and the vaginal secretion; the alkalinity of the 
 blood; the agglutinating action of the blood; the bacteri- 
 cidal action of the blood and lymph; the action of leuco- 
 cytes and phagocytes; the general antitoxic action of the 
 organism. 
 
 See, also, French's "Practice of Medicine" (1907), pages 
 53 and 55. 
 
 4. See Da Costa's "Surgery" (1908), page 130. 
 
 5. See French's "Practice of Medicine" (1907), pages 
 926 and 928; or Osier's "Practice of Medicine" (1909), 
 pages 400 and 403. 
 
 6. See French's "Practice of Medicine" (1907), page 
 921; and Rose and Carless' "Surgery" (1908), page 657. 
 
 7. Staphylococcus pyogenes aureus, Staphylococcus pyo- 
 genes albus, Staphylococcus pyogenes citreus, Staphylococ- 
 cus cereus aureus, Staphylococcus cereus albus, Staphylo- 
 coccus epidermidis albus; and Streptococcus pyogenes, 
 Streptococcus erysipelatis. 
 
 8. See French's "Practice of Medicine" (1907), pages 316 
 and 318; or Osier's "Practice of Medicine" (1909), page 
 130. 
 
 9. See French's "Practice of Medicine" (1907), page 597; 
 or Osier's "Practice of Medicine" (1909), page 822. 
 
 10. See Rose and Carless' "Surgery" (1908), page 138. 
 
 PRACTICE OF MEDICINE. 
 
 I. The symptoms and physical signs of lobar pneumonia 
 and acute pneumonic phthisis may be the same for the 
 
 120 
 
MEDICAL RECORD. 
 
 first eight or ten days ; at this period the fever in pneu- 
 monia drops by crisis; whereas in pnthisis the fever con- 
 tinues for some time longer and the patient gets worse; 
 the sputum contains tubercle bacilli and elastic fibers, and 
 instead of retaining the rusty color it becomes purulent 
 and greenish. 
 
 In pneumonia, the breathing is very rapid, the pulse 1 
 respiration rate is disturbed, the fever is usually high, 
 and runs a regular course, crepitant rales are heard at 
 first, then signs of consolidation follow, and crepitant 
 rales again succeed. 
 
 In phthisis, the breathing is hurried and there is dysp- 
 nea, the fever is often high, but does not run a regular 
 course, at first the signs are tho^ of bronchitis, followed 
 by consolidation, a softening, or excavation in different 
 parts of the lungs ; sometimes there is nothing to be heard 
 but scattered rales. 
 
 2. See French's "Practice of Medicine" (1907), page 
 221; or Osier's "Practiceof Medicine" (1909). page 213. 
 
 3. See French's "Practice of Medicine" (1907), page 230; 
 or Osier's "Practice of Medicine" (1909), page 226. 
 
 4. See French's "Practice of Medicine" (1907), pages 
 (a) 326, 327, and 329; (b) 301, 302, and 306; (c) 317, 318, 
 and 320; or Osier's "Practice of Medicine" (1909), pages 
 (a) 141, 142, and 143; (b) 115, 116, and 119; (c) 132 and 
 134- 
 
 5. See French's "Practice of Medicine" (1907), page 
 449; or Osier's "Practice of Medicine" (1909), page 255. 
 
 6. See French's "Practice of Medicine" (1907), page 
 662; or Osier's "Practice of Medicine" (1909), page 614. 
 
 7. See French's "Practice of Medicine" (1907), page 
 599; or Osier's "Practice of Medicine" (1909), page 820. 
 
 8. See French's "Practice of Medicine" (1907), page 
 623; or Osier's "Practice of Medicine" (1909), page 848. 
 
 9. In follicular tonsillitis the onset is more sudden ; the 
 temperature may be a little higher than that of diphtheria; 
 there is no membrane, but the tonsils are red and swollen, 
 and in the crypts are seen white cheesy spots or plugs, 
 which consist of broken-down epithelium, and are easily 
 brushed away; Klebs-Lofrler bacilli are never found. 
 
 In diphtheria the onset is more gradual; the tempera- 
 ture rises to about 101 ° to 103 F. ; the tonsils are not 
 much enlarged; there is an exudate of a thick grayish 
 membrane which is very adherent, is removed only with 
 difficulty, and leaves a bleeding surface; this membrane 
 soon reforms, and may be found on the fauces and 
 pharynx as well as on the tonsils ; in the exudate the Klebs- 
 Lofrler bacilli may be found. 
 
 10. Malaria; Diphtheria; Snake-bite; Syphilis. 
 
 121 
 
MEDICAL RECORD. 
 
 For malaria: 
 
 5- Quininae bisulphatis, 3iij. 
 Ft. in caps, no xxxvj. 
 Signa : Take one capsule every two hours, beginning 
 twelve hours before the paroxysm is due; and between 
 paroxysms take one three times a day. 
 For diphtheria: 
 
 5. Seri antidiphtheritici, 3,000 units. 
 Siena : To be used by physician only. 
 For snake-bite: 
 
 5. Seri antivenosi, 3iv. 
 Signa : To be used by physician only. 
 For syphilis: 
 
 5- Hydrargyri iodidi rubri, gr. ijss. 
 Sodii iodidi, 5iv. 
 Aquae destillatae, 3J- 
 
 Syrupi sarsaparillae compositi, q.s. ad Jvj. M. 
 Signa : One teaspoonful in water after each meal. 
 
 OBSTETRICS. 
 
 1. Obstetrics is that branch of medicine which treats of 
 the science and art of caring for woman and the product 
 of conception during pregnancy, labor, and the puerperium. 
 
 A rule for determining the date of labor: Count back 
 three calendar months from the first day of the last men- 
 strual period, and add seven days. 
 
 2. See Williams' "Obstetrics" (1909), pages 134 and 128; 
 or Hirst's "Obstetrics" (1909), page 120. 
 
 3. Positive signs of pregnancy: (1) Hearing the fetal 
 heart sound; (2) active movements of the fetus; (3) bal- 
 lottement; (4) outlining the fetus in whole or part by 
 palpation, and (5) the umbilical or funic souffle. 
 
 Doubtful signs of pregnancy: (1) Progressive enlarge- 
 ment of the uterus ; (2) Hegar's sign ; (3) Braxton Hick's 
 sign; (4) uterine murmur; (5) cessation of menstruation; 
 (6) changes in the breasts; (7) discoloration of the va- 
 gina and cervix; (8) pigmentation and striae; (9) morn- 
 ing sickness. 
 
 4. Labor is divided into three stages : The first stage 
 begins with the commencement of labor, and ends with 
 the complete dilatation of the os uteri. The second stage 
 begins with a complete dilatation of the os uteri, and ends 
 with the birth of the child. The third stage immediately 
 follows, the second, and ends with the expulsion of the 
 placenta and the beginning contraction of the uterus. 
 
 5. Puerperal eclampsia is an acute morbid condition, 
 occurring during pregnancy, labor, or the puerperal state, 
 and is characterized by tonic and clonic convulsions, which 
 affect first the voluntary and then the involuntary muscles ; 
 there is total loss of consciousness, which tends either to 
 
 122 
 
MEDICAL RECORD. 
 
 coma or to sleep, and the condition may terminate in re- 
 covery or death. 
 
 The causes may be : Uremia, albuminuria, imperfect 
 elimination of carbon dioxide by the lungs, medicinal 
 poisons, septic infection; predisposing causes are renal 
 disease and imperfect elimination by the skin, bowels and 
 kidneys. 
 
 The line of treatment as laid down by Edgar is as fol- 
 lows: For preventive treatment: (i) the amount of ni- 
 trogenous food should be diminished to a minimum; (2) 
 the production and absorption of poisonous materials in 
 the intestines and body tissues should be limited and their 
 elimination should be aided by improving the action of the 
 bowels, the kidneys, the liver, the skin, and the lungs; (3) 
 the source of the fetal metabolic products and the periph- 
 eral irritation in the uterus should, if necessary, be re- 
 moved by evacuating that organ. 
 
 The curative treatment includes: (1) Controlling the 
 convulsions (by chloroform, veratrum, or chloral) ; (2) 
 elimination of the poison or poisons which are presumed 
 to cause the convulsions; (3) emptying the uterus under 
 deep anesthesia, by some method that is rapid and that 
 will cause as little injury to the woman as possible. 
 
 6. See Williams' "Obstetrics" (1909), page 274; or 
 Hirst's "Obstetrics" (1909), page 404. 
 
 7. Placenta previa is the condition in which the placenta 
 is attached in the lower uterine segment, and may be near 
 or even over the internal os. Symptoms: Sudden hemor- 
 rhage, accompanied by syncope, vertigo, restlessness, and 
 feeble pulse. Varieties: Central, partial, marginal, and 
 lateral. Dangers: Hemorrhage (and death to mother) and 
 sepsis. 
 
 8. Chronic endometritis may accompany numerous path- 
 ologic uterine conditions, but is generally due to gonor- 
 rhea. The symptoms are backache, headache, leucorrhea, 
 profuse menstruation, and impairment of the general health. 
 Treatment consists in removing the cause when possible, 
 and when due to gonorrhea curettage and irrigation of the 
 uterus, with the application of an antiseptic. 
 
 9. Eclampsia and obstetrical operations. See Williams' 
 "Obstetrics" (1909), page 321; or Hirst's "Obstetrics" 
 O909), pages 331, 636, and 7&3- 
 
 10. See Williams' "Obstetrics" (1909), page 400; or 
 Hirst's "Obstetrics" (1909), page 811. 
 
 SURGERY. 
 
 1. See Rose and Carless' "Surgery" (1908), pages 231 
 and 273; or Da Costa's "Surgery" (1908), pages 69 and 246. 
 
 2. In congenital talipes varus, the following tendons 
 should be severed : Tibialis anticus, tibialis posticus, and 
 
 123 
 
MEDICAL RECORD. 
 
 plantar fascia. The mechanical device necessary is the 
 club-foot wrench. 
 
 3. See Rose and Carless' "Surgery" (1908), pages 310 
 and 315; or Da Costa's "Surgery" (1908), pages 360 and 
 
 364. 
 
 4. See Rose and Carless' "Surgery" (1908), pages 1192 
 and 1221' or Da Costa's "Surgery" (1908), pages 1136 and 
 1 184. 
 
 5. In phimosis the foreskin cannot be retracted over the 
 glans penis; in paraphimosis the foreskin has been re- 
 tracted and cannot be replaced. 
 
 6. See Rose and Carless' "Surgery" (1908), page 71; or 
 Da Costa's "Surgery" (1908), page 166. 
 
 7. In appendicitis: The right thigh is flexed, pain and 
 tenderness are confined to the right iliac fossa, there may 
 or may not be vomiting, fullness of the abdomen is above 
 Poupart's ligament. 
 
 In acute peritonitis: Both thighs are flexed, pain and 
 tenderness are more general and are increased by move- 
 ment, vomiting is frequent, the abdomen in general is 
 distended and is tense and tympanitic. 
 
 8. See Da Costa's "Surgery" (1908), pages 174 and 175. 
 
 9. See Rose and Carless' "Surgery" (1908), page 472; 
 or Da Costa's "Surgery" (1908), page 457. 
 
 10. See Rose and Carless' "Surgery" (1908), page 615; 
 or Da Costa's "Surgery" (1908), page 582. 
 
 HYGIENE. 
 
 1. Precautions which should be taken in school rooms 
 to protect the sight of scholars, should include the follow- 
 ing: (1) The light should be ample, and should come 
 from the left side or from behind the scholar, never from 
 the front. (2) The windows should extend nearly to 
 the ceiling, and should have proper shades. (3) Black- 
 boards should be clean and black, neither glazed nor 
 shiny, and must not be on the same side as the windows. 
 (4) Schoolbooks should be of good paper with good clear 
 type, and the lines amply leaded. (5) Pupils should as- 
 sume correct attitudes in writing or reading. (6) Desks 
 and seats should be of a proper size, style and arrange- 
 ment. (7) Proper medical examination should be made 
 of the eyes when necessary, and defects corrected as soon 
 as possible. 
 
 2. The chief sources of contamination of drinking 
 water, are : Sewage, including not only solid and liquid 
 excreta, but also house water and waste water; manufac- 
 turing refuse, such as from dye works, bleaching works, 
 tanneries, and numerous other industrial places; from 
 improper storage or service of water. 
 
 3. A turkish bath should not be taken by patients suf- 
 
 124 
 
MEDICAL RECORD. 
 
 fering from organic heart disease, dilated heart, conges- 
 tion of the lung, chronic bronchitis, with emphysema, pneu- 
 monia, or great obesity. 
 
 4. In exhumations, care should be taken: (1) To ob- 
 tain the necessary permission from the proper parties; (2) 
 to be sure to open the right grave; (3) to have the corpse 
 properly identified; (4) if the coffin is at all broken, to 
 take some of the earth from each side, above and below; 
 (5) during the inspection to keep to windward of the 
 body; (6) to work as rapidly as is consistent with thor- 
 oughness. 
 
 5. Ventilation is less satisfactory and the changes in 
 temperature are greater and more frequent in the cold 
 weather; hence vitality is lowered and there is a greater 
 liability to take diseases. 
 
 6. The advantages of cremation over earth burial are: 
 (1) Economy; cremation is very much cheaper, and there 
 is no need for the community to purchase large tracts of 
 valuable land for the accommodation of the dead. (2) 
 Health ; it is said that earth-burial causes the air to become 
 poisoned, the burial grounds to become offensive, the soil 
 to become laden with disease germs of every description, 
 water to become poisoned, and diseases to be directly 
 originated or propagated. (3) Body-snatching and dese- 
 cration of tombs will be impossible. 
 
 7. "Sterilization of milk requires continuous heating 
 under pressure for about two hours at 248 F., at which 
 temperature not alone the bacteria and their spores are de- 
 stroyed, but the normal appearance and taste of the milk 
 as well. Part of the sugar is converted into caramel, part 
 of the casein is precipitated, and the milk will no longer 
 form a cohesive coagulum with rennet/' (Harrington's 
 Practical Hygiene.) 
 
 8. "In cold climates trees and shrubs obstruct the 
 passage of the sun's rays to the soil, which is therefore 
 liable to be cold and moist; but in hot climates the evap- 
 oration of water from the leaves tends to dry the soil, 
 while the temperature of the air is lowered, and the 
 ground is sheltered from the direct rays of the sun and 
 kept cool. Thus, the heat of summer is lowered and the 
 cold of winter lessened by the presence of trees, and hav- 
 ing a lower temperature than the neighboring earth's sur- 
 face, high forests increase the rainfall. * * * Proba- 
 bly in all climates a due admixture of herbage, shrubs, and 
 trees, without dense undergrowth, but admitting the pas- 
 sage of free currents of air in every direction, is the 
 most conducive to health. Large tracts of country desti- 
 tute of trees and vegetation are in hot climates unbeara- 
 bly warm and dry, and in cold climates are exposed to 
 every chilling wind and to every extreme of temperature. 
 
 125 
 
MEDICAL RECORD 
 
 according to the season of the year. In such districts, too, 
 rainfall is often absent or very slight in amount, the at- 
 tractive influence exerted by trees and vegetation generally 
 upon water-charged clouds being wanting." (Parkes* Prac- 
 tical Hygiene.) 
 
 9. Some diseases to which artisans are especially liable: 
 Phthisis, fibroid phthisis, anthrax, glanders, tetanus, vari- 
 cose veins, septic infection, lead poisoning, mercurial poi- 
 soning, arsenical poisoning, phosphorus poisoning, emphy- 
 sema. 
 
 10. Yes, green wall paper is objectionable; because it 
 may contain arsenic, which is liable to become detached 
 from the paper, and may be present in the air of the 
 room, and then be inhaled. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Board of Medical Examiners, State of Florida. 
 
 ANATOMY. 
 
 1. Describe the clavicle. 
 
 2. Name points of interest on the external surface of 
 the occipital bone. 
 
 3. Describe the liver. 
 
 4. Name regions of abdomen and contents of each. 
 
 5. Give description and branches of the largest nerve of 
 the brachial plexus. 
 
 6. Give apparent and real origin and exit of facial nerve. 
 
 7. Give branches of the axillary artery. 
 
 8. Name most important branch of the occipital artery, 
 and state chief function it has to perform upon ligation of 
 the carotid. 
 
 9. What forms the torcular herophili? 
 
 10. Name veins that compose the portal circulation, with 
 a description of any one of its branches. 
 
 PHYSIOLOGY. 
 
 1. Give the composition, reaction, and uses of blood. 
 
 2. What changes take place in the composition of the 
 blood as it passes through the kidneys? 
 
 3. What is respiration, and what is its purpose? 
 
 4. Do variations in the rate and force of respiration 
 affect the heart, and if so, in what manner? 
 
 5. What is asphyxia, and what are some of its causes? 
 
 6. What is gastric juice, and what part does it play in 
 digestion? 
 
 7. What gland secretes amylopsin, and what is its action 
 in digestion ? 
 
 126 *g 
 
MEDICAL RECORD. 
 
 8. What are the principal uses of water when taken into 
 the body? 
 
 9. What is metabolism? 
 
 10. — Give the functions of the pneumogastric nerve, par- 
 ticularly its action upon the heart. 
 
 MATERIA MEDICA — THERAPEUTICS. 
 
 i. Mention some of the conditions which affect the 
 dosage of medicines, and give the general rule for calcu- 
 lating doses for children. 
 
 <^p How are the iodides best administered, and in what 
 class of cases would you prescribe them? 
 
 3. Give the dose of salol, indications for its use, and the 
 two drugs it is subdivided into in the stomach. 
 
 4. Describe the physical properties and physiological 
 action of heroin. Give some of the indications for its use. 
 
 5. Name some of the drugs that are incompatible with 
 calomel, and state why. 
 
 6. Give the symptoms of a toxic dose of digitalis and 
 your treatment of such a case. 
 
 7. Describe and give the indications for the use of car- 
 diac sedatives, with an example. 
 
 8. Why is it best to combine atropine with morphine, and 
 in what doses would you use it? 
 
 9. W r hat are the three preparations of opium most used, 
 and how much of each dose does it take to represent one 
 grain of opium? 
 
 10. What are antipyretics? By what methods do they 
 act? Name the ones most generally used. 
 
 CHEMISTRY. 
 
 1. What is the difference between a molecule and an 
 atom? 
 
 2. How is the equivalence of atoms expressed, and how 
 termed in notation? 
 
 3. What is the result of water being subjected to elec- 
 trolysis, and how does it take place? 
 
 4. What is ethyl hydrate, and how obtained? 
 
 5. Give some of the reactions illustrating the incompati- 
 bilities of Hg 2 Cl 2 . 
 
 6. Describe Fehling's test for sugar. 
 
 7. How is glucose made, and what used for? 
 
 8. Give a test for morphine. 
 
 9. What are the reactions analytically between mercuric 
 and mercurous chlorides? 
 
 10. How would you test for urea? 
 
 SURGERY. 
 
 1. Define infection, inflammation, suppuration. 
 
 2. Define atrophy, hypertrophy. 
 
 127 
 
MEDICAL RECORD. 
 
 3. Define hydrocephalus, hydrocele. 
 
 4. Define thrombosis, embolism, aneurysm. 
 
 5. Describe the healing process in an incised wound. 
 Healing by granulation. 
 
 6. How would you treat a case of gangrene? 
 
 7. What are the reasons for ligating a blood vessel? 
 
 8. What are the contraindications for the use of chloro- 
 form, ether? 
 
 9. What is a tumor? How are they classified? 
 
 10. What is the principle on which the serum treatment 
 of diseases is based? 
 
 GYNECOLOGY. 
 
 1. Give location, size, shape, and supports of a normal 
 uterus. 
 
 2. What is anteflexion? Give its symptoms and treat- 
 ment. 
 
 3. What is retroflexion? Give some of its causes and 
 symptoms. 
 
 4. Describe briefly the following conditions: 
 
 (a) Amenorrhea. 
 
 (b) Vicarious menstruation. 
 
 (c) Supplementary menstruation. 
 
 (d) Menorrhagia. 
 
 (e) Metrorrhagia. 
 
 5. Define dysmenorrhea and give some of its chief causes. 
 
 6. Give tissues lacerated in incomplete laceration of 
 perineum. Same in complete laceration. 
 
 7. Mention some of the physical changes that take place 
 during the menopause. 
 
 8. Give etiology, symptoms, and trreatment of cancer 
 of cervix. 
 
 9. Define cystocele. Rectocele. Give principal causes and 
 symptoms. 
 
 10. Describe briefly the operation for radical cure of 
 cystocele. 
 
 OBSTETRICS. 
 
 1. Give the symptoms of pregnancy prior to the begin- 
 ning of the fourth month. 
 
 2. What are the positive signs of beginning labor? 
 
 3. Describe in detail the management of a normal case 
 of labor at term. 
 
 4. Under what conditions are the use of forceps justi- 
 fiable? 
 
 5. Describe the manner of application of forceps. 
 
 6. What is placenta praevia, how recognized and treated? 
 
 7. Describe the postpartum hemorrhage, and give best 
 methods for its treatment. 
 
 8. Define eclampsia, and describe its management. 
 
 128 
 
MEDICAL RECORD. 
 
 9. What are the dangers incident to breech presenta- 
 tions, and how are such conditions best managed? 
 
 10. Describe the best methods of resuscitating a stillborn 
 child. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Board of Medical Examiners., State of Florida. 
 
 ANATOMY. 
 
 1. The clavicle forms the anterior part of the shoulder 
 girdle ; it articulates internally with the first part of the 
 sternum, and externally with the acromion process of the 
 scapula. It is broad and flattened at its outer end, and 
 thick and rounded at the inner end. It consists of a double 
 curve, the outer part is concave forward, the inner part 
 convex forward. The bone has two surfaces, superior and 
 inferior, and two borders, anterior and posterior. On the 
 under surface are the conoid tubercle, a groove for the 
 subclavius, a rough impression for the rhomboid ligament. 
 Muscles attached to it are : Deltoid, trapezius, pectoralis 
 major, subclavius, sternomastoid, and sternohyoid. Liga- 
 ments attached to it are: Interclavicular, rhomboid, conoid, 
 trapezoid, and capsular (of sternoclavicular and acromio- 
 clavicular articulations). 
 
 2. External occiptal protuberance, external occipital 
 crest, superior, inferior, and highest curved lines, foramen 
 magnum, condyles, basilar process, pharyngeal spine. 
 
 3. See Cunningham's "Anatomy'' (1909), page 1108; or 
 Gray's "Anatomy" (1907), page 1334. 
 
 4. The regions of the abdomen and their contents are 
 shown in the following table. It is to be remembered that 
 the contents will vary according to the position of the lines 
 drawn; these are arbitrary, and nearly every writer differs 
 from every other. In the following table the superior 
 horizontal line extends between the cartilaginous ends of 
 the tenth ribs, the inferior between the anterior superior 
 iliac spines. The vertical lines pass upward from the ilio- 
 pectineal eminences, at right angles, to the upper horizontal 
 line. 
 
 The viscera situated in each region are as follows : 
 
 RIGHT HYPOCHON- j _ I LEFT HYPOCHON- 
 
 EPIGASTRIC. 
 
 DRIAC 
 
 Liver. ! Liver. 
 
 Right kidney. j Stomach. 
 
 Hepatic flexure of , Gall-bladder. 
 
 the colon. Duodenum. 
 ' Pancreas. 
 
 129 
 
 DRIAC 
 
 Stomach. 
 Spleen. 
 Left kidney. 
 Splenic flexure of 
 the colon. 
 
MEDICAL RECORD. 
 
 RIGHT LUMBAR 
 
 UMBILICAL 
 
 LEFT LUMBAR 
 
 Right kidney. 
 Ascending colon. 
 Ileum. 
 
 Transverse colon. 
 
 Duodenum and 
 
 small intestines. 
 Great omentum. 
 
 HYPOGASTRIC 
 
 Small part of left 
 
 kidney. 
 Descending colon. 
 
 Small intestines. 
 
 RIGHT ILIAC 
 
 LEFT ILIAC 
 
 Cecum. 
 Appendix. 
 
 Last coil of ileum. 
 
 Small intestines. 
 
 Bladder in chil- 
 dren. 
 
 Distended bladder 
 in adults. 
 
 Pregnant uterus. 
 
 Sigmoid colon. 
 
 Sigmoid colon. 
 Small intestines. 
 
 5. Median nerve. See Cunningham's "Anatomy" (1909), 
 page 627; or Gray's "Anatomy" (1907), page 1004. 
 
 6. Facial nerve. Apparent origin: Medulla oblongata, in 
 groove between olivary and restiform bodies. Real origin: 
 Nucleus in floor of fourth ventricle. Exit: Through stylo- 
 mastoid foramen. 
 
 7. Superior thoracic, alar thoracic, acromial thoracic, long 
 thoracic, subscapular, anterior circumflex, posterior cir- 
 cumflex. 
 
 8. The most important branch of' the occipital artery is 
 the arteria princeps cervicis; after ligation of the carotid, 
 it anastomoses with the superficial cervical (of Trans- 
 versalis colli) and deep cervical (of subclavian or superior 
 intercostal). 
 
 9. The torcular herophili is formed by the superior longi- 
 tudinal, lateral, straight, and occipital sinuses. 
 
 10. The gastric, splenic, superior mesenteric, and infe- 
 rior mesenteric veins make up the portal vein. For descrip- 
 tion of one of these veins, see Cunningham's "Anatomy" 
 (1909), page 903; or Gray's "Anatomy" (1907), page 768. 
 
 PHYSIOLOGY. 
 
 1. The constituents of the blood are plasma and cor- 
 puscles. The plasma consists of water and solids (pro- 
 teids, extractives, and inorganic salts). The red corpuscles 
 consist of water and solids (hemoglobin, proteids, fat, and 
 inorganic salts). The white corpuscles consist of water 
 and solids (proteids, leuconuclein, lecithin, histon, etc.). Its 
 reaction is alkaline. Its functions are: To carry oxygen 
 from the lungs to the tissues ; to carry carbon dioxide from 
 the tissues to the lungs ; to convey the absorbed food to 
 the tissues; to protect against bacteria; to carry waste 
 material to skin, lungs, and kidneys for excretion. 
 
 2. As it passes through the kidneys the blood loses: 
 
 130 
 
MEDICAL RECORD. 
 
 water, mineral salts, urea, uric acid, oxygen, and carbon 
 dioxide. 
 
 3. Respiration is the act of breathing; it includes both 
 inspiration and expiration. Its purpose is to introduce oxy- 
 gen into the system and to excrete carbon dioxide. 
 
 4. Yes ; increased frequency of respirations generally 
 cause increased frequency of heart beats, but not always 
 in the same proportion. 
 
 5. Asphyxia is suffocation, due to depriving the lungs of 
 oxygen. It is caused by preventing oxygen from reaching 
 the lungs; by obstruction of the respiratory passages; by 
 inhaling a gas without oxygen, or one which strongly tends 
 to displace oxygen from the hemoglobin, as carbon mon- 
 oxide; or by interfering with the change of gases which 
 should take place between the air and the blood. 
 
 6. Gastric juice is the product secreted by the glands of 
 the stomach. It changes proteids into proteoses and pep- 
 tones, and coagulates milk. 
 
 7. Amylopsin is secreted by the pancreas; it changes 
 starches into sugar. 
 
 8. Uses of water in body: "It enters into the composi- 
 tion of the tissues; it is the chief ingredient of all the 
 fluids, and maintains their proper degree of dilution; it 
 moistens the various surfaces (mucous and serous mem- 
 branes), and so prevents friction; it furnishes blood and 
 lymph with a fluid medium by which food may be taken to 
 remote parts of the body and the waste matter removed, 
 thus promoting rapid tissue change; it serves as a distrib- 
 utor of body heat; it regulates the body temperature (by 
 absorption and evaporation). " 
 
 9. Metabolism is a name given to the entire series of 
 changes that occur in a cell or organism during the proc- 
 esses of nutrition. It is of two kinds: (1) anabolic, or 
 constructive, and (2) catabolic, or destructive. The changes 
 produced in the cells by the oxygen or nutrition conveyed 
 by the blood come under the class of anabolic changes. 
 
 10. Functions of the pneumogastric nerve: "Throughout 
 its whole course the vagus contains both sensory and motor 
 fibers. To summarize the many functions of this nerve 
 . . . it supplies (1) motor influence to the pharynx and 
 esophagus, stomach, and intestines, to the larynx, trachea, 
 bronchi, and lungs; (2) sensory } and, in part* (3) vaso- 
 motor influence, to the same regions; (4) inhibitory influ- 
 ence to the heart: (5) inhibitory afferent impulses to the 
 vasomotor center; (6) excito-secretory to the salivary 
 glands; (7) excito-motor in coughing, vomiting, etc." — 
 (Kirkes' Physiology.) 
 
 MATERTA MEDICA — THERAPEUTICS. 
 
 i. The conditions which affect the dosage of medicines 
 
 131 
 
MEDICAL RECORD. 
 
 are : Age, body weight, body temperature, drug habits, 
 idiosyncrasy, method of administration, intervals between 
 doses, cumulative action of drug, disease, and race. 
 
 x 
 
 Let x = the age of a patient; then = ttie fraction 
 
 x+ 12 
 of the adult dose which the patient should receive. 
 
 4 
 
 1 hus, a patient of four years old should receive = 
 
 41 4 + 12 
 
 — = — of an adult dose. 
 16 4 
 
 2. The iodides are best administered in a syrup, such as 
 the compound syrup of sarsaparilla ; and no other drug 
 should be administered at the same time. Iodides are 
 prescribed in : Syphilis, chronic rheumatism, - for absorption 
 of inflammatory products, arteriosclerosis, interstitial 
 nephritis, asthma, goiter, skin diseases, lead and mercury 
 poisoning. 
 
 3. Salol. Dose: gr. vijss. Indications for use: As a 
 disinfectant, in inflammations of mouth and pharynx, in 
 cystitis, as an intestinal antiseptic in typhoid fever, in 
 muscular rheumatism, in intestinal indigestion and fermen- 
 tation, in cholera. In the stomach it is subdivided into 
 salicylic acid and carbolic acid. 
 
 4. Heroin is a fine white powder, insoluble in water, 
 soluble in dilute acids. It is a respiratory sedative, but has 
 very little hypnotic or analgesic effect. It is used for 
 coughs and bronchitis. 
 
 5. Incompatibilities of calomel, with reasons: Solutions 
 of alkalies and their carbonates convert calomel into a 
 black mass, usually the black oxide; ammonium hydroxide 
 and carbonate form with it a complex black compound ; 
 iodides, bromides, cyanides, and other reducing agents con- 
 vert it into mercury and a mercuric compound; oxidizing 
 agents oxidize it to the mercuric state; exposure to sun- 
 light gradually decomposes calomel ; this is accelerated by 
 the presence of iodoform and other organic substances." 
 
 6. Symptoms of poisoning by digitalis: "Nausea, and 
 occasionally vomiting. Sometimes colic and diarrhea. 
 After two or three hours, marked diminution in the fre- 
 quency of the pulse, which may fall to 40 or even 25. 
 Dyspnea, attended by a sense of oppression in the chest 
 and coldness of the extremities. Headache, vertigo, and 
 tendency to sleep. Usually attacks of syncope occur, pro- 
 voked sometimes by the slightest movement of the patient. 
 Death is generally by syncope, sometimes after several 
 hours of coma succeeded by convulsions. Treatment : 
 The patient must be kept strictly in the recumbent position. 
 
 132 
 
MEDICAL RECORD. 
 
 viz., by : 
 
 (a) Lessening heat production, by 
 
 The stomach should be washed out with infusion of tea by 
 the stomach tube. Stimulants should be given." — (Witt- 
 haus's Essentials of Chemistry.) 
 
 7. Cardiac sedatives are drugs which lessen the force and 
 frequency of the heart's action. They are used to quiet 
 palpitation of the heart, also to slow the pulse in some 
 fevers. Aconite, antimony, potassium, chloral, digitalis 
 are cardiac sedatives. 
 
 8. Atropine is often combined with morphine when the 
 latter is used, for the following reasons: (1) To prevent 
 nausea and insomnia; (2) to intensify the effect of the 
 morphine, and so a smaller dose may suffice; (3) to neu- 
 tralize the effect on the pupils. The dose of morphine 
 could be gr. *A to %; of atropine, gr. 1/150 to 1/100. 
 
 9. (1) Tincture of opium; ten minims = one grain of 
 opium. (2) Camphorated tincture of opium; half ounce = 
 one grain of opium. (3) Dover's powder; ten grains == 
 one grain of opium. 
 
 10. The following table (from Potter's "Materia Med- 
 ica") gives the chief temperature depressants, with their 
 manner of action : Temperature depression may be done 
 by five different actions working upon two principal lines, 
 
 (1) diminishing tissue 
 change. 
 
 (2) reducing the cir- 
 culation. 
 
 (3) dilating cutaneous ves- 
 sels, thus increasing 
 heat radiation. 
 
 (4) promoting perspiration 
 — its evaporation low- 
 ering the temperature. 
 
 (5) abstracting heat from 
 the body. 
 
 The following list of antipyretics includes a few for each 
 
 of the above named actions, to which the numbers refer 
 in each case, viz. : 
 
 Quinine, 1. Aconite, 2. Alcohol, 1, 3. 
 
 Phenol, 1. Nitrous ether, 3, 4. Antimony, 2, 4. 
 
 S'alicin, 1. Acetanilid, 1, 4. Cold bath, 5. 
 
 Digitalis, 2. Phenacetin, 1, 4. Cold drinks, 5. 
 
 Antipyrin, 1, 4. Wet pack, 5. 
 
 CHEMISTRY. 
 
 1. An atom is the smallest quantity of an element that 
 can enter into chemical action, or that can enter into the 
 composition of a molecule. A molecule is the smallest 
 quantity of any substance that can exist free. It is made 
 up of atoms. 
 
 2. The equivalence of atoms is expressed in terms show- 
 
 133 
 
 (b) Promoting heat loss, by* 
 
MEDICAL RECORD. 
 
 ing ratio with that of hydrogen; univalent, bivalent, triva- 
 lent, quadrivalent, quinquivalent, etc. 
 
 3. The water is split up into hydrogen and oxygen gases 
 which can be collected. 
 
 4. Ethyl hydrate is alcohol, C2H5OH. It is made by 
 alcoholic fermentation of grape sugar : 
 
 CeH^Os = 2CO2 + 2GH5OH 
 grape sugar ethyl hydrate 
 
 5. Hg 2 Cl 2 + Ca ( OH ) 2 = CaQ 2 + H 2 + Hg 2 0. 
 
 And see Materia Medica, question 5, and Chemistry, 
 question 9. 
 
 6. Fehling's test: Place in a test-tube a few c.c. of the 
 liquid prepared as stated below, and boil; no reddish tinge 
 should be observable, even after five minutes' repose. Add 
 the liquid under examination gradually, and boil after each 
 addition. In the presence of sugar a yellow or red precipi- 
 tate is formed. In the presence of traces of glucose, only a 
 small amount of precipitate is produced, which adheres to 
 the glass, and is best seen when the blue liquid is poured 
 out. [The reagent must be kept in two solutions, which are 
 to be mixed immediately before use. Solution I consists 
 of 34.653 gms. of crystallized Q1SO4, dissolved in water to 
 500 c.c; and Solution II of 130 gms. of Rochelle salt dis- 
 solved to 500 c.c. in NaHO solution of sp. gr. 1.12. When 
 required for use, equal volumes of the two solutions are 
 mixed, and the mixture diluted with four volumes of 
 water.] 
 
 7. Glucose may be made by heating cane sugar with 
 dilute sulphuric acid. It is used as a sweetening agent, and 
 as a vehicle for medicines. 
 
 8. Solution of neutral ferric chloride gives a blue color 
 with morphine. 
 
 9. 
 
 MERCUROUS. 
 
 HjS a black ppt, insol. in 
 NH 4 HS, HC1, or HNO3. 
 
 NH4HS a black ppt, in- 
 sol. in excess. 
 
 (NH 4 ) 2 C0 8 a dark gray 
 ppt., sol. in hot HNO3, insol. 
 in H 2 S0 4 . 
 
 KHO a dark gray ppt., 
 insol. in excess. 
 
 NH 4 HO same as KHO. 
 
 KI a greenish ppt. 
 
 MERCURIC. 
 
 ppt. at first white, then 
 orange, then black. 
 
 ppt. white to black, insol. in 
 excess, except in presence 
 of organic matter. 
 
 white ppt., sol. in great ex- 
 cess of reagent, in H 2 S0 4 , 
 or in NH 4 HO. 
 
 yellowish-red ppt. 
 
 white ppt., slightly sol. in 
 excess, strong acids, or 
 NH4CI. 
 
 yellow to salmon to red ppt, 
 easily sol, in excess of KI. 
 
 134 
 
MEDICAL RECORD. 
 
 io. To a small amount of the suspected fluid add equal 
 amount of colorless nitric acid; if urea is present crystals 
 of urea nitrate will quickly appear. 
 
 SURGERY. 
 
 1. Infection is a process due to the access of living, viru- 
 lent, pathogenic bacteria to a part whence their toxins may 
 act on the tissues of the body. 
 
 Inflammation is the succession of changes occurring in 
 a part as the result of an injury which is not sufficient to 
 destroy the part. 
 
 Suppuration is the process when inflammation is followed 
 by liquefaction of the tissues; it is due to the presence of 
 pyogenic bacteria. 
 
 2. Atrophy is decrease in the amount of a tissue owing to 
 diminution in size or number of the histological elements 
 of which it is composed. 
 
 Hypertrophy is an increase in the size, weight and func- 
 tional activity of a part beyond the limit of health, and due 
 to an orderly enlargement or multiplication of all its nor- 
 mal constituents. 
 
 3. Hydrocephalus is a condition characterized by excess 
 of fluid in the ventricles of the brain, or outside the ventri- 
 cles but within the cranium. 
 
 Hydrocele is a collection of fluid other than pus or blood 
 in the neighborhood of the testis or spermatic cord, gener- 
 ally in the tunica vaginalis of the testis. 
 
 4. Thrombosis is the coagulation of blood within the 
 vessels during life. 
 
 Embolism is the inpaction of solid substances circulating 
 in the blood in vessels which are too small to allow them to 
 pass. 
 
 Aneurysm is a cavity containing blood, and communi- 
 cating with the lumen of an artery. 
 
 5. Healing in an incised wound, if aseptic, and the edges 
 are in apposition, occurs by first intention. "Exudation of 
 plasma from the neighboring blood-vessels occurs, and its 
 fibrinogen is converted into fibrin, so gluing the edges of 
 the wound together. Leucocytes are poured out and infil- 
 trate the wound, absorbing any blood clot present. These 
 are followed by fibroblasts (connective-tissue cells), which 
 take their place. New capillaries form by budding out 
 from adjacent ones, and vascularize the new tissue. 
 Fibrous tissue is formed by intercellular exudation from 
 the fibroblasts and so the fibrocicatrical union is complete, 
 for at the same time epithelium is spreading over the nar- 
 row surface line." 
 
 Healing by granulation or second intention occurs when 
 the edges or the wound have not been brought together. 
 "Exudation of plasma and leucocytes occurs, followed by 
 
 135 
 
MEDICAL RECORD. 
 
 fibroblasts and budding from the capillaries, thus forming 
 granulation tissue. The dead tissues or sloughs are sep- 
 arated, and a red area of granulation is then exposed. The 
 deeper layer of granulation tissue is converted into fibro- 
 cicatricial tissue, which contracts, and so the wound grad- 
 ually lessens in size. In the meantime epithelium spreads 
 in from the edge over the surface, and so the scar is com- 
 pleted." — Aids to Surgery. • 
 
 6. See Rose and Carless' Surgery (1908), pages 102, 104, 
 106, 107, 109, no, 112, 114, 115, and 117; or Da Costa's 
 Surgery (1908), pages 170, 172, 174, 176, 177, 178, 180, and 
 183. 
 
 7. Reasons for . ligating a blood vessel: To stop hem- 
 orrhage, to cure aneurysm, to starve a tumor, and as a pre- 
 liminary to some bloody operations. 
 
 8. The following contraindications for ether and chloro- 
 form are from Hare's Practical Therapeutics: "Ether 
 should not be used by inhalation in bronchitis or acute 
 nephritis, because of its irritant properties; in peritonitis 
 or gastritis, because it is apt to induce vomiting; in aneur- 
 ysm or in the presence of marked vascular atheroma, be- 
 cause it may rupture a blood vessel by raising arterial 
 pressure ; nor in diabetes, lest it produce diabetic coma ; 
 and if anemia is present and an examination of the blood 
 shows that the hemoglobin is below 50 per cent., the use 
 of the drug should be avoided if possible. 
 
 "Chloroform is not to be used in cases of fatty heart or 
 dilatation of the heart, in those with a known idiosyncrasy, 
 nor in the so-called lymphatic persons with overgrowth of 
 lymphoid tissues, as, for example, adenoids. In the latter 
 case it is particularly apt to cause sudden death. In valvu- 
 lar disease of the heart chloroform may be used with cau- 
 tion, although ether is preferable. Given a case of valvu- 
 lar disease that must be subjected to operation, the chances 
 are bettered with an anesthetic than without it, as the pain 
 and mental shock are worse for the heart than is the an- 
 esthetic." 
 
 9. A tumor is a pathological new growth which tends to 
 persist independently of the structures in which it lies, and 
 which performs no physiological function. 
 
 Tumors are classified as follows: — 
 
 I. Those derived from mesoblast: 
 
 (a) Benign: Lipoma, fibroma, chondroma, osteoma, 
 myxoma, myoma, neuroma, glioma, angioma, lym- 
 phangioma. 
 
 (b) Malignant: Sarcoma. 
 
 II. Those derived from epiblast or hypoblast : 
 
 (a) Benign: Adenoma, papilloma. 
 
 (b) Malignant: Carcinoma. 
 
 III. Cystic tumors. 
 
 136 
 
MEDICAL RECORD 
 
 IV. Teratomata. 
 
 10. "Serum therapy proper is the prophylactic and cura- 
 tive treatment of certain infectious diseases by the subcu- 
 taneous or intravenous administration of a blood serum 
 containing an antibody which is specific to the particular 
 disease." (Potter's Materia Medica.) Examples: (i) 
 Diphtheria antitoxin; (2) antitetanic serum; (3) antiven- 
 omous serum. * 
 
 GYNECOLOGY. 
 
 1. In the nulliparous adult the uterus is about three 
 inches long, about two inches wide at the upper part, and 
 about one inch thick. The uterus lies between the rectum 
 behind and the bladder in front; it is below the abdominal 
 cavity, and above the vagina. Its position is one of slight 
 anteflexion, with its long axis at right angles to the long 
 axis of the vagina. The anterior surface of its body rests 
 on the bladder, and the cervix points backward toward the 
 coccyx. The uterus is not fixed, but moves freely w T ithin 
 certain limits. It is held in place by ligaments — broad liga- 
 ments, round ligaments, vesicouterine, and rectouterine. 
 
 2. Anteflexion is an anterior displacement of the uterus, 
 in which the uterus is bent upon itself. Symptoms: Dys- 
 menorrhea, sterility, and various reflex nervous phenomena 
 (such as disturbances of the bladder). Treatment: Dilata- 
 tion of the cervical canal or a plastic operation (division 
 of the cervix). 
 
 3. Retroflexion is a posterior displacement of the uterus, 
 in which the uterus is bent upon itself. Causes: Distended 
 bladder, retrouterine peritonitis ; chronic cystitis ; small 
 fibroid in posterior wall of uterus ; too long a period in the 
 recumbent position after labor, or too tight bandaging; 
 tight lacing; infection during puerperium ; pressure of 
 tumors; inflammations of uterus and its appendages; gon- 
 orrhea. Symptoms: Bladder disturbances ; constipation 
 and painful defecation ; dysmenorrhea, or amenorrhea, or 
 hemorrhages from the uterus; leucorrhea; sterility, or fre- 
 quent abortion. 
 
 4. (a) Amenorrhea- is absence of menstruation during 
 the period of sexual activity, (b) Vicarious menstruation 
 is a flow of blood from some organ (other than the uterus) 
 recurring at the monthly periods and taking the place of 
 menstruation. It may occur from the hemorrhoidal ves- 
 sels, the lungs, the skin, the nails, the mammary glands, 
 ulcerated surfaces, and many other parts, (c) Supplemen- 
 tary menstruation means a menstrual flow from the uterus 
 and also from some site (as given under vicarious men- 
 struation, (d) Menorrhagia is a condition characterized 
 by excessive loss of blood during the menstrual periods. 
 
 137 
 
MEDICAL RECORD. 
 
 (e) Metrorrhagia is a hemorrhage from the uterus at 
 other than the menstrual periods. 
 
 5. Dysmenorrhea is painful menstruation. Chief Causes: 
 Pelvic congestion, pelvic inflammationfi malnutrition, over- 
 work, lack of development, neuralgia, stenosis or obstruc- 
 tion of the cervix, prolapse or displacement of uterus. 
 
 6. In incomplete laceration of the perineum any of the 
 following tissues may be lacerated : Skin, mucous mem- 
 brane of fourchette, Constrictor vaginae, Transversus peri- 
 nei, and Levator ani. In complete laceration the sphincter 
 ani and the anterior surface of the rectum are involved, in 
 addition to the structures named above. 
 
 7. During the menopause: Menstruation first becomes ir- 
 regular both in periodicity and quantity, and then ceases; 
 the patient suffers from hot flashes, giddiness, pains in 
 breasts, abdomen or limbs ; indigestion, flatulence, constipa- 
 tion and obesity may be present. The ovaries become 
 smaller and wrinkled, the vagina becomes smaller, the cer- 
 vix atrophies, the body of the uterus diminishes in size, the 
 pubic hair becomes less, and is shed, the external genitals 
 atrophy. 
 
 8. Cancer of cervix: "Laceration and erosion are predis- 
 posing factors. It occurs most frequently between the ages 
 of 35 and 50. The symptoms are hemorrhage, pain, and 
 discharge. The diagnosis is made on the physical and mi- 
 croscopical examination. The cervix is hard and nodular, 
 and the mucous membrane seems immovably fixed to the 
 underlying tissue. These nodules break down, the entire 
 cervix becomes ulcerated, or large cauliflower-like masses 
 may fill the upper part of the vagina. The diseased tissue 
 is friable and bleeds upon touch. The prognosis is unfavor- 
 able unless a radical operation is performed. The treat- 
 ment consists in removal of the entire uterus, but is con- 
 traindicated when the disease has extended to inaccessible 
 organs. The palliative treatment consists in relieving the 
 pain by morphine and in the removal of the diseased tissue 
 by the scissors, curet, or caustic for the relief of the hem- 
 orrhage and discharge." 
 
 9. Cystocele is a hernia of part of the bladder into the 
 vagina, covered by the mucous membrane of the anterior 
 vaginal wall. Rectocele is a hernia of the rectum into the 
 vagina, covered by the mucous membrane of the posterior 
 vaginal wall. The two conditions are generally found to- 
 gether. Causes: Lacerated perineum, prolapsed uterus, re- 
 laxation of the structures forming the pelvic floor, and 
 subinvolution of the vagina after labor. Symptoms: A 
 dragging sensation in the lower pelvic cavity; a feeling of 
 distention at the vulva; loss of power in urination or defe- 
 cation ; tumor of anterior or posterior vaginal wall (or 
 both) more apparent on straining; prolapse of uterus. 
 
 138 
 
MEDICAL RECORD. 
 
 io. For radical cure of cystocele: "The patient is placed 
 in dorsal position. The posterior vaginal wall is kept out 
 of the way with a weighted speculum. The cervix is drawn 
 down with a bullet-forceps. With a pair of tenacula the 
 sides of the prominence are drawn together in the median 
 line in order to see how much of the wall is redundant, and 
 these points are marked with small nicks. Next, the whole 
 surface is put on the stretch between four pairs of forceps 
 — one at each of the sidemarks, one near the cervix, and 
 one at the transverse ridge at the inner end of the urethra. 
 With a pair of scissors curved on the flat, a strip about 
 J zi inch wide is cut out of the mucous membrane. Similar 
 strips are removed on both sides until an oval is denuded. 
 Finally a running suture of chromieized catgut is passed 
 under the whole pared surface, uniting the edges from side 
 to side." If necessary, a perineorraphy should be done at 
 the same time. 
 
 OBSTETRICS. 
 
 i. Cessation of menstruation, changes in the breasts, 
 morning sickness, pigmentation, increased frequency of 
 urination, the cervix is soft; none of these are definite or 
 conclusive. 
 
 2. The uterus sinks, the bowel and bladder evacuations 
 are more frequent, free vaginal secretion, a slight discharge 
 of blood or bloody mucus, dilatation of the os, and charac- 
 teristic rhythmic uterine pains. 
 
 3. See Williams' "Obstetrics" (1909), page 303; or 
 Hirst's "Obstetrics" (1909), page 312. 
 
 4. Indications for the use of forceps are: (1) Forces at 
 fault: Inertia uteri in tke presence of conditions likely to 
 jeopardize the interests of mother or child, (a) Impend- 
 ing exhaustion; (b) arrest of head, from feeble pains. (2) 
 Passages at fault: Moderate narrowing, zYa to 3 3 A inches, 
 true conjugate; moderate obstruction in the soft parts. (3) 
 Passenger at fault: A. Dystocia due to (a) occipito- 
 posterior, (b) mentoanterior face, (c) breech arrested in 
 cavity. B. Evidence of fetal exhaustion (pulse above 160 
 or below 100 per minute). (4) Accidental complications: 
 Hemorrhage; prolapse funis; eclampsia^ All acute or 
 chronic diseases or complications in which immediate deliv- 
 ery is required in the interest of mother or child, or both. 
 Conditions necessary for the use of forceps are: (1) The 
 rectum and bladder must be empty; (2) the os uteri must 
 be fully dilated; (3) the membranes must be ruptured; (4) 
 the pelvis must be of sufficient size. 
 
 5. See Williams' "Obstretrics" (1909), page 403; or 
 Hirst's "Obstetrics" (1909), page 811. 
 
 6. Placenta prcevia is the condition in which the placenta 
 is attached in the lower uterine segment, and may be near 
 
 139 
 
MEDICAL RECORD. 
 
 or over (partially or completely) the internal os. Symp- 
 toms: Sudden hemorrhage, accompanied by syncope, ver- 
 tigo, restlessness, and feeble pulse. Treatment : Stop the 
 hemorrhage by a vaginal tampon ; this must be tight and 
 thorough. Accouchement force is indicated; this consists 
 of dilatation of cervix, version, and immediate extraction 
 of the child. 
 
 7. See Williams' "Obstetrics" (1909), page 818; or Hirst's 
 "Obstetrics" (1909), page 585. 
 
 8. Puerperal eclampsia is an acute morbid condition, oc- 
 curring during pregnancy, labor, or the puerperal state, 
 and is characterized, by tonic and clonic convulsions, which 
 affect first the voluntary and then the involuntary muscles ; 
 there is total loss of consciousness, which tends either to 
 coma or to sleep, and the condition may terminate in re- 
 covery or death. Preventive treatment: (1) The amount 
 of nitrogenous food should be diminished to a minimum; 
 (2) the production and absorption of poisonous materials 
 in the intestines and body tissues should be limited and 
 their elimination should be aided by improving the action 
 of the bowels, the kidneys, the liver, the skin, and the 
 lungs; (3) the source of the fetal metabolic products and 
 the peripheral irritation in the uterus should, if necessary, 
 be removed by evacuating that organ. Curative treatment: 
 (1) Control the convulsions (by chloroform, veratrum, or 
 chloral) ; (2) eliminate the poison or poisons which are 
 presumed to cause the convulsions; (3) empty the uterus 
 under deep anesthesia, by some method that is rapid and 
 that will cause as little injury to the woman as possible. 
 
 9. See Williams' "Obstetrics" (1909), page 289; or Hirst's 
 "Obstetrics" (1909), page 424. 
 
 10. See Williams' "Obstetrics" (1909), page 846; or 
 Hirst's "Obstetrics" (1909), page 939. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Board of Medical Examiners of Georgia. 
 
 ANATOMY. 
 
 i. Name bones of tarsus. What bones form internal 
 malleolus? External? What bones comprise the pelvis? 
 Name divisions of vertebral column, and give distinguish- 
 ing characteristics of cervical vertebrae. 
 
 2. What muscles aid in mastication? In deglutition? 
 Give origin, nerve, and arterial supply of masseter muscle. 
 What muscles compose quadriceps extensor femoris. Give 
 origin and insertion of quadriceps extensor femoris. 
 
 3. Name divisions of alimentary canal. Name principal 
 glands found in small intestine. What is average size of 
 
 140 
 
MEDICAL RECORD. 
 
 stomach? Give blood supply. Name abdominal viscera 
 wholly covered by peritoneum. Partially covered. 
 
 4. Name and illustrate by diagram the regions of abdo- 
 men. Where in the topography of abdomen is vermiform 
 appendix? Describe briefly Poupart's ligament. 
 
 5. Give origin of left common carotid artery. Name 
 branches of left external carotid. Name twelve pairs 
 nerves of special sense. Give origin and cranial exit of 
 pneumogastric nerve. Name the three most important 
 branches. 
 
 PHYSIOLOGY. 
 
 i. Define reflex action and give example. 
 
 2. Describe the functions of the kidneys. 
 
 3. Give the normal constituents of the urine. 
 
 4. What is meant by digestion? 
 
 5. Name the secretions of the alimentary canal, their 
 reactions and functions. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. iirgot; its physiological action; its principal uses. 
 
 2. Cocaine hydrochloride; its physiological action; its 
 principal uses. 
 
 (J) Chloroform; define it; when is it indicated as an 
 anesthetic? 
 
 \4) Ether ; define it ; state the conditions that render it 
 preferable as anesthetic. 
 
 5. Define a mydriatic, also a myotic; give examples of 
 each, with dose for local application in each case. 
 
 CHEMISTRY. 
 
 1. Give test for albumen and sugar in urine. 
 
 2. Describe chemical test for blood. 
 
 3. Is organic material admixed to water always delete- 
 rious, and when is it? 
 
 4. Define an alkaloid, and name three principal ones 
 used in medicine. 
 
 5. How are solutions, suspected to contain arsenic, to be 
 tested? 
 
 PATHOLOGY. 
 
 1. Give the pathology in simple lobar pneumonia. 
 
 2. Give the pathology of pellagra, with etiology. 
 
 3. Give the pathology in hookworm disease. 
 
 4. Describe the pathological conditions in meningitis. 
 
 5. (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? 
 
 PRACTICE OF MEDICINE. 
 
 I. Give symptoms and treatment of gastric ulcer, and 
 differentiate between it and cancer of the stomach. 
 
 141 
 
MEDICAL RECORD. 
 
 2. Give symptoms of appendicitis, and describe and locate 
 the pain in (a) appendicitis, (b) renal calculus, (c) gall- 
 stones, (d) ovaritis, (e) cystitis. 
 
 3. Explain how to recognize in a middle-aged person, 
 when found in a comatose state, upon what disease the 
 condition depends. 
 
 4. Outline the area of normal liver dulness, and name 
 the chronic diseases of the liver. 
 
 5. Scarlet ^ fever : etiology, morbid anatomy, symptoms, 
 incubation, invasion, eruption, complications and sequelae, 
 diagnosis; differentiate from acute exfoliating dermatitis, 
 measles, rotheln, septicemia, diphtheria, drug rashes, prog- 
 nosis; treatment. 
 
 OBSTETRICS. 
 
 1. Would the coincidence of diabetes with pregnancy 
 have a harmful effect on the latter? What would you do 
 for such patient? 
 
 2. Give treatment of a subinvoluted uterus. 
 
 3. Differentiate between putrid and true puerperal in- 
 fection and give treatment of each. 
 
 4. How would you distinguish between an epileptic and 
 an eclamptic convulsion? 
 
 5. What are the indications for the use of forceps? 
 
 GYNECOLOGY. 
 
 1. Give causes and treatment of uterine hemorrhage. 
 
 2. Under what conditions would you prefer vaginal to 
 abdominal hysterectomy ? 
 
 3. Describe technique of vaginal hysterectomy. 
 
 4. Give differential diagnosis between fluids in abdo- 
 minal cavity and ovarian cysts. 
 
 5. Describe ectopic pregnancy, varieties, and operation 
 for same. 
 
 SURGERY. 
 
 1. What conditions demand amputation of the extremi- 
 ties? How are amputations classified as to time of opera- 
 tion? What period is most favorable for amputation? De- 
 scribe amputation at upper middle third of thigh, naming 
 arteries and muscles divided. 
 
 2. What is understood by abdominal hernia? Describe 
 an oblique inguinal hernia. Give symptoms of strangula- 
 tion and method of reduction. Described an approved 
 operation for the radical cure of oblique inguinal hernia. 
 
 3. Give differential diagnosis between traumatic coma, 
 apoplexy, opium poisoning, and alcoholic intoxication. De- 
 scribe briefly and give treatment of erysipelas. Give dif- 
 ferential diagnosis between fracture and dislocation. Name 
 cardinal principles in treatment of fractures. 
 
 4. Name inflammatory diseases of bone. What is under- 
 
 142 
 
MEDICAL RECORD. 
 
 stood by ankylosis? Give approved surgical procedure for 
 establishment of joint function in ankylosis. Name and 
 describe briefly the two most common varieties cf club- 
 foot. 
 
 5. Differentiate between abscess and aneurysm ; between 
 hydrocele and scrotal hernia ; describe approved treatment 
 of former. What are the methods of controlling hemor- 
 rhage? What is understood by secondary hemorrhage? 
 Name some of the more frequent causes of secondary 
 hemorrhage. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Board of Medical Examiners of Georgia. 
 
 ANATOMY. 
 
 1. Bones of the tarsus: Os calcis, astragalus, cuboid, 
 scaphoid, internal cuneiform, middle cuneiform, and ex- 
 ternal cuneiform. The internal malleolus is formed by the 
 lower end of the tibia ; the external, by the lower end of 
 the fibula. The pelvis is made up of the ossa innominata 
 (ilium, ischium, os pubis), sacrum, and coccyx. Divisions 
 of vertebral column are : Cervical, dorsal, lumbar, sacral, 
 and coccygeal. Cervical vertebrae are distinguished by a 
 foramen in the transverse process. 
 
 2. Muscles of mastication: Masseter, temporal, external 
 pterygoid, internal pterygoid, and buccinator. Muscles of 
 deglutition: Buccinator, hyoglossus, styloglossus, palato- 
 glossus, palatopharyngeus, azygos uvulae, tensor palati, 
 levator palati, stylopharyngeus, stylohyoid, geniohyoid, 
 mylohyoid, thyrohyoid, digastric, constrictors of pharynx, 
 and the intrinsic muscles of the tongue. Masseter. 
 Origin: From malar process of superior maxillary bone 
 and zygomatic arch. Nerve supply: Inferior maxillary. 
 Arterial supply: Internal maxillary. The Quadriceps 
 extensor femoris is composed of : Vastus externus, vastus 
 internus, rectus, and crureus. Origin: Anterior inferior 
 spine of ilium, brim of acetabulum, anterior intertrochan- 
 teric line, great trochanter, linea aspera, and shaft of fe- 
 mur. Insertion: Tuberosity of tibia. 
 
 3. Divisions of alimentary canal: Mouth, pharynx, 
 esophagus, stomach, small intestine (duodenum, jejunum, 
 ileum), large intestine (cecum, colon, rectum). Principal 
 glands in small intestine: Brunner's, Lieberkuhn's, Peyer's, 
 and solitary glands. Size of stomach is very variable, 
 about ten to twelve inches by four to five inches ; its blood 
 supply is : Gastric, pyloric, right and left gastroepiploic, 
 and vasa brevia arteries. Viscera wholly covered by perito- 
 neum: Liver, stomach, spleen, jejunum, ileum, transverse 
 
 143 
 
MEDICAL RECORD. 
 
 colon, sigmoid flexure. Partially covered: Duodenum, as- 
 cending and descending colon, rectum, bladder, and uterus. 
 
 4. See Cunningham's "Anatomy" (1909), page 1046; or 
 Gray's " Anatomy". (1908), pages 1244 and 1246. The 
 vermiform appendix is in the right inguinal region. For 
 Poupart's ligament see Cunningham's "Anatomy" (1909), 
 page 422; or Gray's "Anatomy" (1908), page 438. 
 
 5. The left common carotid artery arises from the arch 
 of the aorta. Branches of external carotid are : Superior 
 thyroid, lingual, facial, occipital, posterior auricular, as- 
 cending pharyngeal, superficial temporal, and internal max- 
 illary. Twelve pairs of cranial nerves are; 1. Olfactory. 
 2. Optic. 3. Motor oculi. 4. Trochlear or pathetic. 5. 
 Trifacial. 6. Abducens. 7. Facial. 8. Auditory. 9. Glos- 
 sopharyngeal. 10. Pneumogastric or Vagus. 11. Spinal 
 accessory. 12. Hypoglossal. The nerves of special sense 
 are numbers 1, 2, and 8. Pneumogastric. Origin: Be- 
 tween olivary and restiform bodies, and beneath floor _of 
 fourth ventricle. Exit: By jugular foramen. Three 
 branches: Superior laryngeal, recurrent laryngeal, and 
 pharyngeal. 
 
 PHYSIOLOGY. 
 
 1. Reflex actions are involuntary or unconscious move- 
 ments, due to suitable stimuli. They depend upon the 
 integrity of the reflex arc, which is a complex made up of : 
 (1) A surface capable of receiving an impression; (2) an 
 afferent nerve; (3) a nerve cell capable of receiving and 
 also of sending out impulses; (4) an efferent nerve, and 
 (5) a surface capable of responding in some way to the 
 impulse conveyed by the efferent nerve. Example: The 
 patellar reflex consists of a contraction of the extensor 
 muscles of the leg and a movement of the foot forward 
 when the ligamentum patellae is struck ; the quadriceps ex- 
 tensor must first be slightly stretched by putting one knee 
 over the other. Its integrity depends upon a healthy con- 
 dition of the entire reflex arc, consisting of tendon, afferent 
 or sensory nerve, posterior roots, and anterior horn of the 
 spinal cord, the efferent or motor nerve, and the muscle 
 itself. 
 
 2. The functions of the kidney are: (1) To secrete (or 
 excrete) urine; (2) the production of an internal secre- 
 tion. The mechanism of the secretion of urine by the kid- 
 neys is twofold: (1) By filtration, most, if not all, of the 
 fluid is eliminated, and also inorganic salts; this depends 
 upon blood pressure, and takes place in the glomeruli. (2) 
 By cell activity and selection, in the cells of the convoluted 
 tubules, the urea, and principal solids are eliminated. 
 
 3. The normal constituents of the urine are: Water, 
 urea, uric acid, urates, hippuric acid, kreatinin, xanthin, 
 hypoxanthin; sulphates, chlorides, and phosphates of so- 
 
 144 
 
MEDICAL RECORD. 
 
 dium and potassium; phosphates of magnesium and cal- 
 cium; nitrogen, and carbon dioxide. 
 
 4. Digestion is the process by which food is converted 
 into material suitable for absorption and assimilation. 
 
 5. The secretions of the alimentary canal are: Saliva, 
 gastric juice, pancreatic juice, bile, and succus entericus: 
 Of these, the gastric juice has an acid reaction; the others, 
 alkaline. 
 
 The functions of the saliva are: (1) To moisten the 
 mouth, (2) to assist in the solution of the soluble portions 
 of the food, and thus (3) to administer to the sense of 
 taste, (4) to lubricate the bolus of food, and thus (5) to 
 facilitate the acts of mastication and deglutition, and (6) 
 to change starches into dextrin and sugar. 
 
 The functions of the gastric juice are: (1) To change 
 proteids into proteoses and peptones, and (2) to curdle the 
 casein of milk. 
 
 The functions of the pancreatic juice are : (1) To change 
 proteids into proteoses and peptones, and afterwards de- 
 compose them into leucin and tyrosin; (2) to convert 
 starch into maltose; (3) to emulsify and saponify fats; and 
 (4) to cause milk to curdle. 
 
 The functions of the bile are: (1) To assist in the emul- 
 sification and saponification of fats ; (2) to aid in the ab- 
 sorption of fats; (3) to stimulate the cells of the intestine 
 to increased secretory activity, and so promote peristalsis, 
 and at the same time tend to keep the feces moist; (4) 
 to eliminate waste products of metabolism, such as lecithin 
 and cholesterin; (5) it has a slight action in converting 
 starch into sugar ; (6) it neutralizes the acid chyme from 
 the stomach and thus inhibits peptic digestion; (7) it has 
 a very feeble antiseptic action. 
 
 The functions of the succus entericus are: The secre- 
 tion of enterokinase, secretin, and erepsin, w T hich assist the 
 pancreatic juice in digestion. 
 
 MATERIA MEDIC A AND THERAPEUTICS. 
 
 i. Ergot. Physiological action: Ergot stimulates and 
 causes contraction of involuntary muscle fibers, hence it 
 is a vasoconstrictor, hemostatic, and oxytocic. It is also 
 a cardiac sedative, it raises the blood pressure, it increases 
 peristalsis, and is an emmenagogue. Principal uses: To 
 promote uterine contractions during third stage of labor; 
 fibroids, menorrhagia, postpartum hemorrhage. Some 
 forms of amenorrhea and dysmenorrhea, dysentery, ar- 
 terial hemorrhage, congestive headaches, laxity of sphinc- 
 ters, of bladder or rectum, hemorrhoids, aneurysm, dia- 
 betes, urinary incontinence, direct paralysis of the sphincter 
 vesicae, atonic spermatorrhea. 
 
 2. Cocaine hydrochloride. Physiological action: Local 
 
 145 
 
MEDICAL RECORD. 
 
 anesthetic (externally) ; internally it is a muscular, cere- 
 bral, circulatory, and respiratory stimulant, also a mydri- 
 atic. Its principal uses are : As a local anesthetic ; also 
 in paralysis agitans, chorea, and alcoholic tremors. 
 
 3 and 4. Chloroform is a colorless liquid, of sweetish, 
 peculiar odor and taste, with anesthetic properties. Chem- 
 ically it is trichlormethane. Ether is a colorless liquid, 
 of peculiar odor and taste, with anesthetic properties. 
 Chemically it is ethyl oxide. As a general rule, ether 
 would be the anesthetic of choice. But chloroform may 
 be used : (1) In hot climates; (2) when large numbers 
 of persons have to be rapidly anesthetized; (3) in brain 
 surgery; (4) in' labor; (5) in patients* who are known 
 to take ether badly; and (6) in the conditions mentioned 
 below, in which ether is contraindicated. The following 
 contraindications for ether and chloroform are from Hare's 
 "Practical Therapeutics" : "Ether should not be used by 
 inhalation in bronchitis or acute nephritis because of its 
 irritant properties; in peritonitis or gastritis, because it 
 is apt to induce vomiting; in aneurysm or in the pres- 
 ence of marked vascular atheroma, because it may 
 rupture a blood-vessel by raising arterial pressure; 
 nor in diabetes, lest it produce diabetic coma; and if 
 anemia is present and an examination of the blood shows 
 that the hemoglobin is below 50 per cent, the use of the 
 drug should be avoided if possible. Chloroform is not 
 to be used in cases of fatty heart or dilatation of the heart, 
 in those with a known idiosyncrasy, nor in the so-called 
 lymphatic persons with overgrowth of lymphoid tissues, as, 
 for example, adenoids. In the latter case it is particularly 
 apt to cause sudden death. In valvular disease of the heart 
 chloroform may be used with caution, although ether is 
 preferable. Given a case of valvular disease that must 
 be subjected to operation, the chances are bettered with 
 an anesthetic than without it, as the pain and mental shock 
 are worse for the heart than is the anesthetic." 
 
 5. A mydriatic is an agent which causes dilatation of the 
 pupil of the eye. A myotic is an agent which causes con- 
 traction of the pupil. Examples: Mydriatics: Atropine, 
 homatropine, daturine, hyoscyamine, coniine, cocaine; and 
 probably gelsemine, muscarine, hydrocyanic acid, aconite, 
 and amyl nitrite. Myotics: Pilocarpine, physostigmine, and 
 probably nicotine. Atropine sulphate, 1 per cent, solution; 
 homatropine hydrobromide, 2 per cent, solution; cocaine 
 hydrochloride, 4 per cent, solution ; pilocarpine, 1 per cent, 
 solution; physostigmine, Vs to y 2 per cent, solution. 
 
 CHEMISTRY. 
 
 i. Test for albumin in the urine: The urine must be per- 
 fectly clear. If not so, it is to be filtered, and if this does 
 
 146 
 
MEDICAL RECORD, 
 
 not render it transparent it is to be treated with a few 
 drops of magnesia mixture and a<?ain filtered. The reac- 
 tion is first observed. If it be acid, the urine is simply 
 heated to near the boiling point. If the urine be neutral or 
 alkaline, it is rendered faintly acid by the addition of dilute 
 acetic acid and heated. If albumin be present a coagulum 
 is formed, varying in quantity from a faint cloudiness to 
 entire solidification, according to the quantity of albumin 
 present. The coagulum is not redissolved upon the addition 
 
 of HNOs. 
 
 For sugar: Render the urine strongly alkaline by addi- 
 tion of Na 2 C0 3 . Divide about 6 c.c. of the alkaline liquid in 
 two test-tubes. To one test-tube add a very minute quan- 
 tity of powdered subnitrate of bismuth ; to the other as 
 much powdered litharge. Boil the contents of both tubes. 
 The presence of glucose is indicated by a dark or black 
 color of the bismuth powder, the litharge retaining its 
 natural color. 
 
 2. Chemical test for blood: Boil a fragment of dried 
 blood with a drop of glacial acetic acid on a slide ; on cool- 
 ing, hemin crystals separate out. If the blood stain is not 
 recent a crystal of sodium chloride should be added with 
 the acetic acid. 
 
 3. Organic matter in water is not necessarily deleterious ; 
 but when it is derived from sew T age or other animal mat- 
 ter it is dangerous. The presence of nitrites is a pretty sure 
 indication of danger. 
 
 4. An alkaloid is a basic, nitrogenous substance, consist- 
 ing of C, H, N (and sometimes also O), capable of acting 
 with an acid to form a salt in the same way that ammonia 
 does. They generally have a bitter taste and an alkaline 
 reaction. Three examples: Morphine, strychnine, and qui- 
 nine. 
 
 5. Solutions suspected of containing arsenic may be ex- 
 amined by the Reinsch's test, as follows : To the suspected 
 fluid add a little pure HC1 ; suspend in the fluid a small 
 strip of bright copper foil, and boil. If a deposit forms on 
 the copper, remove the copper, wash it with pure water, 
 dry on filter paper, but be careful not to rub ofT the de- 
 posit. Coil up the copper, and put it into a clean, dry glass 
 tube, open at both ends, and apply heat at the part where 
 the copper is. If arsenic is present there will appear in 
 the cold part of the tube a mirror, which will be found on 
 microscopical examination to consist of octahedral crystals 
 of arsenic trioxide. 
 
 PATHOLOGY. 
 
 1. See French's "Practice of Medicine" (1907), page 
 154; or Osier's "Practice of Medicine" (1909), page 170. 
 
 147 
 
MEDICAL RECORD, 
 
 2. See French's "Practice of Medicine" (1907), page 968; 
 or Osier's "Practice of Medicine" (1909), page 384. 
 
 3. See French's "Practice of Medicine" (1907), page 497; 
 or Osier's "Practice of Medicine" (1909), page 44. 
 
 4. See French's "Practice of Medicine" (1907), page 141 ; 
 or Osier's "Practice of Medicine" (1909), page 159. 
 
 5. (a) "Fbrous connective tissue is developed from em- 
 bryonic connective tissue cells, i.e. from spindle-shaped or 
 branched nucleated protoplasmic cells of the mesoblast. 
 The former are met with isolated or in bundles, as in the 
 umbilical cord or embryonic tendon. The latter form a 
 network, as in the fetal skin and mucous membrane. In 
 both instances the protoplasm of the embryonic connective 
 tissue cells become gradually transformed into a bundle 
 of elementary fibrils, with a granular-looking interstitial 
 substance. The nucleus of the original cell finally disap- 
 pears." — (Klein's Histology.) (b) Fibromata or Fibroids. 
 They usually occur in : Uterus, periosteum, ovary, mamma, 
 testicle, tendons, aponeuroses. 
 
 PRACTICE OF MEDICINE. 
 
 i. See French's "Practice of Medicine" (1907), pages 
 748 and 751; or Osier's "Practice of Medicine" (1909), 
 pages 473 and 477- 
 
 Gastric ulcer is generally caused by injury or bacteria, 
 is most apt to occur between the ages of twenty and 
 forty-five; after eating there is pain localized in the 
 stomach, vomiting occurs soon after eating, hemateme- 
 sis is common, there is localized tenderness over the 
 stomach, and examination of the gastric contents shows 
 an excess of free HC1. Gastric cancer does not usually 
 occur before forty years of age, is more common in males, 
 the pain is localized and constant, vomiting is copious 
 and occurs some time after eating; the vomitus contains 
 "coffee ground" material; hemorrhages are common; a 
 tumor may be palpated, and examination of the gastric 
 contents shows absence of free HC1 and presence of lactic 
 acid; severe anemia and cachexia are also present. 
 
 2. See French's "Practice of Medicine" (1907), page 791 ; 
 or Osier's "Practice of Medicine" (1909), page 514. (0) 
 See French, page 792; or Osier, page 514. (b) See French, 
 page 911; or Osier, page 711. (c) See French, page 852; 
 or Osier, page 550. (d) In ovaritis the pain is in the 
 ovarian region, and radiates to the back, thighs, umbilicus, 
 and breasts; on pressure over the ovary, nausea is pro- 
 duced, (e) In cystitis the pain is referred to the perineum 
 and hypogastric region, and may radiate to thighs and 
 sacrum. 
 
 3. The following table (from Eisendrath's Surgical Di- 
 agnosis) gives the diagnosis : 
 
 148 
 
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 28 
 
 
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 rt c3 
 
 So U 
 
 *a5 
 ea 
 
 00 
 
 bo 
 
 |JS 
 
 ^ r3 p 
 
 'age 
 
 « E 
 
 en 
 
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 Si? 
 
 cd 
 
 03 ^ 
 
 U - 
 
 T3 
 
 3 O 
 
 
 
 S e 
 
 a w S 
 <u 22 o « 
 
 Q O (0 4- 
 
 .2 w 
 
 £-3 
 
 c 
 
 cd 
 
 C o3 
 en c3 *j 
 £ C 
 
 o mo 
 
 03 o 
 O ^ 
 
 C C oj 
 
 5 
 
 5 C Y 
 en-- £ 
 
 2 rt rt 
 
 be* 
 ° .- 
 
 ^7* o 
 
 IS 
 
 cr c 
 
 
 1£= 
 
 •71 O. 
 
 -«"2 5 53 g 
 
 <U O rt — 
 
 "Si 
 
 O' 
 
 « c.S ^ 
 
 
 £vj iw 51 :_ 
 
 .5^3 o. 
 
 
 > w p> o -c « 
 
 ■S"s w £ ; s | 
 
 ,«° — ,i+^ o . 
 
 ^.2 « « w o.^w 
 
 3 
 
 .9. o 
 
 149 
 
 
 to 
 
 B c 
 
 C3 (U 
 
 is 
 
 c c £ 
 'C.2 ^ 
 
 ^-" O ~* W. S. r- 
 
 c -^ -- S ? 
 O rt ° *^ c 
 
 St t So *> v - 
 
 C ^•p O U <L> O 
 
 i_ k.^ in ^-^ 
 
MEDICAL RECORD. 
 
 4. The area of liver dullness is shown in the table (from 
 
 Hutchison and Rainy's Clinical Methods) : 
 
 Upper 
 limit 
 
 Deep 
 
 dullness 
 
 Superficial 
 dullness 
 
 Middle 
 Line 
 
 Lower limit 
 
 Blend 
 
 with 
 
 heart 
 
 dulness 
 
 Hand's 
 
 -breadth 
 
 below base 
 
 of xiphoid 
 
 Mammary 
 Line 
 
 4th space 
 
 6 th rib 
 
 Costal mar- 
 gin or some- 
 what above 
 or below it 
 
 Mid-axil- 
 lary Line 
 
 7th space 
 
 8th rib 
 
 10th space 
 
 Scapular 
 Line 
 
 9th space 
 
 10th rib 
 
 Blends with 
 kidney 
 dulness 
 
 Chronic diseases of the liver: Chronic hyperemia, 
 chronic interstitial hepatitis (cirrhosis), echinocoqcus cyst, 
 chronic perihepatitis, gallstones, amyloid liver, chronic 
 atrophy, fatty liver, syphilis of liver. 
 
 5. See French's "Practice of Medicine" (1907), pages 315 
 to 325; or Osier's "Practice of Medicine" (1909), pages 
 130 to 140. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), pages 493 and 380. 
 
 2. See Williams' "Obstetrics" (1909), page 904; or 
 Hirst's "Obstetrics" (1909). page 647. 
 
 3. See Hirst's "Obstetrics" (1909), pages 728 to 752, 
 and 764 to 766. 
 
 4. For eclamptic convulsion see Williams' "Obstetrics" 
 (1909), page 525; or Hirst's "Obstetrics" (1909), page 630. 
 Epilepsy is not accompanied by albuminuria, has different 
 prodromata, there is no rise of body temperature, and 
 there is apt to be a history of previous attacks. 
 
 5. Indications for the use of forceps are : "1, Forces at 
 fault: Inertia uteri in the presence of conditions likely to 
 jeopardize the interests of mother or child, (a) Impend- 
 ing exhaustion; (b) arrest of head, from feeble pains. 2. 
 Passages at fault: Moderate narrowing, 3% to 3.% inches, 
 true conjugate; moderate obstruction in the soft parts. 
 3. Passenger at fault: A. Dystocia due to (a) occipito- 
 posterior, (b) mentoanterior face, (c) breech arrested in 
 cavity. B. Evidence of fetal exhaustion (pulse above 160 
 or below 100 per minute). 4. Accidental complications: 
 Hemorrhage ; prolapsus funis ; eclampsia. _ All acute or 
 chronic diseases or complications in which immediate de- 
 livery is required in the interest of mother or child, or 
 both."— (From Jewett's Practice of Obstetrics.) 
 
 GYNECOLOGY. 
 
 i. The following (from Gould and Pyle's Cyclopedia of 
 
 150 
 
MEDICAL RECORD. 
 
 Medicine and Surgery) is a useful classification of uterine 
 hemorrhages, and also gives the causes of the same : 
 
 1. Hemorrhages complicating pregnancy, labor, or the 
 puerperium: 
 
 A. Hemorrhages of pregnancy: Caused by (i) placenta 
 praevia; (2) premature separation of a normally situated 
 placenta; (3) apoplexy of the decidua or placenta. 
 
 B. Hemorrhages of labor: Caused by (1) placenta 
 previa; (2) premature separation of a normally situated 
 placenta; (3) relaxation of the uterus; (4) laceration of 
 the cervix; (5) rupture or inversion of the uterus. 
 
 C. Hemorrhages of the puerperium: Caused by (1) re- 
 tained secundines; (2) displaced uterus; (3) displaced 
 thrombi; (4) fibroid tumors; (5) r^pertrophied decidua; 
 (6) carcinoma. 
 
 II. Hemorrhages occurring in the non-pregnant woman: 
 
 A. In virgins before the age of thirty: Caused by (1) 
 uterine congestion, the result of cold or exposure; (2) 
 endometritis; (3) polypi and fibroid tumors. 
 
 B. In married women before the age of thirty: Caused 
 by (1) subinvolution; (2) laceration of the cervix; (3) 
 endometritis; (4) retrodisplacements of the uterus; (5) 
 polypi and fibroid tumors. 
 
 C. In women after the age of thirty: Caused by (1) 
 carcinoma of the cervix ; (2) carcinoma of the body of the 
 uterus; (3) sarcoma of the uterus. 
 
 The treatment depends on the cause. For details see any 
 work on obstetrics or gynecology. 
 
 2. The indications for hysterectomy are given as fol- 
 lows : For the abdominal operation: All solid or cystic 
 tumors of the uterus ; cancer ; uterine rupture during labor ; 
 certain conditions of puerperal sepsis; pregnancy compli- 
 cated by pelvic deformity, cancer, or other serious obstacle 
 to the passage of the child ; uterine prolapse or inversion, 
 and, incidentally, as a step in the removal of complicated 
 suppurative conditions of the uterine appendages. 
 
 For the vaginal operation: Bilateral suppurative condi- 
 tions of the appendages; prolapse, cancer, pregnancy with 
 cancer before the sixth month ; certain septic conditions of 
 the uterus ; certain rare conditions which may require the 
 ablation of a small movable uterus. 
 
 For the combined operation: Cancer, certain compli- 
 cated fibroids; failure to secure hemostasis from below. — 
 (From Reference Handbook of the Medical Sciences.^ 
 
 3. Vaginal hysterectomy: 'The patient is catheterized 
 and placed in the lithotomy position and the external geni- 
 tals are thoroughly disinfected. The vagina is held open 
 by broad retractors and the uterus is pulled down by vol- 
 sella forceps grasping the cervix, while the adjoining mu- 
 cous membrane is cut well clear of the disease by blunt- 
 
 151 
 
MEDICAL RECORD. 
 
 pointed scissors. Keeping close to the uterus, the dissec- 
 tion is continued on its anterior and posterior surface by 
 the tip of the finger and short snips of the scissors, but at 
 the sides, after division of the mucous membrane, the cel- 
 lular tissue is simply pushed up as high as possible, or till 
 the pulsations of the uterine artery are felt. The finger is 
 finally thrust through the uterovesical fold of peritoneum, 
 and after cleansing the vagina flat sponges are poked in 
 around the uterus. Douglas' pouch is entered in the same 
 manner, hemorrhage from the vaginal wound being con- 
 trolled by a few catgut sutures through its cut edges, and 
 then the finger is hooked over the fundus, pulling it down 
 into the posterior opening and thus bringing within reach 
 the upper border of the broad ligaments, which are seized 
 by long-bladed clamps and divided on the uterine side. 
 Other clamps are placed on the remaining tissues close to 
 the uterus, which is then excised." — (Stimson's Operative 
 Surgery.) 
 4- 
 
 ASCITES. 
 
 i. Previous history of 
 visceral disease. 
 
 2. Enlargement compara- 
 tively sudden. 
 
 3. Face puffy ; color waxy ; 
 early anemia. 
 
 4. Patient on back; en- 
 largement symmetrical; flat 
 in front. 
 
 5. Sitting up, abdomen 
 bulges below. 
 
 6. Navel prominent and 
 thinned. 
 
 7. Fluctuation decidedly 
 clear, diffuse throughout 
 abdomen, but avoids highest 
 parts in all positions, and al- 
 ways has a hydrostatic level. 
 
 8. Intestines float on top 
 of fluid ; hence percussion 
 gives clear tympanitic note 
 over the highest parts of 
 abdominal cavity, and dull- 
 ness in lowest parts for all 
 positions, i.e. areas of res- 
 onance and dullness change 
 with position. 
 
 9. Vaginal touch detects 
 fluctuation, bulging into va- 
 gina. 
 
 OVARIAN CYST. 
 
 1. No such history. 
 
 2. Gradual. 
 
 3. Facies ovarian. Ane- 
 mia absent, or later. 
 
 4. Asymmetrical until tu- 
 mor is quite large; promi- 
 nent in front. 
 
 5. No appreciable change. 
 
 6. Navel usually un- 
 changed. 
 
 7. Less clear; limited to 
 cyst; not modified by change 
 of position. No hydrostatic 
 level. 
 
 8. No change in areas of 
 dullness and resonance with 
 change of position. Dull- 
 ness over cyst. Clear reso- 
 nant note in all parts beyond 
 cyst limits, i.e. in flanks and 
 toward the diaphragm. 
 
 9. Vaginal fluctuation less 
 clear or absent. 
 
 152 
 
MEDICAL RECORD. 
 
 ASCITES. 
 
 OVARIAN CYST. 
 
 io. Uterus in prolapsed 
 location, but position un- 
 changed. Size and mobility 
 unchanged. 
 
 it. Hydragogues and diu- 
 retics temporarily remove 
 the fluid. 
 
 12. Fluid light straw color 
 and thin. Coagulates spon- 
 taneously. 
 
 10. Uterus displaced for- 
 ward or backward, or later- 
 ally by pressure of cyst. 
 
 11. Medicines have no ef- 
 fect. 
 
 12. Fluid light or dark 
 and of varying consistency; 
 albuminous, but does not 
 coagulate spontaneously ; 
 mav contain colloid matter. 
 
 — (From Dudley's Gynecology.) 
 5. See Williams' "Obstetrics" (1909), page 62s; or 
 Hirst's "Obstetrics" (1909), page 284. 
 
 SURGERY. 
 
 1. Conditions which justify amputation of a limb are: 
 "Any injury, disease, or malformation rendering retention 
 of the limb incompatible with life or comfort; avulsion of 
 limb; compound fracture; compound dislocation; fracture 
 with great comminution of bone; laceration of important 
 vessels ; extensive contusion ; extensive laceration ; gunshot 
 injuries; aneurysm; effects of heat and cold; gangrene; ex- 
 tensive bone disease; tumors; elephantiasis; tetanus; snake 
 bite; deformities." — (Bickham's Operative Surgery.) 
 
 Amputations are classified in regard to time of operating, 
 as follows: (1) Primary, which is performed soon after 
 the accident, as soon as the patient reacts from shock and 
 before there is any fever. (2) Secondary, which is under- 
 taken some time after the injury, when suppuration or bone 
 or joint disease have supervened. (3) Intermediate, which 
 is performed during the existence of the fever, but before 
 suppuration or bone or joint disease have appeared. 
 
 The most favorable period of amputating is after moder- 
 ate reaction has been established; in the primary period. 
 
 See Da Costa's "Surgery" (1908), page 1221. In a 
 cross section of the thigh, at the middle third, there are 
 severed : Muscles, Vastus internus, Rectus femoris, Cru- 
 reus. Vastus externus, Biceps, Semitendinosus, Semimem- 
 branosus, Gracilis, Sartorius, Adductor magnus : Arteries, 
 superficial femoral, anastomotic, deep femoral, perforating. 
 
 2. See Rose and Carless' "Surgery" (1908), pages 1068, 
 1073, 1096, 1 100, 1 103, and 1081 ; or Da Costa's "Surgery'' 
 (1908), pages 971, 999, 994, and 978. 
 
 3. See above, Practice of Medicine, No. 3. For erysip- 
 elas, see Rose and Carless' "Surgery" (1908), pages 119 
 and 122; or Da Costa's "Surgery" O908), page 200. 
 
 153 
 
MEDICAL RECORD. 
 
 FRACTURE. 
 
 1. Crepitus may be present. 
 
 2. Preternatural mobility. 
 
 3. Easily reduced — but 
 
 4. Deformity more liable to 
 
 recur after reduction. 
 
 5. The head of the bone is 
 
 in its proper place. 
 
 6. The socket containing the 
 
 head of the bone is not 
 empty. 
 
 7. When rotated the bone 
 
 does not move as one 
 piece. 
 
 DISLOCATION. 
 
 1. Crepitus never present. 
 
 2. Rigidity rather than mo- 
 
 bility. 
 
 3. Difficult to reduce— but 
 
 4. Deformity less liable to 
 
 recur after reduction. 
 
 5. The head of the bone is 
 
 not in its proper place. 
 
 6. The socket which should 
 
 contain the head of the 
 bone is empty. 
 
 7. When rotated the bone 
 
 moves as one piece. 
 
 The cardinal principles in the treatment of fractures 
 are : Reduction, coaptation, immobilization, and suitable 
 measures for promoting the nutrition of the part and for 
 preventing adhesions in the neighboring joints and mus- 
 cles. Compound fractures, in addition, demand : Asepsis, 
 removal of foreign matter or damaged tissues, stopping the 
 hemorrhage, and measures to combat shock. 
 
 4. Inflammatory diseases of bone: Osteitis, periostitis, 
 osteoperiostitis, and osteomyelitis. For ankylosis, see Rose 
 and Carless' "Surgery" (1908), pages 676 and 678; or Da 
 Costa's "Surgery" (1908), pages 575 and 576. For club- 
 foot, see Rose and Carless' "Surgery'' (1908), page 450; or 
 Da Costa's "Surgery" (1908), page 662. 
 
 5. For abscess and aneurysm, see Rose and Carless' 
 "Surgery" (1908), page 311; or Da Costa's "Surgery" 
 (1908), page 361. Hydrocele: Is pyriform in shape; the 
 swelling is first noted at the lowest part of the scro- 
 tum ; it is tense, smooth, and fluctuates ; it is dull on per- 
 cussion; it is translucent; the testicle is behind the tumor; 
 there is no impulse on coughing. Scrotal hernia: 
 Is sausage-shaped; the swelling begins above; it is not 
 translucent; the testicle is below the tumor; there is an 
 impulse on coughing, as a rule. — {Treatment of Hydro- 
 cele.) See Rose and Carless' "Surgery" (1908), page 
 1267; or Da Costa's "Surgery" (1908), page 1201. Method 
 of controlling hemorrhage: Mechanical, elevation, pres- 
 sure, torsion, ligation, compression, acupressure, and 
 forced flexion of limb. Therapeutic, heat, cold, styptics, 
 and the cautery. The constitutional symptoms must also 
 be treated : lower the head, inject normal salt solution, ad- 
 minister alcohol, strychnine, digitalis, morphine. For sec- 
 ondary hemorrhage: See Rose and Carless' "Surgery" 
 (1908), page 290; or Da Costa's "Surgery" (1908), page 
 394- 
 
 154 
 
MEDICAL RECORD. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Idaho State Medical Licensing Board. 
 
 anatomy. 
 
 i. Give the deep and superficial origin, course, and dis- 
 tribution of the pneumogastric nerve. 
 
 2. What constitutes the brachial plexus? 
 
 3. Give the origin, insertion, and nerve supply of the 
 (a) longest and (b) shortest muscle in the body. 
 
 4. Name the flexor muscles of the forearm and describe 
 one of them. 
 
 5. Describe the sternum, its articulations, and the im- 
 portant muscles attached to it. 
 
 HISTOLOGY. 
 
 1. From what primary layer is the nervous system de- 
 veloped? The peritoneum? The mucous membrane? The 
 kidneys? The teeth? 
 
 2. What are the following: Corpus luteum? Macula 
 lutea? Loop of Henle? Paccinian bodies? Stomata? 
 
 3. Describe the structure of the thyroid gland. 
 
 4. Mention all the histological bodies found in normal 
 blood. 
 
 5. Name the layers of the retina. 
 
 PHYSIOLOGY. 
 
 1. Name the reflex centers of the medulla oblongata. 
 
 2. Is there any localization in the cerebellar cortex? 
 
 3. Name and give the location of the several sympa- 
 thetic ganglia. 
 
 4. Name the principal secreting organs and the general 
 types of structure. 
 
 5. What change takes place in the blood during its 
 passage through the capillaries of the lungs? 
 
 6. Define external and internal secretions, and give an 
 example of each. 
 
 7. Define proteoses and peptones, and say by what 
 process those products are evolved during digestion. 
 
 8. Describe the structure of the uterus. 
 
 9. Give all the causes of contraction of the pupil. 
 
 10. Describe the act of deglutition. By what nerve 
 centers is the process controlled? 
 
 CHEMISTRY AND TOXICOLOGY. 
 
 i. Give the chemical name and formula of (a) common 
 salt, (b) marble, (c) plaster-of-paris, (d) borax, (e) blue 
 vitriol, ■(/) sulphate of iron. 
 
 2. Give the symbol, atomic weight, and valence of five 
 
 non-metals and of five metals. 
 
 155 
 
MEDICAL RECORD. 
 
 3. Define molecular weight and molecular volume. Give 
 an example of each. 
 
 4. Describe two experiments showing the difference 
 between mechanical and chemical action. 
 
 5. Which is the most abundant element? Name the 
 elements represented by the following symbols : K, Na, 
 Ni, Si, Sb, S, Mg, Pb, Cu, Hg, Ag, Co, Mn, F, P. 
 
 6. How may poisons be classified? Give the manner of 
 action of each class. 
 
 7. What is the difference between ptomains and leuco- 
 mains? Give example of each. 
 
 8. Describe symptoms of toxic doses of strychnine, 
 morphine, strophanthus, hydrocyanic acid, and aconite. 
 
 9. What antidotes should be used in phosphorus poison- 
 ing? Explain the action of each. 
 
 10. What is the chemical treatment for carbolic acid 
 poisoning? 
 
 PATHOLOGY. 
 
 1. Define and describe thrombosis, embolism, metastasis, 
 necrosis. 
 
 2. What is amyloid degeneration? In what organs does 
 it generally occur? 
 
 3. Describe the process of parenchymatous inflammation. 
 
 4. Decribe the bacillus of tuberculosis. Describe a 
 tubercle. 
 
 5. State the pathology of fibrinous or lobar pneumonia. 
 
 6. Give the pathological lesions of typhoid fever. 
 
 7. Give the pathology of chronic interstitial nephritis. 
 
 8. Describe the skin lesions occurring in psoriasis. 
 
 9. Locomotor ataxia; give its pathology. 
 
 10. What changes occur in the red blood corpuscles in 
 progressive pernicious anemia? 
 
 DIAGNOSIS. 
 
 1. Tuberculin tests ; give description of, uses, and 
 results. 
 
 2. Give diagnosis of acute pancreatitis. 
 
 3. Differentiate choleocystitis and cholangitis. 
 
 4. Differentiate nephrolithiasis, chronic parenchymatous 
 nephritis, and chronic interstitial nephritis. 
 
 5. Give blood findings in anemia. 
 
 6. Name three diseases caused by microorganisms, de- 
 scribe each organism, and give method of staining. 
 
 7. Differentiate between chronic pneumonia and tuber- 
 culosis of the lungs. 
 
 8. Give concise description of the heart murmurs, where 
 found. 
 
 9. Differentiate between cerebral and gastric vomiting. 
 
 10. (a) Describe Hutchinson's teeth and state in what 
 disease they are most commonly found. (b) What is 
 
 156 
 
MEDICAL RECORD. 
 
 Babinski's sign? (c) Koplik's spots? (d) Cheyne-Stokes 
 respiration; when found? 
 
 THEORY AND PRACTICE. 
 
 i. Give methods of feeding infants who are deprived 
 of mother's milk. 
 
 2. Stomatitis, varieties, symptoms, diagnosis, and treat- 
 ment. 
 
 3. Give short description of serum therapy and name 
 diseases in which it has been successfully employed. 
 
 4. Give etiology, symptoms, prognosis, diagnosis, and 
 treatment of acute ileocolitis. 
 
 5. Give etiology, symptoms, diagnosis, prognosis, com- 
 plications, and treatment of typhoid fever. 
 
 6. Same of gonorrheal arthritis. 
 
 7. Same of tabes dorsalis. 
 
 8. Same of cerebrospinal meningitis, including micro- 
 scopic specimen; how obtained and findings. 
 
 9. Describe bronchiectasis, give symptoms, physical 
 signs, and treatment. 
 
 10. Give etiology, symptoms, prognosis, diagnosis, and 
 treatment of rachitis. 
 
 OBSTETRICS. 
 
 1. Give diagnosis of cystic degeneration of the chorion; 
 treatment; prognosis. 
 
 2. Give mechanism of labor, vertex presentation. 
 
 3. Give presumptive and positive signs of pregnancy. 
 
 4. Give management of lateral placenta prsevia. 
 
 5. Give management of threatened abortion ; treatment 
 of complete abortion. 
 
 6. How diagnose ectopic pregnancy? 
 
 7. What conditions would necessitate (a) version, 
 (b) Cesarean section, (c) forceps delivery? 
 
 8. Why is it necessary hastily to deliver the head in 
 breech or foot presentations? . 
 
 9. What is the cause of phlegmasia alba dolens? 
 
 10. How diagnose and treat invertion of the uterus? 
 
 GYNECOLOGY. 
 
 1. Give the etiology, symptoms, and treatment of acute 
 pelvic peritonitis. 
 
 2. Give the etiology, symptoms, and treatment of acute 
 ovaritis. 
 
 3. _ Make a differential diagnosis between ascites and 
 ovarian cyst. 
 
 4. Give the symptoms and treatment of membranous 
 dysmenorrhea. 
 
 5. Define and give the etiology and symptoms of pelvic 
 hematocele. 
 
 157 
 
MEDICAL RECORD. 
 
 6. Give the etiology, symptoms, and treatment of 
 abscess of the vulvovaginal gland. 
 
 7^ Describe the symptoms of salpingitis. Name the va- 
 rieties of salpingitis according to the tubal contents. 
 
 8. Give the symptoms and treatment of urethral car- 
 uncle. 
 
 9. Describe the symptoms and treatment of a recto- 
 vaginal fistula. 
 
 io. Give the symptoms and treatment of gonorrheal 
 vaginitis. Name the complications. 
 
 SURGERY. 
 
 i. Define asepsis; mention a few of the best antiseptics. 
 
 2. Mention five common suture materials and tissues 
 best joined by each. 
 
 3. Write less than two hundred words, stating your 
 practice with regard to drainage. 
 
 4. Give treatment for paronychia, hordeolum, empyema. 
 
 5. How would you diagnose cystic calculi? 
 
 6. Give the differential diagnosis of appendicitis. 
 
 7. How treat peritonitis? 
 
 8. Give treatment for ingrowing toenail; treatment for 
 actinomycosis. 
 
 9. Mention surgical complications of typhoid fever. 
 
 10. J What is appendicostomy, dactylitis, osteomyelitis, 
 Dubois' abscess, hysterotrachelorrhaphy? 
 
 HYGIENE. 
 
 i. Name the principal constituents of soil and its 
 physical properties. 
 
 2. Define tilth, marl, loam, humus, peat, muck, and state 
 which of those soils will retain the greatest amount of 
 water, and which is most inimical to pathogenic organisms. 
 
 3. To what average depth is soil self -purifying, by 
 what natural agents is the work accomplished, and how do 
 the dwellers on the soil retard it? 
 
 4. Name the different sources of our water supply and 
 its sanitary classification. 
 
 5. How may a well be polluted by a cessrjool on a lower 
 level or remain unaffected by one on higher ground? 
 Answer by diagram if you wish. 
 
 6. Describe an ordinary filter bed for the purification of 
 water, and say what is the fundamental principle of 
 Dibdin's bacteria beds, and Cameron's septic tank. 
 
 7. Do we inspire and expire microorganisms? 
 
 8. Describe the atmospheric conditions desirable for the 
 support of human life. 
 
 9. What effect upon the blood results from the inhala- 
 tion of carbon monoxide and what per cent, by volume is 
 fatal to animal life? 
 
 158 
 
MEDICAL RECORD. 
 
 io. Tabulate the conditions of hygienic interest with 
 regard to various employments. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Idaho State Medical Licensing Board. 
 
 anatomy. 
 
 1. Pneumogastric nerve. Superficial origin: Groove 
 between restiform and olivary bodies. Deep origin: Nuclei 
 in floor of fourth ventricle. Course: Outward across the 
 flocculus, to jugular foramen through which it passes, here 
 it is joined by the accessory portion of the spinal accessory 
 nerve. As it goes down the neck it lies in front of the 
 rectus capitis anticus major and longus colli muscles. It 
 passes in the carotid sheath behind and between the artery 
 and vein. In the thorax the nerve on each side runs a 
 different course. The right passes between the subclavian 
 artery and vein, by side of trachea to root of lung, behind 
 esophagus, through esophageal opening in diaphragm to 
 posterior surface of stomach. The left passes between the 
 subclavian and carotid arteries, in front of arch of aorta 
 to root of lung, along anterior surface of esophagus, 
 through diaphragm, to anterior surface of stomach. Dis- 
 tribution is shown by the names of the branches: Menin- 
 geal, auricular, pharyngeal, superior and inferior laryngeal, 
 cardiac, pulmonary, esophageal, and gastric. 
 
 2. The brachial plexus is formed by the union and subse- 
 quent division of the anterior divisions of the fifth, sixth, 
 seventh, and eighth cervical and the first dorsal nerves. 
 The union of the fifth and sixth makes the upper trunk; 
 the seventh forms the middle trunk, and the eighth cervical 
 and first dorsal make the lower trunk. Each of these trunks 
 is divided into an anterior and a posterior branch. The 
 auterior branches, from the upper and middle trunks, make 
 the upper or outer cord of the plexus ; the anterior branch 
 of the lower trunk becomes the lower or inner cord; the 
 three posterior branches unite to form the posterior or 
 middle cord. The plexus lies between the Scalenus anticus 
 and medius. The branches are: (i) Above the clavicle; 
 communicating, muscular, posterior thoracic, and supra- 
 scapular. (2) From outer cord: External anterior thoracic, 
 musculocutaneous, and outer head of median. (3) From 
 inner cord: Internal anterior thoracic, lesser internal cuta- 
 neous, ulnar, and inner head of median. (4) From pos- 
 terior cord: Subscapular, circumflex, and musculospiral. 
 
 3. Longest muscle in body is Sartorius. Origin: An- 
 terior superior spine of ilium, and notch below. Insertion: 
 
 159 
 
MEDICAL RECORD. 
 
 Inner and upper part of shaft of tibia. Nerve supply: An- 
 terior crural. Shortest muscle is probably Stapedius. 
 Origin: Pyramid of tympanum. Insertion: Neck of 
 stapes. Nerve supply: Facial. 
 
 4. Biceps, brachials anticus, supinator longus, pronator 
 radii teres. The Supinator longus arises from the upper 
 two-thirds of the external supracondylar ridge of the hu- 
 merus, and is inserted into outer side of the base of the 
 styloid process of the radius. It is superficial for most of 
 its extent; it is supplied by the musculospiral nerve. Be- 
 sides being a flexor of the forearm, this muscle acts both 
 as a pronator and supinator ; it tends to bring the bones of 
 the forearm into a position midway between pronation and 
 supination. 
 
 5. The Sternum is a flat, narrow bone, situated in the 
 median line of the front of the thorax. It consists of three 
 portions : Manubrium, gladiolus, and ensiform. It is about 
 seven inches long. At the junction of the first two pieces 
 is the angle of Ludovic; and here the second costal carti- 
 lage joins the bone. It articulates with the clavicle and 
 seven costal cartilages on each side. Muscles attached are : 
 Pectoralis major, sternomastoid, sternohyoid, sterno- 
 thyroid, diaphragm, triangularis sterni, and aponeuroses of 
 external oblique, internal oblique, rectus abdominis, and 
 transversalis. 
 
 HISTOLOGY. 
 
 1. The nervous system is developed from the epiblast; 
 the peritoneum, from mesoblast; mucous membrane, from 
 epiblast and hypoblast; kidneys, from mesoblast; teeth, the 
 enamel from the epiblast, dentine from the mesoblast. 
 
 2. Corpus luteum is a yellow body formed in the ovary 
 at the site where an ovum has been discharged from a 
 Graafian follicle. Macula lutea is a yellow depressed spot 
 at the center of the retina; vision is most acute here. Loop 
 of Henle is a part of the convoluted uriniferous tubule of 
 the kidney. Pacinian bodies are ovoid, laminated bodies 
 surrounding the termination of certain nerves in the skin 
 and mesentery and corpora cavernosa. Stomata are minute 
 orifices between endothelial (and other) cells. 
 
 3. The thyroid gland "is surrounded by a capsule that 
 sends in trabecule, which divide the gland into lobes and 
 lobules. These divisions are irregular, and the lobules are 
 composed of a number of short tubules, sometimes called 
 follicles. Each tubule is lined by cuboidal epithelial^ cells 
 that rest upon a basement membrane ; outside of this is the 
 intralobular, or intertubular, connective tissue that supports 
 the blood-vessels. In the tubules is seen a peculiar, homo- 
 geneous substance, the colloid substance, that is supposedly 
 the result of the activity of the cells. It has a yellowish 
 
 160 
 
MEDICAL RECORD. 
 
 color, and as blood cells are frequently seen in it, the 
 color may be due to the hemoglobin from these." — (Ra- 
 dasch's Compend of Histology.) 
 
 4. Ked corpuscles; white corpuscles (small mononuclear, 
 large mononuclear, transitional, polynuclear, esinophile) ; 
 platelets. 
 
 5. (1) Layer of pigment cells; (2) layer of rods and 
 cones; (3) the external limiting membrane; (4) the outer 
 nuclear, or granular, layer; (5) the outer molecular, or 
 reticular, layer; (6) the inner nuclear, or granular, layer; 
 (7) the inner molecular or reticular layer; (8) the layer 
 of ganglion cells; (9) the layer of nerve fibers; and (10) 
 the internal limiting membrane. 
 
 PHYSIOLOGY. 
 
 1. (1) Center for mastication, (2) for secretion of 
 saliva, (3) for sucking, (4) for deglution, (5) for vomit- 
 ing, (6) for voice, (7) center for expression, (8) cardiac 
 centers, (9) respiratory centers, (10) vasomotor centers. 
 
 2. Strictly speaking, there is no localization. 
 
 3. Ganglion of Ribes, on anterior communicating artery. 
 Superior cervical, in front of the transverse processes of 
 the second and third cervical vertebrae. Middle cervical, 
 opposite sixth or seventh cervical vertebra, and in relation 
 with inferior thyroid artery. Inferior cervical, over back 
 of first rib, and beneath vertebral artery. First thoracic, 
 beneath head of first rib; sometimes blends with inferior 
 cervical. Second to eleventh thoracic, on heads of ribs, 
 under cover of pleura. Twelfth thoracic, on side of twelfth 
 thoracic vertebrae, behind diaphragm. Four lumbar ganglia, 
 in front of bodies of lumbar vertebrae, on inner side of 
 psoas, and being overlapped by aorta and inferior vena 
 cava. Four sacral ganglia, on inner side of anterior sacral 
 foramina. Ganglion impar, in front of coccyx. Also 
 ophthalmio ganglia, at back of orbit. Sphenopalatina, in 
 sphenomaxillary fossa. Otic, below foramen ovale. Sub- 
 maxillary, above submaxillary gland and behind mylohyoid 
 muscle. 
 
 4. Liver, pancreas, salivary glands, intestinal glands ; 
 sweat, and sebacceous glands ; testes, Cowper's glands, mam- 
 mary glands ; lacrymal glands ; small gland in respiratory 
 tract; ductless glands (spleen, thyroid, thymus, and supra- 
 renals). 
 
 General types of structure: I. Simple glands. — Duct 
 undivided, (a) Simple tubular: Undilated at end. (b) 
 Simple acinous (alveolar or saccular): Dilated at end. 
 II. Compound glands. — Duct divided. (a) Compound 
 tubular: Branched elongated tubes, no acini, (b) Com- 
 pound acinous or alveolar (racemose glands), branched 
 duct with saccular acini on terminal branches, (c) Acino- 
 
 161 
 
MEDICAL RECORD 
 
 tubular. — Branched duct, with elongated narrow acini on 
 terminal branches. 
 
 5. (1) The giving up of the C0 2 by the venous, blood, 
 (2) the absorption of oxygen during inspiration, (3) cool- 
 ing of the blood, (4) loss of a small amount of watery 
 vapor, (5) the color becomes red. 
 
 6. External secretions are such as are carried off from 
 the secreting gland by a duct; as, the bile. Internal secre- 
 tions are such as are not carried off by a duct, but are 
 discharged into the blood or lymph; as, the secretion of 
 the thyroid (or other ductless glands). 
 
 7. Proteoses are intermediate products between proteids 
 and peptones. Peptones are the final product of digestion 
 of proteids. They are both evolved by the action of the 
 pepsin of the gastric juice, and the trypsin of the pan- 
 creatic juice, during the digestion of proteids. 
 
 8. See Cunningham's "Anatomy" (1909), page 1187; or 
 Gray's "Anatomy" (1908), page 1498. 
 
 9. (1) Stimulation by light; (2) stimulation of third 
 cranial nerve; (3) paralysis of cervical sympathetic; (4) 
 accommodation for near objects; (5) sleep; (6) myotic 
 drugs, such as opium; (7) turning inwards of the eyeball. 
 
 10. Deglutition: "The masticated food is gathered up 
 by the tongue and formed into a bolus between the tongue 
 and the hard palate. The tongue is then pressed from be- 
 fore backwards against the roof of the mouth, and the 
 bolus slips back, through the fauces, and is ultimately 
 grasped by the pharyngeal muscles, and passed into the 
 esophagus. The act of deglutition is divided into three 
 stages : "The first stage is a voluntary act, by which the 
 food is carried back to the anterior pillars of the fauces. 
 The second stage consists in the passage of the bolus 
 from the anterior pillars of the fauces to the commence- 
 ment of the esophagus; this is a reflex act, and is per- 
 formed very rapidly, as the food has to pass over the 
 opening of the larynx. As soon as the bolus arrives at the 
 isthmus of the fauces, the pharynx is prepared for its re- 
 ception. The hyoid bone is drawn forwards and upwards, 
 so that the larynx is protected by the base of the tongue, 
 which projects over it; the epiglottis^ being closed at the 
 same time, and the vocal cords approximated so as to close 
 the rima glottidis. The pharynx itself is shortened and 
 drawn forward by the contraction of the palato-pharyngei 
 muscles ; the soft palate is also raised and made tense, thus 
 cutting off the upper part of the pharynx and posterior 
 nares, and forming an incline under which the bolus is 
 passed into the pharynx. This passage is effected by the 
 elevation of the hyoid bone and the base of the tongue, and 
 the simultaneous contraction of the pillars of the fauces. 
 The bolus is then seized and carried rapidly down past the 
 
 162 
 
 i 
 
MEDICAL RECORD. 
 
 larynx by the pharyngeal constrictors. The third stage of 
 the act of deglutition is due to the peristaltic contractions 
 of the esophagus." The nerve centers are in the medulla. 
 
 CHEMISTRY AND TOXICOLOGY. 
 
 (a) Common salt 
 
 (&) Marble 
 
 (c) Plaster of Paris.. 
 
 (d) Borax 
 
 (e) Blue vitriol 
 
 (/) Sulphate of iron. . 
 
 2. 
 
 CHEMICAL NAME. 
 
 Sodium chloride 
 Calcium carbonate 
 Calcium sulphate 
 Disodic tetraborate 
 Cupic sulphate 
 Ferrous sulphate 
 
 FORMULA. 
 
 NaCl 
 
 CaCOs 
 
 CaSO* 
 
 Na 2 B 4 7 
 
 CuSO* 
 
 FeSO* 
 
 
 SYMBOL. 
 
 ATOMIC 
 WEIGHT. 
 
 VALENCE. 
 
 Five non-metals: 
 
 i. Hydrogen 
 
 2. Oxygen 
 
 3. Nitrogen 
 
 4. Fluorine 
 
 5. Chlorine 
 
 Five metals: 
 
 1. Mercury 
 
 2. Copper 
 
 3. Aluminum 
 
 H 
 
 N 
 F 
 CI 
 
 Hg 
 Cu 
 Al 
 Au 
 Ag 
 
 I 
 
 16 
 14 
 19 
 
 35.5 
 
 200 
 63 
 27 
 
 197 
 
 I08 
 
 I 
 
 2 
 
 3 or 5 
 1 
 
 1 
 
 2 
 2 
 
 3 
 1 or 3 
 
 1 
 
 4. Gold 
 
 5. Silver 
 
 3. Molecular weight is the weight of a molecule of a 
 substance as compared with the weight of an atom of 
 hydrogen. It may also be said to be the sum of the weights 
 of the atoms composing the molecule. Thus, the molecule 
 weight of sulphuric acid, H 3 S0 4 is (2 + 32 + 64), that is, 
 98; or 98 times the weight of an atom of hydrogen. Mole- 
 cule volume is the molecular weight divided by the specific 
 gravity. 
 
 4. "When a cylinder of lime is strongly heated it be- 
 comes white hot and emits light; it is still lime, however, 
 after the action of the heat, as it was before. This is a 
 physical phenomenon. If, now, we throw this lime into 
 hydrochloric acid it disappears, and, after the action has 
 been completed, we find neither lime nor hydrochloric acid, 
 but two new substances, one a solid, called calcium chlorid, 
 the other a liquid — water; both of which differ in their 
 composition from the original substances, which have disap- 
 peared. This is a chemical phenomenon." 
 
 5. The most abundant element is oxygen. K is potas- 
 
 163 
 
MEDICAL RECORD. 
 
 sium ; Na, sodium ; Ni, nickel ; Si, silicon ; Sb, antimony ; 
 S, sulphur ; Mg, magnesium ; Pb, lead ; Cu, copper ; Hg, 
 mercury; Ag, silver; Co, cobalt; Mn, manganese; F, fluor- 
 ine; P, phosphorus. 
 
 6. Poisons may be classified as: (i) Mineral, (2) vege- 
 table, (3) animal, and (4) synthetic. 
 
 7. Ptomains are basic, nitrogenous compounds, produced 
 from protein material by the bacteria which cause putre- 
 faction. Examples: Cadaverin, and putrescin. Lencomains 
 are similar substances produced in living animals during 
 normal metabolism. Examples: Xanthin and hypoxanthin. 
 . 8. The symptoms of strychnine poisoning are as follows : 
 A sense of suffocation, thirst, tetanic spasms, usually opis- 
 thotonos, sometimes emprosthotonos, occasionally vomiting, 
 contraction of the pupils during the spasms, and death, 
 either by asphyxia during a paroxysm or by exhaustion 
 during a remission. The symptoms of poisoning by mor- 
 phine are as follows : At first there is usually a period of 
 excitation, marked by restlessness, great physical activity, 
 loquacity, and hallucinations. The patient then becomes 
 weary, dull, and drowsy; he yields to the desire for sleep, 
 from which at first he may be roused. The lips are livid, 
 the face pale, the pupils contracted, and the surface bathed 
 in perspiration. The condition of somnolence rapidly 
 passes into narcosis. The patient cannot be roused, and 
 lies motionless and senseless, with completely relaxed mus- 
 cles. The pulse, at first full and strong, becomes feeble, 
 slow, irregular, and easily compressible ; the respiration 
 slow, shallow, stertorous, and accompanied by mucous 
 rales. The patient rapidly becomes comatose, and in fatal 
 cases, dies in from 45 minutes to 56 hours, usually in from 
 12 to 18 hours. Strop hanthus causes : Nausea, colic, diar- 
 rhea, slow pulse, dyspnea, headache, vertigo, cold extremi- 
 ties, drowsiness, and syncope. Hydrocyanic acid causes : 
 Constriction of throat, vertigo, mental confusion, loss of 
 muscular power, quick pulse, slow respirations, tetanic con- 
 vulsions, loss of control of sphincters, and paralysis. 
 Aconite causes: Numbness and tingling, first of the mouth 
 and fauces, later becoming general. Dryness and constric- 
 tion in the throat. Persistent vomiting usually occurs, but 
 is absent in some cases. There is diminished sensibility, 
 with numbness, great muscular feebleness, giddiness, loss 
 of speech, irregularity and failure of the heart's action. 
 
 9. Antidotes to phosphorus are: Old French oil of tur- 
 pentine and potassium permanganate. The latter acts as an 
 oxidizing agent. Fats and oils must not be given, as they 
 would help in the absorption of the phosphorus. 
 
 10. For carbolic acid poisoning: Give sodium sulphate, 
 or magnesium sulphate, or albumin ; follow this with lavage. 
 Alcohol is also recommended. 
 
 164 
 
MEDICAL RECORD. 
 
 PATHOLOGY. 
 
 i. Thrombosis is the coagulation of the blood within the 
 vessels during life. Embolism is the plugging of a blood- 
 vessel by a foreign body. Causes of thrombosis: (i) 
 Changes in the walls of the blood-vessels, due to the pres- 
 ence of infection or foreign bodies; (2) changes in the 
 blood, whereby its tendency to coagulate is increased; (3) 
 diminished rate of the blood flow, due to weak heart action 
 or obstruction. Embolism is generally due to thrombi, but 
 is also caused by fragments of vegetations or atheromatous 
 or calcareous masses from the cardiac valves or the intima 
 of the arteries; other causes are parasites, pieces of new 
 growths, pigment granules, fluid fat, or air. Metastasis is 
 the transfer of some pathological condition from one part 
 of the body to another not immediately connected with it. 
 Necrosis is the complete and permanent arrest of nutrition 
 in a part; or local death of tissue. 
 
 2. Amyloid degeneration is a degenerative process in 
 which the affected tissues have a whitish waxy appearance, 
 due to the presence of a colorless, firm, translucent and 
 lardaceous substance. With iodine it gives a blue stain. 
 It generally occurs in : Liver, kidneys, spleen, lymphatic 
 glands, intestines. 
 
 3. Parenchymatous inflammation is the name occasionally 
 given to an inflammatory process when it attacks the active 
 cells and tissues of an organ; as in parenchymatous ne- 
 phritis, where the renal epithelium is affected. 
 
 4. The tubercle bacillus is rod shaped, is from 1% to $y 2 
 mikrons in length, and about one-third to one-half a 
 mikron in breadth, is a strict parasite, is not motile, and has 
 no flagella ; it has no spores, is non-liquefying, non-chromo- 
 genic, erobic, and acid-resisting. A tubercle is a small 
 nodule, found in the lungs or other organs in cases of 
 tuberculosis, but also found in other diseased conditions. 
 It consists of three layers, the outer one consisting of 
 lymphoid cells, the middle one of epitheloid cells, and the 
 inner one of giant cells. These layers are squeezed or 
 compressed into a firm mass, which may caseate or un- 
 dergo other pathological processes. There is no blood 
 supply to a tubercle. 
 
 5. See French's "Practice of Medicine" (1907), page 154; 
 or Osier's "Practice of Medicine" (1909), page 170. 
 
 6. See French's "Practice of Medicine" (1907), page 70; 
 or Osier's "Practice of Medicine" (1909), page 65. 
 
 7. See French's "Practice of Medicine" (1907), page 902; 
 or Osier's "Practice of Medicine" (1909), page 695. 
 
 8. Round or oval red patches, covered with adherent, 
 silvery, or gray scales; these occur chiefly on the extensor 
 surfaces of elbow, knee, and limbs ; also on scalp. There 
 
 165 
 
MEDICAL RECORD. 
 
 is more or less itching, and the condition is apt to be 
 chronic. On removing the scales a red, punctate, bleed- 
 ing surface is found. 
 
 9. See French's "Practice of Medicine" (1907), page 
 1047; or Osier's "Practice of Medicine" (1909), page 887. 
 
 10. (1) Diminution in number; (2) relative increase in 
 amount of hemoglobin; (3) poikilocytosis ; (4) some are 
 nucleated; (5) variation in size. 
 
 DIAGNOSIS. 
 
 1. The tuberculin test consists in giving a hypodermic 
 dose of 1 mg. of the fluid; if no reaction occurs in 
 twenty-four hours, a dose of 2 mg. is given; if, again, there 
 is no reaction in twenty-four hours, a dose of 3 rng. is 
 given. The maximum dose is 10 mg. Its use is to aid in 
 the diagnosis of tuberculosis. Results: It is said to be 
 valuable; but some say it should never be used. 
 
 2. Pain in epigastrium, which is sudden and severe; 
 vomiting; collapse; swelling and tenderness over epigas- 
 trium ; and slight fever. 
 
 3. In cholecystitis are : Pain in and tenderness over gall- 
 bladder; muscular rigidity; fever, rapid pulse, vomiting. 
 In cholangitis the symptoms are much the same, but the 
 pain is very much more severe, and radiates to right shoul- 
 der; the fever is also less. 
 
 4. Neprolithiasis is characterized by: Renal colic, with 
 pain radiating to testicle; hematuria; tenderness over af- 
 fected kidney; jr-ray may show the calculus. This condi- 
 tion is not likely to be mistaken for the two forms of 
 nephritis. In chronic parenchymatous nephritis: The 
 arine is slightly diminished, turbid, has abundance of albu- 
 min, generally some blood, abundance of sediment, blood 
 corpuscles, casts (especially fatty), diminished urea; may 
 be cardiac hypertrophy; marked dropsy, and often uremia. 
 In chronic interstitial nephritis: The urine is increased 
 in quantity, pale, clear, of low specific gravity, little or 
 no albumin, scanty sediment, few casts, diminished urea; 
 the heart is hypertrophied, sometimes considerably; dropsy 
 often absent till heart fails ; uremia frequent. 
 
 5. In secondary anemia: (1) A diminution in the num- 
 ber of red corpuscles ; (2) a diminution in the amount of 
 hemoglobin, perhaps greater than that of the red cor- 
 puscles; (3) poikilocytosis, and variations in the size of 
 the red corpuscles; (4) the presence of a few nucleated 
 red corpuscles; (5) a moderate leucocytosis. In pernicious 
 anemia: (1) A diminution in the number of red cor- 
 puscles; (2) a relative increase in the amount of hemo- 
 globin; (3) poikilocytosis; (4) the presence of nucleated 
 red cells; (5) variation in the size of the red cells; (6) the 
 leucocytes may be diminished. 
 
 166 
 
MEDICAL RECORD. 
 
 6. (i) Tuberculosis. For description of bacillus, see 
 above, Pathology, Question 4. For staining (in sputum) : 
 See French's "Practice of Medicine" (1907). page 1216. 
 (2) Gonorrhea. The Gonococcus is a diplococcus with a 
 special predilection for the mucous membrane of the ureth- 
 ra; it is sometimes found on the conjunctiva. The ap- 
 pearance is that of two coffee beans; the gonococcus is 
 found in the pus cells, stains with ordinary anilin dyes, but 
 not by Gram's method. It is erobic, and can be cultivated 
 on human blood serum; it will not grow on gelatin, agar, 
 bouillon, or potato. (3) Diphtheria. The Klebs-Loeffler 
 bacilli are from 2 to 6 mikrons in length and from 0.2 to 1.0 
 mikron in breadth; are slightly curved, and often have 
 clubbed and rounded ends ; occur either singly or in pairs, 
 or in irregular groups, but do not form chains; they have 
 no flagella, are non-motile, and erobic; they are noted for 
 their pleomorphism ; they do not stain uniformly, but 
 stain well by Gram's method and very beautifully with 
 Loeffler's alkaline-methylene blue. 
 
 7. The symptoms and physical signs of lobar pneumonia 
 and acute pneumonic phthisis may be the same for the first 
 eight or ten days; at this period the fever in pneumonia 
 drops by crisis ; whereas in phthisis the fever continues for 
 some time longer and the patient gets worse; the sputum 
 contains tubercle bacilli and elastic fibers, and instead of 
 retaining the rusty color it becomes purulent and greenish. 
 
 In pneumonia, the breathing is very rapid, the pulse- 
 respiration rate is disturbed, the fever is usually high, and 
 runs a regular course, crepitant rales are heard at first, 
 then signs of consolidation follow, and crepitant rales 
 again succeed. In phthisis, the breathing is hurried and 
 there is dyspnea, the fever is often high, but does not run 
 a regular course, at first the signs are those of bronchitis, 
 followed by consolidation, a softening, or excavation in 
 different parts of the lungs ; sometimes there is nothing to 
 be heard but scattered rales. 
 
 8. (1) A systolic murmur, soft and blowing, heard best 
 at the apex, and transmitted to the left axilla and toward 
 the angle of the left scapula, indicates mitral regurgitation. 
 (2) A presystolic murmur, harsh and rough, heard best 
 very near the apex, and not transmitted, denotes mitral 
 stenosis. (3) A diastolic murmur, soft, heard best in the 
 second right intercostal space, and transmitted down the 
 sternum or toward the apex, denotes aortic regurgitation. 
 (4) A systolic murmur, harsh, heard best in the second 
 right intercostal space, and transmitted into the carotids, 
 denotes aortic stenosis. (5) A systolic murmur, heard best 
 over the lower end of the sternum, denotes tricuspid re- 
 gurgitation. (6) A presystolic murmur, heard best over the 
 ensiform cartilage, and not transmitted, denotes tricuspid 
 
 167 
 
MEDICAL RECORD. 
 
 stenosis. (7) A diastolic murmur, heard best in the second 
 left intercostal space, denotes pulmonary regurgitation. (8) 
 A systolic murmur, heard best in the second left intercostal 
 space, and not transmitted to the large vessels of the neck, 
 denotes pulmonary stenosis. (9) A murmur, usually sys- 
 tolic, soft, and blowing, heard best over the pulmonic area, 
 associated with evidences of chlorosis or anemia, and af- 
 fected by the position of the patient, is a hemic or func- 
 tional murmur, and denotes as a rule an impoverished con- 
 dition of the blood. 
 
 9. Cerebral vomiting is projectile in character, and is ac- 
 companied by little or no nausea, is continuous even after 
 stomach is emptied; there is no salivation, no tenderness 
 over liver or stomach. Gastric vomiting relieves the previ- 
 ous nausea, and returns on ingestion of food; salivation is 
 present, also tenderness over liver and stomach. 
 
 10. (a) Hutchinson's teeth are notched and stunted in 
 permanent dentition; found in hereditary syphilis. 
 
 (b) Babinski's sign: When the sole of the foot is tickled,, 
 the toes (particularly the great toe) are over-extended, 
 and separated from one another. (In primary lateral 
 sclerosis.) 
 
 (c) Koplik's spots are small red spots with a bluish cen- 
 tral area, found on the buccal mucous membrane, in 
 measles. 
 
 (d) In Cheyne-Stokes respiration the respirations gradu- 
 ally increase in volume and rapidity until they reach a 
 climax, when they gradually subside, and finally cease for 
 from ten to forty seconds, when the same cycle begins 
 again. "In the majority of instances it is associated with 
 apoplexy (toward the end), chronic nephritis (uremia), 
 tumor of the brain, tuberculous meningitis, or degeneration 
 of the heart muscle. Less frequently it is observed as a re- 
 sult of cardiac valvular defects and consequent embolism, 
 diabetes, and certain acute diseases, notably typhoid, pneu- 
 monia, pertussis, cerebrospinal fever, scarlet fever, and 
 septicemic conditions. " — (Butler's Diagnosis of Internal 
 Medicine.) 
 
 THEORY AND PRACTICE. 
 
 1. By wet nurse; by milk of cow or goat; by whole 
 milk and its dilutions ; by cream-milk mixture ; by top-milk 
 mixture; by cream-whey modifications; by milk modified 
 with cereal decoctions or dextrinized gruels; by diluted 
 condensed milk ; by "laboratory milk," which may be gravi- 
 ty-separated or centrifuged; by peptonized milk; or by any 
 of the numerous advertised substitutes. 
 
 2. See French's "Practice of Medicine" (1907), page 
 707; or Osier's "Practice of Medicine" (1909), page 434. 
 
 3. "Serum therapy depends upon the fundamental fact 
 that a group of body cells — for example, those of the cen- 
 
 168 
 
MEDICAL RECORD. 
 
 tral nervous system — have a way of rising to the emer- 
 gency when compelled to defend themselves against a group 
 of foreign cells {e.g. tetanus bacilli) and of producing in 
 excess substances antagonistic to such foreign cells or to 
 their products. Such an antagonism is known as immunity. 
 To be immune against a given cell is to possess the power 
 of poisoning or dissolving that cell. This is known as 
 antibacterial immunity. When the body is attacked, not by 
 cell groups but by cellular products, such as toxins, another 
 type of immunity is produced by virtue of which the blood 
 of the immunized individual is able to neutralize and render 
 inert the toxin molecules." — {Reference Handbook of the 
 Medical Sciences.) Diseases in which it has been success- 
 fully employed are : Diphtheria, tetanus, snake-bites, and 
 rabies. 
 
 a. See French's "Practice of Medicine" (1907), page 
 771 ; or Osier's "Practice of Medicine" (1909), page 508. 
 
 5. See French's "Practice of Medicine" (1907), page 65; 
 or Osier's "Practice of Medicine" (1909), page 57. 
 
 6. See French's "Practice of Medicine" (1907), page 216; 
 or Osier's "Practice of Medicine" (1909), page 282. 
 
 7. See French's "Practice of Medicine" (1907), page 
 1046; or Osier's "Practice of Medicine" (1909), page 886. 
 
 8. See French's "Practice of Medicine" (1907), page 
 139; or Osier's "Practice of Medicine" (1909), page 157. 
 
 9. See French's "Practice of Medicine" (1907), page 
 656; or Osier's "Practice of Medicine" (1909), page 606. 
 
 10. See French's "Practice of Medicine" (1907), page 
 932; or Osier's "Practice of Medicine" (1909), page 426. 
 
 OBSTETRICS. 
 
 i. See Williams' "Obstetrics" (1909), page 576; or 
 Hirst's "Obstetrics" (1909), page 116. 
 
 2. See Williams' "Obstetrics" (1909), page 254; or 
 Hirst's "Obstetrics" (1909), page 395. 
 
 3. Presumptive signs of pregnancy: (1) Progressive en- 
 largement of the uterus; (2) Hegar's sign; (3) Braxton 
 Hick's sign; (4) uterine murmur; (5) cessation of men- 
 struation; (6) changes in the breasts; (7) discoloration 
 of the vagina and cervix; (8) pigmentation and striae; (9) 
 morning sickness. Positive signs of pregnancy: (1) Hear- 
 ing the fetal heart sound; (2) active movements of the 
 fetus; (3) ballottement; (4) outlining the fetus in whole 
 or part by palpation; and (5) the umbilical or funic souffle. 
 
 4. See Williams' "Obstetrics" (1909), page 815; or 
 Hirst's "Obstetrics" (1909), page 577. 
 
 5. See Williams' "Obstetrics" (1909), page 617; or 
 Hirst's "Obstetrics" (1909), page 279. 
 
 6. See Williams' "Obstetrics" (1909), page 647; or 
 Hirst's "Obstetrics" (1909), page 304. 
 
 169 
 
MEDICAL RECORD. 
 
 7. (a) The indications for podalic version are: (1) In 
 transverse presentations; (2) in placenta prsevia; (3) in 
 malpresentations of the head; (4) in simple flattened pel- 
 vis, and in minor degrees of pelvic contraction; (5) in pro- 
 lapsed funis; (6) in sudden death of the mother; and (7) 
 in any case where speedy delivery is imperative, (b) The 
 absolute indications for cesarean section are: Extreme 
 pelvic contraction or deformity in which delivery by for- 
 ceps or version or symphyseotomy is impossible, and in 
 which craniotomy is either impossible or would be more 
 dangerous to the mother; the presence of extreme atresia 
 of the vagina; rupture of the uterus; sudden maternal 
 death, (c) Indications for the use of forceps are: "1. 
 Forces at fault: Inertia uteri in the presence of conditions 
 likely to jeopardize the interests of mother or child, (a) 
 Impending exhaustion; (b) arrest of head, from feeble 
 pains. 2. Passages at fault: Moderate narrowing, 3% to 
 334 inches, true conjugate; moderate obstruction in the soft 
 parts. 3. Passenger at fault: A. Dystocia due to (a) oc- 
 cipito-posterior, (b) mento-anterior face, (c) breech ar- 
 rested in cavity. B. Evidence of fetal exhaustion (pulse 
 above 160 or below 100 per minute.) 4. Accidental compli- 
 cations: Hemorrhage; prolapsus funis; eclampsia. All 
 acute or chronic diseases or complications in which imme- 
 diate delivery is required in the interest of mother or child, 
 or both." (From Jewett's Practice of Obstetrics.) 
 
 8. The head should be delivered promptly to avert the 
 chance of the child being asphyxiated. 
 
 9. Phlegmasia alba dolens is a form of manifestation of 
 puerperal sepsis in which there is a thrombosis of the iliac 
 or femoral vein. Sometimes it occurs after a uterine phle- 
 bitis, in which clots are carried from the uterine sinuses to 
 the hypogastric veins, where they cause obstruction to the 
 blood flow in the crural veins. The trouble may also begin 
 as a crural phlebitis. It is thus due either to cellulitis or 
 to thrombosis. It usually appears about the third or fourth 
 week of the puerperium. 
 
 10. See Williams' "Obstetrics" (1909), page 824; or 
 Hirst's "Obstetrics" (1909), pages 614 and 616. 
 
 GYNECOLOGY. 
 
 1. Acute pelvic peritonitis. Etiology : Infection. Symp- 
 toms: Intense and diffuse abdominal pain, tenderness, and 
 distention; vomiting, constipation, elevation of the temper- 
 ature (i03°-i04° F.), small, hard, rapid, and wiry pulse 
 (120-140), and increased respiration (30-40) of a painful 
 character are also present. The dorsal decubitus with the legs 
 ancl thighs drawn up is assumed. The duration is from 
 six to nine days and the prognosis is unfavorable. The 
 treatment consists in rest in bed, the administration of 
 
 170 
 
MEDICAL RECORD. 
 
 opium or one of its alkaloids, and the application of hot 
 or cold fomentations or turpentine stupes to the abdo- 
 men. If the affection is due to septic infection a saturated 
 solution of magnesium sulphate should be given. If sup- 
 puration has occurred abdominal section should be per- 
 formed with irrigation of the peritoneal cavity with normal 
 salt solution (temperature i05°-no° F.) and the introduc- 
 tion of drainage. — (Gould's and Pyle's Pocket Cyclopedia.) 
 2. Acute ovaritis is usually secondary to salpingitis, as 
 in gonorrhea and puerperal sepsis, but may occur as a com- 
 plication of the eruptive fevers. The symptoms are pain 
 and tenderness in the ovarian region, nausea, vomiting, rise 
 of temperature, and rapid pulse. The treatment consists 
 in rest in bed, hot vaginal douches, free purgation, hot fo- 
 mentations over the lower abdomen, and removal of the 
 diseased structures if the symptoms grow worse and sup- 
 puration ensues. 
 
 ASCITES. 
 
 i. Previous history of vis- 
 ceral disease. 
 
 2. Enlargement compara- 
 tively sudden. 
 
 3. Face puffy ; color waxy ; 
 early anemia. 
 
 4. Patient on back, en- 
 largement symmetrical; flat 
 in front. 
 
 5. Sitting up, abdomen 
 bulges below. 
 
 6. Navel prominent and 
 thinned. 
 
 7. Fluctuation decidedly 
 clear, diffuse throughout ab- 
 domen, but avoids highest 
 parts in all positions, and 
 always has a hydrostatic 
 level. 
 
 8. Intestines float on top 
 of fluid ; hence percussion 
 gives clear tympanitic note 
 over the highest parts of 
 abdominal cavity and dul- 
 ness in lowest parts for all 
 positions — i.e. areas of res- 
 onance and dullness change 
 with position. 
 
 OVARIAN CYST. 
 
 1. No such history. 
 
 2. Gradual. 
 
 3. Facies ovariana. Ane- 
 mia absent, or later. 
 
 4. Asymmetrical until tu- 
 mor is quite large; promi- 
 nent in front. 
 
 5. No appreciable change. 
 
 6. Navel usually un- 
 changed. 
 
 7. Less clear; limited to 
 cyst; not modified by 
 change of position. No hy 
 drostatic level. 
 
 8. No change in areas of 
 dulness and resonance with 
 change of position. Dulness 
 over cyst. Clear resonant 
 note in all parts beyond 
 cyst limits, i.e. in flanks and 
 toward the diaphragm. 
 
 171 
 
MEDICAL RECORD. 
 
 ASCITES. 
 
 9. Vaginal touch detects 
 fluctuation, bulging into va- 
 gina. 
 
 10. Uterus in prolapsed 
 location, but position un- 
 changed. Size and mobility 
 unchanged. 
 
 11. Hydragogues and diu- 
 retics temporarily remove 
 the fluid. m 
 
 12. Fluid light straw color 
 and thin. Coagulates spon- 
 taneously. 
 
 OVARIAN CYST. 
 
 9. Vaginal fluctuation less 
 clear or absent. 
 
 10. Uterus displaced for- 
 ward or backward, or later- 
 ally by pressure of cyst. 
 
 11. Medicines have no ef- 
 fect. 
 
 12. Fluid light or dark 
 and of varying consistency; 
 albuminous, but does not co- 
 agulate spontaneously; may 
 
 ^ contain colloid matter. 
 
 — (From Dudley's Gynecology.) 
 
 4. Membranous dysmenorrhea. Symptoms: Severe pain 
 at the beginning of the menstrual period, which increases 
 till the expulsion of a membrane, which may come away 
 whole or in several pieces. After this the pain usually 
 ceases until the next period. Treatment: Curettage, which 
 may have to be repeated (perhaps more than once) before 
 a cure is effected. 
 
 5. Pelvic hematocele is an accumulation of blood in the 
 pelvis due to rupture of a blood-vessel ; it is generally due 
 to rupture of a tubal pregnancy, or to a tubal abortion. 
 Symptoms: Pain which is sudden and severe, over ab- 
 domen and pelvis; nausea, cold perspiration, cold extrem- 
 ities pulse rapid and weak, pinched features, and shock. 
 
 6. Abscess of valvo-vaginal cland. Etiology: Gonor- 
 rhea, or suppuration following cellulitis. Symptoms: The 
 same as abscess anywhere else (redness, swelling, heat, 
 pain, and sometimes fever and fluctuation). Treatment: 
 Excision, or incision and drainage. 
 
 7. Symptoms of salpingitis: Pain or discomfort, made 
 worse by pressure, examination, or defecation ; or colicky 
 pains over the tube; dysmenorrhea; increased menstrual 
 fjow; tabes are found to be dilated and swollen. Varieties: 
 Hematosalpinx, when tubes are distended with blood; 
 Pyosalpinx, when they contain pus ; Hydrosalpinx, when 
 they contain serous fluid or exudate. 
 
 8. Urethral caruncle is a small red fleshy growth gen- 
 erally situated on the posterior part of the meatus of the 
 urethra. There are local pain and tenderness, which may 
 be excessive; a burning sensation is experienced on urina- 
 tion ; it may bleed. The proper treatment is to excise it 
 or destroy it with the thermocautery. 
 
 172 
 
MEDICAL RECORD. 
 
 9. Rectovaginal fistula. Symptoms: Flatus and feces 
 are passed by the vagina. Digital or speculum examina- 
 tion may show the fistula, and if milk is injected into the 
 rectum, it will be noticed in the vagina. Vaginitis and 
 vulvitis are present. Treatment: A plastic operation is 
 necessary. The edges of the fistula are denuded and then 
 approximated with sutures, the same as for vesicovaginal 
 fistula. 
 
 10. Gonorrheal vaginitis. Symptoms: Pain and burn- 
 ing in the vulva; pain and burning on micturition; dys- 
 pareunia ; yellowish or greenish discharge, in which the 
 gonococcus can be found; the vagina is hot, red, swollen, 
 and tender. Treatment: Rest in bed, salines, mild unirri- 
 tating diet, bathing of external genitals, copious vaginal 
 douches of bichloride of mercury 1 :2000 three or four 
 times a day; later, the vagina may be swabbed daily with 
 a solution of nitrate of silver 1 to 5 per cent, or with a 
 solution of potassium permanganate 1 per cent. Complica- 
 tions: Cystitis, urethritis vulvitis, endometritis, salpingitis 
 septic peritonitis, sterility, condylomata of vulva, abscess of 
 Bartholin's glands. 
 
 SURGERY. 
 
 1. Asepsis means freedom from germs. Antiseptics: 
 Heat, bichloride of mercury, carbolic acid, iodoform, 
 tormalin, formaldehyde, zinc chloride, albuminum acetate, 
 potassium permanganate, hydrogen dioxide, creolin. 
 
 2. Suture. Materials: (1) Silkworm gut, used only on 
 surfaces, from which it may subsequently be removed. (2) 
 Silk, used in abdominal surgery, for suturing intestines and 
 tying pedicles. (3) Catgut, used for buried sutures. (4) 
 Kangaroo tendon, used for bone, and as an absorbable 
 suture which will last a long time. (5) Silver wire, used 
 for bone. 
 
 3. See Da Costa's "Surgery" (1908), pages 70 and 245. 
 
 4. Paronychia: Free and early incision, drainage, anti- 
 septic dressings, tonics, and stimulants ; the nail may or 
 may not have to be removed. Hordeolum: Hot com- 
 presses, evacuate pus as soon as a yellow spot is seen, 
 correct errors of refraction, look after general health. 
 Empyema: Aspiration, drainage, irrigation, resection of 
 ribs (Estlander's operation) or resection of chest wall 
 (Schede's operation). 
 
 5. For diagnosis of stones in the gall-bladder see above, 
 Diagnosis, Question 3. Stone in the urinary bladder may 
 be diagnosed by: Increased frequency of micturition; pain 
 at end of urination, chiefly felt at the end of the penis or 
 in the neck of the bladder ; the urine may contain pus, 
 mucous, or blood; a "click" can be obtained by using a 
 
 173 
 
MEDICAL RECORD. 
 
 searcher or sound; examination by the cystoscope may 
 reveal the presence of the stone. 
 
 6. See Rose and Carless' "Surgery" (1908), pages 1044, 
 J2j, and 1115; or Da Costa's "Surgery" (1908), page 858. 
 
 7. See Rose and Carless' "Surgery" (1908), pages 975 
 and 980; or Da Costa's "Surgery" (1908), page 868. 
 
 8. See Rose and Carless' "Surgery" (1908), page 408; or 
 Da Costa's "Surgery" (1908), page 1060. Actinomycosis: 
 Treatment consists in free local excision; or incision with 
 erosion and cauterization ; slit up sinuses ; drain pus cavi- 
 ties ; give large doses of potassium iodide ; tonics, stimu- 
 lants, and best hygienic conditions are indicated. 
 
 9. The surgical complications of typhoid fever are : Gan- 
 grene; arthritis; abscesses and furuncles; otitis media; 
 hemorrhage from stomach; intestinal perforation; infec- 
 tion of the gall-bladder; perforation of the gall-bladder; 
 orchitis, epididymitis ; parotitis ; cerebral, laryngeal, thyroid, 
 and thoracic troubles. 
 
 10. Appendic ostomy consists in suturing the tip of the 
 appendix to the abdominal wall, and then by opening the 
 appendix at the tip access is gained to the cecum for the 
 purpose of irrigating the large intestine. Dactylitis is in- 
 flammation of a finger or toe. Osteomyelitis is inflamma- 
 tion of the marrow of a bone (either with or without 
 involvement of the bone). Dubois' abscess is an abscess 
 of the thymus gland, found in congenital syphilis. Hystero- 
 trachelorrhaphy is a plastic operation for the repair of a 
 lacerated cervix uteri. 
 
 HYGIENE. 
 
 1. Constituents of soil: Silica, aluminum, lime, magne- 
 sium, phosphorus, sulphur, iron, manganese, chlorine, so- 
 dium, potassium, oxygen, nitrogen. Physical properties of 
 soil: Porosity, permeability, capacity to receive water and 
 to contain water, heat, color, compactness, moisture, capac- 
 ity for air and gases. 
 
 2. Tilth is the superficial layer of soil which is the re- 
 sult of the disintegration of rocks and the decay of animal 
 and vegetable life; or that part of the soil which is moist- 
 ened by the rain, warmed by the sun, permeated by the 
 atmosphere, in which plants extend their roots and gather 
 their soil food. Marl is a mixture of clay, sand, and amor- 
 phous calcium carbonate. Loam is a mixture of sand, clay, 
 and humus. Humus is the entire product of vegetable de- 
 composition in the various intermediate stages of the 
 process. Peat is the result of the incomplete decay of 
 vegetable matter under water, and is compact and fibrous. 
 Muck is similar to peat, but is less compact, not fibrous, 
 and when dry is easily reduced to powder. Humus will 
 
 174 
 
MEDICAL RECORD. 
 
 retain the greatest amount of water; and peat is probably 
 the most inimical to pathogenic organisms. 
 
 3. The average depth to which the soil is self-purifying 
 is about three feet. The dwellers on the soil retard the 
 process by allowing organic filth and moisture to accumu- 
 late. 
 
 4. The sources and varieties of water have been classified 
 thus : 
 
 Wholesome 
 
 1. Spring water , na i afa h1e 
 
 2. Deep-well water... ^ eI > P alatable - 
 
 3. Upland surface 
 
 water [-moderately palatable. 
 
 (4. Stored rain water.] 
 Suspicious. A 5. Surface water from cultivated^ 
 
 I land 
 
 (6. River water, to which sewage Ipalatable. 
 
 Dangerous . . i gains access I 
 
 [7. Shallow- well water J 
 
 5. A well may be polluted by a cesspool on a lower level, 
 because it is not the location of the outlet of the well that 
 determines the possibility of pollution ; but rather the rela- 
 tive position of the cesspool and the point where the water 
 enters the well. 
 
 In those cases in which the cesspool is on higher ground 
 than the well, the latter may be protected by the geological 
 formation of the ground, such as the presence of a ledge 
 of rock. 
 
 6. Ordinary filter beds for the purification of water are 
 tanks of varying size, shape, and construction; the walls 
 may be vertical or sloping; upon the paved bottom are 
 pipes to carry off the filtered water. Above these pipes are 
 successive layers of coarse gravel, fine gravel, coarse sand, 
 and at the top fine sand about four feet deep. Through 
 these layers the water passes. 
 
 The fundamental principle of Dib din's bacteria beds is 
 based on "the idea that purification in a filter bed is not 
 brought about wholly at the surface, but that the whole 
 bulk of the filter is concerned therein, and experiments 
 were made to determine the results of filling a bed and 
 restraining the outflow for different periods, thus giving 
 the organisms throughout the bed the same opportunity for 
 action." (Harrington's Hygiene.) 
 
 The fundamental principle of Cameron's septic tank sys- 
 tem is that "the sewage is first led into a tank from 
 which air and light are excluded. Digestive changes take 
 place in the sewage within this tank as the result of an 
 anaerobic bacterial action, which is favored by the darkness, 
 the absence of air, and the perfect stillness at which the 
 sewage is maintained. Under these circumstances much 
 
 175 
 
MEDICAL RECORD. 
 
 of the solid matter is rendered soluble and dissolved." — 
 (Notter and Firth's Hygiene.) 
 
 7. We inspire microorganisms ; but, in health, we do not 
 expire them. 
 
 8. For the support of human life, the air should contain 
 nearly 21 per cent, of oxygen, about 78 per cent, of nitro- 
 gen, about 0.04 per cent, of carbon dioxide. 
 
 9. The result of inhaling carbon monoxide is that the 
 carbon monoxide forms a very stable compound with the 
 hemoglobin of the blood, and the result is that the hemo- 
 globin cannot carry oxygen, and therefore asphyxiation 
 occurs. 
 
 Less than 0.25 per cent, by volume in the air will cause 
 poisoning; and but 1 per cent, is rapidly fatal to animal 
 life. 
 
 10. ''The occupations which are of particular hygienic 
 interest embrace those which involve exposure to : Air 
 vitiated by respiration; irritating and poisonous gases and 
 fumes ; irritating and poisonous dusts ; infective matter in 
 dust; offensive gases and vapors; extremes of heat; damp- 
 ness ; abnormal atmospheric pressure ; constrained attitude ; 
 overexercise of parts of the body; sedentary life. Some 
 occupations are conducted under such conditions that they 
 may very properly be regarded as belonging to a number of 
 these groups." — (Harrington's Hygiene.) 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Illinois State Board of Health. 
 
 ANATOMY. 
 
 i. What becomes of the umbilical vein of the fetus? 
 
 2. Where and from what do the colic arteries arise, and 
 what are the distributions? 
 
 3. Describe the articulations of the tibia. 
 
 4. From where are the renal arteries derived and into 
 what do the renal veins pass ? 
 
 5. Where does the trigeminus or fifth pair of cranial 
 nerves arise and What are the branches? 
 
 6. W T hat bones compose the orbit of the eye? 
 
 7. Where and how do the cavities of the greater and 
 lesser omenta connect? 
 
 8. In fracture of the neck of the radius, what muscle 
 draws the upper fragment outward and what ligament 
 limits the extent of the displacement? 
 
 9. What is the origin, insertion, nerve supply, and action 
 of the semimembranosus muscle? 
 
 10. What are the principal venous trunks? What veins 
 are without valves? 
 
 176 
 
MEDICAL RECORD. 
 
 PHYSIOLOGY. 
 
 1. What effect would rapid heart with aortic regurgita- 
 tion have on general blood pressure? Give reasons in 
 detail. 
 
 2. Name the different pulse waves usually recorded by 
 the sphygmograph. 
 
 3. Explain difference between clonic and tonic contrac- 
 tion as applied to muscle fiber. 
 
 4. Discuss the relation of the ovaries to menstruation. 
 
 5. What are proteids? How are they digested? 
 
 6. What are the functions of the saliva? What glands 
 secrete it? 
 
 7. What kinds of food would you recommend in cases 
 of obesity? 
 
 NEUROLOGY. 
 
 1. Name three frequent causes of abscess of the brain. 
 
 2. Define and give the symptoms of congenital hydro- 
 cephalus. 
 
 3. Give etiology, symptoms, and treatment of facial 
 paralysis. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 ■I. Outline the general management of fevers, and ex- 
 plain the physiological action of drugs which lower tem- 
 perature. 
 
 2. Name four of the safest antipyretics, giving the dose 
 and therapeutic indications. 
 
 3. Give the indications for use of diuretics. Name one 
 of each of the three principal classes, and give the physi- 
 ologic action of one of them. 
 
 4. Give the indications for the use of cardiac stimulants, 
 and name three, with dose and mode of administration of 
 each. 
 
 /5~. Name three of the animal extracts used in medicine, 
 giving doses and indications for use. 
 
 §/ Give the indications for the use of alteratives. Name 
 three and give doses. 
 
 7. What are the indications for the use of expectorants? 
 Name three and give dose of each. 
 
 8. Give the physiological action of belladonna. 
 
 9. What are the uses of the following: Male fern, ergot, 
 antipyrine, bismuth, sulphate of magnesia, carbonate of 
 magnesia? 
 
 10. Give the physiological action of digitalis. 
 
 CHEMISTRY. 
 
 1. Write the equation representing the action which 
 takes place by treating potassium chlorate with sulphuric 
 acid. 
 
 2. Of what does turpentine consist? 
 
 177 
 
MEDICAL RECORD. 
 
 3. What is the general formula of the monobasic acids? 
 
 4. Complete the following equations: HgS04+2NaCl= 
 
 5. Give the formulae of the chlorate, bromate, iodate, 
 and sulphate of sodium. 
 
 ETIOLOGY AND HYGIENE. 
 
 1. What is the etiology of interstitial hepatitis? 
 
 2. What is the etiology of acute parenchymatous ne- 
 phritis? Is only one or are both kidneys affected? 
 
 3. What is the etiology of Addison's disease (melasma 
 suprarenale) ? 
 
 4. What are the main points to be observed in a general 
 disinfection? 
 
 5. What is the advantage in adding a small amount of 
 sulphate of aluminum to impure water? 
 
 PATHOLOGY. 
 
 i. Describe the lesions produced in the liver by syphilis. 
 
 2. Mention the conditions of the kidneys which may be 
 brought about by tuberculosis. 
 
 3. Describe the modes of formation and appearances of 
 typhoid and of tubercular ulcers of the intestines. 
 
 4. In what general respects do "anemia" and "progres- 
 sive pernicious anemia" differ? 
 
 5. Describe the formation of an acute abscess. 
 
 BACTERIOLOGY. 
 
 1. Describe methods of culture and staining of the bacil- 
 lus of diphtheria. 
 
 2. Name the microorganisms most commonly found in 
 connection with acute endocarditis. 
 
 3. What bacteria are associated with inflammation and 
 suppuration ? 
 
 4. What special culture medium is required for the 
 growth of the gonococcus? 
 
 5. Describe the specific organism of tetanus, and state 
 its peculiar culture characteristics. 
 
 PRACTICE. 
 
 1. Give the symptoms and treatment of chronic diarrhea. 
 
 2. Give the etiology, symptoms, diagnosis, complications, 
 and treatment of chorea. 
 
 3. Give symptoms, dangers, diagnosis, and treatment of 
 bronchial asthma. 
 
 4. Give diagnosis, complications, dangers, and treatment 
 of chronic contracting nephritis. 
 
 5. Give diagnosis of acute endocarditis, differentiating 
 from chronic, and outline fully the management and treat- 
 ment. 
 
 6. Give the diagnosis and treatment of chronic gastritis. 
 
 178 
 
 
MEDICAL RECORD. 
 
 7. Differentiate hemiplegia due to apoplexy from that 
 due to thrombosis or embolism, and give the treatment 
 and prognosis. 
 
 8. Give the etiology, symptoms, and treatment of myx- 
 edema, and distinguish from cretinism. 
 
 9. Give the diagnosis and treatment of pleurisy with 
 effusion. 
 
 10. Give treatment of insomnia. 
 
 PHYSICAL DIAGNOSIS. 
 
 1. Give symptoms and physical signs of pericardial effu- 
 sion. 
 
 2. Give symptoms and physical signs of hydrothorax. 
 
 3. Give symptoms and physical signs of pulmonary ab- 
 scess. 
 
 4. Give symptoms and physical signs of aneurysm of the 
 arch of the aorta. 
 
 5. Give symptoms and physical signs of cirrhosis of the 
 liver (atrophic form). 
 
 OPHTHALMOLOGY AND OTOLOGY. 
 
 i. Give etiology, symptoms, and treatment of iritis. 
 
 2. Give etiology, symptoms, and treatment of corneal 
 ulcer. 
 
 3. Outline your treatment in a* case of chronic otitis 
 media (suppurative). 
 
 PEDIATRICS. 
 
 1. Give etiology, symptoms, and treatment of enteroco- 
 litis. 
 
 2. Give your treatment in a case of marasmus. 
 
 SURGERY. 
 
 1. What are the dangers to the patient during and after 
 thyroidectomy? 
 
 2. Differentiate appendicitis from distended gall bladder. 
 
 3. Define the following terms : Nephrolith, nephrolith- 
 otomy, nephrorrhagia, and nephrorraphy. 
 
 4. Differentiate hip-joint disease from congenital dislo- 
 cation of the hip. 
 
 5. Outline surgical treatment of varicocele. 
 
 6. Describe the varieties of fracture of the scapula, and 
 give the treatment of each. 
 
 7. Xame the structures which are severed in an amputa- 
 tion at the lower third of the leg. 
 
 8. Classify tumors and state in what tissues of the body 
 each is found. 
 
 9. Outline proper surgical treatment of aneurysm of the 
 brachial artery. 
 
 10. Xame the different varieties of wounds, and give 
 treatment of each. 
 
 179 .„ 
 
MEDICAL RECORD. 
 
 OBSTETRICS. 
 
 i. Describe segmentation. Where and at what period 
 does, it occur ? 
 
 2. Describe the changes occurring in the mucous mem- 
 brane of the uterus during uterogestation. 
 
 3. Enumerate and classify the signs of pregnancy. 
 
 4. What are the mental disturbances that may occur 
 during pregnancy? 
 
 5. Describe hour-glass contraction, and give treatment of 
 same. 
 
 6. Describe an embryo at two months. 
 
 7. Enumerate the congenital malformations of the head 
 and face of a child, and state at what period of uterogesta- 
 tion the arrested development occurs. 
 
 8. In an ordinary accouchement, what precautions should 
 be observed to prevent infection? 
 
 9. Under what conditions is obstetric anesthesia to be 
 employed? What anesthetic do you prefer, and how should 
 it be administered? 
 
 10. Discuss the indications for forceps delivery and the 
 application and manipulation of forceps. 
 
 GYNECOLOGY. 
 
 1. Differentiate a fibroid tumor from a pelvic inflamma- 
 tory deposit. 
 
 2. Give methods of treatment of carcinoma of the uterus 
 when a radical operation is not indicated. 
 
 3. Give the etiology, symptoms, and treatment of steno- 
 sis of the cervix. 
 
 4. Give the causes and treatment of pelvic peritonitis. 
 
 5. Give the etiology, symptoms, and treatment of ante- 
 flexion of the uterus. 
 
 6. Give the causes, diagnosis, and treatment of inversion 
 of the uterus. 
 
 LARYNGOLOGY AND RHINOLOGY. 
 
 i. Name the causes and give the appearances of edema 
 of the larynx. 
 
 2. Give the symptoms and results of adenoid vegetations 
 if untreated. 
 
 MEDICAL JURISPRUDENCE. 
 
 1. Describe rigor mortis, and mention some of the con- 
 ditions which promote its early appearance. 
 
 2. Differentiate a burn inflicted before death from one 
 made after death. 
 
 180 
 
MEDICAL RECORD. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Illinois State Board of Health. 
 
 anatomy. 
 
 I. The umbilical vein of the fetus dwindles and becomes 
 the round ligament of the liver. 
 
 2. 
 
 ARISE FROM 
 
 Ileo-colic, 
 
 Right colic. . 
 Middle colic 
 Left colic.., 
 
 Superior Mesenteric. 
 
 Superior Mesenteric. 
 Superior Mesenteric. 
 Inferior Mesenteric. Descending colon. 
 
 DISTRIBUTION. 
 
 Ileum, cecum, ileo-ce- 
 cal valve, vermiform 
 appendix. 
 
 Ascending colon. 
 
 Transverse colon. 
 
 3. The Tibia articulates: Above, with the femur and 
 fibula ; below, with the fibula and astragalus. 
 
 4. The renal arteries are derived from the abdominal 
 aorta. The renal veins pass into the inferior vena cava. 
 
 5. Trigeminus, or fifth pair of cranial nerves. Origin: 
 (1) Superficial, from the side of the pons varolii; (2) 
 Deep (sensory roots) from the medulla and upper part of 
 cord; (motor root) from floor of fourth ventricle and side 
 of the aqueduct of Sylvius. 
 
 Branches: (1) Ophthalmic, giving off the: Lacrymal, 
 Frontal, and Nasal. (2) Superior Maxillary, giving off 
 the : Meningeal, Orbital, Spheno-palatine, Posterior superior 
 dental, Middle superior dental, Anterior superior dental, In- 
 fraorbital, Palpebral, Nasal, and Labial. (3) Inferior Max- 
 illary, giving off the : Recurrent, Internal pterygoid, Masse- 
 teric, Deep temporal, Buccal, External pterygoid, Auriculo- 
 temporal, Inferior dental, and Lingual. 
 
 6. The bones which enter into the formation of the orbit 
 are : The frontal, -sphenoid, ethmoid, superior maxillary, 
 malar, lacrymal, and palate. 
 
 7. The greater and lesser peritoneal cavities connect by 
 means of the foramen of Winslow. 
 
 8. In fracture of the neck of the radius the upper frag- 
 ment is drawn outward by the Supinator brevis ; the orbic- 
 ular ligament limits the extent of the displacement. 
 
 9. Semimembranosus. Origin: Tuberosity of ischium. 
 Insertion: Inner tuberosity of the tibia, posterior ligament 
 of the knee, and popliteal fascia. Nerve supply: Great 
 sciatic. Action: To flex the leg upon the thigh; then in- 
 ward rotation; also extension of the thigh. 
 
 181 
 
MEDICAL RECORD. 
 
 io. See Cunningham's "Anatomy" (1909), page 870,; or 
 Gray's "Anatomy" (1908), page 723. The veins without 
 vcdves are : The venae cavas, hepatic veins, portal vein and 
 its branches, renal, uterine, ovarian, pulmonary, cerebral, 
 spinal, and umbilical veins. The sinuses of the skull and 
 very small veins are also without valves. 
 
 PHYSIOLOGY. 
 
 1. Rapid heart would tend to raise the general blood 
 pressure; in aortic regurgitation the blood pressure would 
 tend to be lowered. Hence in the combined condition sug- 
 gested in the question the effect on the blood pressure 
 would depend upon the relative effect of the two conditions. 
 The one might neutralize the other and the blood pressure 
 be unaltered; or, either might predominate, with corre- 
 sponding effect on the blood pressure. 
 
 2. The pulse waves usually recorded by the sphygmo- 
 graph are : Cataerotic, predicrotic or tidal, dicrotic or 
 recoil, and postdicrotic. 
 
 3. In tonic muscular contraction the muscle remains for 
 some time in a state of rigid contraction. In clonic con- 
 traction the muscle alternately contracts and relaxes. 
 
 4. Relation of the ovaries to menstruation: "It appears 
 to be clearly demonstrated that the phenomenon of men- 
 struation is dependent upon a periodical activity in the 
 ovaries. When the ovaries are completely removed men- 
 struation ceases (artificial menopause), and the uterus 
 undergoes atrophy. When the ovaries are congenitally 
 lacking, or rudimentary, a condition of amenorrhea also 
 exists. These facts and the connection of the ovaries with 
 menstruation are further corroborated in a striking way 
 by experiments upon transplantation or grafting of the 
 ovary. This experiment has been performed upon lower 
 animals (apes) as well as upon human beings. Removal 
 of both ovaries is followed by a cessation of menstruation. 
 Transplantation of an ovary under the skin serves to main- 
 tain menstruation, but if subsequently removed this func- 
 tion disappears. An ovary or a piece of an ovary trans- 
 planted into the uterus itself or the broad ligament caused 
 a return of the menstrual periods, which had ceased after 
 surgical removal of the glands, or brought on free men- 
 struation in conditions of amenorrhea or dysmenorrhea." — 
 (Howell's Physiology.) 
 
 5. Proteid foods are foods containing proteids. They 
 contain nitrogen, and have a composition similar to that of 
 albumin ; other elements contained in them are carbon, 
 hydrogen, oxygen, and sometimes sulphur. Proteids are 
 digested (1) in the stomach, where the pepsin of the gastric 
 juice splits them into proteoses and peptones; and (2) in 
 
 182 
 
MEDICAL RECORD 
 
 the small intestine, where they are similarly treated by the 
 trypsin of the pancreatic juice. 
 
 6. The functions of the saliva are: (i) To moisten the 
 mouth, (2) to assist in the sofution of the soluble portions 
 of the food, and thus (3) to administer to the sense of 
 taste; (4) to lubricate the bolus of food, and thus (5) to 
 facilitate the acts of mastication and deglutition, and (6) to 
 change starches into dextrin and sugar. Saliva is secreted 
 by the parotid, submaxillary, and sublingual glands. 
 
 7. Foods recommended in case of obesity: Dry foods, 
 with diminished carbohydrates. Ebstein's diet for obesity 
 is as follows : "Breakfast consists of a cup of black tea, 
 without sugar or milk, and two ounces of buttered toast. 
 Dinner, which is given at noon, comprises a meat soup or 
 broth; four to six ounces of boiled or roasted fat beef, 
 with meat gravy, not thickened ; one or two fresh vege- 
 tables in moderation, and for dessert, salads and fresh or 
 dried fruits. He allows a little light wine and black tea, 
 without milk or sugar. Supper includes tea as before, a 
 soft-cooked egg, and a moderate allowance of fish, ham, or 
 cold fat meat, an ounce of thin, buttered bread or toast, 
 and fresh fruit.' , 
 
 NEUROLOGY. 
 
 1. Three frequent causes of abscess of the brain: Micro- 
 bic infection following (1) chronic inflammation of the 
 middle or internal ear; (2) caries of ethmoid, nasal, or 
 orbital bones ; (3) compound fracture of the skull, with 
 direct infection from the wound. 
 
 2. Congenital hydrocephalus is an abnormal accumulation 
 of fluid in the ventricles of the brain. Symptoms: The 
 head is of great size and may obstruct delivery: convul- 
 sions, drowsiness, separation of the cranial sutures, bulg- 
 ing of the fontanels, thinning of the bones of the head, and 
 fluctuation may all be present. The forehead is prominent ; 
 the child looks wasted, the head is spherical, and the eyes 
 seem prominent. 
 
 3. See French's "Practice of Medicine'' (1907). page 1008; 
 or Osier's "Practice of Medicine" (1909), page 1019. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 I. The general management of fevers: Attack the cause 
 when possible {e.g. quinine in malaria) ; diminish heat pro- 
 duction ; increase heat loss (diaphoretics); diminish the 
 amount of nitrogenous food; keep the bowels moderately 
 open ; keep up the heart's strength with stimulants, when 
 necessary, and treat complications as they arise. A large, 
 well ventilated room, with absence of unnecessary furni- 
 ture, and absolute cleanliness are also necessary. 
 
 The following table (from Potter's Materia Medico) 
 
 183 
 
MEDICAL RECORD. 
 
 gives the chief temperature depressants, with their manner 
 of action: Temperature depression may be done by five 
 different actions working upon two principal lines, viz., by : 
 
 '(i) diminishing tissue 
 
 (a) Lessening heat production by * 
 
 (b) Promoting heat loss by 
 
 change. 
 (2) reducing the cir- 
 culation. 
 r (3) dilating cutaneous ves- 
 sels, thus increasing 
 heat radiation. 
 
 (4) promoting perspiration, 
 its evaporation lower- 
 ing the temperature. 
 
 (5) abstracting heat from 
 the body. 
 
 The following list of antipyretics includes a few for 
 each of the above-named actions, to which the numbers 
 refer in each case, viz. : 
 
 Quinine, 1. Aconite, 2. Antipyrin, 1, 4. 
 
 Phenol, 1. Alcohol, 1, 3. Antimony, 2, 4. 
 
 Salicin, 1. Nitrous ether, 3, 4. Cold bath, 5. 
 
 Digitalis, 2. Acetanilid, 1, 4. Cold drinks, 5. 
 
 Phenacetin, 1, 4. Wet-pack, 5. 
 
 2. (1) Cold water, generally, and in typhoid fever. (2) 
 Quinine, especially in malaria, dose, 4 grains of the bisul- 
 phate. (3) Aconite, dose, TT£viij of the tincture. Chiefly 
 acute inflammatory conditions ; it is contraindicated in 
 typhoid. (4) Wet pack, same as cold water. 
 
 3. Indications for the use of diuretics: (1) To remove 
 excess of fluid from the tissues, as in dropsy; (2) to dilute 
 the urine; (3) to promote the elimination of waste prod- 
 ucts or poisonous material from the blood, and (4) to 
 maintain the action of the kidneys. 
 
 (1) Hydragogue diuretic: Digitalis. (2) Stimulant diur- 
 etic: Juniper. (3) Refrigerant duretic: Potassium acetate. 
 
 4. Indications for cardiac stimulants : Vasomotor paresis, 
 heart failure, collapse, shock, valvular heart disease, heart 
 weakness. 
 
 Three: (1) Ammonia, by inhalation, or 3j doses of aro- 
 matic spirit of ammonia in water. (2) Alcohol, dose JiJ 
 of whiskey or brandy in water. (3) Salt solution (nor- 
 mal), injected subcutaneously or into the rectum. 
 
 5. Three animal extracts: (1) Desiccated thyroid glands, 
 dose gr. iv; used in myxedema, goiter, arteriosclerosis, and 
 sporadic cretinism. (2) Pepsin, dose gr. iy; used as an 
 aid to gastric digestion, and for predigestion of proteid 
 foods. (3) Pancreatin, dose gr. vij ; used as an aid in 
 digestion, and for predigestion of food. 
 
 ' 6. Indications for the use of alteratives: Conditions of 
 
 184 
 
MEDICAL RECORD. 
 
 faulty nutrition ; perversions of metabolism ; chronic dis- 
 ease or poisoning; cachexias and dyscrasias. 
 
 Three alteratives: Mercury, dose of calomel, gr. j ; 
 arsenic, dose of Fowler's solution, TT^iij ; iodine, dose of 
 Potassium iodide, gr. vijss. 
 
 7. Indications for expectorants: Catarrhal conditions of 
 larynx, trachea, and bronchi. Ammonium chloride, gr. vij ; 
 glycyrrhiza, gr. xxx; senega, 15 minims of the fluid ex- 
 tract. 
 
 8. Physiological action of belladonna: Anodyne, mydri- 
 atic, inhibits secretions, depressant of terminations of 
 nerves, accelerates the heart beat, causes rise in blood 
 pressure, but toxic doses cause the blood pressure to fall ; 
 stimulates the respiratory center, but large doses depress 
 the same ; it may cause vertigo, restlessness, excitement, 
 delirium, or mania. 
 
 9. Malefem, for tape worm; ergot, to cause uterine con- 
 tractions and to stop hemorrhage; antipyrine, as an anti- 
 pyretic and analgesic; bismuth, in gastric irritability, vomit- 
 ing, and as a dusting powder; sulphate of magnesium, as a 
 saline cathartic; carbonate of magnesium, in acidity of 
 stomach, sick headache, and as a laxative. 
 
 10. Digitalis is a gastrointestinal irritant; a cardiac stimu- 
 lant and tonic, slows the rate of the heart, increases _ its 
 force, prolongs diastole, contracts the blood-vessels, raises 
 the blood pressure, and is a diuretic. 
 
 CHEMISTRY. 
 
 1. KC10s + H 2 S0 4 =rKHS0 4 4-HC103. 
 
 2. Turpentine consists of a stearoptene (such as rosin or 
 colophony) and an eleoptene (such as oil of turpentine). 
 
 3. There is no general formula for the monobasic acids. 
 In organic chemistry the monobasic acids all have one 
 COOH (carboxyl) group; the acetic series has the gen- 
 eral formula, CnHon0 2 . 
 
 4. HgS0 4 + 2NaCl = HgCl 2 + Na^SO*. 
 
 5. The formula of Sodium chlorate is NaC10 3 ; of So- 
 dium bromate, is NaBr0 3 ; of Sodium iodate, is NaI0 3 ; of 
 Sodium sulphate, is NaaSCX. 
 
 ETIOLOGY AND HYGIENE. 
 
 i. The etiology of interstitial hepatitis: Alcohol, syphi- 
 lis, obstruction of bile ducts, long continued malaria, stim- 
 ulating and highly spiced food; infectious fevers, heart 
 disease. It is most common in males of middle age. 
 
 2. The etiology of acute parenchymatous nephritis: Ex- 
 posure to cold and wet, acute specific fevers (especially 
 scarlet fever and endocarditis), irritating drugs (turpen- 
 tine, cantharides, potassium chlorate), extensive burns, and 
 pregnancy. Both kidneys are affected. 
 
 18; 
 
MEDICAL RECORD. 
 
 3. The etiology of Addison's disease: Tubercular lesions 
 in the suprarenal bodies, strains and injuries to the back, 
 blows upon the abdomen, hemorrhage into the suprarenal 
 bodies. More common in men. 
 
 4. Disinfection of rooms and their contents: "Articles 
 of little value should be burnt. Bedding, clothing, carpets, 
 etc., should be disinfected by steam. Towels, napkins, and 
 sheeting should be soaked in a 5 per cent, carbolic acid 
 solution and then boiled. Woodwork, floors, and plain 
 furniture should be washed with a chlorinated lime solu- 
 tion (1 per cent.) or with a corrosive sublimate solution 
 (1 15000). Finally, the room should be fumigated with for- 
 maldehyde gas or with sulphur dioxide, preferably with 
 the former." — (Stevens' Materia Medica, etc.) 
 
 5. The addition of the sulphate of aluminum tends to 
 purify the water, if calcium carbonate is also present. Cal- 
 cium sulphate is thus formed, and this, with aluminium 
 hydrate, entangles floating particles and carries them to 
 the bottom of the vessel. 
 
 PATHOLOGY. 
 
 1. Lesions produced in the liver by syphilis: "In the 
 early stage there are pale grayish nodules, varying in size 
 from a pea to a marble. The larger present yellowish cen- 
 ters at first, but later there is a pale yellowish, cheese-like 
 nodule of irregular outline, surrounded by a fibrous zone, 
 the outer edge of which loses itself in the lobular tissue, 
 the lobules dwindling gradually in its grasp. This fibrous 
 zone is never very broad; the cheesy center varies in con- 
 sistence from: a gristle-like toughness to a pulpy softness ; 
 it is sometimes mortar-like from cretaceous change. When 
 numerous, the most extensive deformity of the liver is 
 produced in the gradual healing of these gummata. On the 
 surface there are deep, scar-like depressions, and the entire 
 organ may be divided into a cluster of irregular masses, 
 held together by fibrous tissue. " — (Osier's Practice of 
 Medicine.) 
 
 2. The condition of the kidneys which may be brought 
 about by tuberculosis: Tubercles first form in the medul- 
 lary portion of the kidneys; these coalesce, then caseate 
 and soften. Cavities are thus formed, separated from each 
 other by fibrous tissue. Ultimately the whole substance 
 of the kidney may be destroyed; the pus is discharged in 
 the urine, causing tuberculous pyelitis, and later, perhaps, 
 pyonephrosis. 
 
 3. In the typhoid ulcer (1) the main axis of the ulcer 
 lies parallel with that of the intestine; (2) it lies opposite 
 to the mesenteric attachment; (3) it has smooth floor and 
 undermined edges; (4) it commonly leads to perforation. 
 
 In tubercular ulcer (1) the long axis of the ulcer lies at 
 
 186 
 
MEDICAL RECORD. 
 
 right angles to that of the intestine ; (2) it is not neces- 
 sarily situated opposite the mesenteric attachment; (3) its 
 floor is not smooth nor are its edges undermined, but 
 rather funnel-shaped and irregular ; (4) it is not apt to 
 perforate, but it does not tend to heal, rather to spread. 
 
 4. Anemia is a general term, including a variety of con- 
 ditions, and indicating that the blood is reduced either in 
 quantity, in coloring matter, or in number of red cells. 
 These conditions are often more or less associated. 
 
 Progressive pernicious anemia is a definite disease, of 
 unknown origin, in which the number of the red cells is 
 greatly diminished, the red cells are also changed in size 
 and shape, nucleated red cells are present, and the disease 
 tends to a fatal termination. 
 
 5. See Rose and Carless' "Surgery" (1908), page 62; or 
 Da Costa's "Surgery" (1908), page 132. 
 
 BACTERIOLOGY. 
 
 1. Methods of culture: The bacillus of diphtheria grows 
 upon all the ordinary culture media, and can be readily 
 obtained in pure culture. Loeffler's blood serum, par- 
 ticularly with the addition of a little glucose, is an ad- 
 mirable medium for the rapid growth of this bacillus. 
 The medium should be alkaline and not less than 20 C. 
 
 Method of staining: It stains with any aqueous solu- 
 tion of an anilin dye, and quite characteristically with 
 Loeffler's alkaline methylene blue. Neisser's stain is also 
 recognized. The bacilli also stain well by Gram's method. 
 
 2. The microorganisms most commonly found in con- 
 nection with endocarditis are : Streptococcus pyogenes, 
 Staphylococcus pyogenes aureus, Staphylococcus pyogenes 
 albus, pneumococcus, gonococcus, Bacillus tuberculosis, 
 Eberth's bacillus, Bacillus anthracis, Bacillus coli com- 
 munis, and Micrococcus lanceolatus. 
 
 3. The bacteria associated with inflammation and sup- 
 puration are : Staphylococcus pyogenes aureus, Staphylo- 
 coccus pyogenes albus, Staphylococcus pyogenes citreus, 
 Streptococcus pyogenes, pneumococcus, gonococcus, Bacil- 
 lus coli communis, Bacillus pyocyaneus, typhoid bacillus, 
 Micrococcus tetragenus. 
 
 4. The special culture medium required for the growth 
 of the gonococcus is blood serum or ascitic or pleuritic 
 fluid. 
 
 5. The bacillus of tetanus is characterized by its pecu- 
 liar spore, formed at one end of the bacillus, and giving it 
 the appearance of a pin ; it is purely anaerobic, and cannot 
 be developed at all in the presence of oxygen. It generally 
 comes from the soil, and is found in penetrating wounds. 
 It appears in two forms, the spore-bearing form, as de- 
 scribed above, and the vegetative form, which is a short 
 
 187 
 
MEDICAL RECORD. 
 
 bacillus with rounded ends, and which may occur singly or 
 in pairs, or may form long filaments. It grows in gelatin 
 stab cultures in the middle of the medium, and the colonies 
 look something like a fir tree; its growth is slow, and a 
 disagreeable odor is at the same time emitted. In bouillon, 
 it grows near the bottom of the tube, and produces gases. 
 
 PRACTICE. 
 
 1. See French's "Practice of Medicine" (1907), pages 
 775 and 778; or Osier's "Practice of Medicine" (1909), page 
 
 503. 
 
 2. See French's "Practice of Medicine" (1907), page 
 1 1 17; or Osier's "Practice of Medicine" (1909) page 1045. 
 
 3. See French's "Practice of Medicine" (1907), page 659; 
 or Osier's "Practice of Medicine" (1909), page 610. 
 
 4. See French's "Practice of Medicine" (1907), page 904; 
 or Osier's "Practice of Medicine" (1909), page 700. 
 
 5. See French's "Practice of Medicine" (1907), pages 
 571, 579, 582, 587, and 589; or Osier's "Practice of Medi- 
 cine" (1909), pages 791, 799, 803, 807, and 809. 
 
 6. See French's "Practice of Medicine" (1907), page J2>7\ 
 or Osier's "Practice of Medicine" (1909), page 462. 
 
 7. "Cerebral Hemorrhage occurs after the age of fifty- 
 five, as a rule, with atheromatous arteries and an hyper- 
 trophied heart. The onset is sudden, with coma, during 
 exertion or excitement. The temperature falls in an hour, 
 and then rises, sometimes to 106 . Gradual recovery of 
 consciousness takes place in from three to five days, with 
 permanent 'hemiplegia. 
 
 "Cerebral embolism comes at any age, with heart disease 
 or after childbirth. There is a sudden onset, without loss 
 of consciousness or with slight mental confusion, or with 
 rapid return to consciousness. The temperature does not 
 fall, but may rise as high as 102 °. Improvement occurs 
 within twenty-four hours to a marked degree, but after 
 three or four days the symptoms return. Monoplegia, 
 hemiplegia, or aphasia may remain. Jacksonian epilepsy 
 may develop if the lesion is cortical, involving a special 
 center. 
 
 "Cerebral thrombosis occurs at any age, but chiefly in 
 syphilitic persons and middle-aged men. There are usually 
 premonitions. The onset is slower, without coma, but with 
 dullness of the mind. The temperature does not fall, but 
 may rise to ioo°. The paralysis is similar to that observed 
 in embolism. 
 
 "The diagnosis between these three conditions is hardly 
 ever positive." — (-Caille's Differential Diagnosis.) 
 
 8. See French's "Practice of Medicine" (1907), pages 552, 
 553, and 554; or Osier's "Practice of Medicine" (1909)* 
 pages 768 and 770. 
 
 188 
 
MEDICAL RECORD. 
 
 9. See French's "Practice of Medicine" (1907), pages 691 
 and 697; or Osier's "Practice of Medicine" (1909), pages 
 645, 651, and 653. 
 
 10. Treatment of insomnia: Removal of the cause, if pos- 
 sible; regulation of the diet; systematic exercise; mild 
 salines; avoidance of tea, coffee, or tobacco may be indi- 
 cated; mental rest, change of scene or occupation; tonics: 
 and, last of all, hypnotics. 
 
 "When the habit of sleeplessness has become well estab- 
 lished it may require more than the removal of the cause 
 to effect a complete cure. Simple measures, however, 
 should always be tried first before resorting to hypnotics. 
 The bedroom should be quiet, well ventilated, and of 
 moderate temperature. When the feet are cold the blood 
 should be diverted from the head by hot foot baths, which 
 may be made more effective by the addition of mustard. 
 Vigorous rubbing of the limbs is also useful. A glass of 
 hot milk, a cup of bouillon, or a toddy just before retiring 
 often acts favorably as a derivative. In some persons light 
 reading for half an hour, in others a brisk walk will invite 
 sleep. In neurasthenia, massage and the systematic use of 
 the wet-pack are invaluable aids." — (Stevens' Materia Med- 
 ka, etc.) 
 
 PHYSICAL DIAGNOSIS. 
 
 1. Pericardial effusion: Area of cardiac dullness is in- 
 creased, the heart sounds are muffled, other organs may 
 be displaced, dyspnea is present, the apex beat may be 
 displaced to the left, the pulse is feeble, precordial pain 
 and palpitation are present, the precordium bulges. 
 
 2. Hydrothorax: Bilateral effusion, distended chest, 
 vocal fremitus is absent, there is dullness on percussion, 
 breath sounds and vocal resonance are absent or distant, 
 neighboring organs may be displaced, dyspnea and cyano- 
 sis are present, Skodaic resonance is obtained above the 
 effusion. 
 
 3. Pulmonary abscess: Fever, sweats, chill, leucocytosis, 
 dyspnea, cough, purulent sputum with lung tissue, cavern- 
 ous breathing, pectoriloquy. 
 
 4. Aneurysm of arch of aorta: Palpitation, difference 
 in radial pulses (sometimes), dysphagia, dyspnea, cough, 
 change in voice, pressure on nerves may cause irritation 
 or paralysis, edema, intense pain, murmur, there may be 
 a swelling of expansile character and with a thrill, and 
 tracheal tugging. 
 
 5. Atrophic cirrhosis of the liver: Ascites, hemorrhoids, 
 hematemesis, anorexia, nausea, gastric congestion, vomit- 
 ing, constipation, muddy skin, first enlargement, later con- 
 traction of liver, jaundice is a late symptom, emaciation, 
 pallor, enlarged spleen, distended veins on abdomen, caput 
 medusae. 
 
 189 
 
MEDICAL RECORD. 
 
 OPHTHALMOLOGY AND OTOLOGY. 
 
 ^ I. Iritis. Etiology: Syphilis, rheumatism, gonorrhea, 
 gout, diabetes, leprosy, scrofula, tuberculosis, injury, trans- 
 mission from the eye. Symptoms: Pain, photophobia, 
 small pupil, ciliary congestion, discoloration of iris, exudate 
 in anterior chamber. Treatment: Atropine, dionine, the 
 application of leeches to the temples, hot fomentations, 
 absolute rest in bed, protection from the light, light diet, 
 purgatives, abstinence from alcohol, avoidance of all use 
 of the eyes for near work, constitutional treatment vary- 
 ing according to the etiology, paracentesis, and iridectomy. 
 
 v 2. Corneal ulcer. Causes: Infectious, traumatism, for- 
 eign bodies, extension of inflammation, and nutritional dis- 
 turbances. Symptoms: It is detected by oblique illumina- 
 tion, the ophthalmoscope, or convex lens, and by dropping 
 fluorescin upon the cornea, the denuded area being colored 
 green. Pain, photophobia, lacrimation, swelling of the lids 
 and conjunctiva, and destruction of tissue are symptoms. 
 Treatment: Remove the cause, atropine, eserine, protection 
 of eye by smoked glasses or bandage, hot compresses, anti- 
 septic lotions, cauterization, paracentesis of cornea, or 
 Saemisch's operation. 
 
 3. Chronic otitis media (suppurative). Treatment: 
 Cotton must never be worn in the discharging ear. The 
 discharge must be mopped out, but if very thick and 
 copious syringing by means of sterile water or sterile 
 water containing salt (gr. 5-3 1 ) or carbolic acid (1:40) 
 once or twice in twenty-four hours in bad cases is permis- 
 sible. After mopping the ear 10 drops of an antiseptic 
 solution may be instilled. Formalin solution (1:1000- 
 1:2000), carbolic acid solution (1:40), or, if granulations 
 are present, absolute alcohol may be dropped in and allowed 
 to remain for a few minutes, and then turned out into a 
 towel. This treatment should be continued once or twice 
 a day in very bad cases, and less often when the discharge 
 decreases. If, after several months, improvement does not 
 take place, removal of the ossicles under general anesthesia 
 may be necessary. — (Gould and Pyle's Pocket Cyclopedia.) 
 
 pediatrics. 
 
 1. See French's "Practice of Medicine ,, (1907), page 785; 
 or Osier's "Practice of Medicine" (1909), page 508. 
 
 2. Treatment of marasmus: The diet must be carefully 
 investigated and regulated. If the child is breast-fed, the 
 milk must be examined as to its composition, and the 
 health and mode of life of the mother inquired into. In 
 bottle-fed babies absolute cleanliness of bottles, nipples, 
 and milk pans must be insisted on. If diarrhea is marked, 
 it may be necessary to stop the use of milk for a time. 
 Whey and barley water or peptonized milk may be used 
 
 190 
 
MEDICAL RECORD. 
 
 instead. After the diet has been regulated a dose of castor 
 oil or calomel and magnesia may be given to clear away- 
 irritating substances. Or Gray powder and Dover's powder 
 may be given. The child should be warmly clad, and 
 should be taken in the open air as much as possible. Colon 
 irrigations may be beneficial. 
 
 SURGERY. 
 
 i. The dangers of thyroidectomy are: Sudden death 
 during the operation, suffocation, dyspnea, cardiac inhibi- 
 tion; tetany or acute myxedema may follow. 
 
 2. In appendicitis: The pain is at first diffuse, but later 
 becomes localized over the appendix in the right iliac fossa ; 
 nausea, vomiting, and constipation may be present; tender- 
 ness over the appendix and rigidity of the right rectus 
 abdominis muscle are present; there is generally moderate 
 fever. 
 
 • In distended gall-bladder: The pain is more severe and 
 sudden, and is in the region of the liver; it radiates to the 
 right scapula and toward the umbilicus; chills and sweats 
 are common ; also vomiting, and sometimes symptoms of 
 collapse and jaundice; all the symptoms come on more 
 suddenly. 
 
 3. Nephrolith is calculus of the kidney. 
 Nephrolithotomy is an operation for the removal of 
 
 calculus from the kidney. 
 
 Nephrorrhagia is hemorrhage from or into the kidney. 
 
 Nephrorrhaphy is the suturing of a floating kidney (to 
 the posterior abdominal wall). 
 
 4. Hip- joint disease has the symptoms : Muscular spasm 
 (stiffness of the joint, or limitation of its motion) ; lame- 
 ness ; attitude of the limb standing, or walking, or lying 
 (adduction and abduction of the limb), and shortening; 
 atrophy; and swelling. 
 
 Congenital dislocation: "This need not be mistaken for 
 hip disease, as the clinical history of the former is of 
 continued limp since the child commenced walking. The 
 trochanter is above Nelaton's line. There are no symptoms 
 of muscular stiffness or limitation of motion of the hip 
 in congenital dislocation ; in fact, no symptoms of hip 
 disease except the limp in gait. Patients with congenital 
 dislocation, however, at times have slight attacks of syno- 
 vitis of the hip due to the imperfect mechanism of the 
 joint, but these symptoms subside after a short rest.'' — 
 (Bradford and Lovett.) 
 
 5. See Rose and Carless' "Surgery" (1908), page 1270; 
 or Da Costa's "Surgery" (1908), page 397. 
 
 6. See Rose and Carless' "Surgery" (1908), page 496; 
 or Da Costa's "Surgery" (1908), page 485.^ 
 
 7. The structures severed in an amputation at the lower 
 
 191 
 
MEDICAL RECORD. 
 
 third of the leg are : Skin ; fascia ; muscles, Peroneus 
 longus, Peroneus brevis, tendo Achillis, tendon of Plantaris, 
 Tibialis anticus, Tibialis posticus, Extensor longus hallucis, 
 Extensor communis digitorum, Flexor longus hallucis, 
 Flexor longus digitorum ; Arteries, anterior tibial, posterior 
 tibial, peroneal ; Veins, anterior tibial, posterior tibial, 
 peroneal, external saphenous, internal saphenous; Nerves, 
 anterior tibial, posterior tibial, musculocutaneous, internal 
 saphenous; Bones, tibia and fistula; and interosseous mem- 
 brane. 
 
 8. See Rose and Carless' " Surgery" (1908), page 188; or 
 Da Costa's "Surgery" (1908), page 302. 
 
 9. See Rose and Carless' "Surgery" (1908), page 326; or 
 Da Costa's "Surgery" (1908), page 408. 
 
 10. See Rose and Carless' "Surgery" (1908), page 231; 
 or Da Costa's "Surgery" (1908), pages 239 and 244. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), page 96; or Hirst's 
 "Obstetrics" (1909), page 78. 
 
 2. See Williams' "Obstetrics" (1909), page 120; or Hirst's 
 "Obstetrics" (1909), page 144. 
 
 3. Positive signs of pregnancy: (1) Hearing the fetal 
 heart sound; (2) active movement of the fetus; (3) bal- 
 lottement; (4) outlining the fetus in whole or part by 
 palpation; and (5) the umbilical or funic souffle. 
 
 Doubtful signs of pregnancy: (1) Progressive enlarge- 
 ment of the uterus; (2) Hegar's sign; (3) Braxton Hick's 
 sign; (4) uterine murmur; (5) cessation of menstruation; 
 (6) changes in the breasts; (7) discoloration of the vagina 
 and cervix; (8) pigmentation and striae; (9) morning 
 sickness. 
 
 Subjective signs of pregnancy, in the order of their ap- 
 pearance, are : Cessation of menstruation, morning sick- 
 ness, increased frequency of urination, active fetal move- 
 ments. 
 
 Objective signs of pregnancy, in the order of their ap- 
 pearance, are : Softening of the cervix, changes in the 
 mammary glands, discoloration of the vulva and vagina, 
 pulsation in the vaginal vault, Hegar's sign, active fetal 
 movements, ballottement, palpation of the fetus, intermit- 
 tent uterine contractions, hearing the fetal heartbeat, rate 
 of growth of the uterine tumor. 
 
 4. The mental disturbances that may occur during preg- 
 nancy are : Changes in temper and disposition, the moral 
 sense may be elevated or lowered, delusions may be present. 
 
 5. See Williams' "Obstetrics" (1909), page 664. 
 
 6. See Williams' "Obstetrics" (1909), page 145; or Hirst's 
 "Obstetrics" (1909), page 84. 
 
 7. Congenital malformations of head and face: Acranius, 
 
 192 
 
xMEDICAL RECORD. 
 
 hemicrania, exencephalus, craniorachischisis, cephalocele, 
 hydrocephalus, iniencephalus, microcephalus, micrencepha- 
 lus, porencephalus, cyclocephalus, synophthalmus, synotus 
 arhinencephalus, cyclostomus, anophthalmia, microphthal- 
 mus, aprosopus, hare lip, cleft palate, and other faciai 
 clefts. 
 
 8. See Williams' "Obstetrics" (1909), page 308; or Hirst's 
 "Obstetrics" (1909), page. 778. 
 
 9. See Williams' "Obstetrics" (1909), page 321; or Hirst's 
 "Obstetrics" (1909), pages 329, 636, and 783. 
 
 10. Indications for the use of forceps are: "1. Forces at 
 fault: Inertia uteri in the presence of conditions likely to 
 jeopardize the interests of mother or child, (a) Impend- 
 ing exhaustion; (b) arrest of head, from feeble pains. 2. 
 Passages at fault: Moderate narrowing, 2% to 3I4 inches, 
 true conjugate; moderate obstruction in the soft parts. 3. 
 Passenger at fault: A. Dystocia due to (a) occipito-pos- 
 terior, (b) mento-anterior face, (c) breech arrested in 
 cavity. B. Evidence of fetal exhaustion (pulse above 160 
 or below 100 per minute). 4. Accidental complications: 
 Hemorrhage; prolapsus funis; eclampsia. All acute or 
 chronic diseases or complications in which immediate de- 
 livery is required in the interest of mother or child, or 
 both." — (From Jewett's Practice of Obstetrics.) 
 
 Conditions necessary for the use of forceps are: (1) 
 The rectum and bladder must be empty; (2) the os uteri 
 must be fully dilated; (3) the membranes must be rup- 
 tured; (4) the pelvis must be of sufficient size. 
 
 GYNECOLOGY. 
 
 1. Fibroid tumors are characterized by: Hemorrhage, 
 pain, discomfort, pressure and traction symptoms (piles, 
 constipation, tenesmus, dysuria, frequent micturition, uter- 
 ine displacement); a tumor can be felt; pain, backache, 
 bearing down pains, leucorrhea, and dysmenorrhea are 
 common. 
 
 Pelvic inflammatory infiltrations, unlike fibroids, always 
 give a history of pelvic inflammation, are very tender on 
 pressure, immobile, and prone to disappear by resolution or 
 to undergo suppuration. 
 
 2. See Rose and Carless' "Surgery" (1908), page 1287. 
 
 3. Stenosis of cervix. Etiology: It may be congenital, 
 or occur after labor, or abortion; or be due to caustics or 
 cautery; or to ulceration. Symptoms: Obstructive dys- 
 menorrhea, sterility, cramps. A probe or sound meets with 
 an obstruction. Treatment: Dilatation, and insertion of 
 gauze or a glass stem. The cervix may be cut in four 
 directions under proper aseptic precautions. 
 
 4. Acute pelvic peritonitis. Etiology: Infection. Symp- 
 toms: Intense and diffuse abdominal pain, tenderness, and 
 
 193 
 
MEDICAL RECORD. 
 
 distention ; vomiting, constipation, elevation of the tem- 
 perature (iO3°-i04° F.), small, hard, rapid, and wiry pulse 
 (120-140), and increased respiration (30-40) of a painful 
 character are also present The dorsal decubitus with the 
 legs and thighs drawn up is assumed. The duration is 
 from six to nine days, and the prognosis is unfavorable. 
 The treatment consists in rest in bed, the administration of 
 opium or one of its alkaloids, and the application of hot 
 or cold fomentations or turpentine stupes to the abdomen. 
 If the affection is due to septic infection a saturated solu- 
 tion of magnesium sulphate should be given. If suppura- 
 tion has occurred abdominal section should be performed, 
 with irrigation of the peritoneal cavity with normal salt 
 solution (temperature io5°-no° F.) and the introduction 
 of drainage. — (Gould's and Pyle's Pocket Cyclopedia.) 
 
 5. Anteflexion of uterus. Etiology: Congenital, due 
 to arrested development; acquired, due to inflammation of 
 uterus or its surroundings (cellulitis or parametritis), con- 
 stipation, subinvolution, tumor in anterior wall of uterus. 
 Symptoms: Dysmenorrhea, sterility, and various reflex 
 nervous phenomena (such as disturbances of the bladder, 
 headache, backache, leucorrhea, and frequent urination). 
 Treatment: Dilatation of the cervical canal or a plastic 
 operation (division of the cervix). 
 
 6. Inversion of uterus. Etiology: Childbirth, and uter- 
 ine tumors. Diagnosis: In the case of polypus, the body 
 and fundus of the uterus are in their normal position in 
 the abdomen, a sound can be passed into the uterus, the 
 uterine and cervical canals are not obliterated, the polypus 
 does not bleed easily, and is not particularly sensible to 
 pain. The inverted uterus shows : Absence of body and 
 fundus from. normal position, will not permit passage of 
 a sound into uterine cavity, the uterine and cervical canals 
 are absent, the inverted uterus tends to bleed easily, and is 
 very sensible to pain. In prolapse the largest part of the 
 tumor is above; the opening of the Fallopian tubes cannot 
 be seen ; a sound can be passed into the uterine cavity. 
 Treatment: Reposition; and see Williams' "Obstetrics" 
 (1909), page 824; or Hirst's "Obstetrics" (1909), page 616. 
 
 laryngology and rhinology. 
 
 1. Edema of the larynx. Causes: Wounds of neck or 
 larynx, burns or scalds of larynx, quinsy, aneurysmi, whoop- 
 ing cough, erysipelas, syphilis, tuberculosis, malignant dis- 
 ease, inflammations, diphtheria, Bright's disease, pneumonia. 
 
 Appearances: The epiglottis is swollen, and the affected 
 mucous membrane is pale and semi-translucent. 
 \ 2. Symptoms of adenoids: Mouth-breathing; snoring; 
 open mouth ; a vacant, dull expression of the face ; modifi- 
 
 194 
 
MEDICAL RECORD. 
 
 cation of the voice (nasal twang), with inability to pro- 
 nounce certain letters. 
 
 Effects: Earache and other ear affections; mental de- 
 ficiency; frequent attacks of coryza; nose-bleed; stunted 
 growth; convulsions, laryngismus stridulus, and various 
 other neuroses may also be noticed. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. Rigor mortis is the condition of rigidity or contrac- 
 tion into which the muscles of the body pass after death. 
 It begins at a period varying from about fifteen minutes 
 to about six hours. It usually begins in the muscles of 
 the eye, neck, and jaw; then the muscles of the chest and 
 upper extremity, and last of all those of the abdomen and 
 lower extremity are affected. It passes off in the same 
 order. It is said to be due to the coagulation of the muscle 
 plasma. 
 
 Conditions which promote the early appearance of rigor 
 mortis: Deaths from exhaustion, or violence, or electricity; 
 when the muscular system is fatigued. 
 
 2. In burns produced before death: There is usually a 
 blister, with a bright, red base, and containing a serous 
 fluid, which is albuminous; occasionally there will be no 
 blister if there has been excessive shock; also there will 
 be a red line of demarcation between the injured and the 
 uninjured parts, and this, being a vital process, is only 
 developed during life. 
 
 In burns produced after death there is no true blister, 
 no red base, and gas only is present in place of the serous 
 fluid. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Indiana State Board of Medical Examiners. 
 
 ANATOMY. 
 
 i. Give the structure of the gall-bladder and its sur- 
 gical landmarks. 
 
 2. Give the origin and insertion of each of the follow- 
 ing muscles of abdomen: Obliquus externus, obliquus in- 
 ternus, transversalis. 
 
 3. Name each bony prominence of the elbow and give 
 its relations to the joint. 
 
 4. Name the blood-vessels and nerves divided in an 
 amputation of the forearm at the union of the lower and 
 middle third. 
 
 5. Name the blood-vessels that constitute the portal 
 venous system, and the organs from which each conveys 
 the blood. 
 
 195 
 
MEDICAL RECORD. 
 
 6. Give the periods for the eruption of the temporary 
 teeth. 
 
 7. Give the branches of the subclavian artery and thy- 
 roid axis. 
 
 8. Locate an incision for ligation of external carotid, 
 and state what structures are encountered. 
 
 9. What muscles effect the displacement of the frag- 
 ments in an oblique fracture from above, downward and 
 backward, of the femur immediately above the condyles, 
 and how? 
 
 10. Make a drawing showing the nine regions of the 
 abdominal cavity with the name and contents of each. 
 
 PHYSIOLOGY. 
 
 1. Mention the chief heat-producing tissues of the body 
 in the order of their capacity, and state why these struc- 
 tures evolve more heat than others. 
 
 2. Give your opinion of alcohol as a food, and state 
 your reasons and authority for such opinion. 
 
 3. Define absorption, secretion, and excretion, and state 
 through which anatomical structures each occurs with 
 greatest activity. 
 
 4. What is the mechanical effect upon the circulation 
 of the blood of inspiration, normal expiration, and violent 
 expiration ? 
 
 5. What portion of the vascular system is most sus- 
 ceptible or responsive to the vasomotor nervous influence, 
 and why? 
 
 6. In what particular does the condition of the brain 
 in coma differ from its condition in sleep? 
 
 7. Explain briefly the difference between emulsification 
 and saponification of oil and fats in the process of di- 
 gestion. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. Give derivation, physiological action, and indications 
 for the therapeutic application of ergot. 
 
 2. Name three medicinal agents which increase diaph- 
 oresis. 
 
 3. Name an antagonist to the physiological action of 
 jaborandi. 
 
 4. Name three medicinal agents which are emetic in 
 their action, and dose of each. 
 
 5. Give physiological action, dose, and therapeutic in- 
 dication for tr. of gelsemium. 
 
 6. Name (a) a hydragogue oathartic and (b) a chola- 
 gogue cathartic, and dose of each. 
 
 7. Name some therapeutic indications for mercury. 
 
 8. What effect has benzoin on urine? Name two prep- 
 arations of the agent with dose of each. 
 
 196 
 
MEDICAL RECORD. 
 
 9. Give derivation, therapeutic indications, and dose of 
 apomorphine. 
 
 10. Write a prescription for acute articular rheumatism. 
 
 CHEMISTRY. 
 
 1. Give antidote in case of poisoning by (a) arsenic, 
 (b) corrosive sublimate, and (c) carbolic acid. 
 
 2. Give specific gravity of healthy urine and give test 
 for (a) bile, (b) sugar, and (c) albumin. 
 
 3. What is potassium iodide and how prepared? 
 
 4. Name the bile salts. 
 
 5. Name the fluids of the body that are normally of 
 acid reaction. 
 
 PATHOLOGY AND BACTERIOLOGY. 
 
 i. How would you determine whether a dog had rabies 
 or not? 
 
 2. Give technique of determination of rabies in the 
 dog. 
 
 3. Give technique of determination of an epithelioma. 
 
 4. What is the difference between a benign and ma- 
 lignant growth? 
 
 5. What is meant by a metastatic growth? 
 
 6. Give morphology and method of culture of the diph- 
 theria bacillus. 
 
 7. Give morphology and method of culture of the tu- 
 bercle bacillus. 
 
 8. Give complete technique of determining a case of 
 diphtheria. 
 
 9. How would you stain the tubercle bacillus? 
 
 10. What is meant by (a) pathology and (b) bacteri- 
 ology ? 
 
 PHYSICAL DIAGNOSIS. 
 
 i. Give technique of diagnostic puncture and the evi- 
 dence derived therefrom. 
 
 2. Define ataxia. How is ataxia of the upper extrem- 
 ities tested? How is ataxia of the lower extremities 
 tested? 
 
 3. Give discrimination between organic and functional 
 murmurs. 
 
 4. Give technique of cardiac percussion. 
 
 5. What is the normal pulse rate ? What is the increase 
 for each degree of temperature above normal? 
 
 INTERNAL MEDICINE. 
 
 1. Give common cause, prevention, and treatment of 
 summer diarrheas of infancy and childhood. 
 
 2. In auscultation of healthy lung, what sound is heard, 
 and what is it called? 
 
 197 
 
MEDICAL RECORD. 
 
 3. Name some diagnostic symptoms of secondary syph- 
 ilis. 
 
 4. Name the cardinal symptoms of exophthalmic goiter. 
 
 5. Give differential diagnosis between renal colic and 
 hepatic colic. 
 
 6. Name some of the causes of endocarditis. 
 
 7. What conditions predispose to cerebral hemorrhage? 
 
 8. Differentiate between cerebral vomiting and gastric 
 vomiting. 
 
 9. By what routes and media does the exciting cause 
 of typhoid fever gain entrance to the human organism? 
 How may it be prevented? 
 
 10. Name some points of diagnostic value in chronic 
 interstitial nephritis. 
 
 OBSTETRICS. 
 
 1. State the cause of (a) deficient power of the uterine 
 muscle, and (b) excessive power of the uterine muscle. 
 Give proper management of each. 
 
 2. Define caput succedaneum, and give etiology. 
 
 3. Name four important signs of pregnancy at the third 
 month. 
 
 4. Differentiate between pregnancy and fibroid of the 
 uterus. 
 
 5. Under what conditions would you perform podalic 
 version? Give technique of operation. 
 
 6. What changes occur in the circulation at birth? 
 
 7. Give the causes of cystocele and rectocele, and state 
 the treatment which should be employed. 
 
 8. When should ergot be employed in obstetric practice? 
 What are its contraindications? 
 
 9. Name the symptoms of puerperal sepsis. How would 
 you prevent it? 
 
 10. What are the premonitory symptoms of puerperal 
 convulsions? What treatment would you employ to pre- 
 vent puerperal convulsions? 
 
 GYNECOLOGY. 
 
 1. Define the (a) dorsal posture, (b) left lateral-prone 
 posture, and (c) knee-chest posture. 
 
 2. Give causes, diagnosis, and treatment of endocervi- 
 citis. 
 
 3. Give diagnosis and treatment of ectopic gestation. 
 
 4. Give causes, pathology, diagnosis, and treatment of 
 salpingitis. 
 
 5. Give preparation of patient for an ordinary plastic 
 operation. 
 
 6. Give causes and symptoms of urethrocele. Give 
 differential diagnosis. 
 
 198 
 
MEDICAL RECORD. 
 
 SURGERY. 
 
 1. Give diagnostic points of fracture of base of skull. 
 
 2. Give diagnosis and treatment of appendicitis. 
 
 3. Describe a compound fracture and give treatment. 
 
 4. Give diagnosis and treatment of gallstones. 
 
 5. How many kinds of hernia are there ? 
 
 6. Through what channels is carcinoma disseminated? 
 
 7. What indications are to be followed to promote 
 primary union of a wound? 
 
 8. Give signs, symptoms, and treatment of fracture of 
 the clavicle. 
 
 9. Give indications for trephining in fracture of the 
 skull. 
 
 10. Name five causes of swelling in inguinal region. 
 
 PEDIATRICS. 
 
 1. Give sequelae that most frequently follow eruptive 
 fevers occurring in childhood, and state cause and prog- 
 nosis for same. 
 
 2. Give diagnosis, cause, and treatment for cholera in- 
 fantum. 
 
 NEUROLOGY. 
 
 1. Give symptoms of cerebral compression. 
 
 2. Give definition of dementia and state the more im- 
 portant forms. 
 
 3. What are the diagnostic symptoms of multiple 
 sclerosis ? 
 
 LARYNGOLOGY AND RHINOLOGY. 
 
 1. Give treatment of nasal polypi. 
 
 2. Give etiology and treatment of hypertrophy of the 
 tonsil. 
 
 OPHTHALMOLOGY AND OTOLOGY. 
 
 i. Give causes, diagnosis, and treatment of chronic 
 glaucoma. 
 
 2. Give symptoms, diagnosis, and treatment of gonor- 
 rheal conjunctivitis. 
 
 3. Give etiology, symptoms, and treatment of acute in- 
 flammation of the middle ear. 
 
 ETIOLOGY AND HYGIENE. 
 
 i. Give cause and hygienic treatment of diphtheria. 
 
 2. What is most essential from a sanitary standpoint in 
 plumbing a bath-room? 
 
 3. What method would you use in filtering a city water 
 supply ? 
 
 4. How would you place a water-closet in relation to 
 a farmhouse? 
 
 199 
 
MEDICAL RECORD 
 
 5. Write an article not exceeding seventy-five words on 
 the practical value of the operation of the Pure Food and 
 Drug Act. 
 
 MEDICAL JURISPRUDENCE. 
 
 1. Give signs of death by morphine. 
 
 2. Define (a) delusion, (b) illusion, and (c) hallucina- 
 tion. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Indiana State Board of Medical Examiners. 
 
 anatomy. 
 
 1. See Cunningham's "Anatomy" (1909), pages 11 19 and 
 1270; or Gray's "Anatomy" (1908), page 1350. 
 
 2. See Cunningham's "Anatomy" (1909), page 422; or 
 Gray's "Anatomy" (1908), page 435. 
 
 3. The bony prominences at the elbow are: (1) the 
 external condyle of the humerus, (2) the internal condyle 
 of the humerus, and (3) the olecranon process of the ulna. 
 If the forearm is extended, the internal condyle of the 
 humerus, the tip of the olecranon, and the external condyle 
 will all be found on the same transverse line. In extreme 
 extension the tip of the olecranon is slightly above the level 
 of the condyles. If the forearm is flexed to a right angle, 
 the tip of the olecranon is immediately below the condyles. 
 
 4. In an amputation of the forearm at the union of the 
 lower and middle thirds there will be divided: (1) Arteries: 
 radial, ulnar, anterior and posterior interosseous. (2) 
 Veins: radials, ulnars, interosseous, median, anterior and 
 posterior ulnars. (3) Nerves: median, radial, ulnar, ante- 
 rior and posterior interosseous, musculocutaneous and in- 
 ternal cutaneous. 
 
 5. The blood-vessels that constitute the portal venous 
 system, are: The (1) superior mesenteric vein, which 
 conveys the blood from the small intestines, the cecum, and 
 ascending and transverse colon; (2) splenic vein, which 
 conveys the blood from the spleen; (3) inferior mesenteric 
 vein, which conveys the blood from the descending colon, 
 sigmoid flexure and rectum ; (4) gastric vein, which con- 
 veys the blood from the stomach. 
 
 6. See Cunningham's "Anatomy" (1909), page 1028; or 
 Gray's "Anatomy" (1908), page 1219. 
 
 7. Branches of subclavian artery: Vertebral, thyroid axis, 
 internal mammary, and superior intercostal. Branches of 
 thyroid axis: Inferior thyroid, suprascapular, and trans- 
 versalis colli. 
 
 200 
 
MEDICAL RECORD. 
 
 8. The line of incision for ligation of the external caro- 
 tid artery is the upper part of a line drawn from the 
 sternoclavicular articulation to a point midway between 
 the angle of the jaw and the tip of the mastoid process. 
 The portion above the level of the upper border of the 
 thyroid cartilage represents the line of the external carotid. 
 The structures en-countered 'are: The skin; superficial fas- 
 cia with the external jugular vein and the great auricular 
 nerve ; the platysma myoides, and the deep fascia ; the an- 
 terior border of the sternomastoid; the hypoglossal nerve; 
 facial, lingual, and superior thyroid veins. 
 
 9. In oblique fracture of the femur, immediately above 
 the condyles : The lower fragment is tilted backward by 
 the gastrocnemius and plantaris. The upper fragment 
 is drawn inward by the pectineus and adductors ; and for- 
 ward by the psoas and iliacus. 
 
 10. See Gray's "Anatomy" (1908). pages 1246 and 1244. 
 
 • PHYSIOLOGY. 
 
 1. The chief heat-producing tissues of the body, are : 
 
 (1) The muscles, during contraction (including the heart) ; 
 
 (2) the secreting glands, especially the liver; (3) the 
 brain, during mental activity. 
 
 2. "The exact value of alcohol as a food, broadly con- 
 sidered, is uncertain. Recent experiments, carefully made 
 on man, however, clearly show that when moderate 
 amounts of alcohol are ingested, the alcohol is burned up in 
 the body — i.e. oxidized like any non-nitrogenous food. 
 The potential energy of the alcohol is transformed into 
 kinetic energy, and consequently alcohol is to be considered 
 as having some food value. It may, therefore, be classified 
 with the non-nitrogenous foods. Further, as a non-nitro- 
 genous food, alcohol may replace an isodynamic amount of 
 fat or carbohydrate in the diet without change in the bal- 
 ance of income and outgo. Alcohol serves to protect body 
 protein and fat from oxidation; i.e. like a typical non-pro- 
 teid food it diminishes the oxidation of tissue proteid by 
 being itself oxidized. These facts, however, do not imply 
 that alcohol is necessarily a desirable food or that it is 
 physiologically economical. It is to be remembered that, 
 prior to its oxidation in the body, alcohol may produce 
 deleterious effects of various kinds, more than counter- 
 balancing any gain which may result from its oxidation. 
 It may likewise give rise to changes, either directly or 
 indirectly, in the various metabolic processes of the body, 
 which must of necessity influence more or less its value as 
 a food. Alcohol has a direct and an indirect influence 
 upon the secretion of gastric juice. In this direction it 
 acts as a stimulant. It likewise stimulates the secretion 
 
 201 
 
MEDICAL RECORD. 
 
 of saliva." — (Chittenden in Reference Handbook of the 
 Medical Sciences.) 
 
 3. Absorption is the process by which the products of 
 digestion are taken up into the general circulation. It 
 occurs with greatest activity in the villi of the small 
 intestine. 
 
 Secretion is the process by which certain organs (glands 
 and membranes) separate from the blood certain constitu- 
 ents which are further elaborated and serve some further 
 office in the economy. It occurs with the greatest activity 
 in the liver (unless the urine is considered as a secre- 
 tion). 
 
 Excretion is a similar process by which there are re- 
 moved from the blood waste materials, and products of no 
 further use to the body, and which if retained would be 
 injurious. It occurs with greatest activity in the lungs 
 and kidneys. 
 
 4. Inspiration causes the blood pressure to rise, and 
 the heart to beat faster, but each beat is shallower. 
 
 Expiration causes the blood pressure to fall and the 
 heart to beat slower, but the beats are deeper and more 
 dicrotic. 
 
 5. The portion of the vascular system most susceptible 
 to the vasomotor nervous influence: The arterioles or small 
 arteries. 
 
 The reason: Because they contain relatively the greatest 
 amount of muscular tissue. 
 
 6. In sleep, the brain is anemic; whereas in coma, the 
 cerebral vessels are congested with venous blood. 
 
 7. Under the influence of the steapsin of the pancreatic 
 juice, neutral fats combine with water; the result is a 
 splitting up into glycerin and a free fatty acid. 
 
 In saponification a similar reaction occurs, but the re- 
 sulting products are glycerin and a soap. 
 
 EmulsiUcation is a physical rather than a chemical proc- 
 ess ; the fat is broken up into minute globules which are 
 in a state of more or less permanent suspension. Soap 
 solutions make the most permanent emulsions. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. Ergot. Derivation: The selerotium of the claviceps 
 purpurea. 
 
 Physiological action: Ergot stimulates and causes con- 
 traction of involuntary muscle fibers, hence it is a vaso- 
 constrictor, hemostatic, and oxytocic. It is also a cardiac 
 sedative, it raises the blood pressure, it increases peristal- 
 sis, and is an emmenagogue. 
 
 Indications for the therapeutic application: To promote 
 uterine contractions during third stage of labor; fibroids, 
 menorrhagia, post-partum hemorrhage. Some forms of 
 
 202 
 
MEDICAL RECORD. 
 
 amenorrhea and dysmenorrhea, dysentery, arterial hemor- 
 rhage, congestive headaches, laxity of sphincters, of blad- 
 der or rectum, hemorrhoids, aneurysm, diabetes, urinary 
 incontinence, direct paralysis of the sphincter vesicae, atonic 
 spermatorrhea. 
 
 2. Three medicinal agents which increase diaphoresis: 
 (i) Alcohol; (2) Dover's powder; (3) pilocarpus. 
 
 3. An antagonist to the physiological action of jabor- 
 andi: Atropine. 
 
 4. Three emetics: (1) Apomorphine hydrochloride; 
 dose, gr. 1/10 hypodermically. (2) Copper sulphate; dose, 
 gr. iv to vj in water. (3) Zinc sulphate; dose, gr. x to xv 
 in water. 
 
 5. Tincture of gelsemium. Physiological action: Cir- 
 culatory, respiratory, and nervous depressant. 
 
 Dose: 8 minims. 
 
 Therapeutic Indications: Headache, migraine, asthma, 
 whooping cough, nervous cough, spasmodic dysmenorrhea, 
 torticollis, and other conditions depending upon localized 
 muscular spasm. 
 
 6. (ia) A hydragogue cathartic : Elaterin, dose gr. 1/20 to 
 1/12. (b) A cholagogue cathartic: Podophyllum, dose gr. 
 viij to xij. 
 
 7. Therapeutic indications for mercury: As an anti- 
 septic; as an application to ulcers, sores, warts, chancroids, 
 etc. ; as an antisyphilitic ; as a cathartic, a diuretic, and an 
 absorbent. 
 
 8. Benzoin increases the acidity of the urine. Sodium 
 benzoate; dose, gr. xv. Benzoic acid; dose, gr. vij. 
 
 9. Apomorphine is derived from morphine (by the ab- 
 straction of one molecule of water). 
 
 Therapeutic indications: To cause prompt vomiting, 
 and as an expectorant (in bronchitis and pneumonia). 
 
 Dose of apomorphine hydrochloride : gr. 1/30 as an ex- 
 pectorant; and gr. 1/10 as an emetic. 
 
 10. For acute articular rheumatism: 
 
 5. 
 
 Sodii salicylatis 3ijss 
 Fluidextracti glycyrrhizae. 
 Tincturae aurantii aa 3ijss. 
 Aquae chloroformi q.s. ad. 3 vn J- Misce. 
 Signa : Take two tablespoonfuls every four hours. 
 
 chemistry. 
 
 1. The antidote to: (a) arsenic, is freshly prepared fer- 
 ric hydroxide; (b) corrosive sublimate, is white of egg in 
 moderate quantity, followed by an emetic; (c) carbolic acid, 
 is sodium sulphate, or alcohol. 
 
 2. The specific gravity of healthy urine is about 1015 
 to 1025. 
 
 203 
 
MEDICAL RECORD. 
 
 (a) Test for bile: Put 3 c.c. HN0 3 in a test tube, add 
 a piece of wood, and heat until the acid is yellow; cool. 
 When cold, float some of the urine to be tested upon the 
 surface of the acid. A green band is formed at the junc- 
 tion of the liquids, which gradually rises, and is succeeded 
 from below by blue, reddish-violet, and yellow. 
 
 (b) Test for sugar: The urine should first be tested 
 for albumin. If this be present, it should be removed by 
 heating the urine to near the boiling point, and filtering 
 from the coagulum. 
 
 Fehling's test: Place in a test-tube a few c.c of the liquid 
 prepared as stated below, and boil ; no reddish tinge should 
 be observable, even after five minutes' repose. Add the 
 liquid under examination gradually, and boil after eac^ 
 addition. In the presence of sugar a yellow or red pre- 
 cipitate is formed. In the presence of traces of glucose, 
 only a small amount of precipitate is produced, which ad- 
 heres to the glass, and is best seen when the blue liquid 
 is poured out. 
 
 [The reagent must be kept in two solutions, which are 
 to be mixed immediately before use. Solution I consists of 
 34-653 gms. of crystallized CuS0 4 , dissolved in water to 
 500 c.c. ; and Solution II of 130 gms. of Rochelle salt dis- 
 solved to 500 c.c. in NaHO solution of sp. gr. 1.12. When 
 required for use equal volumes of the two solutions are 
 mixed, and the mixture diluted with four volumes of 
 water.] 
 
 (c) Test for albumin: The urine must be perfectly clear. 
 If not so, it is to be filtered, and, if this does not render 
 it transparent, it is to be treated with a few drops of mag- 
 nesia mixture, and again filtered. The reaction is then ob- 
 served. If it be acid, the urine is simply heated to near 
 the boiling point. If the urine be neutral or alkaline, it 
 is rendered faintly acid by the addition of dilute acetic 
 acid, and heated. If albumin be present, a coagulum is 
 formed, varying in quantity from a faint cloudiness to 
 entire solidification, according to the quantity of albumin 
 present. The coagulum is not redissolved upon the addi- 
 tion of HNO3. 
 
 3. Potassium iodide is a transparent, or milk-white, 
 crystalline, solid; odorless, with a sharp salty taste. It is 
 very soluble in water. It is prepared by saturating a solu- 
 tion of potassium hydroxide with iodine, then evaporating, 
 and calcining the resulting mixture of iodide and iodate 
 with charcoal: 
 
 6KHO + 3I2 = KIO3 + 3H 2 + 5KI 
 
 4. The bile salts are: Sodium glycocholate and sodium 
 taurocholate. 
 
 5. The fluids of the body that are normally of acid re- 
 action, are : The urine, gastric juice, and sometimes sweat 
 
 204 
 
MEDICAL RECORD. 
 
 PATHOLOGY AND BACTERIOLOGY. 
 
 i and 2. "In order to find out whether the dog has hydro- 
 phobia the animal may either be put up and observed to 
 see whether characteristic symptoms develop, or it may 
 be immediately killed. In the latter case the brain and 
 cord should be examined for the presence of the Negri 
 bodies, and the intervertebral ganglia for the presence of 
 round-cell infiltration which is often marked. Rabbits or 
 guinea-pigs should also be inoculated under the dura. 
 It is safer not to wait for the result of the examination, 
 but to subject the person who is bitten to the Pasteur 
 treatment in advance of this, unless it is improbable that 
 the dog is mad. The examination consists in looking for 
 the Negri bodies and in subdural inoculation of rabbits. 
 If the cord of the dog can be obtained, the intervertebral 
 ganglia will show round-cell infiltration. All other ganglia 
 may also show this change. The plexiform and Gasserian 
 ganglia are convenient for examination. Great care must 
 be taken that the operator may not accidentally infect him- 
 self." — (Williams' Bacteriology.) 
 
 3. See Rose and Carless' "Surgery" (1908), page 213. 
 
 4. Benign tumors are encapsulated, do not tend to in- 
 filtrate the surrounding tissues, do not give rise to metas- 
 tatic growths, do not tend to recur after removal, do not 
 produce cachexia, and do not have a fatal tendency (ex- 
 cept from their location). 
 
 Malignant tumors are not encapsulated, tend to infiltrate 
 the surrounding tissues, give rise to metastatic growths, 
 have a tendency to recur after removal, give a cachexia, 
 have a fatal tendency. 
 
 5. A metastatic growth is one that is set up in a part of 
 the body not directlv continuous with the original growth. 
 
 6. The Klebs-Lceffier bacillus is a short rod, about three 
 to six microns in length, and about a half to one micron 
 in breadth ; the extremities may be rounded or clubbed. 
 The bacilli are slightly curved, and may occur singly, in 
 pairs, or in groups ; they are non-motile, have no flagella. 
 are erobic, and contain granules which take on a deeper 
 stain. The bacillus stains with the analine colors, by 
 Gram's method, and with Loefrler's alkaline methylene-blue. 
 
 Method? of culture: The bacillus of diphtheria grows 
 uoon all the ordinary culture media, and can be readily 
 obtained in pure ntilture. LoefBer's blood serum, particu- 
 larly with the addition of a little glucose, is an admirable 
 medium for the rapid growth of this bacillus. The medium 
 should be alkaline and not less than 20 C. 
 
 7. The tubercle bacillus is rod shaped, is from 1^ to 
 S J /2 microns in length, and about one-third to one-half a 
 micron in breadth, is a strict parasite, is not motile, and has 
 
 205 
 
MEDICAL RECORD. 
 
 no flagella. It is slightly curved, does not form spores, is 
 not liquefying, and nonchromogenic, is aerobic; it resists 
 acids; it grows well on blood serum, glycerin agar-agar, 
 glycerin and gelatin; stains well by Ehrlich's, Ziehl-Niel- 
 sen's, or Gabbett's method; it is Gram-positive. 
 
 8. A sterile swab is rubbed over any visible membrane 
 on the tonsils or throat, and is then immediately passed 
 over the surface of the serum in a culture tube. The tube 
 of culture, thus inoculated, is placed in an incubator at 37° 
 C. for about twelve hours, when it is ready for examina- 
 tion. A sterile platinum wire is inserted into the culture 
 tube, and a number of colonies of a whitish color are re- 
 moved by it and placed on a clean cover slip and smeared 
 over its surface. The smear is allowed to dry, is passed 
 two or three times through a flame to fix the bacteria, and 
 is then covered for about five or six minutes with a Loef- 
 fler's methylene-blue solution. The cover slip is then rinsed 
 in clean water, dried, and mounted. The bacilli of diph- 
 theria appear as short, thick rods with rounded ends ; irreg- 
 ular forms are characteristic of this bacillus, and the stain- 
 ing will appear pronounced in some parts of the bacilli and 
 deficient in other parts. 
 
 9. The material must be recent, and, if sputum should 
 be free from particles of food or other foreign matter ; se- 
 lect a cheesy-looking nodule and smear it on a slide, mak- 
 ing the smear as thin as possible. Then cover it with some 
 carbolf uchsin, and let it steam over a small flame for 
 about two minutes, care being taken that it does not boil. 
 Wash it thoroughly in water and then decolorize by im- 
 mersing it in a solution of any dilute mineral acid for about 
 a minute. Then make a contrast stain with solution of 
 Loeffler's methylene blue for about a minute; wash it 
 again and examine with oil immersion lens. The tubercle 
 bacilli will appear as thin red rods, while all other bacteria 
 will appear blue. 
 
 10. Pathology is that branch of science which treats of 
 disease; it includes the causes, nature, manifestations, 
 structural changes, and results. 
 
 Bacteriology is that branch of science which treats of 
 bacteria. 
 
 PHYSICAL DIAGNOSIS. 
 
 1. See Da Costa's "Surgery" (1908), pages 763 and 782. 
 
 2. Ataxia may be defined as lack of co-ordination in 
 muscular movements, so that the performance of certain 
 acts becomes difficult or impossible. 
 
 To test ataxia of the upper extremities: The patient, 
 with his eyes closed or bandaged, is asked to touch the tip 
 of his nose or the lobe of his ear, first with one index 
 finger, then with the other; or the tip of one finger with 
 the tip of some other indicated finger. Or the patient may 
 
 206 
 
MEDICAL RECORD. 
 
 be asked to thread a needle. If these things are done 
 successfully the co-ordination is good, and there is no 
 ataxia. 
 
 To test ataxia of the lower extremities: If the patient 
 can walk, he may be asked to walk along a straight line, 
 such as the crack between two boards of the floor, or along 
 the border of the carpet. If he cannot walk, he should have 
 his eyes covered, and be requested to touch the inner mal- 
 leolus of one foot with the great toe of the other foot. Or 
 the patient may be asked to stand with his heels together 
 and his eyes closed and to notice whether he stands fairly 
 steadily or sways about considerably. In the latter event 
 there is ataxia. 
 
 3. Organic murmurs are due to stenosis or incompetency 
 of one or more of the valves of the heart. 
 
 Functional murmurs are not due to valvular disease. 
 
 Organic murmurs may be systolic or diastolic; may be 
 accompanied by marked dilatation or hypertrophy, and 
 there will probably be a history of rheumatism or of some 
 other disease capable of producing endocarditis. Whereas 
 a murmur, usually systolic, soft, and blowing, heard best 
 over the pulmonic area, associated with evidences of chloro- 
 sis or anemia, and affected by the position of the patient, 
 is a hemic or functional murmur, and denotes as a rule 
 an impoverished condition of the blood. 
 
 4. Method of percussing the heart: "The patient should 
 be recumbent. Commence by defining the area of deep 
 cardiac dullness. . Use moderately strong percussion, and 
 percuss towards the cardiac area. The note is at first 
 pulmonary and gradually grows dull, until the limit of 
 absolute cardiac dullness is reached. For ordinary clinical 
 purposes it is only necessary to percuss in two directions 
 — vertically, parallel to the left margin of the sternum, and 
 transversely, at the level of the fourth rib. (1) Percuss 
 vertically downwards in the left parasternal line, in order 
 to avoid the dullness due to the aorta and pulmonary 
 artery. Percussing downwards from the lower edge of the 
 clavicle, and comparing rib with rib, and interspace with 
 interspace, the full note of the lung becomes impaired at 
 about the upper edge of the third rib. This is, then, the 
 limit of relative or deep cardiac dullness in this situation. 
 (2) Percuss transversely at the level of the fourth rib: To 
 define the left border of the heart commence in the left 
 axilla and, keeping the finger on which percussion is made 
 parallel with the left border of the heart, percuss from 
 left to right along the fourth rib. The left border is nor- 
 mally found about % inch external to the apex beat, or 
 from 2>V2 to 3^4 inches from the mid-sternal line, at the 
 level of the fourth and fifth interspaces, and 3 inches from 
 the mid-sternal line at the level of the fourth rib. To 
 
 207 
 
MEDICAL RECORD. 
 
 define the right border of the heart commence in the right 
 anterior axillary line and percuss from right to left along 
 the fourth rib. The right margin of deep dullness at that 
 level is normally found in the right lateral sternal line, or 
 one inch to the right of the mid-sternal line." — (Brown 
 and Ritchie's Medical Diagnosis.) 
 
 5. The normal pulse rate in the adult is about seventy 
 to seventy-five a minute. For each degree of tempera- 
 ture above the normal, the pulse rate is usually increased 
 about eight or ten beats. 
 
 INTERNAL MEDICINE. 
 
 i. See French's "Practice of Medicine" (1907), page 780; 
 or Osier's "Practice, of Medicine" (1909), page 504. 
 
 2. In auscultation of healthy lung the inspiratory sound 
 is heard, and also a sound during the first part of expira- 
 tion. It is called vesicular breathing. 
 
 3. Some diagnostic symptoms of secondary syphilis: 
 Sore throat, mucous patches; the skin lesions or syphilides, 
 which are characterized: By not itching, by being of a 
 coppery or raw ham color, by being painless, by polymor- 
 phism (macules, papules, pustules, etc., being present at the 
 same time), and by being roughly symmetrical. In this 
 stage may also appear ; iritis, periostitis, and alopecia. 
 
 4. The cardinal symptoms of exophthalmic goiter are : 
 (1) Tachycardia, (2) goiter, (3) exophthalmos, and (4) 
 tremor. 
 
 5. In renal colic: The pain is in the region of the 
 affected kidney, it radiates down the thigh; there are in- 
 tense rigors ; retraction of the testicle may be present ; also 
 history of previous attacks or of calculi; the urine may 
 be scanty, suppressed, or bloody. 
 
 In hepatic colic: The pain is in the region of the liver, it 
 radiates to the right scapula and toward the umbilicus; 
 chills and sweats are common; also vomiting, and some- 
 times symptoms of collapse and jaundice; calculi are found, 
 if at all, in the feces. 
 
 6. Some of the causes of endocarditis, are : Acute articu- 
 lar rheumatism, chorea, tonsillitis, scarlet fever, pneumonia, 
 cancer, gout, diabetes mellitus, Bright' s disease, septicemia, 
 gonorrhea. 
 
 7. The conditions which predispose to cerebral hemor- 
 rhage are: Advanced age, rheumatism, gout, syphilis, al- 
 coholic excesses, Bright's disease, prolonged muscular exer- 
 tion, chronic lead poisoning, severe physical or mental ex- 
 citement. 
 
 8. Cerebral vomiting is projectile in character, and is 
 accompanied by little or no nausea, is continuous even after 
 stomach is emptied; there is no salivation, no tenderness 
 over liver or stomach. 
 
 208 
 
MEDICAL RECORD. 
 
 Gastric vomiting relieves the previous nausea, and re- 
 turns on ingestion of food; salivation is present, also ten- 
 derness over liver and stomach. 
 
 9. Typhoid fever gains entrance to the human body by 
 the mouth, chiefly through water, ice, milk, or other foods. 
 
 The entrance of typhoid fever into the human organism 
 may be prevented by boiling all water that is to be used 
 for drinking or for washing dishes, etc. ; milk should be 
 boiled also; and no ice should be put in water or other 
 drink or food; flies should be kept out of the house as far 
 as possible, by means of screens or otherwise; all dis- 
 charges from the sick person must be disinfected; all 
 utensils, dishes, etc., used by the patient must be thorough- 
 ly cleansed, and boiled every day; soiled linen must be 
 soaked in a disinfectant solution before being washed, 
 after each attendance on a patient, physicians, nurses, and 
 others should wash their hands in a disinfectant ; thor- 
 ough sterilization of all bedding, etc., must be performed 
 after the disease is over. 
 
 10. Some points of diagnostic value in chronic interstitial 
 nephritis, are: Increased arterial tension, urine increased 
 in quantity and of low specific gravity, a few hyaline casts 
 may be present, albumin is either absent or present in very 
 small amount ; hypertrophy of the left ventricle, later on 
 of the whole heart; a systolic murmur; uremia; retinitis, 
 choked disc; anorexia, nausea, vomiting, diarrhea, cramps, 
 numbness, dyspnea. 
 
 OBSTETRICS. 
 
 1. (a) Deficient power of the uterine muscle may be 
 caused by : "Overdistention of the uterus from plural preg- 
 nancy or polyhydramnios; distention of the bladder or 
 rectum; obliquities and displacements of the uterus; thin- 
 ning of the uterine walls resulting from frequent and 
 quickly repeated labors, or from degeneration of the uter- 
 ine tissues; precocious or advanced age; general debility 
 or feebleness of the woman from previous diseases, ener- 
 vating habits, heat of climate, or of season, or the air of 
 a superheated room; exhaustion of the woman from hem- 
 orrhage or from lack of sleep or food. Uterine action is 
 sometimes inefficient from uremia, and when there is mor- 
 bid adhesion between the fetal membranes and uterine wall. 
 Mental emotions : fear, grief, surprise, anxiety, disappoint- 
 ment, and the presence of offensive persons or things will 
 produce it. These last may depend upon idiosyncrasy or 
 unaccountable personal antipathies." — (King's Manual of 
 Obstetrics.) 
 
 (b) Excessive power of the uterine muscle may be 
 caused by: Abnormally large pelvis, small fetus, unusual 
 relaxation of the maternal soft parts, nervous excitability 
 or peculiar temperament of the woman. 
 
 209 
 
MEDICAL RECORD. 
 
 2. Caput succedaneum is a swelling on the presenting 
 part of the fetus, which is developed during birth. It is 
 due to edema of that part of the fetus (the presenting 
 part), which is not compressed by the maternal structure 
 during uterine contraction. 
 
 3. Four important signs of pregnancy at the third 
 month: Softening of the cervix; purplish hue of the 
 vagina; amenorrhea, and the enlargement, pigmentation, 
 hardening, and possible secretion in the mammary glands. 
 
 4. Pregnancy: The tumor is hard and does not fluctu- 
 ate, is situated in the median line, and may give fetal 
 heart sounds and movements; the cervix is soft, and the 
 other signs of pregnancy are present. The rate of growth 
 of the tumor, and the general condition of the patient's 
 health may also help in arriving at a diagnosis. 
 
 Uterine fibroid: Menstruation is irregular and some- 
 times very profuse; absence of the signs of pregnancy; the 
 tumor is nodular, firm, irregular in outline, and while 
 generally placed somewhat centrally is not in the median 
 line, and is not symmetrical ; the rate of growth is irregu- 
 lar, being, as a rule, slow, and sometimes extending over 
 years. 
 
 5. The indications for podalic version are: (1) In 
 transverse presentations; (2) in placenta prsevia; (3) in 
 malpresentations of the head; (4) in simple flattened pel- 
 vis, and in minor degrees of pelvic contraction; (5) in pro- 
 lapsed funis; (6) in sudden death of the mother; and (7) 
 in any case where speedy delivery is imperative. 
 
 6. The changes occurring in the circulation at birth, are : 
 The hypogastric arteries become obliterated, the foramen 
 ovale closes, the Eustachian valve atrophies, the ductus 
 arteriosus and ductus venosus become impervious and 
 shrivel up. 
 
 7. Cystocele is a hernia of part of the bladder into the 
 vagina, covered by the mucous membrane of the anterior 
 vaginal wall. Rectocele is a hernia of the rectum into the 
 vagina, covered by the mucous membrane of the posterior 
 vaginal wall. The two conditions are generally found to- 
 gether. Causes: Lacerated perineum, prolapsed uterus, 
 relaxation of the structures forming the pelvic floor, and 
 subinvolution of the vagina after labor. Treatment ^ con- 
 sists in repair of the perineum, and sometimes, in addition, 
 removal of the redundant tissue. 
 
 For radical cure of cystocele: "The patient is placed in 
 dorsal position. The posterior vaginal wall is kept out of 
 the way with a weighted speculum. The cervix is drawn 
 down with a bullet-forceps. With a pair of tenacula the 
 sides of the prominence are drawn together in the median 
 line in order to see how much of the wall is redundant and 
 these points are marked with small nicks. Next, the whole 
 
 210 
 
MEDICAL RECORD. 
 
 surface is put on the stretch between four pairs of forceps 
 — one at each of the sidemarks, one near the cervix, and 
 one at the transverse ridge at the inner end of the urethra. 
 With a pair of scissors curved on the flat, a strip about 
 Y^ inch wide is cut out of the mucous membrane. Similar 
 strips are removed on both sides until an oval is denuded. 
 Finally a running suture of chromicized catgut is passed 
 under the whole pared surface, uniting the edges from side 
 to side." If necessary, a perineorraphy should be done at 
 the same time. 
 
 8. Ergot should be employed in obstetric practice to pro- 
 mote uterine contractions after the third stage of labor. 
 It is contraindicated if the birth canal is not free and the 
 os uteri is not dilated. 
 
 9. See Williams' "Obstetrics" (1909), pages 875 and 883; 
 or Hirst's "Obstetrics" (1909), pages 728 and 732. 
 
 10. The premonitory symptoms of puerperal convulsions 
 are : Headache ; tinnitus aurium ; dizziness ; pain over 
 stomach ; digestive, visual, and nervous disturbances ; gen- 
 eral debility; insomnia, vomiting, and vertigo. For pre- 
 ventive treatment: (1) The amount of nitrogenous food 
 should be diminished to a minimum; (2) the production 
 and absorption of poisonous materials in the intestines 
 and body tissues should be limited and their elimination 
 should be aided by improving the action of the bowels, the 
 kidneys, the liver, the skin, and the lungs; (3) the source 
 of the fetal metabolic products and the peripheral irrita- 
 tion in the uterus should, if necessary, be removed by 
 evacuating that organ. 
 
 GYNECOLOGY. 
 
 1. In the dorsal posture the patient lies on her back. 
 In the left lateral prone posture the patient lies on her 
 left side and chest, with the right knee .and thigh drawn 
 up and her left arm behind her. In the knee-chest posture 
 the patient rests on her knees and chest, with her thighs 
 at right angles to the table on which she is resting. 
 
 2. Endocervicitis. Causes: Extension of inflammation 
 from uterus or vagina, gonorrhea, sepsis, laceration, ever- 
 sion, traumatism, suppressed menses, uterine displace- 
 ments, subinvolution, pelvic tumors, or disease. Diagnosis 
 is made from the history, leucorrhea, soft and swollen 
 cervix, and patulous and eroded os. Treatment : Removal 
 of cause, if possible; proper hygiene and clothing: relieve 
 constipation ; abdominal massage ; hot vaginal douches ; 
 ichthyol and glycerin tampons; dilatation, and curettage ; 
 
 3. Ectopic gestation. Diagnosis: "When extrauterine 
 pregnancy exists there are: (1) the general and reflex 
 symptoms of pregnancy; they have often comeon after an 
 uncertain period of sterility; nausea and vomiting appear 
 
 211 
 
MEDICAL RECORD. 
 
 aggravated. (2) Then comes a disordered menstruation, 
 especially metrorrhagia, accompanied with gushes of blood, 
 and with pelvic pain coincident with the above symptoms 
 of pregnancy; pains are often very severe, with marked 
 tenderness within the pelvis ; such symptoms are highly 
 suggestive. (3) There is the presence of a pelvic tumor 
 characterized as a tense cyst, sensitive to the touch, actively 
 pulsating; this tumor has a steady and progressive growth. 
 In the first two months it has the size of a pigeon's egg; 
 in the third month it has the size of a hen's egg; in the 
 fourth month it has the size of two fists. (4) The os uteri 
 is patulous; the uterus is displaced, but is slightly en- 
 larged and empty. (5) Symptoms No. 2 may be absent 
 until the end of the third month, when suddenly they be- 
 come severe, with spasmodic pains, followed by the general 
 symptoms of collapse. (6) Expulsion of the decidua, in 
 part or whole. Nos. 1 and 2 are presumptive signs; Nos. 
 3 and 4 are probable signs; Nos. 5 and 6 are positive signs/' 
 — (American Text-Book of Obstetrics.) 
 
 Treatment consists in the removal of the product of con- 
 ception by a laparotomy, as soon as the diagnosis is made. 
 
 4. Salpingitis. Causes: Gonorrhea, septic infection, 
 displaced or subinvoluted uterus, fibroids, lacerated cervix. 
 Pathology: "The inflammation usually extends all along 
 the mucous membrane of the tube to the fimbriae and ovary. 
 The abdominal, opening is closed by adhesions, thus pre- 
 venting escape of the contents of the tube into the ab- 
 dominal cavity. Resolution is rare. At first there is a 
 hyperemia of the mucous membrane more or less intense; 
 later, swelling and softening of the tubes, the tissues be- 
 coming friable ; the fimbriae share in the swelling. The 
 mucous membrane is covered with a glutinous pus. Usu- 
 ally the abdominal opening now closes from adhesions. The 
 uterine opening may remain patulous to permit the escape 
 of the tubal contents. In some cases, however, the swelling 
 of the mucous membrane is sufficient to close this ostium, 
 and thus cause a retention cyst. The uterine end of the 
 cyst may later open from pressure and the contents be 
 discharged through the uterus at intervals. When the 
 cyst contains clear mucus it is known as hydrosalpinx ; 
 when blood is retained, hematosalpinx; when purulent, 
 pyosalpinx. The dilatation usually occurs in the outer 
 two-thirds of the tube. Extension of the inflammatory 
 process beyond the mucous membrane into the muscular 
 and areolar tissue may occur, producing hyperplasia of 
 these structures and hypertrophy of the tube. Although 
 the tube is very much enlarged, its caliber is frequently 
 much decreased in size; it becomes lengthened and 
 markedly tortuous. The tube and ovary may be bound 
 together by adhesion in Douglas' cul-de-sac." (Wells.) 
 
 212 
 
MEDICAL RECORD. 
 
 Diagnosis: A dragging sensation in the neighborhood 
 of the affected tube; colicky pain, which is increased on 
 exertion or even on standing ; abdominal tenderness ; 
 menstrual disorders, as amenorrhea, metrorrhagia, dys- 
 menorrhea, menorrhagia ; dyspareunia; there may be septic 
 symptoms and peritonitis ; sterility generally ensues. On 
 examination there will be found a fullness in Douglas' 
 pouch and one or both lateral f ornices ; in these latter 
 will be felt either the tubes, distorted and possibly ad- 
 herent, or a sausage-shaped tumor, which is very painful ; 
 the uterus is retroverted or retroflexed, and may be bound 
 down by adhesions ; there may be an intermittent expul- 
 sion of pus, accompanied and preceded by a burning pelvic 
 pain. (Wells.) 
 
 The treatment of the acute form "consists in rest in bed, 
 free purgation with Rochelle salts (3i every hour), hot 
 vaginal douches, and hot applications to the abdomen. If 
 the symptoms become more severe, celiotomy is indicated. 
 The chronic form may be treated during the menstrual 
 period by rest in bed, free purgation, hot vaginal douches, 
 local applications of iodin to the cervix and vaginal vaults, 
 and glycerin tampons. If these measures fail removal of 
 the tube and ovary and replacing the retroverted uterus, 
 etc., are necessary." 
 
 5. See Hirst's "Obstetrics" (1909), page 782. 
 
 6. Urethrocele. Causes: Traumatism during labor and 
 stricture or tumor in urethra. 
 
 Symptoms: Frequent and painful micturition; partial 
 incontinence of urine ; retention of urine in the urethrocele, 
 later becoming alkaline and undergoing decomposition. The 
 bulging in the anterior vaginal wall can be seen and 
 touched, and a sound passed into the urethra can be felt 
 through the urethrocele. 
 
 Differential Diagnosis: 
 
 URETHROCELE. 
 
 Indistinct bulging. 
 
 Disappears on 
 pressure. 
 
 Tumor elastic and 
 compressible, not 
 tender on pres- 
 sure. 
 
 No pain on walk- 
 ing or coitus. 
 
 SUBURETHRAL 
 ABSCESS. 
 
 Prominent tumor. 
 
 Only partially dis- 
 appears, and pus 
 may be squeezed 
 out into urethra. 
 
 Tumor fluctuating 
 and prominent, 
 very painful on 
 pressure. 
 
 Very painful. 
 
 VAGINAL TUMOR. 
 
 Prominent tumor. 
 
 Does not disappear 
 on pressure. 
 
 Tumor firm. 
 
 213 
 
MEDICAL RECORD. 
 
 URETHROCELE. 
 
 Only the vaginal 
 and urethral 
 wall between the 
 examining finger 
 and a sound in 
 the urethra. 
 
 SUBURETHRAL 
 ABSCESS. 
 
 The thickness of 
 the intervening 
 structure is in- 
 creased^ by the 
 presence of the 
 abscess. 
 
 VAGINAL TUMOR. 
 
 The thickness of 
 the intervening 
 structure is in- 
 creased by the 
 tumor. 
 
 i. Inguinal. -{ Direct 
 
 (Compiled from Ashton's Gynecology.) 
 
 SURGERY. 
 
 i. See Rose and Carless' "Surgery" (1908), page 745; 
 or Da Costa's "Surgery" (1908), page 708. 
 
 2. See Rose and Carless' "Surgery" (1908), page 1044; 
 or Da Costa's "Surgery" (1908), pages 858 and 861. 
 
 3. See Rose and Carless' "Surgery" (1908), page 481; 
 or Da Costa's "Surgery" (1908), pages 446 and 464. 
 
 4. See Rose and Carless' "Surgery" (1908), pages 1059 
 and 1061; or Da Costa's "Surgery" (1908), pages 891 and 
 
 894. . 
 
 5. Varieties of Hernia: Hernia may be classified: 
 
 I. Anatomically: 
 
 f Acquired 
 
 Oblique i Congenital 
 
 |v Infantile or encysted 
 
 ( External 
 
 ( Internal 
 
 r Intraparietal 
 Interstitial J Interparietal 
 
 ^ Extraparietal 
 
 [Incomplete, or Bubonocele.] 
 Femoral. 
 
 f Congenital 
 Umbilical. < Of infants 
 (.Of adults 
 
 4. Ventral. 5. Lumbar. 6. Obturator. 7. Diaphrag- 
 matic. 8. Pudendal, etc. 
 
 II. Clinically: Reducible irreducible, obstructed or in- 
 carcerated, inflamed, and strangulated. 
 
 6. Carcinoma is desseminated chiefly through the lym- 
 phatics ; less frequently by the circulation ; and occasion- 
 ally by mechanical transportation in the movements of 
 the body. 
 
 7. See Rose and Carless' "Surgery" (1908), page 231; or 
 Da Costa's "Surgery" (1908), page 244. 
 
 8. See Rose and Carless' "Surgery" (1908), page 494; 
 or Da Costa's. "Surgery" (1908), page 482. 
 
 2. 
 
 3- 
 
 214 
 
MEDICAL RECORD. 
 
 9. See Rose and Carless' "Surgery" (1908), page 751; 
 or Da Costa's "Surgery" (1908), page 708. 
 
 10. Five causes of swelling in the inguinal region: 
 Inguinal hernia, iliac abscess, lymphadenoma, retained tes- 
 ticle, and hydrocele of the spermatic cord. 
 
 PEDIATRICS. 
 
 1. See French's "Practice of Medicine" (1907), pages 
 298 and 333; or Osier's "Practice of Medicine" (1909), 
 pages 112 and 145. 
 
 2. See French's "Practice of Medicine" (1907), page 782; 
 or Osier's "Practice of Medicine" (1909), page 507. 
 
 NEUROLOGY. 
 
 1. The symptoms of cerebral compression, are: Head- 
 ache, vertigo, vomiting, mental dullness, sometimes paraly- 
 sis, contracted pupils, coma, and cyanosis. 
 
 2. Dementia is a general enfeeblement of all the mental 
 powers. 
 
 The more important forms of dementia, are : Primary, 
 secondary, acute, chronic, senile, paretic, alcoholic, and 
 syphilitic. 
 
 3. The diagnostic symptoms of multiple sclerosis, are: 
 Nystagmus, scanning speech, intention tremor, exaggerated 
 patellar reflex, ankle clonus, ataxia, vertigo, unsteady gait. 
 
 LARYNGOLOGY AND RHIN0L0GY. 
 
 i. See Rose and Carless' "Surgery" (1908), pages 832 
 and 834. 
 2. See Rose and Carless' "Surgery" (1908), page 868. 
 
 OPHTHALMOLOGY AND OTOLOGY. 
 
 ^ i. Glaucoma is a diseased condition of the eye, produced 
 by increased intraocular pressure, and resulting in excava- 
 vation and atrophy of the optic disc, and blindness. It 
 is due to increase of the contents of the eye, hypersecretion, 
 retention, old age, gout, rheumatism, nephritis. Symptoms: 
 Visual disturbances, increased ocular tension, hazy and 
 anesthetic cornea, sluggish and dilated pupil, shallow an- 
 terior chamber, ciliary neuralgia, cupping of^ optic disc, 
 blindness. Treatment: Myotics, such aseserine or pilo- 
 carpine; massage of the eyeball; mydriatics are contrain- 
 dicated; operative treatment may include paracentesis, 
 iridectomy, or sclerotomy. 
 
 >/ 2. Gonorrheal conjunctivitis. Symptoms: Swelling 
 and redness of the eyes, the presence of a discharge which 
 soon becomes purulent, the conjunctiva of the lids becomes 
 thickened, the eyelids are edematous, pain is severe, and 
 there is some fever. Diagnosis: From symptoms and find- 
 ing the gonococcus in the discharge. Treatment: Protect 
 the sound eye. Wash the eye carefully every half hour 
 
 215 
 
MEDICAL RECORD. 
 
 with a saturated solution of boric acid ; pus must not be 
 allowed to accumulate. Two drops of a 2 per cent, solu- 
 tion of nitrate of silver must also be dropped onto the cor- 
 nea every night and morning. The eyes must be covered 
 with a light, cold, wet compress. The patient must be 
 isolated, and all cloths and compresses used must be burnt. 
 In adults the irrigation must be frequent, about every half 
 hour or hour. 
 
 3. "Acute catarrhal otitis media is frequently caused by 
 acute coryza and the infectious fevers. There is a painless 
 obstructed sensation in one or both ears, impairment of 
 hearing, and tinnitus. The inflammation causes closure of 
 the Eustachian tube. Inflation and aspiration of the middle 
 ear and syringing and douching the nares and nasopharynx 
 must be avoided. A moderate spray of Dobell's solution 
 may be used. If pain is present, dry heat, in the form of 
 hot-water bottle, hot stone wrapped in flannel, etc., may 
 be applied. A few drops (100), warmed, of carbolic acid 
 solution (1:40), or one of formalin (1:2000), may be in- 
 stilled into the ear. 
 
 "Acute purulent otitis media: Acute catarrhal otitis 
 media, instead of undergoing resolution, may pass into 
 acute purulent otitis media (especially in exanthemas) from 
 the passage of pathogenic germs from the nasopharynx 
 into the middle ear. The pain will become more intense, 
 the hearing dull; tinnitus will become louder and more 
 distressing, and fever usually sets in. Dry heat allays the 
 pain. Warmed water or warmed carbolic acid solution 
 (1:40) may be used. Inflations, aspirations, etc., should 
 be avoided. If the nares are filled with tough secretions a 
 spray of Dobell's solution may be used. If the pain con- 
 tinues over six hours in a child or over twelve hours in 
 an adult without spontaneous perforation of the tympanic 
 membrane paracentesis of that structure should be per- 
 formed. The concha and meatus should be smeared with 
 petrolatum to avoid chapping, and the secretions should be 
 gently mopped off as they appear. Under this treatment 
 the ear usually returns to normal in two to three weeks." — 
 (Gould and Pyle's Pocket Cyclopedia of Medicine and 
 Surgery.) 
 
 ETIOLOGY AND HYGIENE. 
 
 i. See French's "Practice of Medicine" (1907), pages 180 
 and 194; or Osier's "Practice of Medicine" (1909), pages 
 193 and 207. 
 
 2. To see that there is no connection between the escape 
 pipe of the bath and that of the water closet. 
 
 3. Filter beds, with fine sand. 
 
 4. If it is a proper water closet, with adequate plumbing, 
 etc., it does not matter where it is placed. If a "privy" 
 
 216 
 
MEDICAL RECORD. 
 
 is meant, it should be placed below the farmhouse, so that 
 water will flow from the farmhouse to the privy, rather 
 than the reverse. 
 
 5. The Pure Food and Drug Act, if properly enforced, 
 will do much to prevent the adulteration of articles of 
 food and drink ; it will do away with many of the so-called 
 preservatives; and people will know what they are taking 
 when they indulge in proprietary "remedies." At the same 
 time the publication of the amount of opium or morphine 
 in certain "pacifiers" will doubtless save many lives; and 
 no one can drink peruna and claim ignorance of its enor- 
 mous alcoholic content. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. There are no characteristic signs of death by mor- 
 phine. The only lesions are those that may usually be 
 observed after death from asphyxia. The blood is dark 
 and fluid ; the brain, meninges, and lungs may be congested ; 
 the bladder is usually full of urine. 
 
 2. A delusion is a belief in something which has no 
 real existence, but is purely imaginary; and out of which 
 the person cannot be reasoned. An illusion is a false or 
 perverted impression, received through one of the senses. 
 An hallucination is the same as an illusion, but without 
 any material basis. 
 
 If an individual believes himself to be made of glass, 
 and is afraid of being touched lest he be broken, he is 
 suffering from a delusion. If the whistling of the wind 
 is mistaken for a voice telling a person to do a certain 
 thing — that ^ would be an illusion. If a person fancied he 
 heard a voice when there was nothing at all to be heard, 
 that would be an hallucination. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Kansas State Board of Medical Registration and 
 
 Examination, 
 anatomy and histology. 
 
 1. Locate the brachial plexus and its branches, naming 
 the latter. & 
 
 2. Describe the medulla oblongata. 
 
 3. Locate and describe a femoral hernia and name its 
 coverings, beginning with the surface. 
 
 4. Describe the intestinal tract and name its divisions. 
 
 5. Locate and describe the omentum, giving the histol- 
 ogy of the same. 
 
 6. Describe the valvulae conniventes. 
 
 217 
 
MEDICAL RECORD. 
 
 7. Locate and describe the pancreas, giving its histology. 
 
 8. Give the histology of the arteries. Does it differ 
 from the histology of the veins? If so, how? 
 
 9. Describe the sympathetic nerve, naming its divisions, 
 and number of ganglia in each. 
 
 10. How many bones are there in the human skeleton? 
 
 CHEMISTRY AND TOXICOLOGY. 
 
 i. What is galvanism? 
 
 2. How can it be demonstrated that hydrogen is lighter 
 than air? 
 
 3. What is analysis and what is synthesis? 
 
 4. What is the effect of inhaling air rich with ozone on 
 the respiratory organs? 
 
 5. In what manner does arsenic prove poisonous? 
 
 6. How does CO act as a poison? 
 
 7. What is the action of KOH on the tissues? 
 
 8. What is the antidote for acute poisoning by HgCla? 
 
 9. What is the reaction of blood during gout? 
 
 10. What is Trommer's test for sugar in urine? 
 
 OBSTETRICS. 
 
 1. Write a page on deformities of the pelvis. 
 
 2. What would you do in a case of postpartum hemor- 
 rhage? 
 
 3. How would you treat a case of hour-glass cpntrac- 
 tion? 
 
 4. Write a page on puerperal eclampsia. 
 
 5. How would you treat a case of pelvic cellulitis? 
 
 6. Into how many stages is labor divided? 
 
 7. How would you treat a case of face presentation? 
 
 8. How would you treat a case of adherent membranes? 
 
 9. Write a page on the use of the forceps. 
 
 10. How would you treat fibroid tumors of the uterus? 
 
 PATHOLOGY. 
 
 1. Define gangrene. 
 
 2. What is a sarcomatous tunapr? Give its pathology. 
 
 3. Define chronic gastritis and give its pathology. 
 
 4. Give symptoms, etiology, pathology, diagnosis and 
 prognosis of herpes zoster. 
 
 5. Give symptoms, etiology, and prognosis of erysipelas. 
 
 6. Give etiology, symptoms, diagnosis, and prognosis of 
 neuritis (multiple). 
 
 7. Define lithemia. 
 
 8. Define purpura hemorrhagica. 
 
 9. Give differential diagnosis of septicemia and pyemia. 
 
 10. Describe the pathology of rachitis. 
 
 218 
 
MEDICAL RECORD. 
 
 BACTERIOLOGY. 
 
 i. How do bacteria multiply? 
 
 2. What is essential to the life of bacteria? 
 
 3. Name and describe the malarial parasites. 
 
 4. What disease does the bite of an infected Stegomyia 
 fasciata produce? 
 
 5. Name five culture media. 
 
 6. Name and describe the pus-producing germs. 
 
 7. Describe Widal's test for typhoid fever. 
 
 8. What are leucocytes, and what occurs when they 
 come in contact with pathogenic bacteria ? 
 
 9. What are ptomaines and toxins? 
 
 10. What are sterilization, antiseptics, disinfectants, and 
 germicides ? 
 
 PHYSIOLOGY. 
 
 1. What are the functions of the spinal cord? 
 
 2. What is the origin of urea and of uric acid? 
 
 3. (a) Describe the vasomotor nervous system and 
 explain its functions, (b) Where is the vasomotor center 
 located ? 
 
 4. (a) Give the function of the suprarenal glands, (b) 
 What is result of their extirpation? 
 
 5. What kind of membrane lines the mastoid cells, and 
 why? 
 
 6. Explain the portal circulation. 
 
 7. (a) What are the functions of bile? (b) Give its con- 
 stituents. 
 
 8. Describe the pleurae, giving kind of tissue and func- 
 tions. 
 
 9. (a) Give functions of the cerebellum, (b) What is 
 the result of its extirpation? 
 
 10. Give the functions of the medulla oblongata, (a) 
 Name the "centers" located in the bulb. 
 
 SURGERY. 
 
 1. What class of patients take ether better than chloro- 
 form, and why? What class take chloroform better, and 
 why ? 
 
 2. What are the signals of danger in general anesthesia ? 
 
 3. How would you treat a suppurating cavity of the 
 thorax? 
 
 4. What is the proper surgical treatment of a chronic 
 varicose ulcer of the leg? Give details. 
 
 5. What is osteoplasty, and in what part of the body is 
 it most frequently called for? Give an example. 
 
 6. Give the cause and treatment of painful cicatrix, ad- 
 herent cicatrix, contracted cicatrix, and exuberant cicatrix. 
 
 219 
 
MEDICAL RECORD. 
 
 7. What kinds of tumors are most safely removed? 
 What kinds are the least safely removed? 
 
 8. How would you treat an ingrowing toenail? Give 
 full details. 
 
 9. What is the best surgical treatment for hemorrhoids? 
 Give details. 
 
 10. What bone in the body is frequently fractured and 
 is the most difficult of all bones to reunite by bony union? 
 How should it be treated when fractured? Give details. 
 
 OPHTHALMOLOGY, OTOLOGY, RHINOLOGY, AND MEDICAL JURIS- 
 PRUDENCE. 
 
 1. Name some causes of ozena. 
 
 2. Discuss the pathological characteristics of nasopharyn- 
 geal adenoids. 
 
 3. Define strabismus. What causes it? 
 
 4. Describe the crystalline lens and give its relations. 
 
 5. The vast majority of all the diseases of the ear have 
 their origin in inflammations of what particular membrane? 
 
 6. Prescribe for chronic case of otitis media purulenta. 
 
 7. Nasal polypi — give diagnosis and surgical treatment. 
 
 8. What do you understood by medical jurisprudence? 
 
 9. What constitutes a dying statement, and what condi- 
 tions are necessary to make it admissible as evidence in a 
 court of justice? 
 
 10. Give diagnostic symptoms between diphtheria and 
 follicular tonsillitis. 
 
 THEORY AND PRACTICE. 
 
 1. Write a page on epidemics. 
 
 2. Write a page on the treatment of typhoid fever. 
 
 3. Give diagnosis and treatment of scarlet fever. 
 
 4. Give treatment of erysipelas. 
 
 5. Give diagnosis and treatment of rickets. 
 
 6. Give diagnosis and treatment of acute laryngitis. 
 
 7. Write a page on pneumonia. 
 
 8. Describe the different murmurs of the heart and ten 
 what they indicate. 
 
 9. Give treatment for acute peritonitis. 
 
 10. Write a page on Bright's disease. 
 
 MATERIA MEDICA. 
 
 1. In what disease is opium used principally? 
 
 2. Name the excitomotors. 
 
 3. What are the preparations and doses of conium? 
 
 4. Is ether ever used as a cardiac stimulant? 
 
 5- How should poisoning by digitalis be treated? 
 
 6. What are the medicinal uses of ipecac? 
 
 7. What substances are incompatible with belladonna? 
 
 220 
 
MEDICAL RECORD. 
 
 8. What are the effects, uses, and doses of calcium 
 chloride? 
 
 9. What are the preparations and doses of gold salts? 
 
 10. Name the mineral tonics. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Kansas State Board of Medical Registration and 
 
 Examination. 
 
 ANATOMY. 
 
 1. See Cunningham's "Anatomy" (1909), page 622 ; or 
 Gray's "Anatomy" (1908), page 994. 
 
 2. See Cunningham's "Anatomy" (1909), page 481; or 
 Gray's "Anatomy" (1908), page 874. 
 
 3. See Gray's "Anatomy" (1908), page 1545. 
 
 4. See Cunningham's "Anatomy" (1909), page 1064; ° r 
 Gray's "Anatomy" (1908). page 1290. 
 
 5. See Cunningham's "Anatomy" (1909), page 1049; or 
 Gray's "Anatomy" (1908), page 1264. 
 
 6. See Cunningham's "Anatomy" (1909), page 1062; or 
 Gray's "Anatomy" (1908), page 1299. 
 
 7. See Cunningham's "Anatomy" (1909), page 1124; or 
 Gray's "Anatomy" (1908), page 1355. 
 
 8. See Cunningham's "Anatomy" (1909), page 781; or 
 Gray's "Anatomy" (1908), page 586. 
 
 9. See Cunningham's "Anatomy" (1909), page 703; or 
 Gray's "Anatomy" (1908), page 1077. 
 
 10. There are 206 named bones in the human skeleton. 
 
 CHEMISTRY AND TOXICOLOGY. 
 
 i. By the term Galvanism is meant current electricity 
 derived from chemical action, in opposition to that pro- 
 duced by heat or induction. The term is no longer used 
 scientifically; but is laxly employed to denote the constant 
 current as distinguished from the induced current (which 
 is sometimes called Faradism or Faradization) . 
 
 2. Soap-bubbles or a toy balloon, if filled with hydrogen 
 gas, will rise rapidly in the air. 
 
 3. Analysis is the splitting up of a compound into its 
 elements or into simpler compounds. Synthesis is the build- 
 ing up of a compound from elements or from simpler 
 compounds. 
 
 4. It causes severe coryza and hemoptysis. 
 
 5. By the ingestion of flypaper, or the water in which it 
 has been placed, poisoning by elementary arsenic may be 
 caused. By the inhalation of hydrogen made from zinc and 
 sulphuric acid containing arsenic, poisoning by Arsin may 
 
 221 
 
MEDICAL RECORD. 
 
 be produced. Arsenic trioxide can cause poisoning by being 
 absorbed from the mouth, stomach, rectum, vagina, or 
 urethra; or by absorption from the skin in the use of 
 parasiticides or cancer cures containing arsenic; also by 
 inhalation of dust from wallpapers containing arsenic; from 
 clothes dyed with arsenic; and by the ingestion of rat 
 poisons, etc. 
 
 6. By uniting with the hemoglobin of the blood and 
 forming a more stable compound than oxyhemoglobin. In 
 this way the power of the red corpuscles to carry oxygen 
 from the air to the tissues is destroyed; and asphyxia is 
 thus produced. 
 
 7. > It acts as a caustic on living tissues ; and disintegrates 
 all tissues, whether, dead or alive. 
 
 8. White of egg, in not too large a quantity, and fol- 
 lowed by an emetic. 
 
 9. Alkaline ; but the degree of alkalinity may be lowered, 
 and uric acid crystals may be found in the blood. 
 
 10. Place in a test tube some urine free from albumin; 
 add a few drops of a solution of cupric sulphate, and then 
 some liquor potassse (about half as much as the urine) ; 
 shake and boil. A yellow or red precipitate is formed in the 
 presence of sugar. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), page 679; or 
 Hirst's "Obstetrics" (1909), page 446. 
 
 2. In postpartum hemorrhage: Grasp the uterus at once, 
 through the abdominal wall, and massage it firmly. Any- 
 thing in the uterus should at once be cleaned out. Pass 
 one hand into the uterus, and with the other on the outside 
 make firm pressure. A hypodermic of ergotin, or ergot 
 can be given by an assistant. An intrauterine douche of hot 
 sterilized water (about 115 F.) may be given. Sometimes 
 a very thorough packing and plugging of gauze of uterus 
 and vagina may be necessary. Whatever is done must be 
 done promptly; and everything likely to be needed for this 
 emergency should be prepared beforehand in every labor. 
 
 3. First, give a hypodermic of morphine and atropine, 
 or a dose of chloral or an anesthetic, and then, with one 
 hand in the vagina, gently introduce the index and middle 
 fingers into the uterus and through the constricting band. 
 After a time the resistance of the constriction will be 
 thus overcome. By pressing the uterus downward, the 
 ringers and the border of the placenta are brought in con- 
 tact. Effort is then made to bring part of the placental 
 mass through the constriction; the placenta being removed 
 as in case of adherent placenta. 
 
 4. Puerperal eclampsia is an acute morbid condition, oc- 
 curring during pregnancy, labor, or the puerperal state, and 
 
 222 
 
MEDICAL RECORD. 
 
 is characterized by tonic and clonic convulsions, which af- 
 fect first the voluntary and then the involuntary muscles; 
 there is total loss of consciousness, which tends either to 
 coma or to sleep, and the condition may terminate in re- 
 covery or death. Etiology: Uremia, albuminuria, imper- 
 fect elimination of carbon dioxide by the lungs, medicinal 
 poisons, septic infection ; predisposing causes are renal dis- 
 ease and imperfect elimination by the skin, bowels, and 
 kidneys. Symptoms: Headache, nausea, and vomiting, 
 epigastric pain, vertigo, ringing in the ears, flashes of light 
 or darkness, double vision, blindness, deafness, mental dis- 
 turbance., defective memory, somnolence ; symptoms easily 
 explained by the circulation of toxic blood through the 
 nerve centers. These may be preceded by lassitude, and 
 accompanied by constipation, or by diarrhea. Headache is 
 perhaps the most significant and common warning symptom. 
 In bad cases the urine is reduced in quantity (almost sup- 
 pressed), very dark in color, its albumin greatly increased, 
 so that it becomes solid on boiling. Next comes the final 
 catastrophe of convulsions. The convulsive fit begins with 
 twitching of the facial muscles, rolling and fixation of the 
 eyeballs, puckering of the lips, fixation of the jaws, pro- 
 trusion of the tongue, etc., soon followed by violent spasms 
 of the muscles of the trunk and limbs, including those of 
 respiration ; hence lividity of the face and stertorous breath- 
 ing, biting of the tongue, opisthotonus, etc. The fit lasts 
 fifteen or twenty seconds, ending in partial or complete 
 coma, possibly death ; or consciousness may return, to be 
 followed by other convulsions. For preventive treatment: 
 (i) The amount of nitrogenous food should be diminished 
 to a minimum ; (2) the production and absorption of 
 poisonous materials in the intestines and body tissues 
 should be limited and their elimination should be aided 
 by improving the action of the bowels, the kidneys, the 
 liver, the skin, and the lungs; (3) the source of the fetal 
 metabolic products and the peripheral irritation in the 
 uterus should, if necessary, be removed by evacuating that 
 organ. The curative treatment includes: (1) Controlling 
 the convulsions (by chloroform, veratrum, or chloral) ; (2) 
 elimination of the poison or poisons which are presumed 
 to cause the convulsions; (3) emptying the uterus under 
 deep anesthesia, by some method that is rapid and that will 
 cause as little injury to the woman as possible. 
 
 5. The vagina should be made as aseptic as possible, 
 by means of vaginal douches of bichloride of mercury 
 1 :2,ooo. The vaginal vault and the cervix uteri can then 
 be painted with tincture of iodine ; sometimes the insertion 
 of a vaginal suppository containing about thirty grains of 
 iodoform is of benefit. In case suppuration occurs, the 
 abscess should be opened; if it bursts into the rectum or 
 
 223 
 
MEDICAL RECORD. 
 
 vagina, measures must be instituted for drainage and dis- 
 infection. Very frequently an abdominal operation is neces- 
 sary. Antipyretics should be given for the fever; and for 
 the pain cold compresses or ice bags should be applied to 
 the perineum and lower part of the abdomen. 
 
 6. Labor is divided into three stages: (i) The first be- 
 gins with the onset of labor, and lasts till the os is com- 
 pletely dilated; (2) the second begins with the complete 
 dilation of the os and ends with the complete expulsion of 
 the child; (3) the third ends with the complete expulsion 
 of the placenta and membranes. 
 
 7. If the chin is presenting anteriorly, expectant treat- 
 ment may suffice; but care must be taken to observe that 
 the chin does not rotate backwards. Spontaneous version 
 may occur, and the presentation become a vertex one. Fail- 
 ing this, or as a means of favoring this, postural treatment, 
 such as Walcher's position, has been recommended. If, in 
 spite of this, engagement has not occurred, cephalic version 
 is indicated, care being taken not to rupture the membranes. 
 If this is not successful, podalic version should be tried. 
 If, after all these manipulations, the child is still alive and 
 the head is engaged, symphyseotomy is indicated; if the 
 child is dead, craniotomy should be performed. 
 
 8. See ixirst's "Obstetrics" (1909), page 436. 
 
 9. See Williams' "Obstetrics" (1909), page 400: or Hirst's 
 "Obstetrics" (1909), page 811. 
 
 10. See Rose and Carless' "Surgery" (1908), page 1282. 
 
 PATHOLOGY. 
 
 1. Gangrene is the complete and permanent loss of 
 vitality in a considerable area of tissue. 
 
 2. A sarcomatous tumor is one arising from connective 
 tissue, with excessive cell formation and very little intercel- 
 lular substance. The cells are either embryonic or imper- 
 fectly developed connective tissue cells. Sarcomata are 
 always mesoblastic in origin; their blood supply is abun- 
 dant, and it is through this channel that they are dis- 
 seminated; of their lymphatics and nerve supply nothing is 
 known. In gross appearance sarcomata are of a more or 
 less homogeneous nature, the color depending upon the 
 quantity of blood present ; occasionally a milky fluid can be 
 expressed, but there is never anything corresponding to the 
 "cancer- juice" of carcinomata. Sarcomata may undergo 
 various secondary changes, such as fatty degeneration, 
 hemorrhages, and mucoid softening. Sarcomata are malig- 
 nant, hence they have a tendency to spread to distant organs 
 (metastasis), are heterologous, have no definite limiting 
 capsule, tend to infiltrate the surrounding tissues, tend to 
 recur after removal, and cause cachexia and death. They 
 have been classified in a variety of ways: (1) according 
 
 224 
 
MEDICAL RECORD. 
 
 to the cells, as round cell sarcoma, spindle cell sarcoma, 
 giant cell sarcoma, mixed cell sarcoma; (2) according to 
 the stroma, as fibrosarcoma, myxosarcoma, chondrosarcoma, 
 osteosarcoma; and (3) according to secondary changes, 
 as melanosarcoma, liposarcoma, chloroma* 
 
 3. See French's "Practice of Medicine" (1907), page 734; 
 or Osier's "Practice of Medicine" (1909), page 459. 
 
 4. See French's "Practice of Medicine" (1907), page 994; 
 or Osier's "Practice of Medicine" (1909), page 900. 
 
 5. See French's "Practice of Medicine" (1907), page 218; 
 or Osier's ''Practice of Medicine" (1909), page 210. 
 
 6. See French's "Practice of Medicine" (1907), page 980; 
 or Osier's "Practice of Medicine" (1909), page 998. 
 
 7. Lithemia is a condition due to imperfect metabolism, 
 and is characterized by an accumulation of uii- acid or 
 urates in the blood. It differs from gout in the absence of 
 joint involvement. 
 
 8. Purpura Hemorrhagica is a disease of unknown or- 
 igin, and is characterized by hemorrhages into the skin and 
 mucous and serous membranes, and usually runs a rapid 
 and fatal course. 
 
 9. Septicemia begins with a rigor, followed by a rise of 
 temperature up to about 104 F., which remains constant. 
 The pulse is weak and progressively rapid; there is an- 
 orexia and constipation, which is followed by diarrhea ; 
 the urine contains albumin; the temperature may become 
 subnormal. There are no repeated^ rigors and no secon- 
 dary (metastatic) abscesses. Pyemia begins with a rigor, 
 which may last for half an hour, and is repeated every 
 one or two days. The temperature rises as in septicemia, 
 but rapidly falls, and at the same time the patient suffers 
 a profuse perspiration. The pulse is weak and rapid ; there 
 is anorexia; and there may be delirium, with jaundice and 
 signs of abscesses in the lungs, joints, etc. In pyemia 
 there are repeated rigors and secondary abscesses. 
 
 10. See French's "Practice of Medicine" (1907), page 
 932; or Osier's "Practice of Medicine" (1909), page 426. 
 
 BACTERIOLOGY. 
 
 1. Bacteria multiply by fission and by sporulation. 
 
 2. Most bacteria require (1) proper temperature, gen- 
 erally at or near that of the body ; (2) oxygen is generally 
 needed, those that cannot live without it being called 
 aerobic, and those that can grow without it, anaerobic; 
 (3) nutriment of a proper kind, containing both organic and 
 inorganic material; (4) a slight degree of moisture; (5) a 
 medium of slightly alkaline reaction ; and (6) rest. Indi- 
 vidual bacteria may require modifications of the above essen- 
 tials. 
 
 225 
 
MEDICAL RECORD. 
 
 3. See French's "Practice of Medicine" (1907), page 233; 
 or Osier's "Practice of Medicine" (1909), page 12. 
 
 4. Yellow fever. 
 
 5. Gelatin, agar, potato, bouillon, and blood-serum. 
 
 6. The pus-producing bacteria are: staphylococcus pyo- 
 genes aureus, staphylococcus pyogenes albus, staphylococ- 
 cus pyogenes citreus, staphylococcus cereus aureus, staphy- 
 lococcus cereus albus, staphylococcus cereus flavus; strep- 
 tococcus pyogenes; micrococcus tetragenus, micrococcus 
 pyogenes tenuis; gonococcus; pneumococcus ; bacillus pyo- 
 cyaneus, bacillus typhosus, and bacillus tuberculosis. 
 
 7. The Widal test: "Three drops of blood are taken 
 from the well-washed aseptic finger tip or lobe of the ear, 
 and each lies by itself on a sterile slide, passed through a 
 flame and cooled just before use; this slide may be wrapped 
 in cotton and transported for examination at the laboratory. 
 Here one drop is mixed with a large drop of sterile water, 
 to redissolve it. A drop from the summit of this is then 
 mixed with six drops of fresh broth culture of the bacillus 
 (not over twenty-four hours old) on a sterile slide. From 
 this a small drop of mingled culture and blood is placed 
 in the middle of a sterile cover-glass, and this is inverted 
 over a sterile hollow-ground slide and examined. A posi- 
 tive reaction is obtained when all the bacilli present gather 
 in one or two masses or clumps, and cease their rapid 
 movement inside of twenty minutes." — (From Thayer's 
 Pathology.) 
 
 8. Leucocytes are white blood corpuscles. When they 
 come in contact with pathogenic bacteria, if the conditions 
 are favorable, they devour and destroy the bacteria (phago- 
 cytosis) ; sometimes, however, the bacteria manage to de- 
 stroy the leucocytes. 
 
 9. Ptomaines are the putrefactive products of dead ani- 
 mal tissues or fluids. 
 
 Toxins are the products of pathogenic bacteria or of pto- 
 maines or leucomaines, and are actively poisonous. 
 
 10. Sterilization is the process of freeing a substance 
 from the live bacteria that may be on it or in it. i 
 
 Antiseptics are agents which prevent or restrain putre- 
 faction. 
 
 Disinfectants are agents which restrain infectious diseases 
 by destroying or removing their specific poisons. 
 
 Germicides are agents whch destroy bacteria and their 
 germs. 
 
 PHYSIOLOGY. 
 
 1. The functions of the spinal cord are: (1) the conduc- 
 tion of nerve impulses ; (2) reflex action ; (3) coordination ; 
 it also contains special centers which preside over definite 
 functions. 
 
 226 
 
MEDICAL RECORD. 
 
 2. Urea is derived from the nitrogenous food ingested; 
 it is manufactured by the cells of the liver. 
 
 Uric acid: "In man uric acid has a twofold origin; one 
 portion, coming from the breaking down of the nuclein- 
 containing tissues or cell elements of the man's own body, 
 and hence is of endogenous origin, while the other portion 
 — usually the larger — is of exogenous origin, coming from 
 the transformation of free and combined purin compounds 
 present in the food." (Chittenden.) 
 
 3. The vasomotor nervous system consists of (1) a 
 vasomotor center in the bulb, (2) of some subsidiary 
 centers in the spinal cord, and (3) of vasomotor nerves, 
 which are of two kinds: (a) those causing constriction of 
 the vessels, and so-called vasoconstrictor nerves; and (b) 
 those causing dilatation of the vessels, and so-called vaso- 
 dilator nerves. These nerves supply the muscle tissue in 
 the walls of the blood-vessels and regulate their caliber, 
 thus influencing the quantity of blood supplied to a part; 
 at the same time they regulate the quality of blood supplied 
 to a part; they also regulate the nutrition of a part, also 
 secretion and heat production. They are concerned, too, in 
 the control of the heart-beat. The center is in the medulla, 
 in the floor of the fourth ventricle, near the calamus scrip- 
 torius. 
 
 4. The function of the suprarenal glands is unknown; 
 it is supposed that they are able to destroy or remove 
 some toxic substance produced elsewhere in the body. Re- 
 moval of these glands is rapidly followed by death. 
 
 5. The mastoid cells are lined by epithelium, continuous 
 with that of the tympanic cavity. 
 
 6. See Cunningham's "Anatomy" (1909), pages 901 and 
 1 120; or Gray's "Anatomy" (1908), pages 768 and 769. 
 
 7. The functions of the bile are: (1) to assist in the 
 emulsifkation and saponification of fats; (2) to aid in 
 the absorption of fats; (3) to stimulate the cells of the 
 intestine to increased secretory activity, and so promote 
 peristalsis, and at the same time tend to keep the feces 
 moist; (4) to eliminate waste products of metabolism, such 
 as lecithin and cholesterin ; (5) it has a slight action in 
 converting starch into sugar ; (6) it neutralizes the acid 
 chyme from the stomach, and thus inhibits peptic digestion ; 
 (7) it has a very feeble antiseptic action. 
 
 The constituents of the bile may be shown in the follow- 
 ing table, which presents the averages of three analyses 
 given by Hammarsten ; the results are given in parts per 
 thousand : 
 
 Water 971.380 
 
 Solids 28.620 
 
 Mucin and pigments 4.910 
 
 227 
 
MEDICAL RECORD 
 
 Bile salts 12.197 
 
 Taurocholate 2.431 
 
 Glycocholate 9.766 
 
 Fatty acids from soaps 1.243 
 
 Cholesterin 1.200 
 
 Lecithin and fats 0.970 
 
 Soluble salts 7.360 
 
 Insoluble salts 0.317 
 
 8. See Cunningham's "Anatomy" (1909), page 977; or 
 Gray's "Anatomy" (1908), page 1391. Function of pleura: 
 With the pleural fluid, to prevent friction in the movements 
 of the lungs. 
 
 9. The functions of the cerebellum are: (1) coordina- 
 tion, (2) equilibrium. Removal of the cerebellum causes 
 loss of these functions. 
 
 10. The functions of the medulla are: (1) Conduction 
 of nerve impulses and impressions, (2) as an independent 
 reflex center. 
 
 The "centers" located in the bulb are: (1) center for 
 mastication, (2) for secretion of saliva, (3) for sucking, 
 (4) for deglutition, (5) for vomiting, (6) for voice, (7) 
 center for expression (8) cardiac centers, (9) respiratory 
 centers, (10) vasomotor centers. 
 
 SURGERY. 
 
 1. See Rose and Carless' "Surgery" (1908), page 1326; 
 or Da Costa's "Surgery" (1908), page 1028. 
 
 2. The danger signals are: (1) lividity or extreme 
 pallor of the face, (2) feeble, irregular, or intermittent 
 pulse, (3) slow and shallow respiration, (4) dilatation of 
 the pupils during deep narcosis. 
 
 3. See Rose and Carless' "Surgery" (1908), page 928; or 
 Da Costa's "Surgery" (1908), page 774. 
 
 4. See Rose and. Carless' "Surgery" (1908), pages 94 and 
 352; or Da Costa's "Surgery" (1908), page 396. 
 
 5. By osteoplasty is meant the transplantation of bone 
 (with periosteum). It is most frequently performed on 
 the skull. 
 
 6. Painful cicatrix is caused by the pressure of a con- 
 tracting cicatrix upon the cut end of a nerve or by the 
 inclusion of a nerve in the scar of an amputation stump. 
 In the former case the painful part should be excised; in 
 the latter the stump must be opened and the end of the 
 affected nerve removed. 
 
 Adherent cicatrix is caused by simultaneous injury (such 
 as burns or scalds) to contiguous and approximated parts, 
 such as the fingers, or the pinna and the side of the head. 
 A plastic operation is indicated. 
 
 Contracted cicatrix is most apt to occur in the flexure 
 of a joint; a serious burn of the hand may cause flexion- 
 
 228 
 
MEDICAL RECORD 
 
 contracture of the fingers. The treatment is to divide the 
 cicatrix, dissect out the scar, and follow with skin-grafting. 
 Exuberant cicatrix consists of a hyperplasia of scar tissue, 
 it is most often found in tuberculous patients, and is of 
 unknown etiology. Excision is useless, as it is very apt to 
 recur. Sometimes it disappears spontaneously. 
 
 7. Benign tumors are most safely removed; and malig- 
 nant tumors are least safely removed. 
 
 8. Ingrowing toenail: 'The essential point is to remove 
 both the edge of the nail and that portion of the matrix 
 from which it grows. The following operation will be 
 found satisfactory : Sterilize the toe as completely as pos- 
 sible and tie a rubber band around its base; inject a few 
 drops of a eucaine or stovaine solution along, the edge of 
 the nail and beneath it as far back as the second phalanx. 
 Make an incision through the nail and overlying skin and 
 matrix in about one-fourth of an inch from the edge of 
 the nail. The overlying skin is next dissected free from 
 the edge of the nail and its matrix. The portion of the 
 nail marked out by the first incision is then dissected out 
 with its matrix, care being taken that all of the matrix 
 corresponding to the nail is removed. The wound is irri- 
 gated with a 1 to 2000 bichloride solution and closed by 
 wrapping a gauze dressing around the toe and securing it 
 by a bandage firmly applied. The rubber bandage is next 
 removed. The wet dressing should be renewed daily for a 
 few days, and after this time a dry dressing may be em- 
 ployed." — (Wharton's Minor Surgery.) 
 
 9. See Rose and Carless' "Surgery" (1908), page 1152; 
 or Da Costa's "Surgery" (1908), page 1015. 
 
 10. The patella. It is best treated by open operation anu 
 wiring. 
 
 OPHTHALMOLOGY, OTOLOGY, RHINOLOGY, AND MEDICAL JURIS- 
 PRUDENCE. 
 
 1. (1) Atrophic nasal catarrh, due to syphilis, glanders, 
 caries, or necrosis of the nasal bones; (2) ulcers ot a 
 syphilitic, lupoid, or tuberculous origin; (3) foreign bodies 
 and new growths in the nose or nasopharynx. 
 
 2. Adenoids consist of lymphoid tissue, which is com- 
 posed of masses of round cells held together by connective 
 tissue. Mucous glands may be found in the deeper parts 
 of the lymphoid tissue; and the whole is covered with cil- 
 iated columnar epithelium. 
 
 • t 3. Strabismus, or squint, is a condition in which the 
 lines of sight of the two eyes are not directed towards the 
 same object of vision. 
 
 The causes are: (1) disturbances of equilibrium of 
 the ocular muscles; (2) errors of refraction; (3) opacities 
 in the cornea or lens; (4) intraocular disease. 
 
 229 
 
MEDICAL RECORD 
 
 4. See Cunningham's " Anatomy" (1909), page 736; or 
 Gray's "Anatomy" (1908), page 1140. 
 
 5. The membrana tympani. 
 
 / 6. $. Acidi borici * gr. xxx 
 
 Zinci sulphatis gr.xvj 
 
 Glycerin 3ij 
 
 Aquas destillatse 3ij- M. 
 
 Sig. A few drops to be instilled into the ear several 
 times a day. 
 
 7. See Rose and Carless' "Surgery" (1908), page 832. 
 
 8. Medical jurisprudence is the application of the knowl- 
 edge of any of the branches of medicine to the problem 
 and requirements of the law. 
 
 9. Any statement made by a dying person who believes 
 that he cannot recover and that he is, at that very time, in 
 actual danger of death. The statement need not be sworn 
 to; it should be voluntary and sincere; and it is admissible 
 as evidence in a court if the individual dies. 
 
 - 10. In diphtheria the onset is more gradual ; the temper- 
 / ature rises to about 101 to 103 F. ; the tonsils are not much 
 enlarged; there is an exudate of a thick grayish mem- 
 brane which is very adherent, is removed only with diffi- 
 culty, and leaves a bleeding surface; this membrane soon 
 re-forms and may be found on the fauces and pharynx as 
 well as on the tonsils; in the exudate the Klebs-Loffler 
 bacilli may be found. 
 
 In follicular tonsillitis the onset is more sudden ; the tem- 
 perature may be a little higher than that of diphtheria ; there 
 is no membrane, but the tonsils are red and swollen, and in 
 the crypts are seen white cheesy spots or plugs, which 
 consist of broken-down epithelium, and are easily brushed 
 away; Klebs-Loffier bacilli are not found. 
 
 THEORY AND PRACTICE. 
 
 I. Epidemic diseases are such as attack, either simulta- 
 neously or in rapid succession, a large number of persons 
 in the same locality, or spread rapidly over a large territory. 
 The causes of these epidemic outbursts are not known. 
 "They have been attributed to climatic and meteorological 
 conditions, accumulation of susceptible persons, facilities 
 for convection or transmission, and (as regards cholera 
 and other 'filth-diseases') imperfect sanitation. Scarlet 
 fever, in temperate climates, where it has established itself 
 permanently, tends to become epidemic at intervals of 
 about five years; measles at intervals of about two years. 
 Whooping cough is more irregular than either, but on an 
 average becomes prevalent every second year. Diphtheria 
 shows no very marked periodicity, apart from its depend- 
 ence upon season, and enteric fever none. The liability to 
 each kind of infection varies in man according to age and 
 
 230 
 
iMEDICAL RECORD. 
 
 sex, as well as locality, climate, season, and surroundings. 
 Similar variation occurs among the different races of men. 
 and still more conspicuously among the different genera 
 and species constituting the animal kingdom." 
 
 2. See French's "Practice of [Medicine" (1907), page 
 109; or Osier's "Practice of [Medicine" (1909), page 99. 
 
 3. See French's "Practice of [Medicine" (1907), pages 
 317, 322 and 324; or Osier's "Practice of Medicine" (1909), 
 pages 132, 136, and 138. 
 
 4. See French's "Practice of [Medicine" (1907), page 
 221; or Osier's "Practice of [Medicine" (1909), page 213. 
 
 5. See French's "Practice of Medicine" (1907), page 
 933; or Osier's "Practice of [Medicine" (1909), page 428. 
 
 6. See French's "Practice of Medicine" (1907), page 645; 
 or Osier's "Practice of Medicine" (1909), page 597. 
 
 7. See "French's "Practice of Medicine" (1907).. page 151 ; 
 or Osier's "Practice of Medicine" (1909), page 164. 
 
 8. (1) A systolic murmur, soft and blowing, heard best 
 at the apex, and transmitted to the left axilla and toward 
 the angle of the left scapula, indicates mitral regurgitation. 
 (2) A presystolic murmur, harsh and rough, heard best 
 very near the apex, and not transmitted, denotes mitral 
 stenosis. (3) A diastolic murmur, soft, heard best in the 
 second right intercostal space, and transmitted down the 
 sternum or toward the apex, denotes aortic regurgitation. 
 (4) A systolic murmur, harsh, heard best in the second 
 right intercostal space, and transmitted into the carotids, 
 denotes aortic stenosis. (5) A systolic murmur, heard best 
 over the lower end of the sternum, denotes tricuspid regur- 
 gitation. (6) A presystolic murmur, heard best over the 
 ensiform cartilage, and not transmitted, denotes tricuspid 
 stenosis. (7) A diastolic murmur, heard best in the second 
 left intercostal space, denotes pulmonary regurgitation. (8) 
 A systolic murmur, heard best in the second left inter- 
 costal space, and not transmitted to the large vessels of the 
 neck, denotes pulmonary stenosis. (9) A murmur, usually 
 systolic, soft, and blowing, heard best over the pulmonic 
 area, associated with evidences of chlorosis or anemia, and 
 affected by the position of the patient, is a hemic or func- 
 tional murmur, and denotes as a rule an impoverished con- 
 dition of the blood. 
 
 9. See French's "Practice of [Medicine" (1907), page 868; 
 or Osier's "Practice of Medicine" (1909), page 591. 
 
 10. See French's Practice of Medicine" (1907), pages 
 895, 900, 904; or Osiers "Practice of Medicine" (1909)* 
 pages 690, 693, and 700. 
 
 MATERIA MEDIC A. 
 
 1. In diabetes; particularly diabetes mellitus. 
 
 2. Nux vomica and ignatia (and their alkaloids strych- 
 
 231 
 
MEDICAL RECORD 
 
 nine and brucine), thebaine, ammonia, ether, chloroform, 
 opium, ergot, alcohol in small doses. 
 
 3. Conium, three grains; fluid extract of conium, three 
 minims. 
 
 4. Yes; on account of the rapidity of its action, ether 
 is a very valuable cardiac stimulant. 
 
 5. The patient must be kept in the recumbent position; 
 the stomach should be washed out with infusion of tea; 
 give stimulants and keep the patient warm; tannic acid 
 may be given, as the chemical antidote; and tincture of 
 aconite, as the physiological antidote. 
 
 6. Ipecac is used externally as an antiseptic, in cases of 
 anthrax. Internally as a stomachic, an expectorant, an 
 emetic, a diaphoretic, and a cholagogue. It is given in cases 
 of dyspepsia, dysentery, bronchitis, asthma, croup, and in 
 the vomiting of pregnancy. 
 
 7. The caustic alkalies are incompatible with belladonna. 
 
 8. It is an irritant; applied externally it hastens the 
 coagulation of the blood and makes a firmer clot. It is used 
 in cases of gastric catarrh and fermentative dyspepsia, in 
 hematemesis and hemoptysis, in glandular swellings of 
 tuberculous patients. It has also been employed in the treat- 
 ment of pneumonia and phthisis. The dose is seven and a 
 half grains. 
 
 9. Auri et sodii chloridum is the only official gold salt; 
 dose, one-tenth of a grain. 
 
 10. Iron, manganese, arsenic, bismuth, and phosphorus. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 State Board of Health of Kentucky. 
 
 ANATOMY. 
 
 1. Describe (a) the gracilis, (b) gastrocnemius, (c) rec- 
 tus femoris, giving origin and insertion of each. 
 
 2. Describe the pancreas. 
 
 3. Name the structures to be divided in operating for 
 strangulation of an oblique inguinal hernia. 
 
 4. Describe the fourth cervical vertebra and distinguish 
 it from the fourth dorsal vertebra. 
 
 5. Bound the axilla and name and give relations of 
 structures in axillary space. 
 
 6. Name the muscles, nerves, and arteries severed by 
 a cross section of the thigh at the junction of the middle 
 and lower thirds. 
 
 7. Describe (a) the superficial and deep palmar arches, 
 (b) the brachial artery, branches and relationship. 
 
 8. Describe and give contents and relations of parts in 
 Scarpa's triangle. 
 
 232 
 
MEDICAL RECORD 
 
 9. Describe (a) the superior longitudinal sinus (b) the 
 lateral sinus, (c) torcular Herophili. 
 
 10. Give the anatomy of the liver. 
 
 SURGERY. 
 
 1. Give varieties of hernia; describe one operation for 
 inguinal hernia. 
 
 2. (a) Name different kind of fractures and give differ- 
 ential diagnosis between fracture of the neck of the femur 
 and dislocation of hip. (b) Give treatment of the latter. 
 
 3. How would you make a diagnosis of gonorrhea? 
 Give a bacteriological examination. 
 
 4. What is empyema? Give diagnosis, prognosis, and 
 treatment. 
 
 5. Give symptoms, diagnosis, and treatment of intestinal 
 obstruction. 
 
 6. How would you diagnose retention of urine? What 
 would you do for it? 
 
 7. How would you determine that a limb is injured 
 beyond hope in a crushing accident? 
 
 8. What are the indications for appendectomy? 
 
 9. Give the treatment of shock resulting from hemor- 
 rhage. 
 
 10. Give contraindications to the employment of ether 
 and chloroform? 
 
 MEDICAL JURISPRUDENCE. 
 
 1. What constitutes expert testimony? 
 
 2. How would you determine that a full term dead baby 
 was born alive? 
 
 3. How would you determine (a) that a wound was in- 
 flicted by a blunt instrument? (b) or that it was done 
 before or after death? 
 
 4. Differentiate between idiocy and lunacy. 
 
 5. What is paresis? Give symptoms, prognosis, and 
 treatment. 
 
 OPHTHALMOLOGY. 
 
 1. Differentiate iritis and glaucoma, giving symptoms of 
 each. 
 
 2. Describe and give etiology of (a) phlyctenular ker- 
 atitis, and (b) interstitial keratitis. 
 
 3. What is ophthalmia neonatorum? Give etiology and 
 the probable results of a badly managed case. 
 
 4. Give symptoms and etiology of ciliary blepharitis. 
 
 5. Differentiate myopia and hyperopia and hypermetro- 
 pia; give the anatomical reasons for their existence, and 
 tell what you would recommend for the relief of each. 
 
 233 
 
MEDICAL RECORD. 
 
 PHYSIOLOGY. 
 
 i. (a) Give several varieties of food, (b) Which en- 
 zymes act on each variety? 
 
 2. (a) Describe absorption, and give the function of the 
 lymphatics, (b) Describe the thoracic duct. 
 
 3. Give chemistry and uses of bile. 
 
 4. Describe the circulation of the blood. What forces 
 govern it? 
 
 5. Give histology of the kidney and function of the 
 various structures. 
 
 6. Name and give the function of each of the cranial 
 nerves. 
 
 7. Describe and .give functions of sympathetic nervous 
 system. 
 
 8. What are the functions of the skin ? 
 
 9. Describe the blood. 
 
 10. Describe the cardiac cycle. 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 1. Define presentation and position. 
 
 2. Tell exactly how you would manage a shoulder pres- 
 entation. 
 
 3. What is mensuration? (b) How is it conducted in 
 obstetrical cases? (c) How is it of value? 
 
 4. How would you diagnose and conduct the delivery of 
 a hydrocephalic fetus? 
 
 5. (a) What would you suspect in antepartum hemor- 
 rhage? (b) How confirm your diagnosis? (c) How 
 manage the case? 
 
 6. (a) When is ventrofixation indicated? (b) What 
 is ballottement, (c) when is it valuable and how is it per- 
 formed ? 
 
 7. Give diagnosis of extrauterine gestation. 
 
 8. Give symptoms and pathology of carcinoma uteri. 
 
 9. Describe ovary and uterus during stages of menstru- 
 ation. 
 
 10. (a) Give two indications for hysterectomy (b) 
 Reasons for preferring abdominal or vaginal method. 
 
 CHEMISTRY. 
 
 1. What is (a) an atom? (b) a molecule? (c) What 
 are isomeric compounds? 
 
 2. (a) What are the symptoms of acute arsenic poison- 
 ing? (b) What is the chemical combination of its anti- 
 dote and how does it act? (c) Tell in detail how to detect 
 arsenic in the stomach of a case of suspected poisoning. 
 
 3. Describe in detail a method for the quantitative esti- 
 mation of sugar in the urine. 
 
 4. Tell in detail how to detect bile in the urine. 
 
 234 
 
MEDICAL RECORD. 
 
 5. (a) Contrast dairy milk with human milk, and (b) 
 give a brief description of the essentials for the production 
 of pure dairy milk. 
 
 6. What is (a) H 2 S0 4 , (b) Ba0 2 , (c) HC1, (d) HNOs? 
 (e) What is the formula for methyl alcohol? 
 
 7. (a) What is acetphenetidin? (b) hexamethylene- tetr- 
 amine? (c) From what are they prepared? 
 
 8. (a) Describe oxygen, (b) Give its formula, (c) val- 
 ency, (d) atomic weight, (e) Tell how to prepare it, 
 and give formula of your method. 
 
 9. (a) What is specific gravity? (b) How obtained for 
 solids, (c) liquids, (d) gases? 
 
 10. Describe the chemical changes in starch during di- 
 gestion in detail, giving formulas. 
 
 NERVOUS DISEASES. 
 
 1. Give etiology of migraine. 
 
 2. Give etiology and symptoms of sciatica. 
 
 3. Describe (a) epilepsy, (b) catalepsy. 
 
 4. Describe a case of progressive bulbar paralysis. 
 
 5. Differentiate between (a) illusions, (b) delusions, 
 (c) hallucinations. 
 
 PREVENTIVE MEDICINE. 
 
 1. How long after recovery would you keep in quaran- 
 tine a case of (a) diphtheria, (b) scarlet fever, (c) small- 
 pox? 
 
 2. Name the portals of entry of tubercular infection in 
 the order of their importance. 
 
 3. Describe in detail just how you would manage cases 
 of typhoid fever for the protection of the community. 
 
 4. How would you disinfect a room after a communi- 
 cable disease? 
 
 5. What is the difference between contagion and in- 
 fection ? 
 
 PRACTICE. 
 
 1. Define constipation; give etiology, diagnosis, and 
 prognosis. 
 
 2. Define vertigo; give varieties and diagnosis. 
 
 3. Define myxedema ; give etiology, diagnosis, and prog- 
 nosis. 
 
 4. Define hydrothorax ; give etiology, diagnosis and 
 prognosis. 
 
 5. Define angina pectoris ; give etiology, diagnosis, and 
 prognosis. 
 
 6. Define asthma ; give etiology, diagnosis, and prognosis. 
 
 7. Define adenoids ; give etiology, symptoms, and dan- 
 gers. 
 
 235 
 
MEDICAL RECORD 
 
 8. Define enterocolitis in a child; give etiology, diag- 
 nosis, and prognosis. 
 
 9. Give essentials for the production and preservation 
 of pure dairy milk. 
 
 10. Give etiology, diagnosis, and prognosis of menin- 
 gitis in a child. 
 
 OTOLOGY. 
 
 1. What is Politzer's method of inflating the tympanum, 
 and how is it accomplished? 
 
 2. Define tinnitus aurium, and give the cause of it. 
 
 3. Give etiology, symptoms, and diagnosis of acute 
 otitis media. 
 
 4. What is the pyramid of light, and where would you 
 expect to find it? 
 
 5. Give symptoms, etiology, and probable serious re- 
 sults of mastoiditis. 
 
 BACTERIOLOGY. 
 
 1. Tell in detail (a) how you would detect malarial 
 organisms in bloo~d, (b) how distinguish between the quar- 
 tan and estivoautumnal parasite. 
 
 2. Describe (a) Widal's test for typhoid fever; (b) 
 what is its diagnostic value? 
 
 3. Differentiate between the culture of ^ Bacillus ty- 
 phosus and that of the Bacillus coli communis. 
 
 4. How would you examine a suspected specimen of 
 sputum for tubercle bacilli? Give details. 
 
 5. Define (a) toxins, (b) antitoxins, (c) amboceptors, 
 (d) bacterioproteins, (e) lysins. 
 
 6. Give the morphology of the tetanus bacillus; what 
 are its toxins? 
 
 7. Tell in detail how to examine a suspected urethral 
 discharge for gonococci. 
 
 8. Discuss Ehrlich's side-chain theory of immunity. 
 
 9. Differentiate between the pneumococcus and Pfeif- 
 fer's bacillus of influenza. 
 
 10. What is phagocytosis? What is accomplished by it? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 State Board Of Health of Kentucky. 
 
 anatomy. 
 
 1. See Cunningham's "Anatomy" (1909), pages 362, 376, 
 and 357; or Gray's "Anatomy" (1908), pages 522, 537, and 
 518. 
 
 2. See Cunningham's "Anatomy" (1909), page 1124; or 
 Gray's "Anatomy" (1908), page 1355. 
 
 3. The structures to be divided in operating for strangu- 
 
 236 
 
MEDICAL RECORD. 
 
 lation of an oblique inguinal hernia are : Skin, superficial 
 fascia, intercolumnar fascia, Cremaster muscle and fascia, 
 infundibuliform fascia, subserous areolar tissue, and peri- 
 toneum. 
 
 4. Differences between the fourth cervical vertebra and 
 the fourth dorsal vertebra : The fourth cervical vertebra 
 has a small, transversely elongated body, with no facets for 
 ribs ; the laminae are long and slender ; the spinous proc- 
 ess is short, nearly horizontal, and bifid; the transverse 
 processes are short and contain a foramen for the vertebral 
 artery; the superior articular process is directed upward 
 and slightly backward; the inferior articular process is di- 
 rected downward and slightly forward ; the spinal foramen 
 is large and triangular. 
 
 The fourth dorsal vertebra has a heart-shaped body with 
 a facet on each side for articulation with a rib; the lam- 
 inae are broad and deep; the spinous process is long and 
 points downward ; the transverse processes are long, artic- 
 ulate with the tubercle of a rib, and do not contain a fora- 
 men; the superior articular process is directed backward 
 and slightly outward; the inferior articular process is di- 
 rected forward and slightly inward; the spinal foramen is 
 smaller and circular. 
 
 5. The axilla is bounded: Anteriorly, by the clavicle, 
 Subclavius, Pectoralis major, costocoracoid membrane, Pec- 
 toralis minor ; posteriorly, by the Subscapulars, Teres 
 major, and Latissimus dorsi; internally, by the first four 
 ribs, first three Intercostal muscles, Serratus magnus ; ex- 
 ternally, by the humerus, Coracobrachialis, and Biceps. 
 
 "Contents: The axillary vessels and brachial plexus of 
 nerves, with their branches, some branches of the inter- 
 costal nerves, and a large number of lymphatic glands, all 
 connected together by a quantity of fat and loose areolar 
 tissue. Their position : The axillary artery and vein, with 
 the brachial plexus of nerves, extend obliquely along the 
 outer boundary of the axillary space, from its apex to its 
 base, and are placed much nearer the anterior than the 
 posterior wall, the vein lying to the inner or thoracic side 
 of the artery and partially concealing it. At the fore part 
 of the axillary space, in contact with the pectoral muscles, 
 are the thoracic branches of the axillary artery, and along 
 the anterior margin of the axilla the long thoracic artery 
 extends to the side of the chest. At the back part, in con- 
 tact with the lower margin of the subscapularis muscle, are 
 the subscapular vessels and nerves ; winding around the 
 lower border of this muscle is the dorsalis scapulas artery 
 and veins ; and toward the outer extremity of the muscle 
 the posterior circumflex vessels and the circumflex nerve 
 are seen curving backward to the shoulder. 
 
 237 
 
MEDICAL RECORD. 
 
 "Along the inner or thoracic side . . . are some important 
 nerves, viz., the posterior thoracic or external respiratory 
 nerve, descending on the surface of the serratus magnus, 
 to which it is distributed ; and perforating the upper and 
 anterior part of this wall, the intercostohumeral nerve or 
 nerves, passing across the axilla to the inner side of the 
 arm." (Gray's Anatomy.) 
 
 6. In a cross section of the thigh, at the junction of the 
 middle and lower thirds there are severed : Muscles, Vas- 
 tus internus, Rectus femoris, Crureus, Vastus externus, Bi- 
 ceps, Semitendinosus, Semimembranosus, Gracitis, Sartor- 
 ius, Adductor magnus ; Nerves, sciatic, long saphenous ; 
 Arteries, superficial femoral, anastomotic, deep femoral, 
 perforating. 
 
 7. (a) See Cunningham's "Anatomv" (1909), page 836; 
 or Gray's "Anatomy" (1908), pages 660 and 666. 
 
 (b) See Cunningham's "Anatomy" (1909), page 830; 
 or Gray's "Anatomy" (1908), page 654. 
 
 8. Scarpa's triangle is a triangular area or depression 
 situated just below the fold of the groin. It is bounded 
 above by Poupart's ligament, externally by the Sartorius, 
 and internally by the inner margin of the Adductor longus ; 
 its apex is formed by the junction of the Adductor longus 
 and Sartorius. The floor is formed, from without inward, 
 by the Iliacus, Psoas, Pectineus, Adductor brevis, and Ad- 
 ductor longus. Contents: The femoral vessels pass from 
 about the center of the base to the apex, the artery being 
 on the outer side of the vein ; the artery gives off the su- 
 perficial and profunda branches, and the vein receives the 
 deep femoral and internal saphenous ; the anterior crural 
 nerve lies to the outer side of the femoral artery; the ex- 
 ternal cutaneous nerve is still further external, lying in the 
 outer corner of the space; just to the outer side of the 
 femoral artery, and in the sheath with it, is the crural 
 branch of the genitocrural nerve. At the apex, the vein 
 (which at the base was internal to the artery) lies behind 
 the artery. The triangle also contains fat and lymphatics. 
 
 9. (a) See Cunningham's "Anatomy" (1909), page 884; 
 or Gray's "Anatomy" (1908), page 736. 
 
 (b) See Cunningham's "Anatomy" (1909), page 886; or 
 Gray's "Anatoirly" (1908), page 738. 
 
 (c) See Cunningham's "Anatomy" (1909), page 884; or 
 Gray's "Anatomy" (1908), page jv. 
 
 10. See Cunningham's "Anatomy" (1909), page 1108; or 
 Gray's "Anatomy" (1908), page 1334. 
 
 SURGERY. 
 
 1. Varieties of Hernia: Hernia may be classified: 
 
 I. Anatomically: 
 
 238 
 
MEDICAL RECORD 
 
 i. Inguinal 
 
 2. Femoral 
 
 3. Umbilical 
 
 Oblique 
 
 Direct 
 
 Acquired 
 
 Congenital 
 
 Infantile or encysted 
 
 External 
 
 Internal 
 
 Intraparietal 
 
 •j Interparietal 
 I E* 
 
 Interstitial L Extraparietal 
 [Incomplete, or Bubonocele.] 
 
 Congenital 
 Of infants 
 Of adults 
 
 4. Ventral. 5. Lumbar. 6. Obturator. 7. Diaphragmatic, 
 
 8. Pudendal, etc. 
 II. Clinically : Reducible irreducible, obstructed or incar- 
 cerated, inflamed, and strangulated. 
 
 2. (a) Fractures are variously classified: 
 
 I. Simple, compound, and complicated. 
 
 II. Complete (transverse, oblique, spiral, longitudinal) 
 and incomplete (fissured, greenstick). 
 
 III. Single, and multiple. 
 
 IV. Comminuted, impacted, etc. 
 
 V. Intra- and extra-articular; intra- and extracapsular. 
 
 In fracture of the neck of the femur, the head of the 
 femur will be found in the acetabulum; in dislocation, the 
 acetabulum will be empty, and the head of the femur will 
 be found elsewhere, e.g. on the dorsum of the ilium. In the 
 fracture, crepitus may be elicited; in the dislocation, never. 
 In the dislocation, there is inversion and a fixed position of 
 the limb, both of which are absent in fracture. 
 
 3. The diagnosis of gonorrhea is made by finding gono- 
 cocci within the leucocytes in a urethral discharge. For de- 
 tails, see below — Bacteriology, Number 7. 
 
 4. See Rose and Carless' "Surgery'' (1908), page 926; or 
 Da Costa's "Surgery" (1908), page 773. 
 
 5- 
 
 Strangulation. 
 
 Subjective Symptoms 
 
 1. Generally occurs af- 
 ter age of 20. 
 
 2. Pain localized, rapid 
 collapse. 
 
 3. Pain intense, par- 
 oxysmal in charac- 
 ter. 
 
 4. Constipation com- 
 plete. 
 
 Intussusception. 
 
 Subjective Symptoms 
 
 1. Most frequent in 
 childhood. 
 
 2. Constant tenesmus. 
 
 3. Pain develops sud- 
 denly and is con- 
 tinuous. 
 
 4. Frequent diarrhea, 
 passage of bloody 
 mucus. 
 
 Twists (Volvulus) 
 
 Subjective Symptoms 
 
 1. Most frequent after 
 age of 30. 
 
 2. Pain diffuse. 
 
 3. Pain paroxysmal ; re- 
 curs less often than 
 in strangulation. 
 
 4. Constipation com- 
 plete. 
 
 239 
 
MEDICAL RECORD 
 
 Strangulation. 
 
 Objec tiv e Sy mp t oms 
 i. Temperature often 
 subnormal. 
 
 2. Pulse very weak. 
 
 3. Stercoraceous vom- 
 iting comes on early 
 
 4. Location in small in- 
 testine. 
 
 Intussusception. 
 
 Objective Symptoms 
 
 1. Temperature normal 
 or subnormal. 
 
 2. Same as in strang- 
 ulation. 
 
 3. Same as in strang- 
 ulation. 
 
 4. Localization in small 
 intestine ifoowel fre- 
 quently protrudes 
 at rectum. 
 
 Twists (Volvulus) 
 
 Objective Symptoms 
 
 1. Temperature slight- 
 ly elevated. 
 
 2. Same as in strangu- 
 lation. 
 
 3. Samje as in, stranjgu* 
 lation. 
 
 4. Location, small in- 
 testine ; abdomen of- 
 ten protrudes, in cer- 
 tain areas, giving 
 
 dullness on percus- 
 sion. 
 
 And see Rose and Carless' "Surgery" (1908), pages mi 
 and 1115; or Da Costa's "Surgery" (1908), pages 838 and 
 841. 
 
 6. See Rose and Carless' "Surgery" (1908), pages 1202 
 and 1244; or Da Costa's "Surgery" (1908), page 1125. 
 
 7. A limb may be said to be injured beyond hope in a 
 crushing accident: (1) When it is pulpefied; (2) when the 
 main artery or vein or both are severed and the collateral 
 circulation is also interfered with ; (3) when very extensive 
 cellulitis or gangrene appears within a short time of the 
 accident; (4) when there is extensive laceration of tissues 
 and extensive comminution of the bone. 
 
 8. The indications for appendectomy vary according to 
 the views of the surgeon. Some maintain that every case of 
 appendicitis should be operated on as soon as the diagnosis 
 is made. Others would operate only in case of rupture, or 
 when suppuration occurs, or in cases which do not improve 
 in a week or so, or in cases which are steadily getting 
 worse. Probably all would agree in taking out every ap- 
 pendix that has undergone more than one mild attack. 
 
 9. See Rose and Carless' "Surgery" (1908), page 260; or 
 Da Costa's "Surgery" (1908), page 242. 
 
 10. The following contraindications for ether and chlo- 
 roform are from Hare's Practical Therapeutics: "Ether 
 should not be used by inhalation in bronchitis or acute 
 nephritis, because of its irritant properties; in peritonitis 
 or gastritis, because it is apt to induce vomiting; in aneur- 
 ysm or in the presence of marked vascular atheroma, be- 
 cause it may rupture a blood-vessel by raising arterial 
 pressure; nor in diabetes, lest it produce diabetic coma; 
 and if anemia is present and an examination of the blood 
 shows that the hemoglobin is below 50 per cent, the use of 
 the drug should be avoided if possible. 
 
 "Chloroform, is not to be used in cases of fatty heart or 
 dilatation of the heart, in those with a known idiosyncrasy, 
 nor in the so-called lymphatic persons with overgrowth of 
 lymphoid tissues, as, for example, adenoids. In the latter 
 
 240 
 
MEDICAL RECORD. 
 
 case it is particularly apt to cause sudden death. In valvu- 
 lar disease of the heart chloroform may be used with 
 caution, although ether is preferable. Given a case of 
 valvular disease that must be subjected to operation, the 
 chances are bettered with an anesthetic than without it, 
 as the pain and mental shock are worse for the heart than 
 is the anesthetic." 
 
 MEDICAL JURISPRUDENCE. 
 
 i. In expert testimony the witness may give his opinion 
 on facts or supposed facts as noted by himself or asserted 
 by others. Theoretically, this can only be done by those 
 perfectly familiar with the subject in question; but prac- 
 tically any (or almost any) physician with a license to 
 practise is accepted as an expert witness. 
 
 2. If respiration has taken place, its lungs will float on 
 being put into water ; if respiration has not taken place, the 
 lungs will sink. Further, the lungs before respiration 
 are situated at the back of the thorax and do not fill the 
 cavity; whereas, after respiration, they fill the whole cavity. 
 
 3. (a) A wound inflicted by a blunt instrument will have 
 somewhat of the appearance of a contused wound; the 
 edges will not be so clean cut, and the surrounding tissues 
 will be more or less bruised. 
 
 (b) A wound inflicted during life is generally charac- 
 terized by hemorrhage, coagulation of the blood, eversion of 
 the edges, and retraction of its sides. It may also be in- 
 ferred that the wound was inflicted during life if any of 
 the following are noticed : The presence of inflammation, 
 swelling, pus or gangrene on the edges of the wound, or 
 if there is any sign of beginning cicatrization. 
 
 4. "Idiocy differs from other states of insanity in the 
 fact that it is marked by a congenital deficiency of the men- 
 tal faculties. There is not here a perversion or a loss of 
 what has once been acquired, but a state in which, from 
 defective structure of the brain, the individual has never 
 been able to acquire any degree of intellectual power to fit 
 him for his social position. It commences with life and 
 continues through it." (Taylor's Medical Jurisprudence.) 
 
 5. See French's "Practice of Medicine" (1907), page 
 1092. 
 
 OPHTHALMOLOGY. 
 I. — 
 
 V 
 
 Age _ 
 
 Tension . . 
 Secretion . 
 Congestion 
 
 GLAUCOMA. 
 
 IRITIS. 
 
 Over forty. 
 Plus. 
 
 None, or watery. 
 General, especially 
 scleral. 
 
 Any. 
 Normal. 
 
 None, or watery. 
 
 General, especially 
 
 circumcorneal. 
 
 241 
 
MEDICAL RECORD 
 
 Cornea 
 
 Anterior chamber.. 
 
 Iris 
 
 Pupil 
 
 Pain 
 
 Vision 
 
 Treatment 
 
 GLAUCOMA. 
 
 Cloudy and steamy 
 ^ surface. 
 Shallow. 
 Discolored. 
 Dilated, oval. 
 
 Severe, contin- 
 uous. 
 Much reduced. 
 
 Eserine, pilocar- 
 pine, iridectomy. 
 
 IRITIS. 
 
 Cloudy. 
 
 Unchanged. 
 Discolored. 
 Contracted, syn- 
 echias. 
 Especially at night. 
 
 Somewhat re- 
 duced. 
 Atropine. 
 
 (From Ailing and Griffin's Diseases of the Eye and Ear.) 
 v 2. (a) Phlyctenular keratitis "is usually associated with 
 phlyctenular conjunctivitis in cnildren of scrofulous dia- 
 thesis, but may occur in others. It is characterized by one 
 or more small cysts found on the limbus of the conjunctiva 
 and extending upon the cornea. The symptoms are acute 
 pain, photophobia, lacrimation, and the characteristic bundle 
 of vessels, with a yellow crescent at the apex, its concavity 
 toward the apex. Blepharospasm is present and may be 
 severe. " 
 
 (b) Interstitial keratitis. — "Deep inflammation of the 
 cornea. The whole cornea becomes more or less opaque and 
 has a ground-glass appearance. Pericorneal injection is 
 present. Inflammations of the iris, ciliary body, and cho- 
 roid occur as complications. The affection is due to some 
 constitutional disease, usually hereditary syphilis, but some- 
 times tuberculosis. The condition is of long duration and 
 results in reduction of visual acuity. Pain, lacrymation, 
 and photophobia appear as subjective symptoms. " — (Gould 
 and Pyle's Pocket Cyclopedia.) 
 
 3. Ophthalmia neonatorum is an infectious, purulent 
 inflammation of the conjunctiva in the newborn, due to the 
 gonococcus or other pyogenic germ; produced by contact 
 of the eye with the vaginal secretion of the mother during 
 labor, or infected fingers, or instruments, etc. The prob- 
 able results of a badly managed case are: Ulceration and 
 sloughing of the cornea, perforation of the anterior cham- 
 / ber, and blindness. 
 
 ^ 4. Ciliary blepharitis. Symptoms: "In the superficial 
 or non-ulcerative form the margins of the lids are swollen 
 and reddened, and present numerous whitish scales at the 
 bases of the lashes. The latter fall out readily, but are 
 replaced, since there is no destruction of the hair follicles. 
 In the deep or ulcerative form the edges^ of the lids are 
 reddened and swollen, and present yellowish crusts which 
 
 242 
 
MEDICAL RECORD. 
 
 glue the lashes together. On removing these crusts small 
 ulcers are seen about the attachments of the lashes; these 
 ulcers bleed readily. The lashes become distorted, fall out, 
 and grow scarce, since they are not replaced on account of 
 destruction of the hair follicles. In both forms there will 
 be itching, soreness, epiphora, and sensitiveness to light." 
 Etiology: "Poor hygienic surroundings; debilitated con- 
 ditions of the system ; following the exanthemata, espe- 
 cially measles; exposure to irritating atmosphere — smoke, 
 wind, dust ; late hours ; insufficient sleep ; uncorrected 
 errors of refraction, especially hyperopia and astigmatism ; 
 chronic conjunctivitis; lachrymal disorders; lack of clean- 
 liness. The disease occurs at all ages, but is very common 
 in children." — (May's Diseases of the Eye.) 
 v 5. Myopia is a condition in which the eye is practically 
 too long, and therefore parallel rays are brought to a 
 focus in front of the retina. Treatment: Concave lenses. 
 Hypermetropics or Hyperopia is a condition in which the 
 eye is practically too short, and therefore parallel rays 
 are brought to a focus behind the retina. Treatment: 
 Convex lenses. 
 
 PHYSIOLOGY. 
 
 1. (a) Foods are classified as follows: 
 
 I. Inorganic { ££*■ 
 
 f Non-nitrogenous f Carbohydrates. 
 II. Organic -j \ Fats. 
 
 [ Nitrogenous — Proteids. 
 
 (b) Carbohydrates are acted on by ptyalin and amylopsin, 
 fats by steapsin, and proteids by pepsin and trypsin. 
 
 2. Absorption is the process by which the products of 
 digestion are taken into the blood current. The nroducts 
 of digestion find their way into the blood by two routes : 
 (1) By the blood-vessels of the gastrointestinal tract, 
 which unite to form the portal vein, and (2) by the lymph 
 vessels of the small intestine, which converge to empty 
 int© the thoracic duct. The water, inorganic salts, pro- 
 teids, and sugar go by way of the portal vein to the ascend- 
 ing vena cava ; the fats go by way of the thoracic duct 
 to the junction of the left subclavian and internal jugular 
 veins. 
 
 The function of the lymphatic system is to provide the 
 tissues with material necessary to their functional activity, 
 growth, and repair ; to receive from the tissues their waste 
 products ; and to convey the products of digestion and 
 absorption to the blood current. 
 
 For thoracic duct see Cunningham's "Anatomy" (1909), 
 page 906; or Gray's "Anatomy" (1908), page 775. 
 
 243 
 
MEDICAL RECORD. 
 
 3. The constituents of the bile may be shown in the fol- 
 lowing table, which presents the averages of three analyses 
 given by Hammarsten; the results are given in parts per 
 thousand : 
 
 Water " 971.380 
 
 Solids 28-620 
 
 Mucin and pigments 4*9 10 
 
 Bile salts 12,197 
 
 Taurocholate 2.431 
 
 Glycocholate 9.766 
 
 Fatty acids from soaps 1,200 
 
 Cholesterin 1,243 
 
 Lecithin and fats 0.970 
 
 Soluble salts 7.360 
 
 Insoluble salts , . . 0.317 
 
 The functions of the bile are: (1) To assist in the 
 emulsification and saponification of fats ; (2) to aid in 
 the absorption of fats; (3) to stimulate the cells of the 
 intestine to increased secretory activity, and so promote 
 peristalsis; and at the same time tend to keep the feces 
 moist; (4) to eliminate waste products of metabolism, such 
 as lecithin and cholesterin; (5) it has a slight action in 
 converting starch into sugar; (6) it neutralizes the acid 
 chyme from the stomach, and thus inhibits peptic diges- 
 tion; (7) it has a very feeble antiseptic action. 
 
 4. The circulation of the blood is regulated in (a) the 
 arteries by: (1) The elasticity and tone of the arteries, 
 (2) the force and frequency of the cardiac contractions, (3) 
 the resistance in the capillaries ; (b) in the capillaries it is 
 regulated by (1) the action of the heart, (2) the action of 
 the arteries: (c) in the veins it is regulated by (1) the 
 action of the heart, (2) aspiration of the thorax, (3) the 
 contraction of the muscles, and (4) slightly by the valves 
 in the veins. 
 
 5. See Cunningham's "Anatomy" (1909), page 1139; or 
 Gray's "Anatomy" (1908), page 1423. 
 
 6. See Cunningham's "Anatomy" U909), page 674; or 
 Gray's "Anatomy" (1908), page 1036. 
 
 7. "The sympathetic nervous system consists of (1) a 
 series of ganglia connected together by a great ganglionic 
 cord, the gangliated cord, extending from the base of the 
 skull to the coccyx, one gangliated cord on each side of 
 the middle line of the body, partly in front and partly on 
 each side of the vertebral column ; (2) of three great 
 gangliated plexuses or aggregations of nerves and ganglia, 
 situated m front of the spine in the thoracic, abdominal, 
 and pelvic cavities respectively; (3) of smaller or terminal 
 ganglia, situated in relation with the abdominal viscera; 
 and (4) of numerous fibers." (Gray's Anatomy.) 
 
 244 
 
MEDICAL RECORD, 
 
 Its functions: "It may safely be said that the sympa- 
 thetic system has, to a great extent, a controlling influ- 
 ence over the secretion of most of the glands, the lacry- 
 mal, the salivary, the sweat glands, the glands of the stom- 
 ach and intestines, the liver, the kidney, etc.; that it pre- 
 sides over the circulation by regulating the caliber of the 
 blood-vessels and the action of the heart; that it influences 
 respiration; and, finally, that all involuntary muscles, those 
 of the digestive apparatus, of the genitourinary system, of 
 the hair follicles (pilomotor nerves), are under its control 
 to such extent that, for instance, in certain mammalians 
 the bladder still continues to fulfill its function for weeks 
 after all the cerebrospinal motor nerves leading to it have 
 been severed. In short, we find that all vegetative life of 
 the organism is, to a greater or less extent, under the con- 
 trol of the sympathetic system. Therefore it may prop- 
 erly be called the vegetative nerve system par excellence/' 
 (Reference Handbook of the Medical Sciences.) 
 
 8. The functions of the skin are : Protection, excretion, 
 secretion, regulation of the body temperature, absorption, 
 sensation, special sense of touch, respiration. 
 
 9. The physical properties of blood: Fluid, somewhat 
 viscid, red; specific gravity, from 1055 to 1062; alkaline re- 
 action; saltish taste; characteristic odor; variable tempera- 
 ture (average, about ioo° F.). 
 
 The constituents of the blood are plasma and corpuscles. 
 The plasma consists of water and solids (proteids, extract- 
 ives, and inorganic salts). The red corpuscles consist of 
 water and solids (hemoglobin, proteids, fat, and inorganic 
 salts). The white corpuscles consist of water and solids 
 (proteid, leuconuclein, lecithin, histon, etc.). 
 
 The red blood corpuscles are biconcave discs, about 
 1-3200 of an inch in diameter; they are non-nucleated, and 
 there are about 4.500,000 or 5,000,000 of them in each cubic 
 millimeter of blood. They are elastic and soft, and their 
 shape is changed by pressure, but is promptly regained on 
 the removal of the pressure. Their color is yellowish. 
 They contain hemoglobin. 
 
 Their function is to carry oxygen from the lungs to the 
 tissues. 
 
 The white blood cells are spheroidal masses, varying 
 in size, having no cell wall, and containing one or more 
 nuclei ; there are about 7,000 to 10,000 of them in each 
 cubic millimeter of blood. They differ much in appearance, 
 and are divided into (1) small mononuclear leucocytes, 
 or lymphocytes, (2) large mononuclear, (3) transitional, 
 
 (4) polynuclear, or polymorphonuclear, or neutrophile, and 
 
 (5) eosinophile. They are all more or less granular, par- 
 ticularly the last two varieties named. They are probably 
 formed in the spleen, lymphatic glands, and lymphoid tis- 
 
 245 
 
MEDICAL RECORD. 
 
 sues. Their fate is uncertain ; it has been asserted that they 
 are converted into red blood cells; they play a part in the 
 formation of fibrin ferment; they are sometimes con- 
 verted into pus cells. Their functions are (i) to serve as 
 a protection to the body from the incursions of pathogenic 
 microorganisms ; (2) they take some part in the process of 
 the coagulation of the blood; (3) they aid in the absorp- 
 tion of fats and peptones from the intestine, and (4) they 
 help to maintain the proper proteid content of the blood 
 plasma. 
 
 There are also platelets, which are very small, colorless, 
 irregular shaped bodies; they are about one-fourth the 
 diameter of a red corpuscle. Their function is not deter- 
 mined ; it is possible that they take some part in the coagu- 
 lation of the blood. In number they vary from about 
 200,000 to more than 500,000 in each cubic millimeter of 
 blood. 
 
 Plasma conveys nutriment to the tissue; it holds in solu- 
 tion the carbon dioxide and water which it receives from 
 the tissues, and takes them to be eliminated by the lungs, 
 kidneys, and skin; it also holds in solution urea and other 
 nitrogenous substances that are taken to and excreted by 
 the liver or kidneys. 
 
 10. The cardiac cycle includes all the changes which occur 
 between the commencement of one heart-beat and the com- 
 mencement of the next ; it consists of the alternate contrac- 
 tions (or systole) and relaxations (or diastole) of the 
 auricles and ventricles of the heart. The contraction of 
 the two auricles takes place simultaneously, and is followed 
 by the simultaneous contraction of the two ventricles; then 
 follows a period during which the whole heart is in a state 
 of diastole. The cycle then begins again with the auricular 
 systole. 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 i. By presentation is meant the part of the fetus which 
 presents at the pelvic brim ; examples — vertex, breech, face. 
 
 By position is meant the relation between a point on 
 the fetus and a point on the maternal pelvis; examples — in 
 a vertex presentation the position may be (1) left occipito- 
 anterior, (2) right occipito-posterior, (3) right occipito- 
 anterior, (4) left occipito-posterior. 
 
 2. In cases of shoulder presentation, if seen before labor, 
 version should be performed to correct the mal-presenta- 
 tion; in case of impaction a Cesarean section is indicated; 
 sometimes decapitation or embryotomy has been performed, 
 but a Cesarean section is preferable. Cases of shoulder 
 presentation have been known to terminate spontaneously, 
 but it is not advisable to rely on this possibility. 
 
 3. Mensuration is measuring (the pelvis) ; the same as 
 
 246 
 
MEDICAL RECORD. 
 
 pelvimetry. See Williams' ''Obstetrics" (1909), page 683; 
 or Hirst's "Obstetrics" (1909), page 448. 
 
 4. See Williams' "Obstetrics" (1909), page 795; or Hirst's 
 "Obstetrics" (1909), page 561. 
 
 5. (a) Placenta previa, or premature separation of a 
 normally situated placenta. 
 
 (b) and (c) See Williams' "Obstetrics" (1909), pages 
 814 and 815; or Hirst's "Obstetrics" (1909)* page 577. 
 
 6. (a) Ventrofixation is indicated in cases of: Retroflexed 
 uterus, prolapsed uterus. 
 
 (b) and (c) See Williams' "Obstetrics" (1909), page 
 183; or Hirst's "Obstetrics" (1909), page 203. 
 
 7. "When extrauterine pregnancy exists there are: (1) 
 The general and reflex symptoms of pregnancy; they have 
 often come on after an uncertain period of sterility. Nau- 
 sea and vomiting appear aggravated. (2) Then comes a 
 disordered menstruation, especially metrorrhagia, accom- 
 panied with gushes of blood, and with pelvic pain coinci- 
 dent with the above symptoms of pregnancy. Pains are 
 often very severe, with marked tenderness within the pel- 
 vis. Such symptoms are highly suggestive. (3) There is 
 the presence of a pelvic tumor characterized as a tense cyst, 
 sensitive to the touch, actively pulsating. This tumor has 
 a steady and progressive growth. In the first two months 
 it has the size of a pigeon's egg; in the third month it has 
 the size of a hen's egg] in the fourth month it has the size 
 of two fists. (4) The os uteri is patulous ; the uterus is 
 displaced, but is slightly enlarged and empty. (5) Symp- 
 toms No. 2 may be absent until the end of the third month, 
 when suddenly they become severe, with spasmodic pains, 
 followed by the general symptoms of collapse. (6) Expul- 
 sion of the decidua, in part or whole. Nos. 1 and 2 are 
 presumptive signs; Nos. 3 and 4 are probable signs; Nos. 5 
 and 6 are positive signs." (American Text-Book of Ob- 
 stetrics.) 
 
 8. See Rose and Carless' "Surgery" (1908), page 1285. 
 
 9. See Williams' "Obstetrics" (1909), pages 81 and 85; 
 or Hirst's "Obstetrics" (1909), pages 58 and 61. 
 
 10. (a) Two indications for hysterectomy: Carcinoma 
 and fibroids. 
 
 (b) As to preference between the vaginal and abdominal 
 routes, the following is taken from Garrigues' Gyne- 
 cology: "If the vaginal route is available, it should be 
 preferred, because it entails much less shock, requires a 
 simple after-treatment, does not leave any visible cicatrix, 
 predisposes less to hernia, and allows the patient to re- 
 sume work in shorter time. On the other hand, the vag- 
 inal route is more difficult on account of the limited space. 
 Hemorrhage is more troublesome to check, adhesions are 
 
 247 
 
MEDICAL RECORD. 
 
 harder to separate, and the bladder and intestine more ex- 
 posed to injury and less accessible for repair. The pelvic 
 cavity cannot be seen so well and the abdominal not at 
 all. If tissue is left to mortify, it emits an offensive odor." 
 
 CHEMISTRY. 
 
 i. (a) An atom is the smallest portion of an element 
 that can enter into a chemical reaction, or that can enter 
 into the composition of a molecule. 
 
 (b) A molecule is the smallest quantity of any substance 
 that can exist in a free state. 
 
 (c) Isomeric compounds are compounds which, while 
 differing in properties, possess the same percentage com- 
 position. 
 
 2. (a) The symptoms of acute arsenical poisoning: 
 "In acute cases the symptoms usually begin in from twenty 
 to forty-five minutes. Nausea and faintness. Violent, burn- 
 ing pain in the stomach, which becomes more and more 
 intense, and increases on pressure. Persisting and distressing 
 vomiting of matters, sometimes brown or gray, or streaked 
 with blood, or green (Paris green). Purging. More or 
 less severe cramps in the lower extremities." (Witthaus' 
 Essentials of Chemistry.) 
 
 (b) The chemical antidote is freshly prepared ferric 
 hydroxide. The ferric hydroxide changes the arsenic into 
 ferrous arsenate, which is nonpoisonous. The reaction is 
 represented by the following equation: 
 
 As 2 3 +2Fe 2 (OH) 6 =:Fe(OH)2+sH 2 0+Fe3(As0 4 ) 2 . 
 
 (c) Test for arsenic: Reinsch's test is as follows: To 
 the suspected fluid add a little pure HC1; suspend in the 
 fluid a small strip of bright copper foil, and boil. If a de- 
 posit forms on the copper, remove the copper, wash it with 
 pure water, dry on filter paper, but be careful not to rub 
 off the deposit. Coil up the copper, and put it into a clean, 
 dry glass tube, open at both ends, and apply heat at the part 
 where the copper is. If arsenic is present there will ap- 
 pear in the cold part of the tube a mirror, which will be 
 found on microscopical examination to consist of octa- 
 hedral crystals of arsenic trioxide. 
 
 3. Method for the quantitative estimation of sugar in 
 urine: (( Fehling's method. — The solution is made as fol- 
 lows: 
 
 I. Dissolve cupric sulphate 51-98 gm. 
 
 in water to 500.00 c.c. 
 
 II. Dissolve Rochelle salt 259.9 gm. 
 
 in sodium hydroxide soln. sp. gr. 1.12 to 1,000 c.c. 
 (Piffard). 
 
 When required for use, one volume of I. is to be mixed 
 
 with two volumes of II. The copper contained, in 10 c.c. 
 
 248 
 
MEDICAL RECORD. 
 
 of this mixture is precipitated completely, as cuprous oxid, 
 by 0.05 gm. of glucose. 
 
 "To determine the quantity of sugar, place 10 c.c. of the 
 mixed soln. in a flask of about 250 c.c. capacity, dilute with 
 H 2 to about 30 c.c, and heat to boiling. On the other 
 hand, the urine to be tested is diluted and thoroughly 
 mixed with four volumes of H 2 if it be poor in sugar, or 
 with nine volumes of H 2 if highly saccharine, and a 
 burette filled with the mixture. When the Fehling soln. 
 boils, add a few gtt. NH 4 HO and then 5 c.c. of the urine 
 from the burette, boil again, and continue the alternate 
 addition of diluted urine and boiling of the mixture until 
 the blue color is quite faint. Now add the diluted urine 
 in quantities of 1 c.c. at a time, boiling after each addition 
 until the blue color just disappears. Have ready a small 
 filter, and, having filtered through it a few gtt. of the hot 
 mixture, acidulate the filtrate with acetic acid, and add to it 
 1 gtt. soln. of potassium ferrocyanide. If a brownish tinge 
 be produced, add another ^4 c.c. of dil. urine to the flask, 
 boil, and test with ferrocyanide as before. Continue this 
 proceeding until no brown tinge is produced. The burette 
 reading, taken at this point, gives the number of c.c. of 
 dilute urine containing 0.05 gm. glucose, and this divided 
 by 5 or 10, according as the urine was diluted with 4 or 9 
 volumes of H 2 0, gives the number of c.c. of urine contain- 
 ing 0.05 gm. sugar. The number of c.c. urine passed in 
 twenty-four hours divided by 20 times the number of c.c. 
 containing 0.05 gm. glucose, gives the elimination of glu- 
 cose in twenty-four hours in grams. 
 Example. Urine in 24 hours = 2,436 c.c. 
 Fehling's soln. used = 10 c.c. 
 Urine diluted with 4 vols. H 2 
 Burette reading = 18.5 c.c. 
 18.5 
 = 3-7 = c.c. urine containing 0.05 gm. glucose. 
 
 5 
 2,436 
 
 = 32.92 = grams glucose eliminated in 24 hours." 
 
 37X20 (Witthaus' Urinalysis.) 
 
 4. Test for bile: Put 3 c.c. HN0 3 in a test tube, add a 
 piece of wood, and heat until the acid is yellow; cool, 
 When cold, float some of the urine to be tested upon the 
 surface of the acid. A green band is formed at the junc- 
 tion of the liquids, which gradually rises, and is succeeded 
 from below by blue, reddish-violet, and yellow. 
 
 5. (a) Dairy milk (assuming it to be pure) contains 
 (approximately^ 4 per cent, each of proteids, fat, and 
 sugar; whereas in human milk the proteids are about 1 to 2 
 per cent., the fat about 3 to 4 per cent., and the sugar about 
 
 249 
 
MEDICAL RECORD. 
 
 6 to 7 per cent. Dairy milk may be acid in reaction and 
 contains numerous bacteria, whereas human milk is ampho- 
 teric or slightly alkaline and generally contains no bacteria. 
 
 6. (a) H2SO4 is the formula for a molecule of sulphuric 
 acid; (b) Ba0 2 for one of barium dioxide; (c) HC1 for 
 one of hydrochloric acid; (d) HNO3 for one of nitric acid, 
 (e) The formula for methyl alcohol is H.CH 2 OH. 
 
 7. (a) Acetphenetidin (or phenacetin) is ethylpara- 
 acetamidophenate. 
 
 (b) Hexamethylene-tetramine is urotropin. 
 
 (c) The former is prepared by the action of glacial acetic 
 acid upon paraphenetidin ; the latter by the action of am- 
 monia upon formaldehyde. 
 
 8. (a) Oxygen is a colorless, odorless, tasteless gas, 
 slightly soluble in water, heavier than air. It has a strong 
 tendency to combine with other elements, and forms binary 
 compounds with all elements except fluorine and bromine. 
 Oxygen is necessary to the processes of life and combus- 
 tion. 
 
 (b) Its symbol is O; (c) valence, two; (d) atomic 
 weight, 16. 
 
 ( e ) Oygen may be prepared by heating potassium 
 chlorate. 
 
 2KCIO3 = 2KCI+3O2. 
 
 9. (a) Specific gravity is the weight of any substance as 
 compared with the weight of an equal volume of another 
 substance taken as a standard under like conditions of tem- 
 perature and pressure. 
 
 (b) Specific gravity of solids: "1. Solids Heavier than 
 Water. — First weigh it in air and then in water. The 
 difference is the weight of the volume of water displaced. 
 The weight in air is divided by this figure. 
 
 2. Solids Lighter than Water. — First weigh it in air, 
 then in water with a sinker attached. The specific weight 
 of the sinker is then determined and subtracted from that 
 of both. The specific gravity is calculated as before. 
 
 3. Solids Soluble in Water. — The specific gravity is de- 
 termined in a liquid having no solvent action, the specific 
 gravity of which is known, and the weight of a correspond- 
 ing volume of water is calculated." 
 
 (c) Of Liquids: "Weigh equal volumes of water and the 
 given liquid and divide the latter by the former. 
 
 The pyknometer is a flask of thin glass holding accurate- 
 ly when completely filled a given volume at a definite tem- 
 perature, and is much used for determining specific gravity 
 of fluids. 
 
 The hydrometer is an instrument used for this purpose, 
 also, and is generally made of glass tubing^ weighted below 
 to maintain it upright when floating^ and with a stem above 
 showing a scale. One form sinks in water to a mark on 
 
 250 
 
MEDICAL RECORD. 
 
 the scale — usually i — and the other marks show at once the 
 specific gravity of the fluid, according as the instrument 
 floats above or below or at this level." — (McGlannan.) 
 
 (d) Of Gases: By the specific gravity bottle; or divide 
 the weight of its molecule by two. 
 
 10. The ptyalin of the saliva and the amylopsin of the 
 pancreatic juice act upon boiled starch, and by hydrolysis 
 convert it into soluble starch. By further hydrolytic cleav- 
 age, maltose, erythrodextrin, and achroodextrin are formed. 
 
 "According to Brown and Heron the reactions may be 
 represented thus : 
 
 One molecule of gelatinous starch is converted by the 
 action of an amylolytic ferment into n molecules of soluble 
 starch. 
 
 One molecule of soluble starch=io(Ci 2 H»Oio)+8(H 2 0), 
 which is further converted by the ferment into 
 
 i. Erythrodextrin + Maltose. 
 
 9(Cl2H2oOlo) (O2H22O11) 
 
 then into 
 
 2. Erythrodextrin -f- Maltose. 
 
 8(CuH»Oio) 2(Ci.H*0u) 
 next into 
 
 3. Achroodextrin + Maltose. 
 
 7(GsH*Oio) 3(Ci«H»Qn) 
 And so on ; the resultant being : 
 io(GtH»Oio)+8(H,0)=8(C«HaOn)+ 2(CttH»0i«) ." 
 Soluble starch Water Maltose Achroodextrin. 
 
 (From Kirkes' Physiology.) 
 
 NERVOUS DISEASES. 
 
 1. Etiology of migraine : Heredity, female sex, and age 
 (about the time of puberty) are all predisposing factors; 
 
 neurotic family history, epilepsy, and hysteria also predis- 
 pose; overwork at school in conjunction with lowered phy- 
 sical health, eyestrain, injury, shock, fatigue, gout, rheuma- 
 tism, indigestion, and autotoxemia may all cause migraine. 
 
 2. See French's "Practice of Medicine" (1907), page 997; 
 or Osier's "Practice of Medicine" (1909), page 1039. 
 
 3. (a) See French's "Practice of Medicine" (1907), page 
 1 125; or Osier's "Practice of Medicine" (1909), page 1058. 
 
 (b) Catalepsy: "A peculiar neurosis characterized by loss 
 of will and muscular rigidity, due to a diseased condition 
 of the central nervous system. It is seen in neurotic indi- 
 viduals between 20 and 30 years, and is commonly asso- 
 ciated with hysteria. It occurs suddenly in paroxysms and 
 usually with loss of consciousness. During the attack ex- 
 ternal stimulation is necessary. Faradization and emetics 
 are also of value. In the interval the neurotic condition 
 
 251 
 
MEDICAL RECORD. 
 
 should receive attention," — (Gould and Pyle's Pocket Cy- 
 clopedia.) 
 
 4. See French's "Practice of Medicine" (1907), page 1044; 
 or Osier's "Practice of Medicine" (1909), page 901. 
 
 5. A delusion is a belief in something which has no real 
 existence, but is purely imaginary; and out of which the 
 person cannot be reasoned. An illusion is a false or per- 
 verted impression, received through one of the senses. An 
 hallucination is the same as an illusion, but without any 
 material basis. 
 
 If an individual believes himself to be made of glass, and 
 is afraid of being touched lest he be broken, he is suffering 
 from a delusion. If the whistling of the wind is mistaken 
 for a voice telling' a person to do a certain thing — that 
 would be an illusion. If a person fancied he heard a voice 
 when there was nothing at all to be heard, that would be 
 an hallucination. 
 
 PREVENTIVE MEDICINE. 
 
 i. (a) Diphtheria: About four weeks; but all discharges 
 must have ceased, there must be no albumin in the urine, 
 and bacteriological examination of nose and throat must be 
 repeatedly negative. 
 
 (fr) Scarlet fever: About six weeks; when all desquama- 
 tion, discharge from ears or nose, albuminuria, and sore 
 throat shall have disappeared. 
 
 (c) Smallpox: About six weeks from the beginning; one 
 week after every scab has disappeared. 
 
 2. Air-passages, mouth (with food and drink), wounds 
 in skin and mucous membranes. 
 
 3. See French's "Practice of Medicine" (1907), page 
 108; or Osier's "Practice of Medicine" (1909), page 96. 
 
 4. See French's "Practice of Medicine" (1907), page 
 309. 
 
 5. A contagion is an infectious disease in which the causa- 
 tive microorganism is readily communicable from person to 
 person by mediate or immediate contact. 
 
 An infection is a disease due to a microorganism. 
 
 PRACTICE. 
 
 1. See French's "Practice of Medicine" (1907), page 805; 
 or Osier's "Practice of Medicine" (1909), page 525. 
 
 2. Vertigo is a disturbance of the sense of equilibrium, 
 a condition in which the patient or objects surrounding him 
 appear to be in a state of rotation or oscillation. It is not 
 a disease ; but is a symptom of many pathological condi- 
 tions. 
 
 The chief varieties are: (1) Auditory, or labyrinthine, 
 also called Meniere's disease; (2) cerebral; (3) gastric; 
 (4) toxic; (5) senile; (6) hysterical; (7) essential. 
 
 252 
 
MEDICAL RECORD. 
 
 The diagnosis is based on the histdy of the case, the 
 etiology and the absence of unconsciousness and of convul- 
 sive movements. It is to be differentiated from epilepsy, in 
 which the patient is unconscious and also has convulsive 
 movements. 
 
 3. See French's "Practice of Medicine" (1907), page 552; 
 or Osier's "Practice of Medicine" (1909), page 768. 
 
 4. See French's "Practice of Medicine" (1907), page 702. 
 
 5. See French's "Practice of Medicine" (1907), page 618; 
 or Osier's "Practice of Medicine" (1909), page 839. 
 
 6. See French's "Practice of Medicine" (1907), page 658; 
 or Osier's "Practice of Medicine" (1909), page 609. 
 
 7. Adenoids are hypertrophied adenoid tissue in the 
 nasopharynx. 
 
 Causes : The real cause is unknown, but the condition 
 is generally observed in childhood; heredity is also sup- 
 posed to be a factor; males are more frequently affected 
 than females ; malnutrition and scrofula seem to be causa- 
 tive factors ; the condition is often associated with enlarged 
 tonsils, enlarged cervical glands, hypertrophy of the nasal 
 mucous membrane, deviations of the septum, spurs ; it often 
 follows some of the acute infectious diseases. 
 
 Symptoms: Mouth-breathing; snoring; open-mouth; a 
 vacant, dull expression of the face; modification of the 
 voice (nasal twang), with inability to pronounce certain 
 letters. 
 
 Effects : Earache and other ear affections ; mental de- 
 ficiency; frequent attacks of coryza; nose-bleed; stunted 
 growth ; convulsions, laryngismus stridulus, and various 
 other neuroses may also be noticed. 
 
 8. See French's "Practice of Medicine" (1907), page 784; 
 or Osier's "Practice of Medicine" (1909), page 508. 
 
 9. Essentials for the production and preservation of pure 
 dairy milk: Vaughan's rules are as follows: "(1) The cows 
 should be healthy, and the milk of any animal which seems 
 indisposed should not be mixed with that from the healthy 
 animals. (2) Cows must not be fed upon swill or the 
 refuse from breweries or glucose factories,, or upon any 
 other fermented food. (3) Milch cows must not be allowed 
 to drink from stagnant pools, but must have access to fresh, 
 pure water. (4) The pasture must be freed from noxious 
 weeds, and the barn and yard must be kept clean. (5) The 
 udders should be washed and then wiped dry before each 
 milking. (6) The milk must be at once thoroughly cooled. 
 This is best done in the summer by placing the milk can in 
 a tank of cold water or ice water, the water being of the 
 same depth as the milk in the can. It would be well if the 
 water in the tank could be kept flowing, and this will be 
 necessary unless ice water is used. The tank should be 
 
 253 
 
MEDICAL RECORD. 
 
 thoroughly cleaned each day to prevent bad odors. The 
 can should remain uncovered during the cooling, and the 
 milk should be gently stirred. The temperature should be 
 reduced to 6o° F., or lower, within an hour. The can 
 should remain in cold water till ready for delivery. (7) 
 Milk should be delivered during the summer in refrigerated 
 cars or in bottles about which ice is packed during trans- 
 portation. (8) When received by the consumer it must be 
 kept in a clean place, and at a temperature some degrees 
 below 6o° F." 
 
 10. See French's "Practice of Medicine" (1907), pages 
 139, 146, and 148; or Osier's "Practice of Medicine" (1909), 
 pages 158, 163, and 164. 
 
 OTOLOGY. 
 
 1. The Politzer Method. — "In usin^r this mode of inflation 
 the patient is directed to take a sip of water from a glass 
 and retain it within the mouth until instructed by the phy- 
 sician by word or sign to swallow. Ihe nozzle of a Politzer 
 airbag (Fig. 51) is placed snugly into one nostril, while 
 the other is held firmly closed. The patient then swallows 
 at the eiven signal, and the air-bag is simultaneously com- 
 pressed, when, if the soft palate rests tightly enough against 
 the pharyngeal wall, the air makes its passage up the 
 Eustachian tube into the tympanum, as may be heard by the 
 auscultation test. Instead of employing the act of swallow- 
 ing to close the pharyngeal space, the patient may be in- 
 structed to forcibly pronounce the word 'hook/ prolonging 
 the 'k' sound, or markedly distend the cheeks in an attempt 
 at forced expiration, when the air-bag may be used as pre- 
 viously indicated." — (Ailing and Griffin.) 
 
 2. Tinnitus aurium is the name given to any subjective 
 sounds heard in the ear. The chief causes are: Neuras- 
 thenia, impacted cerumen, otitis, and other ear diseases; 
 Meniere's disease, obstruction of the Eustachian tube, 
 anemia, leukemia, cerebral hyperemia and anemia, arterio- 
 sclerosis, gout, digestive disorders, excessive use of alcohol 
 or tobacco, and the use of certain drugs such as quinine 
 or salicylic acid. 
 
 3. Acute catarrhal otitis media is frequently caused by 
 acute coryza and the infectious fevers. There is a painless 
 obstructed sensation in one or both ears, impairment of 
 hearing, and tinnitus. The inflammation causes closure of 
 the Eustachian tube. Inflation and aspiration of the middle 
 ear and syringing and douching the nares and nasopharynx 
 must be avoided. 
 
 "Acute purulent otitis media: Acute catarrhal otitis 
 media, instead of undergoing resolution, may pass into 
 acute purulent otitis media (especially in exanthemas) from 
 the passage of pathogenic germs from the nasopharynx 
 into the middle ear. The pain will become more intense, 
 
 254 
 
MEDICAL RECORD. 
 
 the hearing dull; tinnitus will become louder and more 
 distressing, and fever usually sets in. 
 
 4. The pyramid of light is a reflection of light from the 
 anterior inferior quadrant of the membrana tympani. It 
 is roughly triangular in shape, and its apex touches the tip 
 of the manubrium of the malleus, while its base lies on or 
 near the periphery of the membrana tympani. 
 
 5. See Rose and Carless' "Surgery" (1908), page 885. 
 
 BACTERIOLOGY. 
 
 1. To determine the presence of malarial parasite: A few 
 hours before the chill, a drop of blood should be taken 
 from the cleansed lobe of the ear or tip of the finger of 
 the patient. The blood should be received on the center 
 of a cover-glass, which should then be quickly placed, 
 blood-side down, on a slide. Search should be made with 
 a one-twelfth oil immersion objective, and but little illu- 
 mination. The ordinary tertian parasite appears as a 
 small, pale, and ring-like body within the red corpuscles ; 
 it has an active vibratile motion ; sometimes a dark pigment 
 is present, and segmenting bodies or rosettes may be seen. 
 See trench's "Practice of Medicine" (1907), pages 233 and 
 235; or Osier's "Practice of Medicine" (1909;, page 12. 
 
 2. (a) The Widal test for typhoid fever "depends upon 
 the fact that serum from the blood of one ill with typhoid 
 fever, mixed with a recent culture, will cause the typhoid 
 bacilli to lose their motility and gather in groups, the whole 
 called 'clumping/ Three drops of blood are taken from 
 the well-washed aseptic finger tip or lobe of the ear, 
 and each lies by itself on a sterile slide, passed through 
 a flame and cooled just before use; this slide may be 
 wrapped in cotton and transported for examination at 
 the laboratory. Here one drop is mixed with a large drop 
 of sterile water, to redissolve it. A drop from the summit 
 of this is then mixed with six drops of fresh broth culture 
 of the bacillus (not over twenty-four hours old) on a 
 sterile slide. From this a small drop of mingled culture 
 and blood is placed in the middle of a sterile cover-glass, 
 and this is inverted over a sterile hollow-ground slide 
 and examined. ... A positive reaction is obtained 
 when all the bacilli present gather in one or two masses 
 or clumps, and cease their rapid movement inside of 
 twenty minutes." (From Thayer's Pathology.) 
 
 (b) Its diagnostic value is believed by some to be great ; 
 others place little reliance on it. It may be absent in cases 
 of typhoid fever ; it may be present for several months after 
 an attack of typhoid ; the reaction may not be obtained till 
 the third week of the disease ; it may be present in other 
 diseases or in perfectly healthy persons. The above have 
 all been urged as objections; certainly only positive results 
 have any value at all. 
 
 255 
 
MEDICAL RECORD 
 
 3. The cultural and microscopic points of difference be- 
 tween the Bacillus coli communis and the Bacillus ty- 
 phosus (of Eberth) are: 
 
 "(1) The motility of the colon bacillus is, as a rule, not 
 very pronounced, sometimes absent; that of the typhoid 
 bacillus is usually very active. 
 
 "(2) On gelatine plates the colon bacillus develops more 
 rapidly and luxuriantly than the typhoid bacillus, and 
 on potato it grows more -abundantly, being almost always 
 visible. 
 
 "(3) The colon bacillus coagulates milk with acid reac- 
 tion within twenty- four to forty-eight hours; the typhoid 
 bacillus does not coagulate milk. 
 
 "(4) The colon bacillus causes fermentation with pro- 
 duction of gas in media containing sugar; the typhoid 
 bacillus does not. 
 
 "(5) In nutrient agar or gelatine containing lactose and 
 litmus tincture and of a slightly alkaline reaction, the 
 color of the colonies of colon bacillus is pink and the sur- 
 rounding medium red; while the colonies of typhoid bacil- 
 lus are blue and there is little or no reddening of the 
 medium. 
 
 "(6) The colon bacillus produces indol in cultures of 
 bouillon or peptone; the typhoid bacillus does not. 
 
 "(7) When a twenty-four-hour-old bouillon culture of 
 the colon bacillus is mixed with the blood or serum of a 
 patient suffering from genuine typhoid fever, in a dilu- 
 tion of one to ten or more, after the first week of the dis- 
 ease, the Widal reaction is negative; cultures of the 
 typhoid bacillus treated in the same manner and ex- 
 amined in the hanging drop give the characteristic ag- 
 glutination and clumping of the bacilli." (Reference Hand- 
 book of the Medical Sciences.) 
 
 4. The sputum must be recent, free from particles of 
 food or other foreign matter ; select a cheesy-looking 
 nodule and smear it on a slide, making the smear as thin 
 as possible. Then cover it with some carbolfuchsin, and 
 let it steam over a small flame for about two minutes, care 
 being taken that it does not boil. Wash it thoroughly in 
 water and then decolorize by immersing it in a solution of 
 any dilute mineral acid for about a minute. Then make a 
 contrast stain with solution of Loeffler's methylene blue for 
 about a minute ; wash it again and examine with oil immer- 
 sion lens. The tubercle bacilli will appear as thin red rods, 
 while all other bacteria will appear blue. 
 
 5. (a) Toxins are the poisonous products of pathogenic 
 bacteria. 
 
 (b) Antitoxins are substances formed in the body, of a 
 protective character, and capable of rendering inert the 
 poisonous products of bacteria. 
 
 256 
 
MEDICAL RECORD. 
 
 {c) Amboceptors are antibodies having a double com- 
 bining affinity; one linking on to the cell to be destroyed, 
 and the other linking on to the alexin or complement. 
 
 (d) Bacterio proteins are proteins contained in bacteria. 
 
 ( *} Lysins are bacterial products which are capable of 
 destroying alexins and so promote the growth of the bac- 
 teria. 
 
 6. The bacillus of tetanus is characterized by its pecu- 
 liar spore, formed at one end of the bacillus, and giving it 
 the appearance of a pin; it is purely anaerobic, and cannot 
 be developed at all in the presence of oxygen. It generally 
 comes from the soil, and is found in penetrating wounds. 
 It appears in two forms, the spore-bearing form, as de- 
 scribed above, and the vegetative form, which is a short 
 bacillus with rounded ends, and which may occur singly or 
 in pairs, or may form long filaments. It grows in gelatin 
 stab cultures in the middle of the medium, and the colonies 
 look something like a fir tree; its growth is slow, and a 
 disagreeable odor is at the same time emitted. In bouillon, 
 it grows near the bottom of the tube, and produces gases. 
 
 Its toxins, are : Tetanospasmin, tetanolysin, tetanotoxin, 
 tetanin, and another (without a name). 
 
 7. To demonstrate gonococci in a urethral discharge: 
 On a cover-glass make a smear with the discharge as thin 
 as possible, and let it dry in the air ; cover it with a freshly 
 made solution of anilin-oil-gentian-violet for one or two 
 minutes ; wash it in distilled water ; leave it in Gram's solu- 
 tion for two minutes ; wash it in 95 per cent, alcohol until 
 decolorized ; wash it in distilled water ; counterstain with 
 a dilute carbolfuchsin without heat, or with a saturated 
 aqueous solution of Bismarck brown; wash in distilled 
 water, dry with filter paper, mount, and examine with an 
 oil-immersion lens. The gonococci will appear as diplo- 
 cocci within the leucocytes, which have been decolorized by 
 Gram's stain, and have taken the counterstain. 
 
 8. Several theories have been advanced to account for 
 immunity, but the only two that are considered now are : 
 (1) MetchnikofFs theory of phagocytosis and (2) Ehr- 
 lich's side-chain theory. This latter "is based on the idea 
 that the toxin destroys a cell by entering into chemical 
 union with it. The molecule of toxin contains at least two 
 groups of atoms, a toxophore group, in which the poison- 
 ous principle resides, and a haptophore group, which brings 
 the toxophore group into touch with the cell and through 
 which chemical combination takes place. Similarly, the 
 cell contains a haptophore group, but the toxophore group 
 of the toxin can only unite with it and destroy it when its 
 haptophore companion has affinity with that of the cell. If 
 that affinity does not exist the two haptophore groups do 
 not unite, the toxophore group does not come into contact 
 
 257 
 
MEDICAL RECORD. 
 
 with the cell, and the animal is immune. Such is natural 
 immunity. If there is affinity and the cell can throw off a 
 haptophore group (antitoxin), which in its detached con- 
 dition unites with the haptophore group of the toxin, the 
 toxophore group has then nothing with which it can unite 
 and the animal is immunized. When the individual has to 
 contend with a bacterium as well as its toxin, the same 
 principle obtains. Immunity is established by the produc- 
 tion of a double haptophore group, one for the bacterium, 
 the other for its toxin." — (Stenhouse's Pathology.) 
 
 9. The pneumococcus is an encapsulated bacillus, non- 
 motile, non-flagellated, aerobic, non-liquefying, non-sporo- 
 genous, non-chromogenic, staining by ordinary methods, 
 but Gram-negative: 
 
 Pfeiffer's bacillus of influenza is very similar in prop- 
 erties, but it is exceedingly small, and is not encapsulated. 
 
 10. Phagocytosis is the faculty of certain cells (notably 
 the mononuclear and polynuclear leucocytes) to take up 
 and destroy bacteria. It has a protective function. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Board of Medical Examiners of Maryland. 
 
 ANATOMY. 
 
 1. Bone? Composition and structure. 
 
 2. Name bones with which the temporal articulates. 
 
 3. Describe the thoracic duct. 
 
 4. Name the ductless glands. 
 
 5. Describe any one ductless gland. 
 
 6. Make diagram of transverse section of thoracic spinal 
 cord. 
 
 7. Give general plan of circulation. 
 
 8. Describe the ophthalmic nerve. 
 
 9. Describe the middle ear. 
 
 10. Origin, insertion, action, and nerve-supply of teres 
 major and gracilis muscles. 
 
 PHYSIOLOGY. 
 
 1. (a) Define human physiology, (b) Define physiolog- 
 ical leucocytosis and mention some conditions in which 
 it is found, (c) Give normal blood-pressure. 
 
 2. State what you know of the composition and charac- 
 acter of urine, and mention the most frequent abnormal 
 constituents. 
 
 3. (a) What are the sources of oxygen and carbonic- 
 acid gas in the system? (b) What is the effect of each 
 upon the blood? 
 
 4. What is meant by absorption and nutrition? 
 
 258 
 
MEDICAL RECORD. 
 
 5. Where in the body is each of the following found, 
 and what is the function of each : Pepsin, trypsin, glyco- 
 gen, ptyalin, and synovia? 
 
 6. Describe the normal heart sounds and factors produc- 
 ing each. 
 
 7. Describe briefly the functions of the pneumogastric 
 nerve. 
 
 8. Give the functions of the skin, and describe briefly 
 how each function is performed. 
 
 9. Lymph : Origin, description, composition, and func- 
 tions. 
 
 10. (a) Describe the normal pulse, and give the average 
 rate during infancy, youth, and old age. (fr) What is the 
 normal ratio of the pulse to respiration? 
 
 CHEMISTRY. 
 
 1. Define (a) diffusion, (b) dialysis, (c) combustion, 
 (d) reagents, (e) oxidation, and give an illustration of 
 each. 
 
 2. (a) What is the reaction of normal gastric juice, (b) 
 and to what is it due? 
 
 3. (a) Give properties, (b) chemical formula, and (c) 
 uses of permanganate of potash. 
 
 4. Mention one chemical antidote for each of the fol- 
 lowing: (a) Phenol, (b) arsenious oxide, (c) sulphuric 
 acid, (d) mercuric chloride, (e) oxalic acid. 
 
 5. Complete the following equations : 
 
 (a) Ba0 2 + H 2 S04 = 
 
 (b) 2K1 + HgCl 2 = 
 
 (c) Na 2 C0 3 + CaCl 2 = 
 
 (d) Pb(N0 3 ) 2 + Na 2 S04 = 
 
 (e) 2KOH -f H 2 S0 4 = 
 
 6. Describe in detail the examination of a sample of 
 urine for the detection of sugar, albumen and bile. 
 
 7. Give (a) chemical formula, (b) properties, and (c) 
 uses of iodoform. 
 
 8. Give a chemical classification of foodstuffs, with an 
 example of each. 
 
 g. Under what circumstances are the syllables mono, di-, 
 tri-, tetra-, and penta- used in chemical nomenclature? 
 Give examples. 
 
 10. Describe Marsh's test for arsenic. 
 
 MATERIA MEDIC A. 
 
 i. How is opium obtained? (a) What per cent, of mor- 
 phine should the official powdered opium yield? (b) Name 
 two alkaloids of opium and give doses. 
 
 2. Give the official name and composition of (a) Fow- 
 ler's solution, (b) Donovan's solution. 
 
 3. Xame five official preparations of mercury. 
 
 259 
 
MEDICAL RECORD. 
 
 4. State the dose of infusion of digitalis, fluid extract of 
 ergot, oleum terebinthinse, sodium salicylate, and tinctura 
 opii deodorati. 
 
 5. Give the official name and dose of (a) Epsom salts, 
 (b) Rochelle salts, (c) Glauber salts. 
 
 6. What is incompatibility in medicine, and what are 
 the different kinds of incompatibles ? 
 
 7. Would you write potassium chlorate and tannin in 
 the same prescription? Give reasons for your answer. 
 
 8. Define narcotics, anesthetics, and sedatives, and give 
 an example of each. 
 
 9. Name the four principal alkaloids of cinchona. 
 
 1 10. Mention the three principal salts of potassium used 
 ' in medicine, and give dose of each. 
 
 THERAPEUTICS. 
 
 1. Name two respiratory stimulants and two vasomotor 
 depressants. Give doses. 
 
 2. Describe and give the indications for the use of car- 
 diac sedatives, with an example. 
 
 3. For what purpose is diaphoresis produced? Name 
 three diaphoretics. 
 
 4. By what methods do antipyretics act? 
 
 5. Define anthelmintics, and name some remedies of this 
 class. 
 
 6. Explain how antitoxin produces immunity and effects 
 cure. 
 
 7. What therapeutic uses has chloroform other than as 
 an anesthetic? 
 
 8. What is cumulative action? Name one drug that has 
 this tendency, and give symptoms of such action. 
 
 9. What is the important alkaloid of erythroxylon, and 
 what is its principal therapeutic use? 
 
 10. What are the therapeutic uses of the preparations of 
 bismuth ? 
 
 PATHOLOGY. 
 
 1. Define (a) calcification, (b) neuroma and angioma, 
 (c) a retention cyst, (d) What are the degenerative 
 changes of arteries? (e) What is osteomalacia? 
 
 2. How does sarcoma differ histologically from car- 
 cinoma ? 
 
 3. What pathological changes are found in Addison's 
 disease? 
 
 4. Give pathology of tabes dorsalis. 
 
 5. Describe pathological change that takes place in the 
 liver from chronic interstitial hepatitis or atrophic cir- 
 rhosis. 
 
 6. What pathological changes occur in acute lobar pneu- 
 monia? 
 
 r 260 
 
MEDICAL RECORD. 
 
 7. What is diplococcus ? Name two pathogenic diplococci. 
 
 8. Define (a) germicide, (b) antiseptic, (c) asepsis, (d) 
 sterile, (e) disinfectant. 
 
 9. What is essential to the life of bacteria? 
 
 10. What special culture medium is required for the 
 growth of gonococcus? 
 
 PRACTICE. 
 
 1. Define (a) epidemic parotitis, (b) difference between 
 endemic and epidemic diseases, (c) dysphagia, and name 
 some diseases in which it occurs; (d) Koplik's sign and 
 Kernig's sign. In what diseases do they occur? 
 
 2. What is (a) percussion, (b) inspiration, (c) men- 
 suration, (d) palpation, (e) auscultation, (/) succussion, 
 (g) egophony. 
 
 3. Give differential diagnosis between membranous and 
 spasmodic croup, and give treatment of each. 
 
 4. Give differential diagnosis between varioloid and vari- 
 cella. 
 
 5. Give differential diagnosis between hysteria and epi- 
 lepsy. 
 
 6. Give symptoms of Graves' or Basedow's disease. 
 
 7. Give causes and symptoms of ascites, and indicate how 
 to recognize by what disease it is produced. 
 
 8. Give treatment of erysipelas. 
 
 9. Give treatment of diabetes mellitus. 
 
 10. Describe symptoms of herpes zoster and its treat- 
 ment. 
 
 SURGERY. 
 
 1. What is an abscess, an aneurysm, and with what con- 
 ditions may aneurysm be confounded? 
 
 2. Define peritonitis. 
 
 3. Describe operation for ligation of subclavian in its 
 third portion. 
 
 4. Describe tonsillectomy, and how would you arrest 
 dangerous hemorrhage after this operation? 
 
 5. Name and describe the more common errors of re- 
 fraction. 
 
 6. Define glaucoma, and describe its surgical treatment. 
 
 7. W f here and when, if at all, should metallic sutures be 
 used, and why? 
 
 8. Give symptoms, signs, diagnosis, and surgical treat- 
 ment (operative and non-operative) of tuberculous coxitis 
 (hip-joint disease). 
 
 9. Name several local anesthetics and mode of applica- 
 tion. 
 
 10. Cholecystotomy : Indication, limitations, technicque. 
 
 OBSTETRICS. 
 
 1. What are the factors concerned in normal menstru- 
 
 261 
 
MEDICAL RECORD. 
 
 ation? Under what pathological condition may menstrua- 
 tion be absent? 
 
 2. How is external palpation applied in the diagnosis of 
 the position of the fetus? 
 
 3. What is puerperal eclampsia? Describe the prophy- 
 laxis and give treatment. 
 
 4. Give the causes, diagnosis, and treatment of prolapse 
 of the cord. 
 
 5. Give the causes, diagnosis, mechanism, and manage- 
 ment of a face presentation. 
 
 6. Mention all the structures divided in complete lacera- 
 tion of the perineum, and describe an operation for their 
 restoration. 
 
 7. Give the pathological anatomy, symptoms, diagnosis, 
 and treatment of membranous dysmenorrhea. 
 
 8. Give reasons for the shortening of the round liga- 
 ments. Describe the operation. 
 
 9. Describe the structures and development of a dermoid 
 cyst of the ovary. 
 
 10. Give the causes of icterus of the new-born. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Board of Medical Examiners of Maryland. 
 
 ANATOMY. 
 
 1. See Cunningham's "Anatomy" (1909), pages 70 and 
 71; or Gray's "Anatomy" (1908), pages 41 and 34. 
 
 2. The Temporal bone articulates with the Occipital, 
 Parietal, Sphenoid, Inferior Maxillary, and Malar bones. 
 
 3. See Cunningham's "Anatomy" 1909), page 906; or 
 Gray's "Anatomy" (1908), page 775. 
 
 4. The ductless glands are: Spleen, thyroid, parathyr- 
 oids, thymus, suprarenale coccygeal, carotid, pineal pituit- 
 ary, and lymphatic glands. 
 
 5. See Cunningham's "Anatomy" (1909), page 1210; or 
 Gray's "Anatomy" (1908), page 1407. 
 
 6. See Cunningham's "Anatomy" (1909), page 458; or 
 Gray's "Anatomy" (1908), page 843. 
 
 7. See Gray's "Anatomy" (1908), page 557. 
 
 8. See Cunningham's "Anatomy" (1909), page 679; or 
 Gray's "Anatomy" (1908), page 1043. 
 
 9. See Cunningham's "Anatomy" (1909), page 748; or 
 Gray's "Anatomy" (1908), page 1160. 
 
 10. Teres Major. Origin: Inferior angle of scapula. 
 Insertion: Inner bicipital ridge of humerus. Action: 
 draws humerus downward and backward, and is internal 
 rotator. Nerve supply: Subscapular nerve. 
 
 262 
 
MEDICAL RECORD. 
 
 Gracilis. Origin: Symphysis pubis. Insertion: Upper 
 part of inner surface of shaft of tibia. Action: Flexes 
 leg, rotates it inward, and adducts thigh. Nerve supply: 
 Obturator nerve. 
 
 PHYSIOLOGY. 
 
 i. (a) Human physiology is that branch of science which 
 treats of the functions of the organs and tissues of the 
 human body in a state of health. 
 
 (b) Physiological leucocytosis is an increase in the num- 
 ber of the white blood corpuscles occurring under normal 
 or physiological conditions, such as : Digestion, exercise, 
 after a cold bath, or during pregnancy. 
 
 (c) The normal blood pressure in the brachial artery is 
 between no and 130 millimeters of mercury. 
 
 2. Normal urine is a yellowish fluid secreted by the kid- 
 neys to the amount of about 1200-1500 c.c. daily; specific 
 gravity, about 1015 to 1025; acid reaction (due to acid 
 sodium phosphate) ; it has a characteristic odor and a 
 salty taste. Its normal constituents are : Water, urea, uric 
 acid, urates, hippuric acid, kreatin, kreatinin, xanthin, 
 hypoxanthin; sulphates, chlorides, and phosphates of so- 
 dium and potassium; phosphates of magnesium and cal- 
 cium; nitrogen, and carbon dioxide. The most frequent 
 abnormal constituents are: Albumin, casts, sugar, blood, 
 pus, excess of indican, bacteria, bile. 
 
 4. Absorption is the process by which the products of 
 digestion are conveyed to the circulation. Nutrition is 
 the sum of the processes by which the body digests, ab- 
 sorbs, and assimilates suitable materials brought into con- 
 tact with it. 
 
 5. Pepsin is found in the gastric juice; it changes pro- 
 teids into proteoses and peptones in an acid medium. 
 Trypsin is found in the pancreatic juice; it changes pro- 
 teids into proteoses and peptones in an alkaline medium, 
 and afterwards decomposes them into leucin and tyrosin. 
 Glycogen is found in the liver (also in placenta, white 
 blood corpuscles, muscle tissue, etc.) ; it is a source of 
 sugar and of energy. Ptyalin is found in the saliva; it 
 changes starches into dextrin and sugar. Synovia is found 
 in the joints and bursae; it acts as a lubricant. 
 
 6. There are two normal heart sounds which follow in 
 quick succession, and are succeeded by a pause. The first, 
 or systolic, sound is dull and somewhat prolonged; the 
 second, or diastolic, sound is sharper and shorter. The 
 sounds may be expressed by the syllables lubb — dup. The 
 first sound is heard best at the apex beat in the fifth left 
 intercostal space; the second sound is heard best over the 
 second right costal cartilage. The causes producing the 
 first sound of the heart are not definitely ascertained; the 
 following are supposed to be causatory factors: (1) The 
 
 263 
 
MEDICAL RECORD. 
 
 vibration and closure of the auriculoventricular valves, (2) 
 the muscular sound produced by the contraction of the 
 ventricles, and (3) the cardiac impulse against the chest 
 wall. The second sound is caused by the vibration due to 
 the closure of the semilunar valves. 
 
 7. Function of Pneumo gastric Nerve: It supplies (1) 
 motor influence to the pharynx and esophagus, stomach, 
 and intestines, to the larynx, trachea, bronchi, and lungs ; 
 
 (2) sensory and, in part, (3) vasomotor influence, to the 
 same regions; (4) inhibitory influence to the heart; (5) 
 inhibitory afferent impulses to the vasomotor center; (6) 
 excito-secretory to the salivary glands; (7) excito-motor 
 in coughing, vomiting, etc. 
 
 8. The functions of the skin are: (1) Protection, (2) 
 excretion, (3) secretion, (4) heat regulation, (5) absorp- 
 tion, (6) general sensation, (7) special sense of touch, 
 and (8) respiration. 
 
 (1) By its mechanical covering, and also by its being 
 an organ of sensation. (2) Very slight; and see (3). 
 
 (3) It secretes sebum to lubricate the hairs, and sweat 
 (which has several functions : excretion of water, carbon 
 dioxide, and urea; cooling of surface of body; and regu- 
 lator of body heat). (4) By radiation, and see 3. (5) 
 Very slight, chiefly of oily substances. (6) and (7) By 
 end organs. (8) A slight amount of carbon dioxide is 
 exhaled. 
 
 9. Lymph. Origin: There are two theories as to the 
 formation of lymph: (1) That it is formed from the 
 blood plasma by the processes of filtration, diffusion, and 
 osmosis. (2) That in addition to these, the endothelial 
 cells of the capillaries exercise some influence. Descrip- 
 tion: Lymph is a colorless, albuminous fluid, alkaline in 
 reaction, with specific gravity of about 1015, containing 
 lymph corpuscles, and coagulating when drawn from its 
 vessels. Composition: Proteins (serum albumin, fibrino- 
 gen), sugar, sodium chloride and carbonate, water, urea, 
 fat. Function: To provide cells and tissues with materials 
 necessary for their growth, repair, and functional activi- 
 ties ; and to receive and carry away their waste product's. 
 
 10. The pulse is a wave of expansion which travels 
 along the arteries, and is due to the discharge from the 
 left ventricle of a volume of blood, during systole, into 
 the already full arterial system. The points to be observed 
 are: (1) Its frequency; this gives the rate of the heart 
 beats. (2) Its compressibility ; this denotes the force with 
 which the heart is beating. (3) Its tension; this denotes 
 the peripheral resistance, and also the state of the arterial 
 walls. (4) Its regularity or rhythm; this denotes the 
 regularity (or otherwise) of the heart's action in force 
 or rhythm. The average rate during infancy is about 120 
 
 264 
 
MEDICAL RECORD 
 
 per minute ; during youth, about 80 ; and during old age, 
 about 60. The normal ratio of pulse to respiration is about 
 4:1. 
 
 CHEMISTRY. 
 
 1. Diffusion is the thorough mixing of liquids or gases 
 which occurs when they are brought together. Thus, two 
 liquids of different densities, even when at perfect rest, 
 will soon have diffused into each other to form a single 
 liquid whose density and composition are the same 
 throughout. Dialysis is the process of separating sub- 
 stances from each other by placing the mixture contain- 
 ing them in a vessel w T ith porous walls and immersing it 
 in water, when the more diffusible substance will pass 
 through. Reagents are substances used to produce chem- 
 ical reactions ; for example, see Question 6 below : 
 
 By oxidation we mean the act of union of oxygen with 
 another element or compound. This process is attended 
 by the liberation of heat, and, when it takes place rap- 
 idly, of light. The rusting of a given weight of iron is a 
 slow oxidation, while the burning of the same in oxygen 
 is a rapid oxidation. Only the latter produces light, while 
 in both cases the same amount of heat is liberated. 
 
 By combustion, in a general sense, is meant the rapid 
 union of the oxygen of the air with some other substance, 
 as coal or phosphorus. In a wider sense, however, com- 
 bustion may be defined as any chemical union of two sub- 
 stances attended by liberation of heat and light. 
 
 2. (a) Acid, (b) To hydrochloric acid. 
 
 3. Potassium Permanganate is a dark crystalline sub- 
 stance, yielding a red powder when broken. It is soluble 
 in water, and gives it a red color even in very dilute solu- 
 tions. It is an oxidizing agent, and disinfectant. Its 
 formula is K 2 Mn 2 O s . 
 
 4. One chemical antidote for phenol, sodium sulphate ; 
 for arsenious oxide, freshly prepared solution of ferric 
 hydroxide ; for sulphuric acid, magnesia ; for mercuric 
 chloride, white of egg: for oxalic acid, magnesia. 
 
 5. (a) Ba0 2 +H 2 S0 4 = BaS04 + H 2 2 
 
 (b) 2KI -f- HgCl, = 2KCI + Hgl 2 
 
 (c) Na.,C0 3 + CaCl 2 = 2NaCl + CaCOs 
 
 (d) Pb(X0 3 ) 2 4- Na 2 S0 4 = PbSO* + 2NaN0a 
 
 (e) 2KOH + H 2 S0 4 = K 2 S0 4 + 2H 2 
 
 6. Test for albumin: "The urine must be perfectly clear. 
 If not so, it is to be filtered, and if this does not render 
 it transparent it is to be treated with a few 7 drops of mag- 
 nesia mixture and again filtered. The reaction is first ob- 
 served. If it be acid, the urine is simply heated to near 
 the boiling point. If the urine be neutral or alkaline, it 
 is rendered faintly acid by the addition of dilute acetic 
 
 265 
 
MEDICAL RECORD. 
 
 acid and heated. If albumin be present, a coagulum is 
 formed, varying in quantity from a faint cloudiness to en- 
 tire solidification, according to the quantity of albumin 
 present. The coagulum is not redissolved upon the addi- 
 tion of HN0 3 ." 
 
 Test for sugar: Render the urine strongly alkaline by 
 addition of Na 2 C0 3 . Divide about 6 c.c. of the alkaline 
 liquid in two test-tubes. To one test-tube add a very min- 
 ute quantity of powdered subnitrate of bismuth, to the 
 other as much powdered litharge. Boil the contents of 
 both tubes. The presence of glucose is indicated by a 
 dark or black color of the bismuth powder, the litharge 
 retaining its natural color. 
 
 Test for bile pigment in the urine: Put 3 c.c. HNO3 in a 
 test-tube; add a piece of wood, and heat until the acid 
 is yellow; cool. When cold, float some of the urine to be 
 tested upon the surface of the acid. A green band is 
 formed at the junction of the liquid, which gradually 
 rises, and is succeeded from below by blue, reddish-violet, 
 and yellow. 
 
 7. Iodoform has formula CH1 3 . It is a solid, yellow, 
 crystalline substance, insoluble in water, soluble in al- 
 cohol and in ether, with a sweet taste and a peculiar pene- 
 trating odor. It is used as a dressing for wounds, sores 
 and ulcers (particularly tubercular and syphilitic ulcers). 
 
 8. Foods are classified as follows : 
 _ T . (Water. 
 
 I. Inorganic. J Salts (Sodium Chloride.) 
 
 r Non-nitrogenous [Carbohydrates (Sugar). 
 
 II. Organic < (Fats (Fat). 
 
 (_ Nitrogenous — Proteids (Meat). 
 
 9. Mono denotes one; thus, CO carbon monoxide. Di 
 means two ; thus, H2O2 hydrogen dioxide. Tri means 
 three; thus C 3 H 5 (OH) 3 glycerol is a triatomic alcohol. 
 Tetra means four; thus, carbon is tetravalent. Penta 
 means five; thus PCI5 phosphorus pentachloride. 
 
 10. Marsh's test for arsenic: This test depends on the 
 fact that arsenic hydride is formed when nascent hydro- 
 gen acts on a compound of arsenic: 
 
 H 3 As03+3H 2 =AsH3+3H 2 0. 
 A small flask fitted with thistle funnel and a delivery 
 tube, as for the production of hydrogen, is used; pure 
 zinc and hydrochloric acid are introduced, and after a 
 short time the hydrogen is ignited. It is advisable to. cover 
 the flask with a cloth before igniting the gas, as an explo- 
 sion may happen unless the air has all been driven out. 
 If the materials are pure the hydrogen flame gives no 
 deposit upon a piece of cold porcelain brought into it, but 
 commercial zinc usually contains arsenic. When the purity 
 of the gas is proved, a little solution of arsenite may be 
 
 266 
 
MEDICAL RECORD. 
 
 poured down the thistle funnel, which will produce a more 
 rapid evolution of gas, and the flame will become larger 
 and perceptibly colored. A piece of cold porcelain de- 
 pressed upon the flame will be covered with a deposit of 
 metallic arsenic. The films of arsenic are metallic looking 
 in the thicker places, brownish near the edges; they are 
 easily volatized by heat, and dissolve in solution of bleach- 
 ing powder. A portion of the glass tube from which the 
 gas is burned should be heated to redness ; the gas decom- 
 poses and a deposit of arsenic appears on the tube, which 
 may be identified in a similar way, or may be converted 
 into crystals of oxide by cautious sublimation in an open 
 tube. — (Fisher's Elementary Chemistry.) 
 
 MATERIA MEDICA. 
 
 i. Opium is obtained by incising the unripe capsules of 
 Papaver somniferum. It should yield not less than nine 
 per cent, of morphine. Two alkaloids: Morphine, dose 
 gr. 1/5; Codeine, dose gr. ^2. 
 
 2. (a) Fowler's Solution is liquor potasii arsenitis. Its 
 composition is : Arsenic trioxide, potassium bicarbonate, 
 compound tincture of lavender, and water. 
 
 (b) Donovan's Solution is liquor arseni et hydrargyri 
 iodidi. Its composition is : arsenous iodide, red mercuric 
 iodide, and water. 
 
 3. (1) Hydrargyri chloridum corrosivum; (2) Hydrar- 
 gyri chloridum mite; (3) Hydrargyri iodidum flavum; (4) 
 Hydrargyri iodidum rubrum; (5) Hydrargyrum cum 
 creta. 
 
 4. Infusion of digitalis, dose 3ij ; Fluidextract of ergot, 
 dose H£xxx; Oleum terebinthinse, no dose; Sodium salicy- 
 late, dose gr. xv; Tinctura opii deodorati, dose Tl£viij. 
 
 5. 
 
 Epsom salt.. 
 Rochelle salt. 
 Glauber's salt 
 
 OFFICIAL NAME. 
 
 Magnesii sulphas 
 Potassii et sodii tartras 
 Sodii sulphas 
 
 DOSE. 
 
 ~3i7 
 3ij 
 3iv 
 
 6. By incompatibility is understood the simultaneous ad- 
 ministration or combination of substances not suitable for 
 such combination. Varieties: Chemical, pharmaceutical, 
 and therapeutical. 
 
 7. I would not write potassium chlorate and tannin in 
 the same prescription ; because the combination is explosive. 
 
 8. Narcotics are agents which produce deep sleep; as 
 opium. 
 
 Anesthetics are agents which destroy sensation; as ether. 
 Sedatives are agents which reduce functional activity and 
 diminish pain ; as aconite. 
 
 9. Quinine, quinidine, cinchonine, cinchonidine. 
 
 267 
 
MEDICAL RECORD 
 
 io. Potassium iodide, dose gr. vijss; potassium chlorate, 
 dose gr. iv; potassium bitartrate, dose gr. xxx. 
 
 THERAPEUTICS. 
 
 1. Two respiratory stimulants: Strychnine, dose of sul- 
 plate, gr. 1/64; and citrated caffeine, dose gr. ij. Two 
 vasomotor depressants: Amyl nitrite, dose T^iij ; and aco- 
 nite, dose of tincture, TT#x. 
 
 2. Cardiac sedatives lessen the force and frequency of 
 the heart's action. They are used to control palpitation 
 and overaction of that organ, also to slow the pulse in 
 febrile conditions in sthenic subjects, especially when local 
 inflammation is the exciting cause thereof. Most of them 
 are direct cardiac poisons, depressing both the heart muscle 
 and the motor ganglia. The list includes Aconite and 
 Veratrum, also Muscarine, Pilocarpine, Saponin, Hydro- 
 cyanic Acid, Antimony, Potassium salts, and Digitalis, 
 the last-named acting as a sedative by stimulation of the 
 vagus center and the cardiac muscle, slowing the rate and 
 giving regular rhythm to the action of the heart. — (From 
 Potter's Materia Medica.) 
 
 3. Diaphoresis is produced: (1) To remove fluid from 
 the body. (2) To remove poisons from the body. (3) 
 To reestablish disturbed cutaneous circulation, and so to 
 relieve congestion of internal organs. (4) To relieve the 
 kidneys, (5) To increase the alkalinity of the tissues. 
 Three diaphoretics: Alcohol, aconite, and pilocarpus. 
 
 4. The following table (from Potter's Materia Medica) 
 gives the chief antipyretics, with their manner of action: 
 Temperature depression may be done by five different 
 actions working upon two principal lines, viz., by: 
 
 ' ( 1 ) diminishing tissue 
 change. 
 (2) reducing the cir- 
 culation. 
 
 (3) dilating cutaneous ves- 
 sels, thus increasing 
 heat radiation. 
 
 (4) promoting perspiration, 
 its evaporation lower- 
 ing the temperature. 
 
 (5) abstracting heat from 
 the body. 
 
 The following list of antipyretics includes a few for 
 each of the above-named actions, to which the numbers 
 refer in each case, viz. : 
 
 Quinine, 1. Aconite, 2. Antipyrin, 1, 4. 
 
 Phenol, 1. Alcohol, 1, 3. Antimony, 2, 4. 
 
 Salicin, 1. Nitrous ether, 3, 4. Cold bath, 5. 
 
 Digitalis, 2. Acetanilid, 1, 4. Cold drinks, 5. 
 
 Phenacetin, 1, 4 Wet-pack, 5. 
 
 268 
 
 (a) Lessening heat production by 
 
 (b) Promoting heat loss by 
 
MEDICAL RECORD. 
 
 5. Anthelmintics are agents which kill or expel worms 
 inhabiting the intestinal tract. Examples: Oleoresina 
 aspidii, gr. xxx ; Pelletierine tannate, gr. x ; santonin, gr. j ; 
 pumpkin (pepo) seeds, 3J. 
 
 6. How antitoxin produces immunity and affects cure is 
 not known, but theories deduced from observed facts are 
 as follows : "As the various pathogenic bacteria produce 
 the causative toxins of their respective diseases, so the 
 organic cells of the body, reacting under the stimulus of 
 the poisons thus introduced, immediately proceed to elab- 
 orate defensive bodies, which if produced in sufficient 
 quantity will neutralize the effects of the toxins. Residual 
 antibodies remaining in the blood after recovery render 
 the animal immune for a time against the disease. The 
 immunizing and curative effects obtained by the injection 
 of the blood serum of an immunized animal into the 
 circulation of another animal are due either to direct chem- 
 ical neutralization of the toxins themselves by the anti- 
 bodies so introduced (Behring, Kitasato), or to a par- 
 ticular influence exerted by the antibodies upon the living 
 cells of the organism which, being affected in two opposite 
 directions, remain neutral to the disease (Buchner). Some 
 authorities hold that these results are due to the conjoint 
 action of leucytic and chemical forces. Ehrlich , s side- 
 chain theory assumes that every toxin contains toxophore 
 molecules having direct toxic action, and haptophore mole- 
 cules which combine the toxophores with a similar com- 
 bining group of molecules in the tissue cell of the attacked 
 organism. The tissue cell molecules being destroyed by 
 the toxophores, a rapid and profuse regeneration of similar 
 molecules occurs in side chains, and these molecules over- 
 growing are carried into the circulation, becoming the 
 antitoxin, which acts by combining with the haptophores 
 of newly arrived toxin, using up their combining power 
 before they can reach the tissue cells." — (Potter's Materia 
 Medica, etc.) 
 
 7. Besides being an anesthetic, chloroform is a rubefa- 
 cient, an anodyne, an antipruritic^ it is administered inter- 
 nally as a stomachic, in dyspepsia, to disguise nauseous 
 drugs, in diarrhea, in irritating coughs and bronchitis. 
 
 8. Cumulative action is the property which some drugs 
 have of producing more or less sudden and violent action, 
 after single and successive doses have been taken with 
 no untoward effect. Example: Digitalis; this produces 
 fast and irregular pulse, gastroenteritis, small pulse, low 
 blood pressure. 
 
 9. The important alkaloid of erythroxylon is cocaine; 
 its principal therapeutic use is as a local anesthetic. 
 
 10. Preparations of bismuth are used: (1) Externally, 
 as dusting powders for wounds, sores, some skin diseases; 
 
 269 
 
MEDICAL RECORD. 
 
 (2) internally, in vomiting, diarrhea, gastritis, gastralgia, 
 and as an intestinal antiseptic; (3) also in sore mouth, 
 conjunctivitis, granular lids, coryza, mercurial ptyalism. 
 
 PATHOLOGY. 
 
 1. (a) Calcification is a pathological process in which 
 certain tissues are infiltrated with calcareous particles 
 (salts of calcium and magnesium), (b) Neuroma is a 
 tumor consisting almost entirely of nerve tissue. Angioma 
 is a tumor consisting of blood-vessels bound together by 
 a small amount of connective tissue, (c) A retention 
 cyst is a cyst which results from the retention of a normal 
 secretion (as a sebaceous cyst) ; (d) Fatty, calcareous, 
 hyaline, and amyloid degenerations, (e) Osteomalacia is 
 a disease characterized by progressive softening of the 
 bones. 
 
 2. Carcinoma is derived from the epiblast or the hypo- 
 blast; possesses a stroma, in which are both blood-vessels 
 and lymphatics; metastasis occurs by the lymphatics. 
 
 Sarcoma is derived from the mesoblast; it has no stroma 
 and no lymphatics; metastasis occurs by the blood-vessels 
 which are in contact with the cells. 
 
 3. See French's "Practice of Medicine" (1907), page 
 539; or Osier's "Practice of Medicine" (1909), page 756. 
 
 4. In tabes dorsalis the posterior columns of the spinal 
 cord and the posterior nerve roots are involved. The 
 posterior columns of the spinal cord are gray and shrunken, 
 and show considerable overgrowth of connective tissue in 
 the columns of Goll, Burdach, and Lissauer; this process 
 extends upward from the lumbosacral region ; the posterior 
 nerve roots degenerate and become atrophic. The menin- 
 ges over the affected parts become opaque and adherent. 
 Some of the cranial nerves may also atrophy, notably the 
 optic, but also the motor oculi and vagus. The process is 
 destructive and progressive; it is not a simple wasting, 
 although the nerve fibers are atrophied,^ but it is charac- 
 terized by irritation, changes in the axis cylinders, over- 
 growth of the connective tissue, and sometimes congestion ; 
 the spinal ganglia may be affected. 
 
 5. In atrophic cirrhosis: The liver is shrunken and in- 
 durated, rough, and of a pale or yellow color; a growth of 
 new connective tissue is disposed in broad bands which 
 run in various directions, and by their contraction divide 
 the liver into numerous irregular lobes. Many acini may 
 be affected at one time. The capsule may be thickened, or 
 adherent to the diaphragm. Jaundice is slight, and comes 
 on late; ascites is pronounced and may occur early. 
 
 6. See French's "Practice of Medicine" (1907), page 
 154; or Osier's "Practice of Medicine" (1909), page 170. 
 
 7. A diplo coccus is a form of bacteria made up of two 
 
 270 
 
MEDICAL RECORD. 
 
 cocci attached to each other (in pairs). Two pathogenic 
 diplococci : Diplococcus pneumonia: and Diplococcus intra- 
 cellulars meningitidis. 
 
 8. (a) Germicide as an agent capable of destroying bac- 
 teria, (b) Antiseptic is an agent capable of preventing or 
 restraining putrefaction, (c) Asepsis means freedom from 
 pathogenic germs, (d) Sterile means containing neither 
 microorganisms nor spores capable of development, (e) 
 Disinfectant is an agent which restrains infectious diseases 
 by destroying or removing their specific poisons. 
 
 9. Most bacteria require proper temperature, generally 
 at or near that of the body; oxygen is generally needed, 
 those that cannot live without it being called aerobic, and 
 those that can grow without it, anaerobic; nutriment of a 
 proper kind, containing both organic and inorganic ma- 
 terial; a slight degree of moisture; a medium of slightly 
 alkaline reaction; and rest. Individual bacteria may re- 
 quire modifications of the above essentials. 
 
 10. Human blood serum. 
 
 PRACTICE. 
 
 1. (a) Epidemic parotitis is inflammation of the parotid 
 gland (or mumps), occurring in a large number of people 
 at the same time, (b) An endemic disease is one which 
 is more prevalent in certain localities than elsewhere; an 
 epidemic disease is one which attacks a large number of 
 persons in the same locality in rapid succession. (c) 
 Dysphagia means painful or difficult swallowing; it occurs 
 in peritonsillar abscess, tonsillitis, cancer of tongue, pharyn- 
 gitis, etc. (d) Koplik's sign is the presence of small red 
 spots with a bluish-white center on the inner surface of 
 the cheeks, found in measles prior to the development of 
 the eruption on the skin. Kernig's sign is inability to 
 fully straighten the leg after both thigh and leg have 
 been flexed ; it is found in cerebrospinal meningitis. 
 
 2. (a) Percussion is a method of diagnosis, and consists 
 in striking a part with a view to determining the condition 
 of the underlying organs by the sound elicited, (b) In- 
 spiration is the act of breathing in. (c) Mensuration 
 means measuring, (d) Palpation is a method of diagnosis, 
 and consists in feeling or pressing over an organ with 
 fingers or hands, (e) Auscultation is a method of diagno- 
 sis, and consists in listening to the sounds of the heart, 
 blood-vessels, or respiratory apparatus. (/) Succussion is 
 a method of diagnosis, and consists in snaking (slightly) 
 the patient or some viscus. (g) Egophony is a form of 
 vocal resonance in which the voice sounds tremulous and 
 bleating. 
 
 3. Spasmodic croup generally comes on suddenly, at 
 night. There is no appreciable fever, no previous malaise 
 
 271 
 
MEDICAL RECORD 
 
 or sickness, and often the patient is asleep again by the 
 time the physician arrives. There is frequently a thick, 
 tenacious mucus, but neither Klebs-Loeffler bacilli nor 
 streptococci are present. It is entirely a local disturbance. 
 
 Membranous croup is either laryngeal diphtheria or a 
 streptococcus infection. In either case there is a prior 
 stage of malaise, accompanied by chills, fever, and sore 
 throat. The fever may become very high. A membrane 
 forms, in which are found the Klebs-Loeffler bacilli or 
 streptococci. 
 
 For treatment, see French's "Practice of Medicine" 
 (1907), pages 647 and 195; or Osier's "Practice of Medi- 
 cine" (1909), pages 599 and 207. 
 
 4. In varicella the symptoms come on gradually; there 
 i-s no prodromal fever; no pain in the back; the eruption 
 appears on the first day, comes in crops, disappears on 
 stretching the skin, and is not shotty. 
 
 In varioloid the symptoms come on very suddenly; there 
 is fever; severe pain in the back, and headache; the erup- 
 tion appears on the third or fourth day, as papules, be- 
 coming in turn vesicles and pustules. 
 
 5. 
 
 EPILEPSY. 
 
 HYSTERIA. 
 
 I. 
 
 No apparent cause. 
 
 I. 
 
 Cause, emotional. 
 
 2. 
 
 Sudden and rapid onset. 
 
 2. 
 
 Onset gradual, usually 
 after some mental ex- 
 citement. 
 
 3- 
 
 Aura generally present. 
 
 3. 
 
 Globus hystericus or pal- 
 pitation. 
 
 4- 
 
 Consciousness lost. 
 
 4. 
 
 Consciousness generally 
 preserved. 
 
 5- 
 
 Pupils generally dilated. 
 
 5. 
 
 Pupils normal. 
 
 6. 
 
 Tongue often bitten. 
 
 6. 
 
 Tongue never bitten. 
 
 7- 
 
 Patient very liable to 
 
 7. 
 
 Patient not liable to hurt 
 
 
 hurt himself. 
 
 
 himself; may injure 
 others. 
 
 8. 
 
 May be involuntary blad- 
 der and bowel dis- 
 charges. 
 
 8. 
 
 Never. 
 
 9- 
 
 Of short duration. 
 
 9- 
 
 Duration longer. 
 
 6. See French's "Practice of Medicine" (1907), page 
 548; or Osier's "Practice of Medicine" (1909), page 766. 
 
 7. See French's "Practice of Medicine" (1907), page 
 871; or Osier's "Practice of Medicine" (1909), page 589. 
 
 8. See French's "Practice of Medicine" (1907), page 
 221; or Osier's "Practice of Medicine" (1909), page 213. 
 
 9. See French's "Practice of Medicine" (1907), page 
 944; or Osier's "Practice of Medicine" (1909), page 420. 
 
 272 
 
MEDICAL RECORD. 
 
 io. See French's "Practice of Medicine" (1907), page 
 995. 
 
 SURGERY. 
 
 1. An abscess is a circumscribed collection of pus in a 
 cavity of new formation. 
 
 An aneurysm is a pulsating sac containing blood com- 
 municating with the lumen of an artery; it may be con- 
 founded with abscess, cyst, soft tumor. 
 
 2. Peritonitis is inflammation of the peritoneum. 
 
 3. See Rose and Carless' "Surgery" (1908), page 333; or 
 Da Costa's "Surgery" (1908), page 410. 
 
 4. See Rose and Carless' "Surgery" (1908), page 868. 
 
 5. The more common errors of refraction are : Myopia, 
 hypermetropia, and astigmatism. Myopia is a condition 
 in which the anteroposterior axis of the eye is abnormally 
 long, and parallel rays are focused in front of the retina. 
 Hypermetropia is a condition in which the anteroposterior 
 axis of the eye is abnormally short, and parallel rays are 
 focused behind the retina. Astigmatism is a condition in 
 which, owing to a greater curvature of the eye in one 
 meridian than in others, the refractive power of the eye 
 varies. 
 
 6. Glaucoma is a diseased condition of the eye especially 
 characterized by increased intraocular tension. Surgical 
 treatment is iridectomy: "Having first secured a lid specu- 
 lum in position, a fold of conjunctiva, near the cornea 
 and opposite the place where the incision is to be made, is 
 seized by fixation forceps. A keratome is entered through 
 the cornea at the scleral border, the point being kept 
 nearly perpendicular to the sclera until it has reached the 
 anterior chamber, when the handle is depressed so as to 
 bring the blade parallel to the iris. The blade is then 
 pushed forward until it has made a wound sufficiently 
 large for the purpose of the operation ; still depressing 
 the handle, the blade is withdrawn slowly, and iris for- 
 ceps are thrust through the wound closed, and opened 
 in the anterior chamber to seize the iris. The iris is 
 then drawn out of the wound, and as much of it as 
 desired is excised by fine iridectomy scissors held 
 firmly against the eyeball and parallel to the wound. 
 The stump of the iris is then carefully returned to 
 the anterior chamber, no portion of it being allowed to 
 become incarcerated in the corneal incision. The delicate 
 McClure iris scissors are the best for cutting the iris, 
 but they are rather expensive, and not always obtainable. 
 The eye should be thoroughly cocainized, and the opera- 
 tion should be done under antiseptic precautions ; after the 
 operation the eye should be thoroughly irrigated, a light 
 bandage applied, and the eye kept closed until the corneal 
 
 273 
 
MEDICAL RECORD. 
 
 incision has become united. The incision may be made 
 with the Graefe knife instead of the lance-shaped kerat- 
 oma" — (Gould and Pyle's Compend.) 
 
 7. See Rose and Carless' "Surgery" (1908), page 232. 
 
 8. See Rose and Carless' "Surgery" (1908), page 679; 
 or Da Costa's "Surgery" (1908), page 552. 
 
 9. See Rose and Carless' "Surgery" (1908), page 1318; 
 or Da Costa's Surgery (1908), page 1046. 
 
 10. See Rose and Carless' "Surgery" (1908), page 1061 ; 
 or Da Costa's "Surgery" (1908), page 965. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), page 81; or Hirst's 
 "Obstetrics" (1909), page 57. 
 
 Menstruation may be absent, owing to absence or im- 
 perfect development of the generative organs; also to 
 stenosis, obstructions, or atresia of the genital tract; also 
 to operative removal of the uterus or its appendages. 
 Other causative factors are : Acute infectious diseases, 
 anemia, chlorosis, obesity, drug habits, alcoholism, over- 
 study, lack of exercise, exposure to cold, and various emo- 
 tional causes. 
 
 2. See Williams' "Obstetrics" (1909), page 211; or 
 Hirst's "Obstetrics" (1909), page 389. 
 
 3. Puerperal eclampsia is an acute morbid condition, oc- 
 curring during pregnancy, labor, or the puerperal state, and 
 is characterized by tonic and clonic convulsions, which af- 
 fect first the voluntary and then the involuntary muscles; 
 there is total loss of consciousness, which tends either to 
 coma or to sleep, and the condition may terminate in re- 
 covery or death. Preventive treatment: (1) The amount 
 of nitrogenous food should be diminished to a minimum; 
 (2) the production and absorption of poisonous materials 
 in the intestines and body tissues should be limited and 
 their elimination should be aided by improving the action 
 of the bowels, the kidneys, the liver, the skin, and the 
 lungs; (3) the source of the fetal metabolic products and 
 the peripheral irritation in the uterus should, if necessary, 
 be removed by evacuating that organ. Curative treatment: 
 (1) Controlling the convulsions (by chloroform, veratrum, 
 or chloral) ; (2) elimination of the poison or poisons 
 which are presumed to cause the convulsions; (3) empty- 
 ing the uterus under deep anesthesia, by some method that 
 is rapid and that will cause as little injury to the woman 
 as possible. 
 
 4. See Williams' "Obstetrics" (1909), page 842; or 
 Hirst's "Obstetrics" (1909), page 625. 
 
 5. See Williams' "Obstetrics" (1909), page 274; or 
 Hirst's "Obstetrics" (1909), page 409. 
 
 6. In incomplete laceration of the perineum any of the 
 
 274 
 
MEDICAL RECORD. 
 
 following tissues may be lacerated : Skin, mucous mem- 
 brane of fourchette, constrictor vaginae, transversus peri- 
 nei, and lavator ani. In complete laceration the sphincter 
 ani and the anterior surface of the rectum are involved, in 
 addition to the structures named above. 
 
 For repair, see Williams' "Obstetrics" (1909), page 325; 
 or Hirst's "Obstetrics" (1909), page 868. 
 
 7. Membranous Dysmenorrhea. "Pathological anat- 
 omy: When complete the membrane is a hollow cast of 
 the interior of the uterus ; it is the shape of an isosceles 
 triangle, the base of which corresponds to the fundus of 
 the uterus. At each of the truncated angles there is an 
 opening, the small ones at the base indicating the position 
 of the uterine ostia of the Fallopian tubes, and the larger 
 apical opening marking the site of the os internum. A 
 menstrual decidua is usually 2.3 centimeters in length and 
 2 millimeters in thickness. The inner surface is shaggy, 
 as is best seen when the membrane is floated out in water. 
 Histologically, the membrane consists of recent blood-clot, 
 characterized by the presence of a large excess of leuco- 
 cytes ; fragments of organized tissue are found, consisting 
 of small round cells with a small amount of delicate 
 fibrous stroma, and sometimes portions of shed and par- 
 tially disintegrated epithelium. No glands are found, nor 
 are the large decidual cells characteristic of the decidua 
 of pregnancy present. The condition is best described as 
 one of exfoliative menstrual endometritis. Symptoms: 
 The patient complains of severe intermittent pain, begin- 
 ning with the onset of the menstrual period and reaching 
 a maximum just before the expulsion of the membrane, 
 after which the pain usually ceases. The membrane may 
 come away whole, in several pieces, or in numerous shreds, 
 and is usually discharged within forty-eight hours of the 
 commencement of the menstrual flow. Diagnosis: The 
 membranous cast must be distinguished from the decidua 
 that comes away in cases of tubal pregnancy, or from the 
 unimpregnated horn of a gravid uterus, and from the 
 products of early abortion. The histological appearances 
 will usually be decisive ; in addition to which the history 
 will generally serve for a diagnosis. In cases of deciduse 
 associated with pregnancy within or without the uterus 
 there is always a history of one or more missed periods, 
 except in some few cases of tubal gestation. The hemor- 
 rhage in cases of membranous dysmenorrhea is limited to 
 the usual few days, while in cases where the member is de- 
 cidual it may go on for one or several weeks. When 
 the case has been under observation some time the regular 
 painful discharge of membranes at monthly intervals is ab- 
 solutely characteristic. Treatment: No drugs affect the for- 
 mation of the membrane, although pain may be relieved by 
 
 -75 
 
MEDICAL RECORD. 
 
 this means. The incidence of pregnancy sometimes effectu- 
 ally arrests the membranous formation, but not always. 
 The best results are obtained from curetting, which affords 
 at least a temporary relief; but it may require to be re- 
 peated." — (Sutton and Giles' Diseases of Women.) 
 
 8. The round ligaments are shortened when the uterus 
 is retroverted, or retroflexed, and there are no complica- 
 tions. See Hirst's "Obstetrics" (1909), page 914; or Rose 
 and Carless' "Surgery" (1908), page 1278. 
 
 9. Ovarian dermoids: Dermoids are "tumors furnished 
 with skin or mucous membrane occurring in situations 
 where these structures are not found under normal condi- 
 tions." Ovarian dermoids may be lined with skin through- 
 out, or only over a very bmall area. The Sidn may have 
 hair, sebaceous glands, sweat glands, mammae. There may 
 be teeth, muscle, bone, horn, nails; very rarely brain-like 
 tissue. The cavity of a dermoid cyst is generally filled 
 with fluid fat. 
 
 10. The cause of icterus of the new-born is not known. 
 It is found most often in premature and weakly infants, 
 and in those born in maternity hospitals. The following 
 theories have been held as to its etiology: "(1) Obstruction 
 to the outflow of bile by (a) plugs of mucus in the com- 
 mon bile duct; (b) partial blocking of the bile ducts by 
 desquamated epithelium, the result of hyperemia and ca- 
 tarrh of the ducts following on the changes in the circula- 
 tion which take place at birth; (c) congenital narrowing 
 of the bile ducts; (d) inability of the ducts to carry off 
 the secretion of bile, which is considerable at first; and 
 O) delayed ligature of the cord. (2) Pressure on the 
 ducts from without by (a) the portal and hepatic veins 
 becoming distended in consequence of the changes in the 
 circulation following birth; (b) swelling and edema of 
 Glisson's capsule, the result of engorgement of the umbili- 
 cal and portal veins — hence the jaundice is hepatogenous. 
 (3) Closure of the umbilical vein, which leads to such a 
 lowering of blood pressure in the capillaries of the liver 
 that reabsorption of bile takes place. (4) The ductus 
 venosus remains open and thereby allows some portal 
 blood, which contains bile, to pass through it and enter 
 the inferior vena cava." — (From Aids to Diseases of 
 Children. ) 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Massachusetts Board of Registration in Medicine. 
 
 anatomy and histology. 
 I. Describe the arrangement of the dura mater and state 
 
 functions 
 
 276 
 
MEDICAL RECORD. 
 
 2. Make a diagram of the stomach, moderately distended, 
 and state its anatomical relations. 
 
 3. Describe the portal circulation and state how it is con- 
 nected with the systemic. 
 
 4. What is Poupart's ligament? State origin and inser- 
 tion, and the structures which pass under it. 
 
 5. Describe a muscle fiber. Name three parts of the body 
 in which unstriped muscle is found. 
 
 6. State origins of vertebral, internal mammary, and 
 basilar arteries. 
 
 7. Name the largest cranial nerve. How many roots has 
 it, and what is its superficial origin? Why is it called a 
 compound nerve? 
 
 8. Make a diagram of the second nerve. What is its ex- 
 clusive distribution? 
 
 9. Locate and give the gross anatomy of the medulla 
 oblongata. 
 
 10. Oral examination. 
 
 PHYSIOLOGY AND HYGIENE. 
 
 i. State the functions of the fifth nerve. 
 
 2. Trace the nervous path in case of reflex action. Is 
 walking a reflex? 
 
 3. What is the purpose of the Haversian canals? What 
 is the function of the marrow and the periosteum? 
 
 4. Name and locate the valves of the heart and state their 
 functions. What is the velocity of the blood current? 
 
 5. When food of various types is digested, where and in 
 what way does it enter the blood stream ? 
 
 6. Describe the phenomena which occur when muscle is 
 in a state of activity. 
 
 7. What objections may be given to heating dwelling 
 rooms by direct radiation from stoves and from steam 
 or hot water pipes? What would you recommend as a 
 substitute? 
 
 8. What conditions tend to prolong the life of a bacillus 
 outside of the body? 
 
 9. Mention diseases where germs are carried by water; 
 also by air. 
 
 10. Oral examination. 
 
 PATHOLOGY AND BACTERIOLOGY. 
 
 1. Differentiate death by drowning and death by strangu- 
 lation. 
 
 2. Name and describe five abnormal constituents of urine 
 which signify disease. How are they determined? 
 
 3. State pathological conditions for relief of which diu- 
 retics are generally administered. 
 
 4. Describe a tubercle. What is its origin and what tis- 
 sues are most frequently invaded by it? 
 
 277 
 
MEDICAL RECORD. 
 
 5. Give the pathology of the initial, the secondary, and 
 the tertiary stages of syphilis. 
 
 6. Why does metastasis in carcinoma occur through the 
 lymphatic system and sarcoma through the venous system? 
 
 7. What classification is made of bacteria based on the 
 shape of the individuals? 
 
 8. What classification of the cocci, based on the arrange- 
 ment of the individuals composing the groups, can you 
 mention ? 
 
 9. What bacterium is associated generally with specific 
 urethritis? How may it be determined? 
 
 10. State the pathology of hydrocele. 
 
 DIAGNOSIS AND THERAPEUTICS. 
 
 i. What is glaucoma? Discuss symptoms and treatment. 
 
 2. Define and differentiate hallucinations, delusions, and 
 illusions. 
 
 3. Describe paralysis agitans. Give etiology and prog- 
 nosis. 
 
 4. Describe characteristic findings in the urine in a case 
 of acute nephritis. 
 
 5. Give the symptoms indicating intestinal perforation in 
 typhoid fever. What treatment may avail? 
 
 6. Outline the treatment of a case of diphtheria by the 
 use of antitoxin. What is the principle upon which the 
 antitoxin treatment is based? 
 
 7. How should an abscess of the middle ear be treated? 
 What serious complications may arise from such an ab- 
 scess? 
 
 8. What are the indications and contraindications as to 
 the use of digitalis as a cardiac stimulant? 
 
 9. Differentiate diabetes mellitus and diabetes insipidus. 
 What treatment does the latter demand? 
 
 10. What is the significance of the patellar reflex as in- 
 dicative of disease? 
 
 PEDIATRICS AND TOXICOLOGY. 
 
 i. Symptoms and treatment of tuberculosis of the nose; 
 also of the eye and of the ear. 
 
 2. Describe tuberculosis of the lymphatic glands and out- 
 line treatment. 
 
 3. State the nature, symptoms, course, and treatment of 
 Pott's disease. 
 
 4. Describe scabies. How would you treat a well de- 
 veloped case? I 
 
 5. Describe and differentiate pemphigus and varicella. 
 
 6. Describe catarrh of the middle ear; etiology, symp- 
 toms, course, and treatment. 
 
 7. Arriving within five minutes after your patient has 
 swallowed a 2-ounce solution containing 5 to 8 grains of 
 
 278 
 
MEDICAL RECORD. 
 
 cocaine hydrochlorate, in what condition would you expect 
 to find him, and what would you do for him? 
 
 8. Arriving an hour after your patient had taken cocaine 
 as mentioned in question 7, in what condition would you 
 expect to find him, and what would you do for him? 
 
 9. State in detail what you would consider the most effi- 
 cient treatment, when promptly administered, for a patient 
 who has swallowed a dangerous dose of carbolic acid? 
 Should the treatment be delayed for half an hour to an 
 hour after ingestion of the dose, what would be your 
 treatment ? 
 
 10. In what manner does death ensue in poisoning by 
 hydrocyanic acid, by aconite, by morphine, by atropine, by 
 strychnine ? 
 
 SURGERY. 
 
 1. Give etiology, symptoms, and treatment of empyema. 
 State usual results when not treated. 
 
 2. Differentiate chancre and chancroid, and state treat- 
 ment for each. 
 
 3. State the symptoms of fracture of both bones of the 
 forearm in their middle third. How would you treat a 
 case? 
 
 4. State the causes of nonunion in bone fractures. What 
 should be the treatment in such cases? 
 
 5. Differentiate piles, fistula, and fissure. Treat the last. 
 
 6. Discuss ascites — causes, differential diagnosis, and 
 treatment. 
 
 7. Give the symptoms of renal calculus. State cause and 
 treatment during an attack, and also treatment in the 
 interval between attacks. 
 
 8. State the diagnostic points in prostatic hypertrophy. 
 Give palliative treatment. 
 
 9. Define psoas abscess. What is the nature of its fluid? 
 What can you say as to its treatment? 
 
 10. Oral examination. 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 1. Discuss the conditions which may render anesthesia 
 advisable during labor. What anesthetic would you use, 
 and how would you' administer it? 
 
 2. Define second stage of labor and state the conditions 
 which may cause delay of delivery in this stage, and how 
 such conditions should be managed. 
 
 3. Describe toxemia as noted in pregnancy, and state 
 measures of prevention and of alleviation. 
 
 4. Define endometritis and state cause, symptoms, and 
 treatment. 
 
 5. Should the head of the child fail to enter the pelvic 
 brim, how would you conduct your case of labor? 
 
 279 
 
MEDICAL RECORD. 
 
 6. Mention not less than four conditions liable to cause 
 prolapse of the cord, and outline the treatment for any 
 one condition mentioned. 
 
 7. Differentiate the uterus of a virgin and that of a 
 multipara, as observed in post-mortem examination. 
 
 8. Discuss possible injuries to the birth-canal incident to 
 labor. How and when are they best discovered, and state 
 how they should be treated. 
 
 9. How can you differentiate uterine and vaginal leucor- 
 rhea? 
 
 10. Discuss gonorrhea in women — symptoms and far- 
 reaching results. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Massachusetts Board of Registration in Medicine. 
 
 anatomy and histology. 
 
 i. For arrangement of dura, see Cunningham's "Anat- 
 omy" (1909), page 597; or Gray's "Anatomy" (1908), page 
 972. The function of the dura is protection : It forms the 
 internal periosteum of the skull, it forms three parti- 
 tions for the support of the parts of the brain, it forms 
 sinuses or venous channels for the return of the blood 
 from the brain, and it forms sheaths for the nerves as 
 they leave the skull. 
 
 2. See Cunningham's "Anatomy" (1909), page 1051 ; or 
 Gray's "Anatomy" (1908), page 1277. 
 
 3. See Cunningham's "Anatomy" (1909), page 1120; or 
 Gray's "Anatomy" (1908), page 768. 
 
 4. Poupart's ligament is formed by the lower border of 
 the aponeurosis of the external oblique muscle; it extends 
 from the anterior superior spine of the ilium to the spine 
 of the pubes. The anatomical structures which lie beneath 
 Poupart's ligament are (from without inward) : External 
 cutaneous nerve, Iliacus, anterior crural nerve, Psoas, 
 femoral artery, femoral vein, femoral ring. 
 
 5. See Gray's "Anatomy" (1908), page 364. Three 
 places in which unstriped muscle is found : Arteries, stom- 
 ach, intestines. 
 
 6. Vertebral artery is from subclavian artery ; internal 
 mammary artery is from subclavian artery; basilar artery 
 is from two vertebral arteries. 
 
 7. The largest cranial nerve is the fifth, or trigeminal. 
 It has two roots. Its superficial origin is from the side 
 of the pons Varolii, nearer to the upper than the lower 
 border. It is called a compound nerve because it contains 
 both motor and sensory fibers. 
 
 8. See Cunningham's "Anatomy" (1909), page 676; or 
 
 280 
 
MEDICAL RECORD. 
 
 Gray's "Anatomy" (1908), page 1038. It is distributed 
 exclusively to the retina. 
 
 9. See Cunningham's "Anatomy" (1909), page 481; or 
 Gray's "Anatomy" (1908), page 874. 
 
 PHYSIOLOGY AND HYGIENE. 
 
 i. The functions of the fifth cranial nerve. First 
 ophthalmic branch supplies sensation to conjunctiva and 
 skin of upper eyelid, cornea, skin of forehead and nose, 
 lacrymal glands, mucous membrane of nose. Second, or 
 superior maxillary branch, supplies sensation to skin and 
 conjunctiva of lower lid, nose, cheek, upper lip, upper teeth 
 and alveolar processes, and palate. Third, or inferior 
 maxillary branch, supplies sensation to external auditory 
 meatus, side of head, mucous membrane of mouth, an- 
 terior two-thirds of tongue, lower teeth, lower lip, and 
 skin of the lower part of the face. This branch, in addi- 
 tion, supplies motion to the muscles of mastication (Mas- 
 seter, Temporal, External, Pterygoid, Internal Pterygoid), 
 also mylohyoid, and anterior belly of digastric. 
 
 2. Reflex actions are involuntary or unconscious move- 
 ments, due to suitable stimuli. They depend upon the 
 integrity of the reflex arc, which is a complex made up 
 of: (1) A surface capable of receiving an impression; (2) 
 an afferent nerve; (3) a nerve cell capable of receiving 
 and also of sending out impulses; (4) an efferent nerve, 
 and (5) a surface capable of responding in some way to 
 the impulse conveyed by the efferent nerve. Reflexes are 
 classified as: (1) Superficial, (2) deep, and (3) visceral. 
 Example: The patellar reflex consists of a contraction of 
 the extensor muscles of the leg and a movement of the 
 foot forward when the ligamentum patellae is struck; the 
 quadriceps extensor must first be slightly stretched by put- 
 ting one knee over the other. Its integrity depends upon 
 a healthy condition of the entire reflex arc, consisting of 
 tendons, afferent or sensory nerve, pulsterior roots, and 
 anterior horn of the spinal cord; the efferent or motor 
 nerve, and the muscle itself. Strictly speaking, walking is 
 primarily a voluntary act; but practically it may be con- 
 sidered as a reflex. 
 
 3. The Haversian canals serve to conduct arteries, veins, 
 lymphatics, and nerves to and from the bone substance. 
 The marrow supports the blood-vessels, is concerned in the 
 formation of bone, also nourishes spongy bone, and forms 
 red blood corpuscles. The periosteum acts as a protection 
 to the bone; also generates bone, aids in the repair of 
 bone, and takes part in the nourishment of bone. 
 
 4. The valves of the heart are: In the right auricle, the 
 Eustachian and coronary valves ; the former is situated 
 between the anterior margin of the inferior vena cava 
 
 281 
 
MEDICAL RECORD 
 
 and the auriculoventricular orifice. In the fetus it directs 
 the blood from the inferior vena cava through the fora- 
 man ovale into the left auricle; the coronary valve pre- 
 vents the regurgitation of the blood into the coronary 
 sinus during the auricular contraction. In the right ven- 
 tricle are the tricuspid and semi-lunar valves; the former 
 prevents the blood in the right ventricle from flowing 
 back into the right auricle during ventricular cystole; the 
 latter guards the orifice of the pulmonary artery. In the 
 left ventricle are the mitral and semi-lunar valves ; the 
 former acts similarly to the tricuspid; the latter guards 
 the orifice of the aorta. Aortic valves, behind the third 
 intercostal space, close to the left side of the sternum. 
 Pulmonary valves, in front of the aortic, behind the junc- 
 tion of the third rib, on the left side, with the sternum. 
 Tricuspid valves, behind the middle of the sternum, about 
 the level of the fourth costal cartilage. Mitral valves, 
 behind the third intercostal space, about one inch to the 
 left of the sternum. The velocity of the blood current is 
 about one foot per second in the arteries; about one inch 
 per minute in the capillaries; and about eight inches a sec- 
 ond in the veins. The complete circulation around the 
 body is said to occupy a little less than half a minute. 
 
 5. The products of digestion find their way into the 
 blood by two routes: (1) By the blood-vessels of the 
 gastrointestinal tract, which unites to form the portal 
 vein, and (2) by the lymph vessels of the small intestines, 
 which converge to empty into the thoracic duct. The 
 water, inorganic salts, proteids, and sugar go by way of 
 the portal vein to the ascending vena cava; and the fats 
 go by way of the thoracic duct to the junction of the left 
 subclavian and internal jugular veins. 
 
 6. When a muscle is in a state of activity: (1) It be- 
 comes shorter and thicker, but (2) there is no change in 
 volume; (3) there is an increased consumption of oxygen; 
 (4) more carbon dioxide is set free; (5) sarcolactic acid 
 is produced; and hence (6) the muscle becomes acid in 
 reaction; (7) it becomes more extensible, and (8) less 
 elastic; (9) there is an increase in heat production and 
 consequently a rise of temperature; (10) the electrical re- 
 action becomes relatively negative; and (11) a sound is 
 produced. 
 
 7. The objection to stoves is that the air gets dry and 
 unpleasant, the air is thus often hotter than the walls and 
 floor, and so chills are produced; the presence of carbon 
 dioxide is often noted. Steam or hot-water pipes are 
 about as good a method of heating a house as any known. 
 
 8. Conditions that tend to prolong the life of a bacillus 
 outside of the body: Moisture, rest, moderate warmth, 
 dim light, alkaline medium, and suitable nourishment. 
 
 282 
 
MEDICAL RECORD. 
 
 9. Diseases whose germs are carried by water: Typhoid, 
 cholera, dysentery, sometimes diphtheria; germs are car- 
 ried by air: Tuberculosis, scarlet fever, measles, small- 
 pox, pneumonia, influenza, diphtheria, and erysipelas. 
 
 PATHOLOGY AND BACTERIOLOGY. 
 
 i. In death by drowning: The surface is pallid, the 
 face appears tranquil, the eyes and mouth being partly 
 open. The skin often has the appearance known as goose- 
 skin, and, if the body has lain upwards of twelve hours in 
 the water, that of the hands and the feet is sodden by 
 imbibition. The most important external sign is the pres- 
 ence on the mouth and nostrils of a fine froth (possibly 
 blood stained), composed of air, mucus, and the medium 
 in which drowning took place; if the body remains three 
 or four days in water, the froth disappears. Exceptionally, 
 fragments of weeds or other small objects may be found 
 tightly grasped in the hands. On opening the thorax the 
 lungs, gray in color, with reddish staining, are seen to be 
 very voluminous, a condition known as ballooning, partly 
 due to infiltration of the lung tissue with some of the 
 medium in which drowning took place, and partly to true 
 edema. The lung substance is inelastic and pits on pres- 
 sure. On section, fluid and froth resembling that found 
 on the lips exude from the divided air passages. Minute 
 subpleural hemorrhages are not infrequently present, and 
 the pleural cavities may contain fluid. The stomach often 
 contains water or other liquid which was involuntarily 
 swallowed during attempts at respiration. Occasionally 
 some of this fluid is forced by vital action into the in- 
 testines. With one exception, the remaining appearances 
 are those met with after death from asphyxia. The ex- 
 ception is constituted by the blood, which is not only dark 
 colored and fluid, as is usual after death from asphyxia, 
 but is also diluted by the imbibition of water from the 
 stomach and lungs. 
 
 In death by strangulation: The blood is of a dark color, 
 owing to complete reduction of the hemoglobin^ The 
 proportion of carbonic acid is increased, and owing to 
 its excess the blood coagulates slowly or imperfectly; 
 hence it remains fluid or forms few and soft coagula. 
 The large veins, the pulmonary artery, and the cavities of 
 the right side of the heart may be distended with dark 
 fluid blood, but this is by no means necessarily the case. 
 The left side is usually empty or nearly so. The lungs 
 may be congested, but are often pallid and anemic, though 
 the dependent parts usually exhibit appearances of hypo- 
 static engorgement. The abdominal viscera, especially the 
 kidneys, are often congested. The appearance of the brain 
 varies; it may be anemic or more or less congested. Spe- 
 
 283 
 
MEDICAL RECORD 
 
 cial signs characterize special modes of causation of as- 
 phyxia. Very commonly punctate ecchymoses are visible on 
 the conjunctiva, face, neck, and chest. They are consid- 
 ered by Tardieu to be more frequent in strangulation than 
 in asphyxia from other causes, or than in cases of over- 
 straining, which likewise may lead to them. In the sub- 
 cutaneous cellular tissue, and in the fascia of the muscles 
 above and below the hyoid bone extravasations are fre- 
 quently found, as well as on the external surface of the 
 thyroid cartilage and trachea. The lungs vary as regards 
 their vascularity; but on the surface it is common to find 
 pseudomembranous patches, which are due to the rupture 
 of some of the superficial air cells and collection of air 
 bubbles under the pleura. In the substance of the lungs 
 congested patches, or apoplectic extravasations, are often 
 found, varying in size, but larger than those usually found 
 in suffocation. — (From Quain's Dictionary of Medicine.) 
 
 2. Five abnormal constituents : Albumin, sugar, blood, 
 bile pigment, and excess of indican. 
 
 Test for albumin: The urine must be perfectly clear. 
 If not so, it is to be filtered, and, if this does not render 
 it transparent, it is to be treated with a few drops of 
 magnesia mixture and again filtered. The reaction is then 
 observed. If it be acid, the urine is simply heated to 
 near the boiling point. If the urine be neutral or alkaline 
 it is rendered faintly acid by the addition of dilute acetic 
 acid, and heated. If albumin be present, a coagulum is 
 formed, varying in quantity from a faint cloudiness to 
 entire solidification, according to the quantity of albumin 
 present. The coagulum is not redissolved upon the addi- 
 tion of HN0 3 . 
 
 Test for sugar: Render the urine strongly alkaline by 
 addition of Na 2 C0 3 . Divide about 6 c.c. of the alkaline 
 liquid in two test tubes. To one test tube add a very 
 minute quantity of powdered subnitrate of bismuth, to the 
 other as much powdered litharge. Boil the contents of 
 both tubes. The presence of glucose is indicated by a 
 dark or black color of the bismuth powder, the litharge 
 retaining its natural color. 
 
 Test for blood: To the urine add a solution of potassium 
 hydroxide to distinct alkaline reaction ; heat nearly to boil- 
 ing (do not boil). A red precipitate is produced. 
 
 Test for bile pigment: Put 3 c.c. HN0 3 in atest tube, 
 add a piece of wood, and heat until the acid is yellow; 
 cool. When cold, float some of the urine to be tested 
 upon the surface of the acid. A green band is formed at 
 the junction of the liquid, which gradually rises, and is 
 succeeded from below by blue, reddish-violet, and yellow. 
 
 Test for indican: The urine is mixed with one-fifth its 
 volume of 20 per cent, solution of lead acetate and filtered. 
 
 284 
 
MEDICAL RECORD. 
 
 The filtrate is mixed with an equal volume of fuming 
 hydrochloric acid containing 3 : 1000 of ferric chloride, a 
 few drops of chloroform are added, and the mixture 
 strongly shaken one to two minutes. With normal urine the 
 chloroform remains colorless, or almost so; but if an 
 excess of indoxyl compounds be present the chloroform 
 is colored blue, and the depth of the color is a rough in- 
 dication of the degree of the excess. 
 
 3. Indications for the use of diuretics: (1) To remove 
 excessive fluid from the tissues, as in dropsy; (2) to dilute 
 the urine; (3) to promote the elimination of waste prod- 
 ucts, or poisonous material from the blood; and (4) to 
 maintain the action of the kidneys. 
 
 4. A tubercle is a small nodule, found in the lungs, etc., 
 in cases of tuberculosis, but also found in other diseased 
 conditions. It consists of three layers, the outer one con- 
 sisting of lymphoid cells, the middle one of epitheloid 
 cells, and the inner one of giant cells. These layers arc 
 squeezed or compressed into a firm mass, which maj 
 caseate or undergo other pathological processes. There is 
 no blood supplied to a tubercle. Its origin is due to the 
 stimulating or irritating effects of the tubercle bacillus 
 upon the fixed connective tissue elements, causing a round- 
 cell proliferation. The tissues most frequently invaded 
 by it are: Lungs, lymphatic glands, bones, joints, intes- 
 tinal tract, peritoneum, skin, testicle, epididymis, brain, 
 liver, kidneys, spleen, Fallopian tubes, ovaries, uterus. 
 
 5. See French's "Practice" (1907), page 420; or Osier's 
 "Practice (1909), page 267; or Rose and Carless' "Sur- 
 gery" (1908), pages 144, 148, and 151; or Da Costa's "Sur- 
 gery" (1908), pages 276, 279, and 284. 
 
 6. In carcinoma lymphatics are found in the stroma, 
 which abounds; in sarcoma there are no lymphatics, but 
 the blood vessels are in direct contact with the tumor cells. 
 
 7. Bacteria are classified as follows: (1) the coccus, 
 which is spherical ; (2) the bacillus, which is rod-shaped ; 
 and (3) the spirillum, which is spiral. 
 
 8. Cocci are classified as follows : Diplococci, occurring 
 in pairs ; sarcinae, occurring in bales ; streptococci, occur- 
 ring in chains ; and staphylococci, occuring in bundles. 
 
 9. The bacterium generally associated with specific 
 urethritis is the gonococcus of Neisser. The gonococcus 
 is a diplococcus, and is recognized by staining with the 
 ordinary aniline dyes, being found inside the pus cells ; it 
 is Gram negative, and can be cultivated on human blood 
 serum, but will not grow on the ordinary culture media. 
 
 10. See Rose and Carless' "Surgery" (1908), page 1265. 
 
 DIAGNOSIS AND THERAPEUTICS. 
 
 i. Glaucoma is a diseased condition of the eye, pro- 
 
 28s 
 
MEDICAL RECORD. 
 
 duced by increased intraocular pressure, and resulting in 
 excavation and atrophy of the optic disc, and blindness. 
 It is due to increase of the contents of the eye, hyper- 
 secretion, retention, old age, gout, rheumatism, nephritis. 
 Symptoms: Visual disturbances, increased ocular tension, 
 hazy and anesthetic cornea, sluggish and dilated pupil, 
 shallow anterior chamber, ciliary neuralgia, cupping of 
 optic disc, blindness. Treatment: Myotics, such as eserine 
 or pilocarpine; massage of the eyeball; mydriatics are 
 contraindicated ; operative treatment may include para- 
 centesis, iridectomy, or sclerotomy. 
 
 2. A delusion is a belief in something which has no real 
 existence, but is purely imaginary, and out of which the 
 person cannot be reasoned. An illusion is a false or per- 
 verted impression, received through one of the senses. 
 An hallucination is the same as an illusion, but without 
 any material basis. 
 
 If an individual believes himself to be made of glass, 
 and is afraid of being touched lest he be broken, he is 
 suffering from a delusion. If the whistling of the wind is 
 mistaken for a voice telling a person to do a certain thing, 
 that would be an illusion. If a person fancied he heard a 
 voice when there was nothing at all to be heard, that 
 would be an hallucination. 
 
 3. See French's "Practice" (1907), page 11 14; or, Osier's 
 "Practice" (1909), page 1042. 
 
 4. See French's "Practice" (1907), page 893; or, Osier's 
 "Practice" (1909), page 688. 
 
 5. Intestinal perforation in typhoid fever: Sometimes 
 there is severe, sudden pain localized in the abdomen, and 
 sometimes there is little or no pain. Marked tympanites, 
 great weakness, collapse, anxious look, small, rapid' pulse, 
 and difficult breathing are present. The legs are apt to be 
 drawn up, and nausea and vomiting may ensue. Hepatic 
 and splenic dullness appear, and leucocytosis may be 
 present. The treatment is surgical ; laparotomy, with suture 
 of the intestine, should be done as soon as possible. In 
 the meantime opium (or preferably morphine) should be 
 administered. 
 
 6. See French's "Practice" (1907), page 196; or, Osier's 
 "Practice" (1909), page 209. 
 
 7. Treatment of abscess of the middle ear: Leeches, 
 free incision followed by boric acid irrigation or by in- 
 sufflation of dry boric acid powder. Complications that 
 may arise: Eczema, boils, arthritis of temporo-maxillary 
 joint, ankylosis or necrosis of the ossicles, facial paralysis, 
 mastoiditis, subcranial abscess, meningitis, thrombosis of 
 the lateral sinus, cerebral abscess. 
 
 8. Digitalis is indicated in diseases of the heart: (1) 
 when the heart action is rapid and feeble, with low arte- 
 
 286 
 
MEDICAL RECORD. 
 
 rial tension; (2) in mitral lesions when compensation has 
 begun to fail; (3) in non-valvular cardiac affections; (4) 
 in irritable heart, due to nerve exhaustion. Digitalis is 
 contraindicated in diseases of the heart: (1) in aortic 
 lesions when uncombined with mitral lesions; (2) when 
 the heart action is strong and arterial tension is high. 
 
 9. See French's "Practice" (1907), pages 935, 947, and 
 949; or, Osier's "Practice" (1909), pages 408, 424, and 425. 
 
 10. The patella reflex is nearly palways present in health, 
 and denotes a healthy condition of the entire reflex arc 
 (tendon, afferent or sensory nerve, posterior roots and 
 anterior horn of the spinal cord, the efferent or motor 
 nerve, and the muscle itself). It is absent when there is a 
 lesion which affects any part of this reflex are, such as is 
 the case in locomotor ataxia, poliomyelitis, Landry's par- 
 alysis, neuritis, in apoplexy just after the shock, and in 
 epilepsy following the convulsion, etc. It is exaggerated 
 in : Hemiplegia, lateral sclerosis, general paresis, trans- 
 verse myelitis, injuries to the spinal cord, hysteria, neu- 
 rasthenia, tetanus, and strychnine poisoning. 
 
 PEDIATRICS AND TOXICOLOGY. 
 
 i. Tuberculosis of the nose: "Tuberculosis of the nose 
 is characterized by the formation of neoplasms or ulcera- 
 tion of the mucous membrane, and often accompanies a 
 general pulmonic tuberculosis. Symptoms : In the ulcer- 
 ated form there is an accumulation of crusts which are 
 blown from the nose. There may be more or less stoppage 
 of the nose, perforation of the septum, and nasal catarrh. 
 In the neoplastic form, there is nasal obstruction and 
 symptoms of hypertrophic catarrh. Treatment: In the 
 necrotic form of the disease the nose should be sprayed 
 twice daily with a mild alkaline spray, followed by an oil 
 spray containing acetozone. Small papilla-like growths 
 may be destroyed with the galvano-cautery or removed 
 with snare and scissors. It is advisable to refrain as far 
 as possible from surgical procedure in the nasal cavity in 
 a general tuberculosis. The general treatment is directed 
 to combating the tubercular infection by tonics, sunshine, 
 and outdoor life." 
 
 Tuberculosis of the ear. "Symptoms: The ear symp- 
 toms frequently appear after the lung complications are 
 established. There may be tinnitus, followed by deafness 
 and painless rupture of the drum, and a thin mucous or 
 mucopurulent discharge. On the other hand, the symptoms 
 may vary in no wise from simple acute otitis media. 
 Treatment: The surgical treatment is the same as for 
 acute or chronic otitis media. Outdoor exercise and nutri- 
 tive diet are especially essential." — (J. J. Kyle's Manual of 
 Diseases of the Ear, Nose, and Throat.) 
 
 287 
 
MEDICAL RECORD. 
 
 Tuberculosis of the eye. " Tuberculosis of the con- 
 junctiva: A rare condition, most frequently associated 
 with lupus of the skin of the face. It is characterized by 
 large, soft granulations in the fornices, studded with 
 miliary tubercles. Usually there is some infiltration of 
 the sclerocorneal margin and of the cornea, so that vision 
 is reduced. Treatment is best effected by thorough re- 
 moval of the granulations by scraping and subsequent in- 
 sufflation with iodoform/' Tubercular iritis: Symptoms: 
 "This is most frequently seen in children and young adults. 
 It is of a quiet, painless, and chronic type. Miliary tuber- 
 cles are to be seen in the iris — small grayish nodules, with 
 a few pink vessels about them. They usually appear at the 
 root of the iris, close into the angle of the anterior cham- 
 ber, but may affect the border of the iris. Spots of lymph 
 of large size, like spots of mutton fat, may be seen on the 
 back of the cornea, indicating cyclitis. In other cases 
 these symptoms may be complicated by a sclerokeratitis. 
 These are of a more severe order, and shrinkage of the 
 eyeball may result. The diagnosis of tubercle is not easy. 
 We may exclude syphilis by history, by the balance of the 
 symptoms, and by the response to treatment. The reac- 
 tion to injection of Koch's tuberculin or the newer oph- 
 thalmoreaction of Calmette may be utilized, or the aqueous 
 may be tapped and inoculated into rabbits." — (Aids to 
 Ophthalmology.) 
 
 2. Tuberculosis of the lymphatic glands occurs most 
 commonly in people under twenty years of age; heredi- 
 tary disposition and lowered vitality are predisposing fac- 
 tors. The tubercle bacilli reach the glands either by the 
 blood or lymph or through mucous membrane. The glands 
 are enlarged and firm ; later they run together and caseate 
 and frequently suppurate. Later still periadenitis fixes the 
 mass to the deeper structures and to the skin. Still later 
 the abscess bursts on the surface, leaving one or several 
 openings and discharging pus for a long time. Treatment: 
 Improve the general health by fresh air, sunshine, arsenic, 
 cod liver oil, iron, and good nourishing food. The gland 
 or whole glandular chain may be dissected out in cases 
 where periadenitis is present. Where there is an unopened 
 abscess, either excise and drain or dissect out. 
 
 3. See Rose and Carless' "Surgery" (1908), page 718; 
 or, Da Costa's "Surgery" (1908), page 747. 
 
 4. Scabies is a contagious, animal, parasitic disease, due 
 to the Sarcoptes scabiei, characterized by burrows and a 
 multiform eruption, and attended by severe itching. The 
 eruption usually occupies certain areas where the skin is 
 thin; these are the interdigital spaces, the flexor surface 
 of the wrist and arm, the anterior and posterior axillary 
 folds, the mammae and nipples (in women), the umbilicus, 
 
 288 
 
MEDICAL RECORD. 
 
 the buttocks, the penis, the inner side of the thighs and 
 legs, and the toes. The face is exempt except occasionally 
 in infants. The itching is intense and worse at night. The 
 affection is curable, but dermatitis may result from over- 
 treatment. Treatment consists in a thorough scrubbing 
 with soap and warm water, followed by friction to dry 
 the skin, and the application of sulphur ointment, the latter 
 to be repeated morning and night for three days. The 
 whole process may need to be repeated one or more times. 
 
 5. Pemphigus is an acute or chronic inflammatory dis- 
 ease of the skin, characterized by the formation of suc- 
 cessive crops of variously sized, rounded or oval bullae 
 affecting seriously the general health and sometimes termi- 
 nating fatally. The blebs of pemphigus are tense, abruptly 
 elevated, noninflammatory, and come out in crops. For 
 Varicella, see French's "Practice" (1907), page 313; or, 
 Osier's "Practice" (1909), page 128. 
 
 6. ''Acute catarrhal otitis media is frequently caused by 
 acute coryza and the infectious fevers. There is a painless 
 obstructed sensation in one or both ears, impairment of 
 hearing, and tinnitus. The inflammation causes closure of 
 the Eustachian tube. Inflation and aspiration of the middle 
 ear and syringing and douching the nares and nasopharynx 
 must be avoided. A moderate spray of Dobell's solution 
 may be used. If pain is present, dry heat, in the form of 
 hot-water bottle, hot stone wrapped in flannel, etc., may 
 be applied. A few drops (100), warmed, of a carbolic 
 acid solution (1:40), or one of formalin (1:2000), may be 
 instilled into the ear. 
 
 "Acute purulent otitis media: Acute catarrhal otitis 
 media, instead of undergoing resolution, may pass into 
 acute purulent otitis media (especially in exanthemas) 
 from the passage of pathogenic germs from the naso- 
 pharynx into the middle ear. The pain will become more 
 intense, the hearing dull ; tinnitus will become louder and 
 more distressing, and fever usually sets in. Dry heat 
 allays the pain. Warmed water or warmed carbolic acid 
 solution (1:40) may be used. Inflations, aspirations, etc., 
 should be avoided. If the nares are filled with tough secre- 
 tions, a spray of Dobell's solution may be used. If the 
 pain continues over six hours in a child or over twelve 
 hours in an adult without spontaneous perforation of the 
 tympanic membrane, paracentesis of that structure should 
 be performed. The concha and meatus should be smeared 
 with petrolatum to avoid chapping, and the secretions 
 should be gently mopped off as they appear. Under this 
 treatment the ear usually returns to normal in two to 
 three weeks." (Gould and Pyle's Pocket Cyclopedia of 
 Medicine and Surgery.) 
 
 7. The patient will probably be found with pulse in- 
 
 289 
 
MEDICAL RECORD. 
 
 creased in frequency and fulness; the respirations more 
 rapid, much general nervous excitement, and general hyper- 
 esthesia. Empty the stomach, give stimulants; adrenalin 
 is said to be antagonistic; nitroglycerine, amyl nitrite, am- 
 monium carbonate and strychnine, and caffeine have all 
 been recommended. Artificial respiration may be neces- 
 sary; mustard plaster over the heart and stomach may 
 give relief. 
 
 8. The patient is now probably in the stage of depres- 
 sion, with shallow breathing, rapid heart action, and pale 
 or cyanotic face. Chloroform or ether may be given sub- 
 cutaneously, and the measures mentioned in question 7 
 may be adopted. 
 
 9. Alcohol (four to eight ounces of whiskey) followed 
 by water is probably the best treatment when seen imme- 
 diately. Later on some soluble sulphate, such as sodium 
 sulphate or magnesium sulphate, is the proper treatment. 
 
 10. In poisoning by hydrocyanic acid, death is probably 
 due to asphyxia ; by aconite, to asphyxia ; by morphine, 
 usually to paralysis of respiration, occasionally to paraly- 
 sis of the heart; by atropine, to paralysis of respiration; 
 by strychnine, to fixation of respiratory muscles. 
 
 SURGERY. 
 
 1. See Rose and Carless' "Surgery" (1908), page 926; 
 or, Da Costa's "Surgery" (1908), page 773. 
 2. 
 
 CHANCRE 
 
 First lesion of a constitu- 
 tional disease, viz., syphi- 
 lis. 
 
 Due to syphilitic infection. 
 
 Generally a venereal infec- 
 tion. 
 
 May occur anywhere on the 
 body. 
 
 Period of incubation never 
 so short as ten days. 
 
 Generally single. 
 Not autoinoculable. 
 Secretion slight. 
 
 Slightly or not at all pain- 
 ful. 
 
 As a rule only occurs once 
 in any patient. 
 
 Buboes are painless and 
 seldom suppurate. 
 
 CHANCROID 
 
 A local disease. 
 
 Due to contact with secre- 
 tion from chancroid. 
 
 Always a venereal infec- 
 tion. 
 
 Nearly always on genitals. 
 
 Period of incubation al- 
 ways less than ten days 
 (generally about three). 
 
 Generally multiple. 
 
 Autoinoculable. 
 
 Secretion profuse and pur- 
 ulent. 
 
 Generally painful. 
 
 May reoccur in same pa- 
 tient. 
 
 Buboes are painful and 
 usually suppurate. 
 
 290 
 
MEDICAL RECORD. 
 
 For treatment, see Rose and Carless' "Surgery" (1908), 
 pages 157 and 141; or, Da Costa's "Surgery" (1908), pages 
 288 and 1 180. 
 
 3. Rose and Carless' "Surgery" (1908), page 526; or, 
 Da Costa's "Surgery" (1908), page 505. 
 
 4. Nonunion of fracture is caused by: 111 health, want 
 of approximation of the end of the bone, want of blood 
 supply in the bone, defective innervation of the bone, dis- 
 ease of the bone, lack of rest, and immobility. Treatment : 
 "When delayed union exists, seek for a cause and remove 
 it, treating constitutionally if required and thoroughly 
 immobilize the parts by plaster. Orthopedic splints may 
 be of value. Use of the limb while splinted, percussing 
 over the fracture, and rubbing the fragments together, 
 thus in each case producing irritation, have all been rec- 
 ommended. Blistering the skin with iodine or firing it has 
 been employed. If the case be very long delayed, forcibly 
 separate the fragments and put in plaster as a fresh break. 
 If these means fail, irritate by subcutaneous drilling or 
 scraping, or, better, by laying open the parts and then 
 drilling and scraping at many places." 
 
 5. Rose and Carless' "Surgery" (1908), pages 1134, 
 1 137, and 1 148; or, Da Costa's "Surgery" (1908), pages 
 1009 and 1012. 
 
 6. Ascites is caused by: Mechanical obstruction of the 
 portal circulation; cardiac or pulmonary diseases ob- 
 structing the general venous circulation; diseases of the 
 peritoneum; diseases of the kidneys; anemia, debility, ex- 
 posure to cold or wet; cancer, syphilis. Symptoms: Gen- 
 erally of gradual onset; abdominal distention, sense of 
 weight and fulness ; dyspnea ; gastrointestinal disturbances ; 
 lineae albicantes, presence of fluid may be detected by pal- 
 pation, percussion or aspiration. If due to heart or lung 
 disease ascites will occur elsewhere, and the legs are gen- 
 erally affected first; in hepatic disorders the abdominal 
 distention is marked, and appears early; in renal disease 
 the abdominal fluid is generally small in amount. Treat- 
 ment: Tapping, drainage, incision, and administration of 
 cathartics have all been recommended. Ovarian tumor, 
 pregnancy, distended bladder, pancreatic cyst, and echi- 
 ni ococcus cyst may be mistaken for it. Ascites is charac- 
 terized by: Enlargement of the abdomen, most marked in 
 the flanks when the patient is lying on his back, and in the 
 hypogastrium, when he is standing up ; there are dilated 
 superficial veins on the abdomen, and the skin is tense ; 
 the umbilicus is prominent; there are fluctuation and 
 vibration on palpation; dulness is found on percussion 
 over the fluid, while the center of the abdomen is reso- 
 nant. 
 
 291 
 
MEDICAL RECORD 
 
 7. Rose and Carless' "Surgery" (1908), page 1173; or, 
 Da Costa's "Surgery" (1908), page 11 10. 
 
 8. Prostatic hypertrophy is characterized by: Slowness 
 in starting urination; difficult micturition; frequency of 
 micturition, particularly at night; the presence of residual 
 urine; dull, aching pain in the perineum and above the 
 pubes; enlargement of the lateral lobes of the prostate; 
 there may be cystitis and retention of urine. The cause: 
 It is a senile change, and may be due to increase of the 
 glandular substance or of the interstitial fibrous or mus- 
 cular tissue. Palliative treatment consists in : Mild and 
 unirritating diet, avoidance of alcohol, taking plenty of 
 milk or water, .or other diluent. Alkalies and sedatives 
 should be taken, also urotropin or other antiseptic so as 
 to prevent cystitis. Regular catheterization, at least once a 
 day, preferably in the evening, and with due aseptic pre- 
 cautions. 
 
 9. Rose and Carless' "Surgery" (1908), pages 723 and 
 730; or, Da Costa's "Surgery" (1908), pages 151 and 156. 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 i. See Williams' "Obstetrics" (1909), page 321 ; or, 
 Hirst's "Obstetrics" (1909), page 329. 
 
 2. The second stage of labor begins when the os is fully 
 dilated, and terminates with the expulsion of the child. 
 Conditions which may cause delay are rigidity, edema, 
 atresia, or displacement of the os or cervix; fibrous bands 
 or atresia of vagina ; persistent hymen ; unyielding peri- 
 neum ; tumors ; distended bladder or rectum ; hernia ; 
 edema of labia; pelvic deformities; malpositions or mal- 
 presentations of the fetus ; prolapse of limbs ; short cord ; 
 large fetus; dead fetus; twins or monstrosities; uterine 
 inertia; rupture of uterus. 
 
 3. Williams' "Obstetrics" (1909), page 507; or, Hirst's 
 "Obstetrics" (1909), page 263. 
 
 Preventive treatment: (1) The amount of nitrogenous 
 food should be diminished to a minimum; (2) the pro- 
 duction and absorption of poisonous materials in the intes- 
 tines and body tissues should be limited and their elimi- 
 nation should be aided by improving the action of the 
 bowels, the kidneys, the liver, the skin, and the lungs ; v 3) 
 the source of the fetal metabolic products and the periph- 
 eral irritation in the uterus should, if necessar*, be 
 removed by evacuating that organ. Curative treatment 
 includes: (1) Controlling the convulsions (by chloroform, 
 veratrum, or chloral) ; (2) elimination of the poison or 
 poisons which are presumed to cause the convulsions; (3) 
 emptying the uterus under deep anesthesia, by some method 
 that is rapid and that will cause as little injury to the 
 woman as possible. 
 
 292 
 
MEDICAL RECORD 
 
 4. Endometritis is inflammation of the mucous mem- 
 brane lining the uterus. The acute form is due to the 
 introduction of septic bacteria, and is manifested by pain, 
 constipation, irritability of bladder, rapid pulse, rise of 
 temperature, and a profuse discharge. Treatment follow 
 ing miscarriage or labor consists in curettage, intrauterine 
 hot sterile douche, free purgation, hot stupes over the 
 
 er abdomen, milk diet and stimulants. Chronic endo- 
 metritis may accompany numerous pathological uterine 
 conditions, but is generally due to gonorrhea. The symp- 
 toms are backache, headache, leucorrhea, profuse men- 
 struation, and impairment of the general health. Treat- 
 ment consists in removing the cause when possible, and 
 when due to gonorrhea curettage and irrigation of the 
 uterus, with the application of an antiseptic. 
 
 5. See Williams' '"Obstetrics" (1909), page 737. 
 
 6. See Williams' "Obstetrics" (1909), page 842; or, 
 Hirst's •'Obstetrics" (i909\ page 625. 
 
 7- 
 
 VIRGIN" UTERUS 
 
 The cavity is of normal 
 
 length and triangular. 
 The cervix is small, hard, 
 and cartilaginous, and of 
 the same length as the 
 body. 
 The external os is a trans- 
 verse slit or pinhole ori- 
 fice with smooth edges. 
 The sides of the cavity of 
 the body are convex in- 
 ward. 
 The uterus is normally 
 
 anteflexed. 
 There is more or less flat- 
 tening of the anterior and 
 posterior uterine surfaces. 
 The fundus is nearly flat. 
 The internal os is closed. 
 
 UTERUS OF MULTIPARA 
 
 The cavity is increased in 
 length, and oval. 
 
 The cervix is large and 
 soft; it is about one-half 
 the length of the body. 
 
 The external os is irregular 
 and its edges are fissured. 
 
 The sides of the cavity of 
 the body are convex out- 
 ward. 
 
 The uterus is straighter, or 
 even retrodisplaced. 
 
 The contour of the uterus 
 is more rounded, while its 
 diameters are increased. 
 
 The fundus is convex. 
 
 The internal os is patulous. 
 
 (From Dorland's Obstetrics.) 
 8. 'Tears of the perineum destroy the integrity- of the 
 pelvic floor and result eventually in rectocele, cystocele. 
 hemorrhoids, and displacements of the pelvic organs. If 
 the tear involves the sphincter ani, incontinence also 
 results. Lacerations of the cervix retard or check involu- 
 tion of the uterus and predispose to endometritis, menor- 
 rhagia, displacements, eversion of the cervical mucous 
 membrane, cystic degeneration, and malignant disease. 
 
 293 
 
MEDICAL RECORD. 
 
 Deep lacerations of the vaginal vault may open into the 
 base of the broad ligaments, and in the majority of in- 
 stances genitourinary fistulas are caused by traumatisms 
 of labor. All lacerations are immediately dangerous on 
 account of the increased liability to sepsis, while the 
 remote results are generally due to interference with in- 
 volution or the pelvic circulation and to the destruction 
 of the normal supports of the pelvis." — (Ashton.) 
 
 All tears should be repaired as soon as possible (unless 
 there are contraindications). A primary operation is best 
 because the edges are fresh and can be approximated; 
 little (if any more) anesthetic is wanted; the woman has 
 to lie in bed, and therefore only one absence from 
 household work' is requisite; infection is less likely. - In 
 any case, operation may prevent rectocele, cystocele, pro- 
 lapse of uterus, and general weakness, malaise, and dis- 
 ability. For technique, see any text-book on obstetrics or 
 gynecology. ^ • l *\ 
 
 g. Leucorrhea from the vagina is whitish in color, of a 
 creamy consistency. When from the body of the uterus it 
 is a thin, clear, watery, colorless fluid. From the cervix it 
 is a clear, transparent, tenacious, glairy fluid, like white of 
 egg. By means of a speculum the discharge can be seen 
 coming from the uterus in the two latter conditions. 
 
 10. Symptoms: Pain and burning in the vulva and on 
 micturition; dyspareunia; yellowish or greenish discharge 
 containing the gonococcus; the vagina is hot, red, swollen, 
 and tender. Possible results: Cystitis, urethritis, vulvitis, 
 endometritis, salpingitis, septic peritonitis, sterility, condyl- 
 omata of vulva, abscess of Bartholin's glands. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Michigan State Board of Registration in Medicine. 
 
 ANATOMY. 
 
 i. Give the origin, insertion, and action of the rectus 
 femoris. 
 
 2. Describe the scapula, and name the muscles attached 
 to it. 
 
 3. Describe the collateral circulation after ligature of the 
 common carotid artery. 
 
 4. Describe the inferior maxillary bone, and name the 
 muscles attached to it. 
 
 5. Describe the deep palmar arch, and give its formation. 
 
 6. On examination of the under part of the brain, what 
 structures and anatomical features will you observe? 
 
 7. Give the arterial and nerve supply of the pharynx, and 
 mention the openings into it. 
 
 294 
 
MEDICAL RECORD. 
 
 8. Describe the great superficial, petrosal nerve. 
 
 9. Describe the solar plexus and give its situation. 
 
 10. Describe the knee joint. 
 
 HISTOLOGY AND EMBRYOLOGY. 
 
 i. Describe the blood. 
 
 2. Does fetal blood and blood pressure differ from that 
 of the mother? If so, how? 
 
 3. Describe the structure of the lungs. 
 
 A. Give the histology of the thyroid gland. 
 5. Describe the kidney. 
 
 PHYSIOLOGY. 
 
 1. What are the manifestations of cell life? Metabo- 
 lism? Explain significance, and give classification. 
 
 2. Name the nerve centers which regulate intestinal 
 peristalsis. Describe their action. 
 
 3. Name end products resulting from digestion of the 
 three principal types of food, and explain how and by 
 what channels they enter the circulation. 
 
 4. What is the physiological significance of the patellar 
 reflex, and through what nerves is it accomplished? 
 
 5. Name the varieties of blood that circulate through the 
 liver. State the source and give the function of each. 
 
 6. What purpose is served in boiling starchy foodstuffs, 
 and when can a given amount be said to have been com- 
 pletely digested? 
 
 7. Why do we breathe? What sounds are heard on 
 listening to the chest? Where is the respiratory center 
 located? 
 
 8. Give three examples illustrating the value of a knowl- 
 edge of physiological chemistry. 
 
 9. Describe the special function possessed by each nerve 
 factor concerned in a vasomotor action, and state how 
 either affects arterial tension. 
 
 10. What changes take place in the composition of blood 
 as it passes through the kidneys? 
 
 CHEMISTRY AXD TOXICOLOGY. 
 
 1. Name the constituents of the atmosphere. Is air a 
 mechanical mixture or a chemical combination of its con- 
 stituents, and why? What part does carbonic acid play as 
 regards vegetation? State the laws of gaseous diffusion. 
 
 2. Give the equations showing the action of sulphuretted 
 hydrogen on solutions of copper sulphate and on alkaline 
 hydroxide; also equations covering the production of car- 
 bon dioxide. 
 
 3. What is the difference between atoms and molecules 
 of the elements? What volume does the molecule occupy 
 in the gaseous state? Give examples. 
 
 295 
 
MEDICAL RECORD. 
 
 4. Give the characteristics of good drinking water, with 
 method of determining same. 
 
 5. Name the more important of the petroleum products 
 and their uses. 
 
 6. Name three aromatic hydrocarbons, with formulae. 
 
 7. Describe the groups of the compound proteids. 
 
 8. Give a list of the xanthin and creatinin groups of 
 leucomaines. 
 
 9. Symptoms and treatment of poisoning by poison ivy. 
 What active principle is involved? 
 
 10. Symptoms and treatment of poisoning by strychnine. 
 
 MATERIA MEDIC A AND THERAPEUTICS. 
 
 i. Name the toxic and physiological action of atropine 
 and morphine. 
 
 2. What is the true and toxic action of calomel and 
 iodide of potassium? 
 
 3. What are the potassium salts used in medicine? 
 
 4. What are depresso motors? Excito motors? Oxytox- 
 ics? Mydriatics? Alteratives? Give examples of each 
 class. 
 
 5. Give examples of drugs which affect the heart action, 
 their doses, and principal actions. 
 
 PATHOLOGY. 
 
 1. Mention some of the determining causes of disease. 
 
 2. Explain the effect of overfeeding upon the body. 
 
 3. Mention and define the forms of hemorrhage. 
 
 4. What constitutes fatty infiltration? Give etiology and 
 favorite seats. 
 
 5. Describe the phenomena of inflammation in vascular 
 tissues. 
 
 6. Osteoma : Give general appearance, seats, and struc- 
 ture of. 
 
 7. Define glioma. Give its seats, minute structure, and 
 nature. 
 
 8. By what term do we designate the destruction of red- 
 blood cells? Give etiology. 
 
 9. Etiology and pathological anatomy of aneurysm. 
 
 10. What is the condition of the kidney in chronic in- 
 terstitial nephritis? How is the urine affected? 
 
 BACTERIOLOGY. 
 
 1. Describe the Bacillus typhosus, and briefly tell how 
 you would differentiate it from Bacillus coli communis. 
 
 2. Describe fully the organism recognized as the cause of 
 syphilis. 
 
 3. Define immunity, active and passive, natural and ac- 
 quired. 
 
 296 
 
MEDICAL RECORD. 
 
 4. Describe fully the different modes of multiplication in 
 bacteria, and spore formation. 
 
 5. What are bacterial enzymes? 
 
 PRACTICE OF MEDICINE. 
 
 1. Describe the characteristic symptoms and course of 
 scarlet fever. 
 
 2. Discuss the diagnosis, symptoms, and treatment of 
 whooping cough. 
 
 3. Discuss pericarditis and its treatment. 
 
 4. Describe a method of anesthesia you prefer for your 
 patients. 
 
 5. Describe the symptoms present in: (a) Carcinoma of 
 the stomach; (b) gastric ulcer; (c) duodenal ulcer. 
 
 6. Outline the management of a case of lobar pneu- 
 monia. 
 
 7. Give in detail your advice to a young patient in the 
 earliest stage of tuberculosis. 
 
 8. Mention some drugs which lower blood pressure, and 
 give a theory of their action. 
 
 9. Give the therapy of acute cystitis. 
 
 10. Mention some complications which may follow ty- 
 phoid fever. 
 
 OBSTETRICS. 
 
 1. What is "hour-glass contraction"? How would you 
 overcome it to remove adherent placenta? 
 
 2. Describe placenta prsevia, and how would you treat it 
 during labor? 
 
 3. How would you manage a face presentation? 
 
 4. Give the cause, treatment of puerperal eclampsia, in- 
 sanity, and septicemia. 
 
 5. How would you diagnose a shoulder presentation, and 
 its correction? 
 
 GYNECOLOGY. 
 
 1. Describe the uterus, its shape, dimensions, cavities, 
 parts, openings, structure, lining, membranes, secretions, 
 ligaments, nerves, etc. 
 
 2. Describe the vulvovaginal glands. 
 
 3. What are the causes of downward displacements of 
 the uterus? 
 
 4. W T hat is the organ most frequently affected in tuber- 
 culosis of the pelvis? 
 
 5. What are the symptoms of extrauterine gestation? 
 
 SURGERY. 
 
 i. Give the most approved methods of treatment of hem- 
 orrhoids. 
 
 2. Describe fully the best method of procedure in case 
 of recurring dislocation of the sternal end of the clavicle. 
 
 297 
 
MEDICAL RECORD. 
 
 3. What signs and symptoms are always present in 
 fractures? What are usually present? 
 
 4. Describe the best management of penetrating wounds 
 of the skull caused t)y gunshot. 
 
 5. Give full description of operation of thyroidectomy. 
 
 6. Give the conditions under which resection of the 
 bowel should be undertaken. 
 
 7. What is general anesthesia? How is it produced? 
 What are the dangers to be avoided, and how? 
 
 8. Under what condition should the common carotid be 
 ligated? Describe the operation. 
 
 9. What is surgical shock, and how would you relieve it? 
 
 10. Under what circumstances should appendicostomy be 
 resorted to? Give technique of operation. 
 
 HYGIENE. 
 
 1. What is the difference between disinfectants and ger- 
 micides, and how do they severally act in preventing the 
 spread of contagious and infectious materials. 
 
 2. What disease-carrying bacilli may be conveyed to the 
 system by the ingestion of milk ? What are the microscopic 
 characteristics of such bacilli? 
 
 3. Mention three satisfactory disinfectants, and give in- 
 dications for their use. 
 
 4. What deleterious gases accumulate in imperfectly ven- 
 tilated sleeping rooms? 
 
 5. Name five diseases requiring quarantine regulations, 
 and state the time necessary for each. 
 
 EYE, EAR, NOSE, AND THROAT. 
 
 1. Describe, in detail, how you would treat a chemical 
 burn of the eyeball. 
 
 2. Give indications and contraindications for tracheotomy 
 and intubation. 
 
 3. Give causes, symptoms, prognosis, and treatment of 
 chronic suppurative otitis media. 
 
 4. Differentiate between trachoma and conjunctivitis. 
 Give prognosis and treatment for trachoma. 
 
 5. Describe, in detail, the syphilitic conditions that may 
 be found in the nose and throat. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. Define: (a) Medical jurisprudence; (b) expert tes- 
 timony; (c) civil malpractice; (d) criminal malpractice. 
 
 2. Give post-mortem appearances due to : (a) Asphyxia ; 
 (b) drowning; (c) strangulation. 
 
 3. Describe a proper medical investigation in a suspected 
 case of homicide. 
 
 4. How would you determine whether a wound or burn 
 was inflicted before or after death? 
 
 298 
 
MEDICAL RECORD 
 
 5. What is insanity? Distinguish between intellectual 
 and moral insanity. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Michigan State Board of Registration in Medicine. 
 
 anatomy. 
 
 1. Rectus femoris. Origin: Anterior inferior, spine of 
 ilium; and groove above the brim of the acetabulum. In- 
 sertion: Into the patella. Action: It helps to extend the 
 leg upon the thigh and aids in supporting the pelvis and 
 trunk upon the femur. 
 
 2. See Cunningham's "Anatomy" (1909), page 183; or 
 Gray's "Anatomy" (1908), page 172. The muscles attached 
 are: ^ Subscapularis, supraspinatus, infraspinatus, trapezius, 
 deltoid, omohyoid, serratus magnus, levator anguli scapula?, 
 rhomboids major and minor, triceps, teres major and 
 minor, biceps, coraco-brachialis, and pectoralis minor. 
 
 3. After ligature of the common carotid artery the col- 
 lateral circulation is: (1) The superior thyroid (of exter- 
 nal carotid) with inferior thyroid (of subclavian) ; (2) 
 the profunda cervicis (of subclavian) with the arteria 
 princeps cervicis (of occipital) ; (3) the transversalis colli 
 with the occipital; (4) branches of the two vertebrals, with 
 branches of the two external carotids; (5) by the circle of 
 Willis. 
 
 4. See Cunningham's "Anatomy" (1909), page 142; or 
 Gray's "Anatomy" (1908), page 122. _ The muscles attached 
 are: Levator menti, depressor labii inferioris, depressor 
 anguli oris, platysma myoides, buccinator, masseter, orbi- 
 cularis oris, geniohyoid, geniohyoglossus, mylohyoid, di- 
 gastric, superior constrictor of pharynx, temporal, internal 
 and external pterygoids. 
 
 5. See Cunningham's "Anatomy" (1909). page 836; or 
 Gray's "Anatomy" (1908), page 660. 
 
 6. On the under surface of the brain there are: (1) In 
 the middle line: Longitudinal fissure ; Rostrum and pedun- 
 cles of corpus callosum; Lamina cinerea; optic commis- 
 sure; Pitiutary body; Inf undibulum ; Tuber cinereum; 
 Corpora albicantia; Posterior perforated space; Pons; 
 Medulla. (2) On each side of the middle line: Frontal 
 lobe; Olfactory bulb, tract, and roots; Anterior perforated 
 space; Fissure of Sylvius; Optic tracts; Crusta; Tem- 
 poral lobe; Hemisphere of cerebellum. 
 
 7. Pharynx. Arterial supply: Ascending pharyngeal, 
 pterygopalatine, superior or descending palatine, superior 
 thyroid, descending palatine, and tonsillar. Nerve supply: 
 
 299 
 
MEDICAL RECORD. 
 
 From pharyngeal plexus (from vagus, glossopharyngeal, 
 and sympathetic) and from external and recurrent laryn- 
 geal nerves. Openings: Two posterior nares, two Eusta- 
 chian tubes, mouth, larynx, and esophagus. 
 
 8. See Cunningham's "Anatomy" (1909), page 687; or 
 Gray's "Anatomy" (1908), page 1048. 
 
 9. See Cunningham's "Anatomy" (1909), page 712; or 
 Gray's "Anatomy" (1908), page 1091. 
 
 10. See Cunningham's "Anatomy" (1909), page 297; or 
 Gray's "Anatomy" (1908), page 336. 
 
 HISTOLOGY AND EMBRYOLOGY. 
 
 i. The blood is a fluid tissue composed of cellular ele- 
 ments (red corpuscles, white corpuscles, and platelets) and 
 intercellular substance, or liquor sanguinis, or plasma. 
 The red blood corpuscles are biconcave discs, about 1-3200 
 of an inch in diameter; they are nonnucleated, and there 
 are about 4,500,000 or 5,000,000 of them in each cubic milli- 
 meter of blood. They are elastic and soft, and their shape 
 is changed by pressure, but is promptly regained on the 
 removal of the pressure. Their color is yellowish. They 
 contain hemoglobin. 
 
 The leucocytes, or white blood cells, are spheroidal masses, 
 varying in size, having no cell wall, and containing one or 
 more nuclei; there are about 7,000 to 10,000 of them in each 
 cubic millimeter of blood. They differ much in appear- 
 ance, and are divided into : ( 1 ) small mononuclear leuco- 
 cytes, or lymphocytes, (2) large mononuclear, (3) transi- 
 tional, (4) polynuclear, or polymorphonuclear, or neutro- 
 phile, and (5) eosinophile. They are all more or less 
 granular, particularly the last two varieties named. They 
 are probably formed in the spleen, lymphatic glands, and 
 lymphoid tissues. Their fate is uncertain; it has been 
 asserted that they are converted into red blood cells; they 
 play a part in the formation of fibrin ferment; they are 
 sometimes converted into pus cells. 
 
 The platelets are very small, colorless, irregularly shaped 
 bodies; about one-fourth the diameter of a red cell. They 
 vary in number from 200,000 to more than 500,000 per 
 cubic millimeter. 
 
 2. Fetal blood has a lower specific gravity; the red cells 
 vary greatly in size and shape, are nucleated, and are defi- 
 cient in hemoglobin ; the white cells have a different pro- 
 portion of their various kinds, the mononuclears prepon- 
 derating. Wth regard to fetal blood pressure, nothing 
 definite is known. 
 
 3. See Cunningham's "Anatomy" (1909), page 990; or 
 Gray's "Anatomy" (1908), page 1403. 
 
 4. See Cunningham's "Anatomy" (1909), page 1217; or 
 Gray's "Anatomy" (1908), page 1409. 
 
 300 
 
MEDICAL RECORD. 
 
 5. See Cunningham's "Anatomy'' (1909), page 1138; or 
 Gray's "Anatomy" (1908), page 1426. 
 
 * PHYSIOLOGY. 
 
 1. The manifestations of cell life are: Movement, inges- 
 tion, assimilation, excretion, growth, irritability, and re- 
 production. Metabolism is the entire series of changes 
 that occur in a cell or organism during the processes of 
 nutrition. It is of two kinds: (1) Assimilative, or con- 
 structive (anabolism) ; and (2) destructive (katabolism). 
 
 2. Intestinal peristalsis is regulated by: (1) The vagus, 
 which stimulates; and (2) branches of the sympathetic 
 system, by the solar and lumbar plexuses, and the splanch- 
 nics; the effect of the sympathetic system is inhibition. 
 (3) The role of the plexuses of Auerbach and Meissner is 
 not known. 
 
 3. Proteids are converted into proteoses and peptones 
 in the stomach, and in the small intestine (by the action 
 of pepsin and trypsin, respectively). 
 
 Carbohydrates are converted (slightly) into dextrin and 
 sugar in the mouth, by the action of the ptyalin of the 
 saliva ; also in the small intestine (by the action of amy lop- 
 sin) into maltose. 
 
 Fats are emulsified and saponified in the small intestine 
 by the action of steapsin. Bile also has some slight effect 
 on starches and fat. 
 
 The products of digestion find their way into the blood 
 by two routes: (1) By the blood-vessels of the gastroin- 
 testinal tract, which unite to form the portal vein, and (2) 
 by the lymph vessels of the small intestine, which converge 
 to empty into the thoracic duct. The water, inorganic 
 salts, proteids, and sugar go by way of the portal vein to 
 the ascending vena cava; the fats go by way of the thoracic 
 duct to the junction of the left subclavian and internal 
 jugular veins. 
 
 4. The patellar reflex is generally present in health. The 
 afferent nerve is the anterior crural: the efferent nerve is 
 also the anterior crural. 
 
 5. In the liver there is the blood in: (1) The hepatic 
 artery (branch of celiac axis) which supplies Glisson's 
 capsule, walls of the bile ducts, and in general serves for 
 the nutrition of the organ. (2) The hepatic rein, which 
 empties into the inferior vena cava: it arises in the liver, 
 and takes the blood away from the liver. (3) The portal 
 vein, which takes the absorbed products of digestion from 
 the gastric, splenic, superior mesenteric, and inferior mesen- 
 teric veins to the liver. 
 
 6. Boiling breaks the starch grains, bursting the cellulose, 
 and thus allowing the digestive juices to come more readily 
 
 301 
 
MEDICAL RECORD. 
 
 in contact with the granulose. The conversion of the starch 
 into sugar takes place more rapidly. 
 
 A given amount of starch may be said to have been com- 
 pletely digested when no starch is left? it having all been 
 converted into sugar. In the test tube this can be ascer- 
 tained by the iodin test showing the absence of starch, 
 and Fehling's test showing the presence of sugar. 
 
 7. The object of respiration is the interchange of gases 
 in the lungs, so that oxygen may be introduced and carried 
 to the tissues, and carbon dioxide may be expelled from 
 the body. Two respiratory sounds are heard on listening 
 to the chest, the inspiratory and expiratory. The respi- 
 ratory center is located in the medulla. 
 
 8. Three examples of value of knowledge of physiolog- 
 ical chemistry: (1) That albumin is coagulated by heat; 
 (2) that glucose will reduce alkaline copper sulphate so- 
 lution; (3) that pepsin will only exert its proteolytic action 
 in an acid medium. 
 
 9. The nerves concerned in a vasomotor action are: (1) 
 The vasoconstrictor, which causes constriction of the blood- 
 vessels and increase blood pressure; and (2) the vaso- 
 dilator, which causes dilatation of the vessels by inhibiting 
 the action of the vasoconstrictors, and lower blood pres- 
 sure. 
 
 10. As the blood passes through the kidneys it loses: 
 Water, salts, urea, carbon dioxide, and extractives. 
 
 CHEMISTRY AND TOXICOLOGY. 
 
 i. The constituents of the atmosphere are : Oxygen, ni- 
 trogen, carbon dioxide, water vapor, ammonia, argon, etc. 
 Air is a mixture, and not a definite chemical compound. 
 Proof: (1) The composition is not constant; (2) the pro- 
 portion of its constituents bears no relation to their atomic 
 weights; (3) when air is absorbed by water and then ex- 
 pelled, the ratio of the nitrogen and oxygen is not the 
 same as in the original air ; (4) when oxygen and nitrogen 
 are brought together in proper proportions there is no 
 chemical action, nor is heat given off or absorbed, and 
 yet the resulting mixture has all the properties of air. 
 Carbon dioxide is the food of vegetables, and is by them 
 utilized for the building up of complex organic compounds. 
 Diffusion of gases: If two gases be brought in contact 
 with each other they will quickly mingle so as to make. a 
 uniform mixture. A similar diffusion will take place if 
 they are separated by a porous membrane or partition. 
 Graham's law of diffusion is : The velocity of diffusion of 
 different gases is inversely proportional to the square roots 
 of their densities. 
 
 2. H 2 S + CuSO* = CuS + H 2 S0 4 
 H 2 S + KHO == H2O + KHS 
 
 302 
 
MEDICAL RECORD, 
 
 CaC0 3 + 2HCI = CaCl 2 + C0 2 + H 2 
 2NaHC0 3 + heat = Na 2 C0 3 + C0 2 + H 2 
 2CO + 2 = 2 C0 2 
 
 3. An atom of an element is the smallest particle of that 
 element which can enter or leave a chemical reaction. A 
 molecule of an element is the smallest particle of that ele- 
 ment which can exist free. 
 
 The formula weight of the molecule of a gas in grams 
 occupies a volume of 22.4 liters. Thus 2 represents 32 
 grams of oxygen, which will occupy 22.4 liters; and NH 3 
 represents 17 grams of ammonia, which will also occupy 
 22.4 liters. 
 
 4. Characteristics of a good drinking water: (1) It should 
 be clear and limpid. Cloudy and muddy waters should be 
 avoided. (2) It should be colorless. A greenish or yel- 
 lowish color is usually due to vegetable or animal matter 
 in solution or to organisms. (3) It should be odorless; 
 especially free from sulphuretted hydrogen or putrefactive 
 animal matter. (4) It should not be too cold, but should 
 have a temperature of from 46 ° F. to 6o° F. (5) It should 
 have an^ agreeable taste ; neither flat, salty, nor sweetish. 
 A certain amount of hardness and dissolved gases give 
 a sparkling taste. It should contain from 25 to 50 c.c. of 
 gases per liter, of which 8 to 10 per cent, is carbon dioxide 
 and the rest oxygen and nitrogen. (6) It should be as 
 free as possible from dissolved organic matter, especially 
 of animal origin. (7) It should not contain too great an 
 amount of hardness. A certain quantity of saline matter 
 is necessary, however, to give it a good taste. It should 
 not contain over three or four parts of chlorine in 100,000 
 parts of water. — (From Bartley's Chemistry.) 
 
 5. Petroleum products: Cymogene (used in ice ma- 
 chines) ; rhigolene (used to produce cold, and as an anes- 
 thetic) ; gasolene and petroleum ether (used for making 
 "air gas") ; naphtha (used as a solvent for fats and rub- 
 ber) ; benzine (used for varnishes and paints) ; kerosene 
 (used for illuminating purposes) ; lubricating oil (for lubri- 
 cating machinery) ; paraffiin (for making candles). 
 
 6. Three aromatic hydrocarbons: (1) Benzene C 8 H 6 ; (2) 
 Phenol, C 6 H 5 OH ; (3) Salicylic acid, C 6 H 4 OH, # COOH. 
 
 7. Compound proteids are composed of a single proteid 
 united to some non-proteid body. The chief groups are : 
 (a) Hemoglobins — decomposable into an albumin and a 
 crystalline pigment or chromogen. (b) Nucleoproteids — 
 yield nucleic acids and native albumins on decomposition. 
 Nucleohiston, etc. (c) Glycoproteids — decomposable into a 
 reducing substance and a native albumin. Mucin, mucoids, 
 phosphoglycoproteids. 
 
 8. Xanthin group of leucomaines: Adenin, hypoxanthin, 
 guanin, xanthin, heteroxanthin, paraxanthin, carnin, pseudo- 
 
 303 
 
MEDICAL RECORD. 
 
 xanthin, spermin. Creatinin group of leucomaines: Creatin, 
 creatinin, xanthrocreatinin, crusocreatinin, amphicreatinin. 
 
 9. Poison ivy, Symptoms of poisoning: "When ap- 
 plied to the skin it causes, after a few hours, an intense 
 itching and burning, followed by swelling of the skin of 
 the affected parts, with papular eruption or slight vesica- 
 tion, terminating after a few days in desquamation." 
 
 Treatment : "An alcoholic solution of lead acetate usually 
 gives prompt relief. If itching is severe it may be com- 
 bined with opium. Painting the parts with ichthyol is 
 successful with many, as is the application of fluid extract 
 of grindelia robusta. Weak alkaline solutions have given 
 excellent results. "7- ( Riley's Toxicology.) 
 
 The active principle is toxicodendron 
 
 10. Symptoms of poisoning by strychnine: A sense of 
 suffocation, thirst, tetanic spasms, usually opisthotonos 
 sometimes emprosthotonos, occasionally vomiting, contrac- 
 tion of the pupils during the spasms, and death, either by 
 asphyxia during a paroxysm, or by exhaustion during a 
 remission. The symptoms appear in from a few minutes 
 to an hour after taking the poison, usually in less than 
 twenty minutes ; and death in from five minutes to six 
 hours, usually within two hours. Treatment: "The con- 
 vulsions are to be arrested or mitigated by bringing the 
 patient under the influence of chloral or chloroform as 
 rapidly as possible; the stomach is to be washed out, and 
 the patient is to be kept as quiet as possible." (Witthaus' 
 Essentials of Chemistry.) 
 
 PATHOLOGY. 
 
 1. Determining causes of disease: Traumatism, tempera- 
 ture (heat, cold, burns), electricity, environment, poisons, 
 autointoxication, food, parasites, and micro-organisms. 
 
 2. Effect of overfeeding : Indigestion, disturbed metab- 
 olism, increase of urea, increase of fat or glycogen, obesity, 
 fatty infiltration or degeneration, gout, diabetes, anemia. 
 
 3. Hemorrhage is the escape of all the constituents of 
 the blood from the heart or blood-vessels. Forms: Ac- 
 cording to the source of the flow, it may be cardiac, ar- 
 terial, venous, or capillary. ^ Arterial hemorrhages may be 
 primary (occurring at the time of injury), intermediate or 
 reactionary (occurring within twenty-four hours of the in- 
 jury), and secondary (occurring later, even some days 
 after the injury). Petechia are minute, circumscribed 
 hemorrhages, generally subcutaneous ; when larger, they are 
 called ecchymoses, or extravasation, or sugillation; a hema- 
 toma is a collection of blood in a solid tissue. 
 
 4. Fatty infiltration consists in the deposition of fat 
 from the circulation between the cells of which a tissue is 
 composed. Etiology: Heredity, excessive nutrition, diges- 
 
 304 
 
MEDICAL RECORD. 
 
 tive disorders, lack of exercise, anemia, alcohol, diminished 
 oxidation, high external temperature. Seats: Beneath skin 
 and serous membranes, in the fasciae, in areolar connective 
 tissue, mesentery, omentum, liver, heart, and kidneys. 
 
 5. See Rose and Carless' "Surgery" (1908), page 31; or 
 Da Costa's "Surgery" (1908), pages j$ and 76. 
 
 6. Osteoma. General appearance : There are two forms, 
 exostoses and osteoma proper. The former has its sur- 
 face irregular and nodular, and has the consistency of 
 bone. The latter is more rounded and lobulated. Seats: 
 Bone> cartilage, connective tissue near the bones, serous 
 membranes, and organs such as parotid gland and testicle. 
 Structure: Osteoma resembles bone tissue, but cartilage 
 is apt to be mixed with it. Softening and other secondary 
 degenerative changes may occur, and other tumors are apt 
 to be associated with it (chondroma, fibroma, and sar- 
 coma). 
 
 7. Glioma. Seats: Brain, spinal cord, and retina. Struc- 
 ture: It consists of cells containing rounded or oval nuclei, 
 with very little protoplasm, and fine protoplasmic extensions 
 which interlace and form an intercellular reticulum, giving 
 a granular appearance. The number of the cells and the 
 density of the intercellular network vary. As a rule, the 
 cells are larger than # neuroglia cells, and sometimes they 
 contain several nuclei. The tumor is generally quite vas- 
 cular, and occasionally teleangiectatic vessels may be ob- 
 served. Nature: It is benign, but dangerous, on account 
 of pressure; growth is slow, but it may become sarcoma- 
 tous. — (From Stengel's Pathology.) 
 
 8. Destruction of red blood cells is called : Hemocytoly- 
 sis, or hemolysis. Etiology: It occurs in the liver; it may 
 result from burns, also from infections and toxic agents 
 (such as potassium chlorate) ; malaria, pneumonia, and 
 other diseases may cause it. 
 
 9. See Rose and Carless' "Surgery" (1908), page 307; 
 or Da Costa's "Surgery" (1908), pages 359 and 356. 
 
 10. See French's "Practice of Medicine" (1907), pages 
 902 and 903; or Osier's "Practice of Medicine" (1909), 
 pages 695 and 697. 
 
 BACTERIOLOGY. 
 
 1. Bacillus typhosus is a rod-shaped organism, with 
 rounded ends, is from 2 to 4 microns in length, and about 
 three-fourths of a micron in breadth; it does not stain by 
 Gram's method, but stains with all the anilin dyes ; it has 
 flagella, no spores, is aerobic and facultative anaerobic, and 
 is motile. * 
 
 To distinguish the typhoid bacillus from the colon bacil- 
 lus: (1) On gelatin plates, the colonies of typhoid develop 
 more slowly than those of colon bacillus. (2) The colon 
 bacillus causes fermentation with production of gas in 
 
 305 
 
MEDICAL RECORD. 
 
 media which contain sugar; the typhoid bacillus does not. 
 
 (3) The colon bacillus produces a strong acid reaction and 
 coagulates milk within twenty-four to forty-eight hours; 
 the typhoid bacillus does not coagulate milk. (4) In pep- 
 tone solution the colon bacillus produces indol ; the typhoid 
 bacillus does not. (5) The typhoid bacillus gives the Widal 
 reaction with typhoid serum ; the colon bacillus does not. 
 
 2. The cause of syphilis is the treponema pallidum. It 
 is a very slender spiral, about 4 to 20 microns in length, 
 with very close and regular turns, the curves vary in 
 number from three or four to twelve or twenty. At each 
 pole is a fine flagellum. It can move forward and back- 
 ward, and also rotate on its axis. It is not settled whether 
 division is transverse or longitudinal. It has not yet been 
 cultivated on artificial media. 
 
 3. Immunity is the power of resistance of cells and tis- 
 sues to the action of pathogenic bacteria. Immunity may 
 be either natural or acquired. 
 
 Natural immunity is this power of resistance, natural 
 and inherited, and peculiar to certain groups of animals, 
 but common to every individual of these groups. 
 
 Acquired immunity is this resistance acquired: (1) By 
 a previous attack of the disease caused by the bacteria, or 
 (2) by the person being made artificially insusceptible. 
 The conditions which give immunity from the pathogenic 
 action of bacteria are: (1) A previous attack of the dis- 
 ease; (2) inoculation, with small quantities of bacteria, so 
 as to produce a mild attack of the disease; (3) vaccination; 
 
 (4) the introduction of antitoxins; (5) the introduction 
 of the toxins of the bacteria. 
 
 Active immunity follows an attack of^ a certain disease 
 and secures immunity for that alone ; or it f ollcws inocula- 
 tion of a virus weaker than necessary to cause the typical 
 disease ; or it follows inoculation by bacterial products apart 
 from the organisms themselves. 
 
 Passive immunity is the term applied to the effect of a 
 serum derived from an immunized animal and injected into 
 one not immune. 
 
 4. Bacteria multiply by fission. A bacterium about to 
 divide seems to be larger than normal, and if it is a coccus 
 it becomes more ovoid; changes occur first in the nucleus, 
 and the bacterium just falls in two. It has been calculated 
 that a single bacterium could, by fission, produce two in 
 one hour. Fortunately, they seldom obtain food enough 
 to keep up this process for any length of time. 
 
 Spore formation is not so much a method of multiplica- 
 tion as of continuance of the life of the individual bacterial 
 cell ; it is a process by which the organism enters a stage 
 in which it can better resist certain deleterious influences, 
 such as high temperature, desiccation, lack of nutrition. 
 
 306 
 
MEDICAL RECORD. 
 
 It occurs chiefly in bacilli. There are two forms : Endo- 
 spores and arthrospores. The former are true spores. 
 
 5. Bacterial enzymes are enzymes or ferments produced 
 by bacteria, and which cause certain of the chemical ef- 
 fects supposed to be due to the bacteria. The curdling of 
 milk is due to a bacterial enzyme rather than to a micro- 
 organism directly. 
 
 PRACTICE OF MEDICINE. 
 
 i. See French's "Practice of Medicine" (1907), page 
 317; or Osier's "Practice of Medicine" (1909), page 132. 
 
 2. See French's "Practice of Medicine" (1907), page 202; 
 or Osier's "Practice of Medicine" (1909), page 149. 
 
 3. See French's "Practice of Medicine" (1907), page 557; 
 or Osier's "Practice of Medicine" (1909), page 775. 
 
 4. See Rose and Carless' "Surgery" (1908), page 1323; 
 or Da Costa's "Surgery" (1908), page 1031. 
 
 5. Gastric ulcer is generally caused by injury or bacteria, 
 is most apt to occur between the ages of twenty and forty- 
 five; after eating there is pain localized in the stomach, 
 vomiting occurs soon after eating, hematemesis is com- 
 mon, there is localized tenderness over the stomach, and 
 examination of the gastric contents shows an excess of free 
 HC1. 
 
 Gastric carcinoma does not usually occur before forty 
 years of age, is more common in males, the pain is localized 
 and constant, vomiting is copious and occurs some time 
 after eating; the vomitus contains "coffee ground" mate- 
 rial ; hemorrhages are common ; a tumor may be palpated, 
 and examination of the gastric contents shows absence of 
 free HC1 and presence of lactic acid; severe anemia and 
 cachexia are also present. 
 
 In duodenal ulcer the pain is apt to be more to the right, 
 and to occur at an interval of two or three hours after 
 meals ; the hemorrhages will be intestinal, and the blood 
 will be passed by way of the bowels, and not vomited. In 
 many cases the symptoms are identical with those of gastric 
 ulcer. 
 
 6. See French's "Practice of Medicine" (1907), page 174; 
 or Osier's "Practice of Medicine" (1909), page 189. 
 
 7. See French's "Practice of Medicine" (1907), page 391 ; 
 or Osier's "Practice of Medicine" (1909), page 352. 
 
 8. Drugs which lower blood pressure: Amyl nitrite, so- 
 dium nitrite, spirit of nitrous ether, nitroglycerin. They 
 act by producing dilatation of the blood-vessels. 
 
 9. See Rose and Carless' "Surgery" (1908), page 1192; 
 or Da Costa's "Surgery" (1908), page 1135. 
 
 10. Complications which may follow typhoid fever: Re- 
 lapses, indigestion, constipation, diarrhea, perforation of 
 intestine, peritonitis, hepatic abscess, cholecystitis, gall- 
 
 307 
 
MEDICAL RECORD 
 
 stones, hypertrophy of spleen, paralysis, typhoid spine, 
 neuritis. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), page 664. 
 
 2. See Williams' "Obstetrics" (1909), pages 809 and 815; 
 or Hirst's "Obstetrics" (1909), pages 572 and 577. 
 
 3. If the chin is presenting anteriorly, expectant treat- 
 ment may suffice; but care must be taken to observe that 
 the chin does not rotate backward. Spontaneous version 
 may occur, and the presentation becomes a vertex one. 
 Failing this, or as a means of favoring this, postural treat- 
 ment, such as Walcher's position, has been recommended. 
 If, in spite of this, engagement has not occurred, cephalic 
 version is indicated, care being taken not to rupture the 
 membranes. If this is not successful, podalic version 
 should be tried. If, after all these manipulations the child 
 is still alive and the head is engaged, symphyseotomy is in- 
 dicated; if the child is dead, craniotomy should be per- 
 formed. 
 
 4. Puerperal eclampsia. The causes may be : Uremia, 
 albuminuria, imperfect elimination of carbon dioxide by the 
 lungs, medicinal poisons, septic infection; predisposing 
 causes are renal disease, and imperfect elimination of the 
 skin, bowels, and kidneys. The line of treatment laid down 
 by Edgar is as follows: For preventive treatment: (1) 
 The amount of nitrogenous food should be diminished to 
 a minimum; (2) the production and absorption of poison- 
 ous materials in the intestines and body tissues should be 
 limited and their elimination should be aided by improving 
 the action of the bowels, the kidneys, the liver, the skin, 
 and the lungs; (3) the source of the fetal metabolic prod- 
 ucts and the peripheral irritation in the uterus should, 
 if necessary, be removed by evacuating that organ. The 
 curative treatment includes: (1) Controlling the convul- 
 sions (by chloroform, veratrum, or chloral) ; (2) elimina- 
 tion of the poison or poisons which are presumed to cause 
 the convulsions; (3) emptying the uterus under deep anes- 
 thesia, by some method that is rapid and that will cause 
 as little injury to the woman as possible. 
 
 And see Williams' "Obstetrics" (1909), pages 915 and 
 852; or Hirst's "Obstetrics" (1909), pages 256 and 764. 
 
 5. See Williams' "Obstetrics" (1909), pages 799 and 802; 
 or Hirst's "Obstetrics" (1909), pages 426 and 433. 
 
 GYNECOLOGY. 
 
 1. See Cunningham's "Anatomy" (1909), page 1187; or 
 Gray's "Anatomy" (1908), page 1498. 
 
 2. See Cunningham's "Anatomy" (1909), page 1198; or 
 Gray's "Anatomy" (1908), page 1495. 
 
 308 
 
MEDICAL RECORD. 
 
 3. Causes of downward displacements of the uterus ; 
 (i) Pressure from above ^ (pelvic or abdominal tumors, 
 ascites, tight or heavy clothing, straining at stool, musculaf 
 exertion, fecal accumulations, habitual overdistention of the 
 bladder) ; (2) weakening and relaxation of the uterine sup 
 ports (subinvolution, senile atrophy of pelvic floor, abnor 
 mally large pelvis, increased weight of uterus, puerperal 
 traumatisms, pressure from above, traction from below) ; 
 (3) increased weight of uterus (congestion, subinvolution, 
 metritis, pregnancy, fluid in the endometrium, uterine tu- 
 mors) ; (4) traction from below (vaginal cicatrices, falling 
 of pelvic floor, contraction and congenital shortening of 
 vagina, tumors of cervix or vagina). — (From Dudley's 
 Gynecology.) 
 
 4. In tuberculosis of the pelvis the organ most frequently 
 affected is the Fallopian tube. 
 
 5. "When extrauterine pregnancy exists there are: (1) 
 The general and reflex symptoms of pregnancy; they have 
 often come on after an uncertain period of sterility ; nausea 
 and vomiting appear aggravated. (2) Then comes a dis- 
 ordered menstruation, especially metrorrhagia, accompanied 
 with gushes of blood, and with pelvic pain coincident with 
 the above symptoms of pregnancy; pains are often very 
 severe, with marked tenderness within the pelvis; such 
 symptoms are highly suggestive. (3) There is the presence 
 of a pelvic tumor characterized as a tense cyst, sensitive to 
 the touch, actively pulsating; this tumor has a steady and 
 progressive growth. In the first two months it has the 
 size of a pigeon's egg; in the third month it has the size of 
 a hen's egg; in the fourth month it has the size of two 
 fists. (4) The os uteri is patulous; the uterus is displaced, 
 but is slightly enlarged and empty. (5) Symptoms No. 2 
 may be absent until the end of the third month, when sud- 
 denly they become severe, with spasmodic pains, followed 
 by the general symptoms of collapse. (6) Expulsion of the 
 decidua in part or whole Nos. 1 and 2 are presumptive 
 signs; Nos. 3 and 4 are probable signs; Nos. 5 and 6 are 
 positive signs." — (American Text-Book of Obstetrics.) 
 
 . surgery. 
 
 1. See Rose and Carless' "Surgery" (1908), pages 1145 
 and 1151; or Da Costa's "Surgery" (1908), page 1014. 
 
 2. See Rose and Carless' "Surgery" (1908), page 618; or 
 Da Costa's "Surgery" (1908), page 586. 
 
 3. See Rose and Carless' "Surgery" (1908), page 470; or 
 Da Costa's "Surgery" (1908), page 435- 
 
 4. See Rose and Carless' "Surgery" (1908), page 751; or 
 Da Costa's "Surgery" (1908), page 712. 
 
 5. See Rose and Carless' "Surgery" (1908), page 900; or 
 Da Costa's "Surgery" (1908), page 1072. 
 
 309 
 
MEDICAL RECORD. 
 
 6. Indications for resection of bowel: Strictures of in- 
 testine, gangrene of intestine, extensive injury of intestine, 
 tumors of intestine, tuberculosis of intestine, injury to the 
 vessels supplying intestines, some cases of intussusception, 
 and artificial anus. 
 
 7. See Rose and Carless' "Surgery" (1908), page 1325; 
 or Da Costa's "Surgery" (1908), page 1034. 
 
 8. Indications for ligature of common carotid: Wounds 
 of either common carotid, external carotid, or internal 
 carotid (and branches of the two latter); in aneurysms; 
 to limit the growth of inoperable tumors; as a temporary 
 procedure. For the operation, see Rose and Carless' "Sur- 
 gery" (1908), page 331; or Da Costa's "Surgery" (1908), 
 page 415. 
 
 9. Shock is the name given to a sudden and general de- 
 pression of the vital powers, due to some strong stimula- 
 tion (such as injury or emotion) acting on the vital centers 
 in the medulla, and producing vasomotor paralysis. Treat- 
 ment: Place the patient in the recumbent position, with the 
 head low; apply warmth to the body; administer a stimu- 
 lant, and give a hot saline infusion; morphine, hypoder- 
 matically, may be necessary for the relief of pain. 
 
 10. Appendic ostomy is performed to irrigate the colon in 
 cases of chronic ulcerative colitis or chronic dysentery, 
 and in chronic constipation. For technique of the opera- 
 tion, see Da Costa's "Surgery" (1908), page 916. 
 
 HYGIENE. 
 
 1. Disinfectants are agents which restrain infectious dis- 
 eases by destroying or removing their specific poisons ; 
 some are germicides, as chlorine; others act by dilution 
 or removal, as soap and water, and fresh air. Germicides 
 are agents which destroy bacteria and their germs. 
 
 2. The following disease-carrying bacilli may be con- 
 veyed by milk : Tubercle bacillus, Klebs-Loeffler bacillus of 
 diphtheria, typhoid bacillus, cholera bacillus. 
 
 The tubercle bacillus is rod shaped, is from 1^ to 3^ 
 microns in length, and about one-third to one-half a micron 
 in breadth, is a strict parasite, is not motile, and has no 
 flagella. It is slightly curved, does not form spores, is not 
 liquefying, is aerobic and nonchromogenic ; it resists acids; 
 it grows well on blood serum; stains well by Ehrlich's, 
 Ziehl-Nielsen's, or Gabbett's method; it is Gram-positive. 
 
 The bacillus of diphtheria is from 2 to 6 microns in 
 length and from 0.2 to 1.0 micron in breadth; is slightly 
 curved, and often has clubbed and rounded ends; occurs 
 either singly or in pairs, or in irregular groups, but does 
 not form chains; it has no flagella, is nonmotile, and 
 aerobic; is noted for its pleomorphism ; it does not stain 
 
 310 
 
MEDICAL RECORD. 
 
 uniformly, but stains well by Gram's method and very 
 beautifully with Loeffler's alkaline-methylene blue. 
 
 The typhoid bacillus is a rod-shaped organism, with 
 rounded ends, is from 2 to 4 microns in length, and about 
 three-fourths of a micron in breadth; it does not stain by 
 Gram's method, but stains with all the anilin dyes; it has 
 flagella, no spores, is aerobic and facultative anaerobic, and 
 is motile. 
 
 The cholera bacillus is a spirillum, actively motile, and 
 with a flagellum at one end ; it is curved, has rounded ends, 
 and is about half the length of the tubercle bacillus; it 
 stains readily with ordinary anilin stains, but not by Gram's 
 method; it is easily cultivated on the usual media; it has 
 but slight power of resistance; it liquefies gelatin, and 
 does not produce pigment. 
 
 3. Burning is the best disinfectant; then moist heat and 
 dry heat; carbolic acid and mercury bichloride are excel- 
 lent except in the presence of albuminous material, when 
 chloride of lime or formalin are better; formaldehyde and 
 sulphur dioxide are both good disinfectants. 
 
 4. Carbon dioxide; crowd poison; volatile matters from 
 foul mouths, decayed teeth, and the digestive tract; aqueous 
 vapor from the respiration and skin; products of combus- 
 tion of illuminating substances. 
 
 5. Five quarantinable diseases: Cholera, yellow fever, 
 smallpox, plague, typhus. For length of time, see index 
 to these diseases in French's or Osier's "Practice." 
 
 7 
 
 EYE, EAR, NOSE, AND THROAT. 
 
 i. For chemical bums of the eyeball: The treatment con- 
 sists in the complete removal of the caustic substance as 
 soon as possible. Solid particles are removed with cotton 
 or forceps. Then the conjunctival sac is washed out with 
 solutions which tend to neutralize the corrosive substance 
 or render it insoluble. In the case of lime, mortar, or 
 caustic alkalies, we flush out with a solution of boric acid; 
 or we may wash out the eye with oil. If the corrosive 
 agent consisted of an acid, the eye is irrigated with a 
 weak solution of sodium bicarbonate. Subsequently we 
 use cold compresses, atropine, and sometimes a bandage. 
 After the loosening of the eschars, we must separate the 
 adhesions frequently. Symblepharon often occurs notwith- 
 standing the greatest care." — (May's Diseases of the Eye.) 
 
 2. Tracheotomy is indicated in diphtheria when intuba- 
 tion does not relieve and the symptoms are urgent; to re- 
 move foreign bodies from the larynx that cannot be treated 
 by simple methods ; to provide passage for air, in growths, 
 tumors, or abscesses pressing on the larynx and interfer- 
 ing with the proper supply of air; and for edema of the 
 glottis when the intubation tube cannot be introduced. 
 
 311 
 
MEDICAL RECORD. 
 
 Intubation is indicated in any obstruction of the larynx 
 which prevents a sufficient amount of air from entering 
 the lungs, such as croup, edema of the glottis, spasm of 
 the larynx, any form of paralysis that lessens the lumen 
 of the larynx, chronic stenosis. Intubation is not indicated 
 for the removal of a foreign body, nor for any obstruction 
 too far down to be reached by the shaft of the tube. 
 
 3. See Rose and Carless' "Surgery" (1908), page 882. 
 
 4. In conjunctivitis there are no granules with subsequent 
 cicatricial changes. 
 
 Trachoma is an inflammatory condition of the conjunc- 
 tiva, accompanied by hypertrophy, granule formation, and 
 subsequent cicatricial changes. 
 
 Treatment "consists in an attempt to reduce the inflam- 
 matory symptoms and secretion, and to check and remove 
 hypertrophy of the conjunctiva, thus shortening the dura- 
 tion and diminishing the liability to conjunctival cicatriza- 
 tion and to sequelae. This is accomplished either by the use 
 of certain irritating applications, or by mechanical (sur- 
 gical) means. Irritating applications: Sulphate of copper 
 in the form- of a crystal or pencil is the favorite local ap- 
 plication. Nitrate of silver (1 or 2 per cent, solution), 
 gylcerole of tannin (5 to 25 per cent.), and the alum stick 
 are also employed. Mechanical {surgical) treatment in- 
 cludes expression, grattage, excision, curetting, electrolysis, 
 #-rays, and galvano-cautery." — (May's Diseases of the 
 Eye.) 
 
 Prognosis is not favorable; the condition may last for 
 years, and complete recovery is not common. 
 
 5. See Rose and Carless' "Surgery" (1908), pages 822, 
 830, and 871. 
 
 MEDICAL JURISPRUDENCE. 
 
 r. Medical jurisprudence is the application of the knowl- 
 edge of any of the branches of medicine to the problems 
 and reauirements of the law. 
 
 In expert testimony the witness may give his opinion on 
 facts or supposed facts as noted by himself or asserted 
 by others. Theoretically this can be clone only by those 
 perfectly familiar with the subject in question; but prac- 
 tically any (or almost any) physician with a license to 
 practise is accepted as an expert witness. 
 
 In ordinary testimony the witness testifies only to facts 
 which he has seen, or heard, or with which he has become 
 acquainted by personal observation. 
 
 Malpractice is a failure on the part of a medical practi- 
 tioner to use such skill, care, and judgment in the treat- 
 ment of a patient as the law requires; and thereby the 
 patient suffers damage. If due to negligence only, it is 
 civil malpractice. But if done deliberately, or wrongfully, 
 
 312 
 
MEDICAL RECORD, 
 
 or if gross carelessness or neglect have been shown, or if 
 some illegal operation (such as criminal abortion) be per- 
 formed, it is criminal malpractice. 
 
 2. In death by ^ asphyxia: Very commonly punctate 
 ecchymoses are visible on the conjunctiva, face, neck, and 
 chest. They are considered by Tardieu to be more frequent 
 in strangulation than in asphyxia from other causes, or 
 than in cases of overstraining, which likewise may lead to 
 them. In the subcutaneous cellular tissue, and in the fascia 
 of the muscles above and below the hyoid bone extravasa- 
 tions are frequently found, as well as on the external sur- 
 face of the thyroid cartilage and trachea. The lungs vary 
 as regards their vascularity; but on the surface it is com- 
 mon to find pseudomembranous patches, which are due to 
 the rupture of some of the superficial air cells and collec- 
 tion of air bubbles under the pleura. In the substance of 
 the lungs congested patches, or apoplectic extravasations, 
 are often found, varying in size, but larger than those 
 usually found in suffocation. 
 
 In death by drowning: The surface is pallid, the face 
 appears tranquil, the eyes and mouth being partly open. 
 The skin often has the appearance known as gooseskin. 
 and, if the body has lain upwards of twelve hours in the 
 water, that of the hands and the feet is sodden by imbibi- 
 tion. The most important external sign is the presence on 
 the mouth and nostrils of a fine froth (possibly blood 
 stained), composed of air, mucus, and the medium in 
 which drowning took place; if the body remains three or 
 four days in water, the froth disappears. Exceptionally, 
 fragments of weeds or other small objects may be found 
 tightly grasped in the hands. On opening the thorax the 
 lungs, gray in color, with reddish staining, are seen to be 
 very voluminous, a condition known as ballooning, partly 
 due to infiltration of the lung tissue with some of the 
 medium in which drowning took place, and partly to true 
 edema. The lung substance is inelastic and pits on pres- 
 sure. On section, fluid and froth resembling that found 
 on the lips exude from the divided air passages. Minute 
 subpleural hemorrhages are not infrequently present, and 
 the pleural cavities may contain fluid. The stomach often 
 contains water or other liquid which was involuntarily 
 swallowed during attempts at respiration. Occasionally 
 some of this fluid is forced by vital action into the intes- 
 tines. With one exception, the remaining appearances are 
 those met with after death from asphyxia. The exception 
 is constituted by the blood, which is not only dark colored 
 and fluid, as is usual after death from asphyxia, but is 
 also diluted by the imbibition of water from the stomach 
 and lungs. 
 
 In death by strangulation: The blood is of a dark color, 
 
 313 
 
MEDICAL RECORD. 
 
 owing to complete reduction of the hemoglobin. The pro- 
 portion of carbonic acid is increased, and owing to its 
 excess the blood coagulates slowly or imperfectly; hence 
 it remains fluid or forms few and soft coagula. The large 
 veins, the pulmonary artery, and the cavities of the right 
 side of the heart may be distended with dark fluid blood, 
 but this is by no means necessarily the case. The left side 
 is usually empty or nearly so. The lungs may be con- 
 gested, but are often pallid and anemic, though the de- 
 pendent parts usually exhibit appearances of hypostatic en- 
 gorgement. The abdominal viscera, especially the kidneys, 
 are often congested. The appearance of the brain varies ; 
 it may be anemic or more or less congested. Special signs 
 characterize special modes of causation of asphyxia. — 
 (From Quain's Dictionary of Medicine.) 
 
 3. The physician should note the body ; and the surround- 
 ings, conditions, and circumstances under which it is found. 
 If the body is in a building, he should observe the position 
 and arrangement of furniture, etc., blood, position of body, 
 arrangement of clothes, position and character of weapons, 
 footprints, and finger marks. The body should be examined 
 for signs of violence (wounds, bruises, blood spots) ; 
 lividities; the presence of rigor mortis, etc. The physician 
 should keep his suspicions to himself, hear all he can, ob- 
 serve all he can, say nothing, and communicate with the 
 coroner or medical examiner. 
 
 4. A wound inflicted during life is generally character- 
 ized by hemorrhage, coagulation of the blood, eversion of 
 the edges, and retraction of its sides. It may also be in- 
 ferred that the wound was inflicted during life if any of 
 the following are noticed : The presence of inflammation, 
 swelling, pus, or gangrene on the edges of the wound, 
 or if there is any sign of beginning cicatrization. 
 
 In burns produced before death: There is usually a blis- 
 ter, with a bright, red base, and containing a serous fluid, 
 which is albuminous; occasionally there will be no blister 
 if there has been excessive shock; also, there will be a 
 red line of demarcation between the injured and the un- 
 injured parts, and this, being a vital process, is only de- 
 veloped during life. In burns produced after death there 
 is no true blister, no red base, and gas only is present in 
 place of the serous fluid. 
 
 5. According to Taylor, the term insanity is applied to 
 those states of disordered mind in which a person loses 
 the power of regulating his actions and conduct according 
 to the ordinary rules of society. In all cases of real in- 
 sanity the intellect is more or less affected. 
 
 Intellectual insanity refers to those forms which are 
 characterized by hallucinations and delusions, but in which 
 the patient knows right from wrong. 
 
 314 
 
MEDICAL RECORD 
 
 Moral insanity refers to that condition in which the 
 moral perceptions are blunted, and the patient cannot judge 
 a question of right and wrong. As a rule, moral insanity 
 is accompanied with some intellectual disturbance. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Minnesota State Medical Examining Board. 
 anatomy and histology. 
 
 1. Give the histology of a nerve trunk. 
 
 2. Describe the origin, relations and distribution of the 
 fifth pair of cranial nerves. 
 
 3. Describe the cardiac valves. Between what points 
 on the surface are they situated? 
 
 4. Describe the fourth ventricle. 
 
 5. Describe the portal vein. 
 
 6. Describe the thoracic duct. 
 
 7. Describe the azygos veins. 
 
 8. Give names and general description of the flexor 
 muscles of the forearm. 
 
 9. Describe the pronator muscles. 
 
 10. Describe the supinator muscles. 
 
 PHYSIOLOGY. 
 
 1. Describe the human blood, giving reaction, specific 
 gravity, constituents, etc. 
 
 2. Describe the secretion of urine. 
 
 3. What is the composition, reaction, and function of 
 the pancreatic juice? 
 
 4. Describe the pulmonary circulation and the changes 
 which are produced in the blood by aeration. 
 
 5. Describe the secretion of milk, and give the composi- 
 tion of human milk and cow's milk. 
 
 6. What are the functions of the skin? 
 
 7. Describe the normal heart sounds, give probable rea- 
 sons for same, and tell where best heard? 
 
 8. Enumerate the functions of the spinal cord and its 
 special centers. 
 
 9. Explain the physiology of visual accommodation to 
 light and distance. 
 
 10. Give the physiology of menstruation. 
 
 Note — Credits will be given for all diagrams used in 
 explaining questions. 
 
 . MATERIA MEDICA AND TOXICOLOGY. 
 
 fly Write a model prescription for acute bronchitis, giv- 
 ing reasons for use of each ingredient and explaining each 
 step in the writing of the prescription. 
 
 315 
 
MEDICAL RECORD. 
 
 2. (a) What are the symptoms of chronic morphine 
 poisoning? (b) What are the symptoms caused by abrupt 
 withdrawal of the drug? (c) What is the treatment of 
 acute poisoning? 
 
 3= (a) From what is acetanilid derived? (b) Explain 
 its effects, (c) Give treatment of acute poisoning. 
 
 4. (a) From what is hyoscine derived? (b) What is 
 the dose of hydrobromide? Its physiological effects" 
 Some of its therapeutic uses? 
 
 5. Give rule for dosage for children according to age. 
 
 6. Give in parallel columns, the diagnosis between acute 
 ptomaine poisoning and acute poisoning by arsenic? 
 
 •74 Explain the action of chloroform as an anesthetic 
 and tell how you would administer it and with what pre- 
 cautions. 
 
 8. What are the adult doses of and physiological anti- 
 dotes for Tr. strophanthus, apomorphine (by hypodermic), 
 carbolic acid, and chloral hydrate? 
 
 9. Explain the action on the bowels of opium, thymol, 
 and bismuth subnitrate. 
 
 10. (a) What is the U. S. Pharmacopoeia? (b) What 
 is the National Formulary? (c) What is a fluid extract? 
 (d) What is a chemical antidote? 
 
 CHEMISTRY AND URANALYSIS. 
 
 1. Define specific gravity; an acid; a base; allotropy ; 
 synthesis. 
 
 2. (a) Give law of definite proportions, (b) Give tests 
 for iodine, silver, mercury. 
 
 3. Give a test for sewage contamination of drinking 
 water. What do you consider a good drinking water? 
 
 4. Give fully the clinical significance of albuminuria. 
 Name the urinary casts and the commonly associated kid- 
 ney lesions. 
 
 5. Give a test for indican. What is its clinical signifi- 
 cance ? 
 
 6. What is the diazo-reaction of Ehrlich and its signifi- 
 cance ? 
 
 7. How do you estimate urea? 
 
 8. What is the diagnostic value of tests for organic 
 acids found in stomach contents? Describe a test for 
 lactic acid. 
 
 9. What is the normal reaction of cow's milk? Why 
 is it important to determine the reaction before steriliza- 
 tion? 
 
 10. Give test for blood. What is the freezing point for 
 blood? 
 
 BACTERIOLOGY. 
 
 I. In what diseases have the specific microorganisms 
 been recovered from the blood? 
 
 316 
 
 
MEDICAL RECORD. 
 
 2. (a) Give fully the technique of finding the tubercle 
 bacillus in suspected sputum, (b) What is Gram's and 
 Weigert's method of staining? Illustrate its differential 
 value. 
 
 3. Describe the preparation of diphtheria antitoxin. 
 How is its action explained? 
 
 4. Describe the morphology of the microorganisms 
 causing tetanus, gonorrhea, spinal meningitis, relapsing 
 fever. Give mode of infection. 
 
 5. (a) What is the present status of the bacteriology 
 of scarlet fever, rheumatism, and syphilis? (b) Give 
 morphology and cultural properties of the Diplococcus 
 pneumonia. 
 
 PRACTICE OF MEDICINE. 
 
 1. Describe lichen planus. 
 
 2. Describe a typical case of acute miliary tuberculosis. 
 
 3. Define bronchiectasis? Give symptoms and physical 
 signs. 
 
 4. Nephrolithiasis. Give symptoms fully. Differentiate 
 from appendicitis. 
 
 5. Describe the usual symptoms in the secondary stage 
 of syphilis. 
 
 6. Differentiate in parallel columns, gastric ulcer and 
 gastralgia. 
 
 7. Hereditary ataxia (Friedreich's disease) : Describe 
 symptoms and usual course of disease. 
 
 8. Differentiate articular rheumatism and arthritis de- 
 formans. 
 
 9. Define arteriosclerosis. Give usual causes. With 
 what other diseases is it frequently associated? 
 
 10. Hematuria : Give principal causes. How would you 
 determine source of hemorrhage? 
 
 SURGERY. 
 
 1. (a) Give the surgical definition of "tumor." (b) 
 Classify tumors histologically. 
 
 2. (a) Define "wound." (b) Give classification. 
 
 3. Give in detail, treatment of a punctured wound in- 
 volving the deep palmar arch. 
 
 4. State fully how you would treat a blank cartridge 
 wound of the palm of the hand, and give reason for your 
 plan of treatment. 
 
 5. Describe step by step the operation of ligature of the 
 ulnar artery at the wrist, giving linear and muscular guides. 
 
 6. (a) Define "fracture." (b) Give general classifica- 
 tion of fractures. 
 
 7. Pathology, symptoms, and treatment of Pott's frac- 
 ture. 
 
 317 
 
MEDICAL RECORD. 
 
 8. Tracheotomy: Describe operation and after treat- 
 ment. 
 
 9. How would you reach a diagnosis in a case of sus- 
 pected coxitis? 
 
 10. Describe fully the treatment of strangulated in- 
 guinal hernia. 
 
 GYNECOLOGY. 
 
 1. Give differential diagnosis between ovarian cyst and 
 extrauterine pregnancy. 
 
 2. Describe your method of repairing a lacerated cervix. 
 
 3. Describe inversion of the uterus, giving symptoms, 
 diagnosis, and treatment. 
 
 4. Describe uterine polypus, give symptoms, diagnosis, 
 and treatment. 
 
 5. (a) Give two indications for hysterectomy, (b) 
 Your reasons for chosing vaginal or abdominal route. 
 
 DISEASES OF CHILDREN. 
 
 1. Give etiology, pathology, and diagnosis of rachitis. 
 
 2. Give symptoms of pertussis and differentiate it from 
 acute bronchitis. 
 
 3. What alterations would you make in modified milk 
 to overcome constipation. 
 
 4. Give briefly differential diagnosis between epilepsy, 
 convulsions due to intestinal irritation, and uremic convul- 
 sions. 
 
 5. Give symptoms and treatment of dilatation of the 
 stomach. 
 
 OBSTETRICS. 
 
 1. Describe fully your management of a case of face 
 presentation. 
 
 2. Describe your management of a case of neglected 
 transverse presentation where version fails. 
 
 3. In contracted and deformed pelvis, enumerate the 
 different methods to be considered in delivery of child 
 and state your reasons for each. 
 
 4. Describe fully your management of prolapse of cord. 
 
 5. Give your treatment of different grades of asphyxia 
 in the new born. 
 
 6. Describe symptoms and treatment of ectopic preg- 
 nancy. 
 
 7. Describe caput succedaneum and cephalhematoma 
 and give causes of each. 
 
 8. Give indications for podalic version. 
 
 9. Give your treatment of puerperal septicemia. 
 
 10. Give etiology and treatment of mastitis. 
 
 PATHOLOGY. 
 
 1. Give pathology of anemia 2 pernicious anemia, and 
 chlorosis. 
 
 318 
 
MEDICAL RECORD. 
 
 2. Describe changes in chronic alcoholism. 
 
 3. Pathology of carcinoma of liver. 
 
 4. Give pathological findings in typhoid fever. 
 
 5. Describe pathological changes in nephritis. 
 
 EYE AND EAR. 
 
 i. Differentiate glaucoma and iritis. 
 
 2. Describe choked disc and in what diseases we may 
 expect to find it. 
 
 3. Define myopia, hypermetropia, astigmatism. 
 
 4. How would you treat a discharging ear? 
 
 5. Describe otitis media. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. Describe phenomena and signs of death. 
 
 2. How would you distinguish human bood from that of 
 other sources? 
 
 3. Describe death by hanging; how would you determine 
 whether penal or suicidal, ante- or post-mortem? 
 
 4. What is life insurance and upon what does the pre- 
 mium rate depend? 
 
 5. What is the normal duration of pregnancy and what 
 are the most important signs of delivery in the living and 
 in the dead? 
 
 PREVENTIVE MEDICINE. 
 
 1. What quarantine measures are necessary in a case 
 of (a) smallpox^ (b) diphtheria, (c) scarlet fever? 
 
 2. Describe in detail how you would manage cases of 
 typhoid for the protection of the community. 
 
 3. How are the following diseases transmitted: (a) 
 Diphtheria, (b) yellow fever, (c) typhoid fever? 
 
 4. How long would you keep in quarantine a case of 
 (a) scarlet fever, (b) diphtheria, (c) smallpox? 
 
 5. Give a simple, practical method of ventilating a dwel- 
 ling in this climate during the winter season. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Minnesota State Medical Examining Board. 
 
 anatomy and histology. 
 
 1. See Cunningham's "Anatomy" (1909), Page 444; or 
 Gray's "Anatomy" (1908), page 819. 
 
 2. Fifth pair of cranial nerves. Origin: (1) Super- 
 ficial, from the side of the pons varolii; (2) Deep (sensory 
 root), from the medulla, and upper part of cord; (motor 
 
 319 
 
MEDICAL RECORD. 
 
 root) from floor of fourth ventricle, and side of the aque- 
 duct of Sylvius. 
 
 Distribution: First ophthalmic branch supplies sensation 
 to conjunctiva and skin of upper eyelid, cornea, skin of 
 forehead and nose, lachrymal glands, mucous membrane 
 of nose. Second, or superior maxillary branch, supplies 
 sensation to skin and conjunctiva of lower lid, nose, cheek, 
 upper lip, upper teeth and alveolar processes, and palate. 
 Third, or inferior maxillary branch, supplies sensation to 
 external auditory meatus, side of head, mucous membrane 
 of mouth, anterior two-thirds of tongue, lower teeth, lower 
 lip, and skin of the lower part of the face. This branch, 
 in addition, supplies motion to the muscles of mastication 
 (masseter, temporal, external pterygoid, internal ptery- 
 goid), also mylohyoid and anterior belly of digastric. 
 
 Relations: See Cunningham's "Anatomy" (1909), page 
 678; or Gray's "Anatomy" (1908), page 1046. 
 
 3. Relation of , the cardiac valves to the chest wall: 
 "The aortic valves lie behind the third intercostal space, 
 close to the left side of the sternum. The pulmonary 
 valves lie in front of the aortic behind the junction of the 
 third rib, on the left side, with the sternum. The tricus- 
 pid valves lie behind the middle of the sternum, about the 
 level of the fourth costal cartilage. The mitral valves lie 
 behind the third intercostal space, about one inch to the 
 left of the sternum." (Holden.) 
 
 4. See Cunningham's "Anatomy" (1909), page 487; or 
 Gray's "Anatomy" (1908), page 878. 
 
 5. See Cunningham's "Anatomy" (1909), page 902; or 
 Gray's "Anatomy" (1908), page 769. 
 
 6. See Cunningham's "Anatomy" (1909), page 906; or 
 Gray's "Anatomy" (1908), page 775. 
 
 7. See Cunningham's "Anatomy" (1909), page 872; or 
 Gray's "Anatomy" (1908), page 752. 
 
 8. 9 and 10. See Cunningham's "Anatomy" (1909), pages 
 352, 335, and index (for muscles required) ; or Gray's 
 "Anatomy" (1908), page 314, and index (for muscles re- 
 quired). 
 
 PHYSIOLOGY. 
 
 1. The physical properties of blood : Fluid, somewhat vis- 
 cid, red, specific gravity from 1055 to 1062, alkaline reaction, 
 saltish taste, characteristic odor, variable temperature 
 (average about 100 degrees F.). 
 
 The constituents of the blood are plasma and corpuscles. 
 The plasma consists of water and solids (proteids, extract- 
 ives, and inorganic salts). The red corpuscles consist of 
 water and solids (hemoglobin, proteids, fat, and inorganic 
 salts). The white corpuscles consist of water and solids 
 (proteid, leucomiclein, lecithin, histon, etc.). 
 
 320 
 
MEDICAL RECORD. 
 
 The red blood corpuscles are biconcave discs, about 
 1-3200 of an inch in diameter ; they are nonnucleated, and 
 there are about 4,500,000 or 5,000,000 of them in each cubic 
 millimeter of blood. They are elastic and soft, and their 
 shape is changed by pressure, but is promptly regained on 
 the removal of the pressure. Their color is yellowish. 
 They contain hemoglobin. 
 
 Their function is to carry oxygen from the lungs to the 
 tissues. 
 
 The white blood cells are spheroidal masses, varying 
 in size, having no cell wall, and containing one or more 
 nuclei ; there are about 7,000 to 10,000 of them in each 
 cubic millimeter of blood. They differ much in appear- 
 ance, and are divided into (1) small mononuclear leu- 
 cocytes, or lymphocytes, (2) large mononuclear (3) transi- 
 tional, (4) polynuclear, or polymorphonuclear, or neutro- 
 phile, and (5) eosinophile. They are all more or less 
 granular, particularly the last two varieties named. They 
 are probably formed in the spleen, lymphatic glands, and 
 lymphoid tissues. Their fate is uncertain ; it has been as- 
 serted that they are converted into red blood cells ; they 
 play a part in the formation of fibrin ferment; they are 
 sometimes converted into pus cells. Their functions are 
 (1) to serve as a protection to the body from the incur- 
 sions of pathogenic microorganisms ; (2) they take some 
 part in the process of the coagulation of the blood; 
 (3) they aid in the absorption of fats and peptones from 
 the intestine, and (4) they help to maintain the proper 
 proteid content of the blood plasma. 
 
 There are also platelets, which are very small, colorless, 
 irregular shaped bodies ; they are about one-fourth the 
 diameter of a red corpuscle. Their function is not deter- 
 mined ; it is possible that they take some part in the coagu- 
 lation of the blood. In number they vary from about 
 200.000 to more than 500,000 in each cubic millimeter of 
 blood. 
 
 Plasm conveys nutriment to the tissues ; it holds in solu- 
 tion the carbon dioxide and water which it receives from 
 the tissues, and takes them to be eliminated by the lungs, 
 kidneys, and skin ; it also holds in solution urea and other 
 nitrogenous substances that are taken to and excreted by 
 the liver or kidneys. 
 
 2. The mechanism of the secretion of urine by the kid- 
 neys is twofold: (1) By filtration, most, if not all, of the 
 fluid is eliminated, and also inorganic salts ; this depends 
 upon blood pressure, and takes place in the glomeruli. (2) 
 By cell activity and selection, in the cells of the convoluted 
 tubules, the urea and principal solids are eliminated. 
 
 3. Pancreatic Juice: Composition: Water and solids, 
 the latter consisting of three enzymes (trypsin, amylopsin, 
 
 321 
 
MEDICAL RECORD. 
 
 and steapsin), proteid material, soap, fats, lecithin, and 
 inorganic salts (carbonate of sodium, chloride of sodium, 
 and phosphates of sodium, calcium, and magnesium). 
 
 The reaction is alkaline, due to sodium carbonate. 
 
 The functions: (i) It changes proteids into proteoses 
 and peptones, and afterwards decomposes them into leucin 
 and tyrosin; (2) it converts starch into maltose; (3) it 
 emulsifies and saponifies fats, and (4) it causes milk to 
 curdle. 
 
 4. For pulmonary circulation, see Cunningham's "Anat- 
 omy" (1909), page 991; or Gray's "Anatomy" (1908), page 
 1404. 
 
 The changes produced in the blood by aeration, are: (1) 
 The living up of carbon dioxide; (2) the absorption of 
 oxygen: (3) the color is made more red; (4) the blood 
 is cooled, and (5) it also loses a small amount of watery 
 vapor. 
 
 5. Secretion of milk: "The fatty matters in milk are ap- 
 parently formed at the expense of the protoplasm of the 
 epithelial cells. The casein and milk sugar are also formed 
 in the cells. That fat is formed out of the proteid matter 
 of the protoplasm of the cell, and not from the fat taken as 
 food, is proved by the fact that a bitch fed on meat gives 
 out more fat in her milk than has been taken in her food. 
 The secretion of milk is under the influence of the nervous 
 system. There appears to be a nerve-center in the cord, the 
 sensory and motor-secretory fibers being contained in the 
 intercostal nerves. The amount and quality of the milk 
 is influenced both by the mental state and food taken by 
 the mother." — (Ashby.) 
 
 HUMAN MILK CONTAINS 
 APPROXIMATELY : 
 
 Proteid, 
 
 Fats, 
 
 Sugar, 
 
 about 1 to 2% 
 about 3 to 4% 
 about 6 to 7% 
 
 COW'S MILK CONTAINS 
 APPROXIMATELY : 
 
 Proteid, 
 
 Fats, 
 
 Sugar, 
 
 about 4% 
 about 4% 
 about 4% 
 
 6. The functions of the skin are : Protection, sense of 
 touch, excretion, regulation of body temperature, absorp- 
 tion, and respiration. 
 
 7. The causes producing the first sound of the heart 
 are not definitely ascertained; the following are supposed 
 to be causatory factors: (1) the vibration and closure of 
 the auriculo-ventricular valves, (2) the muscular sound 
 produced by the contraction of the ventricles, and (3) the 
 cardiac impulse against the chest wall. 
 
 The second sound is caused by the vibration due to the 
 closure of the semilunar valves. 
 
 322 
 
MEDICAL RECORD. 
 
 The first sound is heard best at the apex; the second 
 sound is heard best at the base. 
 
 8. The functions of the spinal cord are: (i) The con- 
 duction of impulses and impressions ; (2) as a series of 
 nerve centers. 
 
 The special centers in the spinal cord are the centers 
 for (1) cilio spinal center, (2) for sphincter of bladder, 
 (3) for sphincter of rectum, (4) for erection, (5) for con- 
 traction of uterus, (6) for maintaining tonus of muscles. 
 
 9. "Mechanism of Accommodation. — The lens is an elastic 
 structure, and when released from the flattening influence 
 of its suspensory ligament tends to assume a spherical 
 shape. During accommodation the ciliary muscle (espe- 
 cially the circular fibers) contracts, drawing forward the 
 choroid and relaxing the suspensory ligament ; this dimin- 
 ishes the tension of the lens capsule and allows the in- 
 herent elasticity of the lens to increase its convexity. 
 The change in curvature affects chiefly the anterior sur- 
 face of the lens. This is Helmholtz's theory and the one 
 usually accepted. Lately Tscherning has advanced a dif- 
 ferent theory; he maintains that the ciliary muscle in- 
 creases the tension of the suspensory ligament during con- 
 traction and that this causes peripheral flattening of the 
 lens with bulging anteriorly at its center. The act of ac- 
 commodation is accompanied by contraction of the pupil, 
 and (in binocular vision) by convergence of the visual 
 lines." (May's Diseases of the Eye.) 
 
 10. See Williams' "Obstetrics" (1909), page 81 ; or Hirst's 
 "Obstetrics" (1909), page 57. 
 
 MATERIA MEDICA AND TOXICOLOGY. 
 
 1. IJ. Ammonii carbonatis, 5j. 
 
 Spiritus chloroformi, 5j. 
 Syrupi pruni virginianse, 5j. 
 
 Misturse glycyrrhizae composite, q.s. ad. Jviij. 
 Misce. 
 Signa : One teaspoonful every three hours. 
 The ammonium carbonate is a respiratory stimulant and 
 a stimulating expectorant. The chloroform disguises the 
 taste of the ammonium. The prunus virginiana is a seda- 
 tive and expectorant. The glycyrrhiza is an expectorant. 
 
 2. (a) Symptoms of chronic morphine poisoning: 
 Great mental depression, irresolution, loss of self-control, 
 great longing for the drug, nausea, insomnia, anxiety, 
 melancholia, feeble pulse, diarrhea, muscular cramps, and 
 "lying." 
 
 (b) Symptoms caused by abrupt withdrawal of the 
 drug : Diarrhea, vomiting, insomnia. 
 
 (c) Treatment of acute morphine poisoning: "Wash out 
 the stomach with a dilute solution of potassium permarh 
 
 323 
 
MEDICAL RECORD. 
 
 ganate, leaving about 500 c.c. in the stomach; and main- 
 tain the respiration. In the first or second stage the 
 'ambulatory treatment' should be adopted to prevent, if 
 possible, the establishment of the third stage. If this 
 stage develop, the main reliance is to be placed in main- 
 taming the respiration by artificial methods, until the 
 poison has been eliminated. Strong coffee, or caffein, by 
 the mouth or rectum, are of benefit. The same cannot 
 be said of atropin. The urine should be drawn by the 
 catheter." (Witthaus' Essentials of Chemistry.) 
 
 3. (a) Acetanilid is derived from aniline, by the action 
 on it of glacial acetic acid. 
 
 (b) The continuous use of acetanilid may give rise to 
 decrease in the number of red blood cells ; the face is livid 
 and covered with perspiration, the respirations become 
 slow and shallow, the pulse soft, compressible, and gradu- 
 ally weaker. 
 
 {c) Treatment: Stop further administration of the drug, 
 then support the patient by stimulants, warmth and strych- 
 nine. 
 
 4. (a) Hyoscine is derived from Hyoscyamus. 
 (b) The dose of the hydrobromide is gr. 1/128. 
 
 Its physiological effects: it quiets the cerebrum and pro- 
 duces sleep; it may also produce delirium; it also causes 
 loss of reflex action. 
 
 It is used as a hypnotic, in acute mania, insomnia, hys- 
 teria; also in morphine and alcohol habit; it is also used 
 as a sedative mydriatic in plastic iritis. 
 
 x 
 
 5. Let x == the age of a patient ; then = the f rac- 
 
 x + 12 
 tion of the adult dose which the patient should receive. 
 Thus, a patient of four years old should receive 
 
 4 4 1 
 
 =z — = — of an adult dose. 
 
 4 + 12 16 4 
 
 6. The following table, from Gould and Pyle's Cyclo- 
 pedia of Medicine and Surgery, gives the diagnosis be- 
 tween Ptomaine Poisoning, and Poisoning by Arsenic: 
 
 PTOMAINE POISONING. 
 
 1. Onset often from 2 to 
 24 hours. 
 
 2. Results from eating 
 animal (nitrogenous) food. 
 
 3. Nervous symptoms 
 marked (twitching of facial 
 muscles, tingling sensations, 
 dilated pupils, convulsio ns). 
 
 ARSENIC POISONING. 
 
 i. Onset within half an 
 hour. 
 
 2. History negative. 
 
 3. Nervous phenomena, as 
 seen in autointoxication, ab- 
 sent. 
 
 324 
 
MEDICAL RECORD 
 
 PTOMAINE POISONING. 
 
 4. Early dyspnea, cyano- 
 sis. 
 
 5. Temperature often sub- 
 normal. 
 
 6. Dryness of mouth and 
 fauces, often bitter taste. 
 
 7. Vomitus contains mu- 
 cus, contents of stomach, 
 or bile. 
 
 8. Generally watery diar- 
 rhea, sometimes constipa- 
 tion. 
 
 9. Various cutaneous erup- 
 tions (scarlatinal eruptions, 
 urticaria). 
 
 ARSENIC POISONING. 
 
 4. Dyspnea comes on late 
 in mineral poisoning. 
 
 5. Temperature often ele- 
 vated a degree or two. 
 
 6. Metallic taste in mouth. 
 
 7. Vomitus variable, often 
 tinged with blood, and con- 
 taining trace of poison. 
 
 8. Feces may contain blood 
 and trace of poison. 
 
 9. Cutaneous eruptions ab- 
 sent. 
 
 7. Chloroform acts as an anesthetic by paralyzing and 
 suspending the functions of the higher centers in the cere- 
 brum, while at the same time allowing the lower centers 
 in the medulla to carry on the functions of circulation and 
 respiration. For administration, see Rose and Carless' 
 "Surgery" (1908), pages 1321 and 1324; or Da Costa's 
 (1908), page 1030. 
 
 Tr. strophanthus 
 
 Apomorphine 
 
 (by hypodermic) 
 Carbolic acid 
 
 Chloral hydrate 
 
 ADULT DOSE. I PHYSIOLOGICAL ANTIDOTE. 
 
 TT£. V11J 
 
 gr. i/lO 
 
 gr. j 
 
 gr. xv 
 
 Nitroglycerin ; amyl 
 nitrite 
 None 
 
 Magnesium or sodium 
 
 sulphate 
 
 Strychnine. 
 
 9. Opium depresses the motor activity of the intestines, 
 prevents peristalsis, and causes constipation. 
 
 Thymol is an intestinal antiseptic and disinfectant. 
 
 Bismuth sulnitrate has but little effect on the bowels; 
 it is mildly protective, and astringent. 
 
 io ; (a) The U. S. Pharmacopoeia is an official list of 
 medicinal substances, with definitions, descriptions, or for- 
 mulae for their preparation ; it is recognized by the med- 
 ical profession of the United States, but has no legal 
 authority. 
 
 (b) The National Formulary is a collection of prepara- 
 tions not contained in the U. S. Pharmacopoeia. 
 
 (c) Fluid extracts are liquid alcoholic preparations of 
 
 32: 
 
MEDICAL RECORD. 
 
 nearly uniform strength ; each cubic centimeter of the 
 fluid extract represents one gram of the drug. 
 
 (d) A chemical antidote is one that changes the chem- 
 ical character of the poison, and so renders it inert. 
 
 CHEMISTRY AND URANALYSIS, 
 
 1. Specific gravity is the weight of a substance as com- 
 pared with the weight of a like volume of a given sub- 
 stance, taken as a standard, under similar conditions of 
 temperature and pressure. 
 
 An acid is a compound of an electronegative element or 
 radical with hydrogen, part or all of which hydrogen it 
 can part with in exchange for an electropositive element, 
 without the formation of a base. 
 
 A base is a ternary compound capable of entering into 
 double decomposition with an acid to produce a salt and 
 water. 
 
 Allotropy is the property possessed by some elements 
 (such as oxygen, sulphur, phosphorus) of appearing under 
 different forms in which their general chemical characters 
 are unchanged, but their physical properties vary. 
 
 Synthesis is the formation of compounds from elements 
 or from simpler compounds. 
 
 2. (a) The law of definite proportions: The same com- 
 pound always contains the same elements and in the same 
 proportions. 
 
 (b) Test for iodine: Add starch paste; in the presence 
 of iodine it becomes blue. 
 
 Test for silver : Add hydrochloric acid ; in the presence 
 of silver a white precipitate is formed which is insoluble 
 in nitric acid, but soluble in ammonium hydroxide. 
 
 Test for mercury : The Reinsch test is as follows : To 
 the suspected fluid add a little pure HC1 ; suspend in the 
 fluid a small strip of bright copper foil, and boil. If a 
 deposit forms on the copper, remove the copper, wash it 
 with pure water, dry on filter paper, but be careful not 
 to rub off the deposit. Coil up the copper, and put it into 
 a clean dry, glass tube, open at both ends, and apply heat 
 at the part where the copper is. If mercury is present 
 there will appear in the cold part of the tube a mirror, 
 which will be found on microscopical examination to con- 
 sist of metallic globules of mercury. 
 
 3. Sewage contamination of drinking water can be de- 
 tected by the presence of the colon bacillus ; also by Wank- 
 lyn's or Frankland's method of analysis. A good drinking 
 water is one that is cool, limpid, odorless, neither sweet 
 nor salty, has no sediment, is transparent; it should have 
 not more than 30 or 40 grains of total solids to the gallon ; 
 chlorine should be less than 4 parts in 100,000; nitrites, 
 none ; nitrates, none or a mere trace. 
 
 326 
 
MEDICAL RECORD. 
 
 4. (a) Albumin is found in the urine: "(1) In fevers, 
 as typhoid and pneumonia. (2) In valvular heart lesions, 
 degeneration of the heart muscles, diseases of the coronary 
 arteries, impeded pulmonary circulation, in pregnancy by 
 pressure upon the renal veins, in intestinal catarrh, and in 
 Asiatic cholera. (3) In purpura, scurvy, leukemia, per- 
 nicious anemia, jaundice, diabetes, and syphilis. (4) After 
 taking lead, mercury, iodine, phosphorus, arsenic, anti- 
 mony, chloroform, cantharides, oxalic, carbolic, salicylic 
 or the mineral acids, turpentine and nitrates. (5) In large 
 amounts in acute nephritis and chronic parenchymatous 
 nephritis ; in small amounts in chronic interstitial nephritis 
 and amyloid kidney/' (Witthaus' Essentials of Chem- 
 istry.) 
 
 (b) "Casts in the urine occur in nephritis, and different 
 varieties are found in the different forms of that disease. 
 Hyaline casts occur in all forms of nephritis, in congestion 
 of the kidneys, in jaundice, and even in health. Waxy 
 casts occur especially in chronic parenchymatous nephritis. 
 Epithelial casts occur especially in acute parenchymatous 
 nephritis. Granular casts are especially common in chronic 
 nephritis, but they may occur in acute nephritis. Fatty 
 casts occur chiefly in chronic parenchymatous nephritis. 
 Blood casts occur in acute and chronic hemorrhagic 
 nephritis. Pus and bacterial casts are occasionally met 
 with in suppurative nephritis." (From Stevens' Practice 
 of Medicine.) 
 
 5. Test for indican in the urine : The urine is mixed 
 with one-fifth its volume of 20 per cent, solution of lead 
 acetate and filtered. The filtrate is mixed with an equal 
 volume of fuming hydrochloric acid containing 3:1000 of 
 ferric chlorid, a few drops of chloroform are added, and 
 the mixture strongly shaken one to two minutes. With 
 normal urine the chloroform remains colorless, or almost 
 so ; but if an excess of indoxyl compounds be present the 
 chloroform is colored blue, and the depth of the color is 
 a rough indication of the degree of the excess. 
 
 I ndic anuria is found in hypochlorhydria ; in hyperchlor- 
 hydria of gastric ulcer ; in conditions in which there is 
 diminished peristalsis of the small intestines, as in ileus 
 and peritonitis, not in simple constipation ; also in condi- 
 tions in which putrefactive changes occur in the body else- 
 where than in the intestine, as in empyema, putrid bron- 
 chitis, gangrene of the lungs, etc. (From Witthaus , Essen- 
 tials of Chemistry.) 
 
 6. For the diazo reaction of Ehrlich, two solutions are 
 required: (1) A saturated solution of sulphanilic acid in 
 a mixture of 50 c.c. of hydrochloric acid and 950 c.c. of 
 water; and (2) a 0.5 per cent, solution of sodium nitrite. 
 
 To. make the test, 1 c.c. of (2) is added to 40 c.c. of (1) 
 
 327 
 
MEDICAL RECORD. 
 
 and the mixture thoroughly shaken. Equal quantities of 
 this mixture and the urine to be tested are shaken together 
 in a test tube, and i c.c. of ammonia is then floated upon 
 the surface, when, in an affirmative result, a red band is 
 formed at the junction of the fluids. 
 
 Its diagnostic value is uncertain. Von Jaksch "disclaims 
 for this test any clinical importance whatever." Others 
 have claimed that the reaction is pathognomonic of typhoid ; 
 but it has been found in other diseases besides typhoid — 
 namely, phthisis, pneumonia, measles, scarlet fever, small- 
 pox, and malaria. 
 
 7. A comparatively easy test for Urea is that of Fowler, 
 based upon the loss of the specific gravity of the urine 
 after the decomposition of the urea by hypochlorite. "To 
 apply this method the specific gravity of the urine is care- 
 fully determined, as well as that of the liquor sodse 
 chlorinatae (Squibb's). One volume of the urine is then 
 mixed with exactly seven volumes of the liquor sodse 
 chlorinatae, and, after the first violence of the reaction has 
 subsided, the mixture is shaken from time to time during 
 an hour, when the decomposition is complete ; the specific 
 gravity of the mixture is then determined. As the reaction 
 begins instantaneously when the urine and reagent are 
 mixed, the specific gravity of the mixture must be calcu- 
 lated by adding together once the specific gravity of the 
 urine and seven times the specific gravity of the liquor 
 sodse chlorinatae, and dividing the sum by eight. From 
 the quotient so obtained the specific gravity of the mix- 
 ture after decomposition is subtracted; every degree of 
 loss in specific gravity indicates 0.7791 gram of urea in 
 100 c.c. of urine. The specific gravity determinations must 
 all be made at the same temperature ; and that of the 
 mixture only when the evolution of gas has ceased en- 
 tirely/' (Witthaus' Manual of Chemistry.) 
 
 8. The presence in the stomach contents, after a test 
 meal, of considerable quantities of organic acids is sup- 
 posed to be pathological. Lactic acid, particularly, is sup- 
 posed to be diagnostic of cancer of the stomach. Organic 
 acids, as a rule, denote pyloric stenosis, gastric dilatation, 
 or deficient motor power of the stomach. 
 
 "The presence of lactic acid is detected by Uffelmann's 
 reagent, which consists of a solution of Fe 2 Cl 6 and phenol, 
 diluted to an amethyst-blue color, which is changed to 
 yellow by lactic acid. In order to avoid error by the 
 action of other substances which have a like action upon 
 the reagent, 10 c.c. of the filtered gastric contents are 
 agitated with ether, and the ethereal extract separated and 
 agitated with the reagent; or it may be evaporated, the 
 residue dissolved in water, and the solution added to the 
 reagent." (Witthaus' Manual of Chemistry.) 
 
 328 
 
MEDICAL RECORD. 
 
 9. The normal reaction of cow's milk is acid or neutral. 
 If acid, lime water, or sodium bicarbonate must be added 
 after sterilization. 
 
 10. Test for blood : Let some of the stained material 
 soak thoroughly in a very small quantity of saturated solu- 
 tion of sodium chloride. Put a few drops of the fluid on 
 a slide, cover with a cover-glass, let evaporation occur, 
 allow a drop of glacial acetic acid to enter from the side, 
 and gently warm. On cooling, haemin crystals form, and 
 can be seen under the microscope. 
 
 The freezing point for blood is given as 0.56 . 
 
 BACTERIOLOGY. 
 
 1. The specific microorganisms have been recovered from 
 the blood, in the following diseases : Typhoid, relapsing 
 fever, cerebrospinal meningitis, malaria, diphtheria, ery- 
 sipelas, influenza, tuberculosis, cholera, anthrax, pneu- 
 monia, syphilis (?), leprosy, bubonic plague, gonorrhea, 
 tetanus. 
 
 2. (a) To demonstrate the existence of tubercle bacilli 
 in the sputum : The sputum must be recent, free from par- 
 ticles of food or other foreign matter ; select a cheesy- 
 looking nodule and smear it on a slide, making the smear 
 as thin as possible. Then cover it with some carbol- 
 fuchsin, and let it steam over a small flame for about 
 two minutes, care being taken that it does not boil. Wash 
 it thoroughly in water and then decolorize by immersing 
 it in a solution of any dilute mineral acid for about a min- 
 ute. Then make a contrast stain with solution of Loeffler's 
 methylene blue for about a minute ; wash it again and 
 examine with oil immersion lens. The tubercle bacilli will 
 appear as thin red rods, while all other bacteria will ap- 
 pear blue. 
 
 (b) Gram's method: "The section is stained in anilin- 
 water gentian-violet (Koch-Ehrlich) diluted with one- 
 third its volume of water. The section remains in this for 
 about ten minutes at the temperature of the incubator. 
 From this it is taken out and washed alternately in Gram's 
 iodine solution and alcohol until all the naked-eye color has 
 been extracted. It is then put into a watery solution of 
 eosin or Bismarck-brown for one minute, again washed in 
 alcohol a few seconds, and then put for one-quarter minute 
 in absolute alcohol. After this it is transferred to xylol 
 for one-half minute, then lifted to a slide, mounted in 
 Canada balsam, and examined." 
 
 Weigerfs modification: "Stain sections in the Koch-Ehr- 
 lich anilin-water gentian-violet solution for five or ten 
 minutes; wash them afterward in water or physiological 
 salt solution. Transfer to slide and remove excess of fluid 
 with blotting-paper. Treat with the iodine solution of 
 
 329 
 
MEDICAL RECORD. 
 
 Gram for three minutes. Take up the excess of solution 
 with blotting-paper. Cover the section with anilin oil, wash 
 out the oil with xylol, and mount in xylol balsam. The 
 anilin oil in this case acts as a decolorizing agent, and 
 should be removed carefully, otherwise the specimen will 
 not keep." — (Archinard.) 
 
 Gram Positive: Staphylococcus pyogenes aureus and al- 
 bus ; streptococcus pyogenes ; micrococcus tetragenus ; 
 pneumococcus ; Klebs-Loeffler bacillus; tubercle bacillus; 
 tetanus bacillus ; anthrax bacillus. 
 
 Gram Negative: Gonococcus; diplococcus mtracellularis 
 meningitidis; typhoid bacillus; colon bacillus; influenza 
 bacillus; glanders bacillus. 
 
 3. Diphtheria antitoxin is obtained from the horse, the 
 animal having been rendered artificially immune by re- 
 peated injections extending over a period of several 
 months of gradually increasing quantities of the strongest 
 diphtheria toxin. As the bacilli themselves are not in- 
 jected, the horse does not become infected with diphtheria, 
 but he gradually acquires a tolerance for the toxins of the 
 disease and develops in his blood a substance (antitoxin) 
 which has the power to neutralize those toxins. At the 
 proper time, when it is thought that his blood has acquired 
 the requisite degree of potency, the animal is bled, and the 
 serum — the part of the blood containing the antitoxin — 
 is carefully separated from the clot, filtered, and standard- 
 ized. The last procedure is accomplished by determining 
 the quantity of antitoxin serum required to offset the 
 effects of the minimum quantity of toxin necessary to kill 
 a guinea-pig in a definite time. The strength of the anti- 
 toxin is measured in units, a unit containing the amount 
 of antitoxin required to save the life of a guinea-pig which 
 has been injected with 100 faial doses of toxin." — (Stevens' 
 Materia Me die a.) 
 
 How antitoxin produces immunity and effects cure is not 
 known, but theories deduced from observed facts are as 
 follows : "As the various pathogenic bacteria produce the 
 causative toxins of their respective diseases, so the organic 
 cells of the body, reacting under the stimulus of the poisons 
 thus introduced, immediately proceed to elaborate defensive 
 bodies, which if produced in sufficient quantity will neutral- 
 ize the effects of the toxins. Residual anti-bodies remain- 
 ing in the blood after recovery render the animal immune 
 for a time against the disease. The immunizing and cura- 
 tive effects obtained by the injection of the. blood serum 
 of an immunized animal into the circulation of another ani- 
 mal are due either to direct chemical neutralization of the 
 toxins themselves by the antibodies so introduced (Beh- 
 ring, Kitasato), or to a particular influence exerted by 
 the antibodies upon the living cells of the organism which 
 
 330 
 
MEDICAL RECORD. 
 
 being affected in two opposite directions, remain neutral to 
 the disease (Buchner). Some authorities hold that these 
 results are due to the conjoint action of leucytic and chem- 
 ical forces. Ehrlich's sidechain theory assumes that every 
 toxin contains toxophore molecules having direct toxic ac- 
 tion, and haptophore molecules which combine the toxo- 
 phores with a similar combining group of molecules in the 
 tissue cell of the attacked organism. The tissue cell mole- 
 cules being destroyed by the toxophores, a rapid and pro- 
 fuse regeneration of similar molecules occurs in side chains 
 and these molecules overgrowing are carried into the circu- 
 lation, becoming the antitoxin, which acts by combining 
 with the haptophores of newly arrived toxin, using up their 
 combining power before they can reach the tissue cells." — 
 (Potter's Materia Medica, etc.) 
 
 4. See French's "Practice of Medicine" (1907), pages 
 406, 214, 1206, 139, and 128; or Osier's "Practice of Medi- 
 cine" (1909), pages 259, 159, and no. 
 
 The gonococcus is a diplococcus, and is recognized by 
 staining with the ordinary aniline dyes, being found inside 
 the pus cells ; it is Gram negative, and can be cultivated 
 on human blood serum, but will not grow on the ordinary 
 culture media. 
 
 5. (a^> ^ee French's "Practice of Medicine" (1907), pages 
 315 and 222; or Osier's "Practice of Medicine" (1909), 
 pages 130, 221, and 266. 
 
 (b) Diplococcus pneumonic? is a small oval coccus, alone 
 or in pairs, sometimes in chains like streptococci ; generally 
 oval and double as a diplococcus, and surrounded by a cap- 
 sule. In solid media it grows as above; in liquid media 
 the cells are more round, and the chains are longer. 
 
 PRACTICE OF MEDICINE. 
 
 1. Lichen planus "is a chronic inflammatory disease of 
 the skin characterized by small, flat, angular, umbilicated. 
 glazed, reddish papules, accompanied by intense itching. 
 
 The eruption may appear suddenly or gradually and usual- 
 ly appears on the extremities. The lesions vary in size 
 from a pinhead to a pea and tend to occur in patches which 
 often assume a linear form. The papules are flat, angular, 
 glazed, slightly umbilicated, and of a reddish or violaceous 
 color. As -the affection progresses scales form on the le- 
 sions. Itching js marked. After the eruption subsides, the 
 sites of the lesions remain pigmented for an indefinite pe- 
 riod."— (Hughes' Practice of Medicine.) 
 
 2. See French's "Practice of Medicine" (1907), page 
 344; or usler's "Practice of Medicine" (1909), page 298. 
 
 3. See French's "Practice of Medicine" (1907), page 656: 
 or Osiers' "Practice of Medicine" (1909), page 606. 
 
 331 
 
MEDICAL RECORD. 
 
 4. See French's "Practice of Medicine" (1907), pages 910 
 and 796; or Osier's "Practice of Medicine" (1909), pages 
 709 and 518. 
 
 5. See French's "Practice of Medicine" (1907), page 421; 
 or Osier's "Practice of Medicine" (1909), page 267. 
 
 6. See French's "Practice of Medicine" (1907), page 769; 
 or Osier's "Practice of Medicine" (1909), pages 494 and 
 
 474. 
 
 7. See French's "Practice of Medicine" (1907), page 1057; 
 or Osier's "Practice of Medicine" (1909), page 921. 
 
 8. See French's "Practice of Medicine" (1907), page 919; 
 or Osier's "Practice of Medicine" (1909), page 393. 
 
 9. Arteriosclerosis is a condition in which the walls of 
 an artery, especially the intima, become hard, dry, and 
 thickened. 
 
 Usual causes : Syphilis, alcoholism, gout, Bright' s dis- 
 ease, overeating, and excessive muscular exertion. It is 
 most liable to occur in old age. 
 
 It is frequently associated with : Chronic interstitial 
 nephritis, chronic myocarditis, paralysis, and gangrene. 
 
 10. The principal causes of hematuria are : ( 1 ) Condi- 
 tions in which the blood is affected, as in the infectious 
 diseases, in scurvy, pernicious anemia, and purpura; (2) 
 traumatism or inflammations in any part of the urinary 
 tract; (3) congestion of the kidneys secondary to dis- 
 ease of the lungs, heart, or liver. 
 
 In renal hematuria the blood and urine are intimately 
 mixed, tube casts are apt to be present, and there may be 
 renal colic or pain in the lumbar region. In vesical hema- 
 turia the blood and urine are not so well mixed, and pure 
 blood is apt to be passed at the end of urination. In 
 urethral hematuria the urine first passed is bloody. 
 
 SURGERY. 
 
 1. See Rose and Carless' "Surgery" (1908), pages 183 
 and 188; or Da Costa's "Surgery" (1908), pages 296 and 
 302. 
 
 2. A wound is a solution of surface continuity, caused 
 by sudden mechanical force. 
 
 Wounds are classified as : 
 
 I. Contused and open wounds. 
 
 11. Open wounds may be : Incised, lacerated, contused, 
 punctured, gunshot, or poisoned; also penetrating and per- 
 forating. 
 
 III. Aseptic and septic. 
 
 3. See Rose and Carless' "Surgery" (1908), pages 238 
 and 295; or Da Costa's "Surgery" (1908), pages 252, 374 
 and 386. 
 
 4. After a blank-cartridge wound of the palm of the 
 hand, the patient should be anesthetised, hemorrhage 
 
 332 
 
MEDICAL RECORD. 
 
 checked, dead tissue and any foreign matter should be 
 removed, the wound thoroughly disinfected and drained, 
 ind it might be well to administer at once a prophylactic 
 dose of antitetanic serum. 
 
 5. See Rose and Carless' "Surgery" (1908), page 336; 
 or Da Costa's ''Surgery" (1908), page 406. 
 
 6. A fracture is the sudden solution of the continuity of 
 a bone or cartilage. 
 
 Fractures are variously classified: 
 
 (a) Simple, compound, and complicated. 
 
 (b) Complete (transverse, oblique, spiral, longitudinal) 
 and incomplete (fissured, greenstick). 
 
 (c) Single and multiple. 
 
 (d) Comminuted, impacted, etc. 
 
 (e) Intra- and extraarticular; intra- and extracapsular. 
 
 7. See Rose and Carless' "Surgery" (1908), page 558; or 
 Da Costa's "Surgery" (1908), page 541. 
 
 8. See Rose and Carless' "Surgery" (1908), pages 914 
 and 919; or Da Costa's "Surgery" (1908), page 769. 
 
 9. See Rose and Carless' "Surgery" (1908), page 684; or 
 Da Costa's "Surgery" (1908), page 554. 
 
 10. See Rose and Carless' "Surgery" (1908), page 1103; 
 or Da Costa's "Surgery" (1908), page 995. 
 
 GYNECOLOGY. 
 
 1. In extrauterine pregnancy, see below — Obstetrics, 
 Question 6. 
 
 In the ovarian cyst : The history must be taken very 
 carefully, and there will be found absence of the chief 
 signs of pregnancy; there may be the characteristic facies; 
 and the tumor is soft and fluctuating. 
 
 2. See Williams' "Obstetrics" (1909), page 831; or 
 Hirst's "Obstetrics" (1909), page 898. 
 
 3. See Hirst's "Obstetrics" (1909), page 614. 
 
 4. A uterine polypus is a tumor attached to the internal 
 wall of the uterus by a small pedicle. Symptoms: In- 
 creased hemorrhage at first at the menstrual periods; later 
 the bleeding is continuous. If the polypus has been forced 
 through the internal os there will be painful uterine con- 
 tractions. Sterility, endometritis, and later anemia may re- 
 sult from loss of blood. Diagnosis: Examination with the 
 finger will detect the pyriform tumor protruding through 
 the os or extending into the vagina. If attached low down, 
 the linger passed around the cervix will soon feel the point 
 of attachment. Uterine polypus may be confounded with 
 inversion of the uterus. But in the latter the fundus of the 
 uterus is not in its proper place. 
 
 Treatment: When the polypus is attached inside the uter- 
 ine cavity high up, the cervix should be dilated; the tu- 
 mor may be grasped in a pair of forceps and the pedicle 
 
 333 
 
MEDICAL RECORD. 
 
 twisted off, or the growth may be removed by galvanocau- 
 tery or wire ecraseur. If attached low down, a V-shaped 
 incision can be made at the base of the pedicle in the mu- 
 cous membrane and the tumor removed. The uterus may 
 then be packed with iodoform gauze. Multiple polypi may 
 be removed with a sharp curet. All these operations should 
 be done under the strictest asepsis. Endometritis accom- 
 panying the condition should be treated as in other cases. 
 — (From Well's Compend. on Gynecology.) 
 
 5. (a) Two indications for hysterectomy. Carcinoma 
 and fibroids. 
 
 (b) As to preference between the vaginal and abdominal 
 routes, the following is taken from Garrigues' Gynecology : 
 "If the vaginal route is available, it should be preferred, 
 because it entails much less shock, requires a simple after- 
 treatment, does not leave any visible cicatrix, predisposes 
 less to hernia, and allows the patient to resume work in 
 shorter time. On the other hand, the vaginal route is more 
 difficult on account of the limited space. Hemorrhage is 
 more troublesome to check, adhesions are harder to sepa- 
 rate, and the bladder and intestine more exposed to injury 
 and less accessible for repair. The pelvic cavity cannot be 
 seen so well, and the abdominal not at all. If tissue is left 
 to mortify, it emits an offensive odor." 
 
 DISEASES OF CHILDREN. 
 
 i. See French's "Practice of Medicine" (1907), page 932; 
 or Osier's "Practice of Medicine" (1909), page 426. 
 
 2. See French's "Practice of Medicine" (1907), pages 
 202, 204, and 649; or Osier's "Practice of Medicine" (1909), 
 pages 149 and 602. 
 
 3. To overcome constipation, the fats (or both fats and 
 proteids) should be increased. 
 
 4. See French's "Practice of Medicine" (1907), pages 
 1 124 and 889; or Osier's "Practice of Medicine" (1909), 
 pages 1057, 1063, and 685. 
 
 5. See French's "Practice of Medicine" (1907), page 742; 
 or Osier's "Practice of Medicine" (1909), page 468. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), page 280; or Hirst's 
 "Obstetrics" (19^9), page 414. 
 
 2. See Williams' "Obstetrics" (1909), page 803; or Hirst's 
 "Obstetrics" (1909), page 433. 
 
 3. In contracted and deformed pelvis, the different 
 methods to be considered in delivery of the child are : 
 (1) Induction of premature labor; (2) Forceps; (3) Ver- 
 sion; (4) Craniotomy; (5) Cesarean section, or one of its 
 modifications ; (6) Symphyseotomy. 
 
 So many things have to be taken into consideration that 
 
 334 
 
MEDICAL RECORD. 
 
 it is quite impossible to lay down any hard and fast rules 
 to govern every case. The following table (from King) is 
 
 a safe guide : 
 
 WHEN CONJUGATE DIAMETER 
 OF BRIM MEASURES : 
 
 Between 4 and sy 2 inches. . . 
 Between y/ 2 and 2^4 inches. 
 
 Between 2yi and 2 inches. . . 
 
 At 2 inches or less 
 
 THE MODE OF DELIVERY AT 
 TERM IS: 
 
 By Forceps. 
 f By Forceps, Version. 
 J Symphyseotomy. 
 ] Cesarean section, or 
 I Craniotomy, pro re nata. 
 f Cesarean section, if child 
 
 alive. 
 [ Craniotomy, if child dead. 
 ' Cesarean section always. 
 Craniotomy excluded, 
 
 whether child dead 
 
 or alive. 
 
 4. Treatment of prolapsed funis consists in: (1) Not 
 rupturing the membranes prematurely, unless there is some 
 positive indication; (2) postural treatment, in which the 
 woman is placed on her back or on the opposite side to 
 that on which the cord lies, with hips and pelvis elevated, 
 or the knee-chest position may be adopted; (3) reposition 
 of the cord, either manually, or with some form of re- 
 positor; (4) speedy delivery, by forceps or podalic version. 
 
 5. See Williams' "Obstetrics" (1909), page 846; or Hirst's 
 "Obstetrics" (1009), page 939. 
 
 6. Diagnosis: "When extrauterine pregnancy exists 
 there are: (1) The general or reflex symptoms of preg- 
 nancy; they have often come on after an uncertain period 
 of sterility; nausea and vomiting appear aggravated. 
 
 (2) Then comes a disordered menstruation, especially 
 metrorrhagia, accompanied with gushes of blood, and with 
 pelvic pain coincident with the above symptoms of preg- 
 nancy ; pains are often /ery severe, with marked tenderness 
 within the pelvis ; such symptoms are highly suggestive. 
 
 (3) There is the presence of a pelvic tumor characterized 
 as a tense cyst, sensitive to the touch, actively pulsating; 
 this tumor has a steady and progressive growth. In the 
 first two months it has the size of a pigeon's egg; in the 
 third month it has the s.'.re of a hen's egg; in the fourth 
 month it has the size of two fists. (4) The os uteri is 
 patulous ; the uterus is displaced, but is slightly enlarged 
 and empty. (5) Symptoms No. 2 may be absent until the 
 end of the third month, when suddenly they become severe, 
 with spasmodic pains, followed by the general symptoms 
 of collapse. (6) Expulsion of the decidua, in part or 
 
 335 
 
MEDICAL RECORD. 
 
 whole. Nos. i and 2 are presumptive signs; Nos. 3 and 4 
 are probable signs; Nos. 5 and 6 are positive signs." 
 (American Text-Book of Obstetrics.) 
 
 Treatment consists in removal of the product of concep- 
 tion, by a laparotomy, as soon as the diagnosis is made. 
 
 7. See Hirst's "Obstetrics" (1909), page 935. The cause 
 of the former is pressure. 
 
 8. The indications for Podalic Version are: (1) In 
 transverse presentations; (2) in placenta prsevia; (3) in 
 malpresentations of the head; (4) in simple flattened pelvis, 
 and in minor degrees of pelvic contraction; (5) in pro- 
 lapsed funis; (6) in sudden death of the mother; and 
 (7) in any case where speedy delivery is imperative. 
 
 9. See Williams' "Obstetrics" (1Q09), page 883; or Hirst's 
 "Obstetrics" (1909), pages 7^ and 737. 
 
 10. See Williams' "Obstetrics" (1909), page 913; or 
 Hirst's "Obstetrics" (1909), page 708. 
 
 PATHOLOGY. 
 
 x'. In secondary anemia, the blood would show: (1) A 
 diminution in the number of red corpuscles ; (2) a diminu- 
 tion in the amount of hemoglobin, perhaps greater than 
 that of the red corpuscles; (3) poikilocytosis, and varia- 
 tions in the size of the red corpuscles ; (4) the presence 
 of a few nucleated red corpuscles; (5) a moderate leuco- 
 cytosis. 
 
 In pernicious anemia the blood would show: (1) A 
 diminution in the number of red corpuscles ; (2) a relative 
 increase in the amount of hemoglobin; (3) poikilocytosis; 
 (4) the presence of nucleated red cells; (5) variation in 
 the size of the red cells; (6) the leucocytes may be 
 diminished. 
 
 The skin is usually discolored (yellowish) ; fatty degen- 
 eration of the heart is common ; the liver may be fatty. 
 
 In chlorosis, the blood shows: (1) A great diminution 
 in the amount of hemoglobin; (2) a slight diminution in 
 the number of red corpuscles; (3) poikilocytosis; (4) oc- 
 casionally a few nucleated red corpuscles; (5) a very slight 
 leucocytosis. 
 
 The skin is generally yellowish-green, and the blood and 
 conjunctiva pale. 
 
 2. See French's "Practice of Medicine" (1907), page 
 955; or Osier's "Practice of Medicine" (1909), page 370. 
 
 3. See French's "Practice of Medicine" (1907), page 839; 
 or Osier's "Practice of Medicine" (1909), page 567. 
 
 4. See French's "Practice of Medicine" (1907), page 70; 
 or Osier's "Practice of Medicine" (1999), page 65. 
 
 5. See French's "Practice of Medicine" (1907), pages 
 892, 898, and 902; or Osier's "Practice of Medicine" (1909), 
 pages 687, 692, and 695. 
 
 33& 
 
MEDICAL RECORD 
 
 I. 
 
 EYE AND EAR. 
 
 GLAUCOMA. 
 
 Age 
 
 Tension 
 
 Congestion 
 
 Cornea 
 
 Anterior chamber. 
 Pupil 
 
 Pain 
 
 Vision 
 
 Treatment , 
 
 Over fortv. 
 
 Plus. 
 
 General, especially 
 
 scleral. 
 Cloudy and steamy 
 
 surface. 
 Shallow. 
 Dilated, oval. 
 
 Severe, continu- 
 ous. 
 Much reduced. 
 
 Eserine, pilocarpine 
 
 iridectomy. 
 
 IRITIS. 
 
 Any. 
 
 Normal. 
 
 General, especially 
 
 circumcorneal. 
 Cloudy. 
 
 Unchanged. 
 Contracted, syn- 
 echias 
 Especially at night. 
 
 Somewhat re- 
 duced. 
 Atropine. 
 
 (From Ailing and Griffin's Diseases of the Eye and Ear.) 
 2. Choked disc is a condition in which the optic papilla 
 
 is swollen, congested, and inflamed ; it is due to increased 
 
 intracranial pressure. 
 It occurs in brain tumors, tuberculous meningitis, abscess 
 
 of the brain, syphilis, nephritis, rheumatism, toxic agents 
 
 (as lead or alcohol), infectious diseases, and anemia. 
 V 3. Myopia is a condition in which the anteroposterior 
 
 axis of the eye is abnormally long, and parallel rays are 
 
 focused in front of the retina. 
 
 ^ Hypermetropic! is a condition in which the anteropos- 
 terior axis of the eye is abnormally short, and parallel rays 
 
 are focused behind the retina. 
 
 Astigmatism is a condition in which owing to a greater 
 
 curvature of the eye in one meridian than in others, the 
 
 refractive power of the eye varies. 
 
 4. Treatment of a discharging ear: Cleanliness and 
 drainage are primary essentials. The discharge may be 
 removed by sterile cotton, and the use of a warm mild 
 antiseptic lotion. A solution of carbolic acid 1 140 may be 
 dropped in and allowed to remain in the ear for a few 
 minutes. Alcohol may be used when granulations appear. 
 Treatment must only be undertaken once or twice a day, 
 at the first ; and the intervals gradually lengthened as the 
 discharge becomes less. This must be persevered in for a 
 long time. Paracentesis may be necessary, and later on, 
 in complicated cases, the ossicles may have to be removed. 
 
 5. Otitis media. Acute catarrhal otitis media is fre- 
 quently caused by acute coryza and the infectious fevers. 
 There is a painless obstructed sensation in one or both 
 
 337 
 
MEDICAL RECORD. 
 
 ears, impairment of hearing, and tinnitus. The intiamma- 
 tion causes closure of the Eustachian tube. Inflation and 
 aspiration of the middle ear and syringing and douching 
 the nares and nasopharynx must be avoided. A moderate 
 spray of Dobell's solution may be used. If pain is present, 
 dry heat, in the form of hot-water bottle, hot stone wrapped 
 in flannel, etc., may be applied. A few drops (ioo), 
 warmed, of carbolic acid solution (i 40), or- one of forma- 
 lin (1:2000), may be instilled into the ear. 
 
 "Acute purulent otitis media: Acute catarrhal otitis 
 media, instead of undergoing resolution, may pass into 
 acute purulent otitis media (especially in exanthemas) 
 from the passage of pathogenic germs from the naso- 
 pharynx into the middle ear. The pain will become more 
 intense, the hearing dull; tinnitus will become louder and 
 more distressing, and fever usually sets in. Dry heat al- 
 lays the pain. Warmed water or warmed carbolic acid 
 solution (1:40) may be used. Inflations, aspirations, etc., 
 should be avoided. If the nares are filled with tough secre- 
 tions, a spray of Dobell's solution may be used. If the 
 pain continues over six hours in a child or over twelve 
 hours in an adult without spontaneous perforation of the 
 tympanic membrane, paracentesis of that structure should 
 be performed. The concha and meatus should be smeared 
 with petrolatum to avoid chapping, and the secretions 
 should be gently mopped off as they appear. Under this 
 treatment the ear usually returns to normal in two to three 
 weeks." — (Gould and Pyle's Pocket Cyclopedia of Medicine 
 and Surgery.) 
 
 MEDICAL JURISPRUDENCE. 
 
 i. Phenomena and signs of death, are : The complete 
 and permanent cessation of circulation and respiration, 
 rigor mortis, loss of body heat, pallor of the body, putre- 
 faction. 
 
 2. It is, probably not possible to distinguish absolutely 
 human blood from that of other mammals. By careful 
 measurements of the red corpuscles under the high powers 
 of modern microscopes, human blood can be readily dis- 
 tinguished from that of some animals; but in other cases, 
 such as the differential diagnosis between the blood of a 
 man and that of a dog, there is no absolute certainty. 
 
 3. A sure sign of hanging antemortem is the flow of 
 saliva from the mouth, down the chin, and on to the chest. 
 This could not occur in a case of hanging postmortem, as 
 the secretion of saliva is a vital process. 
 
 4. Life insurance is a contract whereby the company 
 insuring, in consideration of a certain premium payable as 
 arranged, agrees to pay a certain amount at the death of 
 the assured to his heirs or other designated person, or to 
 the insured himself if living at a certain date. 
 
 338 
 
MEDICAL RECORD. 
 
 The premium rate depends on: The age, physical con- 
 dition, family history, occupation, residence, personal hab- 
 its, health, etc., of the applicant. 
 
 5. For normal duration of pregnancy: See Williams' "Ob- 
 stetrics" (1909), page 193; or Hirst's "Obstetrics" (1909).. 
 page 210. 
 
 Signs of recent delivery. — In the living: Woman is more 
 or less weak, and incapable of exertion; pallor; soft ab- 
 domen with relaxed skin, and linese albicantes : breasts, 
 full, tumid, and secreting milk; presence of colostrum 
 corpuscles in the milk ; secondary areola ; external genitals 
 relaxed and tumefied; os uteri swollen and dilated; fundus 
 hard and globular; lochial discharge; absence of four- 
 chette; lacerated cervix. In the dead: Uterus enlarged, 
 thick and soft; uterus contains blood, clots, and debris of 
 decidua ; tubes and ovaries congested. 
 
 PREVENTIVE MEDICINE. 
 
 1. See French's "Practice of Medicine" (1907), pages 
 309, 194, and 324; or Osier's "Practice of Medicine" (1909), 
 pages 112, 207, and 138. 
 
 2. Typhoid fever is preventable. When the municipal 
 authorities do not consider it their duty to supply pure 
 water, each household should boil all water that is to be 
 used for drinking or for washing dishes, etc. ; milk should 
 be .boiled also; and no ice should be put in water or other 
 drink or food; flies should be kept out of the house as 
 far as possible, by means of screens or otherwise; all dis- 
 charges from the sick person must be disinfected; all 
 utensils, dishes, etc., used by the patient must be thor- 
 oughly cleansed, and boiled every day; soiled linen must 
 be soaked in a disinfectant solution before being washed; 
 after each attendance on a patient, physicians, nurses, and 
 others should wash their hands in a disinfectant ; thorough 
 sterilization of all bedding, etc., must be performed after 
 the disease is over. 
 
 3. Diphtheria is transmitted by contact with those al- 
 ready infected, by fomites, by careless disposal of secre- 
 tions, by coughing or sneezing whereby the bacilli are car- 
 ried through the air to the nose or mouth of others. 
 
 Yellozv fever is transmitted through the bite of an in- 
 fected mosquito (Stegomyia fasciata). 
 
 Typhoid fever is transmitted through the food and 
 drink becoming contaminated : flies may aid in this con- 
 tamination. 
 
 4. Period of Quarantine for: (a) Scarlet fever: till 
 the patient is quite free from sore throat or discharges 
 of any kind, and the desquamation has entirely disap- 
 peared; generally six to eight weeks. ^ 
 
 (b) Diphtheria: ^11 the patient is free from all signs 
 
 339 
 
MEDICAL RECORD. 
 
 of congestion or rhinitis, and continued bacteriological ex- 
 amination is persistently negative. 
 
 (c) Smallpox: till all crusts or scabs have entirely dis- 
 appeared. 
 
 5. Simple plan of ventilation: Raise the lower sash of a 
 window by an accurately fitting piece of wood, so that a 
 corresponding space is left between the meeting-rails in 
 the center of the window ; through this space fresh air 
 enters, and is directed towards the ceiling. There is thus 
 ventilation without draught. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 State Board of Health of Mississippi. 
 
 ANATOMY. 
 
 1. Through what arteries is the collateral circulation 
 carried on after ligation of the femoral below Scarpa's 
 triangle ? 
 
 2. In amputation of the forearm three inches above the 
 wrist, what arteries will it be necessary to tie, and of what 
 are they branches? 
 
 3. Name the ganglia connected with the fifth pair of 
 cranial nerves. 
 
 4. Name the muscles that move the humerus (a) for- 
 ward, (b) backward, (c) inward. 
 
 5. Describe the diaphragm, its principal openings, and its 
 nerve supply. 
 
 6. What bones make up the pelvis? Describe each. 
 
 7. Locate and describe the bladder. 
 
 8. Name the bones of the ankle joint and give their 
 relations. 
 
 PHYSIOLOGY. 
 
 1. What are the causes of the apex beat of the heart? 
 
 2. Mention the muscles brought into play during the act 
 of deglutition. 
 
 3. Describe the function of the ileocecal valve. 
 
 4„ What effect have strong alcoholic stimulants on the 
 gastric juice? 
 
 5. How are the vocal sounds produced? 
 
 6. How does the impairment of the function of the 
 kidneys affect that of the skin and lungs? 
 
 7. What is the function of the glossopharyngeal nerve? 
 
 8. What are the uses of perspiration? 
 
 MATERIA MEDIC A. 
 
 i. Give two derivatives of morphine used in medicine, 
 with dose of each. 
 2. What are the sources of salicylic acid? 
 
 340 
 
MEDICAL RECORD. 
 
 3. What is the source of carbo ligni, and what are its 
 therapeutic uses? 
 
 4. Give the composition of (a) black wash, (b) Dover's 
 powders. 
 
 5. Name six drugs containing large quantities of tannic 
 acid. 
 
 6. Name and describe three antiseptics useful for in- 
 ternal administration. 
 
 7. Name three animal oils, three vegetable oils, and 
 source of each. 
 
 8. Give dose and physiological action of tincture of the 
 chloride of iron. 
 
 CHEMISTRY. 
 
 1. How many elements are there? 
 
 2. Describe two experiments showing difference between 
 chemical and mechanical action. 
 
 3. Explain difference between metals and non-metals. 
 
 4. What are chlorides, bromides, and iodides? Give 
 an example of each. 
 
 5. Name and describe an allotropic form of oxygen, 
 and give the symbol. 
 
 6. Give the molecular weight, atomic and molecular 
 volume, and density of oxygen. 
 
 7. What percentage of C0 2 exists normally in the at- 
 mosphere, and what percentage is dangerous to life? 
 
 8. What is chloroform chemically, and how is it made? 
 
 HYGIENE. 
 
 i. Mention six desirable factors in the location of a 
 resort for consumptives. 
 
 2. What deleterious gases accumulate in an improperly 
 ventilated sleeping room? 
 
 3. How do nitrites and nitrates get into water, and will 
 their presence condemn it for drinking purposes? 
 
 4. What physical conditions would render the taking of 
 a Turkish bath dangerous? 
 
 5. What gases are most efficient as disinfectants, and 
 how would you prepare the room? 
 
 6. What abnormal condition of the eyes is most common 
 in school children, and what habits tend to produce it? 
 
 7. What are toxins, antitoxins, and how are antitoxins 
 obtained? 
 
 8. What is meant by natural, and acquired immunity? 
 Give an example of each. 
 
 PATHOLOGY. 
 
 1. What histological changes occur in acute simple in- 
 flammation? 
 
 2. What are the joint changes in arthritis deformans? 
 
 3. How do typhoid and tuberculous ulcers of the in- 
 testines differ? 
 
 34i 
 
MEDICAL RECORD. 
 
 4. What conditions predispose to cerebral hemorrhage? 
 
 5. Name the diseases in which you would expect to find 
 spleen enlargement. 
 
 6. Differentiate hematuria and hemoglobinuria, and give 
 the cause of each. 
 
 7. Give the pathology of acute anterior poliomyelitis. 
 
 8. What inflammatory conditions result in enlargement 
 of the lymphatic glands? 
 
 OBSTETRICS. 
 
 1. Describe the fully developed ovum. 
 
 2. What is the composition of the liquor amnii? Give 
 its uses. 
 
 3. Describe the development of the placenta. 
 
 4. What changes occur in the uterus during pregnancy? 
 
 5. Give cause and treatment of vomiting of pregnancy. 
 
 6. When and how would you induce premature labor? 
 
 7. What complications of pregnancy justify an ab- 
 dominal section? 
 
 8. Name the various conditions which retard or obstruct 
 labor. 
 
 SURGERY. 
 
 i. Give indication for ligation of an artery in its con- 
 tinuity. 
 
 2. What symptoms follow division of the radial nerve? 
 
 3. Mention the possible obstacles to the reduction of a 
 dislocation. 
 
 4. Give principles of treatment of compound dislocation 
 
 5. Give cause and treatment of delayed union in fracture. 
 
 6. Classify wounds. 
 
 7. What are the symptoms of cholecystitis? 
 
 8. What is a tumor? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 State Board of Health of Mississippi. 
 
 ANATOMY. 
 
 i. The collateral circulation after ligature of the femoral 
 artery below Scarpa's triangle, in .Hunter's canal: (1) The 
 external circumflex; with the lower muscular branches of 
 the femoral, anastomotica magna, superior articular of the 
 popliteal, and anterior tibial recurrent. (2) The perforat- 
 ing and terminating branches of the profunda; with mus- 
 cular branches of the femoral, and muscular and superior 
 articular branches of the popliteal. (3) The comes nervi 
 ischiadici; with the perforating branches of the profunda, 
 and the articular branch of the popliteal. 
 
 342 
 
MEDICAL RECORD. 
 
 2. In amputation of the forearm three inches above the 
 wrist, the radial, ulnar, anterior interosseous, and posterior 
 interosseous arteries should be tied. The radial and ulnar 
 are branches of the brachial ; the anterior and posterior 
 interosseous are branches of the interosseous (which is a 
 branch of the ulnar). 
 
 3. The ganglia connected with the fifth pair of cranial 
 nerves: Gasserian, lenticular, Meckel's, submaxillary, and 
 otic. 
 
 4. The humerus is moved (a) forward by Pectoralis 
 major, anterior fibers of Deltoid, Coracobrachial, and 
 Biceps when forearm is flexed, (b) Backward, by Latis- 
 simus dorsi, Teres major, posterior fibers of the Deltoid, 
 and Triceps when forearm is extended, (c) Inivard, by 
 Subcapularis, Latissimus dorsi, Teres major, and Pectora- 
 lis major. 
 
 5. The diaphragm is a musculofibrous septum which 
 divides the thoracic from the abdominal cavity; it is fan- 
 shaped; the broad, eliptical portion is horizontal, and the 
 crura are vertical. It is attached to the ensiform, to the 
 internal surfaces of the lower six costal cartilages, to 
 bodies and intervertebral substances of first, second, and 
 third lumbar vertebrae. 
 
 The openings in the diaphragm are : The aortic, the 
 esophageal, for the inferior vena cava, right crural, and 
 left crural. 
 
 The nerves which supply the diaphragm are : The phre- 
 nics, the lower intercostals, and the phrenic plexus of the 
 sympathetic. 
 
 6. The pelvis is made up of : Sacrum, Coccyx, and two 
 ossa innominata (each of which consists of Ilium, Ischium, 
 and Pubis). 
 
 7. The bladder. "Position: — In infancy it lies in the 
 abdomen. In the adult it lies in the pelvis behind the 
 pubes ; in the male in front of the rectum; in the female it 
 is placed in front of the uterus and vagina. The apex is 
 connected to the umbilicus py the urachus and by the ob- 
 literated hypogastric arteries, the part posterior to the 
 urachus being covered with peritoneum. The body is un- 
 covered anteriorly by peritoneum, and in front are the 
 triangular ligament, the symphysis pubis, puboprostatic 
 ligaments, and the internal obturator muscles. Superiorly 
 it is covered by peritoneum in the upper part, and is in 
 relation with the rectum in the male, and uterus in the fe- 
 male, and with small intestines in both. < Crossing obliquely 
 on each side of the bladder is the obliterated hypogastric 
 artery, which forms the lateral limit of the peritoneum ; 
 the vas deferens crosses obliquely the lower part of the 
 lateral surface along the inner side of the ureter and ob- 
 literated hypogastric artery. The base or fundus is di- 
 
 343 
 
MEDICAL RECORD. 
 
 rected backwards and downwards. The cervix or neck of 
 the bladder is the part continuous with the urethra, and is 
 embraced in the male by the prostate. There are two sets 
 of ligaments of the bladder— true and false. The true liga- 
 ments are two anterior and two posterior. These are 
 formed of recto-vesical fascia. The urachus is usually 
 described as the 5th or superior true ligament. The false 
 ligaments, five in number, are formed of peritoneum ; there 
 are two posterior, two lateral, and an anterior, the latter 
 covering the urachus. Interior of the Bladder. — Upon the 
 inner surface of the base of the bladder, just behind the 
 urethral orifice, is a triangular smooth surface or trigone, 
 with the apex looking forwards. It is bounded laterally by 
 two ridges passing to the openings of the ureters, the 
 posterior angles being formed by those openings, placed 
 \y 2 inches apart; at its apex there is an elevation, formed 
 by the prostate, called the uvula vesica, which is i 1 /* inches 
 from the ureters. The mucous membrane over the trigone 
 is smooth, but everywhere else elevated upon the irregu- 
 lar muscular wall and rugose." — {Aids to Anatomy.) 
 
 8. The bones forming the ankle joint are: Above the 
 lower ends of the tibia and fibula, with the two malleoli 
 (the external from the fibula and the internal from the 
 tibia) ; the above form a mortise to receive the upper 
 convex surface of the astragalus. 
 
 PHYSIOLOGY. 
 
 1. The apex beat of the heart is caused by the sudden 
 hardening of the left ventricle during its systole, and by 
 the heart twisting slightly upon its axis, the apex being 
 brought more forward at the same time. 
 
 2. The muscles brought into play during the act of de- 
 glutition are : The hyoglossi, styloglossi, palatoglossi, 
 palatopharyngei, azygos uvulae, tensores palati, levatores 
 palati, stylopharyngei, stylohyoids, geniohyoids, mylo- 
 hyoids, thyrohyoids, digastrics, constrictors of the pharynx, 
 and the muscles of the tongue. 
 
 3. The function of the ileocecal valve is to prevent the 
 contents of the large intestine from passing back again 
 into the small intestine ; it is also a barrier against the 
 passage upward of the bacteria which are normally found 
 in the large intestine. 
 
 4. Alcohol "promotes the absorption of accompanying 
 substances (sugar, peptone, potassium iodide), and stimu- 
 lates the flow of the gastric juice. In this matter it acts as 
 do other condiments (salt, pepper, mustard, peppermint), 
 but if there be too great an irritation of the mucous mem- 
 brane there is less activity (dyspepsia). The rapid absorp- 
 tion gives to alcohol its quick recuperative effect after 
 collapse, and its value in administering drugs, especially 
 
 344 
 
MEDICAL RECORD. 
 
 antidotes. Alcoholic beverages combining alcohol and 
 flavor promote gastric digestion and absorption, but often 
 stimulate the appetite in excess of normal requirements. 
 Alcohol is burned in the body, but may also be found in 
 the breath, perspiration, urine, and milk." — (American 
 Text-Book of Physiology.) 
 
 Excessive use of alcohol causes an increase in the acid- 
 ity, quantity, and total solids of the gastric juice; pepsin 
 is precipitated, albumin is coagulated, and proteid diges- 
 tion is retarded or inhibited ; the movements of the ali- 
 mentary canal are accelerated ; vomiting and diarrhea may 
 be produced. 
 
 5. The vocal sounds are produced by an expiratory blast 
 of air being forced through the narrow chink between the 
 true vocal cords. The current of air sets these vocal 
 cords in vibration, and these vibrations are communicated 
 to the air in the upper air passages. The pitch of the sound 
 produced depends upon the rapidity with which the vocal 
 cords vibrate. 
 
 6. Impairment of the function of the kidneys throws 
 more work upon the skin, which it can only partially per- 
 form ; some of the work must also be performed by the 
 lungs. If severe or long continued, death ensues from 
 autointoxication. 
 
 7. The function of the glossopharyngeal nerve is: (1) 
 Taste, to posterior part of tongue and palate; (2) sensa- 
 tion to mucous membrane of pharynx, fauces, and tonsil; 
 it is also claimed that it is (3) motor to the constrictors 
 of the pharynx. 
 
 8. The uses of perspiration are : Excretion of water, 
 carbon dioxide, and urea ; cooling of surface of body, and 
 regulator of heat of body. 
 
 MATERIA MEDIC A. 
 
 1. Tzvo derivatives of morphine: (1) Codeine, dose, gr. 
 1/2. (2) Apomorphine hydrochloride, dose, gr. 1/10 
 (emetic). 
 
 2. Sources of salicylic acid: (1) Oil of wintergreen ; 
 (2) salicin ; (3) synthetically, from sodium phenate and 
 carbon dioxide. 
 
 3. The source of Carbo ligni is soft wood, charred 
 without access of air. Its therapeutic uses are : For flatu- 
 lence; as a mild laxative, deodorant, and absorbent. 
 
 4. (a) Black wash is made of calomel 3j to one pint of 
 lime water. (b)Dover's powder is a mixture of ten parts 
 of powdered opium, ten parts of ipecac, and eighty parts of 
 sugar of milk. 
 
 5. Six drugs containing tannic acid in large quantities: 
 Gambir, krameria, haematoxylon, hamamelis, geranium, and 
 chimaphila. 
 
 345 
 
MEDICAL RECORD. 
 
 6. Three antiseptics for internal administration: (i) 
 Urotropin; colorless, odorless, crystalline : soluble in about 
 equal parts of water; it inhibits the growth of microorgan- 
 isms by reason of the formaldehyde which it yields up in 
 the body in the urine ; part of it is excreted unchanged and 
 part as formaldehyde. (2) Salol; a white crystalline pow- 
 der, very soluble in hot alcohol, but almost insoluble in 
 water ; it is decomposed into carbolic acid and salicylic acid. 
 
 (3) Naphthalene: characteristic odor, aromatic taste, 
 colorless, insoluble in water. 
 
 7. Three Animal oils: (1) Cod liver oil, from the liver 
 of the cod; (2) Lard oil, from lard (from internal fat of 
 the hog) ; (3) Neat's-foot oil, from the feet of neat cattle. 
 
 Three Vegetable oils: (1) Castor oil, from Ricinus com- 
 munis; (2) croton oil, from croton tiglium; (3) olive oil, 
 from ripe fruit of olea europoea. 
 
 8. Tincture of the chloride of iron: Dose, eight minims. 
 Physiological action: astringent, hemostatic, gastrointestinal 
 irritant, hsematinic, and tonic. 
 
 CHEMISTRY. 
 
 1. There are eighty elements. 
 
 2. "A bar of soft iron may be made to emit light when 
 heated, or sound when caused to vibrate, or magnetism 
 when under the influence of an electric current. Under 
 the influence of these physical forces the iron suffers no 
 change in composition, and, on cessation of the action of 
 the inciting force, the iron returns to its original condition. 
 But if the iron be heated in an atmosphere of oxygen, both 
 the iron and a part of the oxygen disappear, and a new 
 substance, a new chemical species, is produced, having 
 properties of its own, different from those of either the 
 iron or the oxygen. In this case there has been chemical 
 action, causing change of composition, as the new sub- 
 stance contains both iron and oxygen. The result of such 
 action is, moreover, permanent, and the new product con- 
 tinues to exist, until modified by some new manifestation 
 of chemical action."— (Witthaus' Manual of Chemistry.) 
 
 3. The metals are all solid (except mercury), opaque, 
 have metallic luster, are good conductors of heat and elec- 
 tricity, and will replace the hydrogen of acids to form salts. 
 
 Nonmetals do not have the above properties, some are 
 gases, and their properties differ widely among the different 
 elements. 
 
 4. Chlorides, bromides, and iodides are binary compounds 
 of chlorine, bromine, and iodine, respectively. Example: 
 Sodium chloride, NaCl ; potassium bromide, KBr; potas- 
 sium iodide, Kl. 
 
 5. Allotropic form of oxygen is ozone. When pure, it is 
 a dark blue liquid, almost opaque, it is a strong oxidizing 
 
 346 
 
MEDICAL RECORD. 
 
 agent; it oxidizes nearly all metals in the presence of 
 moisture; it decolorizes organic pigments. Symbol is O a . 
 
 6. Oxygen. Molecular weight, 32; atomic volume is the 
 atomic weight divided by the specific gravity; molecular 
 volume, 22.4 ; density, 32. 
 
 7. In air there is 0.04 per cent, of carbon dioxide. The* 
 percentage dangerous to life depends upon the amount of 
 oxygen present; probably 10 per cent, in the atmosphere 
 would prove fatal. 
 
 8. Chloroform is a substitution product of methane. 
 Three of the four hydrogen atoms of methane are replaced 
 by three atoms of chlorine; hence the formula is CHCU, 
 and the proper name would be Trichlormethane. 
 
 Chloroform can be obtained by heating chloral hydrate 
 with an alkali: 
 
 GHCl.(OH), + KHO = CHC1 3 + HCOOK + H 2 
 It is prepared on a large scale by the action of bleaching 
 powder upon acetone : 
 
 2CO(CH 8 ) 2 + 6CaCl(OCl) = 2CHCI. + 2Ca(OH) 2 + 
 Ca(CHs. COO), + 3CaCl». 
 
 HYGIENE. 
 
 1. Six desirable factors in the location of a resort for 
 consumptives: (1) Pure and dry air, free from dust; (2) 
 equable temperature; (3) protection from high winds; (4) 
 dry soil; (5) high altitude; and (6) plenty of sunlight. 
 
 2. Deleterious gases which accumulate in an improperly 
 ventilated sleeping room: Carbon dioxide, carbon monox- 
 ide, methane, sulphur dioxide, hydrogen sulphide, ammo- 
 nium sulphide, ammonia, and organic vapors from decom- 
 posing animal matter. 
 
 3. Nitrates are generally due tc the oxidation of organic 
 matter of animal origin. 
 
 Nitrites generally indicate sewage contamination. The 
 presence of nitrites should condemn the water ; so should 
 a marked amount of nitrates. 
 
 4. Organic heart disease, obesity, cirrhosis of kidney or 
 liver, and arterio-sclerosis. 
 
 5. The most efficient gaseous disinfectants are: Formal- 
 dehyde, sulphur dioxide, and chlorine. 
 
 All apertures or crevices must be carefully closed, so 
 that the gas used may remain as concentrated as possible. 
 
 6. Myopia is the most common abnormal condition of 
 the eye in school children. 
 
 Habits tending to produce it are : Reading of fine or 
 indistinct print, reading in poor illumination, improper posi- 
 tions in reading or writing, using the eyes when tired, and 
 excessive study. 
 
 7. Toxins are harmful or poisonous products of bacteria. 
 Antitoxins are substances formed in the body, of a pro- 
 
 347 
 
MEDICAL RECORD. 
 
 tective character, and capable of rendering inert the poison- 
 ous products of bacteria. 
 
 'The methods used in the production of antitoxins 
 were introduced by Behring, who found that by injecting 
 susceptible animals with increasing amounts of extracel- 
 lular toxin he produced in the blood-serum of the injected 
 animal certain changes which made the serum capable of 
 counteracting the same toxin when injected into other 
 animals. ... In practice, the bacilli are cultivated in 
 bouillon. The cultures are freed from all living bacilli 
 by filtration. The liquid filtrate contains the toxin. This 
 filtrate is injected into healthy susceptible animals, in in- 
 creasing doses. Usually the horse is used, since large 
 quantities of blood can be drawn from this animal on 
 account of its size, and, moreover, the horse is very sus- 
 ceptible. . . . Eventually enormous doses of toxin are 
 given, and the animal acquires a high degree of immunity. 
 The blood of the animal is withdrawn, taking care to 
 avoid contamination, and the serum allowed to separate 
 in the refrigerator. The serum of the blood is drawn off 
 and constitutes the antitoxin." — (Williams' Bacteriology.) 
 
 8. Immunity is the power of resistance of cells and tis- 
 sues to the action of pathogenic microorganisms. Im- 
 munity may be either natural or acquired. 
 
 Natural immunity is that power of resistance, natural 
 and inherited, and peculiar to certain groups of animals, 
 but common to every individual of these groups. 
 
 Acquired immunity is this resistance acquired (i) by 
 a previous attack of the disease, or (2) by the person being 
 made artificially insusceptible. The conditions which give 
 immunity are: (1) a previous attack of the disease; (2) 
 inoculation with the specific microorganisms in small num- 
 bers or of diminished virulence, so as to produce a mild 
 attack of the disease; (3) vaccination; (4) the introduc- 
 tion of antitoxins; (5) the introduction of the toxins of 
 the bacteria. 
 
 Examples. — The rat is naturally immune to anthrax; the 
 white mouse is naturally immune to infection with bacillus 
 mallei. Acquired immunity is seen in the immunity from 
 smallpox after vaccination, or after having suffered from 
 an attack of the disease. 
 
 PATHOLOGY. 
 
 1. The phenomena of inflammation are dilatation of 
 the arterioles, capillaries, and small veins. At first the 
 blood current is quickened, then retardation occurs, and 
 may progress to stasis and thrombosis. During this time 
 exudation of plasma and white corpuscles from the small 
 veins, and perhaps the capillaries, is going on. The fate 
 of the white cell may be either to break up and set free pro- 
 thrombin, or to act as food for connective tissue cells, or 
 
 348 
 
MEDICAL RECORD. 
 
 to act as a phagocyte and be transformed into a pus 
 corpuscle. Red corpuscles may be exuded and broken up, 
 setting free their coloring matter. The prothrombin of 
 the white cells unites with the calcium chloride of the 
 plasma, and forms thrombin, or fibrin ferment, which acts 
 upon the fibrinogen of plasma to form fibrin. 
 
 The tissues are thus invaded with numbers of leucocytes. 
 In bacterial inflammation a varying portion of the tissues 
 is killed by the toxins produced, and is either replaced by a 
 mass of small round cells, or liquefied into pus. In the 
 latter case it is surrounded by a ring of small round cells. 
 The connective tissue cells absorb the leucocytes, and new 
 vessels are formed, thus constituting repair. In nonbac- 
 terial inflammation, exudation may separate layers of cells 
 to a large extent and form blebs. In chronic inflammation 
 the formation of new fibrous tissue is the chief part of the 
 process. — (From Aids to Surgery.) 
 
 2. The joint changes in arthritis deformans are: Pro- 
 liferation of the cartilage cells, the edges of the cartilage 
 become fibrillated and wear away; the underlying bone 
 becomes hard and polished, and later atrophies in parts, 
 part of the bone becomes absorbed ; ossification may also 
 occur, with locking of the joint; the synovial membrane 
 may either atrophy or hypertrophy. 
 
 3. In the typhoid ulcer: (1) The main axis of the ulcer 
 lies parallel with that of the intestine ; (2) it lies opposite 
 to the mesenteric attachment; (*) it has smooth floor and 
 undermined edges ; (4) it commonly leads to perforation. 
 
 In tubercular ulcer: (1) The long axis of the ulcer lies 
 at right angles to that of the intestine ; (2) it is not neces- 
 sarily situated opposite the mesenteric attachment; (3) its 
 floor is not smooth nor are its edges undermined. 
 
 4. The conditions which predispose to cerebral hemor- 
 rhage are : Advanced age, rheumatism, gout, syphilis, alco- 
 holic excesses. Bright's disease, prolonged muscular exer- 
 tion, chronic lead poisoning, severe physical or mental 
 excitement. 
 
 5. Spleen enlargement may be found in: Typhoid fever, 
 malaria, leukemia, pernicious anemia, cirrhosis of liver, 
 and many of the infectious diseases (diphtheria, scarlet 
 fever, erysipelas, pneumonia) and septic processes (septice- 
 mia and pyemia). 
 
 6. Hematuria is blood in the urine. 
 Hemoglobinuria is blood pigment in the urine. 
 
 In hematuria a microscopical examination will show 
 numerous red blood corpuscles in the urine ; in the other 
 condition red cells are either absent or are very scanty. 
 
 The principal causes of hematuria are: (1) Conditions 
 in which the blood is affected, as in the infectious diseases, 
 in scurvy, pernicious anemia, and purpura; (2) traumatism 
 
 349 
 
iMEDICAL RECORD. 
 
 or inflammations in any part of the urinary tract; (3) con- 
 gestion of the kidneys secondary to disease of the lungs, 
 heart, or liver. 
 
 The principal causes of hemoglobinuria are: Poisons, 
 such as arsenic, potassium chlorate, carbolic acid, carbon 
 monoxide; jaundice, malaria, syphilis, Raynaud's disease, 
 scurvy, purpura. 
 
 7. In acute anterior poliomyelitis: Congestion and then 
 destruction of the ganglion cells in the anterior horns of 
 the spinal cord; there is an infiltration of leucocytes; and 
 an overgrowth of connective tissue replaces the cells in the 
 anterior horns. The fibers of the anterior roots show de- 
 generation ; the posterior roots are not affected. 
 
 8. Inflammatory conditions which may result in enlarge- 
 ment of the lymphatic gland: Tonsillitis, gonorrhea, chan- 
 croid, syphilis, septic infections. 
 
 OBSTETRICS. 
 
 i. The ovum when fully developed is a single cell, spher- 
 ical, about 1/125 inch in diameter; it is composed of a 
 yolk, with nucleus, nucleolus, and two enveloping mem- 
 branes. 
 
 2. The liquor amnii is the fluid contained in the amniotic 
 sac ; it is alkaline in reaction, has a specific gravity of about 
 1. 001 to 1.008, its quantity is variable, but is generally about 
 two pints. It consists chiefly of water, but contains small 
 amounts of albumin, epithelial cells, urea, phosphates, 
 chlorides, etc. Its source is unsettled. 
 
 Functions: (a) During Pregnancy: (1) As a protection 
 to the fetus against pressure and shocks from without. (2) 
 As a protection to the uterus from excessive fetal move- 
 ments. (3) It distends the uterus, and thus allows for the 
 growth and movements of the fetus. (4) It receives the 
 excretions of the fetus. (5) It surrounds the fetus with a 
 medium of equable temperature, and serves to prevent loss 
 of heat. (6) It prevents the formation of adhesions be- 
 tween the fetus and the walls of the amniotic sac. (7) It 
 has been supposed, by some, to afford some slight nutrition 
 to the fetus. 
 
 (b) During Labor: It acts as a fluid wedge, and dilates 
 the os uteri and the cervix; it also slightly lubricates the 
 parts. 
 
 3- See Williams' "Obstetrics" (1909), page 128; or Hirst's 
 "Obstetrics" (1909), page 120. 
 
 4. See Williams' "Obstetrics" (1909), page 164; or Hirst's 
 "Obstetrics" (1909), page 180. 
 
 5. Causes of vomiting in pregnancy are: (1) Reflex dis- 
 turbance, due to rapid growth and excessive distention of 
 the uterus ; (2) disease or displacement of uterus, tubes, 
 and ovaries; (3) disease of pelvis or gastrointestinal tract; 
 
 350 
 
xMEDICAL RECORD 
 
 (4) excessive sexual intercourse; (5) renal disease or 
 disturbance. 
 
 6. Conditions warranting the induction of premature 
 labor: (1) Certain pelvic deformities, (2) placenta praevia, 
 (3) pernicious anemia, (4) toxemia of pregnancy, (5) 
 habitual death of the fetus toward the end of pregnancy, 
 (6) hydatidiform mole, (7) habitually large fetal head. 
 
 The methods that may be employed are : Partial dilata- 
 tion of the cervix and the introduction within the cervix 
 (and vagina) of a tamponade of sterile gauze; (2) dilata- 
 tion of the cervix; (3) puncturing the membranes; (4) in- 
 troduction of a sofc rubber bougie into the uterus; (5) in- 
 trauterine injection of glycerin, water, or some other fluid. 
 
 7. The absolute indications of cesarean section are: Ex- 
 treme pelvic contraction or deformity in which delivery by 
 forceps or version or symphyseotomy is impossible, and in 
 which craniotomy is either impossible or would be more 
 dangerous to the mother; the presence of extreme atresia 
 of the vagina; rupture of the uterus; sudden maternal 
 death. 
 
 8. Conditions which retard or obstruct labor: Rigidity, 
 edema, atresia, or displacement of the os or cervix; fibrous 
 bands, or atresia of vagina; persistent hymen; unyielding 
 perineum; tumors; distended bladder or rectum; hernia; 
 edema of labia; pelvic deformities; malpositions or mal- 
 presentations of the fetus; prolapse of limbs ; short cord; 
 large fetus ; dead fetus ; twins or monstrosities ; uterine 
 inertia; rupture of uterus. 
 
 SURGERY. 
 
 1. The indications for ligation of an artery in its con- 
 tinuity are: To check hemorrhage, to promote the cure of 
 an aneurysm, to diminish the rate of growth of a tumor, 
 to cause atrophy of an organ by diminishing its blood 
 supply, as a preliminary to removing some vascular struc- 
 ture (such as the tongue). 
 
 2. Division of the- radial nerve would be followed by : 
 Loss or impairment of sensation in the dorsal aspect of 
 thumb, index finger, and radial side of middle finger as 
 far as the second phalanx. 
 
 3. The possible obstacles to reduction of a dislocation 
 are : Torn capsule embracing the neck of the bone, mus- 
 cular contraction, interlocking of bony points ; inflammatory 
 swelling of the soft parts, and tendons or muscles catching 
 around the neck of the displaced bone. 
 
 4. Principles of treatment in compound dislocations: 
 Open up the wound if there is any chance of its being in- 
 fected, remove destroyed tissue, irrigate thoroughly, re- 
 duce the dislocation, pack with gauze, drain, and im- 
 mobilize. 
 
 351 
 
MEDICAL RECORD. 
 
 5. Delayed union in fracture is caused by: 111 health, 
 want of approximation of the end of the bone, want of 
 blood supply in the bone, defective innervation of the 
 bone, disease of the bone, lack of rest, and immobility. 
 
 Treatment: "When delayed union exists, seek and remove 
 cause treating constitutionally if required, and thoroughly 
 immobilizing the parts by plaster. Orthopedic splints may be 
 of value. Use of the limb while splinted, percussion over 
 the fracture, and rubbing the fragments together, thus in 
 each case producing irritation, have all been recommended. 
 Blistering the skin with iodine or firing it has been em- 
 ployed. If the case be very long delayed, forcibly separate 
 the fragments and put up in plaster as a fresh break. If 
 these means fail, irritate by subcutaneous drilling or scrap- 
 ing, or, better, by laying open the parts and then drilling 
 and scraping at many places." (Da Costa.) 
 
 6. Wounds are classified as: (1) Contused and open. 
 (2) Open wounds may be : Incised, lacerated, contused, 
 punctured, gunshot, or poisoned; also penetrating and per- 
 forating. (3) Aseptic and septic. 
 
 7. Symptoms of cholecystitis: Pain and tenderness in 
 region of gall-bladder'; fever, rapid pulse, vomiting, rigid 
 abdominal muscles, jaundice may be present. 
 
 8. A tumor is a pathological new growth which tends to 
 persist independently of the tissues in which it is found, 
 and which serves no physiological purpose. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Missouri State Board of Health. 
 
 anatomy. 
 
 1. Describe superficial and deep palmar arch; how 
 formed? Give landmarks. 
 
 2. Name all muscles that elevate the arm at shoulder 
 joint, giving origin and insertion of same._ 
 
 3. Give minute and gross anatomy' of kidneys. 
 
 4. Give minute and gross anatomy of pleura. 
 
 5. Give origin, ending, branches, and relationship of pos- 
 terior tibial artery. 
 
 6 Describe the tibia, giving points of ossification. With 
 what bones does it articulate? 
 
 7. Draw cross section amputation of forearm, middle 
 third, naming structures divided. 
 
 8. Give origin, course, exit, and parts supplied by the 
 second pair of cranial nerves. 
 
 9. Describe anterior triangle of neck, how formed, giv- 
 ing contents. 
 
 10. Describe the spinal column, giving characteristics of 
 vertebra in each division. 
 
 352 
 
MEDICAL RECORD 
 
 PHYSIOLOGY. 
 
 i. State the general character and physiological action of 
 the hydrocarbon and albuminoid substances. 
 
 2. Give mode of secretion and composition of the gastric 
 juice. 
 
 3. Give physiological action of the saliva. 
 
 4. Describe the blood and give the composition of the 
 red and white globules. 
 
 5. Explain the cause of coagulation of the blood and its 
 usefulness. 
 
 6. Give the composition of the urine and state which 
 constituent is the most important. 
 
 7. State the most important function of the medulla 
 oblongata as a nervous center, with full explanation of 
 same. 
 
 8. Name and give function of first pair of cranial nerves. 
 
 9. Give origin and function of fifth pair of cranial 
 nerves. 
 
 10. State the general arrangement and function of the 
 sympathetic nervous system. 
 
 CHEMISTRY. 
 
 i. Describe and state the physical and chemical proper- 
 ties of oxygen. 
 
 2. Give the chemical formula for potassium iodide, and 
 state how it is made. 
 
 3. Name the four elements known as Halogens, and de- 
 scribe each. 
 
 4. Give chemical formula for phenic acid. From what 
 derived? For what purpose used in medicine? Give treat- 
 ment for toxic dose. 
 
 5. Give chemical formula for sulphuric acid. How ob- 
 tained? Give toxic dose. For what purpose used in medi- 
 cine? 
 
 BACTERIOLOGY. 
 
 1. Describe the process of producing diphtheria anti- 
 toxin. 
 
 2. Give theory of immunity produced by vaccination. 
 
 3. What diseases confer immunity by vaccination or 
 innoculation? 
 
 4. Give the technique for staining for the pneumococcus. 
 
 5. Describe in detail process of finding tubercle bacilli in 
 a specimen of urine. 
 
 PATHOLOGY. 
 
 1. What is aortic stenosis? Give pathology. 
 
 2. What is the pathological condition found in chronic 
 Bright's disease? 
 
 3. Give the pathology in specific iritis. 
 
 353 
 
MEDICAL RECORD. 
 
 4. What pathological conditions are found in acute ca- 
 tarrhal dysentery? 
 
 5. Give pathology of chronic gastritis. 
 
 THERAPEUTICS. 
 
 l> Name the officinal preparations of opium. Give dose 
 and therapeutic uses. 
 
 2. Give the physiologic action and therapeutic uses of 
 colchicum. 
 
 3. Give the dose and therapeutic indications for bryonia. 
 
 4. Name the onicinal preparations and give therapeutic 
 uses of calcium phosphate. 
 
 5. Give the dose and therapeutic uses of veratrum. 
 
 6. Give the dose, physiologic action, and therapeutic uses 
 of ipecac. 
 
 7. Name the officinal preparations, give the dose and 
 therapeutic uses of nux vomica. 
 
 8. Give the dose and therapeutic indications for tartar 
 emetic. 
 
 a Give the dose and therapeutic indications for aconite. 
 (Jp. Name the officinal preparations of cinchona. Give 
 dose and therapeutic uses. 
 
 PRACTICE. 
 
 1. Give etiology, exciting cause, and treatment of variola. 
 
 2. What are the methods of physical diagnosis, and what 
 phenomena are obtained by these methods? 
 
 3. Give etiology, symptoms, and treatment of lobar pneu- 
 monia. 
 
 4. What are the physical signs of incipient pulmonary 
 tuberculosis? What is the treatment? 
 
 5. What is the etiology and treatment of typhoid fever? 
 
 6. Give the symptoms and treatment of acute bronchitis. 
 
 7. What are the symptoms of acute Bright's disease, and 
 how should it be treated? 
 
 8. W r hat is a cataract, and how would you treat it? 
 
 9. How would you diagnose a case of non-suppurative 
 otitis media? What is the treatment? 
 
 10. What are the conditions found in psoriasis? What 
 is the proper treatment for same? 
 
 OBSTETRICS. 
 
 1. Describe pregnancy from ovulation to maturity of 
 fetus, giving mechanism of delivery in an L. O. A. pres- 
 entation. 
 
 2. Describe placenta praevia, giving varieties, causes, diag- 
 nosis, and treatment. 
 
 3. Differentiate hand from foot, knee from elbow, shoul- 
 der from vertex. Give management of shoulder presen- 
 tation. 
 
 354 
 
MEDICAL RECORD. 
 
 4. Define eclampsia, giving etiology, prognosis, and treat- 
 ment. 
 
 5. When should chloroform be used in labor? Ditto 
 ergot? Give advantages and dangers of each. 
 
 6. When should forceps be used? Give manner of apply- 
 ing the same, with mechanism of delivery after application, 
 selecting your own presentation. 
 
 7. Differentiate false from true labor pains. Give stages 
 of labor and what occurs during each stage. 
 
 8. Describe asphyxia of new born, giving varieties and 
 treatment. 
 
 9. Give your method of caring for the new born from 
 birth until it is dressed. 
 
 10. Give signs of pregnancy at third and sixth months. 
 
 GYNECOLOGY. 
 
 1. Define vulvitis. Give varieties, causes, and treatment. 
 
 2. Define vaginitis, giving varieties, causes, and treat- 
 ment. 
 
 3. Define menstruation. Xame disorders of same, giving 
 usual causes and treatment of each. 
 
 4. Define metritis. Give varieties, causes, and treatment 
 of each. 
 
 5. Give differential diagnosis in inversion, polypi, pro- 
 lapsus uteri, and method of treating each. 
 
 SURGERY. 
 
 1. Give differential diagnosis between brain abscess and 
 brain tumor. 
 
 2. Describe an operation for cure of femoral hernia. 
 
 3. Give symptoms and treatment of acute osteomyelitis. 
 
 4. Give diagnosis between gastric cancer and ulcer. 
 
 5. What is the treatment . of gunshot wound of the knee 
 from a revolver wound? 
 
 6. Give the signs and symptoms of tuberculosis of the 
 kidney. 
 
 7. Differentiate between an old dislocation and tubercu- 
 losis of hip joint. 
 
 8. What is the best treatment for a fracture about the 
 elbow joint? Why? 
 
 9. Give signs and symptoms of intussusception. 
 
 10. What operation do you consider profitable for 
 removal of prostrate gland? Give reasons. 
 
 HYGIENE. 
 
 1. Give etiology and prophylaxis of ophthalmia neona- 
 torum. 
 
 2. Discuss etiology, prophylaxis and nygienic care of 
 cholera infantum. 
 
 3. Name three infections transmitted through air; 
 
MEDICAL RECORD. 
 
 through water; through food; through insects. Give 
 prophylaxis. 
 
 4. Give period of incubation, length of quarantine and 
 hygienic care of the following diseases: Smallpox, scarla- 
 tina, diphtheria, measles. 
 
 5. Discuss vaccination and antitoxine, giving brief his- 
 tory of each, and value of same. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. What evidence would you look for to distinguish 
 cerebral concussion' from intoxication? 
 
 2. What evidences determine a recent from an old 
 cerebral hemorrhage? 
 
 3. What is malpractice — civil, and criminal? 
 
 4. In case ^ of drowning, how would you determine 
 whether homicidal, suicidal, or accidental? 
 
 5. In case of hanging, what circumstantial evidence 
 would you look for, to determine whether the act wns 
 homicidal, or suicidal? 
 
 6. Where a question arises as to personal identity, «n 
 what manner, or by what tests would you determine it? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Missouri State Board of Health. 
 
 anatomy. 
 
 1. The superficial palmar arch is formed by the ulnar 
 artery, and is completed by the ulnar artery anastomosing 
 with a branch of the radial (superficial volar or princeps 
 pollicis). It gives off the four digital branches. The 
 surface marking is a line drawn transversely across the 
 palm from a point where the web of the thumb joins the 
 palm. The deep palmar arch is formed by the radial ar- 
 tery, and is completed by the radial artery anastomosing 
 with a deep branch of the ulnar. Its branches are the pal- 
 mar interosseous, perforating, and palmar recurrent ar- 
 teries. The surface marking is a line drawn transversely 
 across the palm, one-half inch nearer the wrist than the 
 superficial arch. 
 
 2. Muscles that elevate the arm at the shoulder are: 
 Deltoid and supraspinatus. 
 
 Deltoid. Origin: From the outer third of anterior 
 border and upper surface of the, clavicle, from the outer 
 margin and upper surface of the acromion process, and 
 from the lower edge of the spine of the scapula. Inser- 
 tion: Into the deltoid impression on the middle of the 
 outer side of the shaft of the humerus. 
 
 Supraspinatus. Origin: From the supraspinatus fossa 
 
 356 
 
MEDICAL RECORD. 
 
 and fascia. Insertion: Into the great tuberosity of the 
 humerus. 
 
 3. See Cunningham's "Anatomy" (1909), pages 1130 and 
 1138; or Gray's "Anatomy" (1908), pages 1419, 1423, and 
 1426. 
 
 4. See Cunningham's "Anatomy" (1909), page 977; or 
 Gray's "Anatomy" (1908), pages 1391 and 1395. 
 
 5. The posterior tibial artery is the continuation down- 
 ward of the popliteal artery. It begins at the lower border 
 of the popliteus muscle; it ends midway between the in- 
 ternal malleolus and the tuberosity of the os calcis, where 
 it divides into the external and internal plantar arteries. 
 Its branches are: Peroneal, nutrient, muscular, cutaneous, 
 communicating, internal calcanean, and malleolar cutane- 
 ous. Relationships. In front: Tibialis posticus, flexor 
 longus digitorum, tibia, and ankle joint. Behind: Skin, 
 fascia, gastrocnemius, soleus, posterior tibial nerve, and 
 abductor hallucis. On inner side: Posterior tibial nerve, 
 at upper part. On outer side: Posterior tibial nerve, at 
 lower part. 
 
 6. See Cunningham's "Anatomy" (1909), pages 230 and 
 234; or Gray's "Anatomy" (1908), pages 234 and 238. 
 
 7. In amputation of forearm at middle third there will 
 be severed : Skin, fascia, supinator longus, extensor carpi 
 radialis longior and brevior, extensor communis digitorum, 
 extensor carpi ulnaris, supinator brevis, anconeus, pronator 
 radii teres, flexor carpi radialis, palmaris longus, flexor 
 sublimis digitorum, flexor carpi ulnaris, flexor profundus 
 digitorum ; arteries : ' anterior interosseus, radial, ulnar ; 
 veins : radial, interosseous, ulnar, median ; nerves : pos- 
 terior interosseous, radial, median, ulnar ; bones : radius, 
 ulna. 
 
 8. See Cunningham's "Anatomy" (1909), page 675; or 
 Gray's "Anatomy" (1908), page 1038. 
 
 9. The anterior triangle of the neck is bounded: In 
 front by a line from the chin to the sternum; behind by 
 the anterior margin of the sternomastoid ; base is upward, 
 and is formed by the lower border of the body of the 
 lower jaw and a line from the angle of the jaw to the 
 mastoid process. It is divided into three smaller triangles 
 (inferior carotid, superior carotid, and submaxillary) by 
 the digastric muscle and the anterior belly of the omo- 
 hyoid. Contents: Thyroid gland, trachea, larynx, parotid 
 and submaxillary glands. Arteries : Inferior thyroid, com- 
 mon carotid, internal carotid, external carotid, superior 
 thyroid, lingual, facial, ascending pharyngeal, occipital, 
 submental, and mylohyoid. Veins: Inferior thyroid, in- 
 ternal jugular, lingual, facial superior thyroid, pharyn- 
 geal, external jugular, and anterior jugular. Nerves: 
 Pneumogastric, recurrent laryngeal, descendens noni, com- 
 
 357 
 
MEDICAL RECORD. 
 
 municans noni, superior laryngeal, external laryngeal, 
 spinal accessory hypoglossal, glossopharyngeal, mylohyoid, 
 and sympathetic. Also lymphatic glands and vessels. 
 
 10. See Cunningham's "Anatomy" (1909), pages 75, 78, 
 81, 83, and 88; or Gray's "Anatomy" (1908), pages 48, 49> 
 53, 56, and 67. 
 
 PHYSIOLOGY. 
 
 i. Hydrocarbons consist of carbon and hydrogen only; 
 as a rule they are not used as food, and have no particular 
 physiological action. The term was often used loosely to 
 denote fats (containing carbon, hydrogen, and oxygen) 
 whose function is to supply heat and energy, and to serve 
 in the nutrition of the nervous system. Albuminoids are 
 a miscellaneous collection of proteins which are neither 
 albumins nor proteids; they are generally insoluble in 
 the neutral solvent of the proteins; they are found in 
 connective tissues, cartilage, bone, skin. 
 
 2. Secretion of Gastric Juice: "The stomach has two 
 secretions, one thick, tenacious, and alkaline — the gastric 
 mucus; the other, thin, acid, and watery — the gastric juice 
 proper. The former is secreted during fasting, while the 
 latter is only secreted when food or fluid enters the stom- 
 ach. Saliva or alkalies, pepper, alcohol excite the secre- 
 tion of gastric juice. Their action is reflex; the vagus 
 is probably the afferent nerve, which, acting on the me- 
 dulla, inhibits the sympathetic and dilates the blood-vessels 
 supplying the glands; the efferent impulses descending 
 along the splanchnics." — (Ashby.) 
 
 The constituents of gastric juice are : Water, proteid, 
 mucin, pepsin, rennin, hydrochloric acid, salts (sodium and 
 potassium chlorides, and calcium and magnesium phos- 
 phates). 
 
 3. The functions of the saliva are: (1) To moisten the 
 mouth, (2) to assist in the solution of the soluble portions 
 of the food, and thus (3) to administer to the sense of 
 taste, (4) to lubricate the bolus of food, and thus (5) to 
 facilitate the acts of mastication and deglutition, and (6) 
 ;o change starches into dextrin and sugar. 
 
 4. The blood is fluid, somewhat viscid, red, specific gravity 
 from 1055 to 1062, alkaline reaction, saltish taste, charac- 
 teristic odor, variable temperature (average about ioo° F.). 
 The constituents are plasma and corpuscles. The plasma 
 consists of water and solids (proteids, extractives, and in- 
 organic salts). The red corpuscles consist of water and 
 solids (hemoglobin, proteins, fat, and inorganic salts). 
 The white corpuscles consist of water and solids (protein, 
 leuconuclein, lecithin, histon, etc.). 
 
 5. The coagulation of the blood is due to the develop- 
 ment in it of fibrin. In the plasma a proteid substance 
 exists, called fibrinogen. From the colorless corpuscles 
 
MEDICAL RECORD. 
 
 a nucleoproteid is shed out, called prothrombin. By the 
 action of calcium salts prothrombin is converted into fibrin 
 ferment, or thrombin. Thrombin acts on fibrinogen in 
 such a way that two new substances are formed; one of 
 these is unimportant and remains in solution ; the other 
 is important, viz., fibrin, which entangles the corpuscles, 
 and so forms the clot. Its usefulness is seen in the check- 
 ing of hemorrhage. 
 
 6. Composition of urine: Water, urea, uric acid, hippuric 
 acid, xanthin, hypoxanthin, creatin, creatinin, extractives ; 
 chlorides, sulphates and phosphates (of sodium and 
 potassium) ; phosphates of magnesium and calcium; nitro- 
 gen, and carbon dioxide. Urea is the most important con- 
 stituent. 
 
 7. The medulla is the seat of several special centers, the 
 most important of which is probably the respiratory center. 
 
 "The respiratory center is in reality made up of two cen- 
 ters, one for each side, so that, although anatomically con- 
 nected and ordinarily acting together, yet if one center is 
 broken up, while the respiratory movements on that side 
 cease, those on the other side continue. Besides this 
 double character of the center, each half is made up of an 
 inspiratory and an expiratory center. The respiratory 
 center is both an automatic and a reflex center — i. e., it 
 sends out spontaneously impulses which result in move- 
 ments of the respiratory muscles, constituting its auto- 
 matism; and it may also be excited reflexly, i.e. by im- 
 pulses reaching it from without. Its reflex character is 
 most marked, and it is doubtless as a reflex center that its 
 function is ordinarily performed." — {Raymond.) 
 
 8. Olfactory neves; function is special sense of smell. 
 
 9. Trifacial nerve. Origin: — (1) Superficial, from the 
 side of the pons varolii; (2) Deep (sensory root), from 
 the medulla, and upper part of cord; (motor root) from 
 floor of fourth ventricle, and side of the aqueduct of 
 Sylvius. 
 
 Functions: First ophthalmic branch supplies sensation 
 to conjunctiva and skin of upper eyelid, cornea, skin of 
 forehead and nose, lachrymal glands, mucous membrane 
 of nose. Second, or superior maxillary branch, supplies 
 sensation to skin and conjunctiva of lower lid, nose, cheek, 
 upper lip, upper teeth and alveolar processes, and palate. 
 Third, or inferior maxillary branch, supplies sensation to 
 external auditory meatus, side of head, mucous membrane 
 of mouth; anterior two-thirds of tongue, lower teeth, lower 
 lip, and skin of the lower part of the face. This branch, 
 in addition, supplies motion to the muscles of mastication 
 (masseter, temporal, external pterygoid, interna^ ptery- 
 goid), also mylohyoid and anterior belly of digastric. 
 
 10. "The sympathetic nervous system consists of (1) a 
 series of ganglia connected together by a great ganglionic 
 
 359 
 
MEDICAL RECORD. 
 
 cord, the gangliated cord, extending from the base of the 
 skull to the coccyx, one gangliated cord on each side of 
 the middle line of the body, partly in front and partly on 
 each side of the vertebral column; (2) of three great 
 gangliated plexuses or aggregations of nerves and ganglia, 
 situated in front of the spine in the thoracic, abdominal, 
 and pelvic cavities respectively; (3) of smaller or terminal 
 ganglia, situated in relation with the abdominal viscera; 
 and (4) of numerous fibers." 
 
 Function: It has a controlline influence over the se- 
 cretion of most of the glands, the lacrymal, the salivary, 
 the sweat glands, the glands of the stomach and intestines, 
 the liver, the kidney, etc. ; it presides over the circulation 
 by _ regulating the caliber of the blood-vessels and the 
 action of the heart; it influences respiration; and, all in- 
 voluntary muscles, those of the digestive apparatus, of 
 the genitourinary system, of the hair follicles (pilomotor 
 nerves), are under its control to a great extent. 
 
 CHEMISTRY 
 
 1. Oxygen is the most abundant of the elements ; it 
 occurs free in the air, and in combination in very many 
 substances. It is a colorless, odorless, tasteless gas, slightly 
 soluble in water, heavier than air, combines readily with all 
 other elements except fluorine, supports combustion and 
 respiration, and is necessary to animal life. It has a valence 
 of two, atomic weight of 16, and molecular weight of 32. 
 
 2. Potassium Iodide. Formula, KI. Preparation: 
 Saturate an aqueous solution of potassium hydroxide with 
 iodine : 
 
 6KHO + 3I2 = KIO3 + 3H 2 + 5KI 
 
 3. The four halogens are: Fluorine, chlorine, bromine, 
 and iodine. Fluorine is a very irritant, corrosive gas; it 
 decomposes water, forming ozone and hydrofluoric acid ; 
 it attacks organic substances with vigor; it forms com- 
 pounds with all other elements except oxygen. Valence, 
 one; atomic weight, 19. Chlorine is a greenish yellow gas, 
 occurring only in combination. It has a penetrating odor, 
 and is very irritating. It has a tendency to combine with 
 other elements, sometimes with evolution of light and 
 heat. In the presence of water it is an active bleaching 
 and disinfecting agent. Valence, one; atomic weight, 35.5, 
 Bromine is a dark, reddish-brown liquid, giving off an 
 irritating vapor. It is only found in combination. It is 
 somewhat similar to chlorine, but less active. Valence, 
 one ; atomic weight, 80. Iodine is found in combination ; is 
 a solid, volatile, its vapor has a violet color and peculiar 
 odor; it is scaly, with metallic luster. It is somewhat 
 similar to chlorine and bromine, but is less active. Valence, 
 one; atomic weight, 127. 
 
 4. Phenic acid. Formula: CelLOH. Derived from 
 
 360 
 
MEDICAL RECORD. 
 
 coal tar. Used as an antiseptic, disinfectant; as an applica- 
 tion to burns, lupus; as an injection for leucorrhea and 
 gonorrhea in the female ; as an antipruritic. Treatment for 
 toxic dose: Externally, alcohol; internally, sodium sul- 
 phate. 
 
 5. Sulphuric acid. Formula: H2SO4. Obtained by 
 combustion of sulphur, and oxidation and hydration of the 
 resulting sulphur dioxide, by vapor of nitric acid and water. 
 Toxic dose: "One dram is the smallest dose reported fatal 
 to an adult. One-half that quantity has caused the death 
 of a child one year old. There is no doubt, however, that 
 as small a quantity as two or three drops of the concen- 
 trated acid would prove permanently injurious, while it 
 might not prove fatal. Recovery has taken place after four 
 ounces when appropriate treatment has been given." — 
 (Riley's Toxicology.) 
 
 Use in medicine: As a caustic for venereal sores and 
 warts: internally, in serous diarrhea, cholera, acute lead 
 poisoning, and for the night-sweats of phthisis. 
 
 BACTERIOLOGY. 
 
 i. "Diphtheria antitoxin is obtained from the horse, the 
 animal having been rendered artificially immune by re- 
 peated injections extending over a period of several months 
 of gradually increasing quantities of the strongest diph- 
 theria toxin. As the bacilli themselves are not injected, 
 the horse does not become infected with diphtheria, but he 
 gradually acquires a tolerance for the toxins of the disease 
 and develops in his blood a substance (antitoxin) which 
 has the power to neutralize those toxins. At the proper 
 time, when it is thought that his blood has acquired the 
 requisite degree of potency, the animal is bled, and the 
 serum — the part of the blood containing the antitoxin — is 
 carefully separated from the clot, filtered, and standardized. 
 The last procedure is accomplished by determining the 
 quantity of antitoxin serum required to offset the effects 
 of the minimum quantity of toxin necessary to kill a 
 guinea-pig in a definite time. The strength of the antitoxin 
 is measured in units, a unit containing the amount of anti- 
 toxin required to save the life of a guinea-pig which has 
 been injected with 100 fatal doses of toxin." — (Stevens' 
 Materia Medica.) 
 
 2. The introduction into the body of the vaccine is sup- 
 posed to bring about a reaction, which is evidenced by a 
 marked increase in the bactericidal and agglutinative prop- 
 erties of the blood serum against the particular organism. 
 
 3. Smallpox, diphtheria, tuberculosis, bubonic plague, hy- 
 drophobia, cholera, typhoid ; and it has also been tried in 
 some other diseases. 
 
 4. To stain the pneutnococcus: Spread a cover glass with 
 
 36i 
 
MEDICAL RECORD 
 
 a smear containing the bacteria, dry it, then fix it in a 
 flame. It can then be stained for from five to ten minutes 
 in Ehrlich's solution; it is then to be washed in water and 
 afterwards immersed in Gram's solution for two or three 
 minutes. It is then washed in 95 per cent, alcohol. While 
 in the Gram's solution the specimen is very dark brown, 
 but it becomes violet or blue again on application of the 
 alcohol. 
 
 5. To find tubercle bacilli in the urine: The urine should 
 be drawn by a catheter, with the utmost regard to cleanli- 
 ness and asepsis (so as to exclude the smegma bacillus). 
 The urine thus obtained must be centrifuged for a long 
 time. Some of the sediment is placed on a slide with a 
 small quantity of egg albumin ; it is covered with some car- 
 bolfuchsin, and allowed to steam over a small flame for 
 about two minutes, care being taken that it does not boil. 
 Wash it thoroughly in water and then decolorize by im- 
 mersing it in a solution of any dilute mineral acid for about 
 a minute. Then make a contrast stain with solution of 
 Loeffier's methylene blue for about a minute; wash it 
 again and examine with oil immersion lens. The tubercle 
 bacilli will appear as thin, red rods, while all other bac- 
 teria will appear blue. 
 
 PATHOLOGY. 
 
 i. See French's "Practice of Medicine" (1907), page 588; 
 or Osier's "Practice of Medicine" (1909), page 802. 
 
 2. See French's "Practice of Medicine" (1907), pages 
 898 and 002; or Osier's "Practice of Medicine" (1909), 
 pages 692 and 695. 
 
 3. "The iris is congested, swollen, and infiltrated with 
 round cells. There is an exudate of round cells, fibrin, 
 and pigment cells, which fills the anterior chamber and 
 glues the edge of the pupil and back of the iris to the 
 anterior capsule of the lens." — (Ailing and Griffin's Epito- 
 me of the Eye and Ear.) 
 
 4. See French's "Practice of Medicine" (1907), page 
 254; or Osier's "Practice of Medicine" (1909), page 244. 
 
 5. See French's "Practice of Medicine" (1907), page 735; 
 or Osier's "Practice of Medicine" (1909), page 460. 
 
 THERAPEUTICS. 
 
 1. Opium. Official preparations, with doses: Powdered 
 opium, gr. j ; extract of opium, gr. ss ; powder of ipecac 
 and opium, gr. vijss; vinegar of opium, rp^viij ; camphorated 
 tincture of opium, 5ij ; deodorated tincture of opium, 
 Tl^viij ; granulated opium, gr. jss; wine of opium, 
 n^viij ; morphine, gr. 1/5; morphine sulphate, acetate, and 
 hydrochloride, each gr. % ; codeine, gr. y 2 ; codeine sul- 
 phate and phosphate, each, gr. ]/ 2 ; apomorphine hydro- 
 
 362 
 
MEDICAL RECORD. 
 
 chloride, gr. i/io. Therapeutic uses: As an anodyne, in 
 diarrhea, peritonitis, for internal hemorrhages, in mania 
 and delirium tremens, in many respiratory affections, in 
 diabetes, and to prevent or lessen shock. 
 
 2. Colckicum. Physiological action: It is a diuretic, 
 causes irritation of the gastrointestinal tract, salivation, 
 collapse, and increases the output of uric acid. Therapeutic 
 uses: Chiefly used in gout; also in headache, dyspepsia, 
 or neuralgia in gouty people. 
 
 3. Bryonia. Dose, gr. x to lx. It is used as a hydra- 
 gogue cathartic, in cases of dropsy or other serous effu- 
 sions. 
 
 4. Precipitated calcium phosphate, gr. xv; syrup of cal- 
 cium lactophosphate, 5ij. It is used in diseased conditions 
 of the bones, rickets, mollities ossium, scrofula, anemic 
 conditions, tuberculosis. 
 
 5. Veratrum. Dose, gr. ij. Uses: As a circulatory de- 
 pressant in pneumonia, in puerperal convulsions, tonsillitis, 
 puerperal inflammations in general, mania, and as a rule 
 very much as aconite. 
 
 6. Ipecac. Dose, gr. j as an expectorant; gr. xv as an 
 emetic. Action: Hemostatic, expectorant, emetic, stom- 
 achic, cholagogue, and diaphoretic. Uses: As an emetic, 
 to clear the respiratory passages, to relieve the stomach, 
 in bronchitis, emphysema, dysentery and jaundice, and as 
 a diaphoretic in rheumatism. 
 
 7. Nux vomica. Officinal preparations: Extract, gr. %; 
 fluid extract, TT#j ; and tincture of nux vomica, TTgx. Strych- 
 nine (with its sulphate and nitrate), each gr. 1/64. Uses: 
 As a general tonic or bitter; in indigestion, cardiac de- 
 pression, impaired peristalsis, pneumonia, phthisis, amenor- 
 rhea, dysmenorrhea, impotence, and urinary incontinence. 
 
 8. Tartar emetic. Dose, gr. 1/10 as an expectorant, 
 and gr. y 2 as an emetic. Indications: In inflammatory af- 
 fections of the respiratory tract, when the secretion of 
 mucus is not free ; in pneumonia, bronchopneumonia, colds, 
 bronchitis, laryngitis, and tonsillitis. 
 
 9. Aconite. Dose: Fluid extract, TTgj ; tincture, Tl^x. 
 Medicinal uses: For fevers, some inflammatory conditions, 
 in high arterial tension, in nervous palpitation of the heart, 
 and congestive dysmenorrhea ; also externally for neural- 
 gia, pruritus, herpes, chilblains, etc. 
 
 10. Cinchona. Officinal preparations: Fluid extract, 
 TTBxv ; tincture, 3j ; compound tincture of cinchona, 3j. 
 Quinine (with its sulphate, bisulphate, hydrobromide, hy- 
 drochloride, and salicylate), each gr. iv; cinchonine sul- 
 phate, gr. iv; cinchonidine sulphate, gr. iv. Uses: In 
 malaria; as a tonic; in influenza, in dyspepsia, in asthma: 
 as an antipyretic ; and locally, for sores in diphtheria, and 
 in hay fever. 
 
 063 
 
MEDICAL RECORD. 
 
 PRACTICE. 
 
 i. See French's "Practice of Medicine" (1907), page 
 298; or Osier's "Practice of Medicine" (1909), page 112. 
 
 2. Methods of physical diagnosis are : Inspection, palpa- 
 tion, percussion, auscultation, mensuration, and weighing. 
 Inspection shows the shape, size, symmetry, movements, 
 and color of the chest. Palpation confirms and adds to 
 what is learnt by inspection, shows areas of tenderness, 
 condition of chest walls, presence of tumors, action of 
 heart, and the existence and character of fremitus. Per- 
 cussion shows the composition of structures or tissues, the 
 resistance or elasticity or certain organs, and resonance 
 of lungs. Auscultation enables one to study the condition 
 of the heart and lungs. 
 
 3. See French's "Practice of Medicine" (1907), pages 
 151, 156, and 174; or Osier's "Practice of Medicine" (1909), 
 pages 165, 172, and 189. 
 
 4. The early manifestations of pulmonary tuberculosis 
 are: (1) Physical signs: Deficient chest expansion, the 
 phthisical chest, slight dullness or impaired resonance over 
 one apex, fine moist rales at end of inspiration, expiration 
 prolonged or high pitched, breathing interrupted. (2) 
 Symptoms: General weakness, lassitude, dyspnea on exer- 
 tion, pallor, anorexia, loss of weight slight fever, and night 
 sweats, hemoptysis. 
 
 For treatment, see French's "Practice of Medicine" 
 (1907), page 392; or Osier's "Practice of Medicine" (1909), 
 page 352. 
 
 5. See French's "Practice of Medicine" (1907), pages 65 
 and 109; or Osier's "Practice of Medicine" (1909), pages 
 57 and 99. 
 
 6. See French's "Practice of Medicine" (1907), pages 
 649 and 650; or Osier's "Practice of Medicine" (1909), 
 pages 602 and 603. 
 
 7. See French's "Practice of Medicine" (1907), pages 
 893 and 895; or Osier's "Practice of Medicine" (1909), 
 
 j pages 688 and 690. 
 ^ 8. A cataract is an opacity of the crystalline lens or its 
 capsule. Treatment: Extraction of the lens by operation is 
 the only means of relieving a patient of senile cataract; 
 discission is applicable only to cataracts of the young. 
 No medicinal treatment, whether local or constitutional, is 
 of curative value. 
 
 9. See Rose and Carless' "Surgery" (1908), page 882. 
 
 10. Psoriasis "is a common chronic inflammatory disease 
 of the skin, characterized by variously sized lesions, having 
 red bases, covered with white scales resembling mother-of- 
 pearl. It affects by preference the extensor surface of the 
 body. The lesions are infiltrated, elevated, clearly defined, 
 
 364 
 
MEDICAL RECORD. 
 
 covered with white, shining, easily detachable scales which, 
 upon removal, reveal a red, punctuate, bleeding surface. 
 The eruption is absolutely dry, and itching is usually ab- 
 sent. Treatment consists in the internal administration 
 of arsenic, codliver oil, oil of copaiba, or potassium iodid, 
 and the use of local applications. The scales should be 
 removed by soap and water, alkaline baths, or oily sub- 
 stances. Ointments containing salicylic acid (3 per cent, to 
 10 per cent), tar (3i to %i of ointment), ichthyol (3i to 
 Ji), chrysarobin (gr. 10-60 to $1), ammoniated mercury 
 (gr. 10-40 to 5 1 )* etc., are very beneficial, and should be 
 used after the scales have been removed." — (Gould and 
 Pyle's Pocket Cyclopedia.) 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), pages 94, 97, 144, 
 and 254; or Hirst's "Obstetrics" (1909), pages 78, 83, and 
 396. 
 
 2. See Williams' "Obstetrics' (1909), page 809; or 
 Hirst's "Obstetrics" (1909), page 572. 
 
 3. The hand is in a straight line with the forearm, the 
 thumb is at right angles to the other fingers, and may be 
 bent across the palm. The foot is at right angles to the 
 leg, the great toe cannot be altered in its relation to the 
 other toes, the malleoli and os calcis may be felt. 
 
 The knee has two tuberosities with an intervening de- 
 pression ; the patella may also be felt. The elbow has three 
 prominences (the olecranon process of the ulna and the 
 two condyles of the humerus). 
 
 In shoulder cases (as distinguished from vertex) the 
 tumor is unsymmetrical in shape, and is longer transversely 
 or obliquely; the head can be felt in one iliac fossa, and 
 the breech higher up in the flank of the opposite side. 
 
 In cases of shoulder presentation, if seen before labor, 
 version should be performed to correct the representa- 
 tion ; in case of impaction a cesarean section is indicated ; 
 sometimes decapitation or embryotomy has been performed, 
 but a cesarean section is preferable. Cases of shoulder 
 presentation have been known to terminate spontaneously, 
 but it is not advisable to rely on this possibility. 
 
 4. _ Puerperal eclampsia is an acute morbid condition, oc- 
 curring during pregnancy, labor, or the puerperal state, and 
 is characterized by tonic and clonic convulsions, which af- 
 fect first the voluntary and then the involuntary muscles; 
 there is total loss of consciousness, which tends either to 
 coma or to sleep, and the condition may terminate in re- 
 covery or death. The causes may be : UVemia, albumin- 
 uria^ imperfect elimination of carbon dioxide by the lungs, 
 medicinal poisons, septic infection; predisposing causes are 
 renal disease and imperfect elimination by the skin, bowels, 
 
 36s 
 
MEDICAL RECORD. 
 
 and kidneys. Prognosis is serious to mother and child. 
 Preventive treatment: (i) The amount of nitrogenous 
 food should be diminished to a minimum; (2) the pro- 
 duction and absorption of poisonous materials in the in- 
 testines and body tissues should be limited and their elim- 
 ination should be aided by improving the action of the 
 bowels, the kidneys, the liver, the skin, and the lungs; (3) 
 the source of the fetal metabolic products and the periph- 
 eral irritation in the uterus should, if necessary, be re- 
 moved by evacuating that organ. Curative treatment: (1) 
 Control the convulsions (by chloroform, veratrum, or 
 chloral); (2) eliminate the poison or poisons which are 
 presumed to cause the convulsions; (3) empty the uterus 
 under deep anesthesia, by some method that is rapid and 
 that will cause as little injury to the woman as possible. 
 
 5. See Williams' "Obstetrics" (1909), pages 321, 324, 
 661, and 822; or Hirst's "Obstetrics" (1909), pages 331 and 
 
 587. 
 
 6. See Williams' "Obstetrics" (1909), page 397; or Hirst's 
 "Obstetrics" (1909), page 809. 
 
 7. False labor pains are slight, occur before labor, do not 
 cause dilatation of the os, do not produce a "show." 
 
 True labor pains gradually increase in frequency and 
 severity, occur during labor, cause the os to dilate, produce 
 a "show." 
 
 Labor is divided into three stages : The first stage be- 
 gins with the commencement of labor, and ends with the 
 complete dilatation of the os uteri. The second stage begins 
 with a complete dilatation of the os uteri, and ends with 
 the birth of the child. The third step immediately follows 
 the second, and ends with the expulsion of the placenta 
 and the beginning contraction of the uterus. 
 
 8. See Williams' "Obstetrics" (1009) page 844; or Hirst's 
 "Obstetrics" (1909), page 939. 
 
 9. See Williams' "Obstetrics" (1909), page 347; or Hirst's 
 "Obstetrics" (1909), pages 344 and 373. 
 
 10. See Williams' "Obstetrics" (1909), page 190; or 
 Hirst's "Obstetrics" (1909), page 204. 
 
 GYNECOLOGY. 
 
 1. See Rose and Carless' "Surgery" (1908), page 1277. 
 Varieties of vulvitis: Catarrhal, follicular, venereal, diph- 
 theritic, and phlegmonous. 
 
 2. See Rose and Carless' "Surgery" (1908), page 1277. 
 Varieties of vaginitis: Acute, chronic, primary, secondary, 
 catarrhal, membranous, diphtheritic, gonorrheal, granular, 
 emphysematous, and senile. 
 
 3. Menstruation is a periodical disturbance in the female 
 characterized by a bloody mucous discharge from the 
 uterine cavity ; it lasts during the period of woman's sexual 
 
 366 
 
MEDICAL RECORD. 
 
 activity, but is temporarily suspended during pregnancy 
 and early lactation. 
 
 Disorders of menstruation include: (i) Premature or 
 precocious menstruation; (2) protracted menstruation; (3) 
 absence of menstruation (amenorrhea) ; (4) profuse men- 
 struation (menorrhagia) ; (5) flow in between periods 
 (metrorrhagia) ; (6) painful menstruation (dysmenor- 
 rhea) ; (7) vicarious menstruation; (8) regular intermen- 
 strual pain. 
 
 Amenorrhea is physiological: Before puberty, during 
 pregnancy and early lactation, and after the menopause. 
 It may also be due to : Absence or imperfect development 
 of the generative organs; also to stenosis, obstructions, or 
 atresia of the genital tract ; also to operative removal of the 
 uterus or its appendages, Other causative factors are : 
 Acute infectious diseases, anemia, chlorosis, obesity, drug 
 habits, alcoholism, overstudy, lack of exercise, exposure 
 to cold, and various emotional causes. Treatment consists 
 in: (1) Removing the cause, if possible; (2) general treat- 
 ment by means of proper hygiene, rest, diet, bathing, atten- 
 tion to the bowels, exercise, etc.; (3) drugs reputed to be 
 emmenagogues, such as iron, manganese, aloes, strychnine, 
 apiol, oxalic acid, savine, rue, and tansy. 
 
 Common Causes of Menorrhagia. Constitutional: Pur- 
 pura, scorbutus, hemophilia, hepatic cirrhosis, over indulg- 
 ence in food and alcoholic drinks. Local and Vascular: 
 Uterine congestion and displacement, endometritis, subin- 
 volution, fibroids, and other tumors. Common Causes of 
 Metrorrhagia. Constitutional: None. Local and Vascu- 
 lar: Disease of uterus or appendages, polyps, extrauterine 
 gestation, the hemorrhages in connection with pregnancy. 
 
 Treatment of both : Remove the cause, if possible; treat 
 abnormal conditions that are present; vaginal douches, 
 tampons, and curettage have been recommended ; also ergot, 
 hamamelis, hydrastis, and viburnum prunifolium; rest in 
 bed is necessary. Intrauterine applications of astringents 
 or of adrenalin have been used. 
 
 Dysmenorrhea. Causes: Pelvic congestion, pelvic in- 
 flammation, malnutrition, overwork, lack of development, 
 neuralgia, stenosis or obstruction of the cervix, prolapse 
 or displacement of the uterus. Treatment : < If possible, 
 remove cause ; attend to the general condition, hygiene, 
 tonics, regular habits, etc. ; curettage may be necessary, and 
 may have io be repeated (perhaps more than once). 
 
 4. Metritis is inflammation of the body or parenchyma 
 of the uterus. Varieties: Acute, chronic, hemorrhagic, 
 catarrhal, suppurative, granular, ulcerative (and also ac- 
 cording to etiology). Causes: Wounds, injuries, opera- 
 tions, gonorrhea, septic -infection, puerperal sepsis, cold 
 during menstruation, intrauterine medication, and manipu- 
 
 367 
 
MEDICAL RECORD 
 
 lations. Treatment : Remove the cause, if possible, pre- 
 vention of sepsis, rest in bed, anodynes, hot vaginal douche, 
 tampons with glycerin, iodin applications, suppository of 
 opium and belladonna, dilatation, curettage, cauterization, 
 irrigation, drainage, etc. 
 
 5. In the case of polypus, the body and fundus of the 
 uterus are in their normal position in the abdbomen, a 
 sound can be passed into the uterus, the uterine and cer- 
 vical canals are not obliterated, the polypus does not bleed 
 easily, and is not particularly sensible to pain. The in- 
 verted uterus shows : Absence of body and fundus from 
 normal position, will not permit passage of a sound into 
 uterine cavity, the uterine and cervical canals are absent, 
 the inverted uterus tends to bleed easily, and is very sen- 
 sible to pain. In prolapse the largest part of the tumor is 
 above; the opening of the Fallopian tubes cannot be seen; 
 a sound can be passed into the uterine cavity. 
 
 1. SURGERY. 
 
 TUMOR OF BRAIN. 
 
 1. No primary focus of in- 
 fection but often history of 
 syphilis or malignant dis- 
 ease of other organs. 
 
 2. Very slow development. 
 
 3. More definite focal 
 symptoms. 
 
 4. No rigors or septic 
 symptoms. 
 
 5.. Temperature normal or 
 slightly and irregularly ele- 
 vated. 
 
 6. Pulse slow. 
 
 7. Constant headache. 
 
 8. Projectile vomiting fre- 
 quently present. 
 
 9. General symptoms of 
 pressure progressive. 
 
 10. Choked disc constant. 
 
 ABSCESS OF BRAIN. 
 
 i. Suppurating area in ear, 
 nose, pharynx, scalp, or 
 lung abscess. 
 
 2. More rapid. 
 
 3. Focal symptoms often 
 present, but not so definitely 
 localized as in tumor. 
 
 4. Often begins with chills, 
 septic symptoms often con- 
 tinue. 
 
 5. Temperature subnor- 
 mal, other times higher — 
 pus temperature. 
 
 6. Not slow as a rule. 
 
 7. Not a constant or prom- 
 inent symptom. 
 
 8. Not often; vomiting, if 
 present, more frequent and 
 not projectile. 
 
 9. When present, they vary 
 greatly in intensity. 
 
 10. Not constant. 
 
 — (Eisendrath.) 
 
 2. See Rose and Carless' "Surgery" (1908), page 1088; 
 or Da Costa's "Surgery" (1908), page 991. 
 
 3. See Rose and Carless' "Surgery" (1908), page 574; or 
 Da Costa's "Surgery" (1908), page 442. 
 
 4. Gastric ulcer is generally caused by injury or bac- 
 
 36$ 
 
MEDICAL RECORD. 
 
 J 
 
 teria, is most apt to occur between the ages of twenty and 
 forty-five; after eating there is pain localized in the stom- 
 ach, vomiting occurs soon after eating, hematemesis is 
 common, there is localized tenderness over the stomach, 
 and examination of the gastric contents show an excess of 
 free HC1. 
 
 Gastric cancer does not usually occur before forty years 
 of age, is more common in males, pain is localized and 
 constant, vomiting is copious and occurs some time after 
 eating; the vomitus contains ''coffee ground" material; 
 hemorrhages are common ; a tumor may be palpated, and 
 examination of the gastric contents shows absence of free 
 HC1 and presence of lactic acid; severe anemia and ca- 
 chexia are also present. 
 
 5. See Rose and Carless' "Surgery" (1908), page 243; or 
 Da Costa's "Surgery" (1908), pages 572 and 258. 
 
 6. See Rose and Carless' "Surgery" (1908), page 1172; 
 or Da Costa's "Surgery" (1908), page 1115. 
 
 7. Tuberculosis of the hip is characterized by: Mscular 
 spasm, lameness, shortening, atrophy, and swelling. In 
 congenital dislocation there is a history of limp since the 
 child began to walk; the trochanter is above Nelaton's 
 line; there is no muscular stiffness, and no limitation of 
 motion at the hip joint. 
 
 8. See Rose and Carless' "Surgery" (1908), pages 507 
 and 513; or Da Costa's "Surgery" (1908), page 497. 
 
 9. See Rose and Carless' "Surgery" (1908), page 1121; 
 or Da Costa's "Surgery" (1908), page 838. 
 
 10. See Rose and Carless' "Surgery" (1908), page 1229; 
 or Da Costa's "Surgery" (1908), page 1190. 
 
 HYGIENE. 
 
 1. Ophthalmia neonatorum. Etiology: It is due to 
 the gonococcus or some other pyogenic germ ; and is pro- 
 duced by contact of the eye with the vaginal secretion of 
 the mother during labor, or infected fingers, or instru- 
 ments, etc. 
 
 Prophylaxis: Whenever there is the possibility of infec- 
 tion, or in every case, wash the eyelids of the new-born 
 child with clean warm water, and drop on the cornea of 
 each eye one drop of a 1 or 2 per cent, solution of nitrate 
 of silver, immediately after birth. 
 
 2. See French's "Practice of Medicine" (1907), pages 
 782, 783, and 781 ; or Osier's "Practice of Medicine" (1909), 
 pages 507, 508, and 509. 
 
 3. Three infections through air: Tuberculosis, influenza, 
 measles ; through water: typhoid, cholera, dysentery : 
 through food: typhoid, tuberculosis, beriberi; through in- 
 sects: Bubonic plague, malaria, yellow fever. For prophy- 
 laxis see French's "Practice of Medicine" (1909) or Osier's 
 
 369 
 
MEDICAL RECORD. 
 
 "Practice of Medicine'' (1909), under name of the disease, 
 in the index. 
 
 4. See French's "Practice of Medicine" (1907) or Osier's 
 "Practice of Medicine" (1909), under name of the disease, 
 in the index. 
 
 5. "The methods used^ in the production of antitoxins 
 were introduced by Behring, who found that by injecting 
 susceptible animals with increasing amounts of extracel- 
 lular toxin he produced in the blood serum of the injected 
 animal certain changes which made the serum capable of 
 counteracting the same toxin when injected into other 
 animals. ... In practice, the bacilli are cultivated in 
 bouillon. The cultures are freed from all living bacilli by 
 nitration. The liquid nitrate contains the toxin. This fil- 
 trate is injected into healthy susceptible animals, in increas- 
 ing doses. Usually the horse is used, since large quantities 
 of blood can be drawn from this animal on account of its 
 size, and, moreover, the horse is very susceptible. . . . 
 Eventually enormous doses of toxin are given, and the 
 animal acquires a high degree of immunity. The blood of 
 the animal is withdrawn, taking care to avoid contamina- 
 tion, and the serum allowed to separate in the refrigerator. 
 The serum of the blood is drawn off and constitutes the 
 antitoxin." — (Williams' Bacteriology. ) 
 
 And see above, Bacteriology, i, 2, and 3 ; also French's 
 "Practice of Medicine" (1907), article "Serum," in index. 
 
 MEDICAL JURISPRUDENCE. 
 
 1. In cerebral concussion: There is sudden onset; pulse 
 is slow and weak; respirations are shallow, slight, and ir- 
 regular ; there is functional paralysis ; and incontinence of 
 urine and feces. In intoxication there is gradual onset; 
 full pulse ; respirations deep and slightly stertorous ; twitch- 
 ing of muscles ; no incontinence ; the face is flushed, and 
 the odor of alcohol may be on the breath. Note: The 
 two conditions may be coincident. 
 
 2. A recent cerebral hemorrhage has a red color, the 
 coagulum is not very firm. Later the color becomes brown- 
 ish, the coagulum is firmer and more fibrous, and more ad- 
 herent to brain and dura. 
 
 3. Malpractice is a failure on the part of a medical prac- 
 titioner to use such skill, care, and judgment in the treat- 
 ment of a patient as the law requires ; and thereby ^ the 
 patient suffers damage. If due to negligence only, it is 
 civil malpractice. But if done deliberately, or wrongfully, 
 or if gross carelessness or neglect have been shown, or if 
 some illegal operation (such as criminal abortion) be per- 
 formed, it is criminal malpractice. 
 
 4. Drowning. Homicide: Rare, except in case of in- 
 fants ; there are probably marks of violence on the body, 
 
 3?c 
 
MEDICAL RECORD. 
 
 not due to post-mortem factors. Suicide: Very common, 
 and when there were motives to suicide, or tendency to the 
 same, suicide would be suspected; as a rule there would 
 be no witnesses. Accident: Very common; often wit- 
 nesses present; proximity of precipice or other dangerous 
 place would suggest accident. It is often impossible to 
 differentiate the three conditions. 
 
 5. Hanging : The presumption is in favor of suicide; 
 but evidences of great external violence and marks of a 
 struggle or signs of fingers about the throat would point 
 to homicide; a position of the body (with hands and feet 
 tied), in which the patient could not have put himself, 
 would point to homicide. Accidental hanging is rare, and 
 occurs chiefly among children, while playing. 
 
 6. Personal identity is based on : Deformities, tattoo 
 marks, scars, general appearance, actions, voice, manner 
 of speech, apparent age, figure, size, gait, dress, moles, 
 birth-marks, professional stigmata, handwriting, finger im- 
 pressions, foot prints, examination of hair, condition of 
 the teeth, color of hair and eyes. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Board of Medical Examiners of the State of Montana. 
 
 ANATOMY. 
 
 1. Give the origin, insertion, and action of the following 
 muscles : deltoid, latissimus dorsi, rectus femoris, and 
 tibialis anticus. 
 
 2. Trace the arterial blood supply from the heart to the 
 foot, naming the principal branches given off. 
 
 3. Give the origin, course, and distribution of the fol- 
 lowing nerves : seventh cranial, great sciatic, median. 
 
 4. Give classification of joints, with an example of each. 
 
 5. Name and describe the salivary glands. 
 
 P.HYSI0L0GY. 
 
 1. Give the varied functions of the sympathetic nervous 
 system. 
 
 2. How is normal body temperature regulated and sus- 
 tained? 
 
 3. What is metabolism? What are its objects? 
 
 4. Give the mechanism of respiration. How is it reg- 
 ulated? 
 
 5. How is the heartbeat regulated and sustained? 
 
 6. Describe the digestion of a meal of beeksteak and 
 potatoes. 
 
 Answer five questions. 
 
 MATERIA MEDIC A. 
 
 i. What is the alkaloid of hyoscyamus? What is the dose 
 
 371 
 
iMEDICAL RECORD. 
 
 of hyoscyamus? What is the dose of hyoscine hydro- 
 bromate for hypodermic use? 
 
 2. Give the average adult dose of the following: (i) 
 liquor potassii arsenitis, (2) tinctura nucis vomicae, (3) 
 tinctura opii, (4) spiritus glyceritis nitratis, (5) oleum 
 tiglii, (6) eserina, (7) hydrargyri chloridum corrosivum. 
 
 3. Mention the conditions which affect the dosage of 
 medicines. 
 
 4. What are incompatibles in medicine, and what are the 
 different kinds of inqompatibles ? 
 
 5. Name four efficient hypnotics and give source and 
 dose of each. 
 
 THERAPEUTICS. 
 
 1. By what methods do antipyretics act? Give an ex- 
 ample of one that acts by each method. 
 
 2. What are the physiological effects and medicinal uses 
 of the preparations of belladonna? 
 
 3. State the condition of the venous system and that of 
 the arterial system that indicate the use of digitalis, and 
 what effect this drug has on the arterioles. 
 
 4. How do antagonists 'and antidotes differ? Illustrate. 
 
 5. Name three drugs used to accelerate the action of the 
 heart, also three drugs used to retard its action, and state 
 the dose of some preparation of each. 
 
 PRACTICE. 
 
 1. Differentiate cardiac hypertrophy from cardiac dilata- 
 tion ; organic from functional heart murmurs. 
 
 2. What are the causes and symptoms of dilatation of the 
 stomach ? 
 
 3. Give the causes and symptoms of ascites, and tell 
 how to recognize by what disease it is produced. 
 
 4. If summoned to a middle-aged person discovered in a 
 comatose condition, explain how to recognize upon what 
 disease the condition depends and give treatment for the 
 uremic type of coma. 
 
 5. Differentiate catarrhal from croupous pneumonia and 
 £ive treatment for the former disease. 
 
 SURGERY. 
 
 1. Give symptoms, diagnosis, and treatment of strangu- 
 lated inguinal hernia. 
 
 2. Give differential diagnosis between gallstone colic, 
 appendicitis, and kidney colic. 
 
 3. Give symptoms, diagnosis, and treatment of acute 
 empyema. 
 
 4. Give symptoms, diagnosis, and treatment of acute 
 osteomyelitis. 
 
 5. Give symptoms, diagnosis, and treatment of fractures 
 
 372 
 
MEDICAL RECORD. 
 
 in general. Give differential diagnosis between fracture and 
 dislocation. 
 
 DISEASES OF WOMEN AND CHILDREN. 
 
 i. Give the symptoms, diagnosis, and treatment of gonor- 
 rheal cystitis. 
 
 2. What are the indications for a complete hysterectomy? 
 
 3. Give the symptoms, diagnosis, and treatment of laryn- 
 geal diphtheria. 
 
 4. Differentiate scarlet fever, measles, and rotheln. 
 
 5. Give the varieties, symptoms, diagnosis, and treatment 
 of stomatitis. 
 
 OBSTETRICS. 
 
 1. Give the differential diagnosis of the different kinds 
 of convulsions which may arise in the puerperal state. 
 
 2. Give diagnosis of a transverse presentation and its 
 causes and management. 
 
 3. Give the causes and treatment of post-partum hemor- 
 rhage. 
 
 4. Give the symptoms and treatment of an incomplete 
 abortion. 
 
 5. Describe the third stage of labor and its management. 
 
 DISEASES OF THE NERVOUS SYSTEM. 
 
 i. Give the etiology, diagnosis, and treatment of chorea. 
 
 2. Differentiate neuritis from neuralgia. 
 
 3. What is aphasia? Describe its varieties. 
 
 4. Give the etiology, symptoms, and treatment of acute 
 anterior poliomyelitis. 
 
 5. In what conditions is the patellar reflex increased, 
 diminished, or absent? 
 
 DISEASES OF THE EYE AND EAR. 
 
 1. Give the diagnosis and treatment of gonorrheal oph- 
 thalmia. 
 
 2. Give the causes and sequelae of suppurative middle- 
 ear disease. 
 
 3. Give the etiology, diagnosis, and treatment of tra- 
 choma. 
 
 4. Give the symptoms and treatment of acute mastoiditis. 
 
 5. Give the diagnosis and treatment of corneal ulcer. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Board of Medical Examiners of the State of Montana. 
 
 ANATOMY. 
 
 I. Deltoid. Origin: From the outer third of anterior 
 border and upper surface of the clavicle, from the outer 
 
 373 
 
MEDICAL RECORD. 
 
 margin and upper surface of the acromion process, and 
 from the lower edge of the spine of the scapula. Insertion : 
 Into the deltoid impression on the middle of the outer side 
 of the shaft of the humerus. Action : It raises the arm 
 from the side so as to bring it at right angles with the 
 body ; its anterior fibers draw the arm forward ; its poste- 
 rior fibers draw the arm backward. 
 
 Latissimus dorsi. Origin : From the spinous processes 
 of lower six dorsal vertebrae, posterior layer of lumbar 
 fascia, external lip of crest of ilium, and from the three 
 or four lowest ribs. Insertion : Into the bicipital groove of 
 the humerus. Action : It depresses the humerus, draws it 
 backward, adducts it, and rotates it inward. 
 
 Rectus femoris. Origin : Two heads, one from the ante- 
 rior inferior spine of the ilium; the other from groove 
 above the brim of the acetabulum. Insertion : Inco the 
 patella, in common with the Vasti and Crureus. Action : 
 It flexes the hip and extends the knee. 
 
 2. From the heart the blood flows into the arch of the 
 aorta, thoracic aorta, abdominal aorta, common iliac, ex- 
 ternal iliac, femoral, popliteal, anterior tibial, and dorsal- 
 is pedis arteries. 
 
 Branches of the arch of the aorta: Innominate, left 
 common carotid, and left subclavian. Of the thoracic 
 aorta: Bronchial, esophageal, pericardial, mediastinal, and 
 intercostals. Of the abdominal aorta : Phrenic, celiac axis, 
 superior mesenteric, suprarenal, renal, spermatic (or ova- 
 rian), inferior mesenteric, lumbar, and sacra media. Of the 
 external iliac: Deep epigastric and deep circumflex iliac, 
 Of the femoral : Superficial epigastric, superficial circum- 
 flex iliac, superficial external pudic, deep external pudic, 
 profunda femoris, muscular, and anastomotica magna. Of 
 the popliteal: Muscular, cutaneous, superior articulars, in- 
 ferior articulars, and azygos. Of the anterior tibial: An- 
 terior and posterior recurrents, internal and external mal- 
 leolar, and muscular. 
 
 3. See Cunningham's "Anatomy" (1909), pages 686, 648, 
 and 627; or Gray's "Anatomy" (1908), pages 1059, 1030, 
 and 1004. 
 
 4. Classification of Joints, i. Diarthrodial, or freely 
 movable; as hip and knee. 2. Amphiar thro dial, or slightly 
 movable; as symphysis pubis and joints between bodies 
 of vertebrae. 3. Synar thro dial, or immovable ; as ethmoid 
 with vomer and parietal with frontal. 
 
 5. See Cunningham's "Anatomy" (1909), page 1009; or 
 Gray's "Anatomy" (1908), page 1224. 
 
 physiology. * 
 
 1. Functions of the sympathetic nervous system: "It 
 may safely be said that the sympathetic system has, to a 
 
 374 
 
MEDICAL RECORD. 
 
 great extent, a controlling influence over the secretion of 
 
 most of the glands, the lacrymal, the salivary, the sweat 
 glands, the glands of the stomach and intestines, the liver, 
 the kidney, etc. ; that it presides over the circulation by 
 regulating the caliber of the blood-vessels and the action of 
 the heart; that it influences respiration; and, finally, that 
 all involuntary muscles, those of the digestive apparatus, 
 of the genitourinary system, of the hair follicles (pilomo- 
 tor nerves), are under its control to such extent that, for 
 instance, in certain mammalians the bladder still continues 
 to fulfill its function for weeks after all the cerebrospinal 
 motor nerves leading to it have been severed. In short. 
 we find that all vegetative life of the organism is, to a 
 greater or less extent, under the control of the sympathetic 
 system. Therefore it may properly be called the vegetative 
 nerve system par excellence" — {Reference Handbook of 
 the Medical Sciences.) 
 
 2. The normal body temperature is regulated and main- 
 tained by the thermotactic centers in the brain and cord 
 keeping an equilibrium between the heat gained or pro- 
 duced in the body and the heat lost. 
 
 Heat is produced in the body by: (i) Muscular action; 
 (2) the action of the glands, chiefly of the liver; (3) the 
 food and drink ingested; (4) the brain; (5) the heart; 
 and (6) the thermogenetic centers in the brain, pons, 
 medulla, and spinal cord. 
 
 Heat is given off from the body, by: (1) The skin, 
 through evaporation, radiation, and conduction ; (2) the 
 expired air; (3) the excretions — urine and feces. 
 
 3. Metabolism is a name given to the entire series of 
 changes that occur in a cell or organism during the proc- 
 esses of nutrition. It is of two kinds: (1) Anabolic or 
 constructive, and (2) catabolic, or destructive. 
 
 The objects of metabolism, are: Nutrition and life, and 
 the conservation of bodily energy. 
 
 4. Mechanism: This consists of inspiration and expira- 
 tion ; the former is a muscular act brought about by en- 
 largement of the capacity of the thorax. And see Gray's 
 ^Anatomy" (1908), pages 289 and 433; or Cunningham's 
 "Anatomy" (1909), pages 415 and 419. Regulation is by the 
 respiratory center and afferent and efferent nerves. 
 
 "The respiratory center is in reality made up of two cen- 
 ters, one for each side, so that, although anatomical 1 y con- 
 nected and ordinarily acting together, yet if one center is 
 broken up. while the respiratory movements on that side 
 cease, those on the other side continue. Besides this 
 double character of the center, each half is made up of an 
 inspiratory and an expiratory center. The respiratory 
 center is both an automatic and a reflex center — i.e. it 
 sends out spontaneously impulses which result in move- 
 
 37S 
 
MEDICAL RECORD. 
 
 ments of the respiratory muscles, constituting its auto- 
 matism; and it may also be excited reflexly — i.e. by im- 
 pulses reaching it from without. Its reflex character is 
 most marked, and it is doubtless as a reflex center that its 
 function is ordinarily performed." — {Raymond.) 
 
 5. The heart beat is influenced by (1) intrinsic cardiac 
 ganglia, (2) the vagus (which slows it), and (3) the sym- 
 phathetic (which accelerates it) ; these latter are under the 
 control of two centers in the medulla, the cardio-inhibitory 
 and the cardio-accelerator. 
 
 6. The proteids are digested in the stomach and small 
 intestine, where the pepsin of the gastric iuice and the 
 trypsin of the pancreatic juice convert them into proteoses 
 and peptones. The fat is digested in the small intestine, 
 where the steapsin of the pancreatic juice emulsifies and 
 saponifies it (and the bile also helps). The carbohydrate is 
 digested in the mouth and small intestine, where the ptyalin 
 of the saliva and the amylopsin of the pancreatic juice con- 
 vert it into maltose. 
 
 MATERIA MEDICA. 
 
 i. The alkaloid of hyoscyamus is hyoscyamine. 
 The dose of hyoscyamus is gr. vij. 
 The dose of hyoscine hydrobromide for hypodermic 
 use is gr. 1/150. 
 
 2. Average adult dose of: (1) Liquor potassii arsenitis, 
 is Tl#iij ; (2) tinctura nucis vomicae, is Tl#x; (3) tinctura 
 opii, is Tl^viij ; (4) spiritus glycerylis nitratis, is TT#j ; (5) 
 oleum tiglii, is nj?j ; (6) eserina (sulphate or salicylate), 
 is gr. 1/64; (7) hydrargyri chloridum corrosivum, is 
 gr. 1/20. 
 
 3. The conditions which affect the dosage of medicines, 
 are : Age, body weight, body temperature, drug habits, 
 idiosyncrasy, method of administration, intervals between 
 doses, cumulative action of drug, disease, and race. 
 
 4. Incompatibles are substances which, when combined 
 or associated, undergo a more or less complete change. 
 The different kinds of incompatibles are : Chemical, phar- 
 maceutical, and therapeutic. 
 
 5- 
 
 FOUR EFFICIENT 
 
 
 
 
 
 SOURCE. 
 
 DOSE. 
 
 
 HYPNOTICS. 
 
 
 
 
 Chloral hydrate. 
 
 Alcohol and chlo- 
 
 
 
 
 rine. 
 
 gr. xv to xx. 
 
 
 Sulphonal. 
 
 Acetone and mer- 
 
 
 
 
 captan. 
 
 gr. xv to xxv. 
 
 
 Trional. 
 
 Methylethylketone 
 
 
 
 
 and mercaptan. 
 
 gr. xv to xxv. 
 
 
 Paraldehyde. 
 
 Acetic aldehyde 
 and sulphuric 
 
 
 
 
 acid. 
 
 TTj^xxx to 3j. 
 
 
 376 
 
MEDICAL RECORD. 
 
 (b) Promoting heat loss, by 
 
 THERAPEUTICS. 
 
 i. The following table (from Potter's Materia Medico) 
 gives the chief temperature depressants, with their man- 
 ner of action : Temperature depression may be done by 
 five different actions working upon two principal lines, 
 viz., by — 
 
 "(i) diminishing tissue 
 
 (a) Lessening heat production, by -j (2) ^j^jg the dr _ 
 
 culation. 
 
 (3) dilating cutaneous ves- 
 sels, thus increasing 
 heat radiation. 
 
 (4) promoting perspiration 
 — its evaporation low- 
 ering the temperature. 
 
 (5) abstracting heat from 
 the body. 
 
 The following list of antipyretics includes a few for 
 each of the above named actions, to which the numbers 
 refer in each case, viz. : 
 
 Quinine, 1. Aconite, 2. Alcohol, 1, 3, 
 
 Phenol, 1. Nitrous ether, 3, 4. Antimony, 2, 4. 
 
 Salicin, 1. Acetanilid, 1, 4. Cold bath, 5. 
 
 Digitalis, 2. Phenacetin, 1, 4. Cold drinks, 5. 
 
 Antipyrin, 1, 4. Wet pack, 5. 
 
 2. Belladonna and Its Preparations. Physiological 
 effects : Anodyne, mydriatic, inhibits secretions, depres- 
 sant of terminations of nerves, accelerates the heart beat, 
 causes rise in blood pressure, but toxic doses cause the 
 blood pressure to fall, stimulates the respiratory center, 
 but large doses depress the same; it may cause vertigo, 
 restlessness, excitement, delirium, or mania. 
 
 Medicinal uses : To relieve pain, relax spasm, check 
 sweating, as a mydriatic, for night sweats, to check griping 
 of purgatives ; in asthma, to check fevers, in heart dis- 
 ease, shock and collapse, acute coryza, urinary incontinence, 
 chordee, low delirium of fevers, mania, alcoholism; as an 
 antigalactagogue, spasmodic cough. 
 
 3. Digitalis is indicated when there is low arterial ten- 
 sion and rapid pulse. Being a vaso-constrictor, it will 
 contract the arterioles. 
 
 4. Antagonists "are agents which directly oppose each 
 other in some or all of their physiological actions, and 
 therefore may be used, one against the other, in a case of 
 poisoning by either, to counteract its effect upon the organ- 
 ism, after it has been absorbed, and when, therefore, the 
 
 377 
 
MEDICAL RECORD. 
 
 time for an antidote has passed. Antagonistic action takes 
 place in the blood and tissues, and is applicable almost en- 
 tirely to vegetable poisons." 
 
 Antidotes "are agents which act upon poisons in such a 
 manner as to alter their composition, rendering them more 
 or less innocuous and so preventing their toxic action 
 being exerted upon the organism. Antidotal action takes 
 place in the alimentary canal, upon such portion of the 
 poison as is unabsorbed, and is applicable to vegetable as 
 well as to mineral poisons." — (Potter's Materia Medica.) 
 
 5. Three drugs used to accelerate the action of the heart : 
 (1) Ammonia; dose of aromatic spirits of ammonia, 
 TT#xxx. (2) Camphor ; dose of spirit of camphor, TfRxv. 
 (3) Alcohol; dose of brandy, Jj. 
 
 Three drugs used to retard the action of the heart: (1) 
 Aconite; dose of tincture of aconite, TTRviij. (2) Digitalis; 
 dose of tincture of digitalis, TTgxv. (3) Veratrum ; dose of 
 tincture of veratrum, ITgxv. 
 
 PRACTICE. 
 
 1. Cardiac hypertrophy is usually a conservative process; 
 there is an increase in the muscular tissue of the heart; the 
 cardiac area is enlarged ; the precordium bulges ; the heart 
 beat is slow and strong; the pulse strong and regular: the 
 cardiac enlargement is chiefly downward and outward; the 
 first sound is long, loud, and booming, and the second 
 sound is accentuated. 
 
 Cardiac dilatation is generally a destructive process; the 
 cavities of the heart are enlarged ; the cardiac area is en- 
 larged; the heart beat is weak and diffuse; the pulse is 
 weak and irregular and rapid; the cardiac enlargement is 
 outward and upward, and gives the heart a quadrangular 
 outline ; the first sound is short and weak ; the second sound 
 is also weak ; there may be soft, systolic murmurs, and there 
 are generally signs of venous engorgement. 
 
 Organic murmurs are due to stenosis or incompetency of 
 one or more of the valves of the heart. 
 
 Functional murmurs are not due to valvular disease. 
 
 Organic murmurs may be systolic or diastolic; may be 
 accompanied by marked dilatation or hypertrophy, and 
 there will probably be a history of rheumatism or of some 
 other disease capable of producing endocarditis. Whereas 
 a murmur, usually systolic, soft, and blowing, heard best 
 over the pulmonic area, associated with evidences of chlo- 
 rosis or anemia, and affected by the position of the patient, 
 is a hemic or functional murmur, and denotes as a rule an 
 impoverished condition of the blood. 
 
 2. Dilatation of the Stomach. Causes: Motor insuffi- 
 ciency of the stomach wall ; obstruction of the pylorus by 
 
 378 
 
MEDICAL RECORD. 
 
 cancer, or cicatrix from ulcer; pressure on duodenum from 
 without by tumors or adhesions ; pyloric hypertrophy. 
 
 Symptoms : Dyspepsia; emaciation; thirst; constipation; 
 pain,, and vomiting at long intervals of large quantities of 
 sour and fermenting fluid, which contains particles of food 
 taken several days previously; yeast cells and sarcinae 
 may be present in the vomitus. The outline of the stomach 
 may be seen to be enlarged ; percussion and auscultation 
 show enlargement also, and artificial inflation of the 
 stomach may also show increased stomach area. 
 
 3. Ascites is caused by : Mechanical obstruction of the 
 portal circulation ; cardiac or pulmonary diseases obstruct- 
 ing the general venous circulation; disease of the peri- 
 toneum ; diseases of the kidneys ; anemia, debility, ex- 
 posure to cold or wet; cancer, syphilis. 
 
 Symptoms : Generally of gradual onset; abdominal dis- 
 tention, sense of weight and fullness; dyspnea; gastro- 
 intestinal disturbances ; lineas aibicantes, presence of fluid 
 may be detected by palpation, percussion, or aspiration. If 
 due to heart or lung disease, ascites will occur elsewhere, 
 and the legs are generally affected first; in hepatic dis- 
 orders the abdominal distention is marked, and appears 
 early; in renal disease, the abdominal fluid is generally 
 small in amount. 
 
 4. In alcoholic coma the coma is not usually absolute; 
 there may be an odor of alcohol on the breath, the patient 
 can generally be aroused by shouting in his ear ; there is 
 no paralysis; the pupils are normal or dilated; respiration 
 is practically normal; the pulse is first rapid and later 
 feeble, and the skin cool. 
 
 In uremic coma the coma is deep; there may be a uri- 
 nous odor to the breath ; the urine is scanty and contains 
 albumin ; there is slow pulse, with high arterial tension ; the 
 pupils are usually small and equal ; respiration is deep and 
 may be quickened; the body temperature may be above 
 normal or subnormal. 
 
 In cerebral apoplexy there is generally paralysis of the 
 head and upper limbs, and in left-sided lesions there may 
 be aphasia ; the pulse is slow and full ; the respirations are 
 at first slow, regular, and stertorous, later on becoming of 
 the Cheyne-Stokes type. 
 
 In opium poisoning the pupils are contracted, there is no 
 sign of paralysis ; both respirations and pulse are slow 
 and full. 
 
 In coma of epilepsy: History of attack, with previous 
 convulsion ; the coma is of brief duration, and the uncon- 
 sciousness gradually becomes less ; there may be a bitten 
 tongue or other scars. 
 
 379 
 
MEDICAL RECORD. 
 
 5- 
 
 CROUPOUS PNEUMONIA. 
 
 Generally a primary disase. 
 
 Age has little influence. 
 
 Sudden onset. 
 
 Fever is high and regular. 
 
 Ends by crisis between sixth 
 and tenth day. 
 
 Generally only one lung af- 
 fected. 
 
 The physical signs are dis- 
 tinct, and there is a large 
 area of consolidation. 
 
 Sputum is rusty. 
 
 CATARRHAL PNEUMONIA. 
 
 Generally secondary (to 
 bronchitis or an infectious 
 disease). 
 
 Generally found in very 
 young or very old. 
 
 Gradual onset. 
 
 Fever is not so high, and is 
 irregular. 
 
 Ends by lysis, at no partic- 
 ular date. 
 
 Generally both lungs af- 
 fected. 
 
 Physical signs indistinct, and 
 the evidences of consoli- 
 dation are indefinite. 
 
 Sputum is rather streaked 
 with blood. 
 
 SURGERY. 
 
 i. Rose and Carless' "Surgery" (1908), pages 1099 and 
 1103; or Da Costa's "Surgery" (1908), page 994. 
 
 2. In gallstone colic : The pain is in the region of the 
 liver; it radiates to the right scapula and toward the um- 
 bilicus; chills and sweats are common; also vomiting, and 
 sometimes symptoms of collapse and jaundice; calculi are 
 found, if at all, in the feces. 
 
 In appendicitis : The pain is at first diffuse, but later 
 becomes localized over the appendix in the right iliac 
 fossa; nausea, vomiting, and constipation may be present; 
 tenderness over the appendix and rigidity of the right 
 rectus abdominis muscle are present ; there is generally 
 moderate fever. 
 
 In kidney colic : The pain is in the region of the affected 
 kidney; it radiates down the thigh; there are intense 
 rigors; retraction of the testicle may be present; also his- 
 tory of previous attacks or of calculi; the urine may be 
 scanty, suppressed, or bloody. 
 
 3. Acute Empyema. Symptoms : Fever, sweats, chill, 
 diminished breath sounds and vocal fremitus, impaired 
 mobility of chest, dullness on affected side, heart displaced 
 to opposite side, leucocytosis. 
 
 Diagnosis is made by aspiration, showing the fluid to 
 be pus. 
 
 Treatment: Aspiration, drainage, irrigation, resection of 
 ribs (Estlander's operation) or resection of chest wall 
 (Schede's operation). 
 
 380 
 
MEDICAL RECORD. 
 
 4. Osteomyelitis is inflammation of the bone and mar- 
 row ; the term is often used now for inflammation of bone. 
 
 It is caused by infection, the bacteria gaining entrance 
 either through a wound, or by extension from neighboring 
 tissues, or they may be brought by the blood. 
 
 Symptoms: Sudden onset; pain, tenderness, fever, chills, 
 swelling of soft parts; sometimes the joint can be moved 
 gently without pain ; septicemia or pyemia may be present. 
 
 It is to be diagnosed from (1) Rheumatism, in which 
 more than one joint is affected and the tenderness is in 
 the joint, and not near it. (2) Tubercular arthritis, in 
 which the onset is slow and the trouble starts in the 
 epiphysis rather than in the diaphysis. (3) Cellulitis in 
 which the bone and periosteum are not affected, and in 
 which there is always a wound. 
 
 In osteomyelitis, the treatment consists in relieving the 
 constitutional symptoms and preventing the bone from 
 necrosing. An incision down to the bone is made; if pus 
 is beneath the periosteum, the latter is also incised; a piece 
 of bone is removed by chisel or trephine, pus is removed, 
 the endosteum is hurt as little as possible, the wound is 
 irrigated with hot bichloride solution and packed with 
 gauze; the soft parts are closed and the wound well 
 drained. In case this fails, amputation may be necessary. 
 
 5. The general symptoms of fracture are : History of 
 injury, disability, pain, swelling, deformity, abnormal mo- 
 bility, and crepitus. 
 
 The cardinal principles in the treatment of fractures are : 
 Reduction, coaptation, immobilization, and suitable meas- 
 ures for promoting the nutrition of the part and for pre- 
 venting adhesions in the neighboring joints and muscles. 
 Compound fractures, in addition, demand: Asepis, re- 
 moval of foreign matter or damaged tissues, stopping the 
 hemorrhage, and measures to combat shock. 
 
 FRACTURE. 
 
 1. Crepitus may be present. 
 
 2. Preternatural mobility. 
 
 3. Easily reduced — but 
 
 4. Deformity more liable to 
 
 recur after reduction. 
 
 5. The head of the bone is 
 
 in its proper place. 
 
 6. The socket containing the 
 
 head of the bone is not 
 empty. 
 
 7. When rotated the bone 
 
 does not move as one 
 piece. 
 
 DISLOCATION. 
 
 i. Crepitus never present. 
 
 2. Rigidity rather than mo- 
 
 bility. 
 
 3. Difficult to reduce — but 
 
 4. Deformity less liable to 
 
 recur after reduction.^ 
 
 5. The head of the bone is 
 
 not in its proper place. 
 
 6. The socket which should 
 
 contain the head of the 
 bone is empty. 
 
 7. When rotated the bone 
 
 moves as one piece. 
 
 38: 
 
MEDICAL RECORD. 
 
 DISEASES OF WOMEN AND CHILDREN. 
 
 1. Gonorrheal Cystitis. Symptoms: Frequent mictu- 
 rition; pain; bladder irritability and tenesmus; the urine 
 is turbid and may contain blood, pus, or mucus ; the gono- 
 coccus is present; the patient may also experience chills 
 and fever. 
 
 Treatment includes : Rest in bed ; administration of 
 plenty of cold water or milk, diuretics, bland and mild 
 foods, laxatives, hot sitz baths or vaginal douches, irriga- 
 tion of the bladder with antiseptic solution, followed by 
 solution of nitrate of silver. 
 
 2. The indications for hysterectomy are given as fol- 
 lows : For the abdominal operation : All solid or cystic 
 tumors of the uterus ; cancer ; uterine rupture during labor ; 
 certain conditions of puerperal sepsis; pregnancy compli- 
 cated by pelvic deformity, cancer, or other serious obstacle 
 to the passage of the child; uterine prolapse or inversion, 
 and incidentally as a step in the removal of complicated 
 suppurative conditions of the uterine appendages. 
 
 For the vaginal operation: Bilateral suppurative condi- 
 tions of the appendages; prolapse, cancer, pregnancy with 
 cancer before the sixth month ; certain septic conditions of 
 the uterus ; certain rare conditions which may require the 
 ablation of a small movable uterus. 
 
 For the combined operation : Cancer, certain compli- 
 cated fibroids ; failure to secure hemostasis from below. — 
 (From Reference Handbook of the Medical Sciences.) 
 
 3. Laryngeal Diphtheria. Symptoms : General malaise, 
 chills, fever, sore throat, stiff neck, congestion of soft pal- 
 ate, whitish patches of membrane are formed. The fever 
 may become very high ; the membrane is adherent ; re- 
 forms if stripped off, and contains the Klebs-Loeffler 
 bacillus. Cough and dyspnea are present. 
 
 Diagnosis consists in a microscopical examination of the 
 exudate, when the specific (Klebs-LoefBer) bacillus will 
 be found. 
 
 Treatment : The patient should be isolated and put to 
 bed ; the atmosphere of the room should be kept moist ; the 
 diet must be nutritious and easily digested; diphtheria 
 antitoxin should be administered as soon as possible ; alco- 
 hol or strychnine are indicated ; local applications, either 
 hot or cold, will relieve the pain ; mild antiseptic solutions 
 are often used. 
 
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MEDICAL RECORD. 
 
 5. See French's "Practice of Medicine" (1907), page 707; 
 or Osier's "Practice of Medicine" (1909), page 434. 
 
 OBSTETRICS. 
 
 1. See Hirst's "Obstetrics" (1909), page 632. 
 
 2. See Williams' "Obstetrics" (1909), page 798; or Hirst's 
 "Obstetrics" (1909), page 426. 
 
 3. See Williams' "Obstetrics" (1909), page 818; or Hirst's 
 "Obstetrics" (1909), page 586. 
 
 4. See Williams' "Obstetrics" (1909), page 617; or Hirst's 
 "Obstetrics" (1909), page 278. 
 
 5. See Williams'' "Obstetrics" (1909), pages 229 and 298; 
 or Hirst's "Obstetrics" (1909), pages 433 and 338. 
 
 DISEASES OF THE NERVOUS SYSTEM. 
 
 i. See French's "Practice of Medicine" (1907), page 
 1117; or Osier's "Practice of Medicine" (1909), page 1045. 
 
 2. In neuritis the pain is continuous, is always worse 
 after use of the nerve, and does not vary in situation; 
 painful points are present; the nerve trunk is tender, and 
 the pain can be increased proportionately with pressure; it 
 is not limited to sensory nerves, and trophic disturbances, 
 wasting, and alterations in the electrical reactions are very 
 apt to appear. 
 
 In neuralgia the pain is paroxysmal and intermittent; it 
 is independent of the use of the nerve; it may vary in 
 situation ; painful points are not often present ; the nerve 
 trunk is not particularly tender, and a light pressure along 
 the nerve trunk may cause as much pain as a heavy pres- 
 sure; neuralgia only affects sensory nerves, and wasting 
 and trophic disturbances only rarely occur. 
 
 3. Aphasia is the inability to express ideas by either 
 speech or writing. It is caused by lesions of the cortical 
 centers, and is not due to lesions of the peripheral nerves 
 or of the organs concerned in speech or writing. 
 
 In ataxic aphasia there is loss of speech, owing to lack 
 of coordination of the muscles concerned in voice produc- 
 tion. The patient knows what he wants to say, but he 
 cannot utter the words. 
 
 In sensory or amnesic aphasia there is loss of word mem- 
 ory, which may or may not exist in connection with ataxic 
 aphasia. The chief varieties are: (1) Visual aphasia, in 
 which the patient can see, but cannot recognize or under- 
 stand words written or printed. (2) Auditory aphasia, in 
 which the patient hears the sound of spoken words, but they 
 convey no meaning to him. 
 
 4. See French's "Practice of Medicine" (1907), page 
 1034; or Osier's "Practice of Medicine" (1909), page 914. 
 
 5. The patella reflex is nearly always present in health, 
 and denotes a healthy condition of the entire reflex arc 
 
 384 
 
MEDICAL RECORD 
 
 (tendon, afferent or sensory nerve, posterior roots and 
 anterior horn of the spinal cord, the efferent or motor 
 nerve, and the muscle itself). It is absent when there is a 
 lesion which affects any part of this reflex arc, such as is 
 the case in locomotor ataxia, poliomyelitis, Landry's par- 
 alysis, neuritis, in apoplexy just after the shock, and in 
 epilepsy following the convulsion, etc. It is exaggerated 
 in : Hemiplegia, lateral sclerosis, general paresis, transverse 
 myelitis, injuries to the spinal cord, hysteria, neurasthenia, 
 tetanus, and strychnine poisoning. 
 
 DISEASES OF THE EYE AND EAR. 
 
 i. Gonorrheal Ophthalmia. Diagnosis: The conjunc- 
 tiva and the lids are red and swollen; the secretion con- 
 tains pus, in which the gonococcus may be found ; the eye 
 is tender and painful; the cornea may ulcerate; there is 
 generally a history of gonorrheal infection. 
 
 Treatment : Protect the sound eye. Wash the eye care- 
 fully every half hour with a saturated solution of boric 
 acid ; pus must not be allowed to accumulate. Two drops 
 of a 2 per cent, solution of nitrate of silver must also hi 
 dropped onto the cornea every night and morning. The 
 eyes must be covered with a light, cold, wet compress. The 
 patient must be isolated, and all cloths and compresses 
 used must be burnt. In adults the irrigation must be fre- 
 quent, about every half hour or hour. 
 
 2. Suppurative middle ear disease. Causes: Infection, 
 colds, blows, infectious fevers, spread of disease from naso- 
 pharynx, caries or necrosis of bone in the neighborhood. 
 
 rjuelcu: Eczema or boils of auditory meatus; suppura- 
 tive arthritis of temporo-maxiilary joint; ankylosis or ne- 
 crosis of auditory ossicles; necrosis of part of temporal 
 bone; facial paralysis; mastoiditis; meningitis; thrombosis 
 of lateral sinus ; abscess of brain. 
 
 3. Trachoma is an inflammatory condition of the con- 
 junctiva, accompanied by hypertrophy, granule formation, 
 and subsequent cicatricial changes. 
 
 Etiology : It is caused by contagion from another eye, 
 being transferred by means of the secretion. 
 
 Treatment "consists in an attempt to reduce the inflam- 
 matory symptoms and secretion, and to check and remove 
 hypertrophy of the conjunctiva, thus shortening the dura- 
 tion and diminishing the liability to conjunctival cicatriza- 
 tion and to sequelae. This is accomplished either by the 
 use of certain irritating applications, or by mechanical 
 (surgical) means. 
 
 Irritating applications: Sulphate of copper in the form 
 of a crystal or pencil is the favorite local application. 
 Nitrate of silver Tone or two per cent, solution), gylcerole 
 of tannin (five to twenty-five per cent.), and the alum stick 
 are also employed. 
 
 385 
 
MEDICAL RECORD. 
 
 Mechanical (surgical) treatment includes expression, 
 grattage, excision, curetting, electrolysis, .ar-rays, and gal- 
 vano-cautery." — (May's Diseases of the Eye.) 
 
 4. Acute mastoiditis. Symptoms: Tenderness, pain, 
 swelling and redness over the mastoid; bulging of the 
 superior and posterior parts of the auditory canal; tem- 
 perature variable, from normal up to about 104 F. Treat- 
 ment: Hot water, or cold water, or ice; leeches, purga- 
 tives ; light diet ; acetanilid, incision, or mastoid operation. 
 
 5. Corneal ulcer. Diagnosis: It is detected by oblique 
 illumination, the ophthalmoscope, or convex lens, and by 
 dropping fluorescin' upon the cornea, the denuded area be- 
 ing colored green. Pain, photophobia, lacrimation, swell- 
 ing of the lids and conjunctiva, and destruction of tissue 
 are symptoms. 
 
 Treatment: This consists in putting the eye at rest, 
 instilling atropin, and the application of a bandage, seeches 
 to the temple will relieve the pain. Hot compresses have 
 the same effect. The eye should be douched with sublimate 
 solution, 1 15000, and iodoform dusted upon the cornea. 
 Stronger sublimate solution, boroglycerid 50 per cent., and 
 formalin 10 per cent, are sometimes necessary. Cauteriza- 
 tion is occasionally indicated. If perforation seems proba- 
 ble, it should be hastened by a puncture. — (Gould and 
 Pyle's Cyclopedia.) 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Nebraska State Board of Medical Examiners. 
 
 anatomy. 
 
 1. What arteries unite to form the basilar artery? 
 
 2. What arteries, muscles, and nerves would be severed 
 in a cross section at the middle of the humerus? 
 
 3. Describe the ulnar artery. 
 
 4. Where does the abdominal aorta commence and where 
 does it terminate? 
 
 5. Describe the trachea. 
 
 6. Name the bones that form the ankle joint, and give 
 their relations. 
 
 7. Name the abdominal viscera (a) wholly covered with 
 peritoneum; (b) those partially covered. 
 
 8. Name the regions of the abdomen by diagram. 
 
 9. Name five muscles of the back of the leg. 
 
 10. Give the origin and insertion and blood and nerve 
 supply of the humeral biceps muscle. 
 
 PHYSIOLOGY. 
 
 1. What is meant by the term blood pressure? 
 
 2. What part of digestion takes place in the duodenum? 
 
 &6 
 
MEDICAL RECORD. 
 
 3. Describe the pneumogastric nerve, and give its func- 
 tions. 
 
 4. Describe the heart cycle. 
 
 5. How is the heat of the body maintained? 
 
 6. How are nitrogenous foods digested? 
 
 7. Give brief description of special nerve of hearing. 
 
 8. Name ductless glands, and give functions of each. 
 
 9. What is a carbohydrate? 
 
 10. What ferments enter into the digesuon of carbo- 
 hydrate ? 
 
 CHEMISTRY. 
 
 i. Give the chemical name for H 3 BO»; CHCU; CcHbOH; 
 PbC 2 Hs0 2 ; KHCO3. 
 
 2. How is glycerin obtained, and give its chemical for- 
 mula. 
 
 3. What is the chemical basis of the acidity of normal 
 urine? 
 
 4. Describe a test for sugar in the urine. Give a test for 
 bile pigment in urine. What is the normal amount of urea 
 excreted by an adult in 24 hours? 
 
 5. Describe oxygen; give its symbol, valence, and atomic 
 weight; tell how to make it. 
 
 6. Give symptoms and treatment of poisoning by acetan- 
 ilide. 
 
 7. What is a gas? Laughing gas? Marsh gas? Sewer 
 gas ? 
 
 8. Name six metals and six non-metallic elements, and 
 the symbol for each. 
 
 9. Define oxidation and combustion, and give practical 
 examples of each. 
 
 10. Why is a salt of mercury incompatible with potas- 
 sium iodide? 
 
 11. From what sources may chronic lead poisoning come? 
 Give treatment. 
 
 12. What are ptomains? Give symptoms and treatment 
 of ptomain poisoning. 
 
 Only 10 to be answered. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 1. Define analgesic, anesthetic, hypnotic, and give ex- 
 amples. 
 
 2. How does atropine affect the function of (a) the eye, 
 (b) the heart, (c) the intestines, (d) the skin? Tell 
 manner of action in each case. 
 
 3. What are anthelmintics? Name four, with prepara- 
 tion and dose. 
 
 4. Name five official bromides and gives their physiolog- 
 ical action. 
 
 387 
 
MEDICAL RECORD 
 
 5. What drug would you use as (a) a mydriatic, (b ) 
 expectorant, (c) anodyne, (d) escharotic, (e) styptic? 
 
 6. Give the effect of alcohol on (a) the brain, (b) the 
 heart, (c) the kidneys. 
 
 7. Name three drugs that lower temperature, and tel) 
 how each does it. 
 
 8. Give the source and therapeutic uses of ichthyol and 
 adeps lanae. 
 
 9. Explain the action on the bowel of (a) opium, (b) 
 thymol, (c) bismuth subnitrate. 
 
 10. How do saline cathartics produce purgation? 
 
 11. What is an alkaloid, a tincture, a fluid extract? Give 
 an example of each. 
 
 12. For what purpose and in what doses would you 
 administer (a) strychnine, (b) calomel, (c) tincture of 
 aconite, (d) hyoscine, (e) potassium iodide? 
 
 Only 10 to be answered. 
 
 PATHOLOGY. 
 
 1. What causes rise of temperature? 
 
 2. Define hypertrophy; atrophy; give varieties and 
 causes. 
 
 3. Give differences between degeneration and necrosis. 
 
 4. Give pathology of trachoma. 
 
 5. Define gangrene; name the types and give conditions 
 determining each. 
 
 6. Describe briefly the reparative process of a fracture, 
 
 7. Describe the lesions of typhoid fever, and give distri- 
 bution of the typhoid bacillus. 
 
 8. What forms of appendicitis are usually considered, 
 and describe the structural changes which take place. 
 
 9. Define cretinism. 
 
 10. Give the pathology of inflammation. 
 
 PRACTICE OF MEDICINE. 
 
 1. Differentiate between cerebrospinal meningitis and 
 anterior poliomyelitis. 
 
 2. Give cause of rickets, diagnosis and treatment. 
 
 3. Give urinary findings in parenchymatous nephritis and 
 interstitial nephritis. 
 
 4. Differentiate between appendicitis and typhoid fever. 
 
 5. In what diseases will the microscope aid us most in 
 diagnosis? 
 
 6. Describe the normal heart sounds. 
 
 7. Give differential diagnosis of acute glaucoma and 
 acute iritis, and give treatment of each. 
 
 8. Give comparative table of contents of cow's milk and 
 woman's milk, and how would you modify cow's milk so 
 that it would compare with mother's milk for a baby six 
 weeks old? 
 
 388 
 
MEDICAL RECORD. 
 
 9. What are the symptoms and treatment of catarrhal 
 jaundice? 
 
 10. Give cause, symptoms, and treatment of stomatitis. 
 
 OBSTETRICS. 
 
 1. Give signs of pregnancy. 
 
 2. Describe the management of labor in breech presenta- 
 tion. 
 
 3. When does the foramen ovale close? 
 
 4. Name some of the diseases of pregnancy. 
 
 5. Name the varieties of ectopic pregnancy. 
 
 6. Define prolapsis uteri. Give pathology, etiology, and 
 treatment. 
 
 7. Give some causes and treatment of pruritus vulvas. 
 
 8. What is the difference between menorrhagia and met- 
 rorrhagia, and give treatment for both. 
 
 9. What is the difference between vaginitis and vaginis- 
 mus? Give treatment for each. 
 
 10. Give etiology and treatment of subinvolution of the 
 uterus. 
 
 SURGERY. 
 
 1. Define septicemia, and give its causes. 
 
 2. How can the danger of ankylosis be averted after 
 injury to a joint? 
 
 3. How would you arrest epistaxis? 
 
 4. Outline the principle of treatment for a compound 
 dislocation. 
 
 5. Give the dislocations of the knee-joint and a method 
 of reduction of any one. 
 
 6. W r hat are the indications for trephining in fractures 
 of the skull? 
 
 7. How are wounds classified? 
 
 8. How would you proceed surgically to remove the 
 fluid in a case of ascites? 
 
 9. Give the indications for the removal of the mam- 
 nary gland. 
 
 10. What are the chief surgical diseases of the groin? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Nebraska State Board of Medical Examiners. 
 
 anatomy. 
 
 1. The two vertebral arteries. 
 
 2. In a cross-section at middle of humerus, will be 
 severed: Muscles: biceps, coraco-brachialis, brachialis anti- 
 cus, triceps; arteries: brachial, superior profunda, inferior 
 
 389 
 
MEDICAL RECORD 
 
 profunda; nerves: median, ulnar, musculo-spiral, internal 
 cutaneous, musculo-cutaneous. 
 
 3. See Cunningham's "Anatomy" (1909), page 834; or 
 Gray's "Anatomy" (1908), page 662. 
 
 4. The abdominal aorta commences at the aortic opening 
 in the diaphragm and terminates on the body of the fourth 
 vertebra, where it bifurcates into the two common iliac 
 arteries. 
 
 5. See Cunningham's "Anatomy" (1909), page 972; or 
 Gray's "Anatomy" (1908), page 1384. 
 
 ^ 6. The ankle joint is formed by the lower end of the 
 tibia and its malleolus, and the external malleolus of the 
 fibula, which together form a mortise above to receive the 
 upper convex part of the astragalus and its two lateral 
 facets. 
 
 7. (a) Wholly covered with peritoneum: Stomach, first 
 part of duodenum, jejunum, ileum, cecum, transverse colon, 
 sigmoid flexure, first part of rectum, liver. 
 
 (b) Partially covered with peritoneum: Second and 
 third part of duodenum, ascending and descending colon, 
 middle part of rectum, bladder. 
 
 8. See Cunningham's "Anatomy" (1909), page 1046; or 
 Gray's "Anatomy" (1908), page 1246. 
 
 9. Gastrocnemius, soleus, flexor longus digitorum, tibi- 
 alis posticus, and flexor longus hallucis. 
 
 10. Biceps. Origin: Short head, from coracoid process 
 of scapula; long head, from upper margin of glenoid cav- 
 ity. Insertion: Back part of tuberosity of radius. Blood 
 supply: From brachial artery. Nerve supply: Musculo- 
 cutaneous. 
 
 PHYSIOLOGY. 
 
 1. By the term blood pressure is meant the pressure on 
 the blood due to (1) the ventricular systole, (2) the elas- 
 ticity of the walls of the arteries, and (3) the resistance 
 in the capillaries. 
 
 2. In the duodenum, proteids, fats, and starches are 
 digested. 
 
 3. Functions of the pneumo gastric nerve: "Throughout 
 its whole course the vagus contains both sensory and motor 
 fibers. To summarize the many functions of this nerve 
 . . . it may be said that it supplies (1) motor influence 
 to the pharynx and esophagus, stomach, and intestines, to 
 the larynx, trachea, bronchi, and lungs; (2) sensory and, 
 in part, (3) vasomotor influence to the same regions; (4) 
 inhibitory influence to the heart; (5) inhibitory afferent 
 impulses to the vasomotor center; (6) excito-secretory to 
 the salivary glands; (7) excito-motor in coughing, vomit- 
 ing, etc." — (Kirkes' Physiology.) 
 
 For description, see Cunningham's "Anatomy" (1909), 
 page 690; or Gray's "Anatomy" (1908), page 1068. 
 
 390 
 
MEDICAL RECORD. 
 
 4. The heart cycle includes all the changes which occur 
 between the commencement of one heart beat and the com- 
 mencement of the next; it consists of the alternate contrac- 
 tions (or systole) and relaxations (or diastole) of the 
 auricles and ventricles of the heart. The contraction of 
 the two auricles takes place simultaneously, and is followed 
 by the simultaneous contraction of the two ventricles ; then 
 follows a period during which the whole heart is in a state 
 of diastole. The cycle then begins again with the auricular 
 systole. 
 
 5. The heat of the body is maintained by the thermotactic 
 centers in the brain and cord keeping an equilibrium be- 
 tween the heat gained or produced in the body and the 
 heat lost. Heat is produced in the body by: (1) Muscular 
 action; (2) the action of the glands, chiefly of the liver; 
 
 (3) the food and drink ingested; (4) the brain; (5) the 
 heart; and (6) the thermogenetic centers in the brain, 
 pons, medulla, and spinal cord. Heat is given off from the 
 body by: (1) The skin, through evaporation, radiation, and 
 conduction; (2) the expired air; (3) the excretions — urine 
 and feces. 
 
 6. Nitrogenous foods are digested in the stomach by 
 the pepsin of the gastric juice, and in the small intestine 
 by the trypsin of the pancreatic juice. 
 
 7. See Cunningham's "Anatomy" (1909), page 688; or 
 Gray's "Anatomy" (1908), page 1064. 
 
 8. The ductless glands are : The spleen, thymus, thyroid, 
 parathyroids, suprarenals, carotid, cocygeal, pituitary, and 
 pineal glands. The function of the spleen: The following 
 theories have been held: (1) It is a source of production 
 of the white blood corpuscles ; (2) it is a source of pro- 
 duction of the red blood corpuscles during fetal life; (3) 
 it is a place where the red blood corpuscles are destroyed ; 
 
 (4) uric acid is produced in the spleen; (5) an enzyme is 
 produced in the spleen and is carried by the blood to the 
 pancreas, where it converts the trypsinogen into trypsin. 
 The function of the thymus is not settled; it is said: (1) 
 To be a blood forming organ; (2) to have influence on 
 growth and nutrition; (3) in hibernating animals it is 
 supposed to store up materials which can be utilized during 
 the period of inactivity. The function of the thyroid is 
 not definitely settled; (1) it has some trophic function; 
 (2) it is supposed to antagonize toxic substances; (3) it 
 produces an internal secretion. The function of the supra- 
 renals is not definitely settled ; they produce an internal 
 section which is probably necessary to life; it is supposed 
 that they are able to destroy or remove some toxic sub- 
 stance produced elsewhere in the body. The function of 
 the other ductless glands is unknown. They all, or nearly 
 all, furnish an internal secretion. 
 
 391 
 
MEDICAL RECORD. 
 
 9. Carbohydrates were formerly defined as substances of 
 unknown constitution, consisting of carbon, hydrogen, and 
 oxygen ; there being in the molecule six (or some multiple 
 of six) atoms of carbon, and the hydrogen and oxygen 
 being in the proportion to form water. 
 
 10. Ptyalin and Amylopsin. 
 
 CHEMISTRY. 
 
 1. H3BO3 is boric acid ; CHCU is trichlormethane (chloro- 
 form) ; CJisOH is phenol; Pb (C 2 H S 2 ) 2 is lead acetate; 
 KHCOs is monopotassic carbonate. 
 
 2. Glycerin is obtained by decomposing glyceryl stearate 
 by superheated steam. The formula is CsH^OHK 
 
 3. The acidity of the urine is due to acid sodium phos- 
 phate, NaH 2 P0 4 . 
 
 4. Test for sugar: Render the urine strongly alkaline 
 by addition of Na 2 C0 3 . Divide about 6 c.c. of the alkaline 
 liquid in two test tubes To one test tube add a very minute 
 quantity of powdered subnitrate of bismuth, to the other 
 as much powdered litharge. Boil the contents of both 
 tubes. The presence of glucose is indicated by a dark or 
 black color of the bismuth powder, the litharge retaining its 
 natural color. Test for bile pigment: Put 3 c.c. HN0 3 
 in a test tube, add a piece of wood, and heat until the acid 
 is yellow; cool. When cold, float some of the urine to be 
 tested upon the surface of the acid. A green band is 
 formed at the junction of the liquids, which gradually 
 rises, and is succeeded from below by blue, reddish-violet, 
 and yellow. 
 
 The normal amount of urea excreted in 24 hours is about 
 500 grains. 
 
 5. Oxygen is colorless, odorless, tasteless gas; it is 
 sparingly soluble in water; it has a strong tendency to 
 enter into combination with other elements ; it is necessary 
 for respiration, and is both combustible and a supporter of 
 combustion. Its Symbol is O; valence, 2; atomic weight, 
 16; it is made by heating potassium chlorate: 
 
 2KCIO3 + heat = 2KCI + 3O2. 
 
 6. Sympptoms of acetanilid poisoning: Chilliness, cold 
 sweat; nausea; pulse is soft, slow, and feeble; respirations 
 slow and shallow. Treatment: Lavage, diffusible stimu- 
 lants, application of heat, coffee or strychnine, inhalation 
 of oxygen, or saline infusion. 
 
 7. A gas is that form of matter in which the molecules 
 tend to get away from each other ; it has neither definite 
 shape nor volume. Laughing gas is nitrogen monoxide, 
 N2O. Marsh gas is methane, CH 4 . Sewer gas is the air 
 from sewers, of variable composition, containing emana- 
 tions from sewage. 
 
 8. Metals: Lead, Pb; gold, Au ; silver, Ag; copper, Cu; 
 
 392 
 
MEDICAL RECORD. 
 
 zinc, Zn; tin, Sn. Non-metals: Hydrogen, H; oxygen, O; 
 nitrogen, N ; fluorine, F ; chlorine, CI ; iodine, I. 
 
 9. By oxidation we mean the act of union of oxygen 
 with another element, or compound. This process it attended 
 by the liberation of heat, and, when it takes place rapidly, 
 of light. The rusting of a given weight of iron is a slow 
 oxidation, while the burning of the same in oxygen is a 
 rapid oxidation. Only the latter produces light, while in 
 both cases the same amount of heat is liberated. 
 
 By combustion, in a general sense, is meant the rapid 
 union of the oxygen of the air with some other substance, 
 as coal or phosphorus. In a wider sense, however, com- 
 bustion may be defined as any chemical union of two sub- 
 stances attended by liberation of heat and light. 
 
 10. Both mercurous and mercuric salts enter into double 
 decomposition with potassium iodide, and a soluble iodide 
 of mercury is produced. 
 
 11. The most common sources of lead poisoning are the 
 following: 'The contamination of drinking water from 
 lead pipes. Contamination of articles of food or drugs by 
 contact with leaden vessels, or from being enclosed in tin- 
 foil containing an excess of lead. Drinking beer, cider, 
 etc., which has been drawn through leaden pipes or allowed 
 to stand in pewter vessels. The ingestion or constant hand- 
 ling of lead or its compounds, as the acetate, nitrate, car- 
 bonate (white lead — painter's colic), Goulard's extract, etc. 
 The use of hair dyes containing lead." — (Witthaus' Essen- 
 tials of Chemistry.) The treatment is first to remove the 
 cause; then administer a purge of jalap and calomel com- 
 bined with opium; iodide of potassium should also be 
 given to help in the elimination of the lead. 
 
 12. Ptomains are basic, nitrogenous compounds, pro- 
 duced from protein material by the bacteria which cause 
 putrefaction. They are found in protein foods which have 
 partly undergone decomposition. Piomain poisoning. 
 Symptoms: Chilliness, headache, vertigo, muscuLar twitch- 
 ings, hallucinations; imperfect vision, weak and rapid pulse, 
 nausea, vomiting, diarrhea, cyanosis, early dyspnea, often 
 subnormal temperature, and occasionally cutaneous erup- 
 tions. The prognosis is guardedly favorable. Treatment 
 consists in the use of emetics and cathartics, of lavage and 
 rectal irrigation. Morphine may be indicated for the relief 
 of pain, and collapse is to be combatted by atropine, strych- 
 nine, nitroglycerin, external heat, whiskey, etc. After 
 thorough purging, salol, naphthol, or bismuth may be given. 
 
 MATERIA MEDTCA AND THERAPEUTICS. 
 
 i. Analgesic is an agent which relieves pain by blunting 
 sensation; as opium. Anesthetic is an agent which destroys 
 sensation for a period of time; as ether. Hypnotic is an 
 
 393 
 
MEDICAL RECORD 
 
 agent used to induce sleep somewhat resembling natural 
 sleep; as chloral. 
 
 2. Atropine (a) dilates the pupil and causes disordered 
 vision; it stimulates the end organ of the sympathetic, 
 and paralyzes those of the motor oculi nerve, (b) It in- 
 creases the rate (but not the force) of the heart by depres- 
 sing the vagus, (c) Intestinal peristalsis is increased by 
 its action on the splanchnic nerves. (d) The skin is 
 flushed and rendered dry by its paralyzing action on the 
 nerve endings in the- sweat glands. 
 
 3. Anthelmintics are agents which kill or expel worms. 
 Examples: Oleoresina aspidii, gr. xxx; Pelletierine tannate, 
 gr. x; santonin, gr. j; pumpkin (pepo) seeds, 3J. 
 
 4. Bromide of potassium, of sodium, of lithium, of am- 
 monium, of calcium. Physiological action: Depressants of 
 circulatory and nervous systems; hypnotic, analgesic; mus- 
 cular depressant; lower arterial tension and body tempera- 
 ture; anaphrodisiac. 
 
 5. (a) Mydriatic, Atropine; (b) Expectorant, Ipecac; 
 (c) Anodyne, Opium; (d) Escharotic, Silver nitrate; (e) 
 Styptic, Alum. 
 
 6. (a) On the brain, alcohol first acts as a stimulant; 
 the nerve centers, imaginations, feelings, intellect are all 
 exalted; the centers of speech and muscular movements 
 are stimulated; afterwards they may be depressed, (b) 
 On the heart, alcohol causes increase in the force and 
 frequency, dilatation of the peripheral blood-vessels, (c) 
 On the kidneys, alcohol acts as a diuretic. 
 
 7. (1) Alcohol lowers body temperature by diminishing 
 tissue change, and also by dilating the cutaneous vessels, 
 thus increasing heat radiation. (2) Aconite, by reducing 
 the circulation. (3) Acetanilid, by diminishing tissue 
 change, and also by promoting perspiration. 
 
 8. Ichthyol. Source: A quartz containing the fossilized 
 remains of fish. Therapeutic uses: Skin diseases (eczema 
 and psoriasis), to remove inflammatory processes and their 
 products. Adeps lan^:. Source: Sheep's wool. Thera- 
 peutic uses: As a basis for ointments, in various skin dis- 
 eases, chaps, burns, frostbites, and as a vehicle for mor- 
 phine and other anodynes. 
 
 9. (a) Opium is a sedative to the intestine, secretions 
 are dried, pain is relieved or prevented, peristalsis is slowed 
 or arrested, (b) Thymol is an intestinal antiseptic, and an 
 anthelminthic in ankylostomiasis, (c) Bismuth subnitrate 
 is sedative and astringent. 
 
 10. Saline purgatives cause a great increase in the 
 amount of fluid secreted by the intestinal glands ; they also 
 hinder the reabsorption of this fluid. The result is an 
 accumulation of fluid in the intestine, which, by distention, 
 excites peristalsis. 
 
 394 
 
MEDICAL RECORD. 
 
 ii. An alkaloid is an organic nitrogenized substance, 
 alkaline in reaction, and capable of reacting with an acid 
 in the same way that ammonia does. Example, strychnine. 
 A tincture is an alcoholic solution of a non-volatile medic- 
 inal substance. Example, tincture of aconite. A Huidex- 
 tract is a solution of vegetable drug of such strength that 
 i c.c. of the fluidextract represents one gram of the drug. 
 Example, fluidextract of belladonna. 
 
 12. (a) Strychnine, as stimulant to cardiac, respiratory, 
 nervous, or muscular system. Dose, gr. 1/64. (b) Calo- 
 mel, in glandular inflammations of throat and neck, irritable 
 stomach, diarrhea, dysentery, gastric ulcer. Dose, gr. x; 
 but often best given in divided doses, (c) Tincture of 
 aconite, in coryza, tonsillitis, fevers, pleurisy, meningitis, 
 peritonitis, pneumonia, rheumatism. Dose, TC$y of the tinc- 
 ture; but divided doses are often better, (d) Hyoscine, 
 in mania, insomnia, hallucinations, delirium, whooping 
 cough, irritability of the bladder, as a hydriatic. Dose, 
 hyoscine hydrobromide, gr. 1/150. (c) Potassium iodide 
 in tertiary syphilis, neuralgia, paralyses, mercurial poison- 
 ing, after pneumonia, pleurisy, or pericarditis, aneurysm, 
 hay fever, tonsillitis, asthma. Dose, gr. vijss. 
 
 PATHOLOGY. 
 
 1. Rise of temperature is caused by: Disturbances in the 
 thermogenetic, thermolytic, or thermotactic centers; exces- 
 sive heat; toxic substances; infectious diseases. 
 
 2. Hypertrophy is an increase in the size, weight, and 
 functional activity of a part beyond the limit of health, 
 due to an orderly enlargement or multiplication of all its 
 normal constituents. Varieties: (1) Simple, when only the 
 size of the element is increased; (2) Numerical, when the 
 number also is increased. Causes: (1) Excessive vital 
 energy; (2) increased work; (3) increased blood supply; 
 (4) diminished waste; (5) removal of resistance to growth. 
 
 Atrophy is decrease in the amount of tissue, owing to 
 diminution in size (simple atrophy) or number (numerical 
 atrophy) of the histological elements of which it is com- 
 posed. There is also loss of weight, and impairment of 
 function. Varieties: Simple and numerical (see above) ; 
 also general and local. Causes: (1) Deficient supply of 
 nutrition; (2) excessive waste; (3) impaired vital activity; 
 (4) diminished functional activity; (5) pressure; (6) 
 sometimes excessive functional activity. 
 
 3. In necrosis the tissue is dead; in degeneration its 
 vitality remains, but is lowered, and the function may re- 
 main in an impaired state. 
 
 4. Trachoma is infectious, but the causal germ is not 
 identified. There are follicles on the conjunctiva, which 
 become granular masses and spread over the surface of the 
 
 395 
 
MEDICAL RECORD. 
 
 entire lid. Ulceration takes place, and the necrosed mem- 
 brane is replaced by scar tissue. 
 
 5. See Rose and Carless' "Surgery" (1908), pages 98 and 
 102; or Da Costa's "Surgery" (1908), page 168. 
 
 6. See Rose and Carless* "Surgery" (1908), pages 472 
 and 481; or Da Costa's "Surgery" (1908), page 457. 
 
 7. See French's "Practice" (1907), pages 70 and 69; or 
 Osier's "Practice" (1909), pages 65 and 60. 
 
 8. See French's "Practice" (1907), page 789; or Osier's 
 "Practice" (1909), page 513. 
 
 9. Cretinism is a congenital condition, marked by mental 
 hebetude and imbecility, imperfect development, and de- 
 formity of the whole body. It is said to be due to con- 
 genital absence or functional inactivity of the thyroid 
 gland. 
 
 10. See Rose and Carless' "Surgery" (1908), page 30; or 
 Da Costa's "Surgery" (1908), page 73. 
 
 PRACTICE OF MEDICINE. 
 
 i. See French's "Practice" (1907), pages 146 and 1035; 
 or Osier's "Practice" (1909), pages 163 and 916. 
 
 2. See French's "Practice" (1907), page 932; or Osier's 
 "Practice" (1909), page 426. 
 
 3. 
 
 ACUTE PAREN- 
 CHYMATOUS 
 NEPHRITIS. 
 
 1. Urine scanty, 
 dark or smoky 
 color, high specific 
 gravity, 1025 or 
 over. 
 
 2. Large amount 
 of albumin. 
 
 3. Variety of 
 casts, such as hya- 
 line, blood, epithe- 
 lial, and waxy 
 casts, also free red 
 blood globules, and 
 epithelial cells. 
 
 4. Urea dimin- 
 ished. 
 
 CHRONIC PAREN- 
 CHYMATOUS 
 NEPHRITIS. 
 
 I. Urine normal 
 or increased 
 amount; specific 
 gravity may fall 
 to 1010; urine pale. 
 
 2. Late in attack, 
 greatly diminished ; 
 occasionally absent. 
 
 3. Large and 
 small granular 
 casts ; compound 
 granule cells, and 
 fatty epithelium. 
 
 4. Urea dimin 
 ished. 
 
 CHRONIC INTER- 
 STITIAL 
 NEPHRITIS. 
 
 1. Urine greatly 
 increased ; specific 
 gravity low, 1005; 
 urine pale in color. 
 
 2. Albumin 
 greatly diminished, 
 often absent. 
 
 3. Hyaline or 
 finely granular 
 casts, occasionally 
 dark in color; in- 
 frequently blood 
 casts and oil drop- 
 lets. 
 
 4. Urea dimin- 
 i ished. 
 
 4. Typhoid fever is distinguished from appendicitis by 
 its (typhoid's) more gradual onset, characteristic tempera- 
 ture record, diarrhea, enlargement of the spleen, rose- 
 colored rash, and boidal reaction. 
 
 396 
 
MEDICAL RECORD. 
 
 5. Typhoid, malaria, cerebrospinal meningitis, diphtheria, 
 gonorrhea, anemias, leukemias, nephritis, Hodgkin's dis- 
 ease, tuberculosis, empyema, filariasis, anthrax, hydropho- 
 bia, syphilis, leprosy. 
 
 6. There are two normal heart sounds which follow in 
 quick succession, and are succeeded by a pause. The first, 
 or systolic, sound is dull and somewhat prolonged; the 
 second, or diastolic, sound is sharper and shorter. The 
 sounds may be expressed by the syllables lubb — drip. The 
 first sound is heard best at the apex beat in the fifth left 
 intercostal space ; the second sound is heard best over the 
 second right costal cartilage. The causes producing the 
 first sound of the heart are not definitely ascertained; the 
 following are supposed to be causatory factors: (1) the 
 vibration and closure of the auriculo-ventricular valves, 
 (2) the muscular sound produced by the contraction of 
 the ventricles, and (3) the cardiac impulse against the 
 chest wall. The second sound is caused by the vibration 
 due to the closure of the semilunar valves. 
 
 GLAUCOMA. 
 
 IRITIS. 
 
 Age I Over forty. 
 
 Tension I Plus. 
 
 Congestion j General, especially 
 
 scleral. 
 Cornea ! Cloudy and steamy 
 
 surface. 
 Anterior chamber. \ Shallow. 
 Pupil j Dilated, oval. 
 
 Pain 
 
 Vision 
 
 Treatment 
 
 Severe, contin- 
 uous. 
 Much reduced. 
 
 Escerine, pilocar- 
 pine, iridectomy 
 
 Any. 
 
 Normal. 
 
 General, especially 
 
 circumcorneal. 
 Cloudy. 
 
 Unchanged. 
 Contracted, syn- 
 echia?. 
 Especially at night. 
 
 Somewhat re- 
 duced. 
 Atropine. 
 
 Treatment of glaucoma: Myotics, such as eserine or 
 pilocarpine; massage of the eyeball: mydriatics are contra- 
 indicated ; operative treatment may include paracentesis, 
 iridectomy, or sclerotomy. 
 
 Treatment of iritis: Atropine, dionine, the application of 
 leeches to the temples, hot fomentations, absolute rest in 
 bed, protection from the light, light diet, purgatives, absti- 
 nence from alcohol, avoidance of all use of the eyes for 
 near work, constitutional treatment varying according to 
 the etiology, paracentesis, and iridectomy. 
 
 397 
 
MEDICAL RECORD. 
 
 8. 
 
 Fat 
 
 Sugar . , 
 Proteids 
 Salts .., 
 Water . 
 
 WOMAN S MILK. 
 
 COWS MILK. 
 
 Average Per Cent. 
 
 Average Per Cent. 
 
 4.00 
 
 4.00 
 
 7.00 
 
 4.50 
 
 1.50 
 
 3.50 
 
 0.20 
 
 0.75 
 
 87.30 
 
 87.25 
 
 100.00 
 
 100.00 
 
 To make cow's milk resemble human milk: The cow's 
 milk must be diluted and sugar of milk must be added. 
 These modifications must be made in such proportions as 
 to bring the percentage composition of the two milks as 
 near alike as possible. 
 
 9. See French's "Practice" (1907), page 843; or Osier's 
 "Practice" (1909), page 543- 
 
 10. See French's "Practice" (1907), page 707; or Osier's 
 "Practice" (1909), page 434. 
 
 OBSTETRICS. 
 
 1. Positive signs of pregnancy: (1) Hearing the fetal 
 heart sound; (2) active movement of the fetus; (3) bal- 
 lottement; (4) outlining the fetus in whole or part by 
 palpation; and (5) the umbilical or funic souffle. Doubtful 
 signs of pregnancy: (1) Progressive enlargement of the 
 uterus; (2) Hegar's sign; (3) Braxton Hick's sign; (4) 
 uterine murmur; (5) cessation of menstruation; (6) 
 changes in the breasts; (7) discoloration of the vagina and 
 cervix ; (8) pigmentation and striae ; (9) morning sickness. 
 Subjective signs of pregnancy, in the order of their appear- 
 ance, are: Cessation of menstruation, morning sickness, 
 increased frequency of urination, active fetal movements. 
 Objective signs of pregnancy, in the order of their appear- 
 ance, are: Softening of the cervix, changes in the mam- 
 mary glands, discoloration of the vulva and vagina, pulsa- 
 tion in the vaginal vault, Hegar's sign, active fetal move- 
 ments, ballottement, palpation of the fetus, intermittent 
 uterine contractions, hearing the fetal heartbeat, rate of 
 growth of the uterine tumor. 
 
 2. See Williams' "Obstetrics" (1909), page 290; or 
 Hirst's "Obstetrics" (1909), page 425. 
 
 3. The foramen ovale closes any time between the first 
 week and the sixth month of extrauterine life. 
 
 4. See Williams' "Obstetrics" (1909), page 480; or 
 Hirst's "Obstetrics" (1909), page 215. 
 
 5. The varieties of ectopic pregnancy are: Interstitial, 
 tubal, ovarian; and abdominal. 
 
 6. Prolapsis uteri. Definition: A condition in which 
 
 398 
 
MEDICAL RECORD 
 
 the uterus sinks below its normal level, but does not pro- 
 trude through the vagina. Pathology: "Decrease in the 
 power of uterine support. Distention and eversion of the 
 vagina with decrease in the power of its sphincter and 
 thickening of its epithelium. The uterus is enlarged from 
 impairment of its circulation, its cavity is increased in size, 
 and hyperplasia of its areolar tissue may result. The endo- 
 metrium becomes thickened, congested, and inflamed. 
 Ectropion may occur. Varicose degeneration of the ves- 
 sels of the cervix may take place with consequent absorp- 
 tion of its proper tissue; ulceration may also occur. Pelvic 
 congestion from compression of the hypogastric veins. 
 Tension on the broad ligaments may produce obstruction 
 of ureters and hydronephrosis. Occasionally, epithelioma 
 from continued irritation of the cervix. Varicocele of the 
 pampiniform plexus from torsion of the broad ligaments. 
 When cystocele is present, complete evacuation of the 
 bladder cannot be obtained, and the result is dysuria, ardor 
 urinse, and cystitis or retention of urine." 
 
 Etiology: Injury at childbirth, lacerated perineum, re- 
 laxation and elongation of the ligaments of the uterus, 
 loss of rigidity of the abdominal walls, increase in the 
 weight of the uterus, subinvolution, increased intraabdom- 
 inal pressure. Treatment: "Operative, unless some contra- 
 indication to operation exists. In such a case some me- 
 chanic device should be tried for the support of the uterus. 
 Pessaries are not to be recommended, as their constant 
 use leads to irritation and excoriation of the vaginal walls. 
 Probably the best means for supporting the uterus is by 
 Braun's colpeurynter. This is worn only during the day, 
 and can be introduced by the patient herself every morning. 
 The uterus is replaced and the colpeurynter well anointed 
 with carbolized vaseline and containing about an ounce of 
 water, is introduced into the vagina. It is then distended 
 with air, thus making an even pressure on the vaginal walls 
 and not causing ulcerations. Operative treatment gives the 
 most satisfactory results in prolapse. In slight cases of 
 prolapse repair of the perineum will effect a cure. The 
 severer grades will require, in addition, some operation 
 on the anterior vagina. The best of these is Martin's 
 operation for cystocele. If the cervix is hypertrophied it 
 should be amputated. Three operations — on the perineum, 
 for cystocele, and amputation of the cervix — are required 
 in the usual case of prolapse. In addition, hystrorrhaphy 
 may be advisable, since there can be no prolapse so long as 
 the uterus maintains its normal position of anteflexion. 
 These operations failing, hysterectomy may be performed." 
 7. Pruritus vulvae may be caused by: Parasites; dis- 
 eases of the vulva, as inflammation, edema, vegetations, 
 congestion, irritating discharges, lack of cleanliness, dia- 
 
 399 
 
MEDICAL RECORD 
 
 betic urine; it may also be of nervous origin, or idiopathic. 
 Treatment consists in removing the cause, if possible; 
 cleanliness, fresh air, tonics, and general attention to hy- 
 giene; local applications of solution of bichloride of mer- 
 cury, 1:2,000; or carbolic acid, 1:100; or lead and opium; 
 dusting powders of bismuth subnitrate, calomel, or zinc 
 oxide are also useful. 
 
 8. Menorrhagia is an excessive loss of blood at the men- 
 strual periods. Metrorrhagia is a hemorrhage from the 
 uterus^ at other than the menstrual periods. It is very 
 often impossible to differentiate the two conditions. Treat- 
 ment: Remove the cause, if possible; treat abnormal con- 
 ditions that are present; vaginal douches, tampons, and 
 curettage have been recommended; also ergot, hamamelis, 
 hydrastis, and viburnum prunifolium; rest in bed is neces- 
 sary. Intrauterine applications of astringents or of adren- 
 alin have been used. 
 
 9. Vaginitis is a condition of inflammation of the vagina. 
 It is characterized by redness, swelling, pain, heat, irrita- 
 tion, and increased secretion. There may be frequent and 
 painful urination. Treatment consists in rest, cleanliness, 
 douches, the application of soothing lotions, and removal 
 of any cause ; salines and anodynes are also indicated. 
 Vaginismus is a condition of painful and spasmodic con- 
 traction of the vaginal orifice, which renders coitus either 
 painful or altogether impossible. The slightest touch causes 
 painful spasms, and examination may be impossible without 
 an anesthetic. The treatment consists in removing the 
 cause when possible, tonics and general constitutional treat- 
 ment, dilatation of the vaginal orifice; local application of 
 a 5 per cent, solution of cocaine will relieve the hyperes- 
 thesia and allow coitus. The condition is sometimes in- 
 curable. 
 
 10. Subinvolution. Etiology: Lacerations of the cer- 
 vix; absorption of septic products; mismanagement of the 
 convalescent stage of the puerperium, chiefly too early 
 rising; tedious labors; misplacement of the uterus; retained 
 clots or membranes; tumors of the uterus. Treatment: 
 Rest in bed, hot intrauterine and vaginal douches, correc- 
 tion of constipation, abstention from sexual intercourse, 
 tonics, correction of displacement, curettage. An abdom- 
 inal binder may be worn. 
 
 SURGERY. 
 
 1. Septicemia is an acute general infection arising from 
 the presence of pyogenic microorganisms in the blopd. 
 Causes: Streptococcus pyogenes or other pus-producing 
 bacteria which spread from a primary focus through the 
 lymphatics or by an eroded vessel into the blood current 
 
 2. Ankylosis may be averted by: Limiting the effusion 
 
 400 
 
MEDICAL RECORD. 
 
 or inflammatory exudate ; by early passive movement to 
 prevent the union of synovial surfaces; by massage; by 
 removal of loose cartilages and hypertrophied synovial 
 fringes. 
 
 3. To arrest epis taxis: (1) Try to cauterize the bleeding 
 point; (2) plug the nasal cavity with gauze soaked in ad- 
 renalin; (3) inject into the nares a solution of peroxide of 
 hydrogen; (4) plugging the nares, anteriorly and pos- 
 teriorly; (5) an inflating plug may be used. 
 
 4. Rose and Carless' "Surgery" (1908), page 617. 
 
 5. Rose and Carless' "Surgery" (1908), page 634; or Da 
 Costa's "Surgery" (1908), page 604. 
 
 6. Rose and Carless' "Surgery" (1908), page 751; or Da 
 Costa's "Surgery" (1908), page 708. 
 
 7. Wounds are classified as : 
 
 I. Contused and open wounds. 
 
 II. Open wounds may be: Incised, lacerated, contused, 
 punctured, gunshot, or poisoned; also penetrating and per- 
 forating. 
 
 III. Aseptic and septic. 
 
 8. Rose and Carless' "Surgery" (1908), page 984. 
 
 9. Indications for removal of mammary gland: Enor- 
 mous hypertrophy, Paget's disease of the nipple, epithel- 
 ioma of the nipple, carcinoma, sarcoma, cystic adenoma, 
 diffuse tubercular or septic disease if breast is riddled with 
 sinuses. 
 
 10. Chief surgical diseases of the groin are : Hernia 
 (inguinal, femoral, or obturator), aneurysms, tumors, cysts, 
 ulcers, sinuses, abscesses, enlarged glands, undescended tes- 
 ticle, prolapsed ovary. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Nevada State Board of Medical Examiners. 
 
 ANATOMY. 
 
 i. Describe location and name the divisions of the osse- 
 ous labyrinth. 
 
 2. What medictarsal joint is the weakest in the arch of 
 the foot? 
 
 3-4. What bones enter into the formation of the ankle 
 joint? 
 
 5. oive origin and insertion of the trapezius muscle. 
 
 6. What is the combined action of the gastrocnemius 
 and soleus muscles? 
 
 7. At what point in the neck does the common carotid 
 artery divide? 
 
 8. Give location and approximate length of the fissure 
 of Rolando. 
 
 401 
 
MEDICAL RECORD. 
 
 9-10. How many pairs of cerebrospinal nerves are there? 
 Of those how many pairs are spinal ? 
 
 PHYSIOLOGY. 
 
 i. Describe the process of osmosis and give examples in 
 the human economy. 
 
 2. Describe urea, its occurrence, variations in quantity 
 excreted, and recognition in the voided urine. 
 
 3. How can fresh blood stains be distinguished from 
 older blood stains? 
 
 4. State where in the human economy the following sub- 
 stances are found : • Fibrin, chondrin, leucin, hippuric acid. 
 
 5. In what manner is the heart beat influenced by the 
 pneumogastric nerve? What is the average number of 
 heart beats per minute in (a) a child one year old, (b) an 
 adult seventy years old? 
 
 6. Describe the vermicular movement of the stomach 
 and intestines. What purpose does this movement serve? 
 
 7. Describe the glands and villi 01 the intestines. 
 
 8. Locate in the brain the seat of the special sense of 
 sight, hearing, and smell. 
 
 9. What would be the effect on digestion if the pancre- 
 atic duct were obstructed? 
 
 10. What is the office of the columnar carnese? 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. What drug is antagonistic to pilocarpine? 
 
 2. State the source of ichthyol, and give its use in medi- 
 cine. 
 
 3. Describe the therapeutic action of spigelia. 
 
 4. Describe the theiapeutic uses and the dangers of 
 chloral hydrate. 
 
 5. Give the chief source and the dose of gallic acid. 
 
 6. Describe the therapeutic uses of chromium sulphate. 
 -7% Describe the treatment of cerebrospinal meningitis. 
 & What are the therapeutic uses of strophanthus? 
 
 9. Correct the following prescription : 
 
 5- Atropiae sulphati grs. 1 ss. 
 
 Potas. iodidi ^ oz. 
 
 Inf usae digitalis T A fl. oz. 
 
 Elix. simp. q.s. ad 2 fl. oz. 
 
 M. 
 
 S. — Teaspoonful in water four times a day. 
 
 10. Give the theory of the alkaline treatment of rheu- 
 matism. 
 
 CHEMISTRY AND TOXICOLOGY. 
 
 1. Give chemical test for determining the presence of 
 lactic acid in stomach contents. 
 
 2. Give tests in detail for indican in urine. 
 
 402 
 
MEDICAL RFCORD 
 
 3. Give the chemical reason why diabetics should abstain 
 from starchy foods. 
 
 4. Describe the test for detecting the presence of strych- 
 nine. 
 
 5. What is synthesis? Mention three coal-tar products 
 extensively used in medicine that are prepared in the chem- 
 ical laboratory by synthesis. 
 
 6. State the antidote to practically all alkaloids, explain- 
 ing its action. 
 
 7. What is tyrotoxicon, and in what is it found? 
 
 8. What is the treatment for poisoning by wood alcohol? 
 
 9. Wliat emergency treatment should be used for poison- 
 ing by laudanum? 
 
 10. Name a poison, in poisoning by which, fats and oils 
 should not be administered. Explain. 
 
 PATHOLOGY. 
 
 1. Give the pathology of amyloid liver. 
 
 2. Differentiate between epithelioma and lupus. 
 
 3. Give the pathological changes occurring in a fracture 
 of the skull at the base. 
 
 4. Give the pathology of the first and third stages of 
 lobar pneumonia. 
 
 5. Give the pathology of erysipelas. 
 
 6. Give the pathology of pseudoleukemia. 
 
 7. Give the pathology of tabes dorsalis. 
 
 8. Discuss the pathology of gallstone disease. 
 
 9. Give the pathology of acute gastritis. 
 
 10. Discuss the changes occurring in the spleen during 
 an attack of typhoid fever. 
 
 BACTERIOLOGY. 
 
 1. How is yellow fever conveyed, and how would you 
 prevent its spread? 
 
 2. How would you manage a case of typhoid fever in a 
 country with very poor sanitary conditions to prevent its 
 spread ? 
 
 3. Describe and name the bacillus of diphtheria. 
 
 4. How would you detect the tubercle bacillus. De- 
 scribe it 
 
 5. Describe the Streptococcus pyogenes and Staphylo- 
 coccus aureus, and where are they found? 
 
 6. What is meant by the terms antitoxin and immuniza- 
 tion? 
 
 7. What do you know of the Noguchi method of the 
 serum diagnosis of syphilis? 
 
 8. How is tetanus antitoxin prepared and how does it 
 act? 
 
 9. Describe the Streptothrix actinomyces. 
 
 10. Describe the Gram method of staining for bacteria. 
 
 403 
 
MEDICAL RECORD. 
 
 PRACTICE OF MEDICINE. 
 
 1. Discuss autointoxication. 
 
 2. Give etiology, symptoms, and treatment of dilatation 
 of the heart. 
 
 3. Differentiate typhoid fever, malaria, and septicemia. 
 
 4. Describe the characteristic symptoms and course of 
 morbilli. 
 
 5. What are the symptoms of abscess of the lung? 
 
 6. What is the etiology of progressive muscular atrophy? 
 
 7. Give the general symptoms of brain tumor. 
 
 8. Differentiate empyema from pulmonary abscess. 
 
 9. In what cases would the ophthalmoscope aid in diag- 
 nosis? 
 
 10. Describe a typical case of laryngismus stridulus. 
 
 OBSTETRICS. 
 
 1. Give the signs, approximate weight and length, and 
 two principal diameters of the cranium of a fully de- 
 veloped fetus. 
 
 2. In what proportion to single fetuses do twins de- 
 velop? Triples to single fetuses? 
 
 3-4. Give diagnosis of fetal syphilis. What particular 
 sign is most suggestive and generally accepted? 
 
 5. Give treatment for inevitable abortion. 
 
 6-7. Give your technique in treatment of face presenta- 
 tion. What is the fetal mortality in such cases? What 
 of the maternal? 
 
 8. Give treatment of post-partum hemorrhage. 
 
 9-10. Give treatment for prolapsed cord. In whose posi- 
 tion is it generally recommended that the patient be placed ? 
 
 SURGERY. 
 
 i. Describe the anastomosis which takes place after liga- 
 tion of the femoral artery at it's middle third. 
 
 2. At what point is paracentesis thoracis preferably per- 
 formed? 
 
 3. What is an adenoma? Give plan of treatment. 
 
 4. Through what channels is carcinoma disseminated? 
 
 5. Where is the swelling and fluctuation most prominent 
 in synovitis of the ankle joint? 
 
 6. Give a classification, either original or from compe- 
 tent authority, of burns. 
 
 7. What are the conditions which render excision of the 
 lower jaw advisable? 
 
 8. What are the complications of dislocation of the hip? 
 
 9. Name the varieties of shoulder joint dislocation. 
 
 10. What operations are performed for intractable neu- 
 ralgia of the fifth nerve? 
 
 404 
 
MEDICAL RECORD. 
 
 GENITOURINARY AND DERMATOLOGY. 
 
 i. Give the symptoms necessitating fixation of a floating 
 kidney, and describe the operation. 
 
 2. Give the local treatment of venereal bubo. 
 
 3. What is hydrocele? Describe operations for its cure, 
 and state your choice. 
 
 4. Describe syphilis in all its stages, and give treatment 
 of each stage. 
 
 5. Give symptoms of stone in the bladder. 
 
 6. Mention the most common sites of epitheliomata. 
 
 7. What is xanthoma? 
 
 8. What are the causes and treatment of keloid? 
 
 9. What are the causes, symptoms, and treatment of 
 bromidrosis? 
 
 10. What are the causes, symptoms, and treatment of 
 pompholyx ? 
 
 AXSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Nevada State Board of Medical Examiners. 
 
 anatomy. 
 
 1. See Cunningham's "Anatomy" (1909), page 759; or 
 Gray's "Anatomy" (1908), page 11 74. 
 
 2. The astragaloscaphoid is the weakest mediotarsal 
 joint in the arch of the foot. 
 
 3 and 4. The astragalus, internal malleolus (of tibia), 
 and external malleolus (of fibula). 
 
 5. Trapezius. Origin: External occipital protuberance, 
 and superior curved line of occipital bone, ligamentum 
 nuchae, spinous process of seventh cervical and twelfth 
 dorsal vertebra. Insertion: Clavicle, acromion process, 
 spine of scapula. 
 
 6. Combined action of gastrocnemius and soleus: To 
 extend the foot; for use in standing, walking, dancing, 
 and leaping; to raise heel and whole body. 
 
 7. The common carotid artery divides opposite the upper 
 border of the thyroid cartilage. 
 
 8. Draw a straight line over the top of the scalp from 
 the inion to the glabella; bisect this line, and half an inch 
 posterior to the midpoint draw a line downward and for- 
 ward at an angle of 67.5 for a distance of three and one- 
 half inches. This line will represent the location of the 
 Ussnre of Rolando. 
 
 9 and 10. There are thirty-one pairs of spinal nerves 
 and twelve pairs of cranial nerves, making forty-three pairs 
 of cerebrospinal nerves. 
 
 405 
 
MEDICAL RECORD. 
 
 PHYSIOLOGY. 
 
 1. Osmosis: "If two different liquids are separated from 
 each other by a porous partition, a current sets in from 
 each liquid to the other. The strength of these currents 
 depends on the facility with which the liquids are imbibed 
 by the partition and the tendency the two fluids have to 
 mix with each other; the fluid which soaks most rapidly 
 into the partition, — i.e.. that which wets it most readily — 
 passes through it most rapidly. If a bladder be filled with 
 syrup and immersed in water, the water will pass into the 
 bladder more rapidly than the syrup passes out, and may 
 so far raise the pressure in the interior of the bladder as 
 to burst it. The water is said to pass into the bladder by 
 endosmosis, and the syrup to pass out by exosmosis. 
 Dialysis differs from osmosis in this : In dialysis a crystal 
 loid in solution passes into a fluid, which contains a smaller 
 quantity of the crystalloid; osmosis occurs at the same 
 time, but the phenomena are quite distinct. The law of 
 osmosis deals only with the currents of liquid. The blood- 
 vessels of the alimentary canal absorb fluids by osmosis. 
 The plasma has only a very slight tendency to pass out of 
 the vessels, while the liquids contained in the alimentary 
 canal pass into the blood with great readiness. The laws 
 of osmosis are: (i) The liquids must be of different densi- 
 ties. (2) They must be capable of mixing with each other. 
 (3) The membrane must be permeable to at least one of 
 the liquids. (4) The current produced is greater the 
 greater the tendency of the liquid to permeate the mem- 
 brane — the greater current is spoken of as endosmosis, 
 the lesser as exosmosis. All these conditions exist between 
 the blood and the fluids with which the blood-vessels are 
 surrounded, and the fluids outside the vessels pass into 
 them more readily than the blood plasma escapes. Endos- 
 mosis usually occurs from a lower to a higher pressure." — 
 (Aids to Physiology.) 
 
 2. Urea has the formula CO(NH 2 ) 2 ; it "crystallizes in 
 transparent needles or four-sided prisms, without Aq; per- 
 manent in air; odorless, having a cooling, slightly bitter 
 taste, resembling that of saltpeter. Soluble in an equal 
 weight of cold water, very soluble in boiling water, and 
 in five parts of cold or one part of hot alcohol, the solu- 
 tions being neutral in reaction^ At 248 F. it melts, and 
 slightly above that temperature is decomposed. It is found 
 in the blood, chyle, lymph, humors of the eye, saliva, per- 
 spiration, bile, milk, serous fluids, amniotic and allantoic 
 fluids, and especially in the urine." Urea is always present 
 in the urine, a healthy man excreting about 500 grains of 
 urea daily. Pathologically, the amount of urea excreted 
 may be diminished or increased, as follows : A diminution 
 may be due to some condition interfering with the normal 
 
 406 
 
MEDICAL RECORD. 
 
 transformation of proteins in the body, as in certain chronic 
 diseases. More frequently, however, a diminished propor- 
 tion of urea in the urine is not due to a diminution in the 
 production, but to the fact that the urea formed has not 
 been separated by the kidneys, as in uremia and in diseases 
 attended with dropsical effusions. Pathologically it is in- 
 creased in the early stages of all acute febrile diseases, 
 except when these are attended by the formation of drop- 
 sical deposits or by diarrhea; during reabsorption of drop- 
 sical fluids ; in both forms of diabetes, and in chronic in- 
 terstitial nephritis. 
 
 Test for urea: Evaporate a few drops of the urine on 
 a glass slide, moisten the residue with nitric acid, allow 
 it to crystallize; crystals of urea nitrate will be recognized 
 under the microscope. 
 
 3. Fresh blood stains are of a bright red color, contain 
 hemoglobin, and may show corpuscles ; but after a short 
 time of exposure (anywhere from one to five or six days) 
 the stain becomes reddish-brown or brown, and contains 
 hematin crystals, recognizable in solution by their spectro- 
 scopic absorption bands. 
 
 4. Fibrin is found in blood and lymph; chondrin, in 
 cartilage and bone ; leucin, in pancreas and spleen ; hippuric 
 acid, in the urine. 
 
 5. It is slowed or inhibited, (a) About 108 to 130 beats. 
 (b) About 60 to 65 beats. 
 
 6. See Gray's "Anatomy" (1908), pages 1288 and 1330. 
 The purpose is to propel the contents. 
 
 7. See Cunningham's "Anatomy" (1908), page 1062; or 
 Gray's "Anatomy" (1908), pages 1298 to 1304, and 1326. 
 
 8. Center for sight; is located in the occipital lobe; for 
 hearing, in the first temporal convolution ; for smell, in 
 the uncinate gyrus. 
 
 9. If the pancreatic duct were obstructed, there would 
 be a decided diminution in the activity of the digestion of 
 all kinds of foods — particularly of proteids and fats; there 
 would be noticeable carbohydrate indigestion, and starch 
 and fat would be abundant in the stools. 
 
 10. The office of the Columnce carnece is : To prevent too 
 great dilatation of the ventricles ; to regulate their con- 
 traction; and (through the chordae tendineae) to prevent 
 the mitral and tricuspid valves from being turned into the 
 auricles. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 1. Atropine. 
 
 2. Ichthyol. Source: A quartz containing the fossilized 
 remains of fish. Therapeutic uses: Skin diseases (eczema 
 and psoriasis), to remove inflammatory processes and their 
 products ; also in rheumatism, erysipelas, and for ulcers 
 of the leg. 
 
 407 
 
MEDICAL RECORD 
 
 3. Spigelia is an anthelmintic against lumbricoid worms. 
 
 4. Therapeutic indications for use of chloral: As a 
 hypnotic (in absence of pain) ; as an antiseptic, in a 1 per 
 cent, solution; in cases of acute mania or delirium tremens; 
 in nervous dyspepsia, in fevers with high temperature, ex- 
 citement, restlessness, etc. ; in seasickness ; in tedious labor, 
 to relax a rigid os, and for uterine inertia; for nocturnal 
 epilepsy; for infantile convulsions, chorea, whooping cough, 
 and laryngysmus stridulus ; in tetanus and strychnine poi- 
 soning it is said to be antagonistic; as an antipruritic, 
 Dangers: Habit formation; depression of body tempera- 
 ture; it also slows and weakens the heart, lowers blood 
 pressure, and depresses respiration. 
 
 5. Gallic acid. Source: Tannic acid (from nut galls). 
 Dose: 15 grains. 
 
 6. The therapeutic uses of chromium sulphate are of 
 such very recent recognition that they are not even men- 
 tioned in the most modern textbooks. From the literature 
 put out by the chemists who prepare and sell it we extract 
 the following : The diseases in which it has been used with 
 success are : Cirrhosis of the female breast, castration, 
 menopause, functional impotency in men, chronic alcohol- 
 ism, nervous vomiting and vomiting in pregnancy, neuras- 
 thenia, locomotor ataxia, exophthalmic goiter, and the mi- 
 graines. 
 
 7. See French's "Practice of Medicine" (1907), page 149; 
 or Osier's "Practice of Medicine" (1909), page 164. 
 
 8. Indications for strophantus: As a cardiac stimulant; 
 in mitral or aortic obstruction ; in cardiac dilatation ; pal- 
 pitation; alcoholism; exophthalmic goiter; nephritis; when 
 heart action is feeble but rapid, and accompanied by low 
 arterial tension ; in general^ same as digitalis. 
 
 9. 5. Atropinse sulphatis, gr. 16/100. 
 
 Potassii iodidi, Jss. 
 Infusi digitalis, 3ss. 
 Elixiris simplicis, q.s. ad ^Y). M. 
 Sisr. — One teaspoonful in water four times a day. 
 
 10. The alkaline method in the treatment of rheumatism 
 consists in : The internal administration of sufficiently 
 large doses of alkaline salts to render the urine quickly 
 alkaline; in maintaining this alkaline reaction as long as 
 the rheumatic symptoms continue; and in gradually allow- 
 ing a neutral or acid reaction to return by gradually dj- 
 minishing the alkalies as the symptoms decline. It is 
 claimed for this method that, as the alkalies begin to ex- 
 hibit their action on the system, the whole aspect of the 
 case becomes more favorable, the general distress being 
 alleviated, the temperature falling, and the local symptoms 
 relieved ; that these favorable effects continue to become 
 more and more marked, until the rheumatic condition has 
 
 408 
 
MEDICAL RECORD 
 
 disappeared; that the average duration of the attack is 
 greatly shortened; and that the proportion of visceral af- 
 fections is much reduced. — (From Quain's Dictionary of 
 Medicine.) 
 
 CHEMISTRY AND TOXICOLOGY. 
 
 1. "The presence of lactic acid is detected by Uffelmann's 
 reagent, which consists of a solution of Fe 2 Cl 6 and phenol, 
 diluted to an amethyst-blue color, which is changed to yel- 
 low by lactic acid. In order to avoid error by the action 
 of other substances which have a like action upon the re- 
 agent, 10 c.c. of the filtered gastric contents are agitated 
 with ether, and the ethereal extract separated and agitated 
 with the reagent; or, it may be evaporated, the residue 
 dissolved in water, and the solution added to the reagent." 
 — (Witthaus' Manual of Chemistry.) 
 
 2. Test for indican in the urine: The urine is mixed 
 with one-fifth its volume of 20 per cent, solution of lead 
 acetate and filtered. The filtrate is mixed with an equal 
 volume of fuming hydrochloric acid containing 3 : 1000 of 
 ferric chlorid, a few drops of chloroform are added, and 
 the mixture strongly shaken one to two minutes. With 
 normal urine the chloroform remains colorless, or almost 
 so ; but if an excess of indoxyl compounds be present the 
 chloroform is colored blue, and the depth of the color is a 
 rough indication of the degree of the excess. 
 
 3. During the process of digestion starches are changed 
 into glucose, which the system of the diabetic patient can- 
 not utilize; and which, therefore, increases the percentage 
 of glucose excreted in the urine. 
 
 4. Test for strychnine: Strychnine forms a colorless 
 solution with concentrated H 2 S04. If a crystal of potas- 
 sium dichromate be drawn through this solution it is fol- 
 lowed by a track of color which is first (for an instant) 
 blue, then violet, then rose-colored, and finally yellow. 
 
 5. Synthesis is the building up of compounds from sim- 
 pler compounds or from elements. Three synthetic coal- 
 tar products: Acetanilid, phenacetin, and antipyrin. 
 
 6. Tannin or tannic acid is the antidote to practically all 
 alkaloids, because it precipitates them and forms com- 
 pounds (tannates) which are almost insoluble^ 
 
 7. Tyrotoxicon is a ptomaine ; it is found in poisonous 
 cheese, or milk, or ice-cream. 
 
 8. In poisoning by wood alcohol : Wash out the stomach, 
 give pilocarpine .hypodermatically, and administer strych- 
 nine. 
 
 9. In poisoning by laudanum : Wash out the stomach 
 with a 1 per cent, solution of potassium permanganate, 
 give strychnine, keep the patient awake, and institute arti- 
 ficial respiration if necessary. 
 
 10. Fats and oils should not be administered in poison- 
 
 409 
 
MEDICAL RECORD 
 
 ing by phosphorus, because they would aid in the absorp- 
 tion of more of the poison. 
 
 PATHOLOGY. 
 
 i. See French's "Practice of Medicine" (1907), page 
 838; or Osier's "Practice of Medicine" (1909), page 571. 
 2. 
 
 LUPUS. 
 
 EPITHELIOMA. 
 
 Is tuberculous. 
 
 Is not tuberculous. 
 
 Comes in early life: 
 
 Comes later in life. 
 
 Is of slow growth. 
 
 Grows more rapidly. 
 
 Little or no pain. 
 
 May be very painful. 
 
 Edges and base are soft. 
 
 Edges and base are hard. 
 
 
 Ulcer is deep, with waxy 
 
 
 edges crossed with dilated 
 
 
 blood-vessels. 
 
 3. See Rose and Carless' "Surgery" (1908), page 744; or 
 Da Costa's "Surgery" (1908), page 709. 
 
 4. See French's "Practice of Medicine" (1907), page 
 154; or Osier's "Practice of Medicine" (1909), page 170. 
 
 5. See French's "Practice of Medicine" (1907), page 218; 
 or Osier's "Practice of Medicine" (1909), page 210. 
 
 6. See French's "Practice of Medicine" (1907), page 523; 
 or Osier's "Practice of Medicine" (1909), page 740. 
 
 7. In tabes dorsalis the posterior columns of the spinal 
 cord and the posterior nerve roots are involved. The 
 posterior columns of the spinal cord are gray and shrunken, 
 and show considerable overgrowth of connective tissue in 
 the columns of Goll, Burdach, and Lissauer; this process 
 extends upward from the lumbosacral region; the posterior 
 nerve roots degenerate and become atrophic. The menin- 
 ges over the affected parts become opaque and adherent. 
 Some of the cranial nerves may also atrophy, notably the 
 optic, but also the motor oculi and vagus. The process is 
 destructive and progressive; it is not a simple wasting, 
 although the nerve fibers are atrophied, but it is character- 
 ized by irritation, changes in the axis cylinders, overgrowth 
 of the connective tissue, and sometimes congestion; the 
 spinal ganglia may be affected. 
 
 8. See French's "Practice of Medicine" (1907), pages 850 
 and 855; or Osier's "Practice of Medicine" (1909), page 
 
 548. 
 
 9. See French's "Practice of Medicine" (1907), page 731; 
 or Osier's "Practice of Medicine" (1909), page 457. 
 
 10. See French's "Practice of Medicine" (1907), page 73; 
 or Osier's "Practice of Medicine" (1909), page 68. 
 
 BACTERIOLOGY. 
 
 1. Yellow fever is caused by a specific organism not yet 
 
 410 
 
MEDICAL RECORD 
 
 isolated. The Bacillus icteroides of Sanarelli was formerly 
 supposed by some to be the cause. Whatever the cause, it 
 is conveyed by a mosquito, the Stegomyia calopus. 
 
 The spread of yellow fever can be prevented by the use 
 of screens and mosquito nets, by destroying the mosquitos 
 in the house by the use of burning sulphur or pyrethrum, 
 by draining the swamps, by remaining indoors during the 
 hours when the mosquitos are most active. 
 
 2. To prevent the spread of typhoid fever : Flies should 
 be kept out of the house as far as possible, by means of 
 screens or otherwise; all discharges from the sick person 
 must be disinfected; all utensils, dishes, etc., used by the 
 patient must be thoroughly cleansed, and boiled every day; 
 soiled linen must be soaked in a disinfectant solution be- 
 fore being washed; after each attendance on a patient, 
 physicians, nurses, and others should wash their hands in 
 a disinfectant; thorough sterilization of all bedding, etc., 
 must be performed after the disease is over. Further, each 
 household should boil all water that is to be used for 
 drinking or for washing dishes, etc. ; milk should be boiled 
 also; and no ice should be put in water or other drink 
 or food. 
 
 3. The bacillus of diphtheria is called the Klebs-Loeffler 
 bacillus. Characteristics: The bacilli are from 2 to 6 mi- 
 krons in length and from 0.2 to 1.0 mikron in breadth; are 
 slightly curved, and often have clubbed and rounded ends; 
 occur either singly, or in pairs, or in irregular groups, but 
 do not form chains ; they have no flagella, are non-motile, 
 and aerobic; they are noted for their pleomorphism; they 
 do not stain uniformly, but stain well by Gram's method 
 and very beautifully with Loeffler's alkaline-methylene blue. 
 
 4. To demonstrate the existence of tubercle bacilli in the 
 sputum : The sputum must be recent, free from particles 
 of food or other foreign matter; select a cheesy-looking 
 nodule and smear it on a slide, making the smear as thin 
 as possible. Then cover it with some carbolfuchsin, and 
 let it steam over a small flame for about two minutes, care 
 being taken that it does not boil. Wash it thoroughly in 
 water and then decolorize by immersing it in a solution of 
 any dilute mineral acid for about a minute. Then make a 
 contrast stain with solution of Loeffler's methylene blue 
 for about a minute ; wash it again and examine with oil 
 immersion lens. The tubercle bacilli will aooear as thin 
 red rods, while all other bacteria will appear blue. The 
 tubercle bacillus is rod shaped, is from 1^ to 3^/2 mikrons 
 in length, and about one-third to one-half a mikron in 
 breadth, is a strict parasite, is not motile, and has no 
 flagella. It is slightly curved, does not form spores, is not 
 liquefying, and nonchromogenic, is aerobic ; it resists acids ; 
 it grows well on blood serum ; stains well by Ehrlich's, 
 
 411 
 
MEDICAL RECORD 
 
 Ziehl-Nielsen's, or Gabbett's method; it is Gram-positive. 
 
 5. The Streptococcus pyogenes is a micrococcus, of 
 spherical shape, and arranged in chains of about thirty or 
 fortv cocci (in liquid media), but the chains are much 
 shorter in solid media. Each coccus is about one-half to 
 two mikrons in diameter. It is not motile, does not form 
 spores, does not liquefy gelatin, and stains readily with 
 the ordinary anilin dyes, and by Gram's method. 
 
 It is found in the mouth, nose, urethra, vagina, and on 
 the skin; also in suppurations, erysipelas, pneumonia, pye- 
 mia, septicemia, abscesses, empyema, osteomyelitis, etc. 
 
 The staphylococcus pyogenes aureus is a small round 
 cell which appears in clusters like a bunch of grapes; its 
 diameter is about 0.8 to 1.0 mikron ; it is facultative 
 anerobic, has no flagella, is not motile, it stains readily with 
 the anilin dyes, and is not decolorized by Gram's method; 
 it forms an orange pigment on gelatin, potatoes, and other 
 media; it also liquefies gelatin. It is found on the skin; 
 in the nose, mouth, ears, and eyes, and under the nails; 
 also in abscesses, boils, carbuncles, osteomyelitis, arthritis, 
 empyema, and suppurative inflammations in general. 
 
 6. Antitoxins are substances formed in the body* of a 
 protective character, and capable of rendering inert the 
 poisonous products of bacteria. 
 
 Immunization is an experimental process by which the 
 resisting powers may be increased. 
 
 7. The Noguchi method of the serum diagnosis of 
 syphilis is a modification of the Wassermann reaction. This 
 latter Noguchi modifies as follows: "(1) He prepares 
 the antigen by extracting a lipoid substance from the 
 liver and heart of dogs and cows. (2) Instead of using 
 sheep's corpuscles in the hemolytic series, he employs 
 human corpuscles, owing to the fact that a certain per- 
 centage of human sera tested produced hemolysis of the 
 sheep's corpuscles. (3) In his test, therefore, he obtains 
 the hemolytic amboceptor by immunizing rabbits with 
 washed normal human corpuscles. (4) Another important 
 improvement in the technique is the observation of the 
 specific antigen and the hemolytic amboceptor, which rapid- 
 ly lose their strength in solution, in a dried form by soaking 
 measured strips of filter-paper (.5 mm. square) with each. 
 His test is carried out as follows : A strip of antigen filter- 
 paper is brought in contact with a definite quantity of the 
 human serum to be tested and fresh guinea-pig's serum 
 added, the whole being suspended in isotonic salt solution. 
 This is allowed to stand at incubator temperature and then 
 the hemolytic series added b- taking a stripof the hemo- 
 lytic amboceptor paper and a definite quantity of washed 
 normal human blood corpuscles." — (Tyson's Practice of 
 Medicine.) 
 
 412 
 
MEDICAL RECORD 
 
 8. 'Tetanus antitoxin is obtained from the horse, the 
 animal having been rendered artificially immune by re- 
 peated injections extending over a period of several months 
 of gradually increasing quantities of the strongest tetanus 
 toxin. As the bacilli themselves are not injected, the horse 
 does not become infected with tetanus, but he gradually 
 acquires a tolerance for the toxins of the disease and de- 
 velops in his blood a substance (antitoxin) which has 
 the power to neutralize those toxins. At the proper time, 
 when it is thought that his blood has acquired the requisite 
 degree of potency, the animal is bled, and the serum — 
 the part of the blood containing the antitoxin — is carefully 
 separated from the clot, filtered, and standardized. The 
 last procedure is accomplished by determining the quantity 
 of antitoxin serum required to offset the effects of the 
 minimum quantity of toxin necessary to kill a guinea-pig 
 in a definite time. The strength of the antitoxin is meas- 
 ured in units, a unit containing the amount of antitoxin 
 required to save the life of a guinea-pig which has been 
 injected with ioo fatal doses of toxin." — (Stevens' Materia 
 Medico.) 
 
 How antitoxin produces immunity and effects cure is not 
 known, but theories deduced from observed facts are as 
 follows : "As the various pathogenic bacteria produce the 
 causative toxins of their respective diseases, so the organic 
 cells of the body, reacting under the stimulus of the 
 poisons thus introduced, immediately proceed to elaborate 
 defensive bodies, which if produced in sufficient quantity 
 will neutralize the effects of the toxins. Residual anti- 
 bodies remaining in the blood after recovery render the 
 animal immune for a time against the disease. The im- 
 munizing and curative effects obtained by the injection of 
 the blood serum of an immunized animal into the circula- 
 tion of another animal are due either to direct chemical 
 neutralization of the toxins themselves by the antibodies 
 so introduced (Behring, Kitasato), or to a particular in- 
 fluence exerted by the antibodies upon the living cells of 
 the organism which, being affected in two opposite direc- 
 tions, remain neutral to the disease (Buchner). Some au- 
 thorities hold that these results are due to the conjoint 
 action of leucytic and chemical forces. Ehrlich's sidechain 
 theory assumes that every toxin contains toxophore mole- 
 cules having direct toxic action, and haptophore molecules 
 which combine the toxophores with a similar combining 
 croup of molecules in the tissue cell of the attacked or- 
 ganism. The tissue cell molecules being destroyed by the 
 toxophores, a rapid and profuse regeneration of similar 
 molecules occurs in side chains, and these molecules over- 
 growing are carried into the circulation, becoming the 
 antitoxin, which acts by combining with the haptophores of 
 
 413 
 
MEDICAL RECORD 
 
 newly-arrived toxin, using up their combining power before 
 they can reach the tissue cells/' — (Potter's Materia Medica, 
 etc.) 
 
 9. Streptothrix actinomyces appears in the form of 
 branching threads which interlace with each other. The 
 external ends may be rounded or bulbous. Colonies of 
 them have a radiating appearance, and so have been called 
 ray-fungus. It stains with ordinary anilin dyes, and is 
 Gram positive. It is facultative anerobic, non-motile, non- 
 flagellate, parasitic, and pathogenic. 
 
 10. Gram's method of staining: Stain a cover glass 
 preparation for two or three minutes in anilin gentian- 
 violet. Wash in water. Treat with Gram's solution 
 (iodine, 1 gram; potassium iodide, 2 grams; water, 300 c.c.) 
 for a minute and a half, when the preparation becomes 
 nearly black. Decolorize with strong or absolute alcohol 
 for at least five minutes, wash, dry, and mount. Some- 
 times a contrast stain of Bismarck brown or eosin is used. 
 
 PRACTICE. 
 
 1. See French's "Practice of Medicine" (1907), page 7. 
 
 2. See French's "Practice of Medicine'* (1907), page 599; 
 or Osier's "Practice of Medicine" (1909), page 820. 
 
 3. See French's "Practice of Medicine" (1907), page 103; 
 or Osier's "Practice of Medicine" (1909), page 95- 
 
 4. See French's "Practice of Medicine" (1907), page 326; 
 or Osier's "Practice of Medicine" (1909), page 141. 
 
 5. See French's "Practice of Medicine" (1907), page 685; 
 or Osier's "Practice of Medicine" (1909)* page 641. 
 
 6. See French's "Practice of Medicine" (1907), page 
 1039; or Osier's "Practice of Medicine" (1909)* page 902. 
 
 7. See French's "Practice of Medicine" (1907), page 
 1 100; or Osier's "Practice of Medicine" (1909)1 page 9^9- 
 
 8. See French's "Practice of Medicine" (1907), pages 
 695, 698, and 685; or Osier's "Practice of Medicine" (1909), 
 pages 649 and 641. 
 
 9. The ophthalmoscope would aid in the diagnosis of: 
 Brain tumors, abscesses of brain, anemia oi brain, cerebral 
 aneurysm, tabes dorsalis, multiple sclerosis, exophthalmic 
 goiter, nephritis, diabetes, hypertrophy of the left ventricles 
 of the heart, fatty degeneration of the heart, syphilis, alco- 
 holic or tobacco poisoning. 
 
 10. See French's "Practice of Medicine" (1907), page 
 647; or Osier's "Practice of Medicine" (1909), page 598. 
 
 OBSTETRICS. 
 
 i. See Williams' "Obstetrics" (1909), page 147; or 
 Hirst's "Obstetrics" (1909), page 91. 
 
 2. Veit's figures, based on 13,000,000 cases, show that 
 twins occurred once in 89, and triplets once in 7,910 labors. 
 
 414 
 
MEDICAL RECORD. 
 
 3 and 4. See Williams' "Obstetrics" (1909), page 599; or 
 Hirst's "Obstetrics" (1909), page 155. 
 
 5. See Williams 1 "Obstetrics" (1909), page 619; or 
 Hirst's "Obstetrics" (1909), page 281. 
 
 6 and 7. See Williams 1 "Obstetrics" (1909), page 280; 
 or Hirst's "Obstetrics" (1909), page 414. 
 
 8. See Williams' "Obstetrics" (1909), page 821; or 
 Hirst's "Obstetrics" (1909), page 587. 
 
 9 and 10. See Williams' "Obstetrics" (1909), page 843; 
 or Hirst's "Obstetrics" (1909), page 626. The position 
 recommended is the Trendelenburg. 
 
 SURGERY. 
 
 1. Anastomosis after ligation of femoral artery at apex 
 of Scarpa's triangle: (1) External circumflex; with mus- 
 cular branches of femoral, anastomotica magna, superior 
 articular of popliteal, and anterior tibial recurrent. (2) 
 Perforating and terminal of profunda ; with muscular 
 branches of femoral, and muscular and superior articular 
 branches of popliteal. (3) Comes nervi ischiadici; with 
 perforating of profunda and articular of popliteal. 
 
 2. Paracentesis thoracis is preferably performed: "In 
 the fifth interspace, just in front of the angle of the 
 scapula" (Da Costa). "Sixth (or seventh) intercostal 
 space in the midaxillary line; eighth (or ninth, especially 
 on left) intercostal space in the posterior scapular line" 
 (Bickham). 
 
 3. See Rose and Carless' "Surgery" (1908), page 208; 
 or Da Costa's "Surgery" (1908), page 328. Treatment 
 consists in removal. 
 
 4. Carcinoma is disseminated through the lymphatics 
 chiefly, also by the blood, and occasionally by mechanical 
 transportation in the movements of the body. 
 
 5. The swelling and fluctuation are most prominent on 
 either side of each malleolus, and also in front. 
 
 6. See Rose and Carless' "Surgery" (1908), page 115; 
 or Da Costa's "Surgery" (1908), page 1052. 
 
 7. Excision of the lower jaw is advisable in: Various 
 tumors of that bone (chiefly malignant), and also in ex- 
 tensive necrosis. 
 
 8. The complications of dislocation of the hip are: Ex- 
 tensive injury to the soft parts (such as rupture or lacera- 
 tions of the muscles) ; rupture of, or dangerous pressure 
 on, the femoral vessels or sciatic nerve ; fracture of the 
 head, neck, or shaft of the femur, or of the acetabulum. 
 
 9. Varieties of shoulder joint dislocation: (1) Sub- 
 coracoid — forward, inward, and downward. (2) Subglen- 
 oid — downward, forward, and in ward. (3) Subspinous 
 —backward, inward, and downward. (4) Subclavicular— 
 forward, inward, and upward. 
 
 415 
 
MEDICAL RECORD 
 
 io. See Rose and Carless' "Surgery" (1908), page 383; 
 or Da Costa's "Surgery" (1908), pages 680 to 684. 
 
 GENITOURINARY AND DERMATOLOGY. 
 
 i. See Rose and Carless' "Surgery" (1908), page 1159; 
 or Da Costa's "Surgery" (1908), page 1101. 
 
 2. See Rose and Carless' "Surgery" (1908), page 142. 
 
 3. Hydrocele is a collection of fluid other than pus or 
 blood in the neighborhood of the testis or spermatic cord, 
 generally in the tunica vaginalis of the testis. For opera- 
 tions see Rose and Carless' "Surgery" (1908), page 1267; 
 or Da Costa's "Surgery" (1908), page 1201. 
 
 4. See Rose and Carless' "Surgery" (1908), pages 142 
 to 162; or Da Costa's "Surgery" (1908), pages 274 to 296. 
 
 5. Symptoms of stone in the bladder: Increased fre- 
 quency of micturition; pain at end of urination, chiefly 
 felt at the end of the penis or in the neck of the bladder; 
 the urine may contain pus, mucus, or blood ; a "click" 
 can be obtained by using a searcher or sound; examina- 
 tion by the cystoscope may reveal the presence of the stone. 
 
 6. Common sites of epitheliomata: Nose, lower lip, 
 tongue, mouth, larynx, esophagus, stomach, anus, larynx, 
 penis, scrotum, vulva, cervix uteri. 
 
 7. Xanthoma is a disease in which a yellow or brownish 
 discoloration appears about the eyelids and other parts of 
 the body. The discoloration may be flat, or papular, or 
 nodular. 
 
 8. Keloid. Cause is not known ; the negro race is prone 
 to the disease; there may be some minute injury preced- 
 ing the disease. Treatment: Removal is useless, as it may 
 return ; scarification has been recommended ; the x-vz.y has 
 proved beneficial ; violent methods should be avoided; it 
 may disappear spontaneously. 
 
 9. Bromidrosis. Causes: Unknown; racial peculiarity, 
 as in the negro; it has been attributed to decomposition of 
 the sweat; also to a parasite, a bacterium. Symptoms: 
 Offensive odor to the perspiration, most often affecting the 
 feet or axillae. Treatment: Not much use; washing of the 
 affected part with soap and water several times a day and 
 putting on of clean cloths; various dusting powders. 
 Generally ineffective. 
 
 10. Pompholyx. Causes: "It occurs in adults of both 
 sexes, and is believed to depend upon some general dis- 
 turbance of the nervous system. Mental overwork and 
 lowered nerve-tone are ascribed as causes. The disease is 
 considered to be a vasomotor neurosis. Symptoms: The 
 lesions are distributed symmetrically, and occur as deep- 
 seated, tense vesicles usually on the lateral and palmar 
 aspects of the hands, fingers, feet, and toes, accompanied 
 by itching and burning. They may coalesce, but more fre- 
 
 416 
 
MEDICAL RECORD. 
 
 quently they remain discrete, showing no tendency to rup- 
 ture. The contents are absorbed and desquamation fol- 
 lows. The duration of the attack is from several days to a 
 few weeks. Recurrence is common. Treatment: Recur- 
 rence may be prevented to a great extent by the employ- 
 ment of measures calculated to improve the general health. 
 Locally, pastes, ointments, or lotions containing antipruritic 
 drugs often allay the subjective symptoms.'' — (Hughes.) 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 New Hampshire State Board of Medical Examiners. 
 
 anatomy. 
 
 1. What are the organs of assimilation, and how does 
 the nourishment get into the circulation? 
 
 2. Give a diagram of the eyeball, naming all the parts 
 thereof. 
 
 3. What is the relation of the ulna to the elbow and wrist 
 joints? 
 
 4. Locate the gall-bladder. 
 
 5. Name all the bones that constitute the spinal column. 
 
 6. Place and describe the inferior maxillary bone. 
 
 7. Enumerate and describe the muscles of the posterior 
 brachial region. 
 
 8. What vessels go into and out of the heart? 
 
 9. Describe the inferior vena cava. 
 
 10. Give the origin, course, and distribution of the facial 
 nerve. 
 
 PHYSIOLOGY AND HYGIENE. 
 
 i. What is the science of animal physiology? 
 
 2. How is the potential energy of food measured, and 
 how expressed? 
 
 3. Explain the absorptive process that takes place in the 
 stomach? 
 
 4. What is blood pressure, and what are its normal vari- 
 ations? 
 
 5. What is the general classification of special reflex 
 movements? Give two examples. 
 
 6. What is the physiological process in presbyopia? 
 
 7. What comprises the immediate sources of water sup- 
 
 ply? 
 
 8. Give your method of room disinfection after the re- 
 moval of the patient. 
 
 9. What is the best method of garbage disposal in large 
 cities? 
 
 10. Discuss quarantine. 
 
 417 
 
MEDICAL RECORD 
 
 CHEMISTRY. 
 
 i. What is common table salt? How would you dis- 
 tinguish it from iodode of potassium? 
 
 2. Mention some drugs that would be chemically incom- 
 patible if combined in a prescription. 
 
 3. What are proteids? 
 
 4. What is heat? 
 
 5. How would you conduct a chemical analysis of urine? 
 Give names and formulae of all reagents used. 
 
 6. Define oxidation and combustion, and give an exam- 
 ple of each. 
 
 7. Name the chlorine salts of mercury. Give the for- 
 mulae, common name, general properties, and toxicity of 
 each. 
 
 8. Give in detail a reliable test for the detection of 
 hydrochloric acid in a specimen of gastric contents. 
 
 9. What is the difference between an elementary and a 
 compound substance? 
 
 10. What is the difference between alcohol and ether? 
 
 PATHOLOGY AND DIAGNOSIS. 
 
 1. Give symptoms and diagnosis of renal colic. 
 
 2. Diagnose between hypertrophy of prostate and tumor 
 of bladder. 
 
 3. Give symptoms which would lead you to suspect dila- 
 tion of heart. 
 
 4. Give pathological conditions which produce gangrene. 
 
 5. In what pathological condition do you get an excess 
 of earthy phosphates in urine? 
 
 6. Give the symptoms and differential diagnosis of pneu- 
 mothorax. 
 
 7. Enumerate the different forms of anemia. 
 
 8. Describe a case of rodent ulcer. 
 
 9. Give the differential diagnosis between hydatid dis- 
 ease of the liver and other liver diseases. 
 
 10. How would you prepare sputum for bacillus exam- 
 ination? 
 
 MATERIA MEDICA, THERAPEUTICS, AND THE PRACTICE OF 
 
 MEDICINE. 
 
 1. Give rational treatment for sunstroke. 
 
 2. Differentiate laryngeal diphtheria from spasmodic 
 croup and give your treatment for the latter. 
 
 3. What cardiac lesions are likely to accompany or to 
 follow acute articular rheumatism and how are they 
 recognized? 
 
 4. Give therapeutic indications for the use of chloral 
 hydrate and the appropriate dose in each case. 
 
 5. By what rule would you determine the dose of any 
 drug for a child? 
 
 418 
 
MEDICAL RECORD. 
 
 6. Without abbreviating, write a prescription containing 
 at least three drugs for acute bronchitis occurring in an 
 adult. 
 
 Case : Man, fifty years old, a hard drinker, except dur- 
 ing the past year. No family history obtained. For two 
 or three years he has had pain after taking food, occa-i 
 sional vomiting, and progressive loss of flesh and strength. 
 For the past eight or ten weeks he has complained of 
 frequent and severe pain of a "stretching" character in 
 the right hypochondrium, without much tenderness. For 
 the last two weeks he has been deeply jaundiced. For a 
 week he has been confined to bed and is emaciated and 
 prostrated. His nights are disturbed by pain. The liver 
 is greatly enlarged, hard, irregular, and nodulated; the 
 lower edge reaching to the anterior spine of the ilium; 
 it also extends to the left of the median line about two 
 inches. It is slightly tender. There is little or no ascites. 
 Pulse, 92; temperature, 98.5. Urine rather scanty and 
 very dark. No itching of the skin. 
 
 7. What diseases can produce emaciation with jaundice? 
 
 8. Common cause of hepatic enlargement? 
 
 9. What importance would there have been in a good 
 family history? 
 
 10. Diagnosis? Prognosis? Treatment? 
 
 SURGERY. 
 
 1. Enumerate dislocations at shoulder joint and give 
 mode of reduction of each. 
 
 2. How would you treat compound fracture of tibia? 
 
 3. Enumerate and describe various kinds of aneurysm. 
 
 4. Give causes of hematuria and modes of treatment. 
 
 5. Describe technique of tracheotomy. 
 
 6. Give the etiology, pathology, and symptoms of em- 
 pyema and describe best operation for its cure. 
 
 7. Describe fracture of the patella and describe methods 
 of treatment. 
 
 8. Give the symptoms and treatment for fracture at the 
 base of the skull. 
 
 9. Describe operation for the radical cure of oblique in- 
 guinal hernia. 
 
 10. Diagnose fistula in ano and describe operation for its 
 cure. 
 
 OBSTETRICS. 
 
 1. Under what circumstances would you irrigate after 
 confinement, and with what solutions? 
 
 2. Name two of the most frequent non-malignant growths 
 of the uterus. 
 
 3. What is the cause of, and how would you treat the 
 frequent inclination to urinate in a pregnant woman? 
 
 419 
 
MEDICAL RECORD. 
 
 4. Mention the indications for version. 
 
 5. When may an anesthetic be used in a normal labor? 
 
 6. What are the causes of sterility in the female, and 
 what is the treatment? 
 
 7. What is the treatment for persistent eclampsia a few 
 days previous to labor? 
 
 8. Give symptoms and treatment of tubal pregnancy. 
 
 9. Give treatment for suppurative mastitis occurring soon 
 after labor for both the mother and the child. 
 
 10. Name some of the diseases of pregnancy. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 New Hampshire State Board of Medical Examiners. 
 
 ANATOMY. 
 
 1. The term assimilation is "used to cover the subsidiary 
 processes of digestion, respiration, absorption, and excre- 
 tion, through which food material and oxygen are pre- 
 pared for the activity of the living molecules, and the 
 waste products of activity are removed from the organism, 
 as well as the actual conversion of dead material into liv- 
 ing protoplasm." Hence, the organs of assimilation are all 
 the organs of digestion, respiration, absorption, and excre- 
 tion. The nourishment gets into the circulation by two 
 routes: (1) By the blood-vessels of the gastrointestinal 
 tract, which unite to form the portal vein, and (2) by 
 the lymph vessels of the small intestine, which converge 
 to empty into the thoracic duct. The water, inorganic 
 salts, proteids, and sugar go by way of the portal vein to 
 the ascending vena cava ; the fats go by way of the thoracic 
 duct to the junction of the left subclavian and internal 
 jugular vein. 
 
 2. See Cunningham's "Anatomy" (1909), page 724; or 
 Gray's "Anatomy" (1908), page 122. 
 
 3. The ulna is an essential factor of the elbow joint; it 
 does not enter the wrist joint at all, being separated from 
 the first layer of carpal bones by cartilage. 
 
 4. The gall-bladder is situated in a fossa on the under 
 surface of the right lobe of the liver. It is in relation, 
 in front, with the anterior abdominal wall, immediately be- 
 low the ninth costal cartilage. 
 
 5. Seven cervical vertebrae, twelve dorsal vertebrae, five 
 lumbar vertebrae, sacrum (in youth consisting of five 
 segments), and the coccyx (in youth consisting of four 
 segments). 
 
 6. See Cunningham's "Anatomy" (1909), page 142; or 
 Gray's "Anatomy" (9108), page 122. 
 
 420 
 
MEDICAL RECORD. 
 
 7. The muscles of the posterior brachial region are the 
 triceps and anconeus. For description see Cunningham's 
 "Anatomy" (1909), page 335; or Gray's "Anatomy" (1908), 
 page 479. 
 
 8. Vessels going into the heart: Superior vena cava, in- 
 ferior vena cava, pulmonary veins, cardiac veins, coronary 
 sinus, veins of Thebesius. Vessels going out of the heart: 
 Aorta, pulmonary artery. 
 
 9. See Cunningham's "Anatomy" (1909), page 892; or 
 Gray's "Anatomy" (1908), page 764. 
 
 10. See Cunningham's "Anatomy" (1909), page 686; or 
 Gray's "Anatomy" (1908), page 1059. 
 
 PHYSIOLOGY AND HYGIENE. 
 
 i. Animal physiology is that branch of science which 
 treats of the functions of the organs and tissues of the 
 animal body in a state of health. 
 
 2. The potential energy of food is measured by the 
 amount of heat or energy that it will produce ; it is ex- 
 pressed in calories. (A calorie is the amount of heat re- 
 quired to raise one gram of water i° C.) 
 
 3. Substances that may be absorbed in the stomach are : 
 Water, alcohol, salts, sugars, and dextrins that may have 
 been converted from starch by the ptyalin of the saliva, 
 and proteoses and peptones resulting from peptic digestion 
 of proteids. 
 
 4. Blood pressure is the force or pressure of the blood 
 exerted against the vessel walls. "In a case of healthy 
 adults, the pressure in the brachial artery ranges between 
 no and 130 millimeters of mercury." 
 
 5. Reflexes are classified: (1) Superficial reflexes are 
 such as can be elicited by stimulating the skin. Example: 
 The cremasteric reflex. And (2) deep reflexes are such as 
 are elicited by stimulating tendons or muscles. Example: 
 The patellar reflex. 
 
 In the cremasteric reflex, irritation of the skin of the 
 upper and inner part of the thigh causes a retraction or 
 drawing up of the testicle. In the patellar reflex, if the 
 tendon of the quadriceps extensor is struck with the edge 
 of the hand while the leg hangs loosely over the other leg, 
 there will be a single upward jerk of the leg or foot. 
 
 6. Presbyopia is due to a gradual failure of the power 
 of accommodation, dependent on the progressive loss of 
 elasticity in the lens and on the loss of its power to in- 
 crease its refraction. The near point recedes and the range 
 of accommodation is diminished. 
 
 7. The sources of water supply are: (1) Rain and snow; 
 (2) surface waters (rivers, lakes, and ponds) ; (3) subsoil 
 or ground water; (4) deep waters (spring and artesian 
 well). 
 
 421 
 
MEDICAL RFXORD. 
 
 8. Method of room disinfection: All articles that can be 
 disinfected by moist or dry heat or by soaking in some 
 chemical disinfectant should be removed and treated ac- 
 cordingly. All windows, chimneys, and orifices having been 
 closed as tightly as possible, and all cupboards and draw- 
 ers opened and exposed, the space or chamber should be 
 fumigated in presence of moisture with either formalde- 
 hyde, chlorine, or nitrous acid for at least three hours. 
 On re-entering, open all doors and windows, and strip the 
 walls of paper, burn the pieces, have the ceiling well lime- 
 washed, and scrub all floors, all woodwork, and furniture 
 with either plain hot water and soft soap, or with bichlo- 
 ride of mercury (i in 1,000), or with formalin (2 per 
 cent). In many cases adequate disinfection will be secured 
 by free perflation of air, and, in place of fumigation, the 
 free use of a spray of either formalin or mercuric chlo- 
 ride, in the proportions already stated, to the surfaces of 
 walls and furniture. This latter method is probably of 
 greater value than attempts to disinfect by gaseous means, 
 as it is the place itself and not the air of the place we need 
 to disinfect; the air can readily be changed by free venti- 
 lation. (From Notter and Firth's Hygiene). 
 
 9: The best method of garbage disposal in large cities is 
 by cremation. 
 
 10. Quarantine has been defined as "the adoption of 
 restrictive measures to prevent the introduction of dis- 
 eases from one country or locality into another." There are 
 several varieties, such as port quarantine, land, interstate, 
 railroad, municipal, house, and room quarantine. Further, 
 there is quarantine for cattle, also for crops. Most of the 
 leading countries have for a long time been opposed to 
 oppressive, arbitrary, and irrational quarantine measures, 
 and have now adopted rules and regulations, which, while 
 effective as far as can be hoped for or expected, impose the 
 least possible restrictions upon personal liberty and trade. 
 The periods of detention are fixed with reference to the 
 probable incubative period of the disease in question, and 
 questions of the necessity of disinfection and of methods 
 to be followed in carrying out the same are determined by 
 the circumstances of each individual case. Quarantines 
 administered with reason do invaluable work in sifting out 
 infection and protecting the public health from exotic 
 diseases, which, in the absence of precautionary measures, 
 might easily gain access. At the same time they act in 
 restraint of trade to the slightest possible extent, since 
 there is no unnecessary detention. Unfortunately, not all 
 quarantines are administered with reason, and it often 
 happens that great injustice and unnecessary expense are 
 caused by absurdly tenacious adherence to exploded the- 
 ories and routine practice. (From Harrington's Hygiene). 
 
 422 
 
MEDICAL RECORD. 
 
 CHEMISTRY. 
 
 1. Common table salt is sodium chloride. Sodium chlo- 
 ride is insoluble in absolute alcohol, while potassium iodide 
 is soluble in alcohol ; further, by the flame test sodium 
 chloride gives a bright yellow color, while potassium iodide 
 gives a violet color. 
 
 2. Potassium iodide and mercuric chloride are chemically 
 incompatible; so are tincture of cinchona and aromatic 
 spirits of ammonia ; also tincture of opium and liquor 
 plumbi subacetatis ; likewise glycerin and potassium per- 
 manganate. 
 
 3. Proteids are organic substances of very complex com- 
 position and of unknown constitution, which are indis- 
 pensable to all animal and vegetable life. They are com- 
 posed of carbon, hydrogen, oxygen, and nitrogen; some 
 also contain sulphur or phosphorus or some other element. 
 
 4. Heat "is a form of energy into which other forms 
 tend to be converted, which excites peculiar sensations 
 when made to act upon the body ; gives rise to luminous 
 phenomena ; causes expansion in all bodies and dissociation 
 of their molecules, so as to liquefy solids, evaporate liquids, 
 and rarefy gases, and produces various chemical changes, 
 particularly oxidation and combustion." (Duane's Medical 
 Dictionary.) 
 
 5. An analysis of urine includes : Estimation of total 
 quantity passed in twenty-four hours, color, odor, reaction, 
 specific gravity, total solids (by aid of Haeser's coefficient). 
 Then examine for albumin by Heller's test, or by heat and 
 nitric acid (HN0 3 ) ; then for glucose by Moore's test, 
 with potassium hydroxide (KHO), or with Fehling's solu- 
 tion, which contains copper sulphate (CuS0 4 ), sodium 
 hydroxide (NaHO), and Rochelle salt (C 4 6 H 4 NaK) ; 
 then for blood with potassium hydroxide solution (KHO) ; 
 then for bile pigments by Gmelin's test, requiring nitric 
 acid (HNOo) ; then for indican, using lead acetate [Pb 
 (C 2 H 3 2 )], hydrochloric acid (HO), ferric chloride (Fe 2 
 Clo), and chloroform (CHC1 3 ). Then quantitatively for 
 urea, using solution of sodium hypobromite (NaBrO) ; for 
 chlorides, with silver nitrate solution (AgN0 3 ) ; for sul- 
 phates, with barium chloride solution (BaCl 2 ). Acetic acid 
 (C 2 H 4 2 ) will be necessary to acidify alkaline urines. 
 
 6. By oxidation we mean the act of union of oxygen 
 with another element or compound. This process is at- 
 tended by the liberation of heat, and, when it takes place 
 rapidly, of light. The rusting of a given weight of iron is 
 a slow oxidation, while the burning of the same in oxygen 
 is a rapid oxidation. Only the latter produces light, while 
 in both cases the same amount of heat is liberated. 
 
 By combustion, in a general sense, is meant the rapid 
 
 423 
 
MEDICAL RECORD 
 
 union of the oxygen of the air with some other substance, 
 as coal or phosphorus. In a wider sense, however, combus- 
 tion may be defined as any chemical union of two sub- 
 stances attended by liberation of heat and light. 
 
 7. Mercuric chloride (HgCl 2 ), corrosive sublimate, is 
 heavy, white, and crystalline; it has a strong, acrid, styptic 
 taste, and is soluble in water, in alcohol, and in ether; it is 
 decomposed by exposure to light. It is very poisonous. 
 
 Mercurous chloride (Hg 2 Cl 2 ), calomel, is a heavy, white 
 powder, amorphous, tasteless, and odorless ; it is insoluble 
 in cold water and in alcohol, and very slightly soluble in 
 boiling water; when exposed to the light it becomes dis- 
 colored (first yellow, then gray) and partially decomposed; 
 it sublimes without fusing; it is incompatible with the 
 mineral acids, with the alkaline chlorides, bromides, and 
 iodides. It is very much less poisonous than mercuric 
 chloride, and is quite frequently administered internally. 
 
 8. The Dimethylamido-azobenzol test for free HC1 in 
 gastric contents : The reagent is used in 0.5 per cent, alco- 
 holic solution, of which one or two drops are added to a 
 like amount of the filtered gastric juice. If free HC1 is 
 present the yellow solution turns red. 
 
 9. An element is a substance out of which we cannot, by 
 any known means, get any other kind of substance. A 
 compound is a substance made up of two or more ele- 
 ments, chemically united, in definite proportions. Thus in 
 an elementary substance the atoms are all similar; in a 
 compound substance they are not. 
 
 10. An alcohol is the hydroxide of a hydrocarbon rad- 
 ical. An ether is the oxide of a hydrocarbon radical. Thus, 
 ethyl alcohol, C2H5OH; ethyl oxide, or ether (C 2 H 5 ) 2 0. 
 
 PATHOLOGY AND DIAGNOSIS. 
 
 i. See French's "Practice of Medicine" (1907), page 
 911; or, Osier's "Practice of Medicine" (1909), page 711. 
 
 2. See Rose and Carless' "Surgery" (1908), pages 1226, 
 1 197, and 1200; or, Da Costa's "Surgery" (1908), pages 
 1 187 and 1 138. 
 
 3. See French's "Practice of Medicine" (1907), page 
 601; or, Osier's "Practice of Medicine" (1909), pages 821 
 and 827. 
 
 4. The causes of gangrene are local or constitutional. 
 Of the former, injuries, mechanical violence, caustics, ex- 
 tremes of heat and cold, as in burns and in frostbites, the 
 application of a ligature, embolic plugging, strangulated 
 hernia, intussusception, ligated hemorrhoids, very tight 
 bandaging, paraphimosis, even extravasation of urine and 
 feces, and continued pressure, as in bedsores, may be given. 
 Of constitutional causes, a deficient blood supply or senile 
 changes may be cited. In certain diseases, as diabetes, 
 
 424 
 
MEDICAL RECORD. 
 
 typhus, typhoid, measles, and scarlatina, embolism is the 
 usual cause of gangrene. Gangrene from ergotism is due 
 to the effect of this drug on the vessels. Septic gangrene 
 is due to septic infection. (From Gould and Pyle's Cyclo- 
 pedia.) 
 
 5. Excess of phosphates is found in: Phthisis and other 
 wasting diseases, leukemia, severe anemia, neurasthenia, 
 acute yellow atrophy of the liver, rickets, diabetes, osteo- 
 malacia ; in some fevers, particularly in the late stages. 
 
 6. See French's Practice of Medicine" (1907), page 
 703; or. Osier's "Practice of Medicine" (1909), page 658. 
 
 i • { (1) Local f Chlorosis 
 
 7. Anemias are : ) ji; ^^ , Primary J Pernicious 
 
 / Secondary (. Anemia 
 
 8. See Rose and Carless' "Surgery" (1908), page 410; or 
 Da Costa's "Surgery''' (1908), page 334. 
 
 9. See French's "Practice of Medicine" (1907), page 
 483; or. Osier's "Practice of Medicine" (1909), page 35. 
 
 10. To demonstrate the existence of tubercle bacilli in 
 the sputum : The sputum must be recent, free from par- 
 ticles of food or other foreign matter: select a cheesy- 
 looking nodule and smear it on a slide, making the smear 
 as thin as possible. Then cover it with some carbolfuchsin 
 and let it steam over a small flame for about two minutes, 
 care being taken that it does not boil. AYash it thoroughly 
 in water and then decolorize by immersing it in a solution 
 of any dilute mineral acid for about a minute. Then make 
 a contrast stain with solution of Loeffler's methylene blue 
 for about a minute ; wash it again and examine with oil 
 immersion lens. The tubercle bacilli will appear as thin 
 red rods, while all other bacteria will appear blue. 
 
 MATERIA MEDICA, THERAPEUTICS, AXD THE PRACTICE OF 
 
 MEDICIXE. 
 
 i. See French's ''Practice of Medicine" (1907), page 
 971; or, Osier's "Practice of Medicine'' (1909), page 387. 
 
 2. In laryngeal diphtheria there is a prior stage of ma- 
 laise, accompanied by chills, fever, and sore throat. The 
 fever may become very high. A membrane forms, in which 
 are found the Klebs-Loeffler bacillus or streptococci. Spas- 
 modic croup generally comes on suddenly, at night. There 
 is no appreciable fever, no previous malaise or sickness, 
 and often the patient is asleep again by the time the 
 physician arrives. There is frequently a thick, tenacious 
 mucus, but neither Klebs-Loeffler bacilli nor streptococci 
 are present. It is entirely a local disturbance. For treat- 
 ment of spasmodic croup, see French's "Practice of Medi- 
 cine" (1907), page 647; or, Osier's "Practice of Medicine" 
 (1909), paspe 599. 
 
 425 
 
MEDICAL RECORD. 
 
 3. See French's "Practice of Medicine" (1907), pages 
 226, 559> 570, 577, 581, and 603; or, Osier's "Practice of 
 Medicine" (1909), pages 223, 779, 789, 805, and 809. 
 
 4. Therapeutic indications for use of chloral: As a 
 hypnotic (in absence of pain), dose gr. xx; as an antiseptic, 
 in a 1 per cent, solution ; in cases of acute mania or de- 
 lirium tremens, dose gr. xx to xxx; in nervous dyspepsia, 
 dose gr. xv; in fevers with high temperature, excitement, 
 restlessness, etc., dose gr. xv; in seasickness, dose gr. v; 
 in tedious labor, to relax a rigid os, and for uterine in- 
 ertia, dose gr. xx; for nocturnal epilepsy, dose gr. xv; for 
 infantile convulsions, chorea, whooping cough, and laryn- 
 gysmus stridulus, dose according to age of child, taking 
 adult dose as gr. xv to xx; in tetanus and strychnine 
 poisoning it is said to be antagonistic, dose gr. xx; as an 
 antipruritic, in a solution ten grains of chloral to one 
 ounce of water. 
 
 5. To determine the proper dosage for a child: Let 
 
 x 
 
 x z= the age of a patient; then = the fraction of 
 
 x + 12 
 the adult dose which the patient should receive. Thus, a 
 
 4 4 1 
 
 patient of four years old should receive = — = — 
 
 4+12 16 4 
 of an adult dose. 
 
 6. For acute bronchitis in an adult: 
 Recipe : 
 
 Ammonii chloridi, grana triginta. 
 Tincturse opii camphoratse. 
 Syrupi ipecacuanhas, ana drachmas tres. 
 Syrupi pruni virginianse, unciam. 
 Syrupi Tolutani, quantum sufficiat ad uncias quattuor. 
 Misce et Signa : Take one teaspoonful every three hours. 
 The "Case" with questions 7 to 10 is taken from Cabot's 
 Case-teaching in Medicine; the answers are taken from 
 the same source. 
 
 7. Gallstones and their results, cancer obstructing the 
 biliary passages, syphilis of the liver, cirrhosis, septicemia 
 (toxic jaundice). 
 
 8. Passive congestion, biliary obstruction from any 
 cause, fat, cirrhosis, cancer, rickets; rarer causes are 
 abscess, leukemia, pseudo-leukemia, cholangitis, amyloid, 
 and hydatid disease. 
 
 9. None in this case. 
 
 10. Diagnosis: Gastric symptoms, nodular hepatic en- 
 largement with severe pain, with emaciation and jaundice, 
 and without evidence of portal stasis (ascites, etc.), point 
 strongly to cancer of the liver, probably secondary to 
 gastric cancer. The history of alcoholism and the hepatic 
 
 426 
 
MEDICAL RECORD 
 
 enlargement suggest cirrhosis, but there is rarely, if ever, 
 so much pain in cirrhosis (or, indeed, in any liver disease 
 except cancer), and the "hobnails" of cirrhosis are not 
 large enough to make the liver feel "irregular and nodu- 
 lar" through the abdominal wall. The absence of ascites is 
 also against cirrhosis. Syphilis of the liver might produce 
 all the signs described, and can only be finally eliminated 
 by the therapeutic test, but the amount of pain here present 
 is almost unknown in syphilis, and the amount of hepatic 
 enlargement is very unusual. 
 
 Prognosis: Hepatic cancer usually kills within a year 
 of the discovery of its presence. 
 
 Treatment : The relief of symptoms as they arise is all 
 that can be hoped for if the diagnosis is correct, but in all 
 cases of hepatic cancer KI should be given in doses of ten 
 to thirty grains daily until it is proved to be valueless. A 
 patient has been known to die of hepatic syphilis untreated, 
 because her physician was sure it was cancer and had 
 given up hope. The same is true of cirrhosis. All cases 
 should be given KI and the benefit of the doubt whether 
 our diagnosis is correct. The itching which may torture 
 the patient in such cases should be treated by alkaline 
 baths or washes, dilute carbolic washes, or vaseline. 
 
 SURGERY. 
 
 i. See Rose and Carless' "Surgery" (1908), pages 620 to 
 623; or, Da Costa's "Surgery" (1908), pages 587 to 592. 
 
 2. See Rose and Carless' "Surgery" (1908), page 481; or, 
 Da Costa's "Surgery" (1908), page 464. 
 
 3. See Rose and Carless' "Surgery" (1908), page 308; or, 
 Da Costa's "Surgery" (1908), page 356. 
 
 4. Causes of hematuria: "(1) Renal hematuria is due 
 to acute nephritis, calculus, tumors, or injury of the kid- 
 neys. Blood casts may be found. (2} Vesical hematuria 
 is due to calculus, tumors, injury, cystitis, or the presence 
 of the Bilhnrzia hcematobia. In the last the ova cause 
 papillomatous tumors in the bladder. (3) Prostatic hema- 
 turia is due to congestion, calculus, ulceration, or malig- 
 nant disease. (4) Urethral hematuria is due to catheter- 
 ism, laceration, or gonorrhea. The blood flows independ- 
 ently of micturition. (5) Constitutional causes are pur- 
 pura, scurvy, hemophilia. Hemoglobin is present, but not 
 corpuscles, in paroxysmal hemoglobinuria. The spectrum 
 and hemin tests are the most certain, but the guaiacum- 
 ozonic ether test is reliable Tor urine." (From Aids to 
 Surgery.) For treatment, see Rose and Carless' "Surgery" 
 (1908)"; or, Da Costa's "Surgery" (1908), in the Index, 
 under the various conditions mentioned above, under 
 Causes. 
 
 427 
 
MEDICAL RECORD 
 
 5. See Rose and Carless' "Surgery" (1908), page 914; or, 
 Da Costa's ''Surgery" (1908), page 769. 
 
 6. See Rose and Carless' ''Surgery" (1908), page 926; or, 
 Da Costa's "Surgery" (1908), page 773. 
 
 7. See Rose and Carless' "Surgery" (1908), pages 549 to 
 553; or, Da Costa's "Surgery" (1908), pages 532 to 53& 
 
 8. See Rose and Carless' "surgery" (1908), page 745; or, 
 Da Costa's ''Surgery" (1908), page 709. 
 
 9. See Rose and Carless' "Surgery" (1908), page 1081 ; 
 or, Da Costa's "Surgery" (1908), page 978. 
 
 10. See Rose and Carless' "Surgery" (1908), page 1134; 
 or, Da Costa's "Surgery" (1908), page 1009. 
 
 OBSTETRICS. 
 
 1. Irrigation after confinement is done: (1) By some 
 practitioners, as routine treatment after every labor; (2) 
 by others only when there have been repeated vaginal ex- 
 aminations, or (3) in case of foul lochia; (4) or after 
 some operative procedure; (5) in case of sepsis. Intra- 
 uterine douche is indicated when the hand or instruments 
 have been introduced into the uterus, or when sepsis is 
 suspected. The solutions for vaginal douche may be : Hot 
 1 per cent, creolin mixture in boiled water; or bichloride 
 of mercury, 1 :ioooo to 1:5000; or decinormal salt solution. 
 
 For intrauterine douche: Plain sterile water, decinormal 
 salt solution, creolin 1-2 per cent., a bichloride of mercury 
 1.10000, followed by plain sterile water. 
 
 2. Fibroids and polypi. 
 
 3. See Hirst's "Obstetrics" (1909), page 251. 
 
 4. The indications for version are: (1) In tranverse 
 presentations; (2) in placenta prsevia ; (3) in malpresenta- 
 tions of the head ; (4) in simple flattened pelvis, and in 
 minor degrees of pelvic contraction; (5) in prolapsed 
 funis; (6) in sudden death of the mother, and (7) in any 
 case where speedy delivery is imperative. 
 
 5. See Williams' "Obstetrics" (1909), page 321; or, 
 Hirst's "Obstetrics" (1909), page 329. 
 
 6. The most common causes of sterility in women are: 
 Gonorrhea, absence or errors in development of any part 
 ot the genital tract, malformations of genitals, fistulse, 
 lacerations, obesity, alcoholism, pelvic inflammations, dys- 
 pareunia, inflammations of uterus, tubes, or ovaries, elon- 
 gated cervix. Treatment consists in removing the cause, if 
 possible ; curettage has been recommended ; in the pres- 
 ence of developmental errors little or nothing can be done ; 
 atresia of cervix can ^e treated by dilatation; if the uterus 
 is misplaced it must be replaced. 
 
 7. Treatment of eclampsia consists in: (1) Controlling 
 the convulsions (by chloroform, veratrum, or chloral) ; 
 (2) elimination of the poison or poisons which are pre- 
 
 428 
 
MEDICAL RECORD 
 
 sumed to cause the convulsions; (3) emptying the uterus 
 under deen anesthesia, by some method that is rapid and 
 that will cause as little injury to the woman as possible. 
 
 8. "When extrauterine pregnancy exists there are: (1) 
 The general and reflex symptoms of pregnancy; they have 
 often come on after an uncertain period of sterility; 
 nausea and vomiting appear aggravated. (2) Then comes 
 a disordered menstruation, especially metrorrhagia, accom- 
 panied with gushes of blood, and with pelvic pain coinci- 
 dent with the above symptoms of pregnancy; pains are 
 often very severe, with marked tenderness within the 
 pelvis; such symptoms are highly suggestive. (3) There is 
 the presence of a pelvic tumor characterized as a tense 
 cyst, sensitive to the touch, actively pulsating ; this tumor 
 has a steady and progressive growth. In the first two 
 months it has the size of a pigeon's egg ; in the third 
 month it has the size of a hen's ^gg; in the fourth 
 month it has the size of two fists. (4) The os uteri is 
 patulous : the uterus is displaced, but is slightly enlarged 
 and empty. (5) Symptoms Xo. 2 may be absent until the 
 end of the third month, when suddenly they become severe, 
 with spasmodic pains, followed by the general symptoms of 
 collapse. (6) Expulsion of the decidua in part or whole. 
 Xos. 1 and 2 are presumptive signs: Xos. 3 and 4 are 
 probable signs; Nos. 5 and 6 are positive signs." [Ameri- 
 can Text-Book of Obstetrics.) 
 
 Treatment consists in the removal of the product of con- 
 ception -by a laparotomy, as soon as the diagnosis is made. 
 
 9. See Williams 1 "Obstetrics" (1909). pages 914 and 
 -~ or. Hirst's "Obstetrics'* (1909), pages 709 and 929. 
 
 10. See Williams' "Obstetrics" (1909). pages 480 to 623; 
 or. Hirst's "Obstetrics" (1909). pages 215 and 284. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 State Board of Medical Examiners of New Jersey. 
 
 ax atomy. 
 
 Answer any ten questions, but no more. 
 
 1. What change takes place in the vascular system at 
 birth: 
 
 2. Describe the structure of the arteries and give their 
 nerve and blood supply. 
 
 3. How are the saphenous veins formed and where do 
 they empty ? 
 
 4. Give blood and nerve supply of the tonsils. 
 
 5. Describe the renal blood circulation. 
 
 6. Describe the sphincter ani evternus. 
 
 7. How may the fissures of the Sylvius and Rolando be 
 
 429 
 
MEDICAL RECORD. 
 
 approximately mapped out on the surface of the skull? 
 
 8. What would be the collateral circulation if the 
 brachial artery were ligated below its profunda branches? 
 
 9. Describe the dura mater, and mention the processes 
 and sinuses of it. 
 
 10. What nerves form the pharyngeal plexus? 
 
 11. Give origin, course, and distribution of the nerves 
 of the palm of the hand. 
 
 12. Mention a muscle which moves (a) the thumb out- 
 ward, (b) the head forward, (c) the foot inward. 
 
 13. Give origin, insertion, blood and nerve supply, and 
 action of any one of the following muscles : Gracilis, pec- 
 toralis major, semimembranosus. 
 
 14. Give a general idea of the internal structure of the 
 cerebrum. 
 
 15. Outline on the chest wall (a) the lungs, (b) the 
 vena cava superior, (c) the arch of the aorta, (d) the left 
 pulmonary artery. 
 
 PHYSIOLOGY. 
 
 Answer any ten questions in this paper, but no more. 
 
 1. Name the uses of the bile. 
 
 2. Name the circulating fluids of the body, and state the 
 functions of each. 
 
 3. Define tidal and residual air, and state their normal 
 quantity. 
 
 4. Define hemoglobin; state its functions and where it 
 is found. 
 
 5. What effect does diet have upon the secretion and 
 quantity of milk? 
 
 6. State the functions of the thyroid body and the effects 
 of its removal. 
 
 7. Why does blood coagulate? Does lymph coagulate, 
 and, if so, why? What chemical change is essential in 
 either case? 
 
 8. Where is the respiratory center? What nerves are 
 given off from it? What does each do? 
 
 9. State in order of importance the tissues in which 
 animal heat is generated and by which it is given off. 
 
 10. Which of the following are secretions and which 
 are excretions? Aqueous humor, tears, bile, cerebrospinal 
 fluid, urine, perspiration, prostatic fluid. 
 
 11. State the immediate and remote effect of cutting 
 the sciatic nerve. 
 
 12. State the causes of bodily fatigue. 
 
 13. What is a superficial reflex? What is a deep reflex? 
 Name four examples of each. 
 
 14. Why does heat prostration occur more readily in a 
 humid atmosphere than in a dry one? 
 
 15. State functions of the anterior and posterior spinal 
 nerves. How many pairs are there? 
 
 430 -_- - . 
 
MEDICAL RECORD 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 Answer any ten questions, but no more. 
 
 i. Name (a) the officinal preparations of aconite, (b) 
 adult dose of each, (c) medicinal uses, and (d) therapeu- 
 tic effects. 
 
 2. State (a) the indications for the use of strychnine, 
 
 (b) dosage for adults, and (c) symptoms and treatment 
 of poisoning. 
 
 3. What purgatives act (a) on the small intestines, (b) 
 on the large intestines, and (c) dosage of each? 
 
 4. (a) Enumerate the arsenical preparations used in 
 medicine; (b) state their therapeutic properties with adult 
 dose cf each. 
 
 5. Write a prescription based upon a diagnosis of acute 
 ptomain poisoning. 
 
 6. (a) Explain the difference between galvanic and 
 faradic current; (b) mention the classes of cases for the 
 employment of each. 
 
 7. Specify the effect on the arterial system of (a) nitro- 
 glycerin, (b) aconite, (c) digitalis, (d) veratrum viride, 
 and (e) strophanthus. 
 
 8. Describe (a) the Widal serum test and (b) state its 
 value and purpose in diagnosis. 
 
 9. Compare (a) the physiological action and (b) the 
 dosage of podophyllin, cascara sagrada, and aloin. 
 
 10. Discuss the therapeutic uses and effects of (a) acet- 
 anilid, (b) heroin, and (c) terebene; give dosage of each. 
 
 11. Specify (a) the method and (b) the effects of ad- 
 ministering oxygen in pneumonia. 
 
 12. Differentiate the symptoms of poisoning by mor- 
 phine, carbolic acid, and arsenic. 
 
 13. Give (a) the source, (b) therapeutic effect, and (c) 
 dosage of pilocarpine. 
 
 14. Mention (a) three vegetable and (b) three mineral 
 astringents with therapeutic employment and adult dose of 
 each. 
 
 15. Discuss calomel in respect to (a) source, (b) effects, 
 
 (c) dosage, and (d) incompatibilities. 
 
 CHEMISTRY. 
 
 Answer any ten questions, but no more. 
 
 1. Give the composition and properties of urea. 
 
 2. Mention the chemical reason for using lithia and its 
 salts in cases of uric-acid diathesis. 
 
 3. What is the normal composition of urinary calculi? 
 
 4. Define fermentation, putrefaction, decay. 
 
 5. Mention the chemical name for white arsenic, proper- 
 ties and uses. 
 
 6. Explain the atomic theory. 
 
 7. What is the chemical composition of bone? 
 
 431 
 
MEDICAL RECORD 
 
 8. Name the principal pigment of normal urine. 
 
 9. What may very high or very low specific gravity of 
 urine indicate? 
 
 10. Give the chemistry of respiration, showing what is 
 inhaled, what is exhaled, and how the gases enter and leave 
 the blood. 
 
 11. Define specific gravity. 
 
 12. What are the properties of bile? Give the chief con- 
 stituent. 
 
 13. Explain the meaning of the terms reaction and re- 
 agent. 
 
 14. Give Marsh's test. 
 
 15. What is the difference between vegetable and animal 
 life from the chemical standpoint. 
 
 HISTOLOGY, BACTERIOLOGY, AND PATHOLOGY. 
 
 Answer only ten questions, and not less than three on 
 each branch. 
 
 Histology. 
 
 1. Name the varieties of muscle, and what are the differ- 
 ences between them? 
 
 2. Describe the general characteristics of epithelium. 
 
 3. Describe non-medullated nerve-fibers and tell where 
 they occur. 
 
 4. How do veins differ from arteries? 
 
 Bacteriology. 
 
 5. State briefly a method of obtaining a pure culture. 
 
 6. Describe a process by which bacteria multiply. 
 
 7. Give Koch's rules in regard to the bacterial cause 
 of disease. 
 
 8. Why does the air contain more bacteria in Summer 
 than the air in Winter? 
 
 9. Differentiate between the bacillus coli communis and 
 the bacillus of typhoid fever. 
 
 10. Define immunity; susceptibility. 
 
 Pathology. 
 
 11. Describe the lesions of the kidney cortex in acute 
 diffuse nephritis. 
 
 12. Describe the microscopic appearances of the tissues 
 affected in tuberculosis pleuritis. 
 
 13. What are the lesions in infantile scurvy? 
 
 14. Give the pathology of .chronic interstitial hepatitis. 
 
 15. Give the pathology of gastric ulcer. 
 
 PRACTICE OF MEDICINE. 
 
 Answer any ten questions, but no more. 
 
 1. Describe autointoxication. 
 
 2. Describe ulcerative keratitis. 
 
 3. Describe a case of cholelithiasis. 
 
 432 
 
MEDICAL RECORD. 
 
 4. Differentiate melancholia and dementia. 
 
 5. Describe Widal's serum test and its value. 
 
 6. Describe a case of cerebrospinal meningitis. 
 
 7. Describe a case of incipient tuberculosis of the lung. 
 
 8. How does paralysis of the third nerve effect the eye? 
 
 9. Describe (1) functional and (2) organic heart mur- 
 murs. 
 
 10. Describe rales and give the location and significance 
 of each. 
 
 11. Describe renal casts and give the location and signi- 
 ficance of each. 
 
 12. Describe, (1) vesicular and (2) bronchial breathing, 
 and in what condition does the latter replace the former? 
 
 13. Describe, step by step, an uncomplicated case of 
 lobar pneumonitis terminating in recovery. 
 
 14. Describe the eruption of (1) measles, (2) scarlet 
 fever, (3) smallpox, (4) chickenpox, and (5) typhoid 
 fever. 
 
 15. Differentiate the coma of (1) opium poisoning, (2) 
 alcoholism, and (3) compression of the brain from frac- 
 ture of the skull. 
 
 SURGERY. 
 
 Answer any ten questions, but no more. 
 
 1. How would you treat fracture of the internal condyle 
 of the humerus? 
 
 2. Give indications for inguinal colostomy. Describe 
 the operation. 
 
 3. Accidents of anesthesia? How guarded against? 
 How treated? 
 
 4. Diagnosis and treatment of varicocele. 
 
 5. Give diagnosis and treatment of empyema. 
 
 6. Diagnosis of cancer of the stomach. 
 
 7. Define volvulus ; give treatment. 
 
 8. Describe how you would close the abdomen after 
 median section. 
 
 9. Symptoms and treatment of dislocation of the semi- 
 lunar cartilages of the knee-joint. 
 
 10. Diagnosis of renal tuberculosis. 
 
 11. Discuss septicemia. 
 
 12. Give treatment of ophthalmia neonatorum. 
 
 13. Give causes, symptoms, and treatment of mastoid- 
 itis. 
 
 14. Describe technique of operation for carcinoma of 
 the breast. 
 
 15. Treatment of syphilis. 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 Answer any ten questions, but no more. 
 1. Describe pelvimetry, its uses, and name five of the 
 most important measurements. 
 
 433 
 
MEDICAL RECORD. 
 
 2. Tell the method of diagnosing (a) ordinary preg- 
 nancy, (b) multiple pregnancy, (c) ectopic pregnancy. 
 
 3. Name the various uses to which the tampon may be 
 put in obstetrical practice and the kind and method of use 
 in the several conditions for which you advise it. 
 
 4. Describe the third stage of labor, the dangers which 
 attend it and outline your method of conducting it. 
 
 5. Describe the urinary changes during pregnancy. 
 
 6. Through what agencies may puerperal infection 
 occur ? 
 
 7. Describe the principal varieties of puerperal infection 
 and briefly outline laceration. 
 
 8. Describe the operation for immediate repair of a 
 complete perineal laceration. 
 
 9. Describe three operative measures for the relief of 
 prolapsus uteri. 
 
 10. Describe uterine curettage and name three condi- 
 tions which call for it. 
 
 11. Describe the operation for (a) ventral suspension 
 of the uterus, (b) ventral fixation. 
 
 12. What is the Alexander operation and the reasons 
 for or against it? 
 
 13. Name the different types of uterine hemorrhage and 
 their causes. 
 
 14. Outline treatment for any one type of uterine 
 hemorrhage. 
 
 15. What causes pyosalpinix, and what is the proper 
 treatment? 
 
 HYGIENE AND MEDICAL JURISPRUDENCE. 
 
 Answer any ten questions, but no more. 
 
 1. Define disinfectants, _ deodorants, and germicides. 
 What disinfectants are efficient where spores are found? 
 
 2. How do you calculate the annual birth and death 
 rate of a given community? Give illustration, e.g.: Last 
 year there were 1,324 deaths and 1,075 births in Trenton, 
 having a population of 90,000; give rate there. 
 
 3. Give Pettenkofer's method of determining the per- 
 centage of carbon dioxide in the air. 
 
 4. What do you mean by hard water? Give tests for 
 relative hardness of water. 
 
 5. Describe good milk; give test for same. What so- 
 phistications and adulterations are usual? 
 
 6. Name the usual quarantinable disease and require- 
 ments for each at quarantine. 
 
 7. Give directions for making cultures in suspected 
 cases of diphtheria. 
 
 8. (a) Describe hygiene and sanitary science. 
 
 (b) Subdivisions of hygiene. 
 
 (c) Development of hygiene. 
 
 434 
 
MEDICAL RECORD. 
 
 (d) Uses of hygiene to the public. 
 
 9. Describe and give uses of the barometer, ther- 
 mometer, hygrometer, psychrometer, and anemometer. 
 
 10. Give influence of humidity, wind, clouds, and climate 
 upon the health. 
 
 11. Define the duties of a school physician. 
 
 12. How would you proceed to prevent or overcome 
 malaria in any district? 
 
 13. Give different systems of house heating, with ad- 
 vantages and disadvantages of each. 
 
 14. Describe potable water; give natural sources and 
 varieties of water with characteristics of each. 
 
 15. What impurities are found in water? What are 
 their effects upon the animal economy? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS'. 
 
 State Board of Medical Examiners of New Jersey. 
 
 ANATOMY. 
 
 i. The changes which take place in the vascular system 
 at birth: The hypogastric arteries become obliterated; the 
 foramen ovale closes; the Eustachian valves atrophy; the 
 ductus arteriosus and ductus venosus atrophy and become 
 impervious; umbilical vein becomes obliterated. 
 
 2. Structure of arteries: See Cunningham's "Anatomy" 
 (1909), page 781; or Gray's ''Anatomy" (1908), page 586. 
 
 Xerve supply of arteries: Xervi vasorum. 
 Blood supply of arteries: Vasa vasorum. 
 
 3. The saphenous veins are formed from the dorsal 
 venous arch. 
 
 The internal saphenous begins at the inner end of this 
 arch, on the inner side of the foot; it passes upward in 
 front of the internal malleolus, then upward and backward 
 with the internal saphenous nerve, behind the internal 
 condyle of the femur, then upward and outward to the 
 inner side of front of thigh, through the saphenous open- 
 ing, to empty into the femoral vein. 
 
 The external saphenous begins at the outer end of the 
 arch, on the outer side of the foot; it passes upward be- 
 hind the external malleolus, up along the outer side of the 
 tendo Achillis, with external saphenous nerve, to the pop- 
 liteal space, where it enters the popliteal vein. 
 
 4. Tonsils. Blood supply: Ascending palatine, tonsillar, 
 ascending pharyngeal, descending palatine, and dorsalis 
 linguoe arteries. 
 
 Nerves: Tonsillar plexus, formed from glossopharyngeal 
 and pharyngeal plexus. 
 
 435 1. 
 
MEDICAL RECORD. 
 
 5. See Cunningham's "Anatomy" (1909), page 1140; or 
 Gray's ^ "Anatomy" (1908), page 1432. 
 
 6. See Cunningham's "Anatomy" (1909), page 431; or 
 Gray's "Anatomy" (1908), page 452. 
 
 7. To locate the fissure of Sylvius, draw a line from a 
 point one and a quarter inches behind the external angular 
 process of the frontal bone and the same distance above 
 the zygoma, to a point three-quarters of an inch below the 
 most prominent part of the parietal eminence, (a) The 
 main fissure will correspond to the first three-fourths of 
 an inch along this line ; (b) the horizontal limb will corre- 
 spond to the rest of this line ; (c) the ascending limb will 
 correspond to a line one inch long, going upward (parallel 
 to the coronal suture) from the junction of (a) and (b). 
 
 Draw a straight line over the top of the scalp from the 
 inion to the glabella ; bisect this line, and half an inch poste- 
 rior to the midpoint draw a line downward and forward 
 at an angle of 67.5 for a distance of three and one-half 
 inches. This line will represent the location of the fissure 
 of Rolando. 
 
 8. If the brachial artery is ligated below its profunda 
 branches, the collateral circulation is carried on by the 
 branches of the superior and inferior profunda arteries 
 anastomosing with the recurrent branches of the radial, 
 ulnar, and interosseous arteries. 
 
 9. Dura Mater. Description: See Cunningham's "Anat- 
 omy" (1909), page 597; or Gray's "Anatomy" (1908), page 
 972. Processes: Falx cerebri, falx cerebelli, tentorium 
 cerebelli, and diaphragma sella?. 
 
 Sinuses: Superior longitudinal, inferior longitudinal, 
 straight, lateral, occipital, cavernous, circular, transverse, 
 superior petrosal, inferior petrosal. 
 
 10. The pharyngeal plexus is formed by filaments from 
 the pharyngeal branches of the glossopharyngeal, pharyn- 
 geal branches of pneumogastric and sympathetic nerves. 
 
 11. See Cunningham's "Anatomy" (1909), page 628; or 
 Gray's "Anatomy" (1908), page 997- 
 
 12. (a) Extensor ossis metacarpi pollicis; (b) Rectus 
 capitis anticus major; (c) Tibialis anticus and posticus 
 acting together. 
 
 13. See Cunningham's "Anatomy" (1909), pages 362, 323, 
 and 369; or Gray's "Anatomy" (1908), pages 522, 466, and 
 533. 
 
 14. See Cunningham's "Anatomy" (1909), page 588; or 
 Gray's "Anatomy" (1908), page 938. 
 
 15. See Cunningham's "Anatomy" (1909), pages 1254, 
 789, and 796. 
 
 PHYSIOLOGY. 
 
 1. The uses of the bile are: (1) To assist in the emulsi- 
 fication and saponification of fats ; (2) to aid in the absorp- 
 
 436 
 
MEDICAL RECORD. 
 
 tion of fats; (3) to stimulate the cells of the intestine to 
 increased secretory activity, and so promote peristalsis, 
 and at the same time to keep the feces moist; (4) to elimi- 
 nate waste products of metabolism, such as lecithin and 
 cholesterin; (5) it has a slight action in converting starch 
 into sugar; (6) it neutralizes the acid chyme from the 
 stomach, and thus inhibits peptic digestion; (7) it has a 
 very feeble antiseptic action. 
 
 2. The circulating fluids of the body are blood and 
 lymph. 
 
 The functions of the blood as a whole are : To distribute 
 nourishment, oxygen, and the internal secretions to the 
 tissues of the body; to remove carbon dioxide and other 
 waste matters from the tissues so that they may be ex- 
 creted by the lungs, kidneys, and skin ; to regulate the body 
 temperature. In addition, the white corpuscles serve as a 
 protection to the body from the incursions of pathogenic 
 microorganisms ; they take some part in the process of the 
 coagulation of the blood ; they aid in the absorption of fats 
 and peptones from the intestine, and they help to maintain 
 the proper proteid content of the blood plasma. 
 
 The functions of the lymph are : To provide the tissues 
 with material necessary to their functional activity, growth, 
 and repair ; to receive from the tissues their waste products, 
 and to convey the products of digestion and absorption to 
 the blood current. 
 
 3. Tidal air is the air which is constantly passing in and 
 out of the lungs during ordinary calm respiration. It 
 measures about 30 cubic inches. 
 
 Residual air is the air which still remains in the lungs 
 after the deepest expirations. It measures about 100 cubic 
 inches. 
 
 4. Hemoglobin is the coloring matter of the blood ; it is 
 found in the red corpuscles ; it is crystalline, reddish in 
 color, very complex, and contains iron. Its function is to 
 carrry oxygen from the lungs to the tissues of the body. 
 
 5. Too little food decreases both the quantity of milk 
 and the percentage of solids. An ample diet increases both 
 the quantity of milk and the percentage of solids. Abun- 
 dance of proteids in the food increases the fat in the milk ; 
 so also does fat in the food, if it is well digested. Watery 
 food increases the amount of milk, but diminishes the per- 
 centage of solids. 
 
 6. The function of the thyroid is not definitely settled; 
 (1) it has some trophic function, regulating oxidation in 
 the body, and it is supposed to have also a special influence 
 on the vasomotor nerves, the skin, the bones, and on the 
 sexual functions; (2) it is supposed to antagonize toxic 
 substances: and (3) it produces an internal secretion. 
 
 Removal of the thyroid gland causes mental and bodily 
 
 437 
 
MEDICAL RECORD. 
 
 dullness and apathy, tremors, twitchings, overgrowth of 
 the connective tissues, and development of fat; the hairs 
 fall out, and the patient becomes unwieldy and clumsy in 
 both body and mind. The complete removal causes death 
 in most animals, and it is not considered justifiable in man. 
 
 7. The coagulation of the blood is due to the develop- 
 ment in it of fibrin. In the plasma a proteid substance 
 exists, called Fibrinogen. From the colorless corpuscles a 
 nucleoproteid is shed out, called Prothrombin. By the 
 action of calcium salts prothrombin is converted into fibrin 
 ferment, or Thrombin. Thrombin acts on fibrinogen in 
 such a way that two new substances are formed; one of 
 these is unimportant and remains in solution ; the other is 
 important, viz., Fibrin, which entangles the corpuscles, and 
 so forms the clot. Lymph also coagulates, but less rapidly, 
 because there is much less fibrinogen present. 
 
 8. The respiratory center is in the medulla, at the apex 
 of the calamus scriptorius. (Subsidiary centers are also 
 found in the spinal cord.) "The efferent impulses, which 
 originate in the medulla, are distributed to the various 
 respiratory muscles through the following efferent nerves : 
 The facial, vagus, phrenic, and intercostals. The facial 
 nerve is not much concerned in ordinary respiration in 
 man; a slight elevation of the abe nasi sometimes occurs 
 in inspiration, but it is brought into play in laborious res- 
 piration, and in some animals. The vagus is to some ex- 
 tent an efferent respiratory nerve, inasmuch as it supplies 
 the muscle of the bronchi, and acts as a trophic nerve to 
 the lungs. The chief nerves are the phrenics, which sup- 
 ply the diaphragm, and those which are distributed to the 
 other muscles of ordinary inspiration." — {Aids to Physi- 
 ology.) 
 
 9. Heat is produced in the body by: (1) Muscular ac- 
 tion; (2) the action of the glands, chiefly of the liver; (3) 
 the food and drink ingested; (4) the brain; (5) the heart; 
 and (6) the thermogenetic centers in the brain, pons, me- 
 dulla, and spinal cord. 
 
 Heat is given off from the body by: (1) The skin, 
 through evaporation, radiation, and conduction; (2) the 
 expired air; (3) the excretions — urine and feces. 
 
 10. They are all secretions, but urine is also (and chiefly) 
 an excretion ; perspiration and bile are also excretions. 
 
 11. Immediate effects of cutting the sciatic nerve would 
 be : Loss of motion in all the muscles below the knee ; also 
 in biceps, semimembranosus, semitendinosus, and adductor 
 magnus; anesthesia in same parts; vasomotor disturbances 
 (the limb becoming first hyperemic, later colder and with 
 diminished blood supply). 
 
 The remote effects would be: The divided ends retract 
 and become bulbous; Wallerian degeneration occurs in the 
 
 438 
 
MEDICAL RECORD 
 
 peripheral part ; the affected muscles atrophy and the "re- 
 action of degeneration'' is observed ; trophic changes occur 
 in the skin. 
 
 12. Causes of bodily fatigue: Presence of sarcolactic acid 
 and acid potassium phosphate in the muscle ; using up of the 
 material from which the energy is obtained, and accumula- 
 tion of waste products. 
 
 13. Superficial reflexes are such as can be elicited by 
 stimulating the skin. Four examples: The cremasteric re- 
 flex, plantar reflex, gluteal reflex, and abdominal reflex. 
 
 Deep reflexes are such as are elicited by stimulating 
 tendons or muscles. Four examples: The patellar reflex 
 ankle clonus, Tendo Achillis reflex, and triceps reflex (el- 
 bow jerk). 
 
 14. "Great humidity of the air causes lessened evapora- 
 tion from the lungs and skin. For the air, being saturated, 
 or nearly so, with moisture, has little drying power, and 
 the moisture from the skin and lungs is with difficulty 
 evaporated. The evaporation of moisture, by which much 
 heat is rendered latent, is one of the chief sources of cool- 
 ing the body. Consequently, when the air is hot and very 
 moist, the humidity tends to increase the effects of the 
 heat ; the blood is with difficulty kept at its proper tem- 
 perature ; and all the disagreeable results of the high tem- 
 perature are intensified. Moreover, the humidity of the air 
 affects the climate of a place by hindering the terrestrial 
 radiation of heat." — (Parkes' Hygiene.) 
 
 15. The anterior roots of the spinal nerves are efferent 
 and motor, and cause contraction of the muscles to which 
 the nerves are distributed. 
 
 The posterior roots of the spinal nerves are afferent and 
 sensory, and are distributed to the skin. 
 There are thirty-one pairs of spinal nerves. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. Aconite, (a) and (b) Official preparations, with 
 adult dose: Fluid extract, TTJ2J ; tincture, TTPx. (c) Medici- 
 nal uses: For fevers, some inflammatory conditions, in 
 high arterial tension, in nervous palpitation of the heart, 
 and congestive dysmenorrhea ; also externally for neural- 
 gia, pruritis, herpes, chilblains, etc. (d) Therapeutic 
 effects: First stimulates and then paralyzes heart and also 
 sensory nerves; lowers blood pressure; dilates peripheral 
 blood vessels; is a respiratory sedative; reduces body tem- 
 perature; is a diuretic and diaphoretic. 
 
 2. Strychnine, (a) Indications for use: Impaired di- 
 gestion, cardiac weakness, pneumonia, phthisis, amenor- 
 rhea, dysmenorrhea, impotence, some forms of paralysis, 
 chorea, epilepsy, neuralgia, insomnia, alcoholism, (b) Dos- 
 age: 1/64 grain, (c) The symptoms of poisoning by 
 
 439 
 
MEDICAL RECORD. 
 
 strychnine are "a sense of suffocation, thirst, tetanic spasms, 
 usually opisthotonos, sometimes emprosthotonos, occasion- 
 ally vomiting, contraction of the pupils during the spasms, 
 and death, either by asphyxia during a paroxysm, or by 
 exhaustion during a remission. The symptoms appear in 
 from a few minutes to an hour after taking the poison, 
 usually in less than twenty minutes, and death in from five 
 minutes to six hours, usually within two hours." 
 
 Treatment : "The convulsions are to be arrested or miti- 
 gated by bringing the patient under the influence of chloral 
 or chloroform as rapidly as possible; the stomach is to be 
 washed out and the patient is to be kept as quiet as pos- 
 sible." — ( Witthaus' Essentials of Chemistry.) 
 
 3. Purgatives acting on small intestines: Calomel, dose 
 gr. v; castor oil, dose 3ss ; jalap, dose gr. xx; podophyllin, 
 dose, gr. 1/5 (of the resin); rhubarb, dose gr. xx; scam- 
 mony, dose gr. vij ; senna, dose 3j. On large intestine: 
 Colocynth, dose gr. iij (of the extract) ; elaterium, dose gr. 
 1/6 ; gamboge, dose gr. viij ; aloes, dose gr. vij ; magnesium 
 sulphate, dose Jss ; potassium bitartrate, and sulphate, dose 
 (of each) gr. xxx; sodium sulphate, dose Jss. 
 
 4. The official preparations of arsenic, with their doses, 
 are: Arseni trioxidum, gr. 1/30; Liquor acidi arsenosi, 
 rrgvij ; Arseni iodidum, gr. 1/20; Sodii arsenas, gr. 1/6; 
 Sodii arsenas exsiccatus, gr. 1/20; Liquor potassii arsenitis, 
 tT)?vij ; Liquor sodii arsenatis, TT^v ; Liquor arseni et hydrar- 
 gyri iodidi, TTJ^vij. 
 
 5. For acute ptomain poisoning: 
 ]£. Magnesii sulphatis 3vj. 
 
 Signa. To be given at once, dissolved in water. 
 
 6. (a) "The galvanic current is constant and continuous; 
 it always flows in the same direction; it has decided chem- 
 ical and thermal effects. The faradic current is a rapid 
 succession of waves or momentary impulses; the direction 
 is not constant ; the chemical and thermal effects are almost 
 imperceptible. The brain and nerves of special sense re- 
 spond more quickly and decidedly to the galvanic current 
 than to the faradic." 
 
 (b) Galvanic current is best when the brain, spinal cord, 
 and sympathetic system are to be influenced ; also ior mid- 
 dle and internal ear and retina; and in neuralgia, rheu- 
 matism, and muscular atrophy. Faradic current is indi- 
 cated in diseases of the abdominal viscera, and in general 
 muscular debility. 
 
 7. (a) Nitroglycerin dilates the arteries; (b) Aconite 
 dilates the arteries; (c) Digitalis constricts the arteries; 
 (d) Veratrum viride dilates the arteries; (e) Strophan- 
 thus constricts the arteries. 
 
 8. See below : Practice of Medicine, question 5. 
 
 440 
 
MEDICAL RECORD 
 
 g. Podophyllin is a slow, drastic, cholagogue cathartic; 
 dose, gr. 1/4. 
 
 Cascara sagrada is a simple laxative ; dose, gr. xv. 
 
 Aloin is a cholagogue purgative, acting mainly on the 
 large intestine; dose, gr. j. 
 
 10. Acetanilid, dose gr. iv ; is an antipyretic, analgesic, 
 diuretic, diaphoretic, cardiac depressant, and an antiseptic. 
 It is used in fevers, neuralgia, dysmenorrhea, headaches, 
 and as a dressing for wounds, ulcers, and venereal sores. 
 
 Heroin, dose gr. 1/10; is used to control cough, as it is 
 a respiratory sedative. 
 
 Terebene, dose irgviij ; is a diuretic and an expectorant; 
 it is used externally as a dressing for ulcers and wounds ; 
 internally in bronchitis, emphysema, phthisis, and in genito- 
 urinary diseases. 
 
 11. See French's "Practice of Medicine" (1907)* P a § e 
 178; or Osier's "Practice of Medicine" (1909), page 192. 
 
 12. Morphine: "At first there is usually a period of ex- 
 citation, marked by restlessness, great physical activity, 
 loquacity, and hallucinations. The patient then becomes 
 weary, "dull, and drowsy ; he yields to the desire for 
 sleep, from which at first he may be roused. The lips 
 are livid, the face pale, the pupils contracted, and the sur- 
 face bathed in perspiration. The condition of somnolence 
 rapidly passes into narcosis. The patient cannot be roused, 
 and lies motionless and senseless, with completely relaxed 
 muscles. The pulse, at first full and strong, becomes 
 feeble, slow, irregular, and easily compressible ; the respira- 
 tion slow, shallow, stertorous, and accompanied by mucous 
 rales. The patient rapidly becomes comatose, and, in fatal 
 cases, dies in from forty-five minutes to rifty-six hours, 
 usually in from twelve to eighteen hours. In cases of 
 recovery after the stage of narcosis the pulse and respira- 
 tion gradually return to the normal, and the condition of 
 coma passes into one of deep sleep, lasting twenty-four to 
 thirty-six hours." 
 
 Carbolic acid: "Those portions of the skin and mucous 
 membrane which have been in contact with the poison are 
 whitened and hardened. There are burning pains in the 
 mouth, esophagus, and stomach, and vomiting; lowering of 
 the pulse and temperature, contraction of the pupils, stupor, 
 syncope, and collapse, terminating in death. The urine, 
 clear and of the normal color when voided, becomes rapidly 
 greenish, and finally dark olive-green or almost black." 
 
 Arsenic: The symptoms "usually begin in from twenty 
 to forty-five minutes. Nausea and faintness. Violent, 
 burning pain in the stomach, which becomes more and 
 more intense, and increases on pressure. Persisting and 
 distressing vomiting of matters, sometimes brown or gray, 
 
 441 
 
MEDICAL RECORD 
 
 or streaked with blood, or green (Paris green), or black, 
 or blue (charcoal or indigo powder mixed with As 2 2 ). 
 Purging. More or less severe cramps in the lower extremi- 
 ties/' — (Witthaus' Essentials of Chemistry and Toxic ol- 
 ogy.) 
 
 13. Pilocarpine hydrochloride is derived from Pilocarpus 
 Jaborandi. The dose is gr. 1/5. It causes increase of saliva 
 and of perspiration; increased peristalsis; it increases and 
 then diminishes blood pressure and heart action ; it causes 
 the pupil to contract, and depresses the nervous system. It 
 is used in Bright's disease, uremia, and whenever a prompt 
 diaphoresis is required. 
 
 14. Three vegetable astringents : Tannic acid, dose 
 gr. vij ; gallic acid, dose gr. xv ; hematoxylon, dose gr. xv 
 (of the extract). Therapeutics: Astringent, contract the 
 tissues, hence given in intestinal hemorrhage, diarrhea, 
 hematemesis ; locally to stop bleeding; in leucorrhea, tonsil- 
 litis, pharyngitis, piles, and hyperidrosis. Three mineral 
 astringents: Lead acetate, dose gr. j; silver nitrate, dose 
 gr. 1/5; cerium oxalate, dose gr. j. Therapeutics: The lead 
 acts as a protective and sedative; used as a dressing in in- 
 flammations, bruises, and sprains; as an injection for 
 leucorrhea and gonorrhea. Silver nitrate is used as a 
 caustic ; in ophthalmia neonatorum ; for bedsores, pruritis ; 
 internally for gastric ulcer, chorea, and locomotor ataxia. 
 Cerium is used for vomiting (chiefly that during preg- 
 nancy). 
 
 15. Calomel. (a) Source: Mercury. (b) Effects: 
 Diuretic ; cathartic ; healing in venereal ulcers ; anti- 
 syphilitic; for diarrheas and ileocolitis. Overdose pro- 
 duces salivation, (c) Dosage, gr. j to ij. (d) Incom- 
 patabilities : Alkalies, alkaline earths, alkaline carbonates, 
 iron, lead, copper, iodine, chlorides of sodium, potassium, 
 and ammonium, mineral acids, sugar, and soap. 
 
 chemistry. 
 
 I. Urea has the formula CO(NH 2 ) 2 ; it "crystallizes in 
 transparent needles or four-sided prisms, without Aq; per- 
 manent in air ; odorless, having a cooling, slightly bitter 
 taste, resembling that of saltpeter. Soluble in an equal 
 weight of cold water, very soluble in boiling water and in 
 five parts of cold water or one part of hot alcohol, the 
 solutions being neutral in reaction. At 248 F. it melts, and 
 slightly above that temperature is decomposed. It is found 
 in the blood, chyle, lymph, humors of the eye, saliva, per- 
 spiration, bile, milk, serous fluids, amniotic and allantoic 
 fluids, and especially in the urine. 
 
 "It is the principal product of the oxidation of protein 
 substances in the animal body, and is the form in which 
 most of the nitrogen is excreted." 
 
 442 
 
MEDICAL RECORD 
 
 2. Lithia and the salts of lithium are used in cases of 
 uric acid diathesis, because: (i) They diminish the acidity 
 of the urine; (2) they have a diuretic action; (3) they 
 hasten the excretion of the urates ; (4) and so prevent the 
 accumulation of gravel and the formation of calculi; (5) 
 the lithium salt of uric acid is the most soluble of all the 
 urates. 
 
 3. The normal composition of urinary calculi is : Uric 
 acid, sodium urate, ammonium urate, calcium oxalate, cal- 
 cium phosphate, or ammoniomagnesium phosphate. More 
 rarely: Cystin, xanthin, urates of potassium, calcium, or 
 magnesium. 
 
 4. Fermentation is the decomposition of organic matter 
 containing carbon, hydrogen, and oxygen only; it occurs 
 in presence of a ferment. When it also contains nitrogen 
 and sulphur the process is called Putrefaction. 
 
 Decay is slow combustion without the emission of light. 
 
 5. The chemical name for white arsenic is arsenic tri- 
 oxide. It is a white, odorless substance; it has a faint 
 metallic taste, is with difficulty soluble in water; it takes 
 up oxygen readily. It is used in the manufacture of green 
 pigments and of glass; as a vermin poison; to preserve 
 material for dissection. 
 
 6. The atomic theory regards matter as not being infi- 
 nitely divisible, but as being composed of indivisible par- 
 ticles called atoms. Dalton, by ascribing to each atom a 
 relative weight as compared with the weight of other 
 atoms, was able to explain and produce reasons for all the 
 observed numerical laws of chemical combination. 
 
 7. The chemical composition of bone is: Tricalcic phos- 
 phate, magnesium phosphate, calcium carbonate, ferric 
 phosphate, and organic matter (chiefly gelatinous matter). 
 
 8. The principal pigment of normal urine is urochrome. 
 
 9. High specific gravity of the urine may indicate : Dia- 
 betes mellitus, fevers, and chronic parenchymatous ne- 
 phritis. 
 
 Low specific gravity of the urine may indicate : Diabetes 
 insipidus, chronic interstitial nephritis, contracted kidney, 
 some nervous disorders, albuminuria, hysteria. 
 
 Transitory low specific gravity may indicate : Hyste- 
 ria, or some nervous disorders, or the ingestion of an 
 abnormal amount of fluids. 
 
 10. In the blood the changes take place in the capillaries 
 of the lungs, and are: (1) The giving up of the C0 2 by 
 the venous blood, (2) the absorption of oxygen during 
 inspiration, (3) the blood is cooled, and (4) it also loses 
 a small amount of watery vapor. 
 
 The changes produced in the air by respiration are : 
 
 443 
 
MEDICAL RECORD. 
 
 Oxygen 
 
 Nitrogen 
 
 Carbon dioxide 
 
 Other gases 
 
 Watery vapor.. 
 Temperature .. 
 
 Volume 
 
 Bacteria 
 
 Dust 
 
 INSPIRED AIR. 
 
 21 per cent. 
 79 per cent. 
 0.04 per cent. 
 Rare. 
 Variable. 
 Variable. 
 Varies. 
 
 Always present. 
 Always present. 
 
 EXPIRED AIR. 
 
 16.6 per cent. 
 79 per cent. 
 4.4 per cent. 
 Often present. 
 Saturated. 
 That of body. 
 Diminished. 
 None. 
 None. 
 
 Every 100 volumes of blood contain from 50 to 60 
 volumes of gas; arterial blood contains: 
 
 Oxygen 20 volumes 
 
 Carbon dioxide 39 volumes 
 
 And venous blood contains : 
 
 Oxygen 8 volumes 
 
 Carbon dioxide 46 volumes 
 
 Relations of oxygen to the blood: "Although every 100 
 volumes of arterial blood contain 20 volumes of oxygen, 
 none is given off under reduced pressure, as in an air- 
 pump receiver, until the oxygen pressure at the surface 
 is reduced to about 5 millimeters (1/5 of an inch) of 
 mercury. As 1 volume of oxygen could not be held in 
 solution under such a pressure even at 6o° F., it is evident 
 that the oxygen is not simply held in solution in the blood. 
 The hemoglobin of venous blood is dark red, and has a 
 strong affinity for oxygen, which it absorbs readily, and 
 becomes of a bright scarlet color — oxyhemoglobin. When 
 oxyhemoglobin is treated with reducing agents or subjected 
 to an oxygen pressure of less than 5 millimeters of mer- 
 cury, it gives up its oxygen and becomes hemoglobin. 
 Oxygen is not held in solution, but a chemical union 
 exists between it and the hemoglobin. It is evident, how- 
 ever, that the union is not a strong one, as reduced pressure 
 is capable of separating the oxygen from its bonds. 
 
 The hemoglobin of the arterial blood gives up a portion 
 of its oxygen^to the tissues as it passes through the systemic 
 capillaries, so that in venous blood the hemoglobin is par- 
 tially, but not entirely, reduced to the condition of deoxi- 
 dized hemoglobin. 
 
 Relations of carbon dioxide to the blood: Carbon diox- 
 ide exists in both arterial and venous blood, but its quantity 
 is greatest in venous blood. It is absorbed by the blood 
 in the systemic capillaries, and given off in those of the 
 lungs. The carbon dioxide is combined with the plasma 
 and with the corpuscles, but the plasma contains most. 
 It is partly dissolved in and partly combined with the 
 
 444 
 
MEDICAL RECORD 
 
 plasma, chiefly in the form of sodium bicarbonate. It is 
 given off by the capillaries to the air in the lungs because 
 the carbon dioxide tension in the vessels is higher than that 
 in the alveoli." 
 
 ii. Specific gravity is the weight of any substance as 
 compared with the weight of an equal volume of another 
 substance taken as a standard under like conditions of tem- 
 perature and pressure. 
 
 12. The properties of bile are : A greenish or brownish 
 fluid, alkaline or neutral reaction, sweetish-bitter taste. 
 Specific gravity of about 1030, and it contains about 10 or 
 12 per cent, of solids. The chief constituents are water 
 and sodium glyeocholate, sodium taurocholate, and pig- 
 ments. 
 
 13. Reaction has two meanings: (1) The interaction of 
 two or more substances causing a chemical decomposition ; 
 (2) the action of substances upon certain organic pigments, 
 such as litmus. 
 
 Reagent is a substance used to bring about a reaction 
 (first meaning above). 
 
 14. Marsh's test for arsenic: This test depends on the 
 fact that arsenic hydride is formed when nascent hydrogen 
 acts on a compound of arsenic : 
 
 H«AsOs + 3H 2 = AsH 3 + 3H 2 0. 
 A small flask fitted with thistle funnel and a delivery 
 tube, as for the production of hydrogen, is used; pure 
 zinc and hydrochloric acid are introduced, and after a 
 short time the hydrogen is ignited. It is advisable to cover 
 the flask with a cloth before igniting the gas, as an explo- 
 sion may happen unless the air has all been driven out. 
 If the materials are pure the hydrogen flame gives no 
 deposit upon a piece of cold porcelain brought into it, but 
 commercial zinc usually contains arsenic. When the purity 
 of the gas is proved, a little solution of arsenite may be 
 poured down the thistle funnel, which will produce a more 
 rapid evolution of eas, and the flame will become larger 
 and perceptibly colored. A piece of cold porcelain^ de- 
 pressed upon the flame will be covered with a deposit of 
 metallic arsenic. The films of arsenic are metallic looking 
 in the thicker places, brownish near^ the edges; they are 
 easily volatized by heat, and dissolve in solution of bleach- 
 ing powder. A portion of the glass tube from which the 
 gas is burned should be heated to redness ;the gas decom- 
 poses and a deposit of arsenic appears on the tube, which 
 may be identified in a similar way, or may be converted 
 into crystals of oxide by cautious sublimation in an open 
 tube. — (Fisher's Elementary Chemistry.) 
 
 15. In vegetable life the metabolic changes are chiefly 
 synthetic; the plant absorbs water and carbon dioxide and 
 builds up complex substances. 
 
 445 
 
MEDICAL RECORD. 
 
 In animal life the metabolic changes are chiefly ana- 
 lytic; the animal takes as food complex substances and 
 splits them into simpler substances. 
 
 HISTOLOGY, BACTERIOLOGY, AND PATHOLOGY. 
 
 i. There are three varieties of muscle. 
 
 Voluntary 
 Striated. 
 
 Long cylinder. 
 
 1-5 inches. 
 
 Many. 
 Peripheral. 
 
 '.Inltermedlatle. 
 Cross'andtfong. 
 
 Present. 
 Occasional. 
 In masses 
 called muscles. 
 By will. 
 
 Charac- 
 teristic 
 
 Shape. 
 
 Length 
 Nucleus. 
 
 Number. 
 
 Location. 
 
 Shape. 
 Striations. 
 
 Sarcolemma. 
 
 Branches. 
 
 Arrangement. 
 
 Control. 
 
 Smooth. 
 
 Spindle. 
 
 25-200 
 microns. 
 
 One. 
 
 Central. 
 
 Rod. 
 
 (Longi- 
 tudinal 
 occasional- 
 ally.) 
 
 None. 
 
 (Occasional.) 
 
 In layers. 
 
 Not by will, 
 
 Cardiac. 
 
 Stubby 
 
 cylinder. 
 100-200 
 
 microns. 
 One. 
 Central. 
 Oval. 
 Cross and long. 
 
 None. 
 
 Always. 
 
 As a syncytium 
 
 Not by will. 
 
 — (Radasch's Compend of Histology.) 
 
 2. See Cunningham's "Anatomy" (1909), page 28. 
 
 3. See Cunningham's "Anatomy" (1909), page 444. 
 
 4. See Cunningham's "Anatomy" (1909), pages 781 and 
 782; and Gray's "Anatomy" (1908), pages 586 and 722. 
 
 5. To make a pure culture: "All that is necessary is to 
 inoculate the liquefied gelatin with the mixture of bacteria, 
 and after thorough agitation so as to separate each cell 
 from its neighbor, to pour the liquid on to the surface of a 
 sterile plate. The gelatin now solidifies and imprisons, as 
 it were, the separated cells. Each of these now multiplies 
 and reproduces its kind; eventually, in the course of a day 
 or two, a small growth, perhaps of the size of a small pin- 
 head, appears. This is called a colony, and since it is de- 
 rived from a single cell it constitutes a pure culture. Such 
 is the principle of the dilution method for obtaining pure 
 cultures. The isolation once accomplished, all that is neces- 
 sary is to transplant the colony to sterile culture media so 
 as to keep up the growth." — {Reference Handbook of the 
 Medical Sciences.) 
 
 6. Bacteria multiply by fission. A bacterium about to 
 divide seems to be larger than normal, and if it is a coccus 
 it becomes more ovoid; changes occur first in the nucleus, 
 and the bacterium just falls in two. It has been calculated 
 that a single bacterium could, by fission, produce two in 
 one hour. Fortunately, they seldom obtain food enough to 
 keep up this process for any length of time. 
 
 7. Koch's law in regard to the bacterial cause of disease 
 
 446 
 
MEDICAL RECORD. 
 
 is: (i) The microorganism must be found in the tissues, 
 blood, or secretions of a person or animal sick or dead of 
 the disease; (2) the microorganism must be isolated and 
 cultivated from these same sources; it must also be grown 
 for several generations in artificial culture media; (3) the 
 pure cultures, when thus obtained, must, on inoculation 
 into a healthy and susceptible animal, produce the diseases 
 in question, and (4) the same microorganisms must again 
 be found in the tissues, blood, or secretions of the inocu- 
 lated animal. 
 
 8. Because the temperature of the air in summer is better 
 adapted for the life and growth of the bacteria. 
 
 9. Cultural characteristics that differentiate the colon 
 bacillus and the typhoid bacillus: (1) On gelatin plates 
 the colonies of typhoid develop more slowly than those of 
 colon bacillus. 
 
 (2) the colon bacillus causes fermentation with produc- 
 tion of gas in media which contain sugar; the typhoid bacil- 
 lus does not. 
 
 (3) The colon bacillus produces a strong acid reaction 
 and coagulates milk within twenty-four to forty-eight 
 hours ; the typhoid bacillus does not coagulate milk. 
 
 (4) In peptone solution the colon bacillus produces indol ; 
 the typhoid bacillus does not. 
 
 (5) The typhoid bacillus gives the Widal reaction with 
 typhoid serum ; the colon bacillus does not. 
 
 10. Immunity is the power of resistance of cells and 
 tissues to the action of pathogenic microorganisms. 
 
 Susceptibility is the quality or condition of being liable to 
 take a disease; it is the converse of immunity. 
 
 11. See French's "Practice of Medicine ,, (1907), page 
 892; or Osier's "Practice of Medicine" (1909), page 687. 
 
 12. See French's "Practice of Medicine" (1907), pages 
 354 and 696; or Osier's "Practice of Medicine" (1909), 
 pages 308 and 644, 
 
 13. See French's "Practice of Medicine" (1907), page 
 535; or Osier's "Practice of Medicine" (1909), page 753- 
 
 14. See French's "Practice of Medicine" (1907), page 
 825; or Osier's "Practice of Medicine" (1909), page 557- 
 
 15. See French's "Practice of Medicine" (1907), page 
 747; or Osier's "Practice of Medicine" (1909), page 471. 
 
 PRACTICE OF MEDICINE. 
 
 I. Autointoxication is the condition in which a person is 
 (being) poisoned by the reabsorption of the waste products 
 of his own metabolism, which should have been excreted. 
 The source of the toxins producing this condition is the 
 
 v body of the person so suffering. 
 
 V 2/ "Ulcerative keratitis is a term given to designate the 
 loss of corneal tissue from all causes aside from tran- 
 
 447 
 
MEDICAL RECORD. 
 
 matism. (An injury to the cornea produces a superficial 
 defect in the corneal tissue, the walls of which are usually 
 clean. This is known as simple traumatic ulcer of the 
 cornea.) If the walls of a corneal defect are clear, the 
 condition is known as simple ulcer of the cornea. When 
 the walls of the defect assume a grayish appearance and 
 the gray infiltration extends into the corneal tissue the 
 condition is known as one of infiltrative or infectious ulcer 
 of the cornea. In some cases the grayish infiltration, with 
 a defect in corneal tissue, appears at the margin of the 
 cornea, extending along its periphery. The shape of this 
 ulcer causes it to be known as a crescentic ulcer of the 
 cornea. In other cases a grayish infiltration appears in 
 the corneal tissue immediately beneath the epithelium, ex- 
 tending in zigzag lines over a portion of the cornea, caus- 
 ing loss of epithelium eventually in all parts of its course. 
 Its shape eives it the name of serpent ulcer of the cornea. 
 Ulcers are also known .is superficial or deep, according 
 as they affect the superficial or deep layers. In advancing 
 ulceration of the corner pain, referable to the eye and to 
 the parts subjacent, is i lore or less intense, usually being 
 more severe when the superficial layers of the cornea, the 
 epithelium in particular, are being destroyed. Photophobia 
 is a marked symptom. .The iris is frequently involved, and, 
 when it is, pain, referable to the side of the head, is a 
 prominent feature. The patient is unable to use his eyes." 
 — (Miller, McEvoy, and Weeks, on Eye, Ear, Throat, and 
 Nose.) 
 
 3. See French's "Practice of Medicine" (1907), page 852; 
 or Osier's "Practice of Medicine" (1909), page 550. 
 
 4. Melancholia is a form of insanity in which the patient 
 suffers from excessive mental depression. 
 
 "Dementia," when confirmed, consists in a total absence 
 of all reasoning power and an incapacity to perceive the 
 true relations of things ; the language is incoherent and the 
 actions are inconsistent; the patient speaks without being 
 conscious of the meaning of what he is saying; memory is 
 lost, and sometimes the same word or phrase is repeated 
 for many hours together ; words are no longer connected 
 in meaning, as they are in mania and monomania." — -(Tay- 
 lor's Medical Jurisprudence.) 
 
 5. The Widal test for typhoid fever "depends upon the 
 fact that serum from the blood of one ill with typhoid 
 fever, mixed with a recent culture, will cause the typhoid 
 bacilli to lose their motility and gather in groups, the whole 
 called 'clumping/ Three drops of blood are taken from 
 the well-washed asceptic finger tip or lobe of the ear, and 
 each lies by itself on a sterile slide, passed through a flame 
 and cooled just before use; this slide may be wrapped in 
 cotton and transported for examination at the laboratory. 
 
 448 
 
MEDICAL RECORD. 
 
 Here one drop is mixed with a large drop of sterile water 
 to redissolve it. A drop from the summit of this is then 
 mixed with six drops of fresh broth culture of the bacillus 
 (not over twenty-four hours old) on a sterile slide. From 
 this a small drop of mingled culture and blood is placed in 
 the middle of a sterile cover-glass, and this is inverted 
 over a sterile hollow-ground slide and examined. * * * 
 A positive reaction is obtained when all the bacilli present 
 gather in one or two masses or clumps, and cease their 
 rapid movement inside of twenty minutes." — (From Thay- 
 er's Pathology.) 
 
 Its diagnostic value is believed by some to be great; 
 others place little reliance on it. It may be absent in cases 
 of typhoid fever ; it may be present for several months 
 after an attack of typhoid; the reaction may not be ob- 
 tained till the third week of the disease; it may be present 
 in other diseases or in perfectly healthy persons. The above 
 have all been urged as objections; certainly only positive 
 results have any value at all. 
 
 6. See French's "Practice of Medicine" (1907), page 142; 
 or Osier's "Practice of Medicine" (1909), page 160. 
 
 7. The early manifestations of pulmonary^ tuberculosis 
 are: (1) Physical signs: Deficient chest expansion, the 
 phthisical chest, slight dullness or impaired resonance over 
 one apex, fine, moist rales at end of inspiration, expiration 
 prolonged or high pitched, breathing interrupted. (2) 
 Symptoms: General weakness, lassitude, dyspnea on exer- 
 tion, pallor, anorexia, loss of weight, hemoptysis, slight 
 fever, and night sweats. 
 
 8. In paralysis of the third nerve: Ptosis, outward devia- 
 tion of the eye, paralysis of accommodation, diplopia, di- 
 lated pupil, and slight exophthalmos are present. 
 
 9. Organic murmurs are due to stenosis or incompetency 
 of one or more of the valves of the heart. 
 
 Functional murmurs are not due to vulvular disease. 
 Organic murmurs may be systolic or diastolic; may be 
 accompanied by marked dilation or hypertrophy, and 
 there will probably be a history of rheumatism or of some 
 other disease capable of producing endocarditis. Whereas 
 a murmur, usually systolic, soft, and blowing, heard best 
 over the pulmonic area, associated with evidences of 
 chlorosis or anemia, and affected by the position of the 
 patient, is a hemic or functional murmur, and denotes as a 
 rule an impoverished condition of the blood. 
 
 10. Rales are adventitious respiratory sounds. According 
 to location, rales may be: (1) Laryngeal and tracheal; 
 (2) Bronchial; (3) Vesicular; (4) Cavernous; (5) Pleur- 
 itic. "Rales may be dry or moist. Dry rales occur in 
 bronchitis and asthma, and may be low-pitched snoring 
 sounds (sonorous rales) or high-pitched whistling sounds 
 
 4^0 
 
MEDICAL RECORD. 
 
 (sibilant rales). Moist rales are produced by the passage 
 of the air through liquid, and may be crepitant, subcrepi- 
 tant, or gurgling in character. Crepitant rales are ex- 
 tremely fine and occur at the end of inspiration; they are 
 heard in the first stage of pneumonia and in engorgement 
 and edema of the lungs. Subcrepitant rales are compara- 
 tively few in number, and are heard during inspiration and 
 expiration, in capillary bronchitis, pulmonary edema, hypo- 
 static pulmonary congestion, and incipient phthisis. Gurg- 
 ling rales may be large or small, and are heard during in- 
 spiration and expiration in phthisical cavities, bronchial 
 hemorrhage, in the stage of secretion in bronchitis, and 
 over the trachea." 
 
 ii. Casts are cylindrical bodies of, albuminoid material 
 formed in the uriniferous tubules of the kidney. Clinical 
 significance of the different varieties of casts: 
 
 Acute Parenchyma- 
 tous Nephritis. 
 
 Only a few casts 
 
 present. 
 Blood casts, epithelial 
 
 casts, leucocytes. 
 
 During convalescence 
 fatty casts may be 
 present. 
 
 Chronic Parenchy- 
 matous Nephritis. 
 
 Many casts seen. 
 
 In early stages large 
 hyaline and dark 
 granular casts. In 
 later stages epithe- 
 lial, large, and small 
 granular casts, hya- 
 line casts and com- 
 pound granular 
 cells. 
 
 Tn acute exacerba- 
 tions on account of 
 the inflammatory 
 processes, there may 
 be present epithelial 
 casts and many leu- 
 cocytes. 
 
 Chronic Interstitial 
 Nephritis. 
 
 Few casts present. 
 
 Large and small hya- 
 line casts, waxy 
 casts, fatty casts, 
 oil droplets. 
 
 In acute exacerba- 
 tions on account of 
 the inflammatory 
 process, there may 
 be present all varie- 
 ties of casts, especi- 
 ally large and small 
 granular casts. 
 
 — (Gould and Pyle's Pocket Cyclopedia.) 
 
 12. Vesicular breathing is that which is heard normally 
 over the lungs, and is characterized by a soft, breezy, in- 
 spiratory sound, and a shorter, lower, and softer expiratory 
 sound. Bronchial breathing is that which is heard nor- 
 mally over the trachea or larynx. It is characterized by 
 an entire absence of all vesicular quality ; inspiration is 
 high pitched and tubular; and expiration is longer, higher, 
 and of greater intensity; there is an interval between the 
 two sounds. Bronchial breathing replaces vesicular breath- 
 ing when the lung is consolidated (as in pneumonia and 
 phthisis). 
 
 13. See French's "Practice of Medicine" (1907), page 
 156; or Osier's "Practice of Medicine" (1909), page 172. 
 
 14. See French's "Practice of Medicine" (1907), pages 
 
 450 
 
MEDICAL RECORD 
 
 3^7, 318, 302, 313, and 77 ; or Osier's "Practice of Medicine' 
 (1909), pages 142, 132, 116, 129, and 74. 
 15. 
 
 Coma from Intracra- 
 nial Injury. 
 
 Deep coma; may have 
 history of onset after 
 fall or injury. Evi- 
 dence of fracture of 
 vertex or base. 
 
 Pupil dilated on side 
 of lesion. Choked 
 disc. 
 
 Pulse very slow. 
 
 Respiration slow and ; 
 stertorous. 
 
 Temperature higher — 
 
 101° 
 
 Urine normal or con- 
 tains trace of al- 
 bumin. 
 
 Hemiplegia on oppo- 
 site side to that of 
 injury. If contu- 
 sion of brain is also 
 present, may have 
 generalized convul- 
 sions. 
 
 Alcoholic Coma. 
 
 Opium Poisoning. 
 
 Can be aroused by Can be aroused un- 
 
 supraorbital pressure less very deep. 
 unless very pro- 
 found. 
 
 Pupils normal or Pupils contracted to 
 
 somewhat dislated. pinpoint size. 
 
 Pulse 
 
 than 
 
 full. 
 Regular respiration 
 
 more rapid i Pulse rapid, may be 
 normal and ! irregular. 
 
 May be low or nor- 
 mal. 
 Normal. 
 
 Respiration very slow 
 — may be 6 to 8 
 per minute. 
 
 Normal. 
 
 (Eisendrath.) 
 
 SURGERY. 
 
 i. See Rose and Carless' "Surgery" (1908), page 513; or 
 Da Costa's "Surgery" (1908), page 494. 
 
 2. See Rose and Carless' "Surgery" (1908), pages 1025 
 and 1027; or Da Costa's "Surgery" (1908). page 963. 
 
 3. See Rose and Carless' "Surgery" (1908), page 1325; 
 or Da Costa's "Surgery" (1908), page 1034. 
 
 4. See Rose and Carless' "Surgery" (1908), page 1270; 
 or Da Costa's "Surgery" (1908), pages 1202 and 397. 
 
 5. See Rose and Carless' "Surgery" (1908), page 927; 
 or Da Costa's "Surgery" (1908), page 773- 
 
 6. See Rose and Carless' "Surgery" (1908), page 996; 
 or Da Costa's "Surgery" (1908), page 823. 
 
 7. See Rose and Carless' "Surgery" (1908), page 11 13; 
 or Da Costa's "Surgery" (1908), pages 837 and 841. 
 
 8. See Rose and Carless' "Surgery" (1908), page 964; 
 or Da Costa's "Surgery" (1908), page 908. 
 
 9. See Rose and Carless' "Surgery" (1908), page 635; 
 or Da Costa's "Surgery" (1908), pages 607 and 635. 
 
 10. See Rose and Carless' "Surgery" (1908), page 1172. 
 
 11. See Rose and Carless' "Surgery" (1908), page 83; 
 or Da Costa's "Surgery" (1908). page 105. 
 
 451 
 
MEDICAL RECORD. 
 
 12. Treatment of ophthalmia neonatorum. Prophylac- 
 tic: Whenever there is the possibility of infection, or in 
 every case, wash the eyelids of the new-born child with 
 clean worm water, and drop on the cornea of each eye one 
 drop of a one or two per cent, solution of nitrate of silver, 
 immediately after birth. Curative: Wash the eyes care- 
 fully every half hour with a saturated solution of boric 
 acid; pus must not be allowed to accumulate. Two drops 
 of a two per cent. • solution of nitrate of silver must also 
 be dropped on to the cornea every night and morning. 
 The eyes must be covered with a light, cold, wet compress. 
 The patient must be isolated, and all cloths and compresses 
 used must be burnt. 
 
 13. See Rose and Carless' "Surgery" (1908), page 885. 
 
 14. See Rose and Carless' "Surgery" (1908), page 955; 
 or Da Costa's "Surgery" (1908), page 1236. 
 
 15. See Rose and Carless' "Surgery" (1908), page 155; 
 or Da Costa's "Surgery" (1908), page 288. 
 
 obstetrics and gynecology. 
 
 1. See Williams' "Obstetrics" (1909), page 683; or Hirst's 
 "Obstetrics" (1909), page 448. 
 
 2. See Williams' "Obstetrics" (1909), pages 180, 366, and 
 647; or Hirst's "Obstetrics" (1909), pages 204 and 304. 
 
 3. See Williams' "Obstetrics" (1909), page 476. 
 
 4. See Williams' "Obstefc-ics" (1909), pages 229, 292, and 
 298; or Hirst's "Obstetrics" (1909), pages 339 and 433. 
 
 5. See Williams' "Obstetrics" (1909), pages 189 and 201; 
 or Hirst's "Obstetrics" (1909), pages 252 and 186. 
 
 6. See Williams' "Obstetrics" (1909), page 866; or Hirst's 
 "Obstetrics" (1909), pages 715 and 725. 
 
 7. See Williams' "Obstetrics" (1909), pages 852 and 316; 
 or Hirst's "Obstetrics" (1909), pages 723 and 333. 
 
 8. See Williams' "Obstetrics" (1909), page 325; or 
 Hirst's "Obstetrics" (1909), pages 607 and 867. 
 
 9. Prolapsus uteri. Operative treatment gives the most 
 satisfactory results in prolapse. In slight cases of prolapse 
 repair of the perineum will effect a cure. The severer 
 grades will require, in addition, some operation on the 
 anterior vagina. The best of these is Martin's operation 
 for cystocele. If the cervix is hypertrophied it should be 
 amputated. Three operations — on the perineum, for cysto- 
 cele, and amputation of the cervix — are required in the 
 usual case of prolapse. In addition, hystrorrhaphy may be 
 advisable, since there can be no prolapse so long as the 
 uterus maintains its normal position of anteflexion. These 
 operations failing, hysterectomy may be performed. For 
 perineorrhaphy see Rose and Carless' "Surgery" (1908), 
 page 1280. For radical cure of cystocele: "The patient is 
 placed in dorsal position. The posterior vaginal wall is 
 
 AS* 
 
MEDICAL RECORD 
 
 kept out of the way with a weighted speculum. The cervix 
 is drawn down with a bullet forceps. With a pair of tenac- 
 ula the sides of the prominence are drawn together in 
 the median line in order to see how much of the wall is 
 redundant, and these points are marked with small nicks. 
 Next, the whole surface is put on the stretch between 
 four pairs of forceps — one at each of the sidemarks, one 
 near the cervix, and one at the transverse ridge at the 
 inner end of the urethra. With a pair of scissors curved 
 on the flat, a strip about J4 mcn wide is cut out of the 
 mucous membrane. Similar strips are removed on both 
 sides until an oval is denuded. Finally a running suture 
 of chromicized catgut is passed under the whole pared 
 surface, uniting the edges from side to side." If neces- 
 sary, a perineorraphy should be done at the same time. 
 For hysterectomy see Rose and Carless' "Surgery" (1908), 
 page 1283. 
 
 10. Curettage. Indications: For diagnosis, to remove 
 pieces of retained placenta or decidua, endometritis, mucous 
 polypi, hemorrhage, dysmenorrhea, endocervicitis. Dangers: 
 Sepsis, perforation of uterus, hemorrhage, abortion, inflam- 
 mation of uterus or adnexa. Procedure: All antiseptic 
 and aseptic precautions are necessary, the patient should 
 be in the dorsal position, the vagina is to be disinfected, 
 and the cervical canal dilated; a speculum is introduced 
 into the vagina and the cervix is drawn down with volsella; 
 the uterine cavity is irrigated with creolin or lysol; a 
 curette is inserted to the fundus and moved down to the 
 internal os ; the operator should begin at one cornu, and 
 go in the same direction all around till he reaches the 
 starting point, and if necessary repeat till no more spongy 
 or hyperplastic tissue appears ; the fundus should be scraped 
 separately by moving the curette along it from side to 
 side; in going towards the fundus no scraping should be 
 done, and care must be taken not to perforate the uterus ; 
 should this happen, no fluid must be injected: otherwise 
 the uterus and vagina are again irrigated, and one or more 
 strips of iodoform gauze are inserted into the cavity to 
 act either as a hemostatic plug or as a drain, which is 
 diminished with two days' interval and withdrawn on the 
 sixth day. A hemostatic tampon should be placed in the 
 vagina and withdrawn the following day. If anv fever 
 arises the tampon is at once removed and the vagina 
 douched with antiseptic fluid every three hours. If not, 
 the vagina is only swabbed with the same every day and 
 packed loosely with iodoform gauze. After the final re- 
 moval of the gauze the antiseptic douche is given twice a 
 day until there is no more discharge. The patient should 
 remain in bed for a week. 
 
 11. (a) See Hirst's "Obstetrics" (1909), page 918. 
 
 453 
 
MEDICAL RECORD. 
 
 (b) See Rose and Cariess' "Surges" (1908), page 1278. 
 
 12. See Rose and Cariess' "Surgery" (1908), page 1278. 
 
 13. The following (from Gould and Pyle's Cyclopedia of 
 Medicine and Surgery) is a useful classification of uterine 
 hemorrhages, and also gives the causes of the same : 
 
 I. Hemorrhages Complicating Pregnancy, Labor, or the 
 Puerpetium: 
 
 A. Hemorrhages of Pregnancy: caused by (1) pla- 
 centa prsevia; (2) premature separation of a nor- 
 mally situated placenta; (3) apoplexy of the de- 
 cidua or placenta. 
 
 B. Hemorrhages of Labor: caused by (1) placenta 
 prsevia; (2) premature separation of a normally 
 situated placenta; (3) relaxation of the uterus; (4) 
 laceration of the cervix; (5) rupture or inversion of 
 the uterus. 
 
 C. Hemorrhages of the Piter perium: caused by (1) 
 retained secundines ; (2) displaced uterus; (3) dis- 
 placed thrombi; (4) fibroid tumors; (5) hypertro- 
 phied decidua; (6) carcinoma. 
 
 II. Hemorrhages Occurring in the Non-Pregnant 
 Woman: 
 
 A. In * irgins Before the Age of Thirty: caused bv (1) 
 uterine congestion, the result of cold or exposure ; 
 (2) endometritis; (3) polypi and fibroid tumors. 
 
 B. In Married Women Before the Age of Thirty: 
 caused by (1) subinvolution; (2) laceration of the 
 cervix; (3) endometritis; (4) retrodisplacements of 
 the uterus; (5) polypi and fibroid tumors. 
 
 C. In Women After the Age of Thirty: caused by (1) 
 carcinoma of the cervix; (2) carcinoma of the body 
 of the uterus; (3) sarcoma of the uterus. 
 
 14. See Williams' "Obstetrics" (1909), page 821; or 
 Hirst's "Obstetrics" (1909), page 587. 
 
 15. See Rose and Cariess' "Surgery" (1908), page 1288. 
 
 HYGIENE AND MEDICAL JURISPRUDENCE. 
 
 1. Disinfectants are agents which restrain infectious dis- 
 eases by destroying or removing their specific poisons. 
 
 Deodorants are substances which destroy the odorous 
 products of putrefaction. 
 
 Germicides are agents which destroy bacteria and their 
 germs. 
 
 Where spores are found the prolonged application of 
 steam under pressure, or fractional sterilization, will be 
 found efficient. 
 
 2. From the figures given the birth rate in Trenton 
 would be : 
 
 1,075 * 1,000 
 
 =11.9 per thousand. 
 
 90,000 
 
 454 
 
MEDICAL RECORD. 
 
 Similarly, the death rate would be : 
 1,324 X 1,000 
 
 = 14.7 per thousand. 
 
 90,000 
 
 3. Pettenkofer's method of determining the percentage 
 of carbon dioxide in the air: A large cylindrical container 
 of known capacity, say, 15 litres, is filled with the air to be 
 examined; a known volume of barium hydroxide is then 
 added and shaken up with the air. The carbon dioxide 
 combines with the barium hydroxide to form a barium car- 
 bonate, which is insoluble, and also incapable of acting 
 upon an indicator. The barium hydroxide employed is of 
 known strength, e. g., it may be of such strength that 1 ex. 
 of the solution neutralizes 1 c.c. of carbon dioxide at nor- 
 mal temperature and pressure. If then we find that 10 c.c. 
 of the barium hydroxide has been neutralized by the carbon 
 dioxide present in the air, we know that 10 c.c. of carbon 
 dioxide is present in 15 litres or 15,000 c.c. of the air 
 examined. 
 
 4. A water is said to be hard when it contains in solution 
 certain salts, such as calcium and magnesium salts, which 
 are capable of acting upon soap and forming with it a 
 curdy deposit. 
 
 To measure the relative hardness of water a standard 
 soap solution is carefully added to a definite volume of the 
 water until a thin, beady lather is produced. The amount 
 of soap solution which must be added to produce this 
 lather increases with the hardness of the water. 
 
 5. Good milk is of characteristic color and appearance, 
 has a specific gravity of about 1029 to 1034; total solids 12 to 
 13 per cent., of which fat is from ^V 2 to 4 per cent. "The 
 comparison of the specific gravity and the amount of cream 
 which rises with the physical characters will give a very 
 good idea of the quality of milk." — (Parkes.) 
 
 Milk may be sopJ'.isticated or adulterated by: (1) 
 Skimming; (2) the addition of water: (3) the addition of 
 coloring matter, such^ as caramel, annatto, or methyl 
 orange ; (4) the addition of preservatives, as boric acid, 
 formaldehyde, salicylic acid, or salicylates: (5) the addi- 
 tion of arrowroot, flower, sugar, glycerine, chalk, or sodium 
 carbonate. 
 
 6. Quarantinable diseases Cholera, yellow fever, small- 
 pox, plague, typhus, leprosy, diphtheria, scarlet fever., 
 measles, mumps, chicken pox, erysipelas. For length of 
 time see index to these diseases in French's or Osier's 
 "Practice." 
 
 7. A sterile swab is rubbed over any visible membrane on 
 the tonsils or throat, and is then immediately passed over 
 the surface of the serum in a culture tube. The tube of 
 culture, thus inoculated, is placed in an incubator at 37° C. 
 
 455 
 
MEDICAL RECORD. 
 
 for about twelve hours, when it is ready for examination. 
 A sterile platinum wire is inserted into the culture tube, 
 and a number of colonies of a whitish color are removed 
 by it, and placed on a clean cover slip, and smeared over 
 its surface. The smear is allowed to dry, is passed two or 
 three times through a flame to fix the bacteria, and is then 
 covered for about five or six minutes with a Loeffler's 
 methylene-blue solution. The cover slip is then rinsed in 
 clean water, dried, and mounted. The bacilli of diphtheria 
 appear as short, thick rods with rounded ends; irregular 
 forms are characteristic of this bacillus, and the staining 
 will appear pronounced in some parts of the bacilli and 
 deficient in other parts. 
 
 8. (a) Hygiene includes all the principles for the preser- 
 vation of health; Sanitary Science is the practical applica- 
 tion of these principles. 
 
 (&) Hygiene may be subdivided into: (i) Personal, (2) 
 Public, (3) Private, (4) Military, (5) Marine, (6) School 
 hygiene, and (7) hygiene of occupations. 
 
 (<:) and (d)^ Hygiene took a large step forward when 
 the study of vital statistics was started. The growth of 
 bacteriology has done most of all to help hygiene. Public 
 opinion, when once educated on proper hygienic lines, will 
 do much to stamp out diseases, prolong life, and protect 
 both the individual and the community from physical and 
 monetary loss. Its use to the public is further shown by 
 its teaching people how to live in a healthy way, how to 
 build healthy and sanitary houses, how to clothe them- 
 selves, how to dispose of excretions and waste matter. 
 
 9. Barometer is an instrument for measuring the atmos- 
 pheric pressure. Thermometer is an instrument for meas- 
 uring temperature. Hygrometer is an instrument for 
 measuring the moisture in the atmosphere. Psychrometer 
 is a hygrometer in which the amount of atmospheric mois- 
 ture is determined by the degree of cold necessary to 
 produce its precipitation. Anemometer is an instrument 
 for measuring the velocity of the wind. 
 
 10. Humidity: "When the air is very dry, and especially 
 when it is also warm, so that its capacity for taking up 
 moisture is very great, the evaporation from the skin and the 
 lungs is increased. In chronic lung diseases, such as bron- 
 chitis, emphysema, and some cases of phthisis with much 
 congestion of bronchitis, dryness of the atmosphere causes 
 cough and irritation, no doubt from the increased evapora- 
 tion thrown on the lungs. The warm, equable, and fairly 
 moist climates are best suited for the treatment of these 
 complaints. For healthy people in temperate climates 
 the pleasantest degree of humidity is about 75 
 per cent, of saturation (relative humidity 75)." — (Parkes' 
 Hygiene.) And see above, Physiology, No. 14. 
 
 456 
 
MEDICAL RECORD. 
 
 Wind: "The effect of movement of air (winds) on 
 evaporation is very great. In cold weather a chilly wind, 
 if dry, increases the evaporation, and also lowers the tem- 
 perature of the body by the impact of its cold particles, 
 which absorb the heat of the body, and then pass away 
 to be replaced by more cold air. The skin becomes dry 
 and chapped, and the lungs are irritated. In hot climates 
 a dry, hot wind increases the evaporation enormously. 
 The warm and moist southwest winds are mild and re- 
 laxing, while the dry and colder east and north winds are 
 bracing." — (Parkes' Hygiene.) 
 
 Clouds: Their influence is undetermined. 
 
 Climate: A temperate climate, free from extremes of 
 heat and cold, but with a high degree of humidity, is con- 
 ducive to lung troubles and rheumatism. Tropical and sub- 
 tropical climates are favorable for the development of 
 malaria, dysentery, yellow fever, cholera, liver abscess, and 
 numerous parasitical diseases. 
 
 ii. The principal duties of a school physician are: To 
 prevent the spread of contagious diseases, and to promptly 
 detect any physical defect or illness in children. The prin- 
 cipal means of preventing the spread of contagious diseases 
 in schools are : Regular and efficient inspection by physi- 
 cians ; prompt exclusion and isolation of anyone suffering 
 from a contagious disease, or coming from a house where 
 such disease is ; compulsory vaccination ; compulsory noti- 
 fication of all infections and contagious disease; individual 
 towels, drinking vessels, and other implements ; children 
 who have had a contagious or infectious disease, or who 
 have come from a house where such disease prevailed, 
 should not be readmitted to school until sufficient time 
 has elapsed since the occurrence of the last case to insure 
 safety. 
 
 12. Prophylaxis of malarial fever. Individuals should 
 use mosquito netting round their beds and wire gauze in 
 doors and windows, so as to keep out the mosquitos as 
 much as possible. During residence in malarial districts 
 quinine should be taken every morning before breakfast. 
 All pools, stagnant water, etc., where anopheles may breed, 
 should be removed. All mosquitos, larvae, etc., should be 
 destroyed as far as possible. By staying indoors during 
 dusk and darknesss, opportunities for infection may be 
 avoided. Occasional fumigation with formaldehyde or 
 sulphur is also efficacious. 
 
 13. Methods of house heating, (i) Open fires: Waste- 
 ful, only part of room is heated ; but healthy (as ventila- 
 tion is good) and cheerful. (2) Stoves: Heat the whole 
 room, but the air becomes dry and unpleasant, the air is 
 often hotter than the walls and floor, and so chills ensue; 
 carbon monoxide is also produced. (3) Furnaces: Good 
 
 457 
 
MEDICAL RECORD 
 
 Wholesome. 
 
 heaters and also ventilators. (4) Hot-water pipes: 
 Cleanly and effective, but possibility of overheating the air. 
 (5) Steam pipes: The direct method is not so good, be- 
 cause it does not aid in ventilation; the "indirect" method 
 is good, because it brings in large volumes of heated fresh 
 air. (6) Gas: Good, if properly arranged with outlets 
 over the burners ; otherwise, very injurious. 
 
 14. Potable water should be colorless, odorless, cool, 
 limpid, soft; it should have an agreeable taste, neither 
 salty nor sweet nor flat; it should dissolve soap readily 
 without formation of a curdy precipitate ; it should contain 
 not more than about twenty-five to thirty grains of solids 
 per gallon, and should not be polluted with sewage. 
 
 The sources and varieties of water have been classified 
 thus : 
 
 3. Upland surface 1 
 
 I water r moderately palatable. 
 
 (4. Stored rain water. J 
 Suspicious. A 5. Surface water from cultivated") 
 
 I land I 
 
 f 6. River water, to which sewage f palatable. 
 Dangerous. -I gains access j 
 
 [7. Shallow-well water J 
 
 15. The impurities found in water are: Sewage, leaves, 
 surface washings, manufacturing refuse, lead, other metals, 
 leakage from gas pipes, insects, fungi, bacteria, entozoa. 
 
 Impure water may cause typhoid fever, dysentery, diar- 
 rhea, indigestion, goiter, vesical calculi, cholera, yellow 
 fever, scarlet fever, diphtheria, tapeworms, and lead poison- 
 ing. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 University of the State of New York. 
 
 ANATOMY. 
 
 (Answer ten questions only.) 
 
 1. What structures pass through the foramen magnum 
 of the occipital bone? 
 
 2. Describe the patella. 
 
 3. Distinguish synarthrosis and diarthrosis. Illustrate 
 each. 
 
 4. Give the origin, insertion, action, and nerve supply of 
 one of the following muscles : Deltoideus, psoas major 
 (psoas magnus), sternocleidomastoideus, 
 
 5. Mention the openings and the valves of the left ven- 
 tricle of the heart. 
 
 6. Give the origin, course, and distribution of the arteria 
 pulmonalis. 
 
 458 
 
MEDICAL RECORD. 
 
 7. Describe the venae intercostales. 
 
 8. Locate and describe the lymph nodes of the head. 
 
 9. Give the origin, course, and distribution of the nervus 
 ischiadicus f great sciatic nerve). 
 
 10. Describe the nasal fossae. 
 
 11. Give the structure of the stomach. What is the aver- 
 age size of the adult stomach. 
 
 12. Give the gross anatomy of the tongue. 
 
 13. Describe the pelvis of the kidney. 
 
 14. Describe the urogenital triangle (urethral perineum). 
 
 15. Give position and the shape of the pancreas. 
 
 PHYSIOLOGY. 
 
 (Answer ten questions only.) 
 
 1. What are the general functions of epithelium? What 
 are the specific functions of ciliated epithelium? 
 
 2. Explain the dangers of transfusing blood from lower 
 animals into man. 
 
 3. What are the forces that cause the circulation of the 
 lymph ? 
 
 4. Describe the mechanical relation of the ribs to the 
 vertebrae. Explain the relation of this arrangement to res- 
 piration. 
 
 5. Give three examples of enzymes and state the specific 
 functions of each. 
 
 6. Describe the plicae circulares (valvulae conniventes). 
 Where are they found, and in what numbers? What pur- 
 pose do they serve? 
 
 7. Mention in order of importance the avenues through 
 which the heat of the body is lost. 
 
 8. ^escribe the glycogenic function of muscle. 
 
 9. What is the origin of urea? 
 
 10. Is a muscle dependent on its nerve connection for 
 the reception of a stimulus? Explain. 
 
 11. Describe the effects of paralysis of the nervus facialis 
 
 12. Describe the. tuba auditiva (Eustachii), and state its 
 function. 
 
 13. Illustrate by diagram or otherwise the formation of 
 the image of an object on the retina, considering the re 
 fractive surfaces of the eye as a biconvex lens. 
 
 14. State the physical changes in the human body that 
 are characteristic of senility. 
 
 15. What is the significance of the presence of polynu- 
 clear leucocytes in the blood? 
 
 CHEMISTRY. 
 
 (Answer ten questions only.) 
 
 1. Give the graphic formula of (a) sulphur trioxide, (b) 
 phosphoric acid. 
 
 2. Give the meaning and illustrate the use in chemical 
 nomenclature of (a) id, (b) ous, (c) ic, (d) hypo, (e) per 
 
 459 
 
MEDICAL RECORD. 
 
 3. State the centigrade and the Fahrenheit registration 
 of (a) the boiling point of water, (b) the freezing point 
 of water, (c) the freezing point of mercury. 
 
 4. Define and illustrate (a) distillation, (b) pentad ele- 
 ment, (c) molecular weight, (d) gas, (e) acid salt. 
 
 5. Describe H2O2 as to (a) preparation, (b) uses, (c) 
 test by which it may be recognized. 
 
 6. Give the occurrence, preparation, properties, and uses 
 of NH 8 . 
 
 7. What are the chief sources of iodine? Describe a 
 method of preparing iodine. Give the formulas of five 
 compounds of iodine. 
 
 8. Give the preparation, properties, and uses of sulphuric 
 acid. 
 
 9. Give the chemical name, the properties, and the chief 
 sources of K2CO3. 
 
 10. What is the chemical antidote for poisoning by lead? 
 
 11. Give an emergency method of preparing ferric 
 hydroxide for use in a case of arsenic poisoning. 
 
 12. Mention the sources of glucose. Give a test for 
 glucose. 
 
 13. Describe normal urine as to (a) specific gravity, (J?) 
 reaction, (c) color, (d) constituents, (e) quantity voided 
 in twenty-four hours. 
 
 14. Give the formulas of three substances commonly em- 
 ployed as disinfectants. State in detail an approved method 
 of using one of these substances as a disinfectant in a pri- 
 vate house after an infectious disease. 
 
 15. Give the relative proportion of water found in (a) 
 gastric juice, (b) human milk, (c) blood, (d) urine. 
 
 DIAGNOSIS. 
 
 (Answer ten questions only.) 
 
 1. Differentiate cerebrospinal fever and typhus fever. 
 
 2. Give the clinical history of a case of bubonic plague. 
 
 3. Describe the typical course of scarlatina. 
 
 4. Give the symptoms of pernicious anemia. 
 
 5. State the diagnostic value of blood count. 
 
 6. Give the symptoms of (a) cardiac hypertrophy with 
 dilatation, (b) cardiac hypertrophy without dilatation. 
 
 7. What are the characteristics of acute endocarditis? 
 
 8. Give the symptoms and the physical signs of chronic 
 bronchitis. 
 
 9. Make a diagnosis, by exclusion, of retropharyngeal 
 abscess. 
 
 10. What are the symptoms of carcinoma of the stomach? 
 
 11. Give the clinical history of a case of invagination of 
 the bowels. 
 
 12. Give the signs and the symptoms of acute hepatitis. 
 
 460 
 
MEDICAL RECORD. 
 
 13. What are the symptoms of pyuria? Give laboratory 
 methods of confirming the diagnosis. 
 
 14. Give the symptoms of chorea. 
 
 15. Describe an ambulance case of alcoholism, and show 
 how the possibility of its being a case of cerebral hemor- 
 rhage has been eliminated. 
 
 PATHOLOGY. 
 
 (Answer six questions only.) 
 
 1. Describe the changes in the dura mater in pachy- 
 meningitis. 
 
 2. Describe a teratoma (dermoid cyst). 
 
 3. Describe the tissue changes in syohilitic ulcer. 
 
 4. Differentiate the blood pictures in lymphatic leukemia, 
 Hodgkin's disease (lymphadenoma) and trichinosis. 
 
 5. Describe three varieties of thrombus. 
 
 6. Describe the tissue changes in an apoplectic area. 
 
 7. Describe the appearance of a section of the spinal 
 cord in progressive spinal muscular atrophy. 
 
 8. Describe the tissues of the uterus in acute metritis. 
 
 9. What is metastasis? What are the most frequent 
 channels of metastasis? 
 
 BACTERIOLOGY. 
 
 (Answer four questions only.) 
 
 10. Describe and illustrate a spirillum. 
 
 11. Describe the streptococcus, and mention two lesions 
 caused by streptococcus infection. 
 
 12. Mention and describe the microorganism of influenza. 
 
 13. Describe the bacillus diphtheriae. Mention two organ- 
 isms that are frequently found with the bacillus diphtherias 
 in cultures from the throat. 
 
 14. Mention and describe the organism that usually 
 causes lobar pneumonitis, and state how its presence can 
 be demonstrated. 
 
 15. Give four sources of infection, and state the com- 
 parative importance of each. 
 
 SURGERY. 
 
 (Answer ten questions only.) 
 
 1. Describe two methods of producing local anesthesia, 
 and mention indications for the employment of each. 
 
 2. Describe aseptic wound fever (post-operation rise), 
 and give the theory of its cause. 
 
 3. Give the symptoms and the surgical treatment of 
 ischiorectal abscess. 
 
 4. what complications should be feared in a wound made 
 by the wad of a toy pistol, and how should such a wound 
 be treated? 
 
 4<sc 
 
MEDICAL RECORD. 
 
 5. Define lipoma. Describe the surgical treatment of a 
 single subcutaneous lipoma. 
 
 6. Describe an amputation at the ankle joint. 
 
 7. What are the indications for osteotomy? Describe in 
 detail osteotomy for deformed tibia. 
 
 8. Give the symptoms of subcoracoid dislocation, and de- 
 scribe a method of reduction by manipulation. 
 
 9. Describe in detail the operation of lumbar puncture. 
 
 10. Give the symptoms of ulcer of the stomach, and de- 
 scribe the surgical treatment. 
 
 11. Make a differential diagnosis of aneurysm and growth 
 over a vessel. 
 
 12. Describe the surgical treatment of genu valgum. 
 
 13. Describe in detail the diagnostic points of prostatic 
 hypertrophy. 
 
 14. Give the symptoms and the management of trachoma. 
 
 15. What measures should be taken to check primary 
 hemorrhage following removal of the faucial tonsil? 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 (Answer ten questions only.) 
 
 1. Define the terms abortion, miscarriage, and premature 
 labor as employed in a strictly scientific sense. 
 
 2. What changes take place in the uterus after impreg- 
 nation ? 
 
 3. Give general directions for the management of a nor- 
 mal pregnancy. 
 
 4. What care should the breasts receive (a) during 
 pregnancy, (b) during the puerperium? 
 
 5. Give the signs and the symptoms of pregnancy before 
 and after quickening. 
 
 6. Describe the several stages of a high forceps de- 
 livery. 
 
 7. Mention three causes of dystocia and give the man- 
 agement of each. 
 
 8. Give a clinical description of ouerperal insanity. State 
 the causes and give the management of puerperal insanity. 
 
 9. Give an exact description of Crede's method of deliv- 
 ering the placenta. 
 
 10. What conditions indicate version, and how should it 
 be performed? 
 
 11. Describe the secondary operation for laceration of 
 the perineum. ^v. 
 
 12. Give the causes, symptoms, and management of puer- 
 peral eclampsia. 
 
 13. Describe the clinical management of a head-last labor. 
 
 14. Make a differential diagnosis of vaginitis and vagin- 
 ismus. Give the treatment of each. 
 
 15. Give the causes, pathology, symptoms, and diagnosis 
 of chronic endometritis. 
 
 462 
 
MEDICAL RECORD. 
 
 HYGIENE AND SANITATION. 
 
 (Answer ten questions only.) 
 i. What are the functions of vegetable acids? 
 
 2. What precautions should be used in the collection and 
 storage of rain water for drinking? 
 
 3. What general rules should be observed in bathing? 
 Mention the benefits of cold baths. What physical condi- 
 tions render cold baths inadvisable? 
 
 4. What should be the relative arrangement of desks 
 and windows in schoolrooms? What injurious effects may 
 result if this arrangement is not observed? 
 
 5. Describe two processes of freeing water from bacteria. 
 
 6. Describe the principles of construction of a self-clean- 
 ing sewer. 
 
 7. Why is unripe fruit unwholesome ? Wherein are fruits 
 valuable as food? 
 
 8. What general characteristics of an outbreak of dis- 
 ease would lead to the suspicion that the milk supply had 
 become contaminated? 
 
 9. What is koumiss? What is kefir? How are these 
 products made? 
 
 10. Illustrate the theory of immunity by means of anti- 
 toxins. 
 
 11. What agents are used for disinfecting ships and their 
 cargoes? Describe the procedure. 
 
 12. Mention the principal means of preventing the spread 
 of contagious diseases in schools. 
 
 13. Mention six diseases that may be acquired by eating 
 the flesh of diseased cattle. 
 
 14. What relation has soil to malaria and to yellow fever? 
 
 15. What food principles predominate in (a) beef, (b) 
 wheat, (c) eggs? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 University of the State of New York. 
 
 ANATOMY. 
 
 1. Structures that pass through the' foramen magnum: 
 The medulla and its membranes, vertebral arteries, spinal 
 accessory nerves, anterior and posterior spinal arteries, and 
 the occipitoaxial ligament. 
 
 2. See Cunningham's "Anatomy" (1909), page 229; or 
 Gray's "'Anatomy" (1908). page 233. 
 
 3. Synarthrosis is an immovable joint; as in junction 
 between cranial and facial bones (except lower jaw). 
 Diurthrosis is a freely movable joint; as elbow, hip, knee. 
 
 4. Deltoid. Origin: From the outer third of anterior 
 
 463 
 
MEDICAL RECORD. 
 
 border and upper surface of the clavicle, from the outer 
 margin and upper surface of the acromion process, and 
 from the lower edge of the spine of the scapula. Inser- 
 tion: Into the deltoid impression on the middle of the outer 
 side of the shaft of the humerus. Action: It raises the 
 arm from the side so as to bring it at right angles with the 
 body; its anterior fibers draw the arm forward; its poste- 
 rior fibers draw the arm backward. Nerve supply: The 
 circumflex. 
 
 Psoas magnus. Origin: Transverse processes of lum- 
 bar vertebrae; also from bodies of last thoracic and all 
 lumbar vertebrae, with the intervertebral substance. Inser- 
 tion: Lesser trochanter of femur. Nerve supply: Second 
 and third lumbar. 
 
 Sternocleidomastoid. Origin: Upper and anterior part 
 of manubrium, and inner third of upper border and an- 
 terior surface of clavicle. Insertion: Mastoid process of 
 temporal bone and outer half of superior curved line of 
 occipital bone. Action: Draws head to same side, or ro- 
 tates face to opposite side; if both muscles act together, 
 the head is flexed upon the neck. Nerve supply: Spinal 
 accessory. 
 
 5. Openings of left ventricle: Aortic and auriculo- 
 ventricular; valves: mitral and semilunar. 
 
 6. See Cunningham's "Anatomy" (1909), page 795; or 
 Gray's "Anatomy" (1908), page 589. 
 
 7. See Cunningham's "Anatomy" (1909), page 873; or 
 Gray's "Anatomy" (1908), page 752. 
 
 8. See Cunningham's "Anatomy" (1909), page 909; or 
 Gray's "Anatomy" (1908), page 783. 
 
 9. See Cunningham's "Anatomy" (1909), page 648; or 
 Gray's "Anatomy" (1908), page 1030. 
 
 10. The nasal fossa are two large, irregular shaped cavi- 
 ties, situated one on each side of the middle line of the 
 face, extending from the base of the skull to the roof of 
 the mouth, and separated from each other by a median 
 septum. They open in front by the anterior nares, with the 
 face; and behind, by the posterior nares, with the naso- 
 pharynx. They are wider below than above. Bones enter- 
 ing into their formation are: Frontal, sphenoid, ethmoid, 
 lacrymal, nasal, palate, superior maxillary, vomer, and in- 
 ferior turbinated. 
 
 11. See Cunningham's "Anatomy" (1909), pages 1058 
 and 1053; or Gray's "Anatomy" (1908), pages 1281 and 
 1279. 
 
 12. See Cunningham's "Anatomy" (1909), page 1000; or 
 Gray's "Anatomy" (1908), page 1097. 
 
 13. See Cunningham's "Anatomy" (1909), page 1141; or 
 Gray's "Anatomy" (1908), page 1424. 
 
 464 
 
MEDICAL RECORD. 
 
 14. See Cunningham's "Anatomy" (1909), page 1277; or 
 Gray's " Anatomy" (1908), page 1549. 
 
 15. Pancreas. Position: Transversely across posterior 
 abdominal wall, behind the peritoneum, from the duodenum 
 on the right to the spleen on the left; in the epigastric and 
 left hypochondriac regions. Shape: Long and irregular 
 prismatic; its shape has been compared to that of a human 
 or dog's tongue. 
 
 PHYSIOLOGY. 
 
 1. General functions of epithelium: (1) Protection; (2) 
 secretion; (3) motion (ciliary); (4) special sensation; (5) 
 absorption. Special functions of ciliated epithelium: To 
 keep foreign particles out of the respiratory tract, to as- 
 sist the ovum in the Fallopian tube onwards to the uterus, 
 to enable the spermatozoa to progress; generally — protec- 
 tion and motion. 
 
 2. Dangers of transfusing blood from lower animals to 
 man: "The serum of certain animals possesses the prop- 
 erty of dissolving the red corpuscles of another species of 
 animals. The serum of a dog destroys the red corpuscles 
 of a man ; the hemoglobin is dissolved out. The serum, 
 besides its action on the red corpuscles, is also active 
 against the white corpuscles of the same animal, stopping 
 their ameboid movements. The globulicidal action of the 
 serum is related to its poisonous action on microbes. The 
 normal serum of certain animals kills microbes, as the 
 serum of the dog kills the typhoid bacilli. The power to 
 kill red corpuscles and microbes is due to the presence in 
 the serum of a substance, an alexin. In transfusion this 
 plays an important part." — (Ott's Physiology.) 
 
 3. The forces concerned in the circulation of the lymph 
 are: (1) The presence of the blood in the blood-vessels; 
 (2) thoracic aspiration; (3) muscular contractions of the 
 voluntary muscles; (4) contractions of the intestine; (5) 
 the action of the valves in the lacteals and lymphatics. 
 
 4. See Cunningham's "Anatomy" (1909), pages 269 and 
 272; or Gray's "Anatomy" (1908), page 285. 
 
 5. Three enzymes: (1) Ptyalin (of the saliva), which 
 changes starches into dextrin and maltose. 
 
 (2) Trypsin (of the pancreatic juice), which changes 
 proteids into proteoses and peptones, and afterwards de- 
 composes them into leucin and tyrosin. 
 
 (3) Amylopsin (of the pancreatic juice), which converts 
 starches into maltose. All of these act in an alkaline me- 
 dium only, 
 
 6. See Cunningham's "Anatomy" (1909), page 1062; or 
 Gray's "Anatomy" page 1299. 
 
 According to Sappey, there are about six hundred of 
 these valvulae conniventes in the upper half of the small in- 
 
 465 
 
MEDICAL RECORD 
 
 testine, and about two hundred to two hundred and fifty in 
 the lower half. 
 
 7. Avenues through which heat of body is lost, in order 
 of importance : (1) Skin, by radiation and conduction ; (2) 
 skin, by evaporation of the perspiration; (3) expired air; 
 (4) excretions : urine and feces. 
 
 8. The glycogenic function of muscle: "It has been esti- 
 mated that the percentage of glycogen in resting muscles 
 varies from 0.5 to 0.9 per cent, and that in the musculature 
 of the whole body there may be contained an amount of 
 glycogen equal to that in the liver itself. Apparently mus- 
 cular tissue, as well as liver tissue, has a glycogenetic 
 function — that is, it is capable of laying up a supply of 
 glycogen from the sugar brought to it by the blood. The 
 glycogenetic function of muscles has been demonstrated 
 directly by Kulz, who has shown that an isolated muscle 
 irrigated with an artificial supply of blood to which dex- 
 trose is added is capable of changing the dextrose to 
 glycogen, as shown by the increase of the latter substance 
 in the muscle after irrigation. Muscle glycogen is to be 
 looked upon as a temporary and local reserve supply of 
 material ; so that, while we have in the liver a general 
 depot for the temporary storage of glycogen for the use 
 of the body at large, the muscular tissue, which, consider- 
 ing its bulk, is the most active tissue of the body from 
 the standpoint of energy production, is also capable of lay- 
 ing up in the form of glycogen any excess of sugar brought 
 to it. . . . It is found that the supply of glycogen is 
 greatly affected by conditions calling for increased metab- 
 olism in the body. Muscular exercise quickly exhausts 
 the supply of muscle and liver glycogen, provided it is not 
 renewed by new food. In a starving animal glycogen 
 finally disappears, except perhaps in traces, but this dis- 
 appearance occurs much sooner if the animal is made to 
 use its muscles at the same time. ,, — (From Howell's Physi- 
 ology.) 
 
 9. Urea is principally formed in the liver; it is the end 
 product of the metabolism of the proteids, being the result 
 of the conversion, by the liver, of amino-acids absorbed 
 from the intestines into the liver. 
 
 10. Ordinarily muscle is dependent upon its nerve con- 
 nection for the reception of a stimulus; but muscle can be 
 stimulated without any regard to nerve supply. Thus ex- 
 posure of muscle to dilute ammonia (which has no effect 
 on the nerve to the muscle) will cause contraction. 
 
 n. "When the facial nerve is paralyzed, the muscles of 
 the face being all powerless, the countenance acquires on 
 the paralysed side a characteristic, vacant look, from the 
 absence of all expression; the angle of the mouth is lower, 
 and the paralyzed half of the mouth looks longer than that 
 
 466 
 
MEDICAL RECORD. 
 
 on the other side ; the eye has an unmeaning stare, owing 
 to the paralysis of the orbicularis palpebrarum. All these 
 peculiarities increase the longer the paralysis lasts, and 
 their appearance is exaggerated when at any time the mus- 
 cles of the opposite side of the face are made active in any 
 expression, or in any of their ordinary functions. In an 
 attempt to blow or whistle, one side of the mouth and 
 cheeks acts properly, but the other side is motionless, or 
 flaps loosely at the impulse of the expired air; so, in trying 
 to suck, one side only of the mouth acts; in feeding, the 
 lips and cheek are powerless, and, on account of paralysis 
 of the buccinator muscle, food lodges between the cheek 
 and gums."— (Kirkes' Physiology. ) 
 
 12. For description of the Eustachian tube, see Cunning- 
 ham's "Anatomy" (1909), page 7=1: or Gray's "Anatomy" 
 (igc8), page 1163. Its function is to keep the atmospheric 
 pressure within the tympanic cavity the same as that on 
 the outside. 
 
 Diagram of the Method of the Formation of an Inverted Image Ex- 
 actly Focussed upon the Retina. The dotted line is the ideal sur- 
 face of curvature. 
 
 14. Physical changes characteristic of senility: Cessa- 
 tion of growth; loss of weight; loss of stature; brittleness 
 of bones ; rigidity of cartilages ; loss of elasticity of crystal- 
 line lens; feebleness and atrophy of muscles; grayness of 
 hair; diminution of sexual activity and power; arterio- 
 sclerosis, or other diseased conditions of the arteries; 
 lessened capacity of chest; atrophy and degeneration of 
 digestive glands, kidneys, and testicles or ovaries; slowed 
 reflexes ; impairment of the special senses. 
 
 15. Polynuclear leucocytes are present normally in the 
 blood; they are decreased relatively in leukemias ; and in- 
 creased in inflammatory and purulent conditions. 
 
 1. CHEMISTRY. 
 
 O H-0\ 
 
 H— O— P=0 
 0=S=0 H— 0/ 
 
 Sulphur trioxide. Phosphoric acid. 
 
 2. Ide denotes the salt of a hydracid, or a binary com- 
 
 467 
 
MEDICAL RECORD. 
 
 pound. Examples: KG, potassium chloride; H 2 S, hydro- 
 gen sulphide. 
 
 Ous denotes either a binary compound with a smaller 
 proportion of the more electronegative element, as SO*, 
 sulphurous oxid; or a ternary compound, an oxyacid, with 
 less oxygen than is contained in the corresponding ic acid, 
 as H2SO3, sulphurous acid. 
 
 Ic denotes either a binary compound with a greater pro- 
 portion of the more electronegative element, as S0 3 , sul- 
 phuric oxid; or a ternary compound, an oxyacid, with 
 more oxygen than is contained in the corresponding ous 
 acid, as H 2 S0 4 , sulphuric acid. 
 
 Hypo prefixed to an acid or a salt denotes less oxygen 
 than the "ous" acid or the "ite" salt. 
 
 Per prefixed to an acid or a salt denotes more oxygen 
 than the "ic" acid or the "ate" salt. 
 
 Examples: 
 
 HClO = Hypochlorous acid: KCIO = Potassium hypo- 
 chlorite. 
 
 HCIO2 = Chlorous acid: KCIO2 = Potassium chlorite. 
 
 HC10 3 =ChlonV acid: KC10 3 = Potassium chlorate. 
 
 HCIO* = Perchloric acid : KCIO4 = Potassium perchlor- 
 ate. 
 
 3- 
 
 i C 1 F. 
 
 (a) Boiling point of water 
 
 (b) Freezing point of water 
 
 (c) Freezing point of mercury 
 
 4. (a) Distillation is the conversion of a liquid into a 
 gas, followed by the reconversion of the gas into a liquid. 
 Example: The distillation of water. 
 
 (b) A pentad element Jsone that has a valence of five. 
 Example: Phosphorus. ^See graphic formula for phos- 
 phoric acid in question 1. 
 
 (c) Molecular weight is the weight of a molecule of a 
 substance as compared with the weight of an atom of 
 hydrogen. It may also be said to be the sum of the weights 
 of the atoms composing the molecule. Thus, the mole- 
 cular weight of sulphuric acid, H2SO4, is (2 + 32 + 64), 
 that is, 98 ; or 08 times the weight of an atom of hydrogen. 
 
 (d) A gas is that form of matter in which the molecules 
 tend to get away from each other; it has neither definite 
 shape nor definite volume. Example: Oxygen. 
 
 (e) An acid salt is one in which only part of the re- 
 placeable hydrogen has been replaced by a metal. Example: 
 KHSO4, monopotassic sulphate. 
 
 5. H2O2. Preparation: By the action of a dilute acid 
 on sodium dioxide : 
 
 Na 2 2 + 2HCI = 2NaCl + H*0 2 . 
 Uses: Disinfectant, antiseptic, and bleaching agent; as 
 
 100° 212° 
 
 o° I 32° 
 —40 1 —40 
 
 468 
 
MEDICAL RECORD. 
 
 an oxidizing agent ; for renovating old oil paintings and 
 bleaching hair. 
 
 Test: Add freshly prepared tincture of guaiacum and a 
 few drops of a cold infusion of malt; the presence of 
 HxOa is indicated by the appearance of a blue color. 
 
 6. NH 3 . Occurrence: In nature, from the decomposi- 
 tion of animal or vegetable matter containing nitrogen and 
 hydrogen. Preparation: By heating solution of ammonium 
 hydroxide : 
 
 NH4HO + heat = H 2 + NH,. 
 Uses: It is used as a respiratory stimulant, a circulatory 
 stimulant, a counterirritant; it neutralizes acids, making 
 definite salts known as ammonium salts, which are formed 
 by the direct combination of the ammonia with the acid. 
 It is also used in the artificial preparation of ice. 
 
 7. Iodine. Chief sources: Seaweeds, and in seawater in 
 combination with sodium, potassium, calcium, and mag- 
 nesium. Preparation: From Chili saltpeter, in which it 
 occurs as sodium iodate. this latter is treated with a mix- 
 ture of sodium sulphite and sodium bisulphite, when the 
 iodine is precipitated as a black deposit: 
 
 2Nal0 3 + 3Na a S0 8 + 2NaHS0 8 = sNa.SO* + H 2 + I,. 
 
 Five compounds: Hydriodic acid, HI; Iodic acid, HlOs; 
 Potassium iodide, Kl : Phosphorus triodide, Pl 3 ; Iodoform, 
 CHls. 
 
 8. Sulphuric acid. Preparation: By the union of sul- 
 phur trioxide and water : S0 3 + H 2 = H 2 S0 4 . 
 
 Properties: A colorless, heavy, oily liquid; it has a 
 strong attraction for water, and in combining with it there 
 is an increase in the bulk of the liquids and a rise of tem- 
 perature; it is a strong corrosive. Uses: It is used in all 
 branches of chemical industry and in many industrial 
 pursuits. 
 
 9. K 2 C0 3 is Potassium Carbonate, or dipotassic carbon- 
 ate. Properties: It is a white, granular, deliquescent, 
 soluble powder, making an alkaline solution. Chief sources: 
 Wood ashes and cream of tartar. 
 
 10. Magnesium sulphate. 
 
 11. Ferric hydroxide may be hurriedly prepared by pre- 
 cipitating solution of ferric sulphate with magnesia. The 
 two solutions should be kept in separate bottles, and when 
 needed they may be mixed and administered. It is used as 
 an antidote in acute arsenical poisoning. 
 
 12. Glucose. Source: Grapes, honey, diabetic urine. 
 Test for glucose {in urine) : Render the urine strongly 
 alkaline by addition of NatCO*. Divide about 6 c.c. of 
 the alkaline liquid in two test tubes. To one test tube add 
 a very minute quantity of powdered subnitrate of bismuth, 
 to the other as much powdered litharge. Boil the contents 
 of both tubes. The presence of glucose is indicated by a 
 
 469 
 
MEDICAL RECORD. 
 
 dark or black color of the bismuth powder, the litharge 
 retaining its natural color." — (Witthaus' Essentials of 
 Chemistry.) 
 
 13. Urine, (a) Specific gravity, about 1015 to 1025. 
 
 (b) Reaction, acid, (c) Color, yellowish or amber, (d) 
 Constituents: Water; urea, uric acid, hippuric acid, xan- 
 thin, hypoxanthin, creatin, creatinin, extractives ; chlorides, 
 phosphates, sulphates (of sodium, potassium, calcium, and 
 magnesium), (e) About forty to fifty ounces is voided in 
 twenty-four hours. 
 
 14. Three disinfectants: (1) Sulphur dioxide, SO2; (2) 
 Formaldehyde, H COH ; (3) Potassium permanganate, 
 K 2 Mn 2 08. One of the best means of fumigating by formal- 
 dehyde gas is by Trillat's apparatus, which "allows the 
 solution of formalin to flow in a fine stream through a 
 copper coil heated to redness by a flame beneath, and the 
 gas and vapor passing directly into the room. The appa- 
 ratus may be operated outside of a room, and the amount 
 of gas liberated depends directly upon the strength and 
 quantity of the solution evaporated." 
 
 15. Relative proportion of water in: (a) Gastric juice, 
 about 99+ per cent; (b) human milk, about 87 per cent; 
 
 (c) blood, about 78 per cent.; (d) Urine, about 95 per 
 cent. 
 
 DIAGNOSIS. 
 
 i. See French's "Practice of Medicine" (1907), pages 
 146, 148, 126, and 127; or Osier's "Practice of Medicine" 
 (1909), pages 163 and 107. 
 
 2. See French's "Practice of Medicine" (1907), page 284; 
 or Osier's "Practice of Medicine" (1909), page 240. 
 
 3. See French's "Practice of Medicine" (1909), page 317; 
 or Osier's "Practice of Medicine" (1909), page 132. 
 
 4. See French's "Practice of Medicine" (1907), page 510 ; 
 or Osier's "Practice of Medicine" (1909), page 726. 
 
 5. Value of a blood count: Diagnosis may be made of 
 pernicious anemia, secondary anemia, lymphatic leukemia, 
 splenomedullary leukemia, and Hodgkin's disease; also of 
 various inflammatory conditions and conditions in which 
 pus is present. A negative finding is of considerable value. 
 In the first group, the diagnosis is made absolutely by the 
 blood count; in Hodgkin's disease the count is negative; 
 in conditions with pus or inflammations the blood count 
 is of great assistance in arriving at the diagnosis. 
 
 6. See French's "Practice of Medicine" (1907). pages 
 598 and 601. 
 
 7. See French's "Practice of Medicine" (1907), page 569; 
 or Osier's "Practice of Medicine" (iqoq), page 789. 
 
 8. See French's "Practice of Medicine" (1907), page 651 ; 
 or Osier's "Practice of Medicine" (1909), page 604. 
 
 470 
 
MEDICAL RECORD. 
 
 9. See Rose and Carless' "Surgery" (1908), page 872. 
 
 10. See French's "Practice of Medicine" (1907), page 
 755; or Osier's "Practice of Medicine" (1909), page 481. 
 
 11. See Rose and Carless' "Surgery" (1908), page 1121 ; 
 or Da Costa's "Surgery"' (1908), page 838. 
 
 12. See French's "Practice of Medicine" (1907), page 
 822; or Osier's "Practice of Medicine" (1909), page 539. 
 
 13. Symptoms of pyuria may be absent, or slight; there 
 may be pain over neck of bladder, in urethra, or in lumbar 
 region; also scalding pain on urination. To confirm diag- 
 nosis: Centrifuge the urine and examine with microscope; 
 the addition of a 1 per cent, solution of acetic acid makes 
 the nuclei of the cells more evident. Addition or liquor 
 potassse to the deposit of pus cells produces a ropy gela- 
 tinous mass. A bacteriological examination may show the 
 gonococcus, tubercle bacillus, colon bacillus, typhoid ba- 
 cillus, or the ordinary pyogenic bacteria. 
 
 14. See French's "Practice of Medicine" (1907) » page 
 1118: or Osier's "Practice of Medicine" (1909), page 1048. 
 
 15. See French's "Practice of Medicine" (1907), page 
 953; or Osier's "Practice of Medicine" (1909), page 369. 
 
 COMA FROM INTRA- 
 CRANIAL INJURY. 
 
 Deep coma; may 
 have history of on- 
 set after fall or in- 
 jury. Evidence of 
 fracture of vertex 
 or base. 
 
 Pupil dilated on 
 side of lesion. 
 Choked disc. 
 
 Pulse very slow. 
 
 Respiration slow 
 and stertorous. 
 
 Temp erature 
 higher — 101 . 
 
 Urine normal or 
 contains trace of 
 albumin. 
 
 APOPLECTIC 
 COMA. 
 
 Deep coma; sud- 
 den onset. If any 
 injury, only a 
 scalp wound. 
 
 Pupils, unequal 
 or dilated. Con- 
 tracted in hemor- 
 rhage into the 
 pons. 
 
 Pulse full and 
 slow, often arte- 
 riosclerotic, high- 
 tension pulse. 
 
 Respiration slow 
 and irregular. 
 
 Temper ature 
 higher on paralyzed 
 side, but lower in 
 rectum. 
 
 Urine contains 
 trace of albumin, 
 but may be same 
 as in uremia. 
 
 ALCOHOLIC 
 COMA. 
 
 Can be aroused 
 by supraorbital 
 pressure unless 
 very profound. 
 
 Pupils normal or 
 somewhat dilated. 
 
 Pulse more rapid 
 than normal and 
 full. 
 
 Regular respira- 
 tion. 
 
 May be low or 
 normal. 
 
 Normal, 
 
 47i 
 
MEDICAL RECORD. 
 
 COMA FROM INTRA- 
 CRANIAL INJURY. 
 
 Hemiplegia on 
 opposite < side to 
 that of injury. If 
 contusion of brain 
 is also present, 
 may have gener- 
 alized convulsions. 
 
 APOPLECTIC 
 COMA. 
 
 Hemiplegia with 
 convulsions on one 
 side. 
 
 PATHOLOGY. 
 
 i. See French's "Practice of Medicine" (1907), pages 
 1062 and 1063; or Osier's "Practice of Medicine" (1909), 
 page 924. 
 
 2. See Rose and Carless' "Surgery" (1908), page 220; 
 or Da Costa's "Surgery" (1908), page 339. 
 
 3. Syphilitic ulcer: "The initial lesion first presents 
 small areas of round-cell infiltration in the deeper layers 
 of the skin or mucous membrane, and as a rule in the 
 neighborhood of the blood-vessels. The connective tis- 
 sue at the same time undergoes proliferative change, and 
 spindle-shaped cells or irregular embryonal connective tis- 
 sue cells are found mingled with the round lymphoid cells, 
 or surrounding the foci of the latter. Thickening of the 
 blood-vessels may be observed in the later stages or from 
 the very first. The tissue elements of the skin and of the 
 subcutaneous tissue are usually separated by infiltrating 
 liquid, and the latter may loosen the tissues of the surface 
 and cause exfoliation of the superficial epidermis, and thus 
 lead to the development of the primary vesicle or the ero- 
 sion so commonly seen. The induration of the chancre is 
 probably the result of the sclerosis of the vessels and the 
 general connective tissue hyperplasia, as well as in part 
 due to the tense infiltration of serous liquid." — (Stengel's 
 Pathology.) 
 
 4. In lymphatic leukemia the blood shows : An enormous 
 increase in the number of white cells, chiefly in the lympho- 
 cytes, which may be 90 per cent, of the whole number; the 
 polynuclears are greatly diminished; there are no myelo- 
 cytes; the red cells are not much affected, but may 
 show a slight diminution in number and in hemoglobin. 
 In Hodgkin's disease the blood may be normal or there 
 may be a slight or severe anemia, with diminution of red 
 cells; sometimes leucocytosis occurs. In Trichinosis there 
 is a leucocytosis, with a pronounced increase in the eosino- 
 phites. 
 
 5. Three varieties of thrombus: (1) Red thrombus, 
 which originates from blood at rest, such as after ligature 
 of the femoral artery for popliteal aneurysm. It is soft, 
 
 472 
 
MEDICAL RECORD. 
 
 not laminated, consists of a loose network of fibrin which 
 entangles very many red corpuscles and a few leucocytes; 
 it adheres to the vessel wall and later contracts. * (2) 
 White thrombus, which originates from circulating blood, 
 such as is found in an aortic aneurysm; it is firmer than 
 the above, it is laminated, it is dense; it is composed 
 chiefly of leucocytes, but red cells are also present, as well 
 as fibrin network and some granular material, probably 
 derived from broken down blood platelets. (3) Parietal 
 thrombus is one which adheres to the vessel wall, but only 
 partially occludes the blood-vessel, in opposition to an 
 obstructive or obliterating thrombus, which absolutely ob- 
 structs the blood channel. 
 
 6. See Osiers "Practice of Medicine" (1909), page 968. 
 
 7. See French's "Practice of Medicine" (1907), page 
 1030; or Osier's "Practice of Medicine" (1909), page 902. 
 
 8. In acute metritis "the uterus is enlarged, congested, 
 soft, plastic, and infiltrated with the inflammatory exudate. 
 Microscopically, the chief changes are observed along the 
 bloodvessels and lymphatics, where a round-cell infiltration, 
 more or less marked, can be observed. Here and there 
 small abscesses may be seen. The muscle cells may show 
 signs of degeneration. In exaggerated cases of puerperal 
 metritis, gangrene of the tissues may occur. Thrombosis 
 of the uterine sinuses and veins is common, and suppura- 
 tive lymphangitis is frequent in and about the organ." — 
 (McFarland's Pathology.) 
 
 9. Metastasis is the transfer of some pathological condi- 
 tion from one part of the body to another, not immedi- 
 diately connected with it. The most frequent channels of 
 metastasis are the blood and lymphatics. 
 
 BACTERIOLOGY. 
 
 10. A spirillum is a rod-shaped bacterium spirally 
 twisted, and somewhat resembling a corkscrew. Example: 
 The spirillum of Asiatic cholera, which is motile, flagel- 
 lated, liquefying, non-sporogenous, non-chromogenic, aero- 
 bic, parasitic, and saprophytic, stains with the ordinary 
 dyes, but is Gram negative, and causes Asiatic cholera. 
 
 11. The Streptococcus pyogenes is a micrococcus, of 
 spherical shape, and arranged in chains of about thirty or 
 forty cocci (in liquid media), but the chains are much 
 shorter in solid media. Each coccus is about one-half to 
 two mikrons in diameter. It is not motile, does not form 
 spores, does not liquefy gelatin, and stains readily with the 
 ordinary anilin dyes, and by Gram's method. It has been 
 found in meningitis and erysipelas. 
 
 12. The microorganism of influenza is PfeifTer's bacillus. 
 This is a small, non-motile, non-flagellated, non-sporogen- 
 ous, nonliquefying, non-chromogenic, aerobic bacillus, stain- 
 
 473 
 
MEDICAL RECORD. 
 
 ing by ordinary stains, but Gram negative; its cultivation 
 requires the presence of hemoglobin. 
 
 13. The characteristics of the bacillus of diphtheria: The 
 bacilli are from 2 to 6 mikrons in length and from 0.2 to 
 1.0 mikron in breadth; are slightly curved, and often have 
 clubbed and rounded ends; occur either singly or in pairs, 
 or in irregular groups, but do not form chains; they have 
 no flagella, are nonmotile, and aerobic; they are noted for 
 their pleomorphism ; they do not stain uniformly, but stain 
 well by Gram's method and very beautifully with Loeffler's 
 alkaline-methylene blue. Two associated organisms: 
 Streptococcus pyogenes and micrococcus lanceolatus. 
 
 14. Lobar pneumonia is usually caused by the Micro- 
 coccus lanceolatus, better known as the Diplococcus lanceo- 
 latus, or the pneumococcus of Fraenkel and Weichsel- 
 baum. Process of staining: Spread a cover glass with a 
 smear containing the bacteria, dry it, then fix it in a flame. 
 It can then be stained for from five to ten minutes in 
 Ehrlich's solution ; it is then to be washed in water and 
 afterwards immersed in Gram's solution for two or three 
 minutes. It is then washed in 95 per cent, alcohol. While 
 in the Gram's solution the specimen is very dark brown, 
 but it becomes violet or blue again on application of the 
 alcohol. 
 
 15. Four sources of infection: (1) The air; (2) food 
 or water; (3) wounds; (4) unclean implements of all 
 kinds. Their comparative importance cannot be estimated, 
 because certain microorganisms have their special avenues 
 of infection, thus the typhoid bacillus enters by the diges- 
 tive tract. 
 
 surgery. ■ 
 
 1. See Rose and Carless' "Surgery" (1908), page 1318; 
 or Da Costa's "Surgery" (1908), page 1046. 
 
 2. See Rose and Carless' "Surgery" (1908), page 261; or 
 Da Costa's "Surgery" (1908), page 124. 
 
 3. See Rose and Carless' "Surgery" (1908), page 1132; 
 or Da Costa's "Surgery" (1908), pages 138 and 142. 
 
 4. Tetanus is to be feared. See Rose and Carless' 
 "Surgery" (1908), page 235; or Da Costa's "Surgery" 
 (1908), page 251. 
 
 5. See Rose and Carless' "Surgery" (1908), page 195; or 
 Da Costa's "Surgery" (1908), page 302. 
 
 6. See Rose and Carless' "Surgery" (1908), page 131 1 ; or 
 Da Costa's "Surgery" (1908), page 1218. 
 
 7. Indications for osteotomy: Deformities of bones and 
 joints (such as result from congenital conditions) ; dis- 
 eases of bones and joints, followed by curvature or an- 
 gularity; ankylosis; and malunion following fracture. 
 
 See Rose and Carless' "Surgery" (1908), page 448; or 
 Da Costa's "Surgery" (1908), page 612. 
 
 474 
 
MEDICAL RECORD. 
 
 8. See Rose and Carless' "Surgery" (1908), pages 621 and 
 622 ; or Da Costa's "Surgery" (1908), pages 587 and 590. 
 
 9. See Rose and Carless' "Surgery" (1908), page 759; or 
 Da Costa's "Surgery" (1908), page 763. 
 
 10. See Rose and Carless' "Surgery" (1908), pages 989 
 and 991; or Da Costa's "Surgery" (1908), pages 826 and 
 829. 
 
 11. See Rose and Carless' "Surgery" (1908), page 311; 
 or Da Costa's "Surgery" (1908), page 361. 
 
 12. See Rose and Carless' "Surgery" (1908), page 446; 
 or Da Costa's "Surgery" (1908), page 611. 
 
 13. See Rose and Carless' "Surgery" (1908), pages 1226 
 J and 1227; or Da Costa's "Surgery" (1908), page 1187. 
 
 14. Trachoma. Subjective symptoms: "More or less 
 photophobia, lachrymation, itching and burning sensations, 
 feeling of foreign body, pain, and visual disturbance. In 
 a good many cases there are no subjective symptoms." 
 
 Objective symptoms: "Swelling of the lids, narrowing 
 of the palpebral aperture, and drooping of the upper lid 
 (from weight and swelling). There is a variable amount 
 of mucopurulent discharge, marked in recent cases, scanty 
 in chronic forms. The conjunctiva of the tarsus and 
 fornix is reddened, thickened, and uneven, on account of 
 hypertrophy and the occurrence of granules. The ocular 
 conjunctiva is often somewhat injected." 
 
 Treatment "consists in an attempt to reduce the inflam- 
 matory symptoms and secretion, and to check and remove 
 hypertrophy of the conjunctiva, thus shortening the dura- 
 tion and diminishing the liability to conjunctival cicatriza- 
 tion and to sequelae. This is accomplished either by the 
 use of certain irritating applications, or by mechanical 
 (surgical) means. "Irritating applications: Sulphate of 
 copper in the form of a crystal or pencil is the favorite 
 local application. Nitrate of silver (1 or 2 per cent, solu- 
 tion), glycerole of tannin (5 to 25 per cent.), and the alum 
 stick are also employed. Mechanical (surgical) treatment 
 includes expression, grattage, excision, curetting, elec- 
 trolysis, ^r-rays, and galvano cautery." — (May's Diseases of 
 the Eye.) 
 
 15. See Rose and Carless' "Surgery" (1908), page 869. 
 
 obstetrics and gynecology. 
 
 1. See Williams' "Obstetrics" (1909), page 611; or 
 Hirst's "Obstetrics" (1909), page 267. 
 
 2. See Williams' "Obstetrics" (1909), pages 167 and 
 185; or Hirst's "Obstetrics" (1909), page 180. 
 
 3. See Williams' "Obstetrics" (1909), page 199; or Hirst's 
 "Obstetrics" (1909), page 188. 
 
 4. See Williams' "Obstetrics" (1909), pages 201, 343, and 
 355; or Hirst's "Obstetrics" (1909), page 371. 
 
 475 
 
MEDICAL RECORD. 
 
 5. See Williams' "Obstetrics" (1909), page 190; or 
 Hirst's "Obstetrics" (1909), page 204. 
 
 6. See Williams' "Obstetrics" (1909), page 414; or Hirst's 
 "Obstetrics" (1909), page 811. 
 
 7. See index to Williams' "Obstetrics" or Hirst's "Ob- 
 stetrics," under heading "Dystocia." 
 
 8. See Williams' "Obstetrics" (1909), page 915; or Hirst's 
 "Obstetrics" (1909), page 256. 
 
 9. See Williams' "Obstetrics" (1909), page 298; or Hirst's 
 "Obstetrics" (1909), page 343. 
 
 10. The indications for version are: (1) In transverse 
 presentations; (2) in placenta praevia; (3) in representa- 
 tions of the head; (4) in simple flattened pelvis, and in 
 minor degrees of pelvic contraction; (5) in prolapsed 
 funis; (6) in sudden death of the mother, and (7) in any 
 case where speedy delivery is imperative. 
 
 See Williams' "Obstetrics" (1909), pages 434, 437, and 
 439; or Hirst's "Obstetrics" (1909), page 829. 
 
 11. See Hirst's "Obstetrics" (1909), pages 867 to 873. 
 
 12. See Williams' "Obstetrics" (1909), pages 535, 525, 
 and 541; or Hirst's "Obstetrics" (1909), pages 628, 630, 
 and 635. 
 
 13. See Williams' "Obstetrics" (1909), page 289; or 
 Hirst's "Obstetrics" (1909), page 419. 
 
 14. Vaginitis is a condition of inflammation of the va- 
 gina. It is characterized by redness, swelling, pain, heat, 
 irritation, and increased secretion. There may be frequent 
 and painful urination. Treatment consists in rest, cleanli- 
 ness, douches, the application of soothing lotions, and re- 
 moval of any cause ; salines and anodynes are also indi- 
 cated. Vaginismus is a condition of painful and spasmodic 
 contraction of the vaginal orifice, which renders coitus 
 either painful or altogether impossible. The slightest touch 
 causes painful spasms, and examination may be impossible 
 without an anesthetic. The treatment consists in removing 
 the cause when possible, tonics and general constitutional 
 treatment, dilatation of the vaginal orifice; local applica- 
 tion of a 5 per cent, solution of cocaine will relieve the 
 hyperesthesia and allow coitus. The condition is some- 
 times incurable. 
 
 15. Chronic endometritis. Causes: Debility, repeated 
 pregnancies, lacerations, and subinvolution of uterus, fib- 
 roids, gonorrhea, or sepsis. Pathology: The mucous mem- 
 brane is swollen, red, and soft; blood extravasations may 
 be found in some places; the cervical glands may become 
 occluded and form cysts ; mucous polypi or other excres- 
 cences may be present; the os may be eroded or granular. 
 Microscopical examination shows a great development 
 of the utricular glands, round-cell infiltration, and dilated 
 blood-vessels. Later the mucous membrane becomes atro- 
 
 476 
 
MEDICAL RECORD 
 
 phic, and the glands are replaced by connective tissue 
 fibers. Symptoms: Neuralgic, bearing-down pains; 
 cramps; dysmenorrhea; irritable bladder; menorrhagia or 
 metrorrhagia; leucorrhea, which may be blood-stained or 
 purulent; profuse hydrorrhea; loss of appetite, constipa- 
 tion, dyspnea, palpitation, sterility. The uterus as a whole 
 is abnormally tender; the uterine cavity is enlarged; the 
 external os is patulous, and shows a tendency to bleed on 
 being touched. Diagnosis: "In lumbo abdominal neuralgia 
 the uterus may be sensitive, especially in the region of the 
 internal os, but there is no leucorrhea or hemorrhage. A 
 myoma is often accompanied by these symptoms, but then 
 the tumor can be felt. A -fibroid polypus can be diagnosti- 
 cated with the sound. The differentiation from beginning 
 carcinoma may be difficult. In this the neoplasm is so 
 friable that a small portion of it may be detached by the 
 mere examination. Around the new growth is an in- 
 durated ring as hard as a board. Sometimes pieces of the 
 neoplasm may be expelled spontaneously from the interior 
 of the uterus. Bleeding occurring after the menopause is 
 very suspicious. Pain need not be present. If there is 
 any doubt, a small piece should be cut out of the cervix, 
 or scrapings gained by curettage of the cavity of the uterus. 
 These should be hardened and sections examined with the 
 microscope, when the different histological composition 
 will settle the question. A bloody, purulent, offensive 
 discharge may be found in endometritis, and is not suffi- 
 cient for the diagnosis of malignant disease." — (Garrigues' 
 Gynecology.) 
 
 HYGIENE AND SANITATION. 
 
 i. Functions of vegetable acids: They are converted into 
 carbonates, which aid in maintaining the alkalinity of the 
 blood and other fluids; they also tend to prevent scurvy, 
 and furnish a small amount of heat and energy. 
 
 2. In collecting and storing rain water for drinking: 
 The first flow should be allowed to run to waste ; this is to 
 ensure cleanliness. The cisterns for storage should allow 
 of easy inspection and cleansing; they should be kept 
 covered so as to exclude dirt, dust, insects, animals, and 
 lieht; overflow pipes should discharge into the open air 
 and not into the sewer, and the opening should be covered 
 to keep out small animals and foreign matter ; the cisterns 
 should be well ventilated, and regularly and thoroughly 
 inspected. 
 
 3. General rules for bathing: One should not bathe 
 within two hours after a meal, or when tired or heated; 
 avoid chilling; do not bathe in the open air if the body 
 feels chilly or the hands and feet become numbed; those 
 subject to giddiness, fainting, or cardiac discomfort should 
 not bathe out of doors. Cold baths have a tonic and stimu- 
 
 477 
 
MEDICAL RECORD. 
 
 lating effect, the pulse is increased in force and frequency, 
 the respirations are deeper. Cold baths should not be 
 taken by those suffering from organic heart disease or 
 who become chilled thereby, or by women in the later 
 months of pregnancy. 
 
 4. The desks should be so placed that the light comes 
 from the left of the pupils. If it comes from the right, 
 shadows are cast across the writing; if it comes from 
 both sides, double shadows are cast; if it comes from 
 behind, shadows of the body are cast on the writing or 
 work; light from the front is very trying to the eyes. 
 
 5. Water can be freed from bacteria by the use of a 
 Pasteur-Chamberland filter, or a Berkefeld filter ; also by 
 sterilization by heat — boiling. 
 
 6. The sewer should be circular or egg-shaped in sec- 
 tion; it should be laid in as straight a line as possible, and 
 with a regular fall; the junctions should be oblique, so 
 that the sewage may enter in the direction of the flow; 
 if it curves, it should do so with a very wide sweep; it 
 should be made of well cemented brickwork, with the 
 interior smoothly finished; there should be ample arrange- 
 ments for ventilation, flushing, and inspection; the fail 
 should not be too great or too rapid, or the water will 
 run away rapidly and the solid matter will be left behin 1. 
 
 7. Unripe fruit is unwholesome because: (1) It causes 
 malfermentation in the stomach and intestines; (2) it 
 causes colic, cramps, pain, diarrhea, and vomiting; (3) >t 
 may cause gastritis, or choleraic diarrhea; (4) the tannin 
 and vegetable acids which it contains are very astringent 
 and acid. Fruits are valuable as food because they fur- 
 nish nutriment, convey water to the system, relieve thirst, 
 stimulate the appetite, improve digestion, give variety to 
 the diet, introduce various salts and organic acids which 
 improve the quality of the blood and react favorably upon 
 the secretions. — (From Thompson's Dietetics.) 
 
 8. A milk epidemic is characterized by the suddenness 
 with which it makes its appearance, the sufferers being for 
 the most part attacked at about the same time. The in- 
 fected houses will be found to have been supplied, almost 
 without exception, by the particular milk vendor whose 
 supply is at fault ; but it will occasionally _ happen that 
 infected houses are discovered to which milk has been 
 supplied by a different vendor, this circumstance being 
 often due to the fact that the vendors on their rounds 
 very commonly buy small quantities of milk from each 
 other. Sometimes valuable corroborative testimony im- 
 plicating the milk is forthcoming in the circumstance that 
 some of those in the infected households, who have con- 
 sumed no unboiled milk, have escaped; and that house- 
 holds supplied from the implicated dairy, but in which no 
 
 478 
 
MEDICAL RECORD 
 
 unboiled milk is consumed at all, have entirely escaped. — 
 ( Parkes' Hygiene. ) 
 
 g. Koumyss is an effervescing fermented liquor, origin- 
 ally made from mare's milk ; but it is now made from 
 cow's milk, with sugar of milk, and allowed to ferment in 
 open tanks, the casein and butter are skimmed off, and the 
 koumyss is bottled during fermentation. 
 
 Kefir is a fermented drink made from milk by the addi- 
 tion of a special mushroom-like ferment. It contains about 
 four times as much albuminoids (casein, etc.) as koumyss. 
 
 10. How antitoxin produces immunitv and effects cure is 
 not known, but theories deduced from observed facts are 
 as follows : "As the various pathogenic bacteria produce 
 the causative toxins of their respective diseases, so the 
 organic ceils of the body, reacting under the stimulus of 
 the poisons thus introduced, immediately proceed to elab- 
 orate defensive bodies, which if produced in sufficient quan- 
 tity will neutralize the effects of the toxins. Residual 
 antibodies remaining in the blood after recovery render 
 the animal immune for a time against the disease. The 
 immunizing and curative effects obtained by the injection 
 of the blood serum of an immunized animal into the 
 circulation of another animal are due either to direct 
 chemical neutralization of the toxins themselves by the 
 antibodies so introduced (Behring, Kitasato), or to a par- 
 ticular influence exerted by the antibodies upon the living 
 cells of the organism which, being affected in two opposite 
 directions, remain neutral to the disease (Buchner). Some 
 authorities hold that these results are due to the conjoint 
 action of leucytic and chemical forces. Ehrlicli's side 
 chain theory assumes that every toxin contains toxophore 
 molecules having direct toxic action, and haptophore mole- 
 cules which combine the toxophores with a similar com- 
 bining group of molecules in the tissue cell of the attacked 
 organism. The tissue cell molecules being destroyed by 
 the toxophores, a rapid and profuse regeneration of similar 
 molecules occurs in side chains, and these molecules over- 
 growing are carried into the circulation, becoming the 
 antitoxin, which acts by combining with the haptophores 
 of newly arrived toxin, using up their combining power 
 before they can reach the tissue cells."— (Potter's Materia 
 Medica, etc.) 
 
 ii. For disinfecting ships and cargoes, there are used: 
 Formaldehyde: sulphur dioxide, or sulphurous acid; live 
 steam; acid bichloride of mercury. For method of disin- 
 fecting by formaldehyde, see above, Chemistry, 14 
 
 12. The principal means of preventing the spread of con- 
 tagious diseases in schools, are : Regular and efficient in- 
 spection by physicians; prompt exclusion and isolation of 
 anyone suffering from a contagious disease, or coming 
 
 479 
 
MEDICAL RECORD. 
 
 from a house where such disease is; compulsory vaccina- 
 tion; compulsory notification of all infections and con- 
 tagious disease; individual towels, drinking vessels, and 
 other implements; children who have had a contagious 
 or infectious disease, or who have come from a house 
 where such disease prevailed, should not be readmitted to 
 school until sufficient time has elapsed since the occurrence 
 of the last case to insure safety. 
 
 13. Tuberculosis, • trichinosis, tape-worm, ptomaine poi- 
 soning, echinococcus disease, and anthrax. 
 
 14. Malaria: "It has ever been held that the most in- 
 timate relation exists between the soil and malaria, es- 
 pecially prominent in districts abounding in marsh lands. 
 It has been noticed repeatedly that in malarious countries 
 the upturning and excavation of wet or damp soil are 
 commonly followed by the occurrence of the disease among 
 the laborers so engaged; that infection is more common 
 among those who go about at night, and especially among 
 those who sleep out of doors; and that the draining of 
 marsh lands is often followed by the disappearance of the 
 disease. All of these facts are compatible with the theory 
 of transmission by mosquitoes, and it is now accepted 
 generally that malaria is connected with soil conditions 
 only in so far as the latter permit the breeding of the 
 specific mosquitoes." 
 
 Yellow Fever: "There is no evidence of connection 
 between the soil and outbreaks of yellow fever, although 
 for many years such a relation was assumed to exist. The 
 disease is mosquito-borne." — Harrington's Practical Hy- 
 giene, i 
 
 15. (a) In beefy protein; (b) in wheat, carbohydrates; 
 (c) in eggs, protein and fats, predominate. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 North Carolina Board of Medical Examiners. 
 
 anatomy. 
 
 (Answer only ten questions.) 
 
 1. Name the bones of the head and describe the frontal 
 bone. 
 
 2. Where does abdominal aorta commence and where 
 does it terminate? Name its branches. 
 
 3. Name the principal lobes of the brain and the fissures 
 dividing them. 
 
 4. Give the origin and function of the trigeminus (fifth 
 cranial) nerve, and name the divisions of the same. 
 
 5. With what bones does the astragalus articulate ? 
 
 6. Describe the stomach, give its average size, attach- 
 
 480 
 
MEDICAL RECORD. 
 
 ments, regional location, gross structure, blood and nerve 
 supply. 
 
 7. Give origin, insertion, and action and nerve supply of 
 the following muscles : deltoid, soleus, and quadratus lum- 
 borum. 
 
 8. Give the surgical anatomy of femoral hernia. 
 
 9. Locate and describe the ovaries. 
 
 10. Give a histological description of an artery. 
 
 11. Describe the rectum. 
 
 12. Describe the iris, give its blood and nerve supply. 
 
 PHYSIOLOGY AND HYGIENE. 
 
 1. What evidence is there that the secretion of urine is 
 not a simple process of filtration from the blood? State 
 the probable nature of the stimulation controlling the secre- 
 tion of urine. 
 
 2. Explain the structure and use of each of the three 
 coats of blood vessels. 
 
 3. Name the principal centers of organic function situ- 
 ated in the medulla oblongata. 
 
 4. Give the teachings as to the (a) origin, (b) func- 
 tions, (c) variations in number of leucocytes. 
 
 5. Define the functions of carbohydrate foods. 
 
 6. Discuss enzymes, giving (a) their general character, 
 (b) six principal ones, where chiefly found, and their re- 
 spective actions in the process of digestion. 
 
 7. What is the significance of (a) nitrates and (b) 
 nitrites found in drinking water? 
 
 8. Give the prophylaxis of uncinariasis. 
 
 9. Discuss municipal supervision of a city's milk supply. 
 
 10. Discuss the contamination of air in dwellings conse- 
 quent upon improper lighting, heating, and ventilation. 
 
 MATERIA MEDICA. 
 
 1. Name the organs influenced by (a) a cholagogue, (b) 
 a sialogogue, (<:)an oxy toxic, (d) a diaphoretic, (e) a 
 mydriatic. 
 
 2. Give the official name, using the correct Latin termi- 
 nations, of (a) Epsom salts, (b) Dover's powder, (c) 
 calomel, (d) salol, (e) Fowler's solution, (/) Hoffman's 
 anodyne, (g) cod liver oil, (h) sulphonal, (i) aristol, (/) 
 spirit of nitroglycerin. 
 
 3. Define a tincture. Name four of the most important 
 official tinctures and state per cent, strength of each. 
 
 4. Give the dose of (a) apomorphina? hydrochloridum. 
 (b) arseni trioxidum, (c) chloralum hydratum, (d) atro- 
 pine sulphas, (e) hydrargyri chloridum corrosivum, (/) 
 strychnine sulphas, ~(g) hexamethylenamine, (h) tinctura 
 aconiti, (i) tinctura gelsemii, (/) glandula suprarenalis 
 sicca. 
 
 481 
 
MEDICAL RECORD. 
 
 5. Give specific treatment for diphtheria and state (very 
 
 briefly) how the remedy is obtained. 
 
 6. Give specific remedy for myxedema. 
 
 7. Write a prescription for dysentery. 
 
 8. Name four drugs which might be useful as local 
 applications in tonsillitis (official remedies only). 
 
 9. Name five agents (not official drugs) which fre- 
 quently cause poisoning. 
 
 10. Give specific - antidote for poisoning by (a) bichlo- 
 ride of mercury, (b) arsenic, (c) iodine, (d) opium (emet- 
 ics, stomach pump, etc., being taken for granted). 
 
 CHEMISTRY AND DISEASES OF CHILDREN. 
 
 1. A patient is found with a temperature of 104 Fahren- 
 heit. Express this in Centigrade, (b) Express the equiva- 
 lent of one grain (decimally) in grams. 
 
 2. Methyl alcohol: give (a) common name, (d) uses, 
 (e) dangers. 
 
 3. Define combustion, and state what takes place when 
 coal is burned. 
 
 4. What is fractional distillation? 
 
 5. Name four mineral acids used in medicine and give 
 formula of each. 
 
 6. Ophthalmia neonatorum : (a) etiology and symp- 
 toms; (by Crede method of prophylaxis; (c) treatment, 
 general and medicinal. 
 
 7. Describe Kernig's symptom of cerebrospinal menin- 
 gitis. 
 
 8. Give diagnosis and treatment of acute intussusception. 
 
 9. Describe the eruptions in (a) chickenpox, (b) small- 
 pox, (c) measles, (d) scarlet fever. 
 
 10. Give most common complication in scarlet fever and 
 treatment of same. 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 i. Describe the uterus, its normal position, its relation- 
 ship to other organs, and means by which it is held in place. 
 
 2. Give symptoms and treatment of placenta prsevia. 
 
 3. What is phlegmasia alba dolens? At what time does 
 it occur? What is the treatment? 
 
 4. What are the danger signals of impending eclampsia? 
 Give treatment of eclampsia at eighth month of pregnancy. 
 
 5. Define abortion^ miscarriage, and premature labor. 
 Give treatment of an incomplete abortion. 
 
 6. Give the etiology and treatment of an acute general 
 cystitis. 
 
 7. Define plastic operations as applied to gynecology. 
 
 8. What is the differential diagnosis between ascites and 
 ovarian cyst. practice of medicine. 
 
 1. Give differential diagnosis between peptic ulcer and 
 carcinoma of stomach. 
 
 482 
 
MEDICAL RECORD 
 
 2. Give physical signs in croupous pneumonia — in the 
 stage of _ solidification, and differentiate from pleurisy 
 with effusion. 
 
 3. In aortic and mitral insufficiency, where is the mur- 
 mur heard most distinctly, and its direction of transmission? 
 
 4. Give etiology of cerebrospinal meningitis, (epidemic) 
 and characteristic symptoms. 
 
 5. Define arteriosclerosis, and give chief causes produc- 
 ing it. 
 
 6. Give symptoms of hemorrhage in typhoid fever, and 
 treatment. 
 
 7. What is the chief cause of locomotor ataxia? Give 
 symptoms briefly in initial and ataxic stages. 
 
 8. What conditions are found in examination of urine 
 and circulation in chronic interstitial nephritis? 
 
 9. Give briefly treatment for acute articular rheumatism. 
 
 10. Write one prescription for local treatment of ery- 
 sipelas. 
 
 SURGERY. 
 
 (Answer only ten questions.) 
 
 1. What is pathology and treatment of paronychia? 
 
 2. What is pathology and treatment of osteomyelitis of 
 tibia? 
 
 3. Describe operation for radical cure of oblique inguinal 
 hernia. 
 
 4. Describe operation for acute catarrhal appendicitis. 
 
 5. How would you treat a patient who had suddenly 
 ceased to breathe while inhaling chloroform? 
 
 6. Describe method of preparing hands for a surgical 
 operation or obstetrical examination. 
 
 7. Why do we have abscess of the liver following puru- 
 lent appendicitis? 
 
 8. What is the rule as to fixation of joints above and 
 below a fracture? 
 
 9. How do you differentiate between chancre and chan- 
 croid? What is period of incubation for each treatment? 
 
 10. Describe operation for talipes equinovarus. 
 
 11. For the diagnosis of what disease is the Wasser- 
 mann reaction used? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 North Carolina Board of Medical Examiners. 
 
 anatomy. 
 
 1. Bones of the head: Occipital, two parietal, two tem- 
 poral, ethmoid, sphenoid, frontal, two lacrymal, two malar, 
 two nasal, two palate, two superior maxillary, inferior 
 maxillary, vomer, and two inferior turbinated. 
 
MEDICAL RECORD. 
 
 The frontal bone consists of a vertical and a horizontal 
 portion. The external surface of the vertical portion is 
 convex, and presents the frontal eminence on either side 
 of the median line; the superciliary ridges, produced by 
 the frontal sinuses, beneath, below which is the supraorbi- 
 tal arch, forming the upper boundary of the orbit, and 
 terminating on either side in the external angular process, 
 articulating with the malar bone and the internal angular 
 process, articulating with the lacrymal bone, and having at 
 its inner third a notch or foramen, the supraorbital foramen, 
 for passage of supraorbital artery, nerve, and vein. Ascending 
 from the external angular process is the temporal ridge 
 for attachment of temporal fascia. Between the internal 
 angular processes is the nasal notch, for articulation with 
 the nasal bone, and nasal process of superior maxilla, ter- 
 minating below in the nasal spine, and above it projects 
 the nasal eminence, or glabella, marking the location of the 
 frontal sinuses. The posterior surface lodges the anterior 
 lobes of the brain. In the median line is the frontal crest, 
 which gives attachment to the falx cerebri, and terminates 
 below in the foramen cecum. The crest is grooved for 
 longitudinal sinus, and has on either side of it depressions 
 for the Pacchionian bodies. This surface is also grooved 
 for anterior meningeal arteries. The external surface of 
 the horizontal portion is concave, to form the roof of the 
 orbit, and separated from the opposite side by the eth- 
 moidal notch. To the outer side is a depression for the 
 lacrymal gland, and to the inner side one for the pulley of 
 superior oblique. On the margin of the orbital plate are 
 two notches converted into foramina by articulation with 
 the ethmoid, the anterior ethmoidal canal, for passage of 
 nasal nerve and anterior ethmoidal vessels, and the poste- 
 rior ethmoidal canal, for passage of posterior ethmoidal 
 vessels. The internal surface is marked by the convolu- 
 tions of the anterior lobes of the brain. Between the two 
 plates of the vertical portion are the frontal sinuses. It 
 articulates with the parietal, sphenoid, ethmoid, nasal, 
 superior maxillary, lacrymal, and malar bones. Its muscu- 
 lar attachments are three pairs — corrugator supercilii, 
 articularis palpebrarum, and temporal. It is developed from 
 membrane. — (After Young.) 
 
 2. The abdominal aorta commences at the aortic opening 
 in the diaphragm, in front of the lower border of the body 
 of the twelfth dorsal vertebra; it terminates at about the 
 body of the fourth lumbar vertebra, where it bifurcates 
 into the two common iliac arteries. Its branches are: 
 Phrenic, celiac axis (gastric, hepatic, and splenic), supe- 
 rior mesenteric, suprarenal, renal, spermatic (or ovarian), 
 inferior mesenteric, lumbar, and sacra media. 
 
 3. The principal lobes of the brain are : Frontal, parietal, 
 
 484 
 
MEDICAL RECORD. 
 
 occipital, temporosphenoidal, Island of Reil, and limbic 
 lobe. The principal fissures are : The great longitudinal 
 (separating the two cerebral hemispheres) ; the great 
 transverse fissure (between cerebrum and cerebellum) ; the 
 Sylvian fissure ; the fissure of Rolando ; the parietoocci- 
 pital fissure. 
 
 4. Trigeminus (fifth cranial nerve). Origin: Superficial, 
 from side of pons Varolii ; deep, from medulla, and floor 
 of fourth ventricle. Divisions and Functions: First, 
 ophthalmic; sensory to anterior half of scalp, conjunctiva 
 and skin of upper eyelid, cornea, skin of nose, mucous 
 membrane of nose, lacrymal gland. Second, superior max- 
 illary; sensory to conjunctiva and skin of lower eyelid, 
 nose, cheek, upper lip, palate, upper teeth, and alveolar 
 processes. Third, inferior maxillary ; sensory to external 
 auditory meatus, side of head, mucous membrane of mouth, 
 anterior two-thirds of tongue, lower lip, teeth and alveolar 
 processes of lower jaw. It is also motor to the muscles of 
 mastication (temporal, masseter, two pterygoids), mylo- 
 hyoid, and anterior belly of the digastric. 
 
 5. The astragalus articulates with : Tibia, fibula, os 
 calcis, and scaphoid (or navicular). 
 
 6. Stomach is conical, with base to left side; the upper 
 border is concave, and is called the lesser curvature; the 
 lower border is convex, and is named the greater curva- 
 ture. The left extremity is known as the fundus, above 
 and to the right of which is the cardiac orifice, and the 
 right or small end is termed the pyloric extremity. It occu- 
 pies left hypochondriac and epigastric regions. Its orifices 
 are cardiac, above, communicating with the esophagus; 
 pyloric, at the right extremity, passing into the duodenum. 
 It is 10 to 12 inches long, 4 to 5 inches in diameter at 
 widest part. Its left or cardiac end is fixed by esophagus 
 and gastrophrenic ligament to diaphragm, lying beneath 
 the seventh left costal cartilage, one inch from sternum; 
 it is connected with the spleen by the gastrosplenic omen- 
 tum. The right or pyloric end reaches the gall-bladder, 
 touching under part of quadrate lobe of liver; is very 
 movable ; when stomach is empty is in midline four inches 
 below tip of gladiolus. Anterior surface, which also looks 
 upward, is in contact with, from left to right, diaphragm, 
 abdominal parietes (epigastric region), under surface of 
 liver. Posterior surface is separated from pancreas, crura 
 of diaphragm, aorta, vena cava inferior, and solar plexus, 
 by lesser sac of peritoneum. Superior border is attached 
 to liver by small omentum. Inferior border gives attach- 
 ment to great omentum. Coronary and pyloric arteries 
 run along lesser curvature ; right and left gastroepiploic, 
 along inferior or greater curvature; vasa brevia, from the 
 splenic to fundus. Right pneumogastric nerve supplies to 
 
 ,0- , 
 
MEDICAL RECORD. 
 
 posterior surface; left pneumo gastric, the anterior sur- 
 face; sympathetic, from the solar plexus, both surfaces. — 
 {Aids to Anatomy.) 
 
 7. Deltoid. Origin: From the outer third of anterior 
 border and upper surface of the clavicle, from the outer 
 margin and upper surface of the acromion process, and 
 from the lower edge of the spine of the scapula. Insertion: 
 Into the deltoid impression on the middle of the outer side 
 of the shaft of the humerus. Action: It raises the arm 
 from the side so as to bring it at right angles with the 
 body; its anterior fibers draw the arm forward; its poste- 
 rior fibers draw the arm backward. Nerve supply: The 
 circumflex. 
 
 Soleus. Origin: From back of head of the fibula, and 
 upper part of the posterior surface of shaft of fibula; 
 from oblique line of tibia, and middle third of internal 
 border of tibia. Insertion: Into lower part of posterior 
 surface of os calcis. Action: To extend the foot, raise the 
 heel; also in walking, standing, dancing. Nerve supply: 
 Internal popliteal and posterior tibial. 
 
 Quadratus lumborum. Origin: From iliolumbar liga- 
 ment, crest of ilium, and transverse processes of three or 
 four lower lumbar vertebrae. Insertion: Into lower border 
 of twelfth rib and transverse processes of four upper lum- 
 bar vertebrae. Action: It draws down twelfth rib, flexes 
 spine laterally. Nerve supply: Anterior branches of lum- 
 bar nerves. 
 
 8. Femoral hernia leaves the abdomen through the fem- 
 oral ring and descends into the femoral canal ; this canal is 
 funnel-shaped, is about half an inch in length, and ends 
 at the saphenous opening. Femoral hernia is always 
 acquired, and has a sac. Its course is first vertical, then 
 forward, then upward over Poupart's ligament. Its cover- 
 ings, from without inward, are : Skin, superficial fascia, 
 cribriform fascia, crural sheath, septum crurale, subserous 
 tissue, and peritoneum. The neck of the hernia is situated 
 at the femoral ring; to its outer side lies the femoral vein, 
 and to its inner side is Gimbernat's ligament; in front of 
 it is Poupart's ligament, and behind it are the pubis, the 
 Pectineus, and the pubic portion of the fascia lata. In the 
 immediate neighborhood of the femoral ring are: Ante- 
 riorly, the communicating branch between the deep epi- 
 gastric and the obturator arteries ; externallv, the femoral 
 vein and deep epigastric vessels ; superiorly, the spermatic 
 cord (or round ligament) and the deep epigastric vessels. 
 
 9. The ovaries are two in number, and correspond to the 
 testes in the male; they are of a flattened ovoid form, 
 vertically placed in the posterior part of the broad liga- 
 ment. By its anterior border the ovary is connected to the 
 broad ligament, and by its lower pole to the uterus by a 
 
 486 
 
MEDICAL RECORD. 
 
 proper ligament, extending to the superior angle of the 
 uterus, and called the ligament of the ovary. The lateral 
 surfaces and posterior borders are free. The superior pole 
 and posterior border are embraced by the Fallopian tube ; 
 on its inner surface it is in relation with small intestine 
 in Douglas' pouch, and externally lies in a peritoneal fossa 
 between the external and internal iliac vessels as they 
 diverge. The vessels enter the hilum at the attached ante- 
 rior border. — (Aids to Anatomy.) 
 
 10. An artery consists of three coats : The tunica 
 interna, or internal coat; the tunica media, or middle coat, 
 and the tunica adventitia, or external coat. The internal 
 coat consists of a basement membrane, on which is a layer 
 of endothelial cells. The middle coat consists of involun- 
 tary muscle fibers, between the layers of which are some 
 elastic fibers. The external coat consists of connective 
 tissue (white fibrous and yellow elastic). Between the two 
 outer coats is an elastic membrane. 
 
 ii. The rectum is the lowest part of the alimentary 
 canal, and extends from the sigmoid flexure to the anus. 
 It is about six inches in length, and is divided into three 
 portions. The upper half only is invested with peritoneum. 
 The upper third rests upon the sacral nlexus and the pyri- 
 f ormis muscle ; the middle third is in relation with the 
 bladder, prostate, and seminal vesicles (in the female with 
 uterus and vagina) ; the lower third is surrounded by the 
 sphincters. It is not sacculated; the arteries are the hem- 
 orrhoidal branches of the inferior mesenteric, internal 
 iliac, and internal pudic ; the veins form the hemorrhoidal 
 plexus, and empty into the inferior mesenteric and internal 
 iliac veins. 
 
 12. The iris is a thin, circular, colored membrane sus- 
 pended in the aqueous humor, behind the cornea and in 
 front of the lens. It is perforated by a circular aperture — 
 the pupil. It is connected with the choroid, the sclerotic, 
 and cornea. It consists of a stroma of connective tissue, 
 with blood vessels, nerves, pigment cells, and also two 
 groups of involuntary muscle fibers — circular and radiat- 
 ing. Blood supply: Long and anterior ciliary arteries, and 
 short ciliary arteries. Nerves: Ciliary, from lenticular 
 ganglion and nasal branch of ophthalmic division of fifth 
 cranial nerve. 
 
 PHYSIOLOGY AND HYGIENE. 
 
 I. Evidence that the secretion of the urine is not a simple 
 process of filtration from the blood rests mainly on the 
 following facts : 
 
 "i. It has been shown that the renal epithelium does 
 excrete indigo carmine from the blood when a solution of 
 this. material is injected into the veins; by dividing the 
 
 487 
 
MEDICAL RECORD. 
 
 spinal cord to prevent the excretion of water, which would 
 wash away the indigo carmine, after allowing an appropri- 
 ate time to elapse before killing the animal, the epithelium 
 of the convoluted tubules will be found loaded with the 
 indigo carmine. 
 
 "2. In the amphibia (frogs, newts, etc.), the kidney has 
 a double vascular supply; the glomeruli of the Malpighian 
 bodies are supplied by the renal arteries, and the capillaries 
 of the renal tubules by veins called renal portal veins. By 
 tying the one or the other set of vessels and injecting vari- 
 ous materials into the blood it has been shown that urea is 
 only excreted by the cells of the tubules, and that sugar, 
 peptones, and albumins are only excreted by the glomeruli." 
 — {Aids to Physiology.) 
 
 The nerves are both vasodilator and vasoconstrictor ; 
 true secretory nerves have not yet been discovered. 
 
 2. For structure of the three coats of an artery, see 
 above, Anatomy 10. Veins also have three coats, arranged 
 similarly to those of arteries, but the middle coat possesses 
 less elastic and muscle tissue and more fibrous tissue, hence 
 'the tendency of veins to collapse when empty. In veins the 
 external coat is the thickest; in arteries the middle coat is 
 the thickest. Veins have valves, as a rule. Functions of 
 the endothelial lining of the inner coat is to make a smooth 
 surface for the circulation of the blood with as little fric- 
 tion as possible. The muscular fibers supply contractility. 
 The elastic fibers supply- elasticity. The connective tissue 
 fibers supply strength and support. 
 
 3. The principal centers of organic function situated in 
 the medulla are: (1) Center for mastication; (2) for 
 secretion of saliva; (3) for sucking; (4) for deglutition; 
 (5) for vomiting; (6) for voice; (7) center for expres- 
 sion: (8) cardiac centers; (0) respiratory centers; (10) 
 vasomotor centers. 
 
 4. Leucocytes, (a) Origin: Supposed to be formed in 
 the spleen, lymph glands, and lymphoid tissue. (b) Func- 
 tions: (1) To serve as a protection to the body from the 
 incursions of pathogenic microorganisms; (2) they, take 
 some part in the process of the coagulation of the blood; 
 (3) they aid in the absorption of fats and peptones from 
 the intestine, and (4) they help to maintain the proper 
 proteid content of the blood plasma, (c) Variations in 
 number: Normally between 7,000 and 10,000 or 12,000 in 
 each cubic millimeter of blood. 
 
 5. The function of the carbohydrate food is to supply 
 animal heat and energy; also to form fats and possibly to 
 help form proteids. 
 
 6. Enzymes (a) are substances formed by living cells, 
 which act specifically upon definite substances, and which 
 themselves remain unchanged during this action. Their 
 
 488 
 
iMEDICAL RECORD. 
 
 specific action is shown in the following table. Enzymes 
 are generally soluble in water or saline solution ; they act 
 best at about the body temperature, and are destroyed by 
 high temperatures ; excess of alcohol tends to precipitate 
 them from their solutions ; the enzymes can act almost 
 indefinitely, but the products of their activity must be 
 removed, (b) Six principal enzymes: 
 
 ENZYMES 
 
 ORIGIN 
 
 ACTION ON FOOD 
 
 
 
 
 MATERIALS 
 
 Ptyalin. 
 
 
 Saliva. 
 
 Changes starches into 
 
 
 
 dextrin and sugar. 
 
 Pepsin. 
 
 Gastric Juice. 
 
 Changes proteids into 
 proteoses and peptones 
 in an acid medium. 
 
 Trypsin. 
 
 
 
 Changes proteids into 
 proteoses and peptones, 
 and afterward decom- 
 poses them into leucin 
 
 
 ► 
 
 Pancreatic Juice. 
 
 and tyrosin ; in an al- 
 kaline medium. 
 
 Amylopsin. 
 
 
 
 Converts starches into 
 maltose. 
 
 Steapsin. 
 
 
 
 Emulsifies and saponifies 
 fats. 
 
 Converts maltose into 
 
 Invertin. 
 
 Intestinal Juice. 
 
 
 
 Glucose. 
 
 7. (a) Nitrates are generally due to oxidation of organic 
 matter of animal origin. A trace of nitrate, not exceeding 
 N = °-35 per 100,000, would not suffice to condemn a water 
 otherwise pure, (b) Nitrites are due to sewage contami- 
 nation; their presence should condemn the water. They 
 indicate more recent and therefore more dangerous con- 
 tamination than nitrates. 
 
 8. Prophylaxis of uncinariasis consists in: (1) Boiling 
 the drinking water; (2) washing of the hands before 
 meals; (3) not going barefooted; (4) disinfection of the 
 stools of all infected persons. 
 
 9. Municipal supervision of a city's milk supply. The- 
 oretically, this should be desirable, because: (1) Milk is 
 adulterated very frequently; (2) diseases are conveyed 
 through milk; (3) cowsheds, dairies, and milkshops are 
 often in a most unsanitary condition; (4) persons suffer- 
 ing from infectious diseases are occasionally employed in 
 the mijking or storage or distribution of milk. Municipal 
 supervision might prevent all of this. But experience shows 
 that municipal authorities are not always any more keen 
 than others in doing their duty; graft, persecution, and 
 tyrariny might result; the price of milk would be unduly 
 
 489 
 
MEDICAL RECORD. 
 
 raised, and every political evil might reign supreme. If 
 these evils can be prevented, municipal supervision would 
 be most desirable. 
 
 10. The air is contaminated by combustion (in which 
 oxygen is decreased, and there are given off: Nitrogen, 
 carbon dioxide, ammonia, sulphur dioxide, and carbon 
 monoxide) ; respiration (in which oxygen is decreased, 
 carbon dioxide is increased, ammonia and organic matter 
 are produced). Improper ventilation increases all these 
 evils. Various diseases are directly produced, or indirectly 
 induced. 
 
 MATERIA MEDICA. 
 
 1. (a) Cholagogues influence the liver; (b) silagogues, 
 the salivary glands; (c) oxytocics, the uterus; (d) diaph- 
 oretics, the sweat glands; (e) mydriatics, the eye. 
 
 2. (a) Epsom salts is Magnesii sulphas; (b) Dover's 
 powder is Pulvis ipecacuanhas et opii; (c) calomel is 
 Hydrargyri chloridum mite; (d) salol is Phenylis salilylas; 
 (e) Fowler's solution is liquor potassii arsenitis ; (/) Hoff- 
 mann's anodyne spiritus setheris compositus; (g)cod liver 
 oil is Oleum morrhuse; (h) sulphonal is Sulphon-metha- 
 num; (i) aristol is Thymolis iodidum ; (/) spirit of nitro- 
 glycerin is Spiritus glycerylis nitratis. 
 
 3. A tincture is an alcoholic solution of a medicinal sub- 
 stance. (1) Tincture of aconite, 10 per cent. (2) Tincture 
 of nux vomica, 2 per cent. (3.) Tincture of iodine, 7 per 
 cent. (4) Tincture of digitalis, 10 per cent. 
 
 4. Doses, (a) Apomorphinse hydrochloridum, gr. 1/10, 
 as an emetic, (b) Arseni trioxidum, gr. 1/30. (c) Chlor- 
 alum hydratum, gr. xv. (d) Atropinse sulnhas, gr. 1/160. 
 (e) Hydrargyri chloridum corrosivum, gr. 1/20. (/) 
 Strvchninse sulphas, gr. 1/64. ( g) Hexamethylenamine, 
 gr. iv. (h) Tinctura aconiti, tt£x. (i) Tinctura gelsemii, 
 TT^viii. (/) Glandula suprarenalis sicca, gr. iv. 
 
 5. Specific treatment for diphtheria is diphtheria anti- 
 toxin ; dose, 3000 units ; immunizing dose for well persons, 
 500 units. 
 
 The serum of the blood of the horse, immunized by re- 
 peated injections of diphtheria toxin from cultures of the 
 bacillus. 
 
 6. Specific remedy for myxedema — dry thyroid of the 
 sheep. 
 
 7. Prescription for Dysentery: 
 
 5. Acidi sulphurici aromatici, 3jss. 
 Spiritus chloroform, 3ij. 
 Tincturse opii camphoratae, Jij. 
 Syrupi zingiberis, q.s. ad 3iv. Misce. 
 Signa: Dessertspoonful in water every two hours. 
 
 490 
 
MEDICAL RECORD. 
 
 8. For local applications in tonsillitis : Alum, guaiacol, 
 hydrogen peroxide, nitrate of silver. 
 
 9. Poisoning may be produced by: (1) Illuminating gas, 
 (2) headache powders, (3) ptomaines, (4) snake bite, and 
 (5) fungi (mushrooms, toadstools). 
 
 10. Antidote for (a) bichloride of mercury is white of 
 tgg or milk; (b) for arsenic, is freshly prepared solution 
 of ferric hydroxide; (c) for iodine, is starch paste; (d) 
 for opium, is caffeine, or strychnine. 
 
 CHEMISTRY AND DISEASES OF CHILDREN. 
 
 1. Since C° = 5/9 (F°— 32), C° = 5/9 (104 — 32) = 
 5/9 of 72 =40°. 
 
 Therefore 104 Fahrenheit = 40 Centigrade. 
 (b) One grain = 0.065 gram. 
 
 2. Methyl alcohol. (a) Common name: Wood 
 spirit. (b)Uses: Solvent of resins, sulphur, phosphorus, 
 potash, soda, and volatile oils, (c) Dangers: It should 
 not be used in pharmacy, or taken internally, even when 
 purified, for it has caused blindness and death. 
 
 3. Combustion is rapid oxidation with the giving off of 
 light and heat. When coal is burned, the carbon unites 
 with the oxygen of the air, producing carbon monoxide 
 and carbon dioxide; other gases and liquids are also given 
 off, and the coal is decomposed and gradually disappears, 
 only some ashes being left. 
 
 4. Fractional distillation is a process by which liquids 
 with different boiling points may be separated in a pure 
 condition; it is largely used in the separation of coal tar 
 products. The temperature of the mixture is gradually 
 raised, so that the components are distilled off successively 
 in the order of their volatility. 
 
 5. Four mineral acids: Hydrochloric acid, HC1; nitric 
 acid, HN0 5 ; sulphuric acid, H 2 S0 4 ; phosphoric acid, H 8 
 PO4. 
 
 6. Ophthalmia neonatorum. Causes: The gonococcus 
 or some other pyogenic microorganism; the secretions of 
 the mother contain the infecting agent, and transmission 
 may occur directly during parturition, or indirectly by the 
 fingers of physician or nurse, cloths, instruments, etc. 
 Symptoms: Swollen eyelids, with copious purulent dis- 
 charge; ulceration of the cornea may ensue. Prophylaxis: 
 Whenever there is the possibility of infection, or in every 
 case, wash the eyelids of the newborn child with clean 
 warm water, and drop on the cornea of each eye one drop 
 of a 1 per cent, solution of nitrate of silver, immediately 
 after birth. Treatment: Wash the eyes carefully every 
 half hour with a saturated solution of boric acid; pus must 
 not be allowed to accumulate. Two drops of a 2 per cent, 
 solution of nitrate of silver must also be dropped on to the 
 
 491 
 
MEDICAL RECORD. 
 
 cornea every night and morning. The eyes must be covered 
 with a light, cold, wet compress. The patient must be 
 isolated, and all cloths and compresses used must be burnt 
 
 7. Kernig's symptom of cerebrospinal meningitis con- 
 sists in the fact that if the thighs or legs are flexed they 
 cannot then be fully extended, owing to the contracture 
 of the muscles on the posterior of the thigh. 
 
 8. Acute intussusception. Diagnosis: Sudden onset, 
 severe localized pain, vomiting, tenesmus, and passage of 
 blood}'- mucus. There is a sausage-like tumor in the abdo- 
 men ; sometimes it can be felt in the rectum. Fecal im- 
 paction or appendicitis may simulate it, but in the former 
 the swelling is less tender and is on the left side ; in the lat- 
 ter there is fever, and the tumor is on the right side. 
 Treatment : Laparotomy and reduction of the bowel as soon 
 as possible. Gentle manipulations, enemata, and opium have 
 been suggested, but these should be adopted only when 
 surgical relief is not available. 
 
 9. (a) In chickenpox: The eruption usually appears 
 first on the trunk, is evident on the first day, comes in 
 successive crops, is not shotty, and disappears on stretch- 
 ing the skin ; the spots are unilocular, and collapse on 
 being punctured, (b) In smallpox: The eruption usually 
 appears first on the forehead and wrists, and on the third 
 or fourth day; it is first macular, then papular, then ves- 
 icular, and finally pustular; it does not appear in succes- 
 sive crops; the spots are multilocular, and do not collapse 
 on being punctured; the papule is hard and shotty, and 
 does not disappear on stretching the skin, (c) In measles: 
 Eruption appears on fourth day as small dark red papules 
 with crescentic borders, beginning on face and rapidly 
 spreading over entire body; desquamation is branny, (d) 
 In scarlet fever: Eruption appears at end of twenty-four 
 hours, as a scarlet puncture rash, beginning on neck and 
 chest then covering face and body; desquamation is scaly 
 or in flakes. 
 
 10. Most common complications of scarlet fever are : 
 Arthritis, endocarditis, bronchopneumonia, ear troubles 
 (perforation, deafness), facial paralysis or meningitis, 
 suppuration of cervical glands, nephritis. Treatment, as a 
 rule, same as in nonscarlatinal cases; warm and sedative 
 applications, with cotton wool for arthritis, also alkalies; 
 for the throat, ice to suck, warm applications externally, 
 antiseptic sprays ; tonics and stimulants. A minimum of 
 nitrogenous food to avoid irritating the kidneys. For the 
 nephritis : The patient should be kept in bed, kept quiet, 
 and kept warm. Milk diet should be the rule; the milk 
 can be diluted with limewater or Vichy. Salines, as potas- 
 sium bitartrate or magnesium citrate or sulphate, and 
 diaphoretics, as sweet spirit of niter, or pilocarpin, may 
 
 492 
 
MEDICAL RECORD 
 
 be administered. Warm baths are helpful, and infusion of 
 digitalis should be given. 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 i. In the nulliparous adult the uterus is about three 
 inches long, about two inches wide at the upper part, and 
 about one inch thick. The uterus lies between the rectum 
 behind and the bladder in front; it is below the abdominal 
 cavity and above the vagina. Its position is one of slight 
 anteflexion, with its long axis at right angles to the long 
 axis of the vagina. The anterior surface of its body rests 
 on the bladder, and the cervix points backward toward the 
 coccyx. The uterus is not fixed, but moves freelv within 
 certain limits. It is held in place by ligaments — broad liga- 
 ments, round ligaments, vesicouterine, and rectouterine. 
 
 2. The symptoms of placenta praevia are: Sudden hem- 
 orrhage, accompanied by syncope, vertigo, restlessness, and 
 feeble pulse. Treatment: Stop the hemorrhage by a vagi- 
 nal tampon; this must be tight and thorough. Accouche- 
 ment force is indicated ; this consists of dilatation of cer- 
 vix, version, and immediate extraction of the child. 
 
 3. Phlegmasia alba dolens is a form of manifestation of 
 puerperal sepsis in which there is a thrombosis of the iliac 
 or femoral vein. Sometimes it occurs after a uterine phle- 
 bitis, in which clots are carried from the uterine sinuses to 
 the hvoogastric veins, where they cause obstruction to the 
 blood flow in the crural veins. The trouble may also begin 
 as a crural phlebitis. It is thus due either to cellulitis or 
 to thrombosis. It usually appears about the third or fourth 
 week of the puerperium. Treatment: Liquid and nutritious 
 diet, tonics, stimulants, mild laxatives, opiates, or hyp- 
 notics, absolute rest in bed; the affected limb should be 
 slightly elevated; laudanum or belladonna poultices may 
 be applied. An elastic bandage should subsequently be 
 worn. 
 
 4. The danger signals of impending eclampsia are : Head- 
 ache ; tinnitus aurium ; dizziness ; pain over stomach ; diges- 
 tive, visual, and nervous disturbances; general debility; 
 insomnia, vomiting, and vertigo. For preventive treat- 
 ment: (1) The amount of nitrogenous food should be 
 diminished to a minimum; (2) the production and absorp- 
 tion of poisonous materials in the intestines and body 
 tissues should be limited and their elimination should be 
 aided by improving the action of the bowels, the kidneys, 
 the liver, the skin, and the lungs; (3) the source of the 
 fetal metabolic products and the peripheral irritation in the 
 uterus should, if necessary, be removed by evacuating that 
 organ. The curative treatment includes: (1) Controlling 
 the convulsions (by chloroform, veratrum, or chloral) ; 
 (2) elimination of the poison or poisons which are pre- 
 
 493 
 
MEDICAL RECORD. 
 
 sumed to cause the convulsions; (3) emr^ing the uterus 
 under deep anesthesia, by some method that is rapid and 
 that will cause as little injury to the woman as possible. 
 
 5. Abortion is delivery of the product of conception be- 
 fore the twelfth week. 
 
 Miscarriage is delivery of the product of conception 
 between the twelfth and twenty-eighth weeks. 
 
 Premature labor is delivery of the fetus between the 
 twenty-eighth week and full term. 
 
 Treatment of an incomplete abortion: Anesthetize the 
 patient, dilate the' cervix, with finger or curette remove 
 all debris, irrigate with saline or antiseptic solution, and 
 keep in bed. 
 
 6. Acute cystitis, (a) Etiology: Various pathogenic 
 bacteria, foreign bodies, traumatism, retention of urine, 
 unclean catheters, cold, (b) Treatment includes: Rest, 
 administration of olenty of cold water or milk, diuretics, 
 bland and mild^ food, laxatives, hot sitz baths or vaginal 
 douches, irrigation of the bladder with antiseptic solution 
 followed by solution of nitrate of silver. 
 
 7. Plastic operations in gynecology are such as are done : 
 (1) for the repair of lacerations of the perineum or cer- 
 vix; (2) for vaginal fistula? ; (3) for the narrowing of the 
 vagina, and the treatment of cystocele or rectocele; and 
 (4) various other operations on vulva, urethra, or anus. 
 8. 
 
 ASCITES. 
 
 1. Previous history of 
 visceral disease. 
 
 2. Enlargement compara- 
 tively sudden. 
 
 3. Face puffy ; color waxy ; 
 early anemia. 
 
 4. Patient on back, en- 
 largement symmetrical ; flat 
 in front. 
 
 5. Sitting up, abdomen 
 bulges below. 
 
 6. Navel prominent and 
 thinned. 
 
 7. Fluctuation decidedly 
 clear, diffuse throughout ab- 
 domen, but avoids highest 
 parts in all positions, and 
 always has a hydrostatic 
 level. 
 
 8. Intestines float on tor 
 of fluid; hence percussion 
 gives clear tympanitic note 
 
 OVARIAN CYST. 
 
 1. No such history. 
 
 2. Gradual. 
 
 3. Facies ovariana. Ane- 
 mia absent, or later. 
 
 4. Asymmetrical until tu- 
 mor is quite large ; promi- 
 nent in front. 
 
 5. No appreciable change. 
 
 6. Navel usually unchanged. 
 
 7. Less clear; limited to 
 cyst ; not modified by change 
 of position. No hydrostatic 
 level. 
 
 8. No change in areas of 
 dullness and resonance with 
 change of position. Dull- 
 
 494 
 
MEDICAL RECORD. 
 
 ASCITES. 
 
 over the highest parts of 
 abdominal cavity, and dul- 
 ness in lowest parts for all 
 positions — i.e. areas of res- 
 onance and dullness change 
 with position. 
 
 9. Vaginal touch detects 
 fluctuation, bulging into va- 
 gina. 
 
 10. Uterus in prolapsed lo- 
 cation, but position un- 
 changed. Size and mobility 
 unchanged. 
 
 n. Hydragogues and diu- 
 retics temporarily remove 
 the fluid. 
 
 12. Fluid light straw color 
 and thin. Coagulates spon- 
 taneously. 
 
 OVARIAN CYST. 
 
 ness over cyst. Clear res- 
 onant note in all parts be- 
 yond cyst limits, i.e. in 
 flanks and toward the dia- 
 phragm. 
 
 9. Vaginal fluctuation less 
 clear or absent. 
 
 10. Uterus displaced for- 
 ward or backward, or later- 
 ally by pressure of cyst. 
 
 11. Medicines have no ef- 
 fect. 
 
 12. Fluid light or dark 
 and of varying consistency ; 
 albuminous, but does not 
 coagulate spontaneously; 
 may contain colloid matter. 
 
 — (From Dudley's Gynecology.) 
 
 PRACTICE OF MEDICINE. 
 
 i. Peptic ulcer is generally caused by injury or bacteria; 
 is most apt to occur between the ages of twenty and forty- 
 five; after eating there is pain localized in the stomach, 
 vomiting occurs soon after eating; hematemesis is com- 
 mon, there is localized tenderness over the stomach, and 
 examination of the gastric contents shows an excess of 
 free HCL 
 
 Carcinoma of the stomach does not usually occur before 
 forty years of age, is more common in males, the pain is 
 localized and constant, vomiting is copious, and occurs 
 some time after eating; the vomitus contains "coffee 
 ground" material; hemorrhages are common ; a tumor 
 may be palpated, and examination of the gastric contents 
 shows absence of free HC1 and presence of lactic acid; 
 severe anemia and cachexia are also present. 
 
 2. In croupous pneumonia, in the stage of solidification, 
 the physical signs are: Diminished chest movement ; in- 
 creased vocal fremitus; absence of vesicular breathing, 
 presence of tubular breathing, increased vocal resonance, 
 bronchophony, or pectoriloquy; dullness on percussion. 
 
 495 
 
MEDICAL RECORD. 
 
 ACUTE PNEUMONIA. 
 
 Onset very sudden and 
 symptoms severe — convul- 
 sions, etc., cough first, fol- 
 lowed by pain in the side. 
 
 Temperature very high, 104 
 or often 105 F. 
 
 Pulse- respiration ratio 
 greatly disturbed. 
 
 Bright crimson flush on the 
 cheeks, and the muscular 
 prostration is consider- 
 able. 
 
 Cough is short and hack- 
 ing or in paroxysms; and 
 the sputum, when brought 
 up, is rusty and tenacious. 
 
 Organs not displaced. 
 
 Dullness on percussion not 
 complete, and the sense of 
 resistance almost nil. 
 
 Respiratory sounds tubular, 
 and fine crepitation heard 
 at border of consolida- 
 tion. 
 
 Vocal resonance increased. 
 
 Vocal fremitus increased. 
 
 The physical signs are lim- 
 ited to the front or back 
 of the chest. 
 
 EXUDATIVE PLEURISY. 
 
 Onset moderately sudden, 
 and symptoms not severe- 
 chilliness and pain in the 
 side, followed by cough. 
 
 Temperature not high, 101.5 
 or 102 F. 
 
 Pulse-respiration ratio not 
 disturbed. 
 
 Face is pale, and there is 
 little loss of muscular 
 power. 
 
 Cough is dry and painful, 
 and patient tries to re- 
 press it. 
 
 Organs displaced. 
 Dullness complete, with 
 sense of great resistance. 
 
 Respiratory sounds much 
 diminished, and friction 
 heard at upper margin of 
 effusion. 
 
 Vocal resonance greatly di- 
 minished. 
 
 Vocal fremitus diminished 
 or absent. 
 
 The physical signs are 
 found both at the back 
 and front of the affected 
 side. 
 
 3- 
 
 Aortic Insufficiency. . 
 Mitral Insufficiency. . 
 
 MURMUR 
 HEARD BEST. 
 
 Second right in- 
 tercostal space. 
 At apex. 
 
 TRANSMITTED. 
 
 Down sternum, and 
 
 towards apex. 
 Left axilla and an- 
 
 gle of scapula. 
 
 4. Cerebrospinal meningitis. Etiology: The diplococ- 
 cus intracellularis of Weichselbaum, or streptococcus pyo- 
 genes, or pneumococcus. 
 
 Characteristic symptoms: Sudden onset, very severe pain 
 in neck, back of head and spine, head is strongly retracted, 
 causing opisthotonos, Kernig's sign (see above, Chemistry, 
 No. 7) is present; delirium may be present; the diplococcus 
 may be found in the cerebrospinal fluid. 
 
 496 
 
MEDICAL RECORD 
 
 5. Arteriosclerosis is a condition in which the walls of 
 an artery, especially the intima, become hard, dry, and 
 thickened. 
 
 Etiology: Syphilis, alcoholism, gout, Bright' s disease, 
 overeating, and excessive muscular exertion. It is most 
 liable to occur in old age. 
 
 6. Symptoms of hemorrhage in typhoid fever: Sudden 
 drop in the body temperature, dark red or tarry stools, 
 collapse. 
 
 Treatment: Absolute rest; elevate the foot of the bed: 
 ice, morphine, and ergot have all been used with satisfac- 
 tion. 
 
 7. The chief cause of locomotor ataxia is syphilis. 
 
 Symptoms: Loss of coordination; characteristic and un- 
 steady gait ; tendency to staeger when standing up with feet 
 together and eyes closed ; sharp and paroxysmal pain, called 
 crises: girdle sensation: loss of knee-jerk and other re- 
 flexes; Argyll-Robertson pupil. 
 
 8. In chronic interstitial nephritis the urine is increased 
 in quantity, is of low specific gravity, a few hyaline casts 
 mav be present, albumin is present in small amount or is 
 absent, and urea and salts are diminished. 
 
 Circulation: Heart is generally hypertrophied and di- 
 lated ; arteries are sclerosed and thickened ; pulse is hard 
 and there is increased arterial tension. 
 
 9. Treatment of acute articular rheumatism: The pa- 
 tient must lie in bed, between blankets, and in flannel ; the 
 affected joints and limbs must further be covered with 
 warm flannel or cotton wool. Sodium salicylate or oil of 
 wintergreen must be administered, and oil of gaultheria 
 may also be applied locally to the affected parts. Acetate 
 and citrate of potassium are also useful. For the pain. 
 Dover's powder, or phenacetin, or morphine may be neces- 
 sary. A cold bath is probably the best thing for the high 
 fever. The diet should be liquid, and simple but nourish- 
 ing; milk being the best. 
 
 10. Prescription for local treatment of erysipelas: 
 B. Ichthyol, -gr^jxxxv. 
 
 Resorcin. 3ss. 
 
 Unguenti hydrarevri, 3iv. 
 
 Adipis lanae hydrosi, 3v. Misce. 
 
 Signa : Apply freely, and cover with lint. 
 
 SURGERY. 
 
 1. Paronychia is a cellulitis beginning at the end or side 
 of the finger and involving the parts around and below the 
 nail. The pus organisms enter through a puncture, an 
 abrasion, or an ulcerated hang-nail. Treatment is free 
 and early incision, drainage, antiseptic dressings, tonics, 
 and stimulants. The nail may or may not have to be re- 
 moved. 
 
 497 
 
MEDICAL RECORD. 
 
 2. Osteomyelitis of Tibia. Pathological Changes: "The 
 area of the medulla affected becomes hyperemic ; exudation 
 occurs in the cancellous spaces, Haversian canals, and 
 under the periosteum. Pus soon forms in these three situa- 
 tions. If the disease begins in the superficial part of the 
 bone, the pus may only be subperiosteal, the deeper part of 
 the bone escaping, though large areas of the superficial 
 portion may die from the combined action of (i) stripping 
 up of the periosteum by the pus, (2) strangulation of the 
 vessels in the bone by the pressure of the exudation, and 
 (3) the toxic action of the bacterial products. . . . 
 When the disease begins in the deeper layers of the bone, 
 the pus may reach the periosteum, or extend along the 
 medullary cavity, so that the veins become filled with 
 septic thrombus, which may be disintegrated and carried 
 off as septic emboli (pyemia). There is profound toxemia, 
 and necrosis of the whole diaphysis may occur. ... If 
 the infection is mild, a chronic abscess may be formed in 
 the cancellous tissue. The usual course of an acute case, 
 if a patient survives, is that there is some necrosis of the 
 shaft of the bone. The abscess bursts externally, and there 
 are numerous openings in the skin leading through open- 
 ings (cloacae) in the periosteum and involucrum down to 
 the sequestrum. The sequestrum becomes loose in six 
 weeks to six months." (From Aids to Surgery.) 
 
 Treatment is immediate incision down through the peri- 
 osteum ; the surface of the bone must be opened with gouge 
 or chisel, pus evacuated, and drainage instituted; irrigation 
 with hot bichloride solution and packing with gauze. The 
 medulla of the bone must be freely exposed, and any sup- 
 purating material removed. Constitutional treatment and 
 rest are, of course, indicated. 
 
 3. "Many operations are practised, but Bassini's is the 
 most useful. An incision 2^/2 inches long is made over the 
 inguinal canal, exposing the structures of the cord and the 
 external oblique. The external oblique fibers are split 
 from the apex of the external ring to expose the canal. 
 The sac is found, opened, emptied of its contents, and 
 isolated from the structures of the cord up to the internal 
 ring. If the hernia is irreducible, the intestine is freed 
 and returned to the abdomen, omentum being ligatured and 
 removed. The neck of the sac is then transfixed and tied 
 with silk, and the fundus removed. The stump returns to 
 the abdomen, three or four stitches are then passed 
 through the conjoined tendon and arched fibers of the 
 internal oblique and transversalis muscles above, and the 
 deep part of Poupart's ligament below. These are tied 
 behind the cord. The external oblique is then sutured in 
 front of the cord, leaving just sufficient opening for it to 
 pass through without pressure. The skin is then closed by 
 
 498 
 
MEDICAL RECORD. 
 
 a continuous stitch. The patient should be kept in bed for 
 three weeks, and should not exert himself for at least six 
 weeks. If the wound has suppurated, or if the case is one 
 in which the abdominal muscles are weak, it -is advisable 
 that a light truss should be worn afterwards for six 
 months/' (From Aids to Surgery.) 
 
 4. For operation, see any text-book on Surgery. 
 
 5. Stop the administration of further chloroform, open 
 the patient's mouth, draw out his tongue, start artificial 
 respiration. Mouth and throat must be sponged out if 
 necessary; a hypodermic injection of strychnine, ether or 
 brandy may be given, but the artificial respiration must not 
 be stopped. 
 
 6. To prepare the hands: The hands and forearms 
 should be rubbed with spirits of turpentine; then scrubbed 
 with castile soap, hot water, and a sterilized nail brush ; 
 this should continue for several minutes; thorough rinsing 
 must follow; the hands are then to be soaked for two 
 minutes in a 1 : 1,000 bichloride of mercury solution. Care 
 must then be taken lest the hands touch anything that is 
 not sterile. 
 
 7. Abscess of the liver may occur after purulent appen- 
 dicitis, owing to the possibility of infection from the 
 appendix reaching the liver through the portal vein, or 
 through the lymphatics. 
 
 8. The joints both above and below a fracture should 
 always be immobilized. 
 
 9. " 
 
 CHANCRE. 
 
 First lesion of a _ constitu- 
 tional disease, viz., syphi- 
 lis. 
 
 Due to syphilitic infection. 
 
 Generally a venereal infec- 
 tion. 
 
 May occur anywhere on the 
 body. 
 
 Period of incubation never 
 so short as ten days. 
 
 Generally single. 
 Not autoinoculable. 
 Secretion slight. 
 
 Slightly or not at all painful. 
 As a rule only occurs once 
 
 in any patient. 
 Buboes are painless and sel- 
 
 dom suppurate. 
 
 CHANCROID. 
 
 A local disease. 
 
 Due to contact with secre 
 
 tion from chancroid. 
 Always a venereal infection. 
 
 Nearly always on genitals. 
 
 Period of incubation always 
 less than ten days (gen- 
 erally about three). 
 
 Generally multiple. 
 
 Autoinoculable. 
 
 Secretion profuse and puru- 
 lent. 
 
 Generally painful. 
 
 May reoccur in same pa- 
 tient. 
 
 Buboes are painful and 
 usually suppurate. 
 
 499 
 
MEDICAL RECORD. 
 
 The period of incubation of chancre is anywhere from 
 two to six weeks after infection; of chancroid is about two 
 to five days after infection. 
 
 10. Phelps' Operation. Step. i. — Render limb bloodless 
 by elevation and apply tourniquet. Place the foot, with 
 outer side downwards, on a sand-bag. Have the heel held 
 firmly. Grasp the distal portion of the foot and make the 
 plaster tissues tense. Step 2. — On the inner side of the 
 foot make an incision beginning directly in front of the 
 malleolus and ending one-fourth of the distance across the 
 sole of the foot. Divide all resisting structures, penetrat- 
 ing to the bone if necessary. Step 3. — By manipulation 
 complete the overcorrection of the varus. Step 4. — Correct 
 the equinus by achillotomy. Step 5. — Pack the wound with 
 iodoform gauze. Dress. Immobilize, in a position of 
 overcorrection, by a plaster-of-Paris bandage, which 
 reaches well up the calf. While the plaster is hardening, 
 hold the foot in its new position by means of a flat board 
 laid against the sole. Step 6. — Remove the tourniquet. 
 Elevate the limb for twenty-four hours. 
 
 11. The Wasserman reaction is used for the diagnosis of 
 syphilis. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Medical Examining Board of North Dakota. 
 
 anatomy. 
 
 1. Name the divisions of the ear and the contents of the 
 tympanum. 
 
 2. Describe the male urethra. 
 
 3. What nerves form the brachial plexus? 
 
 4. Name all the muscles moving the arm. 
 
 5. Describe the elbow joint. 
 
 6. Describe the popliteal space; gave its boundaries and 
 contents. 
 
 7. Describe the axillary artery. 
 
 8. With what bones does the fibula articulate? 
 
 HISTOLOGY. 
 
 1. Give the distribution and structure of nonstriated 
 muscle. 
 
 2. Describe the lining of the stomach. 
 
 3. Give the histology of the gall-bladder and ducts. 
 
 4. Name and describe the different kinds of epithelium. 
 
 5. Give the histology of a medium-sized artery. 
 
 PHYSIOLOGY. 
 
 1. Describe the function of the heart. 
 
 500 
 
MEDICAL RECORD. 
 
 2. Define: (a) proteids; (b) carbohydrates, and name 
 an example of each. 
 
 3. Describe the process of digestion of an egg sandwich. 
 
 4. Describe carefully normal urine. 
 
 5. What structures possess the function of : (a) elimi- 
 nation; (b) secretion? 
 
 MATERIA MEDICA. 
 
 1. What is meant by incompatibility? Distinguish be- 
 tween chemical and physiological incompatibility. 
 
 2. Define diuretic and diaphoretic, and name three drugs 
 belonging to each class. 
 
 3. What is an anthelmintic. Give names of three. 
 
 4. Give physiological action of strophanthus, the dose of 
 the tincture, and indications for its use. 
 
 5. Give dose of the following drugs: (i)*morphine sul- 
 phate; (2) atropine sulphate; (3) apomorphine hydro- 
 chlorate; (4) Dover's powder; (5) phenacetin; (6) tinc- 
 ture of opium ; (7) oleum tiglii ; (8) oleum terebinthinae ; 
 (9) pilocarpine nitrate. 
 
 CHEMISTRY AND TOXICOLOGY. 
 
 1. Describe a chemical test for detection of organic im- 
 purities in drinking water. 
 
 2. Give formula and explain difference between corro- 
 sive mercuric chloride and mild mercurous chloride of the 
 pharmacopoeia. 
 
 3. Give a chemical test for hydrochloric acid in stomach 
 contents. 
 
 4. Describe methyl and ethyl alcohol. 
 
 5. AgN0 3 + NaCl=? 
 
 6. What is an antidote for poisoning by corrosive sub- 
 limate ? 
 
 7. Give symptoms and treatment of arsenical poisoning. 
 
 8. Differentiate between alcoholic and opium coma. 
 
 PATHOLOGY. 
 
 1. (a) What are the causes of fever? (b) What are the 
 effects of fever? 
 
 2. (a) Mention all the pathological conditions which may 
 produce hemoptysis, (b) The same of hematemesis. 
 
 3. Give the pathology of tubercle. 
 
 4. Explain the propagation of tapeworm. 
 
 5. Mention the different varieties of goiter and give their 
 pathological differences. 
 
 PRACTICE. 
 
 1. How diagnose typhoid fever? 
 
 2. Give differential diagnosis between smallpox and 
 chickenpox. 
 
 501 
 
MEDICAL RECORD 
 
 3. Discuss the treatment of pulmonary tuberculosis 
 among the poor. 
 
 4. Give treatment for the two most common of the 
 valvular heart lesions. 
 
 5. Give treatment for the different pleural effusions. 
 
 6. Discuss prognoses in cerebral embolism and cerebral 
 hemorrhage. 
 
 7. Write a short article on epilepsy. 
 
 8. Discuss intestinal neurosis. 
 
 9. How would you manage a case of nervous prostration 
 in a very poor family? 
 
 10. What are the comparative urinary findings in the 
 first stages of chronic parenchymatous and chronic inter- 
 stitial nephritis? 
 
 NERVOUS DISEASES. 
 
 1. Give diagnosis and treatment of infantile paralysis. 
 
 2. Diagnosis of cerebral tumor. 
 
 3. Name five reflexes and manner of detecting them. 
 
 4. Diagnosis and treatment of chorea. 
 
 5. Diagnosis and treatment of tuberculous meningitis. 
 
 OBSTETRICS. 
 
 1. Diagnosis of pregnancy at three months; at six 
 months, and number of days in which it terminates at full 
 term. 
 
 2. Name and describe the various head presentations. 
 
 3. How would you proceed in a case of placenta previa? 
 
 4. What are the dangers of prolapsus of the cord, and 
 how would you treat it? 
 
 5. Give the causes for asphyxiation of the infant, and 
 your method of overcoming it. 
 
 6. How treat a case of puerperal sepsis? 
 
 DISEASES OF WOMEN AND CHILDREN. 
 
 1. Give cause, symptoms, diagnosis, prognosis, and path- 
 ology of pyosalpinx. 
 
 2. Mention some of the causes of sterility in women, and 
 outline treatment. 
 
 3. Differentiate between ^ tubal pregnancy, pyosalpinx, 
 ovarian cyst, and appendicitis. 
 
 4. Describe the uterus and its changes during pregnancy. 
 
 5. Give causes and treatment of rectovaginal fistula. 
 
 6. Describe and give cause for "Hutchinson's teeth." 
 
 7. In what class of subjects are the cells sensitized to 
 diphtheria antitoxin, making its administration almost sure 
 to cause sudden death? 
 
 8. Give symptoms, diagnosis, and treatment of intus- 
 susception in a boy twelve years of age. 
 
 S02 
 
MEDICAL RECORD. 
 
 9. Give symptoms, pathology, and treatment of Pott's 
 disease of the spine. 
 
 10. How do you make a positive diagnosis of diphtheria? 
 
 SURGERY. 
 
 1. Give diagnosis, prognosis, and treatment of fracture 
 at the neck of femur. 
 
 2. Give indications for trachelorrhaphy. Describe the 
 operation. 
 
 3. Give causes and treatment of retention of urine. 
 
 4. How do you treat punctured wounds? 
 
 5. How do you select and administer a general anes- 
 thetic? 
 
 6. Give diagnosis and treatment of strangulated in- 
 guinal hernia. 
 
 7. Give diagnosis and surgical treatment of gall-stones ; 
 describe the operation in detail. 
 
 8. Give diagnosis and treatment of the different disloca- 
 tions of the shoulder. 
 
 9. What is a Colles fracture? How do you dress it? 
 
 EYE AND EAR. 
 
 i. Cause, symptoms, and treatment of ophthalmia neon- 
 atorum. 
 
 2. Causes, symptoms, and treatment of iritis. 
 
 3. Causes, symptoms, and treatment of glaucoma. 
 
 4. Treatment of blepharitis marginalis. 
 
 5. Define astigmatism, myopia, hypermetropia, diplopia, 
 and chalazion. 
 
 6. Treatment of acute otitis media. 
 
 7. Symptoms and treatment of acute mastoiditis. 
 
 8. How do you remove foreign bodies from the ear? 
 
 9. How relieve pain in furunculosis of the auditory 
 canal? 
 
 10. Describe fully effect of nasopharyngeal adenoids 
 upon the ear and its function. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. What is a malingerer, and how would you set about to 
 discover whether a patient were feigning sickness or not? 
 
 2. Within what period after the treatment complained of 
 can a patient maintain an action for malpractice against a 
 physician or surgeon in this State? 
 
 3. (a) Does the law of this State fix a schedule of fees 
 limiting charges of physicians and surgeons either for 
 traveling to attend patients professionally, or for pro- 
 fessional services rendered, and if so, what is it? (b) 
 What, if any, preference is given by the statutes of this 
 State to physicians and surgeons in the matter of collec- 
 
 503 
 
MEDICAL RECORD. 
 
 tion of their fees for professional services rendered tneir 
 patients? 
 
 4. Does the law of this State fix any definite minimum 
 period of gestation in civil or criminal matters in the 
 courts of the State involving the determination of pater- 
 nity, and if so, what is it? 
 
 5. A duly licensed physician and surgeon in this State 
 is called upon by a female who complains of symptoms 
 which indicate ovarian trouble. The doctor diagnoses the 
 case as one of infected cyst of the ovary, and advises that 
 an immediate operation is necessary. The patient consents, 
 and the doctor operates and finds the trouble to be that 
 diagnosed. He successfully removes the cyst, but in doing 
 so accidentally incised the intestine. While he undertook 
 to repair the unnecessary incision in the intestines, he 
 nevertheless failed, and the woman died. Is he liable to 
 action for malpractice, and if so, why? 
 
 6. Has the State Board of Medical Examiners power, 
 under the laws of this State, to reinstate a physician and 
 surgeon in good standing and reissue a license to him to 
 practise medicine and surgery in the State, after their 
 former license to him has been revoked for the commission 
 of a felony of which he has been convicted in this State? 
 
 PREVENTIVE MEDICINE. 
 
 i. If treating a case of typhoid in the country, give your 
 instructions in full to family regarding the prevention of 
 spread of the disease. 
 
 2. Name all the ways you know in which tuberculosis 
 may be communicated, and what would be your method of 
 preventing the same? 
 
 3. Give your method of fumigating for smallpox. 
 
 4. Describe the different methods of obtaining a pure 
 water supply for a prairie town of 2,500. 
 
 5. Name all the diseases you know of that need quaran- 
 tine and length of time required in each case. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Medical Examining Board of North Dakota. 
 
 anatomy. 
 
 1. External ear, middle ear, or tympanum; and internal 
 ear or labyrinth. For contents of tympanum see Cunning- 
 ham's "Anatomy" (1909), page 74$; or Gray's "Anatomy" 
 (1908), page 1 160. 
 
 2. See Cunningham's "Anatomy" (1909), page 1177; or 
 Gray's "Anatomy" (1908), page 1450. 
 
 504 
 
MEDICAL RECORD. 
 
 3. The anterior divisions of the fifth, sixth, seventh, and 
 eighth cervical, and the first dorsal nerve. 
 
 4. See Cunningham's "Anatomy" (1909), page 331; or 
 Gray's "Anatomy" (1908), page 308. 
 
 5. See Cunningham's "Anatomy" (1909), page 279; or 
 Gray's "Anatomy" (1908), page 310. 
 
 6. See Gray's "Anatomy" (1908), page 707. 
 
 7. See Cunningham's "Anatomy" (1909), page 827; or 
 Gray's "Anatomy" (1908), page 649. 
 
 8. Tibia and astragalus. 
 
 HISTOLOGY. 
 
 i. In non-striated muscle "the individual fibers are short, 
 narrow, and spindle-shaped. Each is usually 25 to 200 
 microns in length, and 5 to 70 microns in breadth. No 
 sarcolemma is present, and striations are absent. In each 
 fiber there is but one nucleus, which is long, slender, 
 darkly staining, and centrally located. This is not seen in 
 all cross-sections, but when present shows as a small, 
 dark dot. These fibers vary in length from 25 to 200 
 microns, ordinarily; in diameter they average about 5 
 microns. The fibers are arranged in bundles, but instead 
 of forming masses like muscles the bundles are arranged 
 into layers, which extend circularly and longitudinally in 
 the hollow viscera. Capillaries exist between the fibers. 
 The nerves are chiefly of the sympathetic variety. Distri- 
 bution: Involuntary muscles are found in the alimentary 
 tract from the middle third of the esophagus to the anus, 
 in the ducts of glands, in the trachea and bronchial tubes, 
 the internal urinary and genital systems, circulatory (ex- 
 cept the heart) and lymphatic systems, and the capsules 
 of some organs." — (From Radasch's Compend.) 
 
 2. See Cunningham's "Anatomy" (1909), page 1059; or 
 Gray's "Anatomy" (1908), page 1283. 
 
 3. See Cunningham's "Anatomy" (1909), page 11 19; or 
 Gray's "Anatomy" (1908), page 1352. 
 
 4. Kinds of Epithelium, (i) Pavement or Squamous: 
 A single layer of flat, nucleated cells, cemented together 
 at their edges. (2) Stratified: In layers of cells that are 
 unlike in form. (3) Columnar: Tall, cylindrical cells ar- 
 ranged in a single layer. (4) Cuboidal: Similar to 
 columnar, but the cells are shorter. (5) Ciliated: Colum- 
 nar cells with hair-like processes (cilia) on their free 
 surface. (6) Goblet: Cylindrical cells distended with 
 mucin. (7) Transitional: When the cells are neither ar- 
 ranged in a single layer like squamous, nor yet in many 
 superimposed layers like stratified, but in two or three 
 layers. 
 
 5. See Cunningham's "Anatomy" (1909), page 781; or 
 Gray's "Anatomy" (1908), page 587. 
 
 505 
 
MEDICAL RECORD 
 
 PHYSIOLOGY. 
 
 i. The function of the heart is to propel the blood 
 through the blood-vessels. The cardiac cycle includes all 
 the changes which occur between the commencement of one 
 heart-beat and the commencement of the next; it consists 
 of the alternate contractions (or systole) and relaxations 
 (or diastole) of the auricles and ventricles of the heart. 
 The contraction of the two auricles takes place simultane- 
 ously and is followed by the simultaneous contraction of 
 the two ventricles; then follows a period during which the 
 whole heart is in a state of diastole. The cycle then be- 
 gins again with the auricular systole. 
 
 2. (a) Proteids are highly complex compounds of un- 
 known constitution, whose molecule contains carbon, hydro- 
 gen, oxygen, nitrogen, and sulphur, and sometimes other 
 elements, and occurring in nearly all parts of the body. 
 Example: Albumin. 
 
 (b) Carbohydrates are compounds consisting of carbon, 
 hydrogen, and oxygen, the last two being in the proportion 
 to form water; most of the simple carbohydrates are 
 aldehydes or ketones. Example: Sugar. 
 
 3. The egg consists of : Proteid and fat. Bread consists 
 of carbohydrate, proteids, and fat. Butter consists of fat 
 and proteids. Of these, the proteids are digested in the 
 stomach by the pepsin of the gastric juice, and in the 
 small intestine by the trypsin of the pancreatic juice. The 
 carbohydrates are digested (slightly) by the ptyalin of the 
 saliva and mainly in the small intestine by the amylopsin 
 of the pancreatic juice. The fat is digested in the small 
 intestine by the steapsin of the pancreatic juice. 
 
 4. Normal urine is a yellowish fluid secreted by the kid- 
 neys to the amount of about 1200-1500 c.c. daily; specific 
 gravity, about 1015 to 1025; acid reaction (due to acid 
 sodium phosphate) ; it has a characteristic odor and a 
 salty taste. Its normal constituents are : Water, urea, 
 uric acid, urates, hippuric acid, kreatin, kreatinin, xanthin, 
 hypoxanthin; sulphates, chlorides, and phosphates of so- 
 dium and potassium; phosphates of magnesium and cal- 
 cium ; nitrogen, and carbon dioxide. 
 
 5. (a) Structures of elimination: Lungs, kidneys, in- 
 testines, skin, (b) Structures of secretion: Serous and 
 synovial membranes ; mucous membranes (glands in mouth, 
 stomach, and intestines); salivary glands and pancreas; 
 liver ; mammary glands ; lacrimal glands ; kidneys ; skin ; 
 testes. 
 
 MATERIA MEDIC A. 
 
 i. By incompatibility is understood the simultaneous 
 administration or combination of substances not suitable 
 for such combination. Physiological incompatibility occurs 
 
 506 
 
MEDICAL RECORD. 
 
 when two remedies are thus administered which offset each 
 other's physiological action, so that they are inert. Chem- 
 ical incompatibility occurs when remedies which are mixed 
 together undergo chemical decomposition or explosion. 
 
 2. Diuretics are agents which promote the secretion of 
 urine. Examples : water, alcohol, potassium acetate. 
 
 Diaphoretics are agents which promote the secretion of 
 sweat and increase the activity of the skin. Examples : 
 alcohol, Dover's powder, Turkish bath. 
 
 3. Anthelmintics are agents which kill or expel worms. 
 Examples : Oleoresina aspidii, gr. xxx ; Pelletierine tan- 
 nate, gr. x; santonin, gr. j ; pumpkin (pepo) seeds, 3J- 
 
 4. Strophant Juts causes stiffness of limbs and loss of 
 voluntary movement ; it paralyzes the muscles ; it stimulates 
 the heart, prolongs diastole, increases the force of the 
 cardiac contractions, lowers and regulates cardiac rhythm, 
 and raises blood pressure; it is a diuretic. The dose of 
 the tincture is Tf#viij. It is used like digitalis in mitral 
 diseases, aortic stenosis, tricuspid diseases, cardiac dilata- 
 tion, exophthalmic goiter, chronic alcoholism, nephritis, 
 palpitation of the heart. 
 
 5. Dose of: (1) Morphine sulphate, is gr. %. (2) 
 Atropine sulphate, gr. 1/160. (3) Apomorphine hydro- 
 chloride, gr. 1/10. (4) Dover's powder, gr. vijss. (5) 
 Phenacetin, gr. vijss. (6) Tincture of opium, TTgviij. (7) 
 Oleum tiglii, Ti^j. (8) Oleum terebinthinoe rectificatum, 
 r$xv. (9) Pilocarpine nitrate, gr. 1/5. 
 
 CHEMISTRY AND TOXICOLOGY. 
 
 1. Organic matter in drinking water can ordinarily be 
 detected by the addition of solution of potassium perman- 
 ganate, which becomes rapidly discolored in the presence 
 of the former. 
 
 2. Corrosive mercuric chloride, HgCl 2 . Corrosive subli- 
 mate is heavy, white, and crystalline ; it has a strong, acrid, 
 styptic taste, and is soluble in water, in alcohol, and in 
 ether ; it is decomposed by exposure to light. 
 
 Mild mercurous chloride, Hg 2 Cl 2 , calomel, is a heavy, 
 white powder, amorphous, tasteless, and odorless ; it is 
 insoluble in cold water and in alcohol, and very slightly 
 soluble in boiling water ; when exposed to the light it be- 
 comes discolored (first yellow, then gray) and partially 
 decomposed ; it sublimes without fusing. 
 
 3. Test for free hydrochloric acid in the gastric juice: 
 The best is probably the Dimethylamido-azobenzol test ; the 
 reagent is used in 0.5 per cent, alcoholic solution, of which 
 one or two drops are added to a like amount of the filtered 
 gastric juice. If free HC1 is present, the yellow solution 
 turns red. 
 
 4. Methyl alcohol is a colorless liquid having an ethereal 
 
 507 
 
MEDICAL RECORD. 
 
 and alcoholic odor and a sharp, burning taste ; burns with a 
 pale flame, giving less heat than that of ethylic alcohol; 
 mixes with water, alcohol, and ether in all proportions; is 
 a good solvent of resinous substances, and also dissolves 
 sulphur, phosphorus, potash, and soda. 
 
 Ethyl alcohol is a thin, colorless, transparent liquid hav- 
 ing a spirituous odor and a sharp, burning taste. It mixes 
 with water in all proportions, the union being attended 
 by elevation in temperature and contraction in volume 
 (after cooling to the original temperature). It also at- 
 tracts moisture from the air to such a degree that abso- 
 lute alcohol only remains such for a very short time after 
 its preparation. 
 
 5. AgNOs + NaCl = AgCl + NaN0 3 . 
 
 6. White of egg in moderate quantity, followed by an 
 emetic. 
 
 7. The symptoms of acute arsenical poisoning: "In acute 
 cases the symptoms usually begin in from 20 to 45 minutes. 
 Nausea and faintness. Violent, burning pain in the stom- 
 ach, which becomes more and more intense, and increases 
 on pressure. Persisting and distressing vomiting of mat- 
 ters, sometimes brown or gray, or streaked with blood, 
 or green. Purging. More or less severe cramps in the 
 lower extremities."— (Witthaus' Essentials of Chemistry.) 
 The chemical antidote is freshly prepared ferric hydroxide. 
 The ferric hydroxide changes the arsenic into ferrous arse- 
 nate, which is nonpoisonous. 
 
 8. In opium coma: The pupils are contracted, the res- 
 piration is slow and full, the skin warmer than in alcohol 
 poisoning, the face suffused, and the pulse slow and full. 
 In alcohol coma: The pupils are not contracted, the res- 
 piration approaches the normal, the skin is cool and some- 
 times moist, the face may be pallid, and the pulse is rapid. 
 
 PATHOLOGY. 
 
 1. (a) Causes of fever: Disturbance of the heat-regulat- 
 ing centers, either directly or by toxic substances circulat- 
 ing in the blood. These latter may come from bacteria, 
 or may be due to disordered metabolism, or to chemical or 
 mechanical injury of the tissues. 
 
 (b) Effects of fever: Loss of appetite, thirst, emaciation, 
 disturbance of function, the alkalinity of the blood is les- 
 sened; degenerative changes such as cloudy swelling, fatty 
 degeneration, and coagulation necrosis may occur in the 
 tissues, particularly in the heart, liver, kidneys, and muscles. 
 
 2. (a) The causes of Hemoptysis: Traumatism; certain 
 organic diseases of the lung, especially tuberculosis, 
 lobar pneumonia, bronchiectasis, gangrene, infarct, and can- 
 cer. Passive congestion, the result of heart disease, espe- 
 cially mitral lesions; rupture of aortic aneurysm; diseases 
 
 508 
 
MEDICAL RECORD 
 
 profoundly affecting the blood, such as purpura, hemophilia, 
 scurvy, and leukemia ; ulcers, traumatic, syphilitic, or ma- 
 lignant of the trachea or larynx; and vicarious menstrua- 
 tion (very rare). 
 
 (b) The causes of Hemat erne sis: Traumatism; gastric 
 ulcer; gastric cancer; venous engorgement of the stomach 
 following cirrhosis of the liver, primary splenomegaly, or 
 chronic heart disease ; acute gastritis ; blood dyscrasia, as 
 in scurvy, purpura, severe infections, and grave anemias; 
 rupture of aneurysm ; swallowing of blood from nose, 
 mouth, or throat; vicarious menstruation; hysteria. — (From 
 Stevens' Practice.) 
 
 3. See French's "Practice" (1907), page 342; or Osier's 
 "Practice" (1909), page 295. 
 
 4. The cycle of the adult tapeworm is as follows : "From 
 each individual segment, which is possessed of a complete 
 reproductive system, great numbers of eggs are discharged. 
 The latter are expelled from the intestine with the feces, 
 and some of them may eventually enter the digestive tract 
 of swine or cattle through the food or water. In the 
 intestine the embryos become liberated from the eggs, and 
 they then make their way in large numbers to the muscular 
 tissue, brain, liver, and other parts, where they come to 
 rest and develop as bladder worms. The living animal 
 shows nothing in its appearance to indicate the presence 
 of the parasite, excepting when the cyst can be seen in the 
 under side of the tongue or between the tongue and the 
 lower jaw. If now the animal is slaughtered and the meat 
 eaten raw or imperfectly cooked, the cysticercus is freed 
 from its enveloping capsule and proceeds to develop into 
 an adult tapeworm, and the cycle is complete." — (From 
 Harrington's Hygiene.) 
 
 5. See French's "Practice" (1907), pages 546 and 548; 
 or Osier's "Practice" (1909), pages 763 and 765. 
 
 PRACTICE. 
 
 i. See French's "Practice" (1907), page 101 ; or Osier's 
 "Practice" (1909), page 93. 
 
 2. (1) Very young children are attacked with varicella, 
 whereas variola usually shows itself in adults. (2) Vac- 
 cinated children readily take varicella ; not so variola, even 
 in the modified form. (3) Children who have had varicella 
 may contract variola, even soon afterwards; or the two 
 diseases may coexist. (4) Varicella is noninoculable, 
 whereas variola is notoriously so. (5) The eruption of 
 varicella appears in 24 hours ; that of variola not till the 
 third day. (6) The febrile symptoms continue after the 
 eruption appears in varicella; those of variola subside. (7) 
 In varicella the spots come out in excessive crops; this 
 is never seen in variola. (8) The spots in varicella are 
 
 509 
 
MEDICAL RECORD. 
 
 unilocular, and collapse on being punctured; the spots in 
 variola are multilobular, and do not collapse on being 
 punctured. (9) In varicella the eruption is very irregular, 
 and appears over the body generally; in variola it appears 
 in groups of threes and fives, and is always seen on the 
 limbs. (10) The papule in varicella is soft, and disappears 
 on stretching the skin; in variola it is hard and snotty, 
 and does not disappear on stretching the skin. — (From J. 
 W. Moore's work on Variola and Varicella.) 
 
 3. See French's ."Practice" (1907), page 391; or Osier's 
 "Practice" (1909), page 352. 
 
 4. See French's "Practice" (1907), page 592; or Osier's 
 "Practice" (1909), page 816. 
 
 5. See French's "Practice" (1907), page 699; or Osier's 
 "Practice" (1909), page 653. 
 
 6. See French's "Practice" (1907), pages 1076, 1079, and 
 1082; or Osier's "Practice" (1909), pages 976 and 978, 
 
 7. See French's "Practice" (1907), page 1125; or Osier's 
 "Practice" (1909), page 1058. 
 
 8. Intestinal neurosis includes any disturbance of the 
 motor, sensory, or secretory functions of the intestine, pro- 
 vided such disturbance is of nervous causation. (1) Motor 
 includes : Paralysis of the intestines, disorders of defeca- 
 tion, constipation, intestinal obstruction, increased peristal- 
 sis, spasm, colic, tenesmus. (2) Sensory includes: Pain, 
 colic, enteralgia. (3) Secretory includes: Nervous diar- 
 rhea, mucous colitis. For details of these see Index to 
 French's or Osier's "Practice." 
 
 9. See French's "Practice" (1907), page 1153; or Osier's 
 "Practice" (1909), page 1092. 
 
 10. In chronic parenchymatous nephritis: The urine is 
 slightly diminished, turbid, has abundance of albumin, 
 generally some blood, abundance of sediment, blood cor- 
 puscles, casts (especially fatty), diminished urea. 
 
 In chronic interstitial nephritis: The urine is increased 
 in quantity, pale, clear, of low specific gravity, little or no 
 albumin, scanty sediment, few casts, diminished urea. 
 
 NERVOUS DISEASES. 
 
 1. See French's "Practice" (1907), page 1084; or Osier's 
 "Practice" (1909), page 916. 
 
 2. See French's "Practice" (1907), page 1104; or Osier's 
 "Practice" (1909), page 9QI- 
 
 FIVE REFLEXES. 
 
 Knee jerk. 
 
 MODE OF EXCITA- 
 TION. 
 
 By striking patel- 
 lar tendon with 
 
 Sio 
 
 NATURE OF 
 
 RESULT. 
 
 A single upward 
 jerk of the leg 
 
MEDICAL RECORD. 
 
 FIVE REFLEXES. 
 
 MODE OF EXCITA- 
 
 NATURE OF 
 
 
 TION. 
 
 RESULT. 
 
 
 edge of hand or 
 
 and foot, slight 
 
 
 with percussion 
 
 or distinct. 
 
 
 hammer, while 
 
 
 
 leg hangs loose- 
 
 
 
 ly over other leg, 
 
 
 Ankle clonus 
 
 With knee extend- 
 
 A series of clonic 
 
 
 ed or very slight- 
 
 contractions a t 
 
 
 ly flexed, by 
 
 the ankle-joint, 
 
 
 pressing quickly 
 
 continuing as 
 
 
 and firmly against 
 
 long as the pres- 
 
 
 anterior part of 
 
 sure is main- 
 
 
 sole of foot (so 
 
 tained, and in- 
 
 
 as to stretch calf- 
 
 stantly ceasing 
 
 
 muscles) and 
 
 when it is re- 
 
 
 then keeping up 
 
 laxed. 
 
 
 the pressure. 
 
 
 Plantar reflex 
 
 Tickling sole of 
 
 Movements of 
 
 
 foot. 
 
 toes ; o f these 
 and foot; or of 
 these and leg. 
 
 Gluteal reflex 
 
 Irritation of skin 
 
 Contraction of 
 
 
 of buttock. 
 
 glutei. 
 
 Cremasteric reflex. 
 
 Irritation of skin 
 
 Drawing up of 
 
 
 of upper and 
 
 testicle. 
 
 
 inner part of 
 
 
 
 thigh. 
 
 
 4. See French's 
 "Practice" (1909), 
 
 5. See French's 
 "Practice" (1909), 
 
 "Practice" (1907), page 1120; or Osier's 
 page 1051. 
 
 "Practice" (1907), page 350; or Osier's 
 pages 302 and 926. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), page 190; or 
 Hirst's "Obstetrics". (1909), page 204. 
 
 2. See Williams' "Obstetrics" (1909), page 206; or 
 Hirst's "Obstetrics" (1909), page 395. 
 
 3. See Williams' "Obstetrics" (1909), page 815; or 
 Hirst's "Obstetrics" (1909), page 577. 
 
 4. See Williams' "Obstetrics" (1909), page 843; or 
 Hirst's "Obstetrics" (1909),. page 626. 
 
 5. See Williams' "Obstetrics" (1909), pages 844 and 846; 
 or Hirst's "Obstetrics" (1909), page 939- 
 
 6. See Williams' "Obstetrics" (1909), page 883; or 
 Hirst's "Obstetrics" (1909), page 737- 
 
 DISEASES OF WOMEN AND CHILDREN. 
 
 I. See Rose and Carless' "Surgery" (1908), page 1288. 
 
 5ii 
 
MEDICAL RECORD. 
 
 2. The most common causes of sterility in woman are : 
 Gonorrhea, absence or errors in development of any part 
 of the genital tract, malformations of genitals, fistulae, 
 lacerations, obesity, alcoholism, pelvic nflammation, dys- 
 pareunia, inflammation of uterus, tubes, or ovaries, elon- 
 gated cervix. Treatment consists in removing the cause, if 
 possible; curettage has been recommended; in the pres- 
 ence of developmental errors little or nothing can be done ; 
 atresia of cervix can be treated by dilatation; if the uterus 
 is misplaced it must be replaced. 
 
 3. In extrauterine pregnancy, there will be signs of early 
 pregnancy, hypogastric or inguinal pains, probable history 
 of a previous sterility, probable expulsion of decidual mem- 
 brane or shreds, softening of the cervix, enlargement of 
 the uterus, presence of a distended tube, contractions of 
 the wall of the gestation sac; if rupture occurs, there will 
 be sudden, excruciating pains over the lower abdomen and 
 on the affected side, shock, collapse, and symptoms of 
 internal hemorrhage. In appendicitis, there are no signs of 
 pregnancy; there are sudden pain and tenderness in the 
 right iliac fossa, rigidity of right rectus muscle, fever, 
 nausea, vomiting, constipation, no history of menstrual 
 irregularities. In pyosalpinx the tubes are inflamed 
 usually secondary to inflammation of uterus or to infection 
 (either gonorrheal or puerperal), backache, pain in lower 
 abdomen, history of menstrual irregularity, leucorrhea, 
 tube is enlarged and tender. In ovarian cyst, no signs 
 of pregnancy, the tumor may grow to enormous size, fluc- 
 tuation generally distinct, emaciation, not painful, facies 
 ovariana. 
 
 4. In the nulliparous adult the uterus is about three 
 inches long, about two inches wide at the upper part, and 
 about one inch thick. The uterus lies between the rectum 
 behind and the bladder in front; it is below the abdominal 
 cavity and above the vagina. Its position is one of slight 
 anteflexion, with its long axis at right angles to the long 
 axis of the vagina. The anterior surface of its body rests 
 on the bladder, and the cervix points backward toward the 
 coccyx. The uterus is not fixed, but moves freely within 
 certain limits. It is held in place by ligaments — broad liga- 
 ments, round ligaments, vesicouterine and rectouterine. 
 During pregnancy the uterus increases in size (from 3 to 
 12 inches in length; from iy 2 to 9 inches in breadth), in 
 weight (from about one ounce to two pounds, not includ- 
 ing its contents). The cavity is enlarged over 500 times. 
 All the tissues, muscles, ligaments, arteries, veins, lymph- 
 atics, and nerves become tremendously hypertrophied. The 
 uterus also changes its position; at first it drops, later it 
 gradually rises, till just before labor (when it again 
 drops). 
 
 512 
 
MEDICAL RECORD. 
 
 5. Rectovaginal Fistula. Causes: Protracted labor, ul- 
 ceration due to pessaries or foreign bodies, carcinoma, 
 syphilis or tuberculosis, pelvic abscess; it may be con- 
 genital. Treatment: A plastic operation is necessary. The 
 edges of the fistula are denuded and then approximated 
 with sutures, the same as for vesicovaginal fistula. 
 
 6. See French's "Practice" (1907), page 424; or Osier's 
 "Practice" (1009), page 271. 
 
 7. See Osier's "Practice" (1909), page 205. 
 
 8. See French's "Practice" (1907), page 804; or Osier's 
 ••Practice" (1909), page 525. 
 
 9. See Rose and Carless' "Surgery" (1908), page 718; or 
 Da Costa's "Surgery" (1908), page 748. 
 
 10. By finding the Klebs-Loeffler bacilli. 
 
 SURGERY. 
 
 1. See Rose and Carless' "Surgery" (1908), page 535 J or 
 Da Costa's "Surgery" (1908), page 512. 
 
 2. Trachelorrhaphy. Indications: Laceration of cer- 
 vix uteri; particularly when followed by subinvolution of 
 uterus, by eversion and hypertrophy of cervix, by infection, 
 by Xabothian-cysts, by menorrhagia, leucorrhea, backache, 
 and reflex nervous disturbances. 
 
 Operation: "The patient is anesthetized and placed in 
 the lithotomy position, and the cervix well exposed by a 
 speculum. The vagina is thoroughly disinfected by douch- 
 ing and swabbing, and dilatation and curetting are then 
 carried out when necessary. After this the anterior lip of 
 the cervix is seized with a volsella, and the reversible ten- 
 acula forceps introduced exactly in the middle line and the 
 points separated. The volsella is then removed. By means 
 of scalpel and forceps two flaps are now dissected off the 
 exposed surface, taking care to leave a narrow strip of 
 mucous membrane in the middle line, which will form the 
 lining for the new cervical canal when the lips are approx- 
 imated. While the surfaces are being vivified there is 
 usually free oozing; this is useful, as it serves to deplete 
 the cervix and diminish its volume. In many cases before 
 operation the bulk}', everted lips look as if they could not 
 come together, yet, after depletion brought about by dissec- 
 tion, they can be approximated with ease. When the flaps 
 have been dissected off, the tenacula forceps are removed, 
 the lips of the cervix are allowed to fall together, and the 
 forceps are then reapplied in such a way as to hold them 
 in apposition. Care must be taken to secure the cervix in 
 the middle line. A curved needle is used to introduce the 
 sutures ; the best material is silkworm gut, and, if secured 
 by means of shot and coil, their subsequent removal is 
 greatly facilitated. Three or four sutures should be placed 
 on each side, and those nearest the middle line should be 
 
 513 
 
MEDICAL RECORD 
 
 about one centimeter apart. The tenacula forceps are now 
 removed and a sound is passed into the uterus, to make 
 sure that the cervical canal is free. The parts are then 
 carefully dried, and the vagina lightly packed with iodo- 
 form gauze." 
 
 3. See Rose and Carless' "Surgery" (1908), pages 1202 
 and 1244; or Da Costa's "Surgery" (1908), page 1125. 
 
 4. See Rose and Carless' "Surgery" (1908), page 238; or 
 Da Costa's "Surgery" (1908), page 252. 
 
 5. See Rose and Carless' "Surgery" (1908), pages 1321 
 and 1324; or Da Costa's "Surgery" (1908), page 1025. 
 
 6. See Rose and Carless' "Surgery" (1908), pages 1100 
 and 1 103; or Da Costa's "Surgery" (1908), page 992. 
 
 7. See Rose and Carless' "Surgery" (1908), pages 1058 
 and 1061 ; or Da Costa's "Surgery" (1908), pages 891 and 
 
 894. 
 
 8. See Rose and Carless' "Surgery" (1908), page 619; or 
 Da Costa's "Surgery" (1908), page 587. 
 
 9. See Rose and Carless' "Surgery" (1908), pages 521 
 and 525; or Da Costa's "Surgery" (1908), pages 505 and 
 508. * 
 
 EYE AND EAR. 
 
 i. Ophthalmia neonatorum. Causes: The gonococcus 
 or some other pyogenic microorganism; .the secretions of 
 the mother contain the infecting agent, and transmission 
 may occur directly during parturition, or indirectly by the 
 fingers of physician or nurse, cloths, instruments, etc. 
 Symptoms: Swollen eyelids, with copious purulent dis- 
 charge; ulceration of the cornea may ensue. Prophylaxis: 
 Whenever there is the possiblity of infection, or in every 
 case, wash the eyelids of the newborn child with clean 
 warm water, and drop on the cornea of each eye one drop 
 of a 1 per cent, solution of nitrate of silver, immediately 
 after birth. Treatment: Wash the eyes carefully every 
 half hour with a saturated solution of boric acid ; pus must 
 not be allowed to accumulate. Two drops of 2 per cent, 
 solution of nitrate of silver must also be dropped onto the 
 cornea every night and morning. The eyes must be cov- 
 ered with a light, cold, wet compress. The patient must be 
 isolated, and all cloths and compresses used must be burnt. 
 
 2. Iritis. Causes: Syphilis, rheumatism, gonorrhea, 
 gout, diabetes, leprosy, scrofula, tuberculosis, injury, trans- 
 mission from the other eye. Symptoms: Pain, photophobia, 
 small pupil, ciliary congestion, discoloration of iris, exudate 
 in anterior chamber. Treatment: Casual, abstraction of 
 blood from temples, atropine, diaphoresis, shielding the eye 
 from light. 
 
 3. Glaucoma. Causes: Increase of contents of eye, 
 hypersecretion, retentfon, old age, gout, rheumatism, ne- 
 
 514 
 
MEDICAL RECORD. 
 
 phritis. Symptoms: Visual disturbances, increased ocular 
 tension, hazy and anesthetic cornea, sluggish and dilated 
 pupil, shallow anterior chamber, ciliary neuralgia, cupping 
 of optic disc, blindness. 
 
 Treatment consists first in the local instillation of mi- 
 otics, such as eserin or pilocarpin, to contract the pupil, and 
 massage of the eyeball. Mydriatics are distinctly contra- 
 indicated. The operative treatment includes paracentesis, 
 iridectomy, sclerotomy, and incision of the ligamentum 
 pectinatum. 
 
 4. Treatment of blepharitis marginalis: Remove cause, 
 if possible; remove scales, and keep edges of lids clean and 
 fresh, warm water or w^eak boric acid solution, or bichlor- 
 ide of mercury 1:5,000; massage; silver nitrate (2 per 
 cent.) on ulcers; epilation of distorted cilia; treat con- 
 junctival or corneal disease. 
 
 5. Astigmatism is a condition in which, owng to a greater 
 curvature of the eye in one meridian than in others, the 
 refractive power of the eye varies. 
 
 v Myopia is a condition in which the anteroposterior axis 
 of the eye is abnormally long, and parallel rays are focused 
 in front of the retina. 
 
 Hypermetropia is a condition in which the anteropos- 
 terior axis of the eye is abnormally short, and parallel rays 
 are focused behind the retina. 
 
 Diplopia is a condition in which an object seen appears 
 double. 
 
 Chalazion is a tumor in the eyelids, due to obstruction 
 of the duct in a Meibomian gland. 
 
 6. Treatment of acute otitis media: "The treatment de- 
 pends upon the symptoms, which are exceedingly variable. 
 When the symptoms are those of middle ear-ache without 
 great exudation, the treatment consists in the inflation of 
 the Eustachian tube, alkaline spray to the post-nasal space, 
 two to three drops of 8 per cent, solution of cocaine, 
 dropped into the ear, and afterwards hermetically sealing 
 the canal with small pledgets of cotton or inserting into 
 the ear a few drops of the following, which will bring 
 immediate results : 
 
 I£ Chloralis camphorat., 5 parts. 
 
 Glycerini, 30 " 
 
 01. amygdalae dulcis, 10 " 
 
 As soon as the pain has disappeared the hyperemia and 
 swelling of the Eustachian tube is quickly reduced by 
 spraying the post-nasal space with alkaline solution, fol- 
 lowed by the application of argentum nitrate eight grains 
 to the ounce. The treatment of the external auditory canal 
 and tympanum consists in dropping three to four drops of 
 solution of zinc sulphate, eight grains to the ounce, into the 
 ear and hermetically sealing with collodion. This is re- 
 
 515 
 
MEDICAL RECORD. 
 
 peated twice daily until all symptoms have passed away. 
 If the pain and effusion into the ear is great, dry hot appli- 
 cations, paracentesis, purging, antipyretics, and rest in bed 
 are indicated. The disease runs its course in from three 
 to ten days." 
 
 7. Acute Mastoiditis. Symptoms: Tenderness, pain, 
 swelling and redness over the mastoid; bulging of the 
 superior and posterior parts of the auditory canal; tem- 
 perature variable, from normal up to about 104 F. Treat- 
 ment: Hot water,, or cold water, or ice; leeches, purga- 
 tives; light diet; acetanilid, incision, or mastoid operation. 
 
 8. Foreign bodies may be removed from ear: (1) In- 
 sects, by warm water or chloroform oil; (2) by* syringing 
 carefully; (3) wax may be removed by disintegrating it 
 with hydrogen dioxide, followed by warm water irrigation. 
 
 9. Leeches; hot applications of hops or salt; cleaning 
 with hydrogen peroxide; morphine; evacuate pus. 
 
 10. "The presence of adenoid tissue in the vault of the 
 pharynx affects the ear in two ways. If the mass is large 
 by direct pressure upon the Eustachian orifice the supply 
 of air in the tympanic cavity may be disturbed. . . . 
 Any slight increase in the volume of the mass will close 
 the lumen of the tube, after which the intratympanic air 
 is gradually absorbed by the blood which circulates through 
 vessels in the walls of the cavity. With each act of swal- 
 lowing, at which time the tube opens momentarily, the air 
 is aspirated into the nasopharynx, the tube closing so 
 quickly that the passage of air into the tympanum does not 
 take place. In this manner a passive congestion of the 
 mucous membrane of the middle ear is produced, a condi- 
 tion which constitutes practically the first stage of an in- 
 flammation, and, if long continued, results in permanent 
 tissue changes. . . . The more important manner in 
 which adenoid growths affect the organ of hearing is by 
 the obstruction to the venous return current from the 
 tympanum and labyrinth. The pharyngeal tonsil, in virtue 
 of its presence, may exert sufficient pressure to partially 
 obstruct the venous flow from the tympanic cavity. Any 
 condition which affects, for a considerable period, the cir- 
 culation within the middle ear will also cause a disturbance 
 of the labyrinthine circulation from an alteration in the 
 tension of the fluid contained. Such changes in the laby- 
 rinth render it particularly susceptible to inflammation, 
 either as the result of infecton or of mechanical irritation, 
 the most fruitful source of the latter being the crowding 
 inward of the ossicular chain by atmospheric pressure, 
 when the tension of air within the tympanum is reduced. 
 . . . There may also be a diminution of bone conduc- 
 tion and a hyperesthetic condition of the auditory nerve." 
 (From Dench's Diseases of the Eqr,) 
 
 516 
 
MEDICAL RECORD 
 
 MEDICAL JURISPRUDENCE. 
 
 i. A malingerer is one who preterits to be ill when he 
 is not. To aid in the discovery: Try to ascertain if there 
 is any motive in such claim to be ill; make frequent and 
 thorough examinations ; the examiner should be well read 
 and expert ; instruments of precision and anesthetics should 
 be used if necessary; malingerers are apt to overdo their 
 part. 
 
 2. As a rule, there is no statute of limitations fixing 
 time within which an action for malpractice must be 
 brought ; but generally no such action will lie after a physi- 
 cian has brought suit for his fee. 
 
 3. (a) No. (b) None. 
 
 4. No. 
 
 5. If carelessness or negligence is proved, he is liable ; 
 but the matter will rest with the jury, and the verdict will 
 depend largely on the "doctor on the other side," and the 
 evidence of his "professional brethren." 
 
 6. No. 
 
 PREVENTIVE MEDICINE. 
 
 i. See French's "Practice" (1907), page 107; or Osier's 
 "Practice" (1909), page 96. 
 
 2. See French's "Practice" (1907), pages 335 and 390; or 
 Osier's "Practice" (1909), pages 287 and 351. 
 
 3. Fumigation should be by formaldehyde or sulphur. 
 The best means of fumigating by formaldehyde gas are 
 the following: 
 
 (1) By Trillat's apparatus, which "allows the solution of 
 formalin to flow in a fine stream through a copper coil 
 heated to redness by a flame beneath, and the gas and 
 vapor passing directly into the room. The apparatus may 
 be operated outside of a room, and the amount of gas 
 liberated depends directly upon the strength and quantity 
 of the solution evaporated. 
 
 (2) In Schering's method the solid paraform is heated 
 in a receptacle over an alcohol lamp, and is especially valu- 
 able in disinfecting small rooms, closets, etc. 
 
 (3) The cheapest and most common form develops 
 the gas directly by the oxidation of methyl alcohol, 
 the vapors of the latter passing over or through tubes or 
 coils of heated metal. The amount is uncertain and results 
 indefinite." (Gould and Pyle's Cyclopedia of Medicine and 
 Surgery.) 
 
 Formaldehyde gas is formed by the oxidation of 
 methyl alcohol. The action is quicker and more cer- 
 tain if the temperature of the room is from 95 F. up to 
 about 110 F. 
 
 4. Water supply from: (1) Rain water collected imme- 
 diately as it falls as rain, dew, snow, etc. (2) Surface 
 
 517 
 
MEDICAL RECORD. 
 
 water collected in ponds, lakes, streams, etc., and in free 
 contact with air. (3) Ground water, or subsoil water, de- 
 rived from the rain water of the district, but which perco- 
 lates through the subsoil, and so is not directly exposed to 
 the atmosphere. (4) Deep or artesian water, which is 
 separated from the ground water by one or more imper- 
 meable layers. 
 
 5. Quarantinable diseases: Cholera, yellow fever, small- 
 pox, plague, typhus, leprosy, diphtheria, scarlet fever, 
 measles, mumps, chicken pox, erysipelas. For length of 
 time, see index to these diseases in French's or Osier's 
 "Practice." 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Ohio State Board of Medical Registration and Exami- 
 nation. 
 
 ANATOMY. 
 
 1. Enumerate the bones forming the orbit. 
 
 2. Give the nerve supply of the stomach. 
 
 3. Name the ligaments of the knee-joint. 
 
 4. Describe the lungs, briefly. 
 
 5. Describe histologically the structure of the kidney. 
 
 6. Give the arteries arising from the thoracic aorta in 
 order, beginning at the heart. 
 
 7. Give the composition of bones and classify them. 
 
 8. Name the structures forming the larynx. 
 
 9. Describe the gastrocnemius muscle. 
 10. Describe the femur. 
 
 PHYSIOLOGY. 
 
 1. What are some of the properties of protoplasm,? 
 
 2. Describe a neuron. 
 
 3. What is ameboid movement? 
 
 4. What are capillaries, and what function do they per- 
 form ? 
 
 5. What forces contribute to the flow of blood through 
 the veins? 
 
 6. What is reflex action? 
 
 7. In what does digestion and nutrition consist? 
 
 8. What function is performed by hydrochloric acid in 
 digestion ? 
 
 9. What is the nutritive value of proteids? Name some 
 articles of food containing a large proportion of proteid. 
 
 10. How should cow's milk be modified to resemble human 
 milk? 
 
 CHEMISTRY. 
 
 1. Milk: Give its composition. What impurities are most 
 common and how would you detect them? 
 
 518 
 
MEDICAL RECORD. 
 
 2. What is the chemical difference between acids having 
 the termination ous and ic ? What names are given to com- 
 pounds of such acids? 
 
 3. W^hat effect do alkalies have on gastric secretions? 
 
 4. Name and describe three general methods for the 
 purification of water. 
 
 5. Explain where and how HC1 is made in the human 
 body. 
 
 6. How are urates formed in the system, and how would 
 you recognize them? 
 
 7. What is a calcium sulphide? Give its properties and 
 uses. 
 
 8. What are the common properties of 'the mineral acids? 
 
 9. State the toxicological effect of carbolic acid and the 
 therapeutic measures you would employ in a case of pois- 
 oning. 
 
 10. What is meant by physiological antidotes? Name 
 some you consider physiological for strychnine poisoning. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. Name and give the physical characteristics and prop- 
 erties of the official salts and preparations of mercury com- 
 monly employed. 
 
 2. Name the more important official preparations of 
 digitalis. Under what conditions would you prescribe each? 
 
 3. Name the various serums whose place in medicine is 
 recognized, and give uses of each. Also state modes of 
 administration. 
 
 4. In what form should the iodides be administered? 
 With what are they incompatible ? 
 
 5. Discuss the comparative value of ether and chloroform 
 as general anesthetics. Give contraindications for each, and 
 treatment for untoward effects. 
 
 6. In what particular conditions would you advise sug- 
 gestive therapeutics? State briefly how you would manage 
 a case requiring this treatment. 
 
 7. What symptoms follow the continued use of cocaine? 
 How would you treat a cocaine habitue? 
 
 8. What indications would suggest digitalis or the nitrite 
 group in cardiovascular disease? 
 
 9. Define alkaloids, give their common characteristics and 
 physical properties. 
 
 10. When would you use galvanism and when the faradic 
 current? 
 
 PRACTICE OF MEDICINE. 
 
 i. Name four diseases in which a leukocyte count of 
 over 25,000 is probably present. 
 
 2. Differentiate a large ovarian cyst from hydronephrosis 
 of the right kidney. 
 
 3. Differential diagnosis of lead colic. 
 
 519 
 
MEDICAL RECORD. 
 
 4. Name the cardinal symptoms of aortic stenosis. 
 
 5. How would you treat bronchopneumonia in a child? 
 
 6. Diagnose empyema. How treat it? 
 
 7. Differentiate gallstones and appendicitis. 
 
 8. What is paranoia? 
 
 9. How would you manage a case of pulmonary tuber- 
 culosis in an ordinary family and home, with a view to 
 the prevention of infection to others? 
 
 10. What is the difference between active and passive 
 hyperemia? 
 
 DIAGNOSIS. 
 
 1. State pathological significance of an excessive respira- 
 tory action of the abdomen — abdominal respiration. 
 
 2. A persistently frequent pulse in persons without fever, 
 what affections may it suggest? 
 
 3. What pathologic significance is attached to amenor- 
 rhea? 
 
 4. What results follow a back pressure of the superior 
 cava? 
 
 5. State physical signs of pyloric stenosis. 
 
 SURGERY. 
 
 1. Describe a compound, comminuted fracture, and give 
 general treatment for same. 
 
 2. Where are ununited fractures most commonly found? 
 Give some of the causes and treatment. 
 
 3. Describe ileus, and give treatment. 
 
 4. What injuries are common to the knee-joint? Give 
 treatment for same. 
 
 5. Give diagnostic symptoms and treatment of incipient 
 coxalgia. 
 
 6. Describe symptoms and give treatment of flat-foot. 
 
 7. Give diagnostic symptoms of tuberculous kidney. 
 
 8. Give technique of suprapubic prostatectomy. 
 
 9. Give symptoms and surgical treatment of renal calculi. 
 10. Describe surgical management of chronic cystitis. 
 
 OBSTETRICS. 
 
 1. What factors make up the expulsive forces of labor? 
 
 2. What group of symptoms and what signs in particular 
 would suggest to you pregnancy in a primipara at two 
 months' gestation? 
 
 3. Give the measurements obtained by external pelvi- 
 metry that would indicate a normal birth canal. What 
 value can be placed upon such measurements? 
 
 4. What advantage, if any, to mother and child is gained 
 by intermittent contractions of the uterus during labor ? 
 
 5. In endeavoring, wholly by external examination, to 
 determine the presentation and position of the fetus at 
 about term, what anatomical guides are employed? 
 
 520 
 
MEDICAL RECORD. 
 
 6. Describe the development of the bladder in embryo. 
 
 7. Make a differential diagnosis between a fibroid of the 
 uterus and an ovarian cyst. 
 
 8. Give briefly the etiology and treatment of suppurative 
 inflammation of a vulvovaginal gland. 
 
 9. Give the causation and general symptomatology of 
 subinvolution of the uterus. 
 
 10. What treatment would you suggest for senile vaginitis? 
 
 DERMATOLOGY, SYPHILOLOGY, AND DISEASES OF THE EYE, EAR, 
 NOSE., AND THROAT. 
 
 i. Describe scabies. What is the cause of the disease? 
 How is it treated? 
 
 2. What is dermatitis? Mention its varieties. 
 
 3. Describe psoriasis. 
 
 4. Are there any general characteristics to distinguish 
 syphiloderma from other diseases of the skin? 
 
 5. What is syphilitic gumma? 
 
 6. How do you recognize astigmatism subjectively and 
 objectively? 
 
 7. Define glaucoma, enumerate its varieties, and mention 
 principal symptoms. 
 
 8. Describe symptoms of catarrhal otitis media. 
 
 9. Describe mucous polypi of nasal cavities and give their 
 causes. 
 
 10. Chronic laryngitis : Symptoms and causes. 
 
 PATHOLOGY, BACTERIOLOGY, AND HYGIENE. 
 
 i. What is the microscopical appearance of the kidney 
 during acute congestion? 
 
 2. Name the different kinds of tissue degeneration. 
 
 3. Name four possible sequelse which may follow peptic 
 ulcer of the stomach. 
 
 4. Describe the microscopical appearance of a gumma. 
 
 5. What is the so-called "nutmeg" liver? How caused? 
 
 6. What is the morphology of Bacillus mallei f 
 
 7. What diseases are caused by the following bacteria : 
 Shiga's bacillus, Koch-Weeks bacillus, Klebs-Loeffler ba- 
 cillus, Diplococcus of Neisser, bacillus of Unna Ducrey? 
 
 8. What is a trap ? What purpose does it serve in drains ? 
 
 9. Describe the construction of a filter for river water to 
 be used for drinking purposes by the people of a small city. 
 
 10. How many cubic feet of air is necessary for each 
 patient in a general hospital? 
 
 521 
 
MEDICAL RECORD. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 QUESTIONS. 
 
 Ohio State Board of Medical Registration and 
 Examination. 
 
 anatomy. 
 
 i. The bones which enter into the formation of the orbit 
 are : The frontal, sphenoid, ethmoid, superior maxillary, 
 malar, lacrymal, and palate. 
 
 2. Nerve supply of the stomach: The pneumogastrics, 
 and the sympathetic. 
 
 3. Ligaments of the knee-joint: Anterior, or Ligamen- 
 tum Patellae; Posterior; Internal lateral; Two external 
 laterals ; Capsular ; External crucial ; Internal crucial ; 
 Transverse; Coronary; Ligamentum mucosum; and Liga- 
 menta alaria. 
 
 4. See Cunningham's "Anatomy" (1909), page 983; or 
 Gray's "Anatomy" (1908), page 1398. 
 
 5. See Cunningham's "Anatomy" (1909), page 1139; or 
 Gray's "Anatomy" (1908), page 1426. 
 
 6. Coronary arteries, innominate, left common carotid, 
 left subclavian, pericardial, bronchial, esophageal, posterior 
 mediastinal, intercostals, and subcostal. 
 
 7. Composition of bones: (1) Organic matter (gelatin 
 and blood-vessels) ; and (2) inorganic matter (calcium 
 phosphate, calcium carbonate, calcium fluoride, and mag- 
 nesium phosphate). 
 
 Bones are classified as: Long, short, flat, and irregular. 
 
 8. Structures forming the larynx: Nine cartilages, viz., 
 Thyroid, cricoid, epiglottis, two arytenoids, two cornicula 
 laryngis, and two cuneiform. The thyrohyoid membrane, 
 cricothyroid membrane, thyroarytenoid ligaments, capsular 
 ligaments, hyoepiglottic ligament, thyroepiglottic ligament; 
 and, interiorly, the vocal cords. 
 
 9. See Cunningham's "Anatomy" (1909), page 376; or 
 Gray's "Anatomy" (1908), page 537. 
 
 10. See Cunningham's "Anatomy" (1909), page 223; or 
 Gray's "Anatomy" (1908), page 223. 
 
 PHYSIOLOGY. 
 
 1. Properties of protoplasm: (1) Irritability, or power 
 of responding to a stimulus; (2) power of movement; (3) 
 power of assimilation; (4) power of growth; (5) power of 
 excretion, and (6) power of reproduction. 
 
 2. A Neuron is the unit of the nervous system; it con- 
 sists of a nerve-cell with its processes and terminations. 
 
 3. Ameboid movement: The ameba puts out from its 
 sides projections of the protoplasm; and later the whole 
 
 522 
 
MEDICAL RECORD. 
 
 mass flows into these projections, and thus the ameba 
 changes its position and its shape. The white blood corpus- 
 cles and some other cells also exhibit this same movement. 
 
 4. Capillaries are tiny blood channels, generally consist- 
 ing of a single layer of endothelial cells, and connecting the 
 smallest arterioles with the venules. Function: It is here 
 that all the changes occur which take place between the 
 blood and the tissues of the body. Oxygen and the prod- 
 ucts of digestion and absorption are conveyed to the tis- 
 sues, and carbon dioxide and waste matters are taken up 
 and carried away from the tissues. 
 
 5. The forces contributing to the flow of blood through 
 the veins are : The action of the heart, aspiration of the 
 thorax, contraction of the muscles, and the valves in the 
 veins. 
 
 6. Reflex actions are involuntary or unconscious move- 
 ments, due to suitable stimuli. They depend upon the in- 
 tegrity of the reflex arc, which is a complex made up of : 
 (1) A surface capable of receiving an impression; (2) an 
 afferent nerve; (3) a nerve cell capable of receiving and 
 also of sending out impulses ; (4) an efferent nerve, and 
 (5) a surface capable of responding in some way to the 
 impulse conveyed by the efferent nerve. 
 
 7. Digestion is the process by which the food is converted 
 into material suitable for absorption and assimilation. 
 
 Nutrition consists in the absorption and assimilation of 
 such physiological principles as are necessary to preserve 
 the normal structure and function of the body. 
 
 8. The function of the hydrochloric acid in digestion: 
 "Hydrochloric acid exerts its influence in a variety of 
 ways. It is the main agent in the derivation of pepsin 
 and rennin from their antecedent zymogen compounds ; 
 it imparts activity to these ferments ; it prevents and even 
 arrests fermentative and putrefactive changes in the food, 
 by destroying microorganisms ; it softens connective tis- 
 sue, it dissolves proteids and acidifies the proteids, thus 
 making possible the subsequent action of pepsin." — (From 
 Brubaker's Physiology.) 
 
 9. The proteids are necessary for life; they build up and 
 repair the tissues of the body; they also supply heat and 
 energy. A large proportion of proteid is found in : Beef, 
 beans, cheese, fish, fowl, peanuts. 
 
 10. To make cow's milk resemble human milk: The 
 cow's milk must be diluted and sugar of milk must be 
 added. These modifications must be made in such propor- 
 tions as to bring the percentage composition of the two 
 milks as near alike as possible. 
 
 CHEMISTRY. 
 
 1. Milk consists of water and solids (Proteids, fats, 
 
 523 
 
MEDICAL RECORD. 
 
 sugar, and salts). These are (roughly) about 4 per cent. 
 each of proteids, fats, and sugar in cow's milk. 
 
 The most common impurities are: (Dirty) water, micro- 
 organisms, boric acid, formaldehyde, salicylic acid, flour, 
 arrowroot, coloring matters, etc. 
 
 2. Acids with the ic termination contain more oxygen 
 than the corresponding acids with the ous termination. 
 Thus: HNO3 is nitric acid; HN0 2 is nitrous acid. 
 
 The salts from the ic acids end in ate; those from the 
 ous acids end in ite. Thus: KN0 3 is potassium nitrate; 
 KN0 2 is potassium nitrite. 
 
 3. The alkalies, if given just before meals, increase the 
 flow of the gastric juice; but if given towards the end of 
 gastric digestion, they are antacid, and neutralize any ex- 
 cessive acidity. 
 
 4. Water may be purified by: Distillation; boiling and 
 filtration; and by precipitation, with the aid of an alum 
 or ferric salt. 
 
 5. HC1 is made in the human body in the glands of the 
 stomach. How it is made is not known. It is supposed to 
 be derived from the chlorides of the blood. One view is 
 that it is due to a reaction between the chlorides and phos- 
 phates of the blood, thus : 
 
 NaH 2 P0 4 + Nad == Na 2 HPO* + HC1. 
 
 There are other views, but the matter is not settled. 
 
 6. Urates are probably precipitated in the bladder owing 
 to concentration and absorption of water from the urine; 
 also from acid fermentation. Urates may be recognized 
 by: (1) Their pinkish color; (2) dissolving upon warming 
 the urine; (3) their ^ appearance under the microscope 
 (amorphous or crystalline). 
 
 7. A calcium sulphide is a binary compound whose mole- 
 cule consists of one atom of calcium and either one or 
 two or five atoms of sulphur, CaS., CaS 2 , or CaS 5 . The 
 monosulphide, CaS, is a white amorphous substance, but 
 slightly soluble; when heated, it shines in the dark. It is 
 used for making luminous paints, also as a depilatory. 
 
 8. Common properties of the mineral acids: They are 
 acid in reaction and in taste, are irritant, and corrosive. 
 
 9. Symptoms of carbolic acid poisoning: Buccal mucous 
 membrane is whitened and hardened; vomiting; burning 
 pain in mouth, esophagus, and stomach; pulse and body 
 temperature are lowered; the pupils are contracted; col- 
 lapse, and finally death. The urine may become dark. 
 
 The treatment of carbolic acid poisoning consists in ad- 
 ministering white of cgg f sodium sulphate, or saccharated 
 lime, followed by lavage. Alcohol is said to be antidotal. 
 
 10. Physiological antidotes act as such by combating the 
 physiological action of the poison. 
 
 524 
 
MEDICAL RECORD. 
 
 Physiological antidotes for strychnine: Chloral hydrate, 
 chloroform. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. Mercury is a shining, silver- white metal, without odor 
 or taste, liquid at ordinary temperature, and easily divisible 
 into spherical globules. Ammoniated mercury: White 
 pulverulent pieces or a white amorphous powder, with 
 an earthy or styptic or metallic taste; insoluble in water 
 or alcohol. Mercury with chalk: A light gray, rather 
 damp powder, odorless, with a slightly sweetish taste. 
 Corrosive sublimate: Heavy, odorless crystals, colorless, 
 acrid metallic taste. Calomel: White, impalpable powder, 
 odorless, tasteless, insoluble in alcohol, water, or ether. 
 Yellow mer curous iodide: Bright yellow, amorphous pow- 
 der, odorless, tasteless, becomes darker on exposure to 
 light, almost insoluble in water. Red mercuric iodide: 
 A scarlet red, amorphous powder, odorless, tasteless, almost 
 insoluble in water. Yellow mercuric oxide: Light orange- 
 yellow, heavy, amorphous powder, impalpable, odorless, 
 metallic taste, almost insoluble in water. Red mercuric 
 oxide: Heavy, orange-red, crystalline scales, or crystalline 
 powder, odorless, metallic taste, almost insoluble in water. 
 
 2. The more important official preparations of digitalis 
 are : The tincture and the infusion. Of these the tincture 
 is generally given for its action on the heart, and the infu- 
 sion for its diuretic action. 
 
 3. Antidiphtheritic serum (dose 3,000 units) is official; 
 tuberculin, tetanus antitoxin (dose 3ijss to 5v), antistrep- 
 tococcic serum (dose 3ijss to 5v), and some others are also 
 used. 
 
 Sera may be administered by hypodermic injection or by 
 mouth. The use of the above mentioned sera is indicated 
 by their names. 
 
 4. Iodides should be administered in a syrup, such as the 
 compound syrup of sarsaparilla. No other drug should be 
 administered with it. 
 
 The iodides are incompatible with the mineral acids, me- 
 tallic salts, ammonia, alkaloids and their salts. 
 
 5. As a general rule, ether would be the anesthetic of 
 choice. But chloroform may be used: (1) in hot climates; 
 (2) when large numbers of persons have to be rapidly 
 anesthetized; (3) in brain surgery; (4) in labor; (5) in 
 patients who are known to take ether badly; and (6) in 
 the conditions mentioned below, in which ether is contra- 
 indicated. 
 
 The following contraindications for ether and chloro- 
 form are from Hare's Practical Therapeutics: "Ether 
 should not be used by inhalation in bronchitis or acute 
 nephritis because of its irritant properties; in peritonitis 
 
 525 
 
MEDICAL RECORD. 
 
 or gastritis, because it is apt to induce vomiting; in 
 aneurysm or in the presence of marked vascular atheroma, 
 because it may rupture a blood-vessel by raising arterial 
 pressure; nor in diabetes, lest it produce diabetic coma; 
 and if anemia is present and an examination of the blood 
 shows that the hemoglobin is below 50 per cent., the use 
 of the drug should be avoided if possible. 
 
 "Chloroform, is not to be used in cases of fatty heart or 
 dilatation of the heart, in those with a known idiosyncrasy, 
 nor in the so-called lymphatic persons with overgrowth of 
 lymphoid tissues, as, for example, adenoids. In the latter 
 case it is particularly apt to cause sudden death. In valvu- 
 lar disease of the heart chloroform may be used with 
 caution, although ether is preferable. Given a case of 
 valvular disease that must be subjected to operation, the 
 chances are bettered with an anesthetic than without it, as 
 the pain and mental shock are worse for the heart than is 
 the anesthetic." 
 
 6. In neurasthenia and hysteria. See French's "Practice 
 of Medicine" (1907), page 1149. 
 
 7. Symptoms of continued use of cocaine: Emaciation, 
 mental and moral impairment, delusions, circulatory dis- 
 turbances, and insomnia. 
 
 Treatment consists in sustaining the patient's strength ; 
 nitrite of amyl or ammonia may be inhaled; belladonna 
 and caffeine have been tried ; stimulants are indicated. 
 
 8. Digitalis is indicated: (1) When the heart action is 
 rapid and feeble, with low arterial tension; (2) in mitral 
 lesions when compensation has begun to fail; (3) in non- 
 valvular cardiac affections ; (4) in irritable heart, due to 
 nerve exhaustion. Digitalis is contraindicated in diseases 
 of the heart (1) in aortic lesions when uncombined with 
 mitral lesions; (2) when the heart action is strong and 
 arterial tension high. 
 
 Nitrites are indicated: When arterial tension is high, 
 in angina pectoris, epilepsy, asthma, cardiac dyspnea, puer- 
 peral eclampsia, chronic nephritis, arteriosclerosis. 
 
 9. Alkaloids are organic nitrogenized substances, alka- 
 line in reaction, and capable of combining with acids in 
 the same way that ammonia does. 
 
 General properties of alkaloids: Alkaloids are of two 
 kinds, volatile and fixed. The volatile alkaloids are liquid, 
 readily volatile without decomposition, and consist of C, 
 H, and N. The fixed alkaloids are for the most part solid 
 and crystalline, not, or only partially, volatile without 
 decompositon, and consists of C, H, N, and O. 
 
 Most of the alkaloids are alkaline in reaction, of a bitter 
 taste, and of white color. 
 
 Most of the alkaloids are nearly insoluble in water, but 
 are soluble in alcohol, chloroform, ether, and benzine ; 
 
 526 
 
MEDICAL RECORD 
 
 their salts are generally soluble in water and alcohol, but 
 insoluble in the other solvents just named. They combine 
 with acids to form salts in the same way that ammonia 
 does. 
 
 10. Galvanic current is best when the brain, spinal cord, 
 and sympathetic system are to be influenced ; also for 
 middle and internal ear, and retina ; also for neuralgia, 
 rheumatism, and muscular atrophy. Faradic current is 
 indicated in diseases of the abdominal viscera and in gen- 
 eral muscular debility. 
 
 PRACTICE OF MEDICINE. 
 
 i. In diphtheria, pneumonia, scarlet fever, and empyema, 
 the leucocyte count is probably over 25,000. 
 2. 
 
 HYDRONEPHROSIS 
 
 OVARIAN CYSTS 
 
 1. Enlargement unilateral 
 and from above downward. 
 Growth fixed in region of 
 kidney. 
 
 2. Expression unchanged. 
 
 3. Growth usually slow. 
 
 4. Intestines may be in 
 front of tumor. 
 
 5. Fluid not necessarily 
 albuminous ; may contain 
 calculi. 
 
 6. Vaginal touch nega- 
 tive. 
 
 7. Urine may contain pus, 
 blood, or albumin. 
 
 8. Cystoscopy shows ab- 
 sence of urine through ure- 
 ter on affected side. 
 
 Exceptions. — In case of a 
 movable kidney the tumor 
 may not be fixed. 
 
 1. Enlargement at first 
 unilateral ; later symmet- 
 rical and from below up- 
 ward. No fixation. 
 
 2. Facies ovariana. 
 
 3. Growth relatively rap- 
 id. 
 
 4. Intestines in the flanks 
 above and back of tumor. 
 
 5. Fluid albuminous; no 
 calculi. 
 
 6. Tumor usually felt by 
 vaginal touch. 
 
 7. Urine generally normal. 
 
 8. Urine flows through 
 ureter on both sides. 
 
 Exceptions. — In case of 
 adhesions the cyst may be 
 fixed. 
 
 (From Dudley's Gynecology.) 
 
 3. See French's "Practice of Medicine" (1907). page 963. 
 
 4. In aortic stenosis: A systolic murmur heard over the 
 aortic area, transmitted into the carotids, and usually 
 accompanied by a loud first sound. Hypertrophy of the 
 left ventricle, increased area of cardiac dullness, apex beat 
 is displaced downward and to the left, the pulse is gen- 
 erally small and infrequent. 
 
 5. See French's "Practice of Medicine" (1907). page 674: 
 or Osier's "Practice of Medicine" (1909), page 626. 
 
 ??7 
 
MEDICAL RECORD. 
 
 6. Empyema is diagnosed by : High and irregular fever, 
 sweats, chill, diminished breath sounds and vocal fremitus, 
 impaired mobility of chest, dullness on affected side, heart 
 displaced to opposite side, leucocytosis. Absolute diagnosis 
 is made by aspiration, showing the fluid to be pus. 
 
 Treatment : Aspiration, drainage, irrigation, resection of 
 ribs (Estlander's operation), or resection of chest wall 
 ( Schede's operation) . 
 
 7. In gallstones: The pain is in the region of the liver; 
 it radiates to the right scapula and toward the umbilicus; 
 chills and sweats are common; also vomiting, and some- 
 times symptoms of collapse and jaundice; calculi may be 
 found in the feces. 
 
 In appendicitis: The pain is at first diffuse, but later be- 
 comes localized over the appendix in the right iliac fossa; 
 nausea, vomiting, and constipation may be present; tender- 
 ness oyer the appendix and rigidity of the right rectus ab- 
 dominis muscle are present; there is generally moderate 
 fever. 
 
 8. Paranoia is a primary chronic form of insanity, oc- 
 curring especially in degenerates, and marked by hallucina- 
 tions and delusions which are systematized, i.e. exhibit a 
 logical connection and sequence, so that the patient from 
 his perverted ideas, in which he firmly believes, draws log- 
 ical and coherent influences. (From Duane's Medical 
 Dictionary.) 
 
 9. Hygienic precautions to be taken in treating a case of 
 tuberculosis : "The patient's quarters should be free from 
 dust and admit of spending many hours daily in the open 
 air in all weathers, properly sheltered, and, if very ill, lying 
 wrapped in a hammock or reclining chair. His bed-room 
 should be well aired at night, draughts being avoided. The 
 room should be uncarpeted and free from hangings. It 
 should be often cleaned and periodically disinfected. All 
 sputum should be collected in paper spit-cups, which should 
 be burned daily. Smoking should be forbidden. Harm is 
 done by any exercise which results in fatigue, and while 
 fever exists it should not be attempted at all. Patients 
 should be taught the necessity of practising lung gym- 
 nastics and breathing only through the nose, which should 
 be kept clear and free from occlusion by secretions, or an 
 hypertrophied catarrhal mucosa. * * * The clothing 
 should be woolen, but not too heavy, or sweating is in- 
 creased : and a flannel nightgown and loosely knit leggings 
 should be worn at night in cool weather. The skin should 
 be cleansed by daily sponge-baths of lukewarm alcohol 
 and water." — (Thompson's Practical Medicine.) 
 
 10. In active hyperemia there is an excess of arterial 
 blood in a part, with, generally, acceleration of flow. 
 
 In passive hyperemia the excess of blood is in the veins 
 
 528 
 
MEDICAL RECORD. 
 
 and capillaries, and the flow is retarded ; it is generally due 
 to some mechanical obstacle. 
 
 DIAGNOSIS. 
 
 i. "The causes of excessive respiratory action of the 
 abdomen — ue. of the diaphragm — are found in conditions 
 which render movement of the thorax painful, such as 
 pleurisy, pleurodynia, or fracture of a rib; or which 
 mechanically hinder thoracic expansion, as in double pleu- 
 ral effusion, calcification of the costal cartilages, emphy- 
 sema (permanent inspiratory form of the thorax throwing 
 extra work upon the diaphragm), the rare scleroderma of 
 the chest wall, and ossifying myositis. Inaction of the 
 thorax may also be due to paralysis of the muscles of 
 inspiration, as in injury or diseases of the cervical portion 
 of the cord or bulbar paralysis, or spasm of the same 
 muscles in strychnine poisoning or tetanus." (Butler's 
 Diagnostics of Internal Medicine.) 
 
 2. A persistently frequent pulse in persons without 
 fever may suggest: Phthisis, exophthalmic goiter, Addi- 
 son's disease, pernicious anemia, chlorosis, locomotor 
 ataxia; also neurasthenic conditions, sexual excesses, abuse 
 of alcohol, coffee, or tobacco. 
 
 3. Amenorrhea may indicate: Hysteria, melancholia, 
 mental overwork, anemia, phthisis, nephritis, diabetes, 
 cancer, malaria, leukemia, morphine habit. 
 
 4. Back pressure in the superior cava is followed by: 
 Cyanosis of the lips and face, clubbing of the fingers, and 
 (with tricuspid regurgitation) a systolic jugular pulse. 
 
 5. The physical signs of pyloric stenosis are : The stom- 
 ach may be observed to be dilated, a tumor may be felt at 
 the pylorus, splashing or succussion sounds may be ob- 
 tained. 
 
 SURGERY. 
 
 1. See Rose and Carless' "Surgery" (1908), page 482; or 
 Da Costa's "Surgery" (1908), page 464. 
 
 2. The united fractures are most commonly found in: 
 Patella, olecranon, coracoid process, humerus, neck of 
 femur. 
 
 Causes: Wide separation of the fragments, interposition 
 of soft parts, want of rest, defective blood supply, bone 
 disease. 
 
 Treatment : Continued immobilization in plaster of paris, 
 with use of limb (if it does not increase the displacement) ; 
 rubbing the ends of the bone together; refreshing the 
 bony ends and fixing by plates, or wires, or screws ; or 
 retentive apparatus. 
 
 3. See Rose and Carless' "Surgery" (1008), pages 11 11 
 and 1 1 15: or Da Costa's "Surgery" (1908), pages 839 and 
 841. 
 
 529 
 
MEDICAL RECORD. 
 
 4. Injuries common to knee joint are : Sprains, disloca- 
 tions, penetrating wounds, fracture into the joint, fracture 
 of patella, rupture of quadriceps tendon or of ligamentum 
 patellae, displacement of semilunar cartilage. 
 
 For treatment, see Rose and Carless' "Surgery" (1908), 
 or Da Costa's "Surgery" (1908), index, under these head- 
 ings. 
 
 5. The early symptoms of hip-joint disease are : Night 
 cries (in a child) ; lameness in the morning; a slight limp; 
 tendency to become tired on slight exertion; wasting; 
 spasm; pain; swelling; and deformity (either real or 
 apparent). 
 
 Treatment: In the early stages, rest in bed is indicated, 
 with extension; also tonics, restoratives, fresh air. If 
 necessary, the limb should be straightened and put up in 
 plaster-of-paris, or a brace or other mechanical appliance 
 should be used. Intraarticular injections of iodoform have 
 been recommended. Resection of the hip may be necessary. 
 
 6. See Rose and Carless' "Surgery" (1908), pages 1175 
 Da Costa's "Surgery" (1908), page 663. 
 
 7. The diagnostic symptoms of tuberculous kidney are : 
 Frequent micurition, with pus, and sometimes blood in 
 the urine ; pain and tenderness over the kidney, enlarge- 
 ment of kidney; chills, fever, and sweats; tubercle bacilli 
 may be found in the urine ; the cystoscope will show a 
 retracted ureteral, meatus on the affected side; the symp- 
 toms are not made worse by movement or improved by rest. 
 
 8. See Rose and Carless' "Surgery" (1908), page 1229; 
 or Da Costa's "Surgery" (1908), page 1191. 
 
 9. See Rose and Carless' "Surgery" (1908), pages 1175 
 and 1178; or Da Costa's "Surgery" (1908), pages 1110 and 
 1 1 18. 
 
 10. See Rose and Carless' "Surgery" (1908), page 1193; 
 or Da Costa's "Surgery" (1908), page 1137. 
 
 OBSTETRICS. 
 
 1. The factors in the expulsive forces of labor are : The 
 uterine contractions and the contractions of the diaphragm 
 and of the abdominal muscles. 
 
 2. At two months none of the certain signs would be 
 present. Cessation of menstruation, in a woman who had 
 previously been regular, with morning sickness, increased 
 frequency of micturition, softened cervix and breast signs 
 (enlarged breast, more prominent veins, deeper pigmenta- 
 tion) would all be very suggestive, especially in a primi- 
 para. 
 
 3. See Williams' "Obstetrics" (1909), page 684; or Hirst's 
 "Obstetrics" (1909), page 448. 
 
 4. The intermittency of the contractions enables the 
 
 530 
 
MEDICAL RECORD 
 
 mother to "rest" in between the pains, hence it is a saving 
 to her ; it also is a protective measure for the child. 
 
 5. See Williams' "Obstetrics" (1909), page 211; or Hirst's 
 "Obstetrics" (1909), page 388. 
 
 6. See Cunningham's "Anatomy" (1909), page 1202. 
 
 UTERINE MYOMA. 
 
 1. Slow growth. 
 
 2. Facial expression un- 
 changed. Face may be full 
 and flushed; later pale from 
 hemorrhage. 
 
 3. General health usual- 
 ly unimpaired except from 
 loss of blood, if submucous 
 or mural; may be painful. 
 
 4. Abdomen usually very 
 asymmetrical from irregu- 
 lar shape of tumor. 
 
 5. Abdominal veins not 
 usually enlarged. 
 
 6. Action of kidneys nor- 
 mal. 
 
 7. Usual menorrhagia. 
 
 8. Elasticity, not fluctua- 
 tion. No percussion wave. 
 
 9. Surface firm and usual- 
 ly lobulated. 
 
 10. Vaginal touch and 
 conjoined examination show 
 tumor dense and firm, and, 
 unless pedunculated, con- 
 tinuous with uterus. Uterus 
 large and heavy. 
 
 11. Uterine cavity much 
 elongated. 
 
 12. Uterus moves with tu- 
 mor. 
 
 13. Negative results from 
 aspiration, but aspiration is 
 not advised. 
 
 Exception. — A subperito- 
 neal myoma with a long 
 pedicle moves independently 
 of the uterus, and the uter- 
 
 OVARIAN CYSTOMA. 
 
 1. Usually 
 growth. 
 
 more rapid 
 
 2. Facies ovariana. 
 
 3. General health early 
 impaired from emaciation. 
 Not painful. 
 
 4. Abdomen more sym- 
 metrical, especially when tu- 
 mor is large. 
 
 5. Usually enlarged, espe- 
 cially in large polycysts. 
 
 6. Kidneys less active. 
 
 7. Menstruation unchang- 
 ed or diminished. 
 
 8. Fluctuation marked. 
 Percussion wave marked. 
 
 9. Surface yielding; in 
 monocysts, regular ; in poly- 
 cysts, irregular. 
 
 10. Uterus normal, except 
 displacement from pressure. 
 Tumor compressible, fluctu- 
 ating, detached from uterus. 
 
 11. Not materially elon- 
 gated. (This is a most im- 
 portant diagnostic point.) 
 
 12. Does not move with 
 tumor. 
 
 13. Positive results from 
 aspiration, but aspiration is 
 not advised. 
 
 Exception. — A cyst with 
 semisolid contents yields 
 negative results on aspira- 
 tion. Fluctuation, if pres- 
 
 531 
 
MEDICAL RECORD. 
 
 UTERINE MYOMA. 
 
 ine cavity is not necessarily 
 lengthened. If the myoma 
 has degenerated to a fibro- 
 cyst there will be more or 
 less fluctuation, and aspira- 
 tion may yield positive re- 
 sults. 
 
 OVARIAN CYSTOMA. 
 
 ent, is indistinct, and per- 
 cussion wave is absent or 
 indefinite. 
 
 (From Dudley's Gynecology.) 
 
 8. Suppurative inflammation of vulvo- vaginal gland. 
 Etiology: Gonorrhea, or suppuration following cellulitis. 
 Symptoms: The same as abscess anywhere else (redness, 
 swelling, heat, pain, and sometimes fever and fluctuation). 
 Treatment: Excision, or incision and drainage. 
 
 9. See Williams' "Obstetrics" (1909), page 904; or Hirst's 
 "Obstetrics" (1909), page 645. 
 
 10. Treatment of senile vaginitis: When the subjective 
 symptoms are not annoying, do little or nothing. Vaginal 
 douche with hot normal salt solution; or corrosive subli- 
 mate solution (1 in 10,000), followed by saline solution; 
 tampons of ichthyol and glycerin (1 to 10) ; ulcers may 
 be painted with a mild solution of silver nitrate occa- 
 sionally. 
 
 DERMATOLOGY, SYPHILOLOGYj and diseases of the eye, ear, 
 NOSE, AND THROAT. 
 
 i. Scabies in a contagious animal parasitic disease, due 
 to the Sarcoptes scabiei, characterized by burrows and a 
 multiform eruption, and attended by severe itching. The 
 eruption usually occupies certain areas where the skin is 
 thin; these are the interdigital spaces, the flexor surface 
 of the wrist and arm, the anterior and posterior axillary 
 folds, the mammae and nipples (in women), the umbilicus, 
 the buttocks, the penis, the inner side of the thighs and 
 legs, and the toes. The face is exempt except occasionally 
 in infants. The itching is intense and worse at night. The 
 affection is curable, but dermatitis may result from over- 
 treatment. 
 
 Treatment consists in a thorough scrubbing with soap 
 and warm water, followed by friction to dry the skin, and 
 the application of sulphur ointment; the latter to be re- 
 peated morning and night for three days. The whole 
 process may need to be repeated one or more times. 
 
 2. Dermatitis is inflammation of the skin. Varieties: 
 Dermatitis blastomycotica, bullosa, calorica, ambustionis 
 congelationis, contusiformis, epidemica, exfoliativa, exfolia- 
 tiva neonatorum, gangrenosa, herpetiformis, malignant 
 
 532 
 
MEDICAL RECORD 
 
 papillary, medicamentosa, papillaris capillitii, repens, sebor- 
 rheica, traumatica, venenata. 
 
 3. Psoriasis: "A common chronic inflammatory disease 
 of the skin, characterized by variously sized lesions having 
 red bases, covered with white scales resembling mother-of- 
 pearl. It affects by preference the extensor surface of 
 the body. The lesions are infiltrated, elevated, clearly de- 
 fined, covered with white, shining, easily detachable scales 
 which, upon removal, reveal a red, punctate; bleeding sur- 
 face. The eruption is absolutely dry, and itching is usually 
 absent." — (Gould and Pyle's Pocket Cyclopedia.) 
 
 4. Syphilitic skin eruptions are characterized: By not 
 itching; by being of a coppery or raw ham color; by being 
 painless ; by polymorphism, macules, papules, pustules, etc., 
 being present at the same time; by being generally sym- 
 metrical. 
 
 5. See Rose and Carless' "Surgery" (1908), page 152; or 
 Da Costa's "Surgery" (1909), page 285. 
 
 6. Astigmatism. Subjective symptoms: Headache, nau- 
 sea, anorexia, indigestion, inability to perform near work 
 continuously; in reading there is confusion of letters. Ob- 
 jective tests: By cards, dials, stenopaic disc, keratoscope, 
 ophthalmoscope, ophthalmometer, retinoscope, test lenses. 
 For details of the use of these see a good book on eye 
 diseases. 
 
 7. Glaucoma is a diseased condition of the eye, produced 
 by increased intraocular pressure, and resulting in excava- 
 tion and atrophy of the optic disc, and blindness. It is due 
 to increase of the contents of the eye, hypersecretion, re- 
 tention, old age, gout, rheumatism, nephritis. Varieties: 
 Primary, secondary, inflammatory, simple, acute, chronic, 
 infantile, malignant, absolute, and hemorrhagic. Symp- 
 toms: Visual disturbances, increased ocular tension, hazy 
 and anesthetic cornea, sluggish and dilated pupil, shallow 
 anterior chamber, ciliary neuralgia, cupping of optic disc, 
 blindness. 
 
 8. See Rose and Carless' "Surgery" (1908), page 882. 
 
 9. See Rose and Carless' "Surgery" (1908), page 831. 
 
 10. See French's "Practice of Medicine" (1907), page 
 645; or Osier's "Practice of Medicine" (1909), page 597. 
 
 PATHOLOGY, BACTERIOLOGY, AND HYGIENE. 
 
 i. See French's "Practice of Medicine" (1907), page 
 878; or Osier's "Practice of Medicine" (1909), page 667. 
 
 2. Kinds of tissue degeneration: Cloudy swelling; fatty 
 infiltration and degeneration ; amyloid, mucoid, hyaline, 
 and colloid degenerations; glycogenic infiltration; hy- 
 dropic ; and bone caries. 
 
 3. Four possible sequela of peptic ulcer of the stomach: 
 
 533 
 
MEDICAL RECORD. 
 
 Hemorrhage, perforation, gastroduodenal fistula, peri- 
 tonitis. 
 
 4. See Rose and Carless' "Surgery" (1908), page 152. 
 
 5. See French's ''Practice of Medicine" (1907), page 817; 
 or Osier's "Practice of Medicine" (1909), page 541. 
 
 6. Bacillus mallei is a small bacillus, straight or slightly 
 curved, generally with rounded ends, about the same length 
 as the tubercle bacillus, but is shorter and thicker than 
 the latter, is non-sporogenous, non-motile, non-liquefying, 
 non-chromogenic, aerobic, grows on the ordinary media 
 and particularly well in the presence of glycerin. 
 
 7. 
 
 BACTERIA 
 
 Shiga's bacillus. 
 Koch- Weeks bacillus. 
 Klebs-LoefBer bacillus. 
 Diplococcus of Neisser. 
 Bacillus of Unna-Ducrey. 
 
 DISEASES CAUSED BY 
 
 Dysentery. 
 
 Conjunctivitis. 
 
 Diphtheria. 
 
 Gonorrhea. 
 
 Chancroid. 
 
 8. A trap is a bend in a pipe; it contains water, and 
 serves to prevent the passage of sewer gases into houses. 
 
 9. Ordinary filter beds for the purification of water are 
 tanks of varying size, shape, and construction; the walls 
 may be vertical or sloping; upon the paved bottom are 
 pipes to carry off the filtered water. Above these pipes 
 are successive layers of coarse gravel, fine gravel, coarse 
 sand, and at the top fine sand about four feet deep. 
 Through these layers the water passes. 
 
 10. The air space for sick people should be at least one- 
 fourth more than that allowed for well people. Hence, 
 1,000 cubic feet + 250 cubic feet = 1,250 cubic feet of 
 space should be allowed in hospitals for each person. Of 
 course, as much more than this as is possible, provided it 
 is properly warmed and distributed, is desirable. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Oklahoma State Board of Medical Examiners. 
 
 physiology. 
 
 1. What effect has respiration upon the circulation? 
 
 2. What is the action of the nervous system upon the 
 salivary glands? 
 
 3. What is the function of gastric juice? 
 
 4. What is the nervous mechanism of stomach digestion? 
 
 5. What are the functions of the liver? 
 
 6. What circumstances affect glandular activity? 
 
 7. What is a ganglion? 
 
 534 
 
MEDICAL RECORD. 
 
 8. What is the effect of stimulation of the divided optic 
 nerve? 
 
 9. What is the dutv of the large intestine in digestion? 
 
 10. What are the uses of the blood? 
 
 CHEMISTRY. 
 
 1. How may ferric hydrate be hurriedly prepared? When 
 and how should ferric hydrate be used as an antidote? 
 
 2. How may lead enter the system and produce lead 
 poisoning? oive a diagnosis of lead poisoning and mention 
 the chemical antidotes for it. 
 
 3. Mention the principal products obtained from petro- 
 leum and describe the properties of one of the products 
 mentioned. 
 
 4. How is chloroform (a) prepared, (b) tested for im- 
 purities? 
 
 5. Mention a chemical antidote for sulphuric acid and 
 explain the action of this antidote. 
 
 6. How would you detect the presence of bile in the 
 urine? 
 
 7. 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. 
 
 8. Technical name of: (a) Aqua regia, (b) aqua fortis, 
 (r) oil of vitriol. 
 
 9. Give the formula for: (a) Mercuric chloride, (b) 
 cupric nitrate, (c) calcium carbonate. 
 
 10. Give formula for carbolic acid. How is it obtained 
 and what are its properties and uses? 
 
 PATHOLOGY AND BACTERIOLOGY. 
 
 i. What are some of the phenomena attending pus for- 
 mation ? 
 
 2. What are some of the conditions favorable to the in- 
 crease of bacteria; and what is meant by their toxic prod- 
 ucts? 
 
 3. What is immunity and how produced? 
 
 4. Describe the protective agencies by which the body 
 guards itself against the entrance and harmful effects of 
 pathogenic microorganisms. 
 
 5. Describe the comma bacillus, and give the manner of 
 its introduction into the system. 
 
 6. How should sputum be examined for tubercle bacilli ? 
 
 7. What is ischemic paralysis? 
 
 8. Describe syphilitic gummata. 
 
 9. Give the probable causes of occlusion of the bile duct. 
 
 10. W f hat are cysts, and how formed? 
 
 PHYSICAL DIAGNOSIS. 
 
 1. Diagnose mitral regurgitation. 
 
 535 
 
MEDICAL RECORD. 
 
 2. Give the physical signs of pericarditis. 
 
 3. How would you diagnose aneurysm of the thoracic 
 aorta ? 
 
 4. Describe the physiological action of the heart. 
 
 5. Define rude respiration, bronchial respiration, cavern- 
 ous respiration, and amphoric respiration. 
 
 6. Classify pulmonary tuberculosis. What is the posi- 
 tive diagnostic sign? 
 
 7. Describe test for blood in urine. 
 
 8. Give physical signs in acute appendicitis. 
 
 9. Describe the normal signs of the heart. 
 
 10. Give physical signs of acute otitis media. 
 
 THEORY AND PRACTICE OF MEDICINE. 
 
 i. Write a prescription for (a) a collyrium, (b) a sup- 
 pository, and (c) a mouth wash. 
 
 2. Prescribe a local application for erysipelas, for rhus 
 toxicodendron poisoning; also write a prescription for 
 night sweats of phthisis, for ascites, and for ptyahsm. 
 
 3. In what disease does leucocytosis occur, and in what 
 diseases is it absent? 
 
 4. Give the cause and treatment of bronchial, spasmodic, 
 or essential asthma. 
 
 5. Describe the Brand method of treatment in typhoid 
 fever, and what is your opinion of the same? 
 
 6. Describe the skin appearance in (a) rubeola, (b) 
 rubella, (c) scarlatina, and (d) varicella. 
 
 7. Give etiology, symptoms, and treatment of gastroin- 
 testinal catarrh of intancy and childhood. 
 
 8. Make a differential diagnosis between renal colic and 
 hepatic colic. 
 
 9. What are the symptoms of obstruction of the ductus 
 communis choledochus? 
 
 10. Differentiate heat exhaustion from sunstroke. 
 
 OBSTETRICS AND HYGIENE. 
 
 1. Differentiate a foot from a hand presentation. What 
 would you do in either case? 
 
 2. What is the bag of waters? What is its function 
 during pregnancy ? During labor ? 
 
 3. How diagnose hour-glass contraction with retained 
 placenta? (b) Give treatment. 
 
 4. After the fifth month, how may death of fetus in 
 utero be recognized; (b) what should be done? 
 
 5. When and how is the pk centa formed? 
 
 6. (a) State fully the duties of physicians as required by 
 the statutes of Oklahoma, (b) What diseases must be re- 
 ported to the State Commissioner of Health? 
 
 7. What are the dangers of cold storage foods? 
 
 536 
 
MEDICAL RECORD. 
 
 8. What evil consequence n:ay arise from the use of to- 
 bacco ? 
 
 9. Describe procedure in disinfecting and disposing of 
 typhoid fever stools. 
 
 10. (a) How much water per dav, in ounces, should be 
 consumed by an average adult? (b) Mention most fre- 
 quent pollution of water, (c) Give test for organic mat- 
 ter in water. 
 
 GYNECOLOGY. 
 
 1. Name the most frequent causes of endometritis; (b) 
 give treatment, both palliative and surgical. 
 
 2. What is atresia of the vagina? Give treatment. 
 
 3. Give most frequent causes of pyosalpinx; diagnosis 
 and treatment. 
 
 4. Differentiate between menorrhagia, metrorrhagia, and 
 amenorrhea, (b) Give treatment of each. 
 
 5. Give treatment of prolapsus uteri, both palliative and 
 surgical. 
 
 6. Differentiate between ovaritis, cystic ovary, and sal- 
 pingitis. 
 
 7. Give symptoms and treatment of extrauterine preg- 
 nancy. 
 
 8. Describe the female genital and pelvic organs, and 
 give their functions. 
 
 SANITARY SCIENCE. 
 
 i. In case you were a health officer, what regulations 
 would you prescribe governing schools, water supply, and 
 sewerage? 
 
 2. What would be the most important precautions to 
 be observed for the preservation of health in a city of 
 20,000 people? 
 
 SURGERY. 
 
 1. Define hemorrhoids, name varieties, and give treat- 
 ment. 
 
 2. Give differential diagnosis between osteomyelitis and 
 acute rheumatism, and describe treatment of former. 
 
 3. Give technique of tracheotomy. 
 
 4. Diagnosis and treatment of strangulated inguinal 
 hernia. 
 
 5. Give your rule for locating and method of ligating the 
 femoral artery in situ. 
 
 6. Diagnose and give treatment of dislocation of the 
 astragalus. 
 
 7. Name and describe the measurements you would use 
 in ascertaining whether or not there is shortening in neck 
 of femur in case of suspected impacted fracture. 
 
 8. What would be your treatment of compound fracture 
 of tibia with laceration of the anterior tibial artery? 
 
 537 
 
MEDICAL RECORD 
 
 9. Differentiate floating kidne^ from other abdominal 
 tumors, and describe treatment for same. 
 
 10. Give diagnosis and treatment of intussusception. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. What conditions would you find in a case of rape 
 of a girl of twelve years? 
 
 2. Enumerate the causes of sudden death. 
 
 3. Give the difference between an incised wound made 
 before and one made after death ; also gunshot wound. 
 
 4. Give the cause and duration of rigor mortis. 
 
 5. To what kind of a crime does strangulation point; 
 tlso hanging? 
 
 TOXICOLOGY. 
 
 1. What is the antidote and treatment of oxalic acid 
 poisoning? 
 
 2. Give the detailed account of post-mortem appearance 
 of carbolic acid poisoning. 
 
 3. What are the symptoms and treatment of poisoning 
 with bichloride of mercury? 
 
 4. What is the antidote for strychnine? 
 
 5. Mention ten drugs, the use of any one of which may 
 cause skin eruptions. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Oklahoma State Board of Medical Examiners. 
 
 physiology. 
 
 1. The respiratory changes in the blood: (1) In the 
 lungs the blood is changed in color, gains oxygen, loses 
 carbon dioxide, loses heat, and loses watery vapor. (2) In 
 the capillaries of the body the blood loses oxygen and re- 
 ceives carbon dioxide. 
 
 2. The submaxillary gland is supplied by the chorda 
 tympani (which contains secretory fibers and vasodilator 
 fibers). The sympathetic slows the secretion of saliva in 
 parotid and submaxillary glands. In the parotid gland the 
 auriculotemporal is the secretory nerve. The secretion of 
 saliva is a reflex action ; the afferent nerves being : The 
 glossopharyngeal, the lingual branch of the fifth, and the 
 chorda tympani; the efferent nerves are: Sympathetic 
 nerves, auriculotemporal branch of the fifth, and chorda 
 tympani. 
 
 3. The function of gastric juice is: (1) To change pro- 
 teids into proteoses and peptones; (2) to curdle the casein 
 of milk; (3) it is also antiseptic. 
 
 4. The pneumogastric nerves are motor to the stomach, 
 
 538 
 
MEDICAL RECORD 
 
 and induce peristalsis ; the sympathetic fibers are inhibi- 
 tory, causing cessation of peristalsis and dilatation of the 
 sphincter pylori. 
 
 5. The functions of the liver are: (1) The secretion of 
 bile, (2) the formation of glycogen, (3) the formation of 
 urea and uric acid, (4) the manufacture of heat, and (5) 
 the conversion of poisonous and harmful into inert ma- 
 terial. 
 
 6. Circumstances affecting glandular activity are: Blood 
 supply; nerve impulses (trophic, secretory, vasomotor) ; 
 sometimes food, sensations, or emotions. 
 
 7. A ganglion is an aggregation of nerve cells, connected 
 with nerves, or other ganglia, or with the cerebrospinal 
 axis ; masses of gray matter at the base or in the interior 
 of the brain are also called ganglia. 
 
 8. Stimulation of the divided optic nerve causes : Flashes 
 of lig-ht, but no pain. 
 
 9. In the large intestine: Digestion which is already 
 begun may continue, but there is no special digestive action ; 
 there is marked absorption of water; there are numerous 
 bacteria, and, as a consequence, proteid putrefaction. 
 
 10. The functions of the blood as a whole are: To dis- 
 tribute nourishment, oxygen, and the internal secretions to 
 the tissues of the body; to remove carbon dioxide and 
 other waste matters from the tissues so that they may be 
 excreted b^ the lungs, kidneys, and skin ; to regulate the 
 body temperature. In addition the white corpuscles serve 
 as a protection to the body from the incursions of patho- 
 genic microorganisms ; they take some part in the process 
 of the coagulation of the blood ; they aid in the absorption 
 of fats and peptones from the intestine, and they help to 
 maintain the proper proteid content of the blood plasma. 
 
 CHEMISTRY. 
 
 1. Ferric hydrate may be hurriedly prepared by precipi- 
 tating solution of ferric sulphate with magnesia. The two 
 solutions should be kept in separate bottles, and when 
 needed thev may be mixed and administered. It is used as 
 an antidote in acute arsenical poisoning. 
 
 2. The most common sources of lead poisoning are the 
 following: 'The contamination of drinking water from 
 lead pipes. Contamination of articles of food or drugs by 
 contact witn leaden vessels, or from being enclosed in tin- 
 foil containing an excess of lead. Drinking beer, cider, 
 etc., which has been drawn through leaden pipes or allowed 
 to stand in pewter vessels. The ingestion or constant 
 handling of lead or its compounds, as the acetate, nitrate, 
 carbonate (white lead — painter's colic), Goulard's extract, 
 etc. The use of hair dyes containing lead." 
 
 Lead poisoning causes: Metallic taste, dryness of throat, 
 
 539 
 
MEDICAL RECORD. 
 
 thirst, severe, colicky abdominal pains, particularly in um- 
 bilical region; pulse feeble and slow; great prostration; 
 constipation; urine scanty and red; violent cramps; par- 
 alysis of lower extremities; convulsions; tetanic spasms, 
 and (in chronic cases) wrist drop. Chemical antidote is 
 magnesium sulphate. 
 
 3. Principal products of petroleum are: Paraffin, vase- 
 line, kerosene, benzine, gasoline, mineral oils, rhigolene. 
 Vaseline is a yellowish or whitish fatty substance, with 
 slight odor and taste, and is sticky. 
 
 4. Chloroform is prepared bv the action of calcium hypo- 
 chlorite on acetone. It is tested: (1) For excess of alco- 
 hol, by taking the specific gravity ; (2) for HC1 and CI, by 
 shaking it with water, which afterward should not give a 
 precipitate with AgN0 3 . 
 
 5. Chemical antidote for sulphuric acid is magnesia; it 
 acts by neutralizing the acid and converting it into a harm- 
 less salt. 
 
 6. Test for bile pigment in the urine: Put 3 c.c. HNOr 
 in a test-tube ; add a piece of wood, and heat until the acid 
 is yellow; cool. When cold, float some of the urine to be 
 tested upon the surface of the acid. A green band is 
 formed at the junction of the liquid, which gradually 
 rises, and is succeeded from below by blue, reddish-violet, 
 and yellow. 
 
 7. (a) Chemical; (b) physical; (c) physical; (d) chem- 
 ical; (e) chemical. 
 
 8. (a) Aqua regia is nitrohydrochloric acid; (b) aqua 
 fortis is nitric acid; (c) oil of vitriol is sulphuric acid. 
 
 9. (a) Mercuric chloride, HgCl 2 ; (b) cupric nitrate, Cu 
 (NOs)2; (c) calcium carbonate, CaCOs. 
 
 10. Carbolic acid, C 6 H 5 OH. It is obtained by heating 
 phenyl iodide and potassium hydroxide. It is a crystalline 
 substance, with characteristic odor and acrid, burning taste, 
 neutral in reaction, and very soluble in alcohol and ether. 
 It is used as an antiseptic and in the manufacture of 
 medicinal compounds, dyes, and explosives; also as a local 
 anesthetic, for pruritus, and sometimes internally in ner- 
 vous vomiting. 
 
 PATHOLOGY AND BACTERIOLOGY. 
 
 i. See Da Costa's "Surgery" (1908), pages 127, 130, and 
 132. 
 
 2. Most bacteria require (1) proper temperature, gen- 
 erally at or near that of the body; (2) oxygen is generally 
 needed, those that cannot live without it' being called 
 aerobic, and those that can grow without it, anaerobic; 
 nutriment of a proper kind, containing both organic and 
 inorganic material; a slight degree of moisture; a medium 
 of slightly alkaline reaction, and rest. Individual bacteria 
 may require modifications of the above essentials. 
 
 540 
 
MEDICAL RECORD. 
 
 By the toxic products of bacteria is meant the production 
 of disease or infection by bacteria. 
 
 3. Immunity is the power of resistance of cells and 
 tissues to the action of pathogenic bacteria. Immunity 
 may be either natural or acquired. 
 
 Natural immunity is this power of resistance, natural 
 and inherited, and peculiar to certain ^roups of animals, 
 but common to every individual of these groups. 
 
 Acquired immunity is this resistance acquired: (1) By 
 a previous attack of the disease caused by the bacteria, or 
 (2) by the person being made artificially insusceptible. 
 The conditions which give immunity from the pathogenic 
 action of bacteria are: (1) A previous attack of the dis- 
 ease; (2) inoculation with small quantities of bacteria, so 
 as to produce a mild attack of the disease; (3) vaccina- 
 tion; (4) the introduction of antitoxins; (5) the introduc- 
 tion of the toxins of the bacteria. 
 
 Several theories have been advanced to account for 
 immunity, but the only two that are considered now are: 
 (1) MetchnikofT's theory of phagocytosis and (2) Ehr- 
 lich's side-chain theory. This latter "is based on the idea 
 that the toxin destroys a cell by entering into chemical 
 union with it. The molecule of toxin contains at least two 
 groups of atoms, a toxophore group, in which the poison- 
 ous principle resides, and a haptophore group, which brings 
 the toxophore group into touch with the cell and through 
 which chemical combination takes place. Similarly, the cell 
 contains a haptophore group, but the toxophore group of 
 the toxin can only unite with it and destroy it when its 
 haptophore companion has affinity with that of the cell. If 
 that affinity does not exist the two haptophore groups do 
 not unite, the toxophore group does not come into contact 
 with the cell, and the animal is immune. Such is natural 
 immunity. If there is affinity and the cell can throw off a 
 haptophore group (antitoxin), which in its detached con- 
 dition unites with the haptophore group of the toxin, the 
 toxophore group has then nothing with which it can unite 
 and the animal is immunized. When the individual has to 
 contend with a tacterium as well as its toxin, the same 
 principle obtains. Immunity is established by the produc- 
 tion of a double haptophore group, one for the bacterium, 
 the other for its toxin/' — (Stenhouse's Pathology.) 
 
 4. The chief protective agencies by which the body 
 guards itself against the entrance and harmful effects of 
 pathogenic microorganisms are : The acidity of the gastric 
 juice, urine, and the vaginal secretion : the alkalinity of the 
 blood; the agglutinating action of the blood; the bacte- 
 ricidal action of the blood and lymph; the action of leuco- 
 cytes and phagocytes; the general antitoxic action of the 
 organism. 
 
 541 
 
MEDICAL RECORD. 
 
 5. The comma bacillus is a spirillum, actively motile, and 
 with a flagellum at one end ; it is curved, has rounded ends, 
 and is about half the length of the tubercle bacillus; it 
 stains readily with ordinary anilin stains, but not by 
 Gram's method; it is easily cultivated on the usual media; 
 it has but slight power of resistance; it liquefies gelatin, 
 and does not produce pigment. 
 
 It may be introduced into the system by: water, milk, 
 food, fingers, and flies. 
 
 6. To demonstrate the existence of tubercle bacilli in the 
 sputum : The sputum must be recent, free from particles 
 of food or other foreign matter; ielect a cheesy-looking 
 nodule and smear it on a slide, making the smear as thin 
 as possible. Then cover it with some carbolfuchsin, and let 
 it steam over a small flame for about two minutes, care 
 being taken that it does not boil. Wash it thoroughly in 
 water and then decolorize by immersing it in a solution of 
 any dilute mineral acid for about a minute. Then make a 
 contrast stain with solution of Loeffler's methylene blue 
 for about a minute; wash it again and examine with oil 
 immersion lens. The tubercle bacilli will appear as thin 
 red rods, while all other bacteria will appear blue. 
 
 7. Ischemic paralysis is a local paralysis due to stoppage 
 of the circulation in a part (often the result of embolism 
 or thrombosis). It is also another name for myositis 
 fibrosa, or fibrous degeneration of muscles. 
 
 8. Syphilitic gummata are firm, elastic, yellow or whitish 
 nodular masses, varying in size from a tubercle to an 
 orange. Their shape and outline are irregular, owing to 
 fibrous processes which go through them ; they often have 
 a kind of capsule consisting of fibrous-looking but trans- 
 lucent material, which fastens them firmly to adjacent 
 structures. On section they are mucoid or gelatinous, and 
 vascular. Microscopically, they consist of round cells and 
 giant cells, nuclei, fat granules and cholesterin ; around this 
 portion will be found epithelioid cells, and an outer layer 
 consisting of leucocytes, giant cells, and epithelioid cells. 
 There is some intercellular material ; and blood-vessels are 
 present. 
 
 9. Occlusion of the bile duct may be due to : Foreign 
 bodies within the duct (gallstones, hydatids, or other 
 parasites, inspissated bile) ; thickening of the mucosa due 
 to inflammation, or cicatricial overgrowth of connective 
 tissue; pressure from without (tumors, enlarged glands, 
 aneurysm) ; adhesions, due to peritonitis.* 
 
 10. A cyst is a circumscribed cavity containing liquid 
 or pultaceous material. Cysts may be formed: (1) By 
 the accumulation of secretions and other products within 
 cavities which are already in existence; and (2) inde- 
 pendently, by the softening or liquefaction of tissues. 
 
 542 
 
MEDICAL RECORD 
 
 Varieties: Retention cysts, dilatation cysts, exudation 
 cysts, extravasation cysts, parasitic cysts, congenital cysts, 
 dermoid cysts. 
 
 PHYSICAL DIAGNOSIS. 
 
 i. See French's "Practice of Medicine" (1907), page 579; 
 or Osier's "Practice of Medicine" (1909), page 807. 
 
 2. See French's "Practice of Medicine" (1907), page 
 560; or Osier's "Practice of Medicine" (1909), pages 777 
 and 779. 
 
 3. See French's "Practice of Medicine" (1907), pages 
 630 to 633; or Osier's "Practice of Medicine" (1909), pages 
 857 to 861. 
 
 4. A complete physiological revolution of the heart or 
 cardiac cycle includes all the changes which occur between 
 the commencement of one heart-beat and the commence- 
 ment of the next; it consists of the alternate contractions 
 (or systole) and relaxations (or diastole) of the auricles 
 and ventricles of the heart. The contraction of the two 
 auricles takes place simultaneously and is followed by the 
 simultaneous contraction of the two ventricles ; then fol- 
 lows a period during which the whole heart is in a state 
 of diastole. The cycle then begins again with the auricular 
 systole. 
 
 5. Rude Respiration is a form of breathing which is 
 neither bronchial nor vesicular, but partakes of the charac- 
 teristics of both ; it is generally called bronchovesicular 
 breathing. 
 
 Bronchial Respiration is chaacterized W t absence of the 
 vesicular quality. Inspiration is high pitched and tubular; 
 expiration is higher pitched and prolonged ; the two are 
 separated by a short interval. 
 
 Cavernous Respiration is a blowing sound, but constant, 
 heard during both inspiration and expiration, lower in 
 pitch than bronchial respiration, and hollow in character. 
 
 Amphoric Respiration is a blowing respiration, of 
 metallic or musical quality; it is present in inspiration 
 and expiration. 
 
 6. Pulmonary tuberculosis is classified as an infectious 
 disease. The positive diagnostic sign is the finding of the 
 tubercle bacilli in the sputum. See above, Pathology, 
 Question 6. 
 
 7. Test for Blood. — To the urine add a solution of 
 potassium hydroxide to distinct alkaline reaction; heat 
 nearly to boiling (do not boil). A red precipitate is pro- 
 duced. 
 
 8. See French's "Practice of Medicine" (1907), page 
 792; or Osier's "Practice of Medicine" (1909), page 514. 
 
 9. This question is not intelligible. 
 
 10. See Rose and Carless' "Surgery" (1908), page 882. 
 
 543 
 
MEDICAL RECORD. 
 
 THEORY AND PRACTICE OF MEDICINii. 
 
 i. (a) A Collyrium: 
 
 I£ Atropine sulphatis, gr. ij. 
 
 Sodii chloridi, er. ij. 
 
 Aquae destillatae, 3ss. Misce. 
 Signa : One drop to be placed in the eye every night. 
 
 (b) A Suppository: 
 
 $. Cocainae hydrochloride gr. ij. 
 Aquae destillatae, 11$ vj. 
 Olei theobromatis, 3jss. Misce. 
 Fiant suppositoria No. vj. 
 Signa: Insert one night and morning. 
 
 (c) A Mouth Wash: 
 ]£ Thymol, gr. vij. 
 
 Spiritus chloroformi, 3vj. 
 Spiritus menthae piperitae, 3ij. 
 Tincturae hamamelidis q.s. ad %iv. Misce. 
 Signa: One teaspoonful to be added to two table- 
 spoonfuls of water, and used after each meal. 
 
 2. For Erysipelas: 
 # Ichthyol, Sss. 
 
 Olei citronellae, Vtyxx. 
 Adipis, SJ- M. 
 Signa : Apply as directed. 
 
 For Rhus Tqxicodendron Poisoning: 
 ]£ Fluidextracti grindeliae robustae, 3j. 
 
 Aquae, 3x. M. 
 Signa: Apply as directed. 
 For Night Sweats of Phthisis: 
 ]£ Acidi camphorici, 3iv. 
 Alcohol, 3ij- 
 Mucilaginis acaciae, Jiij. 
 Syrupi aurantii corticis, q.s. ad Jvj. M. 
 Signa: One dessertspoonful one hour before sweat is 
 expected. 
 For Ascites: 
 
 5 Pulveris digitalis. 
 
 Pulveris scillae, aa Gr. xx. M. 
 Fiat massa in pilulas No. xx. dividenda. 
 Signa : One every five hours. 
 For Ptyalism: 
 
 5 Atropinae sulphatis, gr. ss. 
 Sacchari lactis, 3j. M. 
 Ft. in caps. No. L. 
 Signa: One after each meal. 
 
 3. Leucocytosis occurs in: Cholera, relapsing fever, 
 typhus, scarlet fever, diphtheria, tonsillitis, syphilis, erysipe- 
 
 544 
 
MEDICAL RECORD. 
 
 las, bubonic plague, pneumonia, smallpox, malignant endo- 
 carditis, septicemic conditions, actinomycosis, glanders, 
 rheumatism, meningitis, affections of gall-bladder, pan- 
 creatitis, endometritis, gonorrhea, abscesses, carbuncle, 
 furuncle, appendicitis, pyonephrosis osteomyelitis salpin- 
 gitis, inflammations of serous membranes, many inflam- 
 matory skin diseases, and in many cases of poisonings. 
 
 Leukocytosis is absent in: Typhoid, malaria, influenza, 
 measles, rotheln, and tuberculosis. (From Cabot's Exam- 
 ination of the Bloody 
 
 4. See French's "Practice of Medicine" (1907), pages 658 
 and 661; or Osier's "Practice of Medicine" (1909), pages 
 609 and 612. 
 
 5. See French's "Practice of Medicine" (1907), page 113; 
 or Osier's "Practice of Medicine" (1909), page 100. 
 
 6. (a) Rubeola: Character of eruption, small, dark 
 red papules with crescentic borders, beginning on face and 
 rapidly spreading over the entire body; desquamation is 
 branny. The eruption is dark, not uniform, shotty. 
 
 (b) Rubella: The rash is more diffuse, and is of a 
 rose-red color, is brighter, and less crescentic than in 
 measles. It appears on first day, is most intense on second 
 day, consists of red papules, often fades from face before 
 it is seen on the limbs. 
 
 (c) Scarlatina: A scarlet punctate rash, beginning on 
 neck and chest, then covering face and body; desquama- 
 tion is scaly or in flakes. The eruption is brighter, is on 
 a red background, punctiform, and is more uniform. 
 
 (d) Varicella: The eruption usually appears first on 
 the trunk, is evident on the first day, comes in successive 
 crops, is not shotty, and disappears on stretching the 
 skin; the spots are unilocular, and collapse on being punc- 
 tured. 
 
 7. See French's "Practice of Medicine" (1907), page 
 782; or Osier's "Practice of Medicine" (1909), page 507. 
 
 8. In renal colic: The pain is in the reigon of the af- 
 fected kidney; it radiates down the thigh; there are in- 
 tense rigors; retraction of the testicle may be present; 
 also history of previous attacks or of calculi; the urine 
 may be scanty, suppressed, or bloody. 
 
 In hepatic colic: The pain is in the region of the liver; 
 it radiates to the right scapula and toward the umbilicus; 
 chills and sweats are common; also vomiting, and some- 
 times symptoms of collapse and jaundice; calculi are found, 
 if at all, in the feces. 
 
 9. See Osier's "Practise of Medicine" (1909), page 547. 
 
 10. See French's "Practice of Medicine" (1907), page 
 969; or Osier's "Practice of Medicine" (1909), page 385. 
 
 545 
 
MEDICAL RECORD. 
 
 OBSTETRICS AND HYGIENE. 
 
 I. 
 
 FOOT. 
 
 This is at right angles to 
 the leg. 
 
 The inner border is thicker 
 than the outer. 
 
 The toes are short and 
 are in a straight line. 
 
 The great toe cannot be 
 altered in its relation to the 
 remaining toes. 
 
 The toes cannot be sepa- 
 rated to any great extent. 
 
 The malleoli and heel 
 (projecting os calcis) may 
 be felt. 
 
 The ankle-joint is not 
 freely movable. 
 
 HAND. 
 
 This is a straight line 
 with the arm. 
 
 Both borders are of equal 
 thickness. 
 
 The fingers are longer, 
 and the thumb is at right 
 angles to the other digits. 
 
 The thumb may be bent 
 across the palm, and thus 
 brought into contact with 
 the other fingers. 
 
 The thumb and first finger 
 may be considerably sepa- 
 rated. 
 
 There is an absence of 
 such features. 
 
 The wrist joint is quite 
 movable. 
 
 — (Dorland's Obstetrics.) 
 
 For treatment, see Williams' "Obstetrics" (1909), page 
 802. 
 
 2. The bag of water is the amniotic sac with the liquor 
 amnii; this latter is alkaline in reaction, has a specific 
 gravity of about 1.001 to 1.008, its quantity is variable, but 
 is generally about two pints. It consists chiefly of water, 
 but contains small amounts of albumin, epithelial cells, 
 urea, phosphates, chlorides, etc. Its source is unsettled. 
 
 Functions. — (a) During pregnancy: (1) As a protection 
 to the fetus against pressure and shocks from without. (2) 
 As a protection to the uterus from excessive fetal move- 
 ments. (3) It distends the uterus, and thus allows for 
 the growth and movements of the fetus. (4) It receives 
 the excretions of the fetus. (5) It surrounds the fetus 
 with a medium of equable temperature, and serves to pre- 
 vent loss of heat. (6) It prevents the formation of ad- 
 hesions between the fetus and the walls of the amniotic 
 sac. (7) It has been supposed, by some, to afford some 
 slight nutrition to the fetus. 
 
 (b) During labor: It acts as a fluid wedge, and dilates 
 the os uteri and the cervix ; it also slightly lubricates the 
 parts. 
 
 3. See Williams' "Obstetrics" (1909), page 664. 
 
 4. Symptoms of death of the fetus during the later 
 months of pregnancy are : Cessation of the signs of preg- 
 nancy, the abdomen and uterus are both diminished in size, 
 
 546 
 
MEDICAL RECORD. 
 
 the fetal heart sounds and movements cease, there is no 
 pulsation in the cord, the mother's breasts become flaccid 
 and occasionally secrete milk. If the fetus has been dead 
 for some time, crepitus of its cranial bones may be elicited. 
 Treatment: Abortion or premature labor must be in- 
 duced, and the contents of the uterus removed immediately. 
 
 5. See Williams' "Obstetrics" (1909), page 128; or 
 Hirst's "Obstetrics" (1909), page 120. 
 
 6. (a) To report all cases of infectious and contagious 
 diseases ; to effect a temporary quarantine on these same 
 cases ; to report all births and deaths occurring in their 
 practice, (b) All infectious and contagious diseases. 
 
 7. The dangers of cold-storage foods are : The keep- 
 ing quality of the food is impaired, and so the food must 
 be consumed soon after it leaves the cold storage; danger 
 may lurk in the ice, particularly when not made from pure 
 water; a similar danger exists when food is put in dirty 
 water and surrounded by ice ; ptomaine poisoning may 
 occur; typhoid bacilli may retain their vitality even in 
 water at the freezing point. 
 
 8. "The continued use of tobacco, by smoking or chew- 
 ing it to excess, produces granular inflammation of the 
 fauces and pharynx, atrophy of the retina, dyspepsia, low- 
 ered sexual power, sudden faints, nervous depression, car- 
 diac irritability, and occasionally angina pectoris. Used by 
 the young, it hinders the development of the higher nerve 
 centers and impairs the nutrition of the body by interfer- 
 ing with processes of digestion and assimilation. It has 
 been credited with causing cancer of the lips and tongue, 
 blunting the moral sense, mental aberration, and even in- 
 sanity."— ( Potters' Materia Medica.) 
 
 9. See French's "Practice of Medicine" (1907), page 
 108; or Osier's "Practice of Medicine" (1909), page 97. 
 
 10. (a) About 65 to 70 ounces of water should be drunk 
 in a day, besides about 20 ounces taken in as an ingredient 
 of solid food. (b)The chief sources of contamination of 
 drinking water are : Sewage, including not only solid and 
 liquid excreta, but also house water and waste water; 
 manufacturing refuse, such as from dye works, bleaching 
 works, tanneries, and numerous other industrial places; 
 from improper storage or service of water, (c) The 
 presence of organic matter is shown by the change of 
 color which occurs in a pink solution of potassium per- 
 manganate; it loses oxygen and becomes brownish. 
 
 GYNECOLOGY. 
 
 1. Endometritis: The acute form is due to the introduc- 
 tion of septic bacteria, and is manifested by pain, consti- 
 pation, irritability of bladder, rapid pulse, rise of tempera- 
 ture, and a profuse discharge. Treatment following mis- 
 
 547 
 
MEDICAL RECORD. 
 
 carriage or labor consist's in curettage, intrauterine hot 
 sterile douche, free purgation, hot over the lower abdomen, 
 milk diet, and stimulants. Chronic endometritis may ac- 
 company numerous pathological uterine conditions, but is 
 generally due to gonorrhea. The symptoms are backache, 
 headache, leucorrhea, profuse menstruation, and impair- 
 ment of the general health. Treatment consists in re- 
 moving the cause when possible, and when due to gonor- 
 rhea curettage and ' irrigation of the uterus, with the appli- 
 cation of an antiseptic. 
 
 2. Atresia of the vagina is an obstruction of the vagina 
 by adhesion (either congenital or acquired). Treatment: 
 Adhesions are to be separated, bands cut off short, cicatri- 
 cial tissue dissected out, the wound closed, and a dilator 
 inserted into the vagina. 
 
 3. Most frequent causes of pyosalpinx are : Gonorrhea, 
 puerperal septic endometritis, and sepsis from use of dirty 
 instruments. It is diagnosed by: Pain or discomfort, 
 made worse by pressure, examination, or defecation; or 
 colicky pains over the tube; dysmenorrhea; increased men- 
 strual flow; tubes are found to be dilated and swollen. 
 Treatment : Removal of the affected tube. 
 
 4. MenorrMgia is an excessive loss of blood at the men- 
 strual periods. Metrorrhagia is a hemorrhage from the 
 uterus at other than the menstrual periods. It is very often 
 impossible to differentiate the two conditions. Treatment: 
 Remove the cause, if possible; treat abnormal conditions 
 that are present; vaginal douches, tampons, and curettage 
 have been recommended; also ergot, hamamelis, hydrastis, 
 and viburnum prunif olium ; rest in bed is necessary. In- 
 trauterine applications of astringents or of adrenalin have 
 been used. Amenorrhea is absence of menstruation during 
 the oeriod of sexual activity. Treatment consists in: (1) 
 Removing the cause, if possible; (2) general treatment by 
 means of proper hygiene, rest, diet, bathing, attention to 
 the bowels, exercise, etc.; (3) drugs reouted to be em- 
 menagogues such as^ iron, manganese, aloes, strychnine, 
 apiol, oxalic acid, savine, rue, and tansy. 
 
 5. Prolapsus uteri. Treatment: "Operative, unless 
 some contraindication to operation exists. In such a case 
 some mechanic device should be tried for the support of 
 the uterus. Pessaries are not to be recommended, as their 
 constant use leads to irritation and excoriation of the 
 vaginal walls. Probably the best means for supporting 
 the uterus is by Braun's colpeurynter. This is worn only 
 during the day, and can be introduced by the patient her- 
 self every morning. The uterus is replaced and the col- 
 peurynter well anointed with carbolized vaseline and con- 
 taining about an ounce of water, is introduced into the va- 
 gina. It is then distended with air, thus making an even 
 
 548 
 
MEDICAL RECORD. 
 
 pressure on the vaginal walls and not causing ulcerations. 
 Operative treatment gives the most satisfactory results in 
 prolapse. In slight cases of prolapse repair of the peri- 
 neum will effect a cure. The severer grades will require, 
 in addition, some operation on the anterior vagina. The 
 best of these is Martin's operation for cystocele. If the 
 cervix is hypertrophied it should be amputated. Three 
 operations — on the perineum, for cystocele, and amputation 
 of the cervix — are required in the usual case of prolapse. 
 In addition, hystrorrhaphy may be advisable, since there 
 can be no prolapse so long as the uterus maintains its nor- 
 mal position of anteflexion. These onerations failing, 
 hysterectomy may be performed." 
 
 6. In ovaritis: The ovary is increased in size; is tender 
 on pressure, and pressure causes a sickening sensation; is 
 generally displaced (backward) ; dyspareunia and hysteria 
 may be present. In cystic ovary: The condition is gener- 
 ally unilateral, not often adherent, may grow to be very 
 large size. In salpingitis; Both tubes are apt to be af- 
 fected, the tube is oblong and generally adherent, ovary 
 may be palpated as distinct from the tumor- usually it is 
 not very large, and there may be leucocytosis. 
 
 7. See Williams' "Obstetrics" (1909), pages 644 and 
 649; or Hirst's "Obstetrics" (iox | 9), pages 303 and 306. 
 
 8. See Williams' "Obstetrics" (1909), page 26; or Hirst's 
 "Obstetrics" (1909), page 43. 
 
 SANITARY SCIENCE. 
 
 i. Concerning schools: The school building should be 
 as near as possible to the center of the area which it is to 
 serve; the site should be airy and open, of sufficient size, 
 free from swamps, and somewhat elevated ; it should not 
 be too near factories, busy streets, or railways; the soil 
 should be as free as possible from organic matter. The 
 building should be so planned that the corners look towards 
 the four points of the compass. In this way the sun will 
 have access to each side and to every room during some 
 part of the day. The building should have as few stories 
 as possible. The walls should be of brick or stone, and 
 should be pointed with cement; the inner surface of the 
 wall should be cemented smooth. The foundations must 
 be solid. The general arrangement will depend upon 
 size of site, number of scholars, and number of required 
 rooms. Fifteen square feet per child should be allowed. 
 Details will have to be considered on: plans, accommo- 
 dations to be provided, shape and size of class rooms, 
 distribution of rooms, teachers' rooms, corridors, entrances 
 and staircases, playground, ventilation, heating, lighting, 
 and placing of windows, sanitation, lavatories water sup- 
 ply, drinking water, sewage disposal, removal of refuse, 
 sanitary appliances, and drainage. Special care must be 
 
 549 
 
MEDICAL RECORD. 
 
 given to the prevention of contagious diseases, and the ex- 
 clusion of all possible sources of infection or contagion; 
 there should be physical examination of children, also, for 
 non-contagious physical defects. 
 
 Concerning water supply: This must be free from ex- 
 creta of human beings and animals ; and the intake must 
 be a sufficient distance from any possible source of pollu- 
 tion by sewage or other impurities. If the water comes 
 from a source which cannot be controlled by inspection, 
 sand filtration or other means of purification must be used. 
 
 Concerning sewerage: This should not be deposited into 
 water which may be the source of supply for any town. 
 For small towns, sedimentation and filtration (or some 
 other recognized method) should be adopted. 
 
 2. The main thing is the prevention and check of con- 
 tagious diseases by isolation, quarantine, and subsequent 
 disinfection. There must be a sufficiency of water, and 
 adequate inspection of the source of its supply; examina- 
 tion of food supplies, particularly milk, and insistence 
 that food is not exposed to dust, flies, or other deleterious 
 influences; purity and wholesomeness of milk and water; 
 proper sewage disposal ; adequate medical school inspec- 
 tion ; proper laboratory facilities for production of anti- 
 toxins and vaccines, and for early diagnosis of diphtheria, 
 tuberculosis, typhoid, and malaria; abatement of nuisances 
 (such as noise, smoke, odors). 
 
 SURGERY. 
 
 1. See Rose and Carless' "Surgery" (1908), page 1148; 
 or Da Costa's "Surgery" (1908), page 1012. 
 
 2. In osteomyelitis: There are sudden onset, pain, chills, 
 fever, tenderness, swelling of soft parts, sometimes the 
 joint can be moved gently without pain; septicemia or 
 pyemia may be present. In rheumatism there is succes- 
 sive involvement of many joints; the tenderness, pain, and 
 swelling are over the joints, and not over the bones; pro- 
 fuse sweats are present, and the condition responds to 
 treatment by salicylates. 
 
 In osteomyelitis the treatment consists in relieving the 
 constitutional symptoms and preventing the bone < from 
 necrosing. An incision down to the bone is made; if pus 
 is beneath the periosteum, the latter is also incised; a piece 
 of bone is removed by chisel or trephine, pus is removed, 
 the endosteum is hurt as little as possible, the wound is 
 irrigated with hot bichloride solution and packed with 
 gauze; the soft parts are closed and the wound well 
 drained. In case this fails, amputation mav be necessary. 
 
 3. See Rose and Carless' "Surgery" (1908), page 915; 
 or Da Costa's "Surgery" (1908, oa^ 769. 
 
 4. See Rose and Carless' "Surgery" (1908), pages 1099 
 and 1103; or Da Costa's "Surgery" (1908), page 992. 
 
 550 
 
MEDICAL RECORD. 
 
 5. See Rose and Carless' "Surgery" (1908), page 340; or 
 Da Costa's "Surgery" (1908), page 423. 
 
 6. See Rose and Carless' "Surgery" (1908), page 638; or 
 Da Costa's "Surgery" (1908), page 609. 
 
 7. See Rose and Carless' "Surgery" (1908), page 538; or 
 Da Costa's "Surgery" (1908), page 515. 
 
 8. See Rose and Carless' "Surgery" (1908), passes 534 
 and 481; or Da Costa's "Surgery" (1908), pages 540 and 
 464. 
 
 9. See Rose and Carless' "Surgery" (1908), page 1161; 
 or Da Costa's "Surgery" (1908), page 1104. 
 
 10. See Rose and Carless' "Surgery" (1908), page 1121; 
 or Da Costa's "Surgery" (1908), pages 838 and 962. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. In case of rape of a girl of twelve years old, one 
 might find: (1) Marks of violence about the genitals; (2) 
 wounds, bruises, or other marks of injury on the body; 
 (3) bloodstains and seminal stains on the person or 
 clothing. 
 
 2. The causes of sudden death are: Cerebral hemor- 
 rhage; rupture of a gastric ulcer; valvular disease of the 
 heart, especially aortic ; angina pectoris ; rupture of an 
 aortic aneurysm; suffocation during an epileptic fit; shocks 
 of electricity; sunstroke; mental or physical shock; diabetic 
 coma ; uremia ; exertion on an overloaded stomach. 
 
 3. A wound inflicted during life is generally character- 
 ized by hemorrhage, coagulation of the blood, eversion of 
 the edges, and retraction of its sides. It may also be in- 
 ferred that the wound was inflicted during life if any of 
 the following are noticed : The presence of inflammation, 
 swelling, pus, or gangrene on the edges of the wound, or 
 if there is any sign of beginning cicatrization. 
 
 4. Rigor mortis is supposed to be due to the coagulation 
 of the myosin in the muscles. It lasts for a variable period, 
 generally from about sixteen to twenty-four hours. 
 
 5. Strangulation generally points to homicide; hanging, 
 to suicide. 
 
 TOXICOLOGY. 
 
 1. Antidote (for oxalic acid) is calcium carbonate, or 
 hydroxide, or magnesia. Treatment: Give bland mucilag- 
 inous drinks, and antidotes; do not use stomach pump. 
 
 2. Post-mortem appearances in carbolic acid poisoning: 
 "The mouth and throat show corrosive effects. The mu- 
 cous membrane is generally white or gray and pultaceous, 
 or it may be hardened and corrugated. The stomach usu- 
 ally shows relatively little corrosion. The blood is dark 
 and fluid. All the fluids of the body exhale the odor of 
 phenol. The bladder is empty, or contains a small quantity 
 of dark or greenish urine. As death is usually due to 
 asphyxia, the veins of the head and brain are congested. 
 
 551 
 
MEDICAL RECORD. 
 
 Putrefaction is apt to be retarded." — (Riley's Toxicology.) 
 
 3. Symptoms of poisoning by corrosive sublimate are : 
 A burning pain in the mouth, pharynx, and stomach; the 
 mouth and tongue are white; the vomitus is white, with 
 shreds of mucous membrane, and tinged with blood; there 
 may be bloody stools, also salivation. Treatment: The 
 antidote is white of egg, but too much must not be given 
 at one time ; this should be followed by an emetic. 
 
 4. The antidote for strychnine is tannic acid, or weak 
 solution of potassium permanganate. 
 
 5. Quinine, cubebs, copaiba, belladonna, bromides, iodides, 
 mercury, salicylic acid, arsenic, and opium. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Board of Medical Examiners, State of Oregon. 
 
 ANATOMY. 
 
 1. Give the course and distribution of the trifacial^ nerve. 
 
 2. Name and give the origin of the arteries supplying the 
 stomach, small intestine, large intestine. 
 
 3. Give the course and branches of distribution of the 
 femoral artery. 
 
 4. Name the structures passing beneath Pouparfs liga- 
 ment. 
 
 5. What structures would be severed in an amputation 
 at junction of the middle and upper thirds of the forearm? 
 
 6. Give the coverings of an incomplete oblique inguinal 
 hernia. 
 
 7. Name and locate the various valves of the heart, and 
 give the function of each set. 
 
 8. Name the tunics and the humors of the eye. 
 
 PATHOLOGY. 
 
 1. Give pathology of a carbuncle; and how does it differ 
 from a furuncle? 
 
 2. Define phagocytosis, metastasis, leucocytosis. 
 
 3. Give the pathological anatomy and histology of acute 
 parenchymatous or degenerative nephritis. 
 
 4. Give the pathology of atrophic portal cirrhosis ("gin- 
 drinker's liver") . 
 
 PHYSIOLOGY. 
 
 1. What is the function of the red corpuscles? State 
 their number and what variation with altitude. 
 
 2. Give function of white corpuscles and state under what 
 normal conditions leucocytosis occurs. 
 
 3. Describe the lymphatic system and state what factors 
 control lymphatic circulation. 
 
 4. Give functions of auricles and ventricles of heart, and 
 state what is meant by systole and diastole. 
 
 552 
 
MEDICAL RECORD. 
 
 5. Name kinds and location of digestive ferments and 
 state their action on foods in the small intestine. 
 
 6. How prove the spinal cord a center for reflexes? 
 
 7. Give name and state what kind of nerves the sixth 
 and eleventh cranial nerves are. What does each supply? 
 
 8. What maintains the pitch of the voice? 
 
 HISTOLOGY. 
 
 1. Describe protoplasm. Does it possess structure? 
 
 2. Describe white fibrous tissue; also yellow elastic 
 tissue, and state where found. 
 
 3. Describe in detail a lobule of the liver. 
 
 4. Where are nerve cells found? 
 
 GYNECOLOGY. 
 
 1. Name three leading causes of sterility, with treatment 
 in each case. 
 
 2. Etiology, diagnosis, and treatment of retrodisplace- 
 ments of the uterus. 
 
 3. Give five causes of pruritus of the vulva, with treat- 
 ment in each case.^ 
 
 4. Give diagnosis, symptomatology, and treatment of 
 septic abortion. 
 
 5. Name two common causes of dysmenorrhea, giving 
 diagnosis and treatment. 
 
 6. Describe a miscarriage at five months, giving treat- 
 ment to successful conclusions. 
 
 7. Diagnose and describe operation of salpingo-oopho- 
 rectomy for adherent tubes and ovaries. 
 
 8. Describe operation for vaginal hysterectomy. 
 
 GENERAL DIAGNOSIS. 
 
 i. What diseases produce conditions of the skin which 
 are of general diagnostic value? 
 
 2. What are the grades of temperature that come under 
 observation in the sick? 
 
 3. Give the method for the detection of the tubercle 
 bacillus in the sputum. 
 
 4. What is the diagnostic significance of dropsy? 
 
 5. Describe the characteristics and significance of the 
 several kinds of pulse. 
 
 6. Give the symptoms of acute meningitis. 
 
 7. What are the diagnostic points in secondary syphilis? 
 
 8. What casts are frequently found in albuminous urine, 
 and what do they denote? 
 
 NERVOUS DISEASES. 
 
 i. Give symptoms of tuberculous meningitis. 
 
 2. Define and give etiology of acute ascending paralysis. 
 
 3. What symptoms would you expect to find following 
 rupture of a branch of the middle meningeal artery? 
 
 553 
 
MEDICAL RECORD. 
 
 4. Give definition, prognosis, and treatment of puerperal 
 
 insanity. 
 
 PRACTICE OF MEDICINE. 
 
 1. Give the etiology, pathology, common complications, 
 and symptoms of typhoid fever. 
 
 2. Give the differential diagnosis of variola, varicella, 
 scarlet fever, measles, and erysipelas. 
 
 3. State the etiology, pathology, diagnosis, and symptoms 
 of croupous pneumonia. 
 
 4. Give the differential diagnosis of mitral regurgitation, 
 aortic regurgitation, and aortic stenosis. 
 
 5. Give the pathology, etiology, and diagnosis of chronic 
 interstitial nephritis. 
 
 6. Give the differential diagnosis of acute alcoholism, 
 acute morphinism, and apoplexy. 
 
 7. State the pathology, etiology, symptoms, and treatment 
 of ileocolitis of childhood. 
 
 8. State the pathology, etiology, and differential diagnosis 
 of chronic gastric ulcer. 
 
 PRACTICE OF SURGERY. 
 
 1. Give the mechanism, pathology, symptoms, and treat- 
 ment, and name the ligaments injured in backward dislo- 
 cation of the hip-joint. 
 
 2. Describe amputation at middle third of arm, and name 
 all tissues cut. 
 
 3. Give complete preparation of patient for abdominal 
 section. 
 
 4. Describe the operation of posterior gastroenterostomy, 
 and name the complications that may follow. 
 
 5. Give the anatomical relations, covering of sac, and 
 detail of operation for femoral hernia. 
 
 6. State the etiology, pathology, diagnosis, symptoms, 
 and treatment of osteomyelitis of the tibia. 
 
 7. Name the triangles of the neck; describe the relations 
 and ligation of the common carotid artery. 
 
 8. State the etiology, pathology, symptoms, and treat- 
 ment of pyelitis. 
 
 EYE AND EAR. 
 
 i. Give the etiology, diagnosis, symptoms, indications, 
 and describe operation for mastoid abscess. 
 
 2. Give the differential diagnosis of gonorrheal conjunc- 
 tivitis and blepharitis ciliaris. 
 
 3. Give the etiology, diagnosis, symptoms, and treatment 
 of acute myringitis. 
 
 4. Give the treatment and your instructions to patient 
 with marginal corneal ulcer. 
 
 5. Give the anatomy and appearance of a normal ear 
 drum. 
 
 554 
 
MEDICAL RECORD. 
 
 CHEMISTRY. 
 
 i. Write a comprehensive definition of chemistry in not 
 more than sixty words. 
 
 2. Define briefly the following chemical terms and name 
 a substance that is characteristic of each: Deliquescent; 
 efflorescent ; effervescent; fluorescent. 
 
 3. What do you consider the most practical chemical 
 test for sugar, albumin, pus, blood, urea, in the urine? 
 
 4. Differentiate between empirical formula and graphic 
 formula, giving as an example the formation of acetic acid. 
 
 5. Define "equation," and express the formation of mer- 
 curous chloride by chemical equation. 
 
 6. What do you understand by the term equivalent 
 amounts in chemistry? 
 
 7. Define molecular weight, giving an example. 
 
 8. Define specific heat and name its unit. 
 
 MEDICAL JURISPRUDENCE. 
 
 1. What are the requisites of a hypothetical question, 
 and under what circumstances may the opinion be given in 
 evidence of (a) an expert witness, and (b) a non-expert 
 witness? 
 
 2. What are the constituent elements of blood? How do 
 you distinguish between the blood of mammalian verte- 
 brates and that of oviparous vertebrates, and between the 
 blood of different mammals? Name the different tests for 
 blood stains, and give the principles upon which each test 
 depends. 
 
 3. Define and describe the different kinds of wounds; 
 how to determine whether a wound is ante- or post-mor- 
 tem, and why. if at all, the size and shape of a wound does 
 not always correspond to the size and shape of the instru- 
 ment with which it was made. 
 
 4. Describe generally the proper method of conducting 
 a post-mortem examination, giving details as to head, chest, 
 abdomen, and spinal cord; state how you would test the 
 lungs of a dead child to determine whether it had been 
 born alive, and how you would recognize flotation caused 
 by (a) artificial insufflation, (b) putrefaction, and (c) 
 freezing. 
 
 OBSTETRICS. 
 
 1. What is the conjugate and transverse diameter of the 
 inlet and outlet of the pelvis? Give its anatomical points 
 of measurements. 
 
 2. What is the cause of rupture of the uterus, and under 
 what circumstances does it occur? 
 
 3. Give your treatment for inevitable abortion. 
 
 4. Give your treatment for post-partum hemorrhage. 
 
 5. .Give cause and treatment for transverse presentations. 
 
 555 
 
MEDICAL RECORD. 
 
 6. Give cause, diagnosis, and treatment of puerperal 
 eclampsia. 
 
 7. When would you use forceps, and how ? 
 
 8. Give the anatomy of the uterus, and state what 
 changes take place during gestation. 
 
 DISEASES OF CHILDREN. 
 
 1. Give the symptoms in morbus coxarius during the 
 early stage of the disease. What other diseases might you 
 differentiate it from? 
 
 2. Give the etiology and describe the pathology of hip- 
 joint disease. 
 
 3. Give a clinical description of the various stages of 
 rubeola. 
 
 4. Describe symptoms, prognosis, and treatment in ileo- 
 colic intussusception. 
 
 5. Atelectasis pulmonum; what is it? Note its symptoms 
 and treatment. 
 
 6. Describe a process of peptonizing cow's milk, suitable 
 for infant use. 
 
 7. Describe the principal striking clinical changes that 
 take place in the skeleton in rhachitis. 
 
 8. From what other diseases would rhachitis have to be 
 differentiated? 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 1. Write an appropriate prescription in case of catarrhal 
 jaundice; also two prescriptions to relieve cough in acute 
 bronchitis. 
 
 2. Carbolic acid: origin, dose, and physiological action. 
 Give appropriate treatment in case of poisoning. 
 
 3. What would be a suitable dietary in hyperchlorhydria, 
 and give reason for same. 
 
 4. Apomorphine hydrochlorate : dose, physiological ac- 
 tion, and therapeutic uses and indications. 
 
 5. Spiritus setheris nitrosi; origin, dose, therapeutic 
 uses, and common name. 
 
 6. What is a diaphoretic? Name four agents, and appro- 
 priate doses of each. 
 
 7. What do you understand (a) a cardiac tonic to be, 
 and how does it act? (b) A cardiac stimulant, and how 
 does it act? Give examples of each. 
 
 8. What are cathartics, and how do they act? Name five 
 diseases or conditions in which the administration of a 
 cathartic would be contraindicated. 
 
 556 
 
MEDICAL RECORD 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Board of Medical Examiners, State of Oregon. 
 
 ANATOMY. 
 
 i. Superficial origin: From the side of the pons Varolii. 
 Deep (sensory root), from the medulla and upper part of 
 cord; (motor root) from floor of fourth ventricle and 
 side of the aqueduct of Sylvius. Exit: The ophthalmic 
 division, through the sphenoidal fissure; the superior max- 
 illary division, through the foramen rotundum ; the inferior 
 maxillary division, through the foramen ovale. Ophthalmic 
 branch distributed to conjunctiva, skin of upper eyelid, 
 cornea, skin of forehead, and nose, lacrymal gland. Supe- 
 rior maxillary, to skin and conjunctiva of lower eyelid, 
 nose, cheek, upper lip, upper teeth, and palate. Inferior 
 maxillary, to external auditory meatus, side of head, mu- 
 cous membrane of mouth, anterior two-thirds of tongue, 
 lower teeth, and skin of lower part of face. Also _ to 
 muscles as indicated under Function. It supplies sensation 
 to all the parts mentioned above; but, in addition, Inferior 
 maxillary supplies motion to the muscles of mastication, 
 the mylohyoid, and anterior belly of the digastric. 
 
 2. The stomach is supplied by the gastric (from celiac 
 axis), pyloric (from the hepatic), right gastroepiploic 
 (from the gastroduodenal), left gastroepiploic and vasa 
 brevia (from the splenic). The duodenum, by the pyloric 
 and pancreaticoduodenal from the hepatic), the inferior 
 pancreaticoduodenal (from the superior mesenteric). The 
 rest of the small intestine, by branches of the superior 
 mesenteric (from abdominal aorta). The large intestine, 
 by the ileocolic, right colic, and middle colic (from the 
 superior mesenteric) ; left colic, sigmoid, and superior 
 hemorrhoidal (from inferior mesenteric). The rectum, 
 by superior hemorrhoidal (from inferior mesenteric) ; 
 middle hemorrhoidal (from internal iliac), and inferior 
 hemorrhoidal (from internal pudic). 
 
 3. The femoral artery begins at Poupart's ligament; it 
 is the continuation of the external iliac, and passes down 
 the fore part and inner side of the thigh, to terminate at 
 the opening in the adductor magnus at the junction of the 
 middle with the lower third of the thigh, where it becomes 
 the popliteal artery. Branches: Superficial epigastric, su- 
 perficial circumflex iliac, superficial external pudic, deep 
 external pudic, muscular, anastomotica magna, and pro- 
 funda f emoris (with branches : external circumflex, inter- 
 nal circumflex, and three perforating). 
 
 4. These are (from without inward) : External cuta- 
 
 557 
 
MEDICAL RECORD. 
 
 neous nerve, iliacus, anterior crural nerve, psoas, femoral 
 artery, femoral vein, femoral ring. 
 
 5. In amputation of forearm at junction of middle and 
 upper third, there will be severed: Skin, fascia, supinator 
 longus, extensor carpi radialis, longior and brevior, exten- 
 sor communis digitorum, extensor carpi ulnaris, supinator 
 brevis, anconeus, pronator radii teres, flexor carpi radialis, 
 palmaris longus, flexor sublimis digitorum, flexor carpi 
 ulnaris, flexor profundus digitorum ; arteries : anterior 
 interosseous, radial, ulnar; veins: radial, interosseous, 
 ulnar, median ; nerves : posterior interosseous, radial, me- 
 dian, ulnar ; bones : radius, ulna. 
 
 6. From without inward : Skin, superficial fascia, inter- 
 columnar fascia, cremasteric fascia, infundibuliform fascia, 
 subperitoneal areolar tissue, and peritoneum. 
 
 7. In the right auricle are the Eustachian and coronary 
 valves; the former is situated between the anterior margin 
 of the inferior vena cava and the auriculo-ventricular ori- 
 fice; in the fetus it directs the blood from the inferior 
 vena cava through the foramen ovale into the left auricle; 
 the coronary valve prevents the regurgitation of blood into 
 the coronary sinus during the auricular contraction. In the 
 right ventricle are the tricuspid and semilunar valves; the 
 former prevent the blood in the right ventricle from 
 flowing back into the right auricle during ventricular 
 systole; the latter guard the orifice of the pulmonary 
 artery. In the left ventricle are the mitral and semilunar 
 valves; the former acts similarly to the tricuspid; the 
 latter guard the orifice of the aorta. Aortic valves, behind 
 the third intercostal space, close to the left side of the 
 sternum. Pulmonary valves, in front of the aortic, behind 
 the junction of the third rib, on the left side, with the 
 sternum. Tricuspid valves, behind the middle of the ster- 
 num, about the level of the fourth costal cartilage. Mitral 
 valves, behind the third intercostal space, about one inch 
 to the left of the sternum. 
 
 8. Tunics:, (1) Sclerotic and cornea; (2) choroid, 
 ciliary body, and iris; (3) the retina. Humors: (1) 
 Aqueous humor; (2) vitreous body; (3) crystalline lens. 
 
 PATHOLOGY. 
 
 1. A carbuncle is due to infection with a pus organism, 
 which causes an acute inflammatory exudation. The dense 
 fibrous tissue under the skin does not yield, and the com- 
 pression strangles the vessels. Septic gangrene results 
 from these causes. Later, the living tissues suppurate 
 around the septic slough and form pus. The pus breaks 
 through the overlying skin in one or two places and the 
 slough is discharged, the cavity being filled up by granu- 
 lation and cicatrization. A furuncle opens by a single open- 
 ing, instead of several, and is frequently multiple. 
 
 558 
 
MEDICAL RECORD. 
 
 2. Phagocytosis is the faculty of certain cells (notably 
 the mononuclear and polynuclear leucocytes) to take up 
 and destroy bacteria. Metastasis is the transfer of a morbid 
 process from one part of the body to another not directly 
 continuous with it. Leucocytosis is an increase in the 
 number of white corpuscles in the peripheral blood. 
 
 3. The epithelium of the tubules, especially in the convo- 
 luted portions, is swollen, cloudy, and considerably desqua- 
 mated. Leucocytes and some red corpuscles are found 
 within the tubules and the Malpighian capsule. The kidney 
 is enlarged, somewhat swollen, and rather pale in color. 
 The changes are most marked in the cortex, which is 
 thicker than normal. The capsule strips easily. 
 
 4. The liver is shrunken and indurated, rough, and of a 
 pale or yellow color ; a growth of new connective tissue is 
 disposed in broad bands which run in various directions, 
 and by their contraction divide the liver into numerous 
 irregular lobes. Many acini may be affected at one time. 
 The capsule may be thickened, or adherent to the dia- 
 phragm. Jaundice is slight, and comes on late ; ascites is 
 pronounced and may occur early. 
 
 PHYSIOLOGY. 
 
 1. The function of the red corpuscles is to supply the 
 tissues with oxygen. There are about 4,500,000 to 5,000,000 
 to the cubic millimeter of blood. Altitude causes an in- 
 crease in their number. 
 
 2. The white corpuscles serve as a protection against 
 pathogenic microorganisms ; they take some part in the 
 process of the coagulation of the blood ; they aid in the 
 absorption of fats and peptones from the intestine, and 
 they help to maintain the proper proteid content of the 
 blood plasma. Leucocytosis occurs normally during diges- 
 tion, after exercise, during pregnancy, and the puerperium, 
 in the newborn, and just before death. 
 
 3. The lymphatic system consists of: lymphatic glands, 
 lymph vessels, perivascular lymph spaces, the lymph canal- 
 icular system, the pericardial, pleural, peritoneal, and syno- 
 vial cavities, and the lacteals. The forces concerned in the 
 circulation of the lymph are: The pressure of the blood 
 in the blood-vessels; thoracic aspiration; contractions of 
 the voluntary muscles ; contractions of the intestine ; the 
 action of the valves in the lacteals and lymphatics. 
 
 4. The function of the auricles is to receive the blood 
 from the body and from the lungs. That of the ventricles 
 is to send the blood to all parts of the body and to the 
 lungs. Systole is that period when the ventricles (or 
 auricles) are contracting. Diastole is that period when the 
 ventricles (or auricles) are not contracting, but are at 
 rest, and receiving blood. 
 
 559 
 
MEDICAL RECORD. 
 
 DIGESTIVE FERMENTS 
 
 ORIGIN 
 
 FUNCTIONS 
 
 Ptyalin. 
 
 Saliva. 
 
 Changes starches 
 into dextrin and 
 sugar. 
 
 Pepsin. 
 
 Gastric juice. 
 
 Changes proteids 
 into proteoses 
 and peptones in 
 an acid medium. 
 
 A curdling ferment. 
 
 Gastric juice. 
 
 Curdles the casein 
 of milk. 
 
 Trypsin. 
 
 Pancreatic juice. 
 
 Changes proteids 
 into proteoses 
 and peptones, 
 and afterward 
 decomposes 
 them into leucin 
 and tyrosin in an 
 alkaline medium. 
 
 Amylopsin. 
 
 Pancreatic juice. 
 
 Converts starches 
 into maltose. 
 
 Steapsin. 
 
 Pancreatic juice. 
 
 Emulsifies and sa- 
 ponifies fats. 
 
 A curdling ferment. 
 
 Pancreatic juise. 
 
 Curdles the casein 
 of milk. 
 
 Invertin. 
 
 Succus entericus. 
 
 Converts maltose 
 into glucose. 
 
 6. The fact that parturition can occur in a woman when 
 under the influence of an anesthetic shows that the center 
 of the movement of the uterus is in the spinal cord, and 
 not in the brain. 
 
 7. The sixth cranial nerve is the abducens; it is the 
 motor nerve to the external rectus muscle of the eye. The 
 eleventh cranial nerve is the spinal accessory; it is a motor 
 nerve. 
 
 8. The pitch of the voice depends upon the number of 
 vibrations and the length of the vocal cords during a 
 given time, and is maintained by the state of tension of 
 the vocal cords. 
 
 HISTOLOGY. 
 
 1. Protoplasm is an unstable albuminoid substance, viscid, 
 and generally colorless. It consists of a fibrous network 
 and a more fluid portion, which fills the meshes of the 
 former. Views differ as to the structure of protoplasm. 
 
 2. White fibrous tissue is made of glistening fibers 
 covered with loose flocculent tissue. It has no elasticity, 
 very little extensibility, but very great strength. In liga- 
 ment and tendons the bundles are parallel with each other; 
 
 560 
 
MEDICAL RECORD. 
 
 in membranes, they intersect each other at various planes. 
 The cells are situated on the surface of groups of bundles, 
 are arranged in single file and joined by cement substance. 
 It is found in ligaments, tendons, muscular fascia, perios- 
 teum, perichondrium, pericardium, dura mater, sclerotic 
 coat of eye, tumica albuginea of testis, epineurium. Yellow 
 elastic tissue is of yellowish color, is very elastic, and has 
 but little of the fibrous variety. It consists of fibers with 
 curling ends and of well-defined outline; these are larger 
 than the white fibrous kind. It is found in Ligamenta 
 subflava, vocal cords, trachea, bronchi, larynx, blood- 
 vessels, thyrohyoid, cricothyroid, and stylohyoid ligaments. 
 
 3. A lobule of the liver is about 1-20 to 1-12 inch in 
 diameter. It has a darkish red center and a lighter cir- 
 cumference. The center is occupied by an intralobular 
 vein which collects the blood from the capillaries of the 
 lobule, and flows into the sublobular vein, which latter 
 opens into the hepatic vein. Around the lobules are the 
 interlobular veins; these are branches of the portal sys- 
 tem; capillaries passing from the circumference to the 
 center of the lobule connect the interlobular and intra- 
 lobular veins. Between the network of capillaries in the 
 lobule the hepatic cells are packed. 
 
 4. In the gray matter of the brain and spinal cord sym- 
 pathetic ganglia, ganglia on cerebrospinal nerves, and in 
 the organs of special sense. 
 
 GYNECOLOGY. 
 
 i. (1) Absence of, or errors in development of, any 
 part of the genital tract. Treatment: Little or nothing 
 can be done; atresia of the crevix can be treated by dila- 
 tation. (2) Malpositions of the uterus. Treatment: Re- 
 placement. (3) Membranous dysmenorrhea. Treatment: 
 Dilatation of cervix and curettage. 
 
 2. Retroflexion. Etiology: Tight lacing and tight cloth- 
 ing; congenital conditions; pressure by tumors; metrititis 
 and parametritis with adhesions; atonic conditions of the 
 uterus following labor ; and the conditions that cause retro- 
 version. Diagnosis: The cervix is low in the pelvis; the 
 fundus is in the cul de sac of Douglas ; bimanual examina- 
 tion will show the flexion. Treatment: If there are no 
 adhesions, the flexion should be corrected by digital manip- 
 ulation and a pessary introduced; hysteropexy may be 
 necessary. 
 
 Retroversion. Etiology: Relaxation of uterine liga- 
 ments; increased weight of fundus; subinvolution; ova- 
 rian or other tumor pressing on front of uterus ; distended 
 bladder; peritonitis or cystitis; prolonged dorsal decubitus 
 and tight bandaging in the puerperium. Diagnosis: Con- 
 joined manipulation will show the cervix displaced toward 
 
 56i 
 
MEDICAL RECORD. 
 
 the pubes, and the body of the uterus in the hollow of the 
 sacrum. Treatment: Remove the cause, if possible; re- 
 place the uterus and keep it in position by pessaries, tam- 
 pons, and knee-chest position; pelvic massage and vaginal 
 douches; proper hygiene, particular attention being paid 
 to the bowels, clothing, and exercise. Curative treatment: 
 The choice lies between ventral suspension of the uterus 
 and shortening of the round ligament. 
 
 3. Parasites, diseases of the vulva, irritating discharges, 
 diabetic urine; it may also be of nervous origin, or idio- 
 pathic. Treatment consists in removing the cause, if pos- 
 sible ; cleanliness, fresh air, tonics, and general attention 
 to hygiene; local applications of solution of bichloride of 
 mercury, 1:2,000; or carbolic acid, 1:100; or lead and 
 opium; dusting powders of bismuth subnitrate, calomel, 
 or zinc oxide are also useful. 
 
 4. Septic abortion shows chili, followed by high temper- 
 ature and rapid pulse; lochia is first diminished or sup- 
 pressed, later returns and is dark, purulent, and has an 
 offensive odor; uterine pains, suppression of urine, ex- 
 haustion, and typhoid state are present. The symptoms 
 usually come on in from one day to a week after the 
 operation. The diagnosis is made by the history of the 
 case and the symptoms. Treatment : Uterine douche of 
 corrosive sublimate (1:2,000), two or three times at inter- 
 vals of eight hours, followed by hot normal salt solution. 
 If there is no immediate improvement, curettage is indi- 
 cated. If the symptoms are severe, curettage should be 
 done at once, and the douching take place subsequently. 
 The vagina is douched twice a day with corrosive subli- 
 mate and saline solutions, as above. If the symptoms do 
 not subside, the intrauterine douche or curettage may be 
 repeated. 
 
 5. Dysmenorrhea may be due to: (1) Anteflexion of 
 uterus; for treatment, see above, No. 2. (2) Tumors, such 
 as fibroids ; treatment consists in removal of the tumor. 
 
 6. In a miscarriage at five months there will be profuse 
 hemorrhage ; severe cramp-like pains, like labor pains ; 
 rupture of membranes, and escape of liquor amnii, and 
 the fetus will be expelled. There will be a history of preg- 
 nancy and the signs of the same. The patient should be 
 put to bed and the case in general be managed the same 
 as if it had been a labor at full term. 
 
 7. Salpingo-oophoritis. When adhesions bind together 
 the tube, ovary, and adjacent peritoneum, these parts form 
 a lump, the component parts of which cannot be distin- 
 guished without opening the abdomen. All the symptoms 
 may be caused by other diseases ; sometimes there are no 
 symptoms, but this is exceptional. There is pain, referred 
 principally to the lower abdomen, lessened slightly by 
 
 562 
 
MEDICAL RECORD. 
 
 lying down ; it is aggravated by defecation, exertion, and 
 sexual intercourse. Menstruation is generally profuse, 
 irregular, and painful. Micturition is frequent and painful. 
 The general health is poor, and anorexia, nausea, insom- 
 nia, and neurasthenia may be present. If both sides are 
 affected, sterility results. The uterus alone can be felt 
 bimanually, the other parts constituting a thickened mass 
 on either side or behind the uterus. 
 
 Operation of salpingo-oophorectomy : "(i) Perform a 
 median abdominal section — control hemorrhage — and re- 
 tract lips of abdominal wound. (2) Pass the first and 
 second ringers into the wound, with the back of the hand 
 to the abdomen; follow down the under surface of the 
 abdominal parietes to the symphysis, thence down on to 
 the bladder and uterus, and thence out laterally over the 
 superior cornu of the uterus, with the palm of the hand 
 still downward, to and along the broad ligament, along the 
 posterior superior aspect of which the Fallopian tube is 
 found, and, just posterior to the tube, the ovary. These 
 structures are drawn toward the median line into an 
 accessible position in the abdominal wound. (3) The ova- 
 wan artery and veins are first tied, with silk, the ligature 
 being carried, upon a laterally curved aneurysm needle, 
 through the clear space of the broad ligament and tied 
 over the top of the infundibulopelvic ligament, outside of 
 the fimbriated end of the Fallopian tube, and close to the 
 brim of the pelvis. (4) The uteroovarian ligament, lying 
 behind the Fallopian tube, is ligated with chromic gut, 
 rather nearer the uterus, carried upon a laterally curved 
 aneurysm needle. (5) The inner end of the Fallopian tube 
 and the upper free part of the broad ligament are ligated 
 with silk near the horn of the uterus — which ligature also 
 controls the branches from the uterine artery. (6) The 
 structures are now removed by cutting through the broad 
 ligament well within the outer ligature of the ovarian 
 vessels — and cutting through the Fallopian tube and ova- 
 rian ligament well to the outer side of their ligatures — 
 and carrying the incision through the broad ligament well 
 below the hilum of the ovary. Any doubtful ligature is 
 strengthened, and any bleeding point is surrounded by an 
 additional gut ligature. (7) The edges of the anterior and 
 posterior layers of the broad ligament, left by the removal 
 of the above structures, are sutured together with gut. The 
 patient is lowered to the horizontal position and the intes- 
 tines and omentum are replaced. (8) The abdomen is 
 closed, as after median abdominal section/' — (Bickham's 
 Operative Surgery.) 
 
 8. Vaginal hysterectomy: "The patient is catheterized 
 and placed in the lithotomy position and the external geni- 
 tals, are thoroughly disinfected. The vagina is held open 
 
 563 
 
MEDICAL RECORD. 
 
 by broad retractors and the uterus is pulled down by vol- 
 sella forceps grasping the cervix, while the adjoining mu- 
 cous membrane is cut well clear of the disease by blunt- 
 pointed scissors. Keeping close to the uterus, the dissec- 
 tion is continued on its anterior and posterior surface by 
 the tip of the finger and short snips of the scissors, but at 
 the sides, after division of the mucous membrane, the 
 cellular tissue is simply pushed up as high as possible, or 
 till the pulsations of the uterine artery are felt. The finger 
 is finally thrust through the uterovesical fold of perito- 
 neum, and after cleansing the vagina flat sponges are 
 poked in around the uterus. Douglas's pouch is entered in 
 the same manner, hemorrhage from the vaginal wound 
 being controlled by a few catgut sutures through its cut 
 edges, and then the finger is^ hooked over the fundus, pull- 
 ing it down into the posterior opening and thus bringing 
 within reach the upper border of the broad ligaments, 
 which are seized by long-bladed clamps and divided on the 
 uterine side. Other clamps are placed on the remaining 
 tissues close to the uterus, which is then excised.— (Stim- 
 son's Operative Surgery.) 
 
 GENERAL DIAGNOSIS. 
 
 1. Syphilis, erysipelas, measles, scarlet fever, smallpox, 
 chickenpox, typhoid fever, typhus fever, yellow fever, 
 jaundice, purpura hemorrhagica. Addison's disease, 
 argyria, chlorosis, anemia, various drug eruptions, and 
 skin diseases. 
 
 2. Subnormal temperature, below 97.50; normal, 97.5 to 
 99.5; subfebrile, 99.5 to 100.5; slight fever, 100.5 to 101.5; 
 moderate fever, 101.5 to 103; high fever, 103 to 105, hyper- 
 pyrexia, above 106. 
 
 3. The sputum must be recent, free from particles of 
 food or other foreign matter; select a cheesy-looking 
 nodule and smear it on a slide, making the smear as thin 
 as possible. Then cover it with some carbolfuchsin, and 
 let it steam over a small flame for about two minutes, care 
 being taken that it does not boil. Wash it thoroughly in 
 water and then decolorize by immersing it in a solution of 
 any dilute mineral acid for about a minute. Then make a 
 contrast stain with solution of Loeffler's methylene blue 
 for about a minute; wash it again and examine with oil 
 immersion lens. The tubercle bacilli will appear as thin 
 red rods, while all other bacteria will appear blue. 
 
 4. Dropsy may indicate obstruction of the portal circu- 
 lation, cardiac or pulmonary diseases, disease of the peri- 
 toneum, diseases of the kidneys, anemia, debility, exposure 
 to cold or wet, cancer, syphilis. 
 
 5. (1) Frequent pulse: In fevers, exophthalmic goiter, 
 early phthisis, heart disease, anemia, chlorosis, locomotor 
 
 564 
 
MEDICAL RECORD. 
 
 ataxia, abuse of alcohol, tea, coffee. (2) Slow pulse: In 
 cardiac disease, cerebral tumor or hemorrhage, meningitis, 
 myxedema, epilepsy, some poisons, digestive disorders. 
 (3) Intermittent pulse: In cardiac disease, fevers, poisons, 
 neurasthenia, cerebral troubles, digestive disturbances. (4) 
 High tension pulse: In arteriosclerosis, gout, diabetes, 
 contracted kidney. (5) Low tension pulse: In fevers, 
 anemia. 
 
 6. Sudden onset ; very severe pains in neck, back of 
 head and spine; head is strongly retracted, causing opis- 
 thotonos ; Kernig's sign (inability to straighten the leg 
 when the patient is lying down and the thigh flexed at 
 right angle to the body) ; delirium may be present; and in 
 the cerebrospinal fluid there may be found the Diplococcus 
 intracellular is of Weichselbaum, or the Streptococcus 
 pyogenes. 
 
 7. The skin eruptions, or syphilides (characterized by 
 not itching, by being of a coppery or raw ham color; gen- 
 erally symmetrical ; painless ; by polymorphism) ; mucous 
 patches; sore throat; condylomata; alopecia; iritis; perios- 
 titis. 
 
 8. Hyaline casts occur in all forms of nephritis, in con- 
 gestion of the kidneys, in jaundice; waxy casts, in chronic 
 parenchymatous nephritis ; epithelial casts, in acute paren- 
 chymatous nephritis; granular casts, in chronic nephritis 
 and in acute nephritis ; fatty casts, in chronic parenchy- 
 matous nephritis ; blood casts, in hemorrhagic nephritis ; 
 pus and bacterial casts, in suppurative nephritis. 
 
 NERVOUS DISEASES. 
 
 i. In addition to the symptom of ordinary meningitis (see 
 above, Diagnosis, Xo. 6), there is frequently tubercu- 
 losis in other parts of the body. The onset is sudden, and 
 there is the hydrocephalic cry. The pulse is first rapid, 
 then slow and irregular, the respirations irregular and 
 sighing, and the pupils are generally contracted. In the 
 second stage there are constipation, retraction of the abdo- 
 men, stupor, and irregular pupils. The temperature ranges 
 from 101 to 103 F. Later there may be various paralyses, 
 diarrhea may replace constipation, and the symptoms be- 
 come typhoid in character. 
 
 2. Acute ascending paralysis is an acute disease char- 
 acterized by a motor paralysis beginning in the feet and 
 legs, rapidly extending to the trunk and arms, and finally 
 involving the muscles of respiration and deglutition. The 
 cause is unknown. It has been asserted to be a peripheral 
 neuritis, of infectious origin, or a functional disorder 
 whose anatomical basis is unknown. 
 
 3. A period of unconsciousness followed by hemiplegia 
 and convulsions, pupils dilated on side of lesion, stupor or 
 
 565 
 
MEDICAL RECORD 
 
 coma, slow and labored breathing, slow and full pulse, 
 vomiting, aphasia, hemianesthesia, loss ,of -control of 
 sphincters, increased reflexes. 
 
 4. Puerperal insanity is insanity following childbirth. 
 Patients recover, but the prognosis for life is better than 
 that for recovery. Treatment should be directed to the 
 patient's general condition; food, rest, sleep, and strength- 
 ening medicines are particularly indicated. Good nursing, 
 constant watchfulness, and tact are essential. The bowels 
 and bladder must be regularly evacuated, and care should 
 be taken to prevent bedsores. 
 
 PRACTICE OF MEDICINE. 
 
 1/ Typhoid fever. The bacillus of Eberth is the patho- 
 genic microorganism of the disease; it is conveyed by con- 
 taminated food or water. In the first stage Peyer's patches 
 become swollen, hyperemic, and reddened; a few days 
 later they appear as whitish or gray elevations, and the 
 hyperemia has disappeared; the surface of the patch is 
 smooth and its edge is sharply defined; after the first 
 week necrosis may occur; the necrotic portion falls off, 
 leaving an irregular ulcer with undermined edges. These 
 ulcers are elongated, with the long axis parallel with that 
 of the intestine ; they may heal or go on to perforation. 
 The spleen becomes congested and enlarged, is liable to 
 infarction; the liver is enlarged; the heart becomes soft 
 and flabby. Common complications: Hemorrhage or per- 
 foration of bowel, peritonitis, thrombosis, meningitis, pneu- 
 monia. Symptoms: Insidious onset, weakness, headache, 
 epistaxis, vague pains. The temperature rises gradually, 
 about 2 in the evening, and falling i° in the morning. 
 Diarrhea, tenderness in the right iliac fossa, enlarged 
 spleen, and a characteristic rash which appears from sev- 
 enth to twelfth day. During the second week the tempera- 
 ture remains at a uniform level ; typhoid state and de- 
 lirium may be present. The pulse becomes rapid, weak, 
 and dicrotic ; the heart sounds are feeble ; the tongue is 
 coated, fissured, and tremulous; sordes appear on the 
 teeth ; the abdomen is distended ; the stools are yellowish 
 and offensive (said to be like pea soup) ; the Widal # reac- 
 tion may be positive. In the fourth week the temperature 
 becomes normal. 
 
 2. Variola: The eruption usually appears first on the 
 forehead and wrists, and on the third or fourth day ; it is 
 first macular, then papular, then vesicular, and finally 
 pustular; it does not appear in successive crops; the spots 
 are multilocular, and do not collapse on being punctured; 
 the papule is hard and shotty, and does not disappear on 
 stretching the skin. Varicella: The eruption usually ap- 
 pears first on the trunk, is evident on the first day, 
 
 566 
 
MEDICAL RECORD. 
 
 comes in successive crops, is not shotty, and disapppears 
 on stretching the skin ; the spots are unilocular, and col- 
 lapse on being punctured. Scarlet fever: Period of incu- 
 bation, from a few hours to seven days. Stage of inva- 
 sion, twenty-four hours. Character of eruption, a scarlet 
 punctate rash, beginning on neck and chest, then cover- 
 ing face and body; desquamation is scaly or in flakes. The 
 eruption is brighter, is on a red background, punctiform, 
 and is more uniform ; the temperature is higher, the pulse 
 quicker; the tongue is of the "strawberry" type, the 
 lymphatics in the neck may be swollen, and there is sore 
 throat; Koplik's spots are absent. Measles: Period of in- 
 cubation, ten to twelve days. Stage of invasion, four days. 
 Character of eruption, small, dark red papules with cres- 
 centic borders, beginning on face and rapidly spreading 
 over the entire body; desquamation is branny. The erup- 
 tion is darker, less uniform, more shotty; the temperature 
 is lower, pulse slower, the tongue is not of the "straw- 
 berry" type; coryza, coughing, and sneezing may be pres- 
 ent; Koplik's spots are present. Erysipelas is characterized 
 by: A rise of temperature; a tendency to spread; the skin 
 is swollen and the affected part has a well-defined border 
 and raised margins ; the rash is local, not punctate, but 
 bullous; there are pain, considerable constitutional disturb- 
 ance, and a possibility of infection. 
 
 3. See French's Practice of Medicine (1907), pages 151 
 et seq.; or Osier's Practice of Medicine (1909), pages 164 
 et seq. 
 
 4. In mitral regurgitation there is a systolic murmur, 
 heard loudest at the apex, transmitted toward the left 
 axilla, and often heard at the angle of the left scapula. 
 The heart is enlarged. In aortic regurgitation there is a 
 diastolic murmur, heard loudest at the second interspace, 
 transmitted down the sternum. The left ventricle is hyper- 
 trophied. There will also be present Corrigan's pulse, and 
 pulsating arteries in the neck. In aortic stenosis: A sys- 
 tolic murmur heard over the aortic area, transmitted into 
 the carotids, and usually accompanied by a loud first 
 sound. Hypertrophy of the left ventricle, increased area 
 of cardiac dullness, apex beat is displaced downward and 
 to the left, the pulse is generally small and infrequent. 
 
 5. See French's Practice of Medicine (1907), pages 901 et 
 seq.; or Osier's Practice of Medicine (1909), pages 694 
 et seq. 
 
 6. In acute alcoholism the coma is not usually absolute; 
 there may be an odor of alcohol on the breath, the patient 
 can generally be aroused by shouting in his ear; there is 
 no paralysis; the pupils are normal or dilated; respiration 
 is practically normal ; the pulse is first rapid and later 
 feeble, and the skin cool. In acute morphinism the pupils 
 
 567 
 
MEDICAL RECORD. 
 
 are contracted, there is no sign of paralysis; both respira- 
 tions and pulse are slow and full. In apoplexy there is 
 generally paralysis of the head and upper limbs, and in 
 left-sided lesions there may be aphasia; the pulse is slow 
 and full; the respirations are at first slow, regular, and 
 stertorous, later on becoming of the Cheyne- Stokes type. 
 
 7. See French's Practice of Medicine (1907), pages 771 
 et seq.; or Osier's Practice of Medicine (1909), pages 508 
 et seq. 
 
 8. See French's Practice of Medicine (1907), pages 745 
 et seq.; or Osier's Practice of Medicine (1909), pages 470 
 et seq. 
 
 PRACTICE OF SURGERY. 
 
 1. Backward dislocation of the hip is of two kinds: (1) 
 On to the dorsum ilii ; (2) on to the sciatic notch. Dorsal 
 dislocation: Head of femur lies on the dorsum ilii, and 
 can be felt in the buttock. The obturator internus is rup- 
 tured in most cases. The short rotator muscles are lacer- 
 ated. The trochanter lies well above Nelaton's line and 
 approximated to the anterior superior iliac spine. The leg 
 is shortened two to three inches. The iliotibial band is 
 relaxed. The leg is flexed, adducted, and inverted. The 
 femur crosses the lower third of the opposite thigh. The 
 toe rests on the opposite instep. A hollow exists in 
 Scarpa's triangle. Sciatic dislocation: Similar to the above, 
 except in the following: — The obturator internus tendon 
 is intact and lies over the neck of the femur, holding it 
 down in the sciatic notch. Shortening amounts only to one 
 inch or less. The axis of the femur crosses the opposite 
 knee. The great toe rests on the dorsum of the opposite 
 great toe. Treatment: In posterior luxation of the hip 
 joint the patient should be placed on a mattress on the 
 floor, and then be anesthetized. The leg is then to be 
 flexed on the thigh, and the thigh flexed on the abdomen; 
 adduction is to be increased so that the knee is beyond the 
 middle line of the body; then abduct, freely circumduct 
 outward, and finally extent the limb so that it is parallel 
 with the other. Ligaments injured: Ligamentum teres 
 and capsular ligament. 
 
 2. For the technique see any textbook on Operative 
 Surgery. In amputation through the middle of the arm 
 the following parts are divided: Skin; fascia; biceps, tri- 
 ceps, and brachialis anticus muscles; brachial, superior 
 profunda, and inferior profunda arteries; brachial, basilic, 
 and cephalic veins ; median, ulnar, internal cutaneous, 
 musculospiral, and musculocutaneous nerves; and hu- 
 merus. 
 
 3. See Rose and Carless' Surgery (1902), page 966; or 
 Da Costa's Surgery (1903) page 48. 
 
 568 
 
MEDICAL RECORD. 
 
 4. See Rose and Carless' Surgery (1902), page 918; or 
 Da Costa's Surgery (1903), page 797^ 
 
 5. Femoral hernia is always acquired, and has a sac. 
 Its course is first vertical, then forward, then upward over 
 Poupart's ligament. Its coverings, from without inward, 
 are : Skin, superficial fascia, cribriform fascia, crural 
 sheath, septum crurale, subserous tissue, and peritoneum. 
 The neck of the hernia is situated at the femoral ring; to 
 its outer side lies the femoral vein, and to its inner side is 
 Gimbernat's ligament; in front of it is Poupart's ligament, 
 and behind it are the pubis, the pectineus, and the pubic 
 portion of the fascia lata. In the immediate neighborhood 
 of the femoral ring are: Anteriorly, the communicating 
 branch between the deep epigastric and the obturator ar- 
 teries ; externally, the femoral vein and deep epigastric 
 vessels; superiorly, the spermatic cord or round liga- 
 ment) and the deep epigastric vessels. 
 
 For details of operation see Rose and Carless' Surgery 
 (1903), page 991; or Da Costa's Surgery (1903), page 841. 
 
 6. Etiology: It is caused by infection, the bacteria gaining 
 entrance either through a wound or by extension from 
 neighboring tissues, or they may be brought by the blood. 
 Pathological Changes: "The area of the medulla affected 
 becomes hyperemic ; exudation occurs in the cancellous 
 spaces, Haversian canals, and under the periosteum. Pus 
 soon forms in these three situations. If the disease begins 
 in the superficial part of the bone, the pus may only be 
 subperiosteal, the deeper part of the bone escaping, though 
 large areas of the superficial portion may die from the 
 combined action of (1) stripping up of the periosteum by 
 the pus, (2) strangulation of the vessels in the bone by the 
 pressure of the exudation, and (3) the toxic action of the 
 bacterial products. . . . When the disease begins in 
 the deeper layers of the bone, the pus may reach the 
 periosteum, or extend along the medullary cavity, so that 
 the veins become filled with septic thrombus, which may be 
 disintegrated and carried off as septic emboli (pyemia). 
 There is profound toxemia, and necrosis of the whole 
 diaphysis may occur. ... If the infection is mild, a 
 chronic abscess may be formed in the cancellous tissue. 
 The usual course of an acute case, if a patient survives, is 
 that there is some necrosis of the shaft of the bone. The 
 abscess bursts externally, and there are numerous openings 
 in the skin leading through openings (cloacae) in the 
 periosteum and involucrum down to the sequestrum. The 
 sequestrum becomes loose in six weeks to six months. 
 Symptoms: Sudden onset; pain, tenderness, fever, chills, 
 swelling of soft parts; sometimes the joint can be moved 
 gently without pain ; scepticemia or pyemia, may be pres- 
 ent." It is to be diagnosed from (1) Rheumatism, in which 
 
 569 
 
MEDICAL RECORD. 
 
 more than one joint is affected and the tenderness is in 
 the joint, and not near it. (2) Tubular arthritis, in^ which 
 the onset is slow and the trouble starts in the epiphysis 
 rather than in the diaphysis. (3) Cellulitis, in which the 
 bone and periosteum are not affected, and in which there 
 is always a wound. Treatment: Immediate incision 
 through the periosteum ; the surface of the bone must be 
 opened, pus evacuated, and drainage instituted; irrigation 
 with hot bichloride solution and packing with gauze. The 
 medulla of the bone must be freely exposed, and any sup- 
 purating material removed. Constitutional treatment and 
 rest are indicated. 
 
 7. The triangles of the neck are: (1) Anterior (contain- 
 ing the inferior carotid, superior carotid, and submaxillary 
 triangles) ; (2) Posterior (containing the occipital and 
 subclavian triangles). For the relations of the common 
 carotid see Cunningham's Anatomy (1905), page 802; or 
 Gray's Anatomy (1908), page 600; for the ligations, see 
 Rose and Carless' Surgery (1902), page 283; or Da Costa's 
 Surgery (1903), page 348. 
 
 8. Pyelitis is due to: (1) calculi; (2) tuberculous 
 disease; (3) extension of sepsis from the bladder and 
 urethra; (4) sometimes movable kidney; (5) the ingestion 
 of cantharides or turpentine; (6) a pyemic embolus. 
 
 The lining membrane is red and swollen, and exudes 
 muco-pus or pus. A certain amount of hydronephrosis 
 occurs from the blockage produced by the swelling. 
 When pyogenic organisms are present, the kidney sub- 
 stance may be invaded (pyelonephritis). Perinephric sup- 
 puration may follow from extension. 
 
 The Symptoms are pain and tenderness over the kidney, 
 frequency of micturition, and pus in acid urine, unless 
 there is cystitis as well, when the urine is alkaline. The 
 pyuria is intermittent when the ureter is occasionally 
 blocked. 
 
 Treatment: The cause is removed if possible. When 
 pyelitis is due to extension from the bladder, the latter 
 must be attended to. 
 
 EYE AND EAR 
 
 i. Mastoid abscess. Etiology: Infection from naso- 
 pharynx or ear, purulent otitis, exanthemata, grippe, in- 
 flammation of middle ear. Symptoms: Tenderness, pain, 
 swelling and redness over the mastoid; bulging of the 
 superior and posterior parts of the auditory canal ; tem- 
 perature variable, from normal up to about 104 F. Treat- 
 ment: Hot water, or cold water, or ice; leeches; purga- 
 tives; light diet; acetanilid; incision, or mastoid operation. 
 Operation: A semicircular incision of the soft parts is 
 carried from a point about one-half inch above the attach- 
 ment of the auricle, backward and downward, keeping 
 
 570 
 
MEDICAL RECORD. 
 
 parallel to the auricular attachment and terminating at 
 the tip of the mastoid. The periosteum is now elevated 
 or dissected from the bone and the osseous structure 
 thoroughly exposed by means of retractors, which are 
 held by an assistant, the auricle being pulled forward so 
 as to lie upon the side of the head. The hemorrhage is 
 controlled by the use of hot sponges and artery forceps. 
 The surface of the mastoid is thoroughly examined for 
 areas of necrosis or the existence of a fistulous opening, 
 especially if a fluctuating swelling obtains previous to 
 the operation. If these exist, the openings are enlarged 
 by means of a gouge or a chisel and mallet, and followed 
 inward to their origin. Should the surface present a 
 healthy appearance, the primary opening of the mastoid 
 is made into the antrum by means of the chisel, the point 
 of entrance being effected just below the line of the 
 superior wall of the meatus and about one-quarter of an 
 inch backward from the posterior wall or anterior edge of 
 the mastoid bone. When the antrum has been exposed, 
 the cortex of the mastoid is chiselled away from this 
 point downward toward the tip until a sufficient amount 
 has been removed to expose all parts of the mastoid 
 process. The cells are now all broken down, and every 
 vestige of a necrotic or granulating area is completely 
 eradicated. A free communication of the antrum with 
 the tympanum should be established, which may be proved 
 by syringing an antiseptic solution into the antrum, when 
 it will escape from the external auditory meatus through 
 a previous perforation of the drum head. The cavity of 
 the mastoid is packed with sterile gauze, and the flaps of 
 overlying tissue allowed to regain their former position, 
 when a gap remains between their edges, through which 
 the dressings may be changed (From Ailing and Griffin's 
 Epitome on Eye and Ear). 
 
 2. In gonorrheal conjunctivitis: The conjunctiva and 
 the lids are red and swollen ; the secretion contains pus, 
 in which the gonococcus may be found ; the eye is tender 
 and painful ; the cornea may ulcerate ; there is generally a 
 history of gonorrheal infection. 
 
 In blepharitis: The margins of the lids are swollen and 
 reddened; the lashes fall out, and may or may not grow 
 again ; the lids are glued together by yellowish crusts ; 
 under these crusts are ulcers which bleed readily; itching, 
 soreness, epiphora, and sensitiveness to light are noticed; 
 there may be eczema of the eyelids. 
 
 3. Myringitis. Etiology: Trauma; extension of in- 
 flammation from middle ear or nasopharynx ; exposure. 
 Symptoms and Diagnosis: Pain, fulness; tinnitus; slight 
 disturbance of hearing; if abscess forms the pain is 
 great. Treatment: Irrigate auditory canal with a warm 
 
 571 
 
MEDICAL RECORD. 
 
 alkaline antiseptic solution, or with a solution of corrosive 
 sublimate 1:5,000, and insert a pledget of cotton in the 
 meatus; vesicles should be opened. 
 
 4. In corneal ulcer the patient's general condition must 
 be kept up with proper food, hygiene, fresh air, tonics, 
 and attention to bowels, etc. Atropine, antiseptic applica- 
 tions, bandages, hot compresses, paracentesis of the cornea, 
 or Saemisch's operation (division of the ulcer) are in- 
 dicated. 
 
 5. The membrana tympani separates the external audi- 
 tory meatus from the tympanic cavity. It is a thin, semi- 
 transparent, oval membrane, broader above than below, 
 concave outwards, and lying obliquely downwards and 
 inwards. The most depressed part of the cavity is called 
 the umbo. Its outer surface is continuous with that of 
 the meatus; its inner covering is reflected from the lining 
 of the tympanum; between the two is a fibrous membrane. 
 There can be seen a ridge formed by the handle of the 
 malleus, and also a bright triangular reflection of light 
 at the anterior and lower part, running from the umbo 
 towards the periphery. This is called the "pyramid of 
 light." It is lustrous, and of a pearly color. 
 
 CHEMISTRY. 
 
 1. Chemistry is that branch of science which treats of 
 the composition of substances, their changes in composi- 
 tion, and the laws governing such changes. 
 
 2. A deliquescent substance is one that absorbs sufficient 
 moisture from the air to form a solution ; example, calcium 
 chloride. An efflorescent substance loses its water of 
 crystallization on exposure to the air; example, sodium 
 carbonate. An effervescent substance, when placed in a 
 liquid, causes sudden liberation of a gas; example, seid- 
 litz powder. A fluorescent substance possesses the quality 
 of lowering the refrangibility of light rays so as to con- 
 vert the invisible ultraviolet rays into visible violet rays; 
 example, quinine. 
 
 3. Sugar: Render the urine strongly alkaline by addi- 
 tion of Na 2 C0 3 . Divide about 6 c.c. of the alkaline liquid 
 in two test tubes. To one test tube add a very minute 
 quantity of powdered subnitrate of bismuth, to the other 
 as much powdered litharge. Boil the contents of both 
 tubes. The presence of glucose is indicated by a darker 
 black color of the bismuth powder, the litharge retaining 
 its natural color. 
 
 Albumin: The urine must be perfectly clear. If not 
 so, it is to be filtered, and, if this does not render it 
 transparent, it is to be treated with a few drops of mag- 
 nesia mixture, and again filtered. The reaction is then 
 observed. If it be acid, the urine is simply heated to 
 
 572 
 
MEDICAL RECORD. 
 
 near the boiling point. If the urine be neutral or alkaline, 
 it is rendered faintly acid by the addition of dilute acetic 
 acid, and heated. If albumin be present, a coagulum is 
 formed, varying in quantity from a faint cloudiness to 
 entire solidification, according to the quantity of albumin 
 present. The coagulum is not redissolved upon the addi- 
 tion of HX0 3 . 
 
 Pus in the urine : Acidify the urine with acetic acid, 
 then filter it, and treat the filter with a few drops of 
 freshly prepared tincture of guaiacum ; a deep blue color 
 denotes the presence of pus. 
 
 Blood: To the urine add a solution of potassium 
 hydroxide to distinct alkaline reaction ; heat nearly to 
 boiling (do not boil). A red precipitate is produced. 
 
 Urea: "The specific gravity of the urine is carefully de- 
 termined, as well as that of the liquor sodae chlorinatse. 
 One volume of the urine is than mixed with exactly seven 
 volumes of the liquor sodse chlorinatse, and, after the first 
 violence of the reaction has subsided, the mixture is shaken 
 from time to time during an hour, when the decomposi- 
 tion is complete ; the specific gravity of the mixture is 
 then determined. As the reaction begins instantaneously 
 when the urine and reagent are mixed, the specific gravity 
 of the mixture must be calculated by adding together once 
 the specific gravity of the urine and seven times the 
 specific gravity of the liquor sodae chlorinatae, and divid- 
 ing the sum by eight. From the quotient so obtained 
 the specific gravity of the mixture after decomposition is 
 subtracted; every degree of loss in specific gravity indi- 
 cates 0.7791 gram of urea in 10c c.c. of urine. The specific 
 gravity determinations must all be made at the same 
 temperature ; and that of the mixture only when the 
 evolution of gas has ceased entirely." (Witthaus' Manual 
 of Chemistry.) 
 
 4. The empirical formula shows only the composition, 
 that is, the number and kinds of atoms that are present in 
 a molecule. The graphic formula shows both the com- 
 position and the constitution, that is, the relation that 
 the atoms bear to each other within the molecule. The 
 empirical formula for acetic acid is GH 4 2 ; the graphic 
 formula is CH, .COOH. 
 
 5. An equation is an expression, by means of symbols, 
 numbers and signs, of a chemical action. HgSO* + Hg 
 + 2XaCl = Na 2 S0 4 + Hg 2 Cl*. 
 
 6. The equivalent weight is the weight of an atom or 
 radicle which can replace or combine with one part by 
 weight of hydrogen or chlorine. It is the atomic weight 
 of the element divided by its valence. 
 
 7. Molecular weight is the weight of a molecule of a 
 substance as compared with the weight of an atom of 
 
 573 
 
MEDICAL RECORD. 
 
 hydrogen. It may also be said to be the sum of the 
 weights of the atoms composing the molecule. Thus, the 
 molecular weight of sulphuric acid, H2SO4 is (2 -\- 32 -\- 
 64), that is 98; or 98 times the weight of an atom o£ 
 hydrogen. 
 
 8. Specific heat is the amount of heat required to raise 
 the temperature of a substance a given number of degrees* 
 The unit of specific heat is the Calorie, which is the 
 amount of heat required to raise the temperature of one 
 gram of water from 4 to 5 C. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. The requisites of a hypothetical question, are: (1) 
 It should embrace substantially all the evidence in the 
 case relating to the subject. (2) It need not embrace all 
 the evidence on the subject. (3) Each side may submit 
 a different hypothetical question, based on the hypothesis 
 of the facts which it considers proved. (4) It should 
 be sufficiently explicit to warrant the formation of an 
 opinion. (5) It should contain no irrelevant matter. 
 
 An expert witness may give his opinion on facts or 
 supposed facts as noted by himself or asserted by others. 
 Theoretically, this can only be done by one perfectly 
 familiar with the subject in question; but practically any 
 (or almost any) physician with a license to practise is 
 accepted as an expert witness. A non-expert witness 
 testifies only the facts which he has seen, or heard, or 
 with which he has become acquainted by personal observa- 
 tion. 
 
 2. The constituent elements of blood, are : Red corpuscles, 
 white corpuscles, platelets, and serum. In mammals as a rule, 
 the red corpuscles are circular and nonnucleated ; in ovipar- 
 ous vertebrates, as a rule, the red corpuscles are oval and 
 nucleated. The blood of different mammals is differen- 
 tiated by the measurement of the red corpuscle. To 
 identify blood stains: (1) Some of the material from 
 the suspected stain is thoroughly mixed with a few drops 
 of a saturated solution cf sodium chloride, and then 
 allowed to evaporate to dryness on a slide covered with 
 a cover-glass. Now add a drop of glacial acetic acid to 
 the slide, and allow it to enter under the cover slip; then 
 apply gentle warmth. If the suspected stain is blood, 
 crystals of hemin will form later, and can be seen under 
 the microscope; this will not be the case with iron rust. 
 (2) The demonstration of the corpuscles by the aid of 
 the microscope; (3) spectroscopic appearance of two dark 
 absorption bauds in the green rays, and at the junction of 
 the green and yellow rays; (4) chemical tests, and as the 
 action of guaiacum and ozonic ether, nitric acid, or 
 caustic potash, 
 
 S^ 574 
 
MEDICAL RECORD. 
 
 3. A wound (medicolegal) is an injury or lesion caused 
 by mechanical or chemical means. Incised wounds are 
 made by sharp-cutting instruments; the hemorrhage is 
 free, the wound gaps, there is no bruising of the 
 margins. Punctured wounds are deep wounds with a 
 small orifice ; they are made by narrow instruments. 
 Lacerated and contused wounds are made by blunt instru- 
 ments and by crushing; the soft parts are torn, the edges 
 are bruised and ragged, the deep parts are infiltrated with 
 blood; there is little free bleeding. Gunshot wounds. 
 
 A wound inflicted during life is generally characterized 
 by hemorrhage, coagulation of the blood, eversion of the 
 edges, and retraction of its sides. It may also be inferred 
 that the wound was inflicted during life if any of the 
 following are noticed : The presence of inflammation, 
 swelling, pus, or gangrene on the edges of the wound, or 
 if there is any sign of beginning cicatrization. The shape 
 and size of the wound do not always correspond with 
 that of the instrument making it, because: (1) The 
 edges of the wound may retract; (2) variation may 
 occur on account of the tension or relaxation of the 
 skin at the time the wound was inflicted; (3) the weapon 
 may be withdrawn at a different angle from that at which 
 it was introduced; (4) other factors are the size, weight, 
 sharpness, or force applied to the weapon. 
 
 4. For the details of post-mortem examinations, see any 
 textbook on Medical Jurisprudence for Pathology). Lung? 
 in which respiration has taken place float ; those in which 
 it has not taken place sink. Further, the lungs before 
 respiration are situated at the back of the thorax and 
 do not fill the cavity: whereas, after respiration, they fill 
 the whole thorax, (a) Artificial insufflation is a difficult 
 operation, and is not likely to be attempted by the mother, 
 or anyone else. If done, the lungs would be bloodless, 
 and there would be air in stomach and intestines. Prac- 
 tically, it need not be considered, (b) In cases of putre- 
 faction, the air can be expelled by pressure, and none is 
 found in the air cells ; further, putrefaction of the lungs 
 occurs late, and if found, and the lungs sink, the child was 
 born dead, (c) If the flotation has been caused by freez- 
 ing, the lungs would sink after being thawed out. 
 
 OBSTETRICS. 
 
 1. The conjugate diameter of the inlet of the pelvis is 
 a line drawn down the middle of the sacral promontory to 
 the top of the symphysis pubis. It is about four inches 
 in length. The transverse diameter of the inlet of the 
 pelvis is a line drawn risrht across the pelvis from one 
 lateral margin of the brim to the other. It is about five 
 inches in length. The conjugate diameter of the outlet of 
 
 575 
 
MEDICAL RECORD. 
 
 the pelvis is a line drawn from the tip of the coccyx to the 
 lower surface of the symphysis pubis. It is about five 
 inches in length. The transverse diameter of the outlet 
 of the pelvis is a line extending across the pelvis from 
 one tuberosity of the ischium to the other. It is about 
 four inches in length. 
 
 2. The cause of rupture of the uterus is : Strong uter- 
 ine contraction in combination with some obstacle to the 
 birth of the fetus. It is apt to occur in cases of con- 
 tracted or deformed pelves, transverse presentation, ob- 
 struction from tumors, unduly large fetal head. 
 
 3. Expectant plan: Place the patient in bed, and if the 
 bleeding is profuse, insert a tampon of iodoform gauze 
 (one yard) well up against the cervix. If this fails to 
 control the hemorrhage, reinforce it by another yard or 
 two of gauze and a perineal pad and binder. Small doses 
 (3j^) of the fluid extract of ergot should now be given 
 every two or three hours. At the end of from eight to 
 twelve hours remove the tampon, when the ovum may be 
 found extruded from the cervix; if not, a vaginal douche 
 of mercuric chloride (1:4000) must be given, and another 
 tampon introduced. If, upon the removal of this second 
 tampon at the end of ten or twelve hours, the ovum is not 
 discharged, then more vigorous methods to secure its ex- 
 pulsion must be adopted. Active plan: The physician's 
 hands and instruments are sterilized; the patient is ether- 
 ized and placed on an appropriate table; the genitalia are 
 thoroughly cleansed and a vaginal douche of mercuric 
 chloride (1:4000) is given; the anterior lip of the cervix 
 is brought down to the vulvar orifice; the cervix is dilated 
 if necessary; the placental forceps is introduced into the 
 uterus, and as much as possible of the ovum is removed; 
 the uterus is thoroughly curetted, and an intrauterine 
 douche of sterile water is given. A light tampon of iodo- 
 form gauze is placed in the vagina; the patient is then re- 
 turned to bed. A strip of the gauze may be placed in the 
 uterus in cases of sharp retroflexion, to secure free drain- 
 age, and occasionally an intrauterine tampon will be neces- 
 sary when the uterus refuses to contract and hemorrhage 
 persists after the use of the curette." (Gould & Pyle's 
 Pocket Cyclopedia.) 
 
 4. Grasp the uterus at once, through the abdominal wall, 
 and massage it firmly. Anything in the uterus should at 
 once be cleaned out. Pass one hand into the uterus, and 
 with the other on the outside make firm pressure. A 
 hypodermic of ergotin, or ergot can be given by an assis- 
 tant. An intrauterine douche of hot sterilized water 
 (about 115 F) may be given. Sometimes a very thorough 
 packing and plugging of gauze of uterus and vagina may 
 be necessary. Whatever is done must be done promptly; 
 
 576 
 
MEDICAL RECORD. 
 
 and everything likely to be needed for this emergency 
 should be prepared beforehand in every labor. 
 
 5. Causes of Transverse Presentation: Prematurity^ of 
 the labor; placenta prsevia ; narrowness of pelvic brim; 
 great lateral obliquity of the uterus; multiple pregnancies; 
 undue mobility of the child from excess of liquor amnii; 
 accidental pressure externally from blows, falls, dress, etc.; 
 repeated occurrence of cross-births in the same woman is 
 probably due to a narrow pelvic brim. Treatment: Early 
 correction of the presentation, converting it into a head, 
 breech, or foot, by version (external, internal, or bipolar). 
 In cases of arrested spontaneous evolution, with impaction, 
 version is out of the question. The child is usually dead 
 from compression ; the method of delivery is embryotomy, 
 usually decapitation. — (From King's Obstetrics). 
 
 6. Puerperal eclampsia is an acute morbid condition, oc- 
 curring during pregnancy, labor, or the puerperal state, 
 and is characterized by tonic and clonic convulsions, which 
 affect first the voluntary and then the involuntary muscles; 
 there is total loss of consciousness, which tends either to 
 coma or to sleep, and the condition may terminate in re- 
 covery or death. The causes may be : Uremia, albuminuria, 
 imperfect elimination of carbon dioxide by the lungs, 
 medicinal poisons, septic infection ; predisposing causes are 
 renal disease and imperfect elimination by the skin, bowels, 
 and kidneys. Preventive treatment: (1) The amount of 
 nitrogenous food should be diminished to a minimum ; (2) 
 the production and absorption of poisonous materials in 
 the intestines and body tissues should be limited and their 
 elimination should be aided by improving the action of the 
 bowels, the kidneys, the liver, the skin, and the lungs; (3) 
 the source of the fetal metabolic products and the periph- 
 eral irritation in the uterus should, if necessary, be re- 
 moved by evacuating that organ. Curative treatment: (1) 
 Controlling the convulsions (bv chloroform, veratrum, or 
 chloral) ; (2) elimination of the poison or poisons which 
 are presumed to cause the convulsions; (3) emptying the 
 uterus under deep anesthesia, by some method that is rapid 
 and that will cause as little injury to the woman as possible. 
 
 7. Indications for the use of forceps are: (1) Forces at 
 fault: Inertia uteri in the presence of conditions likely to 
 jeopardize the interests of mother or child, (a) Impending 
 exhaustion; (b) arrest of head, from feeble pains. (2) 
 Passages at fault: Moderate narrowing, s l A to z z A inches, 
 true conjugate; moderate obstruction in the soft parts. 
 (3) Passenger at fault: A. Dystocia due to (a) occipito- 
 posterior, (b) mentoanterior face, (c) breech arrested in 
 cavity. B. Evidence of fetal exhaustion (pulse above 160 
 or below 100 per minute). (4) Accidental complications: 
 Hemorrhage; prolapse funis; eclampsia. All acute or 
 
 577 
 
MEDICAL RECORD. 
 
 chronic diseases or complications in which immediate de- 
 livery is required in the interest of mother or child, or 
 both. Conditions necessary for the use of forceps are: 
 (i) The rectum and bladder must be empty; (2) the os 
 uteri must be fully dilated; (3) the membranes must be 
 ruptured ; (4) the pelvis must be of sufficient size. 
 
 8. In the nulliparous adult the uterus is about three 
 inches long, about two inches wide at the upper part, and 
 about one inch thick. The uterus lies between the rectum 
 behind and the bladder in front ; it is below the abdominal 
 cavity and above the vagina. Its position is one of slight 
 anteflexion, with its long axis at right angles to the long 
 axis of the vagina. The anterior surface of its body rests 
 on the bladder, and the cervix points backward toward the 
 coccyx. The uterus is not fixed, but moves freely within 
 certain limits. It is held in place by ligaments — broad liga- 
 ments, round ligaments, vesicouterine, and rectouterine. 
 During pregnancy the uterus increases in size (from 3 to 
 12 inches in length; from iy 2 to 9 inches in breadth), in 
 weight (from about one ounce to two pounds, not including 
 its contents). The cavity is enlarged over 500 times. All 
 the tissues (muscles, ligaments, arteries, veins, lymphatics, 
 and nerves become tremendously hypertrophied. The uterus 
 also changes its position ; at first it drops, later it gradually 
 rises, till just before labor (when it again drops). 
 
 DISEASES OF CHILDREN. 
 
 1. Night cries; lameness in the morning; a slight limp; 
 tendency to become tired on slight exertion; wasting; 
 spasm; pain; swelling; and deformity (either real or ap- 
 parent) ; growing pains, sacroiliac disease, congenital dis- 
 location of the hip, spinal caries and psoas abscess, infantile 
 paralysis, lordosis, rickets, and rheumatism. 
 
 2. Etiology: Tuberculosis (traumatism and cold may be 
 exciting causes). Pathology: It may begin in the synovial 
 membrane, or acetabulum, or femur; if it begins in the 
 bone it spreads to the synovial membrane and causes gen- 
 eral infection of the joint. First of all the bacilli enter, 
 multiply, and by their products cause irritation and new 
 growth; as this advances embryonic connective tissue is 
 formed, and the joint is filled with an effusion; later on 
 caseation occurs, the joint is destroyed, and there may also 
 be destruction of the surrounding tissues. 
 
 3. (1) Stage of incubation: Lasts about nine to twelve 
 days, during which the child loses weight, but is not other- 
 wise sick. (2) Stage of invasion lasts about four days, 
 the child has catarrh, coryza, fever, sneezing, laryngitis; 
 buccal spots appear about the first or second day, head- 
 ache, anorexia, furred tongue, fever and diarrhea or vomit- 
 ing may be present. The fever rises till the eruption ap- 
 
 578 
 
MEDICAL RECORD. 
 
 pears; the pulse is rapid, 120 to 150. (3) Stage of eruption: 
 Eruption generally appears on fourth day (for details see 
 above, Practice, No. 2) ; the fever and catarrh continue till 
 the rash is fully developed. (4) Stage of decline: The 
 eruption fades rapidly, is followed by desquamation, the 
 other symptoms subside, but the bronchial catarrh is the 
 last to disappear. 
 
 4. Symptoms: Sudden onset, severe localized pain, vom- 
 iting, tenesmus, and passage of bloody mucus. There is a 
 sausage-like tumor in the abdomen ; sometimes it can be 
 felt in the rectum. Fecal impaction or appendicitis may 
 simulate it, but in the former the swelling is less tender 
 and is on the left side; in the latter there is fever, and the 
 tumor is on the right side. Treatment: Laparotomy and 
 reduction of the bowel as soon as possible. Gentle manipu- 
 lations, enemata, and opium have been suggested, but these 
 should be adopted only when surgical relief is not available. 
 
 5. Atelectasis Pulmonum is collapse of the lung. 
 Symptoms: The child becomes livid or pale, also restless; 
 he breathes quicker, and his temperature becomes subnor- 
 mal ; pinched features, cold sweats, and cessation of the 
 cough are all noticed. There are bronchial breathing, ab- 
 sent or diminished vocal resonance, dullness on percussion 
 at base and posterior border of lungs. Treatment: The 
 child must be put at once in a hot mustard bath; then 
 wrapped up in cotton wool, vomiting must be produced 
 by an emetic; atropine sulphate (gr. 1/300-gr. 1/200) may 
 be given hypodermically as a respiratory stimulant. 
 
 6. To peptonize coiifs milk: Put into a bottle one pint 
 of fresh cow's milk and 4 ounces of water; add a powder 
 containing 5 grains of pancreatic extract and 15 grains of 
 bicarbonate of sodium ; shake the mixture. The mixture 
 should be kept at a temperature of about no° F., by plac- 
 ing the bottle in hot water ; it should be occasionally shaken. 
 For partial peptonization, this is continued for 6 to 20 
 minutes ; for complete peptonization, two hours. 
 
 7. The principal clinical changes that occur in the skele- 
 ton in rickets are : Enlargement of the epiphyses of the 
 long bones, curvatures are increased, flat bones have promi- 
 nences or thickenings, green stick fractures are common, 
 the head is large and square, the ribs are beaded, the 
 fontanelles are open, dentition is delayed and irregular, the 
 wrists and ankles are thickened. 
 
 8. Hydrocephalus, Syphilis, and Mollities ossium. 
 
 materia medic a and therapeutics. 
 (1) I£. Tincturae aconiti, 3j. 
 
 Liquoris ammonii acetatis, Jv. 
 Spiritus setheris nitrosi, 3J. 
 M. Siena : One tablespoonful every three hours in 
 half a tumblerful of lemonade or effervescent water. 
 
 579 
 
MEDICAL RECORD. 
 
 (2) 5. Ammonii chloridi, gr. xxx. 
 
 Tincturse opii camphoratse.^ 
 
 Syrupi ipecacuanhas, aa 5iij. 
 
 Syrupi pruni virginianse, 3J- 
 
 Syrupi tolutani, q.s. ad Jiv. Misce. 
 Signa : One teaspoonf ul every three hours. 
 fy Morphinse sulphatis, gr. j. 
 
 Ammonii chloridi, 3j. 
 
 Spiritus chloroformi, 3j. 
 
 Syrupi pruni virginianse, 3J. 
 
 Mist, glycyrrhizae comp., ad 3 vn J. Misce. 
 Signa: One tablespoonful every three hours. 
 
 2. Carbolic acid. Origin: From coal tar oil, by frac- 
 tional distillation; or it can be made synthetically. Dose: 
 One grain. Physiological action: "Irritant; caustic; anti- 
 septic; disinfectant; deodorant; Darasiticidal ; antizymotic; 
 antipyretic; in solutions of moderate strength, locally an- 
 esthetic. The heart and respiration are at first stimulated 
 and afterward depressed. Smokiness of the urine is a 
 characteristic feature. ,, Treatment in case of poisoning: 
 Sodium sulphate or magnesium sulphate, warm muci- 
 laginous drinks, cardiac and respiratory stimulants by hy- 
 podermic, warmth to the body, emetics, are all indicated. 
 
 3. The following is given by Einhorn: All substances 
 that are liable to excite intensely the glands of the stomach 
 must be excluded. Therefore all kinds of acids must be 
 forbidden. The food should consist of material rich in 
 albumin, while the quantity of starchy substances should 
 be diminished. Thus all kinds of meat (even game), fish, 
 oysters, eggs, milk should be taken in large quantities. 
 Bread and butter are permitted. Potatoes, spinach, aspara- 
 gus, green peas, farina, and rice should be taken only in 
 small amounts. Whiskey and wines should, as a rule, be 
 avoided. Cacao, weak tea, weak coffee, and beer can be 
 given in moderate quantities. 
 
 4. Apomorphine hydrochloride. Dose: As an emetic, 
 gr. 1/10 subcutaneously ; as an expectorant, gr. 1/30. 
 Physiological action: It acts on the vomiting center in the 
 medulla, hence is emetic ; it increases pulse, blood pressure, 
 and rate of respiration; it is also an expectorant. Its w- 
 dications are chiefly those requiring a prompt emetic; also 
 as an expectorant in bronchitis and lobular pneumonia. 
 
 5. Spiritus /etherjs nitrosi is prepared from sodium 
 nitrite, sulphuric acid, monosodic carbonate, potassium 
 carbonate, alcohol, and water. Dose: 30 minims. Thera- 
 peutic uses: In feverishness, nausea, asthma, flatulence, as 
 a mild diaphoretic, diuretic, carminative. Common name: 
 Sweet spirit of nitre. 
 
 6. An agent which increases the action of the skin and 
 promotes perspiration. (1) Alcohol, Jss to ii; (2) Pulvis 
 
 580 
 
MEDICAL RECORD. 
 
 ipecacuaphae et opii, gr. x to xx; (3) Spiritus aetheris 
 nitrosi, TTRxxx ; (4) Turkish bath. 
 
 7. (a) Cardiac tonics stimulate the cardiac muscle, and 
 thus slow and strengthen its contractions. Examples : 
 Digitalis and strophantus, (b) Cardiac stimulants in- 
 crease the force and frequency of the heart beat when the 
 heart is depressed. Examples : Alcohol and ether. 
 
 8. Cathartics increase or hasten the intestinal evacua- 
 tion. They act by : Increasing peristalsis, stimulating in- 
 testinal secretion, causing exosmosis of serum. Contra- 
 indicated in inflammation of stomach, intestines, or peri- 
 toneum, pregnancy, threatened intestinal hemorrhage. 
 
 STATE MEDICAL BOARD EXAMINATION QUES- 
 TIONS. 
 
 Pennsylvania State Board of Medical Examiners. 
 
 ANATOMY. 
 
 1. Describe the relations of the gall-bladder with its sur- 
 rounding organs. 
 
 2. Describe the clavicle and its articulations. 
 
 3. Describe the heart, its cavities, and the vessels lead- 
 ing into and from it. 
 
 4. Describe the hip joint and name its ligaments. 
 
 5. Describe the pancreas and name the important struc- 
 ture that passes through its head. 
 
 6. Describe the position of the palmar arterial arches. 
 
 7. Describe the female mammary gland, with special 
 reference to its lymphatics, and its relations with the sur- 
 rounding structures. 
 
 8. What vessels furnish the nutritional, and what the 
 functional, supply of blood to the lungs? 
 
 9. Name the external and internal rotators of the thigh. 
 
 10. Where are the motor centers of the cerebrum lo- 
 cated, and how is their location delineated on the surface 
 of the scalp? 
 
 PHYSIOLOGY. 
 
 1. Explain the endogenous (internal) and exogenous 
 (external) sources of the purin bases and the production of 
 uric acid. 
 
 2. Name and describe the causes producing the respec- 
 tive heart sounds. 
 
 3. Discuss the factors concerned in the venous circu- 
 lation. 
 
 4. Describe the principal functions of the digestive 
 juices. 
 
 5. Briefly describe visual accommodation, and mention 
 the function of each involved factor. 
 
 581 
 
MEDICAL RECORD. 
 
 MATERIA MEDICA. 
 
 I. Discuss the official iodine preparations with regard to 
 their respective important medicinal properties, doses, and 
 methods of employment. 
 
 Q) Name the drugs that produce local anesthesia and 
 describe the methods of using them. 
 
 3. Give the official names and the doses of the prepara- 
 y^Xxons of mercury which are prescribed for internal admin- 
 
 ^ istration. 
 
 4. Name the drugs that are pharmaceutical^ incompat- 
 ible with the following: (a) iron salts, (b) vegetable alka- 
 loids, (c) gum resins. 
 
 5. Correctly write the following prescription without 
 abbreviation (using official titles and either Metric system 
 or U. S. measure and Troy weight) : 
 
 Take of : — 
 
 Oil of Turpentine 120 minims 
 
 Powdered Gum Arabic 3 drams 
 
 Chloroform 16 minims 
 
 Syrup of Tolu 2 fluidounces 
 
 Peppermint Water a sufficient quantity to make 
 
 4 fluidounces 
 Directions — One fluidram sufficiently diluted with water 
 
 every three hours. 
 
 CHEMISTRY. 
 
 1. Name and discuss the significance of five morbid 
 products of the urine, and detail the tests for any two. 
 
 2. Give the chemical composition of two forms of 
 urinary calculi and describe chemical tests for each form. 
 
 3. Name common and convenient antidotes for poison- 
 ing by the mineral acids, and tell what course should be 
 pursued when the acid to be counteracted is unknown. 
 
 4. Describe two chemical tests to be used in water sup- 
 posed to be contaminated with sewage. 
 
 5. a State what diagnostic reaction takes place when dia- 
 betic urine is added to a heated alkaline solution of potas- 
 siocupric tartrate. 
 
 PATHOLOGY. 
 
 1. Define infarcts, and state where they most frequently 
 occur. 
 
 2. Explain the production of the respective cardiac val- 
 vular murmurs, their conduction, and where most distinctly 
 heard. 
 
 3. Describe the changes that occur in the crystalline lens 
 in cataract. 
 
 4. Define and explain the causes of dry and senile gan- 
 grene. 
 
 5. Discuss the direct and indirect effects of the gono- 
 
 582 
 
MEDICAL RECORD. 
 
 coccus upon the human body, and outline the technic for 
 staining and recognizing its presence in the secretions. 
 
 DIAGNOSIS. 
 
 i. Differentiate acute pharyngitis and diphtheria. 
 
 2. Differentiate renal colic, hepatic colic, and appendi- 
 citis. 
 
 3. Differentiate tabes dorsalis and ataxic paraplegia. 
 
 4. Diagnosticate cerebrospinal meningitis. 
 
 5. Diagnosticate interstitial keratitis. 
 
 PRACTICE OF MEDICINE AND THERAPEUTICS. 
 
 1. Describe the course of a typical case of scarlet fever. 
 
 2. What are the symptoms of diabetes mellitus? 
 
 3. What are the symptoms of abscess of the liver? 
 
 4. W r hat are the symptoms of tuberculous peritonitis? 
 
 5. What are the symptoms and signs present in pleurisy 
 with purulent effusion (empyema) ? 
 
 6. Outline a treatment for a case of acute follicular ton- 
 sillitis. 
 
 7. Outline a treatment for tapeworm. 
 
 8. What are the symptoms of poisoning by belladonna 
 and how would you treat it? 
 
 9. How would you treat a case of cholera morbus. 
 
 10. What are the indications and contraindications in 
 the use of arsenic? 
 
 SURGERY. 
 
 i 1. Describe the surgical and adjuvant treatment of sep- 
 tic peritonitis. 
 
 2. _ Give the symptoms of pyosalpinx and describe an op- 
 eration for the same. 
 
 3. Describe the manipulations for the reduction of a 
 posterior luxation of the hip joint. 
 
 4. Give a classification of burns, and the treatment for 
 one of the third degree. 
 
 5. Define and outline the treatment for a penetrating 
 wound of the urinary bladder. 
 
 6. Describe the symptoms of pyothorax (emypema) 
 and an operation for its relief. 
 
 7. What are the general principles governing the treat- 
 ment of fractures at or near joints? 
 
 8. Give the symptoms and treatment of dislocation of 
 the semilunar cartilages of the knee joint. 
 
 Q. Give the causes, symptoms, and treatment of varico- 
 cele. 
 
 10. Describe methods of control of severe epistaxis. 
 
 OBSTETRICS. 
 
 1. What maternal conditions would warrant the destruc- 
 tion of fetal life? 
 
 583 
 
MEDICAL RECORD. 
 
 2. Differentiate normal pregnancy, tumors within the ab- 
 dominal cavity, and ectopic gestation. 
 
 3. During the process of an apparently normal labor, 
 what conditions may arise requiring either version or- de- 
 livery by the forceps? 
 
 4. What may be the causes of uterine hemorrhages dur- 
 ing pregnancy, and what would be your treatment? 
 
 5. For repeated spontaneous abortion, what is the course 
 of treatment? 
 
 6. Should you find albumin and tube casts, or sugar, 
 in the urine of a pregnant woman, what morbid conditions 
 would be indicated, and what would be your treatment? 
 
 7. How would you manage a face presentation, with the 
 chin in the hollow of the sacrum? 
 
 8. When the action of the uterus is insufficient, what 
 measures and remedies may be used to bring about normal 
 contractions ? 
 
 9. Name the conditions requiring immediate delivery, 
 and describe the methods of procedure. 
 
 10. What are the causes of ophthalmia neonatorum, and 
 what means should be employed to prevent it? How 
 should it be treated? 
 
 HYGIENE. 
 
 1. What measures should be enforced to prevent the 
 spread of diseases throueh the schools? 
 
 2. What regime should be enforced in the sick-room 
 of a tuberculous patient? 
 
 3. Why should we avoid using a general drinking and 
 communion cup? 
 
 4. What methods are necessary in cities to reduce in- 
 fant mortality resulting from digestive diseases? 
 
 5. Explain why the principles of "preventive medicine ,, 
 can be more successfully and efficiently applied in the 
 properly appointed home, with ample accommodations, than 
 in a public or municipal institution? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Pennsylvania State Board of Medical Examiners. 
 
 ANATOMY. 
 
 1. The gall bladder is in relation above with the liver; 
 below, with the first part of the duodenum, the hepatic 
 flexure of the colon, the beginning of the transverse colon, 
 and the pylorus; the fundus approaches the anterior ab- 
 dominal wall behind the ninth costal cartilage and near 
 the outer border of the right rectus abdominis muscle. 
 
 584 
 
MEDICAL RECORD 
 
 2. See Cunningham's ''Anatomy'' (1909), page 181; or 
 Gray's "Anatomy" (1908), page 169. 
 
 3. See Cunningham's "Anatomy" (1909), page 783; or 
 Gray's '"Anatomv" (1908), page 564. 
 
 4. The hip- joint is an enarthrodial joint, formed by the 
 head of the femur and the acetabulum. The articular sur- 
 faces are covered with cartilage. Near the center of the 
 head of the femur is attached the ligamentum teres. The 
 ligaments are: (1) The capsular, which embraces the mar- 
 gin of the acetabulum above, and the neck of the femur 
 below. (2) The ileo-femoral or Y ligament, which passes 
 obliquely across the front of the joint, and is attached 
 above to the anterior inferior spine of the ileum, and 
 below to the anterior intertrochanteric line. -(3) The liga- 
 mentum teres. (4) The cotyloid ligament, which deepens 
 the acetabulum and bridges over the cotyloid notch, being- 
 there called (5) the transverse ligament. The joint has a 
 very extensive synovial membrane. It is capable of the 
 following movements : Flexion, extension, abduction, ad- 
 duction, circumduction, and rotation. 
 
 5. See Cunningham's "Anatomy'' (1909), page 1124; or 
 Gray's "'Anatomy''' (1908), page 1355. 
 
 6. The position of the superficial palmar arch is repre- 
 sented by a line going across the palm of the hand from a 
 point where the web of the thumb joins the palm. 
 
 The position of the deep palmar arch is represented by a 
 line roughly parallel with the above, but one-half inch 
 nearer to the wrist. 
 
 7. See Cunningham's '"Anatomy" (1009), pages 1207 and 
 323: or Gray's "Anatomy" (1908), page 1516. 
 
 8. The bronchial and pulmonary arteries respectively. 
 
 9. The external rotators of the thigh are: Obturator 
 externus, Obturator interims, Gemellus superior, Gemellus 
 inferior, Gluteus maximus, Gluteus medius and minimus 
 (posterior fibers), Pyriformis, Quadratus femoris, Ad- 
 ductor longus, Adductor magnus, Adductor brevis, Pec- 
 tineus, Ilio-psoas, Sartorius. 
 
 The internal rotators of the thigh are: Tensor vaginae 
 femoris, Gluteus medius and minimus (anterior fibers). 
 
 10. The motor centers of the cerebrum are located in 
 the ascending frontal and ascending parietal convolutions, 
 and the cortex adjacent thereto: they lie on each side of 
 the fissure of Rolando. The leg center occupies the 
 upper third of this part on the cortex, the arm center the 
 middle third, and the face center the lower third. On 
 the median si- r face, the centers for the head, trunk, and 
 lower extremities are situated in this same order from 
 before backwards. 
 
 To locate the fissure of Rolando on the scalp: Draw a 
 straight line over the top of the scalp from the inion to 
 
 585 
 
MEDICAL RECORD. 
 
 the glabella; bisect this line, and half an inch posterior 
 to the midpoint draw a line downward and forward at an 
 angle of 67.5 for a distance of three and one-half inches. 
 This line will represent the location of the fissure of 
 Rolando. 
 
 PHYSIOLOGY. 
 
 1. Uric acid belongs chemically to the group of sub- 
 stances called "purins," uric acid being trioxypurin. The 
 uric acid which is derived from the purin bodies con- 
 tained in the food is called "exogenous" uric acid; while 
 that which comes from the breaking down of the tissues 
 of the body which contain amiuo purins and oxypurins or 
 nucleins is called "endogenous" uric acid. 
 
 2. The causes producing the first sound of the heart are 
 not definitely ascertained; the following are supposed to 
 be causatory factors: (1) The vibration and closure of the 
 auriculo-ventricular valves, (2) the muscular sound pro- 
 duced by the contraction of the ventricles, and (3) the 
 cardiac impulse against the chest wall. 
 
 The second sound is caused by the vibration due to the 
 closure of the semilunar valves. 
 
 3. The factors concerned in the venous circulation are: 
 (1) The action of the heart, (2) aspiration of the thorax, 
 (3) the contraction of the muscles, and (4) some slight 
 action of the valves in the veins. 
 
 4- 
 
 DIGESTIVE JUICES. 
 
 Saliva 
 
 Gastric juice 
 
 Pancreatic juice. 
 
 Intestinal juice. 
 
 ACTIVE PRIN- 
 CIPLE. 
 
 Ptyalin. 
 Pepsin. 
 
 A curdling 
 ferment. 
 Trypsin. 
 
 Amylopsin. 
 
 Steapsin. 
 
 A curdling 
 ferment. 
 Invertin. 
 
 5«T 
 
 ACTION. 
 
 Changes starches into 
 dextrin and sugar. 
 
 Changes proteids into 
 proteoses and peptones 
 in an acid medium. 
 
 Curdles the casein of 
 milk. 
 
 Changes proteids into 
 proteoses and peptones, 
 and afterwards decom- 
 poses them into leucin 
 and tyrosin; in an al- 
 kaline medium. 
 
 Converts starches into 
 maltose. 
 
 Emulsifies and saponifies 
 fats. 
 
 Curdles the casein of 
 milk. 
 
 Converts maltose into 
 glucose. 
 
MEDICAL RECORD. 
 
 The bile is also a digestive juice, and its functions are 
 as follows: (i) To assist in the emulsification and saponi- 
 fication of fats; (2) to aid in the absorption of fats; (3) 
 to stimulate the cells of the intestine to increased secretory 
 activity, and so promote peristalsis; and at the same time 
 tend to keep the feces moist; (4) to eliminate waste prod- 
 ucts of metabolism, such as lecithin and cholesterin ; (5) 
 it has a slight action in converting starch into sugar; (6) 
 it neutralizes the acid chyme from the stomach, and thus 
 inhibits peptic digestion; (7) it has a very feeble antiseptic 
 action. 
 
 5. "Mechanism of Accommodation. — The lens is an elas- 
 tic structure, and when released from the flattening in- 
 fluence of its suspensory ligament tends to assume a 
 spherical shape. During accommodation the ciliary muscle 
 (especially the circular fibers) contracts, drawing forward 
 the chorioid and relaxing the suspensory ligament; this 
 diminishes the tension of the lens capsule and allows the 
 inherent elasticity of the lens to increase its convexity. 
 The change in curvature affects chiefly the anterior surface 
 of the lens. This is Helmholtz's theory and the one 
 usually accepted. Lately Tscherning has advanced a dif- 
 ferent theory; he maintains that the ciliary muscle in- 
 creases the tension of the suspensory ligament during 
 contraction and that this causes peripheral flattening of 
 the lens with bulging anteriorly at its center. The act of 
 accommodation is accompanied by contraction of the pupil, 
 and (in binocular vision) by convergence of the visual 
 lines." — May's Diseases of the Eye. 
 
 MATERIA MEDICA. 
 
 i. Tinct re of iodine: Used as a local application, or for 
 injection into cavities. It is an irritant, disinfectant, ab- 
 sorbent, and parasiticide. Compound solution of iodine, 
 dose tl^iij, well diluted; action as the tincture. Potassium 
 iodide, dose gr. vij ; Sodium iodide , dose gr. vij ; Ammonium 
 iodide, dose gr. iv ; Strontium iodide, dose gr. vij ; Zinc 
 iodide, dose gr. j. The iodides are irritant, absorbent, and 
 alterative ; in excess may produce iodism. Iodoform, gener- 
 ally used as a dusting powder for syphilitic and other 
 ulcers. 
 
 2. The drugs that produce local anesthesia are: (1) 
 Ether, (2) Rhigolene, (3) Ethyl chloride, (4) Cocaine, (5) 
 Eucaine, (6) Holocaine, (7) Stovain, (8) Schleich's solu- 
 tion. Nos. 1, 2, and 3 are used as a spray; Nos. 4, 5, 6, 
 and 7 are used hypodermically, or by being applied to a 
 mucous surface ; Schleich's solution is used by infiltration. 
 
 3. The official names and doses of the preparations of 
 mercury which are prescribed for internal administration 
 are: (1) Hydrargyri choloridum corrosivum, gr. 1/20; 
 
 587 
 
MEDICAL RECORD 
 
 (2) hydraragyri iodidum rubrum, gr. 1/20; massa hy- 
 drargyri, gr. iv ; (4) hydrargyri chloridum mite, gr. ij ; 
 (5) hydrargyrum cum creta, gr. iv; (6) hydrargyri 
 iodidum flavum, gr. 1/5; (7) hydrargyri subsulphas flavus, 
 gr. 1/4 to 1/2. 
 
 4. The incompatibles of (a) the iron salts are: Vege- 
 table astringents, alkalies, acids, phenol; (b) of the vege- 
 table alkaloids: alkaline hydrates, tannic acid, picric acid, 
 salicylates, bromides, iodides, chlorides, bromine, iodine; 
 (c) of the gum resins: oxidizing agents, phenol, menthol. 
 
 5. Recipe : 
 
 Olei terebinthinaa 3ij 
 
 Pulveris acaciae 3iij 
 
 Chlorof ormi fftjxvj 
 
 Syrupi tolutani . , % . 3ij 
 
 Aquae menthae piperitae quantum sufficiat ad %iv 
 Misce. 
 Signa: One teaspoonful in half a glass of water, every 
 three hours. 
 
 CHEMISTRY. 
 
 1. Five morbid products- in the urine: Albumin, glu- 
 cose, acetone, pus, and excess of indican. 
 
 Albumin is found in the urine: "(1) In fevers, as typhoid 
 and pneumonia; (2) in valvular heart lesions, degeneration 
 of the heart muscle, diseases of the coronary arteries, im- 
 peded pulmonary circulation, in pregnancy by pressure upon 
 the renal veins, in intestinal catarrh, and in Asiatic cholera; 
 
 (3) in purpura, scurvy, leukemia, pernicious anemia, jaun- 
 dice, diabetes, and syphilis ; (4) after taking Pb, Hg, I, 
 P, As, Sb, chloroform, cantharides, oxalic, carbolic, salicylic 
 or. the mineral acids, turpentine, and nitrates; (5) in large 
 amounts in acute nephritis and chronic parenchymatous 
 nephritis; in small amount in chronic interstitial nephritis 
 and amyloid kidney." 
 
 Glucose is found in urine as ''transitory glycosuria/' "(1) 
 in certain hepatic derangements, congestion, cirrhosis, and 
 amyloid degeneration ; (2) in many diseases of the central 
 nervous system, with tumors or hemorrhages at the base 
 of the brain, in meningitis, concussion, fracture of cer- 
 vical vertebrae, railway injuries, in epileptic and apoplectic 
 seizures, and also in certain diseases of the peripheral 
 nervous system, as in sciatica and in tetanus; (3) in acute 
 febrile diseases, pneumonia, typhoid, acute articular rheu- 
 matism, scarlatina, etc., particularly during convalescence; 
 
 (4) under the influence of many poisons, such as curare, 
 chloral, carbon monoxide, morphine, arsenic, and the anes- 
 thetics. As 'permanent glycosuria' (1) in lesions of the 
 brain involving the floor of the fourth ventricle ; and (2) 
 in diabetes mellitus/' 
 
 588 
 
MEDICAL RECORD. 
 
 Acetone is found in the urine "in febrile diseases when 
 the febrile condition is prolonged, in certain mental dis- 
 eases, such as general paresis, melancholia and epilepsy, 
 after chloroform narcosis, in puerperal eclampsia, and in 
 diabetes." 
 
 Pus is found in the urine in suppuration of any part of 
 the urinary tract, and in case of rupture of an abscess 
 into that tract. 
 
 Excess of indie an is found in the urine "in hypochlor- 
 hydria ; in hyperchlorhydria of gastric ulcer ; in conditions 
 in which there is diminished peristalsis of the small intes- 
 tines, as in ileus and peritonitis, not in simple constipation; 
 also in conditions in which putrefactive changes occur in 
 the body elsewhere than in the intestine, as in empyema, 
 putrid bronchitis, gangrene of the lungs, etc/' 
 
 Test for Albumin. — The urine must be perfectly clear. 
 If not so, it is to be filtered, and, if this does not render it 
 transparent, it is to be treated with a few drops of mag- 
 nesia mixture, and again filtered. The reaction is then 
 observed. If it be acid, the urine is simply heated to near 
 the boiling point. If the urine be neutral or alkaline, it is 
 rendered faintly acid by the addition of dilute acetic acid, 
 and heated. If albumin be present, a coagulum is formed, 
 varying in quantity from a faint cloudiness to entire solidi- 
 fication, according to the quantity of albumin present. The 
 coagulum is not redissolved upon the addition of HN0 3 . 
 
 Test for indican in the urine: The urine is mixed with 
 one-fifth its volume of 20 per cent, solution of lead acetate 
 and filtered. The filtrate is mixed with an equal volume of 
 fuming hydrochloric acid containing 3:1000 of ferric 
 chloride, a few drops of chloroform are added, and the 
 mixture strongly shaken one to two minutes. With normal 
 urine the chloroform remains colorless, or almost so; but 
 if an excess of indoxyl compounds be present the chloro- 
 form is colored blue, and the depth of the color is a rough 
 indication of the degree of the excess. — From Witthaus' 
 Essentials of Chemistry. 
 
 2. Two forms of urinary calculi: (1) Uric acid calculi, 
 and (2) ammonium urate calculi. 
 
 Chemical tests: Saw the calculus in two, take some of 
 the sawdust and heat it on a platinum foil. If it is entirely 
 volatile, take a fresh portion of the dust, moisten with 
 nitric acid, evaporate to dryness at a low heat, add some 
 ammonium hydroxide solution; a red color will be pro- 
 duced. Treat a portion of the dust with solution of 
 potassium hydroxide, but without heating; if an ammoniacal 
 odor is observed, the calculus is ammonium urate; if no 
 such odor is observed, the calculus is uric acid. 
 
 3. In cases of poisoning by the mineral acids magnesia 
 in .water, or a strong solution of soap should be adminis- 
 
 580 
 
MEDICAL RECORD. 
 
 tered. The same course of treatment should be pursued 
 even if the acid is not known. 
 
 4. (1) Wanklyn's ammonia process: "Half a liter of 
 the water to be examined, made alkaline if necessary, is 
 put into a large flask, connected with a Liebig's condenser 
 by means of a bent glass tube passing through a perforated 
 India rubber stopper. The flask is heated by a Bunsen's 
 burner, and the first 50 c.c. of distillate are collected and 
 Nesslerized, and the amount of ammonia they contain is 
 recorded. This ammonia is part of the free ammonia con- 
 tained in the water as such, and it is found by experience 
 that the first 50 c.c. contain three-quarters of the free am- 
 monia. Hence, adding one-third to the amount recorded 
 in the first 50 c.c, we get the whole amount contained in 
 the half liter of water under analysis, and, doubling this, 
 the mgrs. of free ammonia per liter, i.e. parts per million. 
 
 "Thus, if the first 50 c.c. strike a tint with Nessler, which 
 is matched in the second glass by the addition of 1.2 c.c. 
 standard ammonia solution, we must allow one-third of 
 1.2, that is, 0.4, making a theoretical total of 1.6 c.c. This 
 corresponds to 0.016 mgr. of ammonia in the half liter 
 taken for analysis, or 0.032 part per million. Meanwhile 
 150 c.c. more are distilled over, to exhaust the free am- 
 monia, but, as already explained, it is unnecessary to Ness- 
 lerize these. 
 
 "There are then 300 c.c. left in the flask, and to this are 
 now added 50 c.c. of the alkaline permanganate, and the 
 distillation is resumed. The first, second, and third 50 c.c. 
 are collected separately and Nesslerized. Should the third 
 50 c.c. be found to contain noteworthy quantities of am- 
 monia, a fourth 50 c.c. are distilled over. 
 
 "The ammonia coming over at this second stage is called 
 albuminoid ammonia, being derived from the albuminoid 
 and other nitrogenous organic matter in the water. The 
 second 50 c.c. contain much less than the first, and the 
 third less than the second. Adding together the amount 
 of ammonia found in the three lots, we have the total for 
 the half liter of water; and twice this will give the propor- 
 tion in parts per million. Thus : 
 
 1st 50 = 2.5 c.c. standard ammonia solution. 
 2d 50=1.0 c.c. 
 3d 50 = 0.3 c.c. 
 
 Total = 3.8 c.c. =0.038 mgr. ammonia per half liter. 
 Albuminoid ammonia = 0.076 part per million." 
 
 — (Whitlegge's Hygiene.) 
 (2) Kjeldahl's process is based upon the conversion of 
 the nitrogen of organic substances into sulphate of am- 
 monia if charred by heating with strong sulphuric acid. 
 The water is concentrated by distillation, and charred by 
 
 590 
 
MEDICAL RECORD. 
 
 strong sulphuric acid. The organic residue is then broken 
 up with permanganate of potash in the presence of a 
 caustic alkali. On further distillation the organic nitrogen 
 is determined from the resulting ammonia by Nesslerizing. 
 The organic nitrogen by Kjeldahl's process is about twice 
 the nitrogen of the albuminoid ammonia, and in usable 
 drinking water does not usually exceed 0.016 parts per 
 100,000. Any water, unless peaty, containing more than 
 this may be regarded with suspicion.— (Notter and Firth.) 
 5. When diabetic urine is added to a heated alkaline 
 solution of potassiocupric tartrate, a yellow or red precipi- 
 tate is formed. 
 
 PATHOLOGY. 
 
 i. Infarcts are areas of tissue in which, owing to the 
 plugging up of an end artery or terminal artery, nutrition 
 is prevented. 
 
 Infarcts most frequently occur in the kidneys, spleen, 
 lungs, base of brain, retina, and heart. 
 
 2. See French's "Practice of Medicine" (1907), pages 
 574, etc.; or Osier's "Practice of Medicine" (1909), pages 
 793, etc. 
 
 3. "Cataract means opacity of the crystalline lens, and 
 is due to changes in the structure and composition of the 
 lens fibers. The capsule is often thickened, but otherwise 
 not much altered. The changes seldom occur throughout 
 the whole lens at once, but begin first in a certain region, 
 e.g. the center {nucleus) or the superficial layers {cortex), 
 while in some forms of partial cataract the change never 
 spreads beyond the part first affected. With advancing 
 age the lens, which is from birth firmest at the center, 
 becomes harder, and acquires a very decided yellow color; 
 its refractive power usually decreases, its surface reflects 
 more light, and its substance becomes somewhat fluorescent. 
 The result of all these changes is that at an advanced age 
 the lens is more easily visible than in early life, the pupil 
 becoming grayish instead of being quite black. This gray- 
 ness of the pupil may easily be mistaken for cataract, but 
 ophthalmoscopic examination shows that the lens is trans- 
 parent, the fundus being seen without any appreciable haze. 
 It has hitherto been supposed that the lens became smaller 
 in old age, but the researches of Priestley Smith have 
 lately shown that the lens continues to increase in all di- 
 mensions so long as it remains transparent. As a rule, 
 however, cataractous lenses are undersized. The consist- 
 ence of a cataract depends chiefly on the patient's age. 
 The wide physical differences between cataracts depend less 
 on variations in the cause, position, or character of the 
 opacity than on the degree of natural hardness which is 
 proper to the lens at the time when the opacity sets in. 
 
 591 
 
MEDICAL RECORD. 
 
 Below about thirty-five all cataracts are 'soft.'" — (Nettle- 
 ship's Diseases of the Eye.) 
 
 4. See Rose and Carless' "Surgery" (1907), pages 99 and 
 105. 
 
 5. The gonococcus, on being implanted on the mucous 
 membrane of the urethra, may produce : Gonorrhea, ure- 
 thritis, prostatitis, orchitis, epididymitis, vulvitis, vaginitis, 
 endometritis, salpingitis, by direct extension ; conjunctivitis 
 may result if the discharge is carried to the eye; by 
 metastasis there may result : Gonorrheal arthritis, tenosy- 
 novitis, involvement of the pleura, pericardium, endo- 
 cardium, or myocardium ; also involvement of the lymphatic 
 glands, e.g., bubo. 
 
 To demonstrate the gonococcus: On a cover-glass make 
 a smear with the discharge as thin as possible, and let it 
 dry in the air ; cover it with a freshly-made solution of 
 anilin-oil-gentian-violet for one or two minutes ; wash it 
 in distilled water; leave it in Gram's solution for. two min- 
 utes; wash it in 95 per cent, alcohol until decolorized; 
 wash it in distilled water ; counterstain with a dilute car- 
 bolfuchsin without heat, or with a saturated aqueous solu- 
 tion of Bismarck brown; wash in distilled water, dry with 
 filter paper, mount, and examine with an oil-immersion lens. 
 The gonococci will appear as diplococci within the leuco- 
 cytes, which have been decolorized by Gram's stain, and 
 have taken the counterstain. 
 
 DIAGNOSIS. 
 
 1. In acute pharyngitis there is little or no systemic dis- 
 turbance ; the patient complains of pain and sore throat ; 
 the pharynx is red and dry ; and there are no Klebs 
 Loeffler bacilli present. 
 
 In diphtheria there is severe constitutional disturbance; 
 an exudate is present, which is removable only with diffi- 
 culty, and recurs after removal, and contains the Klebs 
 Loeffler bacilli. 
 
 2. In renal colic: The pain is in the region of the af- 
 fected kidney, it radiates down the thigh ; there are intense 
 rigors ; retraction of the testicle may be present ; also 
 history of previous attacks or of calculi ; the urine may be 
 scanty, suppressed, or bloody. 
 
 In hepatic coli: The pain is in the region of the liver, it 
 radiates to the right scapula and toward the umbilicus; 
 chills and sweats are common ; also vomiting, and some- 
 times symptoms of collapse and jaundice; calculi are found, 
 if at all, in the feces. 
 
 In appendicitis: The pain is at first diffuse, but later be- 
 comes localized over the appendix in the right iliac fossa; 
 nausea, vomiting, and constipation may be present; tender- 
 ness over the appendix, and rigidity of the right rectus 
 
 592 
 
MEDICAL RECORD. 
 
 abdominis muscle are present ; there is generally moderate 
 fever. 
 
 3. In tabes dorsalis: There are lightning pains, loss of 
 knee jerk, the presence of the Argyll-Robertson pupil. 
 
 In ataxia paraplegia: There are very rarely lightning 
 pains, the knee jerk is exaggerated, ankle clonus is present, 
 there is no Argyll-Robertson pupil. 
 
 4. See French's "Practice of Medicine" (1907), page 146; 
 or Osier's "Practice of Medicine" (1909), page 163. 
 
 5. ''Interstitial keratitis commences as a slight cloudiness 
 of the central portion of the cornea, with some roughening 
 or irregularity of the epithelium. It extends from the cen- 
 ter towards the margin, and is liable to be attended, in 
 different cases and at different stages of its course, by 
 variable degrees of ciliary and corneal congestion, and 
 intolerance of light. If neglected, or if treated by irri- 
 tants, it is liable to assume the characters of vascular kerati- 
 tis, and also to extend to the iris, in such instances often 
 doing irreparable mischief. It is most common during 
 childhood, but its appearance may be delayed until adoles- 
 cence, or even until adult age. It attacks both eyes, one 
 commonly somewhat later than the other, and its course 
 is often protracted over several months. V\ "hen severe, it 
 leaves some residual cloudiness of the cornea, and, even 
 when mild, it is doubtful whether the cornea ever entirely 
 regains the transparency of health. Still, when a case is 
 seen and judiciously treated early, the prognosis ma}* gener- 
 ally be a favorable one." — (Quain's Dictionary of Medi- 
 ci tie.) 
 
 PRACTICE OF MEDICINE AND THERAPEUTICS. 
 
 i. See French's "Practice of Medicine" (1907), page 317; 
 or Osier's "Practice of Medicine" (1909), page 132. 
 
 2. See French's "Practice of Medicine" (1907), page 940; 
 or Osier's "Practice of Medicine" (1909), page 414. 
 
 3. See French's /'Practice of Medicine" (1907), page 835; 
 or Osier's "Practice of Medicine" (1909), page 564. 
 
 4. See French's "Practice of Medicine" (1907), page 357; 
 or Osier's "Practice of Medicine" (1909), page 310. 
 
 5. See French's "Practice of Medicine" (1907), page 695; 
 or Osier's "Practice of Medicine" (1909), page 649. 
 
 6. See French's "Practice of Medicine" (1907), page 719; 
 or Osier's "Practice of Medicine" (1909), page 447. 
 
 7. See French's "Practice of Medicine" (1907), page 478; 
 or Osier's "Practice of Medicine" (1909), page 30. 
 
 8. Symptoms of poisoning by belladonna: "In the first 
 stage, that of delirium, there are dryness of the throat, 
 thirst, difficulty of deglutition and spasms upon swallowing 
 liquids, face at first pale, afterwards highly reddened, pulse 
 extremely rapid, eyes prominent, brilliant, with widely- 
 
 593 
 
MEDICAL RECORD. 
 
 dilated pupils, complete paralysis of accommodation, dis- 
 turbances of vision, attacks of giddiness and vertigo, with 
 severe headache, followed by delirium, occasionally silent 
 or muttering, but usually violent, noisy, and destructive, 
 accompanied by the most fantastic delusions and hallucina- 
 tions. Usually the urine is retained, and the body tempera- 
 ture is above the normal. The delirium gradually sub- 
 sides, and the second stage, that of coma, is established, 
 with slow, stertorous respiration, and gradually failing 
 pulse, until death occurs from respiratory or cardiac par- 
 alysis, or sometimes in an attack of syncope during ap- 
 parent amelioration." 
 
 Treatment: Lavage of the stomach; morphine may be 
 given cautiously during the period of violent excitement. 
 Maintain respiration; strong coffee by the mouth or rec- 
 tum is beneficial. Pilocarpine may be given, in not too 
 large doses, to stimulate the secretion of saliva." — -From 
 Witthaus' Essentials of Chemistrv. 
 
 9. See French's "Practice of Medicine" (1907), page 773. 
 
 10. Arsenic. Indications: To remove hairs, as a caustic; 
 in gastric ulcer or cancer, irritative dyspepsia, pyrosis, 
 diarrhea coming on immediately after eating, alcoholism, 
 nausea, malaria, anemia, chlorosis, chorea, epilepsy, chronic 
 rheumatism, chronic, scaly, and papular skin diseases. Con- 
 traindications: Acute skin diseases and pulmonary tuber- 
 culosis, with a tendency to hemoptysis. 
 
 SURGERY. 
 
 1. See Rose and Carless' "Surgery" (1908), pages 975 
 and 969; or Da Costa's "Surgery" (1908), page 868. 
 
 2. Symptoms of pyosalpinx: Pain or discomfort, made 
 worse by pressure, examination, or defecation; or colicky 
 pains over the tube; dysmenorrhea; increased menstrual 
 flow; tubes are found to be dilated and swollen. Treat- 
 ment: Removal of the affected tube; or salpingo-oopho- 
 rectomy. 
 
 Operation of salpingo-oophorectomy: "(1) Perform a 
 median abdominal section — control hemorrhage — and re- 
 tract lips of abdominal wound. (2) Pass the first and 
 second fingers into the wound, with the back of the hand 
 to the abdomen ; follow down the under surface of the ab- 
 dominal parietes to the symphysis, thence down on to the 
 bladder and uterus, and thence out laterally over the 
 superior cornu of the uterus, with the palm of the hand 
 still downward, to and along the broad ligament, along the 
 posterior superior aspect of which the Fallopian tube is 
 found, and, just posterior to the tube, the ovary. These 
 structures are drawn toward the median line into an ac- 
 cessible position in the abdominal wound. (3) The ovarian 
 artery and veins are first tied, with silk, the ligature being 
 carried, upon a laterally curved aneurysm needle, through 
 
 594 
 
MEDICAL RECORD. 
 
 the clear space of the broad ligament and tied over the 
 top of the infundibulopelvic ligament, outside of the 
 fimbriated end of the Fallopian tube, and close to the brim 
 of the pelvis. (4) The uteroovarian ligament, lying be- 
 hind the Fallopian tube, is ligated with chromic gut, rather 
 nearer the uterus, carried upon a laterally curved aneurysm 
 needle. (5) The inner end of the Fallopian tube and the 
 upper free part of the broad ligament are ligated with silk 
 near the horn of the uterus — which ligature also controls 
 the branches from the uterine artery. (6) The structures 
 are now removed by cutting through the broad ligament 
 well within the outer ligature of the ovarian vessels — and 
 cutting through the Fallopian tube and ovarian ligament 
 well to the outer side of their ligatures — and carrying the 
 incision through the broad ligament well below the hilum 
 of the ovary. Any doubtful ligature is strengthened, and 
 any bleeding point is surrounded by an additional gut 
 ligature. (7) The edges of the anterior and posterior 
 layers of the broad ligament, left by the removal of the 
 above structures, are sutured together with gut. The 
 patient is lowered to the horizontal position and the intes- 
 tines and omentum are replaced. (8) The abdomen is 
 closed, as after median abdominal section." — (Bickham's 
 Operative Surgery.) 
 
 3. In posterior luxation of the hip joint the patient should 
 be placed on a mattress on the floor, and then be anes- 
 thetized. The leg is then to be flexed on the thigh, and 
 the thigh flexed on the abdomen ; adduction is to be in- 
 creased so that the knee is beyond the middle line of 
 the body; then abduct, freely circumduct outward, and 
 finally extend the limb so that it is parallel with the other. 
 
 4. See Rose and Carless' "Surgery" (1908), pages 115 
 and 117; or Da Costa's "Surgery" (1908), pages 1052 and 
 
 1053. 
 
 5. See Rose and Carless' "Surgery" (1908), page u8g: 
 or Da Costa's "Surgery" (1908), page 1128. 
 
 6. See Rose and Carless' "Surgery" (1908), page 926; or 
 Da Costa's "Surgery" (1908), page 773. 
 
 7. See Rose and Carless' "Surgery" (1908), pages 475, 
 479, and 482; or Da Costa's "Surgery" (1908), page 497. 
 
 8. See Rose and Carless' "Surgery" (1908), page 635; 
 or Da Costa's "Surgery" (1908), pages 607 and 635. 
 
 9. See Rose and Carless' "Surgery" (1908), page 1269;. 
 or Da Costa's "Surgery" (1908), pages 1202 and 397. 
 
 10. See Rose and Carless' "Surgery" (1908), page 838; 
 or Da Costa's "Surgery" (1908), page 390. 
 
 OBSTETRICS. 
 
 I. Certain pelvic deformities, placenta praevia, pernicious 
 anemia, toxemia of pregnancy. 
 
 595 
 
MEDICAL RECORD 
 
 2. See Williams' "Obstetrics" (1909), pages 190 and 647; 
 or Hirst's "Obstetrics" (1909), pages 204 and 304. 
 
 3. Indications for the use of forceps are : Inertia uteri 
 in the presence of conditions likely to jeopardize the in- 
 terests of mother or child. Impending exhaustion; arrest 
 of head, from feeble pains. Evidence of fetal exhaustion 
 (pulse above 160 or below 100 per minute). Hemorrhage; 
 prolapsus funis ; eclampsia. All acute or chronic diseases 
 or complications in which immediate delivery is required in 
 the interest of mother or child, or both, (b) Indications 
 for version are : Prolapsed funis, sudden death of the 
 mother, and in any case where speedy delivery is impera- 
 tive. 
 
 .4. Hemorrhage during pregnancy may be due to : Pla- 
 centa praevia, premature separation of placenta, or apoplexy 
 of decidua or placenta. Treatment: See Williams" "Ob- 
 stetrics" (1909), pages 808 and 815; or Hirst's "Obstetrics" 
 (1909), pages 577 and 585. 
 
 5. See Williams' "Obstetrics" (1909), page 618; or Hirst's 
 "Obstetrics" (1909), page 279. 
 
 6. See Williams' "Obstetrics" (1909), pages 201, 520, 
 and 493; or Hirst's "Obstetrics" (1909), pages 253 and 247. 
 
 7. See Williams' "Obstetrics" (1909), page 282; or Hirst's 
 "Obstetrics" (1909), page 416. 
 
 8. See Williams' "Obstetrics" (1909), page 661 ; or Hirst's 
 "Obstetrics" (1909), page 442. 
 
 . 9. See Williams' "Obstetrics" (1909), page 384. 
 
 10. Ophthalmia neonatorum is an infectious, purulent in- 
 flammation of the conjunctiva in the new-born. 
 
 It is due to the gonococcus or some other pyogenic germ; 
 and is produced by contact of the eye with the vaginal 
 secretion of the mother during labor, or infected fingers, 
 or instruments, etc. 
 
 The treatment is: (1) Prophylactic: Whenever there is 
 the possibility of infection, or in every case, wash, the eye- 
 lids of the new-born child with clean warm water, and drop 
 ori the cornea of each eye one drop of a one or two per 
 cent, solution of nitrate of silver, immediately after birth. 
 (2) Remedial: Wash the eyes carefully every half hour 
 with a saturated solution of boric acid; pus must not be 
 allowed to accumulate. Two drops of a two per cent, 
 solution of nitrate of silver must also be dropped on to the 
 cornea every night and morning. The eyes must be cov- 
 ered with a light, cold, wet compress. The patient must be 
 isolated, and all cloths and compresses used must be burnt. 
 
 HYGIENE. 
 
 I. The principal means of preventing the spread af con- 
 tagious diseases in schools are : Regular and efficient in- 
 spection by physicians; prompt exclusion and isolation of 
 
 596 
 
MEDICAL RECORD. 
 
 anyone suffering from a contagious disease, or coming 
 from a house where such disease is ; compulsory vaccina- 
 tion ; compulsory notification of all infections and con- 
 tagious disease ; individual towels, drinking vessels, and 
 other implements ; children who have had a contagious 
 or infectious disease, or who have come from a house 
 where such disease prevailed, should not be readmitted to 
 school until sufficient time has elapsed since the occurrence 
 of the last case to insure safety. 
 
 2. Hygienic precautions to be taken in treating a case 
 of tuberculosis : ''The patient's quarters should be free 
 from dust and admit of spending many hours daily in the 
 open air in all weathers, properly sheltered, and, if very ill, 
 lying wrapped in a hammock or reclining chair. His bed- 
 room should be well aired at night, draughts being avoided. 
 The room should be uncarpeted and free from hangings. 
 It should be often cleaned and periodically disinfected. 
 All sputum should be collected in paper spit-cups, which 
 should be burned daily. Smoking should be forbidden. 
 Harm is done by any exercise which results in fatigue, and 
 while fever exists it should not be attempted at all. Pa- 
 tients should be taught the necessity of practising lung 
 gymnastics and breathing only through the nose, which 
 should be kept clear and free from occlusion by secretions, 
 or a hypertropnied catarrhal mucosa. * * * The cloth- 
 ing should be woolen, but not too heavy, or sweating is 
 increased ; and a flannel nightgown and loosely knit leg- 
 gings should be worn at night in cool weather. The skin 
 should be cleansed by daily sponge baths of lukewarm 
 alcohol and water." — (Thompson's Practical Medicine.) 
 
 3. Because diseases may be easily conveyed by such 
 usae-e. 
 
 4. Proper instruction of the mothers in the proper 
 method of feeding and caring for infants; proper pro- 
 vision for an adequate supply of good, pure milk and ice, 
 at reasonable prices. See, too, French's "Practice of 
 Medicine" (1907), page 780. 
 
 5. Because in the home the individual and his comfort 
 and necessities are studied ; more assistance is present or 
 is obtainable; there is no routine to be kept up; the physi- 
 cians and nurses are selected by the patient and his family, 
 and there is more likelihood of adequate personal attention 
 being given. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 South Carolina State Board of Medical Examiners. 
 
 GENERAL ANATOMY. 
 
 i. - Name the bones of the head. 
 
 597 
 
MEDICAL RECORD. 
 
 2. Name the bones of the lower extremity. 
 
 3. Name the muscles of the abdomen — deep and super- 
 ficial. 
 
 4. What chief arteries supply the neck and head? 
 
 5. Where are the epigastric arteries found? Branches 
 of what arteries? 
 
 REGIONAL OR SURGICAL ANATOMY. 
 
 1. In the lymphatics of the peritoneum, which are most 
 rapid in absorption, those of the diaphragm or of the 
 pelvis? If you wish to stimulate in abdominal incision, 
 what position would you place the patient in? If to re- 
 tard too rapid absorption of pus in cavity, what position? 
 
 2. What are the anatomical points to be remembered 
 in paracentesis thoracis? 
 
 3. From its anatomical position, why is rupture of the 
 kidney of less danger than rupture of the liver and the 
 spleen ? 
 
 4. A case presented with apparent dislocation with 
 atrophy of shoulder muscles and arm, only partial mo- 
 tion. What anatomical points would decide between dis- 
 location of the shoulder and paralysis of the deltoid? 
 
 5. What nerve supplies the superior oblique muscle of 
 the eye, and what defect of vision would you have in 
 paralysis of the same? What nerve supplies the external 
 rectus ; what would you find in paralysis of that muscle ? 
 
 6. What is the most common point of fracture of the 
 humerus? What are some of the sequelae? 
 
 7. Give surface marking of the brachial artery. 
 
 8. Give surface marking of the femoral artery (common 
 and superficial) ; where best compressed? Where best li- 
 gated? 
 
 9. In lateral lithotomy, name anatomical points to be 
 avoided. 
 
 10. Give the anatomical position of the deep epigastric 
 artery to direct and indirect hernia. 
 
 PHYSIOLOGY. 
 
 1. What conditions hasten or retard the coagulation of 
 blood, and mention the physical properties of the blood? 
 
 2. What produces the second sound of the heart, where 
 best heard, and what events in the heart's action are co- 
 incident with it? 
 
 3. What is the difference between warm and cold 
 blooded animals, and how is heat produced and dissemi- 
 nated from the body? 
 
 4. How is the secretion of glands chiefly regulated, 
 and how do the kidneys secrete urine? 
 
 5. What results would follow a complete division of 
 the right facial nerve? 
 
 598 
 
MEDICAL RECORD. 
 
 CHEMISTRY. 
 
 i. Give chemical formula for common salt; nitrate of 
 silver; sulphuric acid; nitric acid; water. 
 
 2. What is the difference between blue mass, mercurial 
 ointment, and citrine ointment? 
 
 3. What is gray powder? 
 
 4. What is the difference between static and galvanic 
 electricity? Give methods of production. 
 
 5. What are the positive and negative poles of a bat- 
 tery termed? 
 
 PRACTICAL URANALYSIS, MICROSCOPY, TOXICOLOGY. 
 
 i. How do you make a chemical analysis of the urine 
 for life insurance? 
 
 2. Give indications of high and low specific gravity in 
 the twenty-four hour urine. 
 
 3. What does transitory low specific gravity indicate? 
 
 4. Give differential morphology of blood, pus, oil and 
 water under the microscope. 
 
 5. Describe simple and compound microscopes. 
 
 6. What oculars and objectives are in common use? 
 
 7. Give symptoms and antidotes to poisoning by sul- 
 phate of atropine. 
 
 8. Give symptoms and antidotes to poisoning by opium. 
 
 9. How would you detect a case of poisoning with car- 
 bolic acid or potassium hydrate? 
 
 10. What fumes are given off by arsenic when it is 
 burned? 
 
 MATERIA MEDICA. 
 
 Give the dose and physiological effect of: 
 
 1. Fluid extract of ergot. 
 
 2. Sulphate of sparteine. 
 
 3. Veratrum viride. 
 
 4. Chloral hydrate. 
 
 5. Tincture of digitalis. 
 
 THERAPEUTICS. 
 
 In treating the following diseases, give dose, frequency 
 of administration and physiological effect of drugs used; 
 also other remedial measures used, giving physiological 
 effect and mode of use: 
 
 1. Acute articular rheumatism. 
 
 2. Acute lobar or croupous pneumonia. 
 
 3. Erysipelas. 
 
 4. Dysentery. 
 
 5. Enterocolitis of children. 
 
 6. Dysmenorrhea. 
 
 7. Orchitis (non-specific). 
 ' 8. Acute nephritis. 
 
 599 
 
MEDICAL RECORD. 
 
 9. Acute gastritis. 
 
 10. Gastric ulcer. 
 
 BACTERIOLOGY AND PATHOLOGY. 
 
 i. What is meant by aerobic bacteria? What is meant 
 by anaerobic bacteria? 
 
 2. Name three most important culture media. 
 
 3. State briefly the morbid anatomy of catarrhal ap- 
 pendicitis. 
 
 4. What connection has typhoid fever with the forma- 
 tion of gallstones? 
 
 5. Differentiate between fatty degeneration and fatty 
 infiltration. 
 
 PRACTICE OF MEDICINE AND DISEASES OF CHILDREN. 
 
 1. Differentiate simple melancholia and hypochondria. 
 
 2. (a) What are the causes of cardiac arrhythmia? (b) 
 Symptoms and treatment of angina pectoris? 
 
 3. (a) What are the possible sequelae of pneumonia? 
 (b) What symptoms would cause you to suspect incipient 
 pulmonary tuberculosis ? 
 
 4. Mention the causes of anemia, 
 
 5. Symptoms of interstitial nephritis. 
 
 6. Symptoms and treatment of acute dysentery. 
 
 7. Make diagnosis and give reasons from following 
 history and symptoms : 
 
 J. S., aged 40 years. He had suffered for years with 
 indigestion, and for several months with pain in epigas- 
 trium, which was relieved by eating, and for one week 
 remained in bed on account of aggravation of epigastric 
 pain. At 1 o'clock in the day got up and went to the back 
 door to look out. While there was seized with sudden se- 
 vere pain in abdomen. He vomited and crawled back to 
 bed. At 3 p.m. his pulse was 90, temperature 101 degrees 
 F., abdomen of board-like rigidity, tenderness everywhere, 
 but more tender in epigastrium. He was given morphine, 
 gr. Y^. At 9 p.m. he was somewhat improved, and his 
 muscular spasm was a little less. At 11 p.m. was pale 
 and looked sick. There was distinct spasm and tenderness 
 in epigastrium, shading off into other regions of abdomen, 
 which was generally retracted. There was no dullness. 
 Tongue moist. Pulse 90, temperature 101 degrees F. 
 
 8. Symptoms and sequelae of scarlet fever. 
 
 9. What per cent, of fat and proteids would you pre- 
 scribe for a child four months old? How would you 
 direct the mother to make it? 
 
 10. Causes of convulsions in children? Causes of 
 vomiting in children? 
 
 OBSTETRICS AND DISEASES OF WOMEN. 
 
 i. With what conditions may pregnancy be confounded? 
 
 600 
 
MEDICAL RECORD. 
 
 2. (a) How does placenta praevia develop? (b) Where 
 does the hemorrhage come from that endangers the moth- 
 er's life? (c) In what way is the child's life endangered 
 in this condition? (d) How would you treat a case of 
 placenta praevia when hemorrhage occurs prior to full 
 term ? 
 
 3. How would you treat a case of postpartum hemor- 
 rhage? 
 
 4. What are the prodromal symptoms of eclampsia, and 
 what would you do to prevent it? 
 
 5. How would you treat a case of prolapse of the arm 
 in a transverse position? 
 
 6. How would you treat a case of retained placenta? 
 
 7. Under what conditions is a physician justified in 
 inducing premature labor? 
 
 8. What symptoms and conditions would cause you to 
 suspect twin pregnancy? 
 
 9. How would you perform a curettage after an incom- 
 plete abortion? 
 
 10. \Y T hat are the ultimate dangers from gonorrhea in 
 the female? 
 
 SURGERY. 
 
 1. Causes which retard, interfere with, or prevent a 
 wound from healing; (1) in wound itself; (2) in subject 
 of wound; (3) in treatment. 
 
 2. To promote the primary union of a wound, name 
 six important factors. 
 
 3. When a visible part is inflamed, there are four nota- 
 ble phenomena to be observed; what are they? 
 
 4. (1) What causes bedsores? (2) How would you 
 prevent them? (3) When present, how would you treat 
 them? 
 
 5. Acute orchitis: (1) Etiology; (2) symptoms; (3) 
 treatment. 
 
 6. How would you treat chronic ulcer of the leg? 
 
 7. Give symptoms and treatment in downward disloca- 
 tion of the head of the humerus. 
 
 8. How would vou treat a simple fracture of the mid- 
 dle third of the femur? 
 
 9. Necrosis of the lower third of femur in a boy of 
 twelve years. Give early symptoms and treatment. 
 
 10. In amputating the lower third of the leg, give the 
 several steps of the operation, including dressing. 
 
 PRACTICAL HYGIENE. SANITARY SCIENCE., STATE MEDICINE. 
 
 1. State the period of incubation and contagion in 
 c carlet fever, diphtheria, pertussis, measles, rubella, small- 
 pox, typhoid fever, parotitis. 
 
 2. What hygienic care should be taken by pregnant 
 and parturient women ? 
 
 601 
 
MEDICAL RECORD. 
 
 3. What condition would cause you to condemn meat, 
 and what would you do to insure milk from impurities, 
 that is, milk meant for the public? 
 
 4. What infectious diseases may be conveyed through 
 the medium of air, water and food, respectively? 
 
 5. What are the injurious effects of excessive use of 
 tobacco ? 
 
 6. Give draft of acceptable regulations of schools as 
 to contagious diseases. 
 
 7. At a moderate temperature what is the most satis- 
 factory relative humidity for comfort? 
 
 8. At 80 degrees F. what humidity is uncomfortable? 
 
 9. Give hygienic care of infants as to clothing, bath, 
 and their various organs. 
 
 10. Name six diseases subject to quarantine, and how 
 long would you quarantine each? 
 
 MEDICAL JURISPRUDENCE. 
 
 1. In what condition would you expect to find the 
 lungs, kidneys and heart after death from asphyxia? 
 
 2. What is the difference in the appearance of burns 
 produced before death and those made after death? 
 
 3. When a physician takes charge of a case gratuit- 
 ously, is he exempt from tne charge of malpractice if it 
 can be proven that his treatment was improper, or that he 
 neglected his patient? 
 
 4. What causes rigor mortis? 
 
 5. In women what is the last of the internal organs 
 to putrify? 
 
 6. What is the duty of the physician when it is neces- 
 sary for him to take down a dying declaration? 
 
 7. In a case of suspected infanticide, describe the 
 method of determining whether the child breathed or not. 
 
 8. What is legally meant by feticide? Is the crimini- 
 nality of the act any greater if performed after quickening 
 than before? 
 
 9. State briefly the difference between idiocy and 
 mania. 
 
 10. In death by lightning, in what condition would you 
 expect to find the heart? In what condition the other 
 internal organs? 
 
 ANSWERS TO STATE MEDICAL BOARD EXAM- 
 INATION QUESTIONS. 
 
 South Carolina State Board of Medical Examiners. 
 
 general anatomy. 
 
 I. The bones of the head are: Occipital, 2 parietal, 2 
 temporal, frontal, ethmoid, sphenoid, 2 lacrymal, 2 malar, 
 
 602 
 
MEDICAL RECORD. 
 
 2 nasal, 2 palate, 2 superior maxillary, 2 inferior turbinate, 
 vomer, and inferior maxillary. 
 
 2. Bones of lower extremity: Ilium, ischium, os pubis, 
 femur, tibia, fibula, patella, os calcis, astragalus, cuboid, 
 scaphoid, 3 cuneiforms, 5 metatarsals, and 14 phalanges. 
 
 3. Abdominal muscles: External oblique, internal oblique, 
 transversalis, rectus, pvramidalis, quadratus lumborum. 
 
 4. Subclavian, carotid (external and internal), superior 
 thyroid, lingual, facial, occipital, posterior auricular, as- 
 cending pharyngeal, superficial temporal, internal maxillary, 
 ophthalmic, anterior meningeal, anterior cerebral, middle 
 cerebral, posterior communicating, arteria princeps cervicis, 
 transverse facial, middle temporal, middle meningeal, 
 lacrymal, frontal, nasal, circle of Willis, vertebral, basilar, 
 posterior meningeal, inferior thryoid, tracheal, ascending 
 cervical. 
 
 5. The internal or deep epigastric artery is a branch of 
 the internal iliac; the superficial epigastric is a branch of 
 the femoral artery; the superior epigastric is a branch of 
 the internal mammary artery. 
 
 REGIONAL OR SURGICAL ANATOMY. 
 
 i. In the lymphatics of the peritoneum, those of the 
 diaphragm are more rapid in absorption than those of 
 the pelvis. 
 
 To stimulate, the patient should have the foot of his 
 bed raised, so that the fluid (salt solution) may be con- 
 veyed more readily to the diaphragm, where absorption 
 is more rapid. 
 
 To retard the too rapid absorption of pus in the ab- 
 dominal cavity, the head of the bed should be raised so 
 that drainage may be directed toward the pelvis, where 
 absorption is slower. 
 
 2. In paracentesis thoracis: The puncture should be 
 made in the mid-axillary line, and in the fifth, sixth or 
 seventh spaces ; it should be made midway between the 
 ribs, so as to avoid the intercostal vessels ; it should 
 be made during inspiration, as then the spaces are wider. 
 
 3. Rupture of the kidney is of less danger than rup- 
 ture of the liver and the spleen, because the kidney is 
 retroperitoneal, and therefore the peritoneal cavity is not 
 so liable to be infected bv the extravasation. 
 
 4. In dislocation of the shoulder: the head of the 
 humerus is not in the glenoid cavity, and motion of the 
 arm is considerably impaired ; in paralysis of the deltoid, 
 the head of the humerus is in the glenoid cavity, and the 
 arm is freely movable. 
 
 5. The superior oblique muscle of the eye is supplied 
 by the fourth cranial nerve (the trochlear or patheticus) ; 
 in paralysis of the same diplopia results. The external 
 
 603 
 
MEDICAL RECORD 
 
 rectus is supplied by the sixth cranial nerve (the ab- 
 ducens) ; in paralysis of the same there will result con- 
 vergent strabismus and diplopia. 
 
 6. The most common place of fracture of the humerus, 
 is at the lower extremity of the bone. Some of the se- 
 quelce, are: (i) non-union; (2) "gun-stock" deformity; 
 and (3) loss of the "carrying angle." 
 
 7. With the arm extended, and the forearm supinated, 
 the brachial artery- is indicated by a line drawn from the 
 anterior axillary fold, along the inner border of the biceps, 
 to the middle of the bend of the elbow-joint. 
 
 8. The femoral artery is indicated by a line drawn from 
 the central point of a line joining the anterior superior 
 spine of the ilium and the symphysis pubis to the adductor 
 tubercle on the inner condyle of the femur. 
 
 The femoral artery is best compressed just below Pou- 
 part's ligament; and it is best ligated at the apex of 
 Scarpa's triangle. 
 
 9. In lateral lithotomy, the anatomical points to be 
 avoided, are: (1) The bulb of the urethra, and its artery; 
 (2) the rectum; (3) the pudic artery; (4) complete di- 
 vision of the prostate gland; (5) the left ejaculatory duct. 
 
 10. The deep epigastric artery is internal to indirect 
 inguinal hernia; and external to direct inguinal hernia. 
 
 PHYSIOLOGY. 
 
 1. Conditions which hasten the coagulation of the blood 
 are: (1) Moderate warmth, (2) contact with foreign mat- 
 ter, (3) agitation, (4) the presence of calcium salts. 
 
 Conditions retarding the coagulation of the blood are : 
 
 (1) A low temperature, (2) the addition of neutral salts 
 in large quantities, (3) contact with oil, (4) contact with 
 the living vessel walls, (5) when mixed with an oxalate, 
 (6) the injection of peptones or lead extract. 
 
 The physical properties of blood: Fluid, somewhat vis- 
 cid, red, specific gravity from 1055 to 1062, alkaline reac- 
 tion, saltish taste, characteristic odor, variable temperature 
 (average about 100 degrees F.). 
 
 2. The second sound of the heart is caused by the vi- 
 brations due to the closure of the semilunar valves. 
 
 It is best heard at the base of the heart, over the second 
 right costal cartilage. 
 
 The events in the heart's action coincident with the sec- 
 ond sound, are: (1) The closure of the semilunar valves; 
 
 (2) the continued dilatation of the auricles; (3) the begin- 
 ning of the dilatation of the ventricles ; (4) the opening 
 of the auriculoventricular valves. 
 
 3. Warm-blooded animals are those whose body tem- 
 perature remains almost constant. 
 
 Cold-blooded animals are those whose body tempera- 
 
 604 
 
MEDICAL RECORD. 
 
 ture varies with that of the surrounding medium, but which 
 is always a little above that of the medium. 
 
 The heat of the body is maintained by the thermotactic 
 centers in the brain and cord keeping an equilibrium be- 
 tween the heat gained or produced in the body and the 
 heat lost. 
 
 Heat is produced in the body, by: (i) Muscular action; 
 (2) the action of the glands, chiefly of ^ the liver; (3) the 
 food" and drink ingested; (4) the brain; (5) the heart; 
 and (6) the thermogenetic centers in the brain, pons, 
 medulla, and spinal cord. 
 
 Heat is given off from the body, by: (1) The skin, 
 through evaporation, radiation, and conduction ; (2) the 
 expired air; (3) the excretions — urine and feces. 
 
 4. The secretion of glands is chiefly regulated by: (1) 
 The variations in the quantity of blood which the gland 
 receives; (2) the nerve impulses to the gland. 
 
 The mechanism of the secretion of urine by the kidneys 
 is twofold: (1) By filtration, most, if not all, of the 
 fluid is eliminated, and also inorganic salts; this depends 
 upon blood pressure, and takes place in the glomeruli. (2) 
 By cell activity and selection, in the cells of the con- 
 voluted tubules, the urea and principal solids are elimi- 
 nated. 
 
 5. When the facial nerve is divided, paralysis of the 
 facial muscles ensues, and "the muscles of the face be- 
 ing all powerless, the countenance acquires on the para- 
 lyzed side a characteristic, vacant look, from the absence 
 of all expression; the angle of the mouth is lower, and 
 the paralyzed half of the mouth looks longer than that on 
 the other side ; the eye has an unmeaning stare, owing 
 to the paralysis of the orbicularis palpebrarum. All these 
 peculiarities increase the longer the paralysis lasts, and 
 their appearance is exaggerated when at any time the 
 muscles of the^ opposite side of the face are made active 
 in any expression, or in any of their ordinary functions. 
 In an attempt to blow or whistle, one side of the mouth 
 and cheeks acts properly, but the other side is motionless, 
 or flaps loosely at the impulse of the expired air; so, in 
 trying to suck, one side only of the mouth acts ; in feeding, 
 the lips and cheek are powerless, and, on account of 
 paralysis of the buccinator muscle, food lodges between 
 the cheek and gums." — (Kirkes* Physiology.) 
 
 CHEMISTRY. 
 
 1. Chemical formula, for common salt, is NaCl; for 
 nitrate of silver, AgN0 3 ; for sulphuric acid, H2SO4; for 
 nitric acid, HNO s ; for water, H 2 0. 
 
 2. Blue mass contains 33 per cent, of mercury; mer- 
 
 605 
 
MEDICAL RECORD. 
 
 curial ointment contains 50 per cent, of mercury; and 
 citrine ointment contains 7 per cent, of mercury. 
 
 3. Gray powder is Hydrargyrum cum Creta, or mer- 
 cury with chalk, and contains 38 per cent, of mercury. 
 
 4. Static electricity is produced by friction; galvanic 
 electricity is produced by chemical action in a galvanic 
 cell. 
 
 t( Static or frictional electricity is generated for practical 
 purposes by an electric machine, consisting essentially of a 
 plate or wheel of glass, or some similar substance, revolved 
 by a mechanical contrivance against some material capable 
 of producing positive electricity on the plate. This posi- 
 tive charge is carried from the plate by metal combs or 
 rods to the prime conductor; the negative generated on 
 the rubbing cushions may be collected on a conductor, but 
 is generally carried to the ground by a chain." 
 
 Galvanic electricity: "Zinc placed in a vessel containing 
 dilute sulphuric acid is gradually dissolved, evolving hydro- 
 gen gas. Platinum is not acted on by dilute sulphuric acid. 
 If plates of both metals be placed in sulphuric acid and 
 water, and connected by a piece of wire as a conductor, 
 no bubbles of gas are evolved on the zinc, but escape from 
 the platinum plate. If the wire be placed near a magnetic 
 needle this will be turned from its course (deflected) ; 
 when the ends of the divided wire touch the tongue a ting- 
 ling and metallic taste are perceived. All these phenomena 
 disappear if the connection between the plates is broken, 
 and reappear when restored^ and are manifestations of 
 electricity generated by the action of the acid on the metals, 
 traveling through the wire to which it imparts its proper- 
 ties. The zinc, platinum, and sulphuric acid may be re- 
 placed bv many other materials. Electricity will be gener- 
 ated whenever two solid conductors, usually in plate or 
 cylinder form, are connected by a conductor, and placed 
 in a liquid having the power of acting chemically on one 
 of them. Such an arrangement is called a voltaic or gal- 
 vanic cell ; the liquid the electrolytic or exciting agent ; and 
 the solids the electrodes; and all are called the elements 
 of the cell. In a galvanic cell the electrolytic agent is split 
 into two parts, called ions ; and these ions, charged with + 
 and — electricity, respectively, unload the charges on the 
 plates. The conductor restores the electrical equilibrium. 
 In the zinc, platinum, and sulphuric acid cell the acid is 
 split up into hydrogen and S0 4 , the H 2> escapes from the 
 platinum plate while the S0 4 combines with the zinc, form- 
 ing zinc sulphate, which dissolves in the water." — (McGlan- 
 nan's Epitome of Chemistry.) 
 
 5. The positive pole of a battery is termed the anode; 
 the negative pole is termed the cathode. 
 
 606 
 
MEDICAL RECORD 
 
 PRACTICAL URANALYSIS, MICROSCOPY, TOXICOLOGY. 
 
 1. In examining normal urine the following points are 
 to be considered : 
 
 The quantity voided in twenty-four hours, its general 
 appearance, color, odor, reaction, specific gravity, quantity 
 of solids excreted, quantity of urea, uric acid, chlorides, 
 sulphates, phosphates. 
 
 In abnormal urine, in addition to the above, examina- 
 tion should be made for albumin, sugar, excess of indican, 
 acetone, blood, bile, pus, casts, epithelium, parasites, patho- 
 genic bacteria, and foreign bodies. 
 
 2. High specific gravity of the urine, may indicate : 
 Diabetes mellitus, fevers, and chronic parenchymatous 
 nephritis. 
 
 Low specific gravity of the urine, may indicate : Diabetes 
 insipidus, chronic interstitial nethritis, contracted kidney, 
 some nervous disorders, albuminuria, hysteria. 
 
 3. Transitory low specific gravity may indicate : Hys- 
 teria, or some nervous disorders, or the ingestion of an 
 abnormal amount of fluids. 
 
 4. Blood is yellowish, and shows the corpuscles (both 
 colored and colorless). 
 
 Pus is opaque, and shows the pus corpuscles and gran- 
 ules. 
 
 Oil is homogeneous, clear, and may be transparent. 
 Water is homogeneous, clear, colorless, and transparent. 
 
 5. A Simple Microscope. "With this an enlarged, erect 
 image of an object may be seen. It always consists 
 of one or more converging lenses or lens-systems, and the 
 object must be placed within the principal focus. The 
 simple microscope may be held in the hand or it may be 
 mounted." 
 
 A Compound Microscope. "This enables one to see an 
 enlarged, inverted image. It always consists of two optical 
 parts, an objective, to produce an enlarged, inverted, real 
 image of the object, and an ocular, acting in general like 
 a simple microscope to magnify this real image. There 
 is also usually present a mirror, or both a mirror and 
 some form of condenser or illuminator for lighting the 
 object. The stand of the microscope consists of certain 
 mechanical arrangements for holding the optical parts 
 and for the more satisfactory use of them." — (Gage's The 
 Microscope.) 
 
 6. Oculars in common use, are : Those having a mag- 
 nification of 5. 7.5, 10, 12.5, and 15 times. 
 
 Objectives in common use, are: Dry: 2 inches, 1% 
 inches, %-inch, %-inch, 1/6-inch and Ms-inch; (2) Immer- 
 sion: 1/12-inch and 1/16-inch. 
 
 7. Symptoms of poisoning by sulphate of atropine: 
 
 607 
 
MEDICAL RECORD. 
 
 Dryness of the mouth and throat, thirst, drowsiness, dys- 
 phagia, face flushed, pupils much dilated, eyes prominent, 
 numbness and partial paralysis of the extremities, and 
 there may be delirium and coma. 
 
 Antidotes: Pilocarpine and morphine are physiological 
 antidotes. 
 
 8. Opium poisoning: Symptoms: In opium poisoning 
 there may be three stages: (i) a period of excitement, 
 in which the patient is active, talkative, and has hallucina- 
 tions ; (2) a period of drowsiness, in which the patient 
 is sleepy, but may be aroused ; his face is pale, lips livid, 
 pupils contracted; this passes into (3) the stage of coma, 
 from which the patient cannot be aroused; reflexes are 
 abolished, pupils are contracted, the pulse is slow and 
 irregular, and respirations are infrequent and shallow. 
 
 Treatment consists in washing out the stomach, prefer- 
 ably with a dilute solution of potassium permanganate ; 
 ambulatory treatment, to keep the patient awake ; artificial 
 respiration is indicated, and strong coffee should be ad- 
 ministered by the mouth or rectum; the bladder should be 
 emptied by the catheter. 
 
 There is no antidote. 
 
 9. Carbolic acid poisoning may be detected by the 
 white and corrugated mucous membrane of the mouth ; 
 the dark or smoky urine ; the brown spots wherever the 
 carbolic acid came in contact with the skin; the odor of 
 phenol. 
 
 Poisoning by potassium hydrate may be detected by the : 
 sloughing of the mucous membrane of mouth and eso- 
 phagus ; the stomach contents are alkaline, soapy and 
 frothy; on warming the stomach contents there is no 
 odor of ammonia. 
 
 10. When arsenic is heated in air, it is converted into 
 arsenic trioxide. 
 
 MATERIA MEDICA. 
 
 i. Fluid Extract of Ergot. Dose: r$. xxx. 
 
 Physiological effect: It stimulates and causes contrac- 
 tion of involuntary muscle fibers, hence it is a. vasocon- 
 strictor, hemostatic, and oxytocic. It is also a cardiac 
 sedative, it raises the blood pressure, it increases peristal- 
 sis, and is an emmenagogue. 
 
 2. Sulphate of Sparteine. Dose: gr. 1/5. 
 Physiological effect: It increases the force of the heart, 
 
 paralyses the respiratory and motor centers, and increases 
 the flow of urine. 
 
 3. Veratrum Viride. Dose: gr. ij. 
 
 Physiological effect: It reduces body temperature, re- 
 duces arterial pressure, is a respiratory depressant, relaxes 
 
 608 
 
MEDICAL RECORD. 
 
 voluntary and cardiac muscle, causes gastrointestinal irri- 
 tation and diaphoresis. 
 
 4. Chloral Hydrate. Dose: gr. xv. 
 Physiological effect: It is a hypnotic and antiseptic, it 
 
 is a cardiac respiratory depressant, and it lowers the blood 
 pressure and body temperature. 
 
 5. Tincture of Digitalis. Dose: Tl#. xv. 
 Physiological effect: It is a gastrointestinal irritant, it 
 
 slows the rate of the heart, prolongs diastole, increases 
 the force of the heart, it contracts the blood-vessels and 
 causes a rise in blood pressure, it also acts as a diuretic. 
 
 THERAPEUTICS. 
 
 1. See French's "Practice of Medicine" (1907), page 
 230; or Osier's "Practice of Medicine" (1909), page 226. 
 
 2. See French's "Practice of Medicine" (1907), page 174; 
 or Osier's "Practice of Medicine" (1909), page 189. 
 
 3. See French's "Practice of Medicine" (1907), page 221; 
 or Osier's "Practice of Medicine" (1909), page 213. 
 
 4. See French's "Practice of Medicine" (1907), page 258; 
 or Osier's "Practice of Medicine" (1909), pages 6 and 246. 
 
 5. See French's "Practice of Medicine" (1907), pages 781 
 and 785; or Osier's "Practice of Medicine" (1907), page 
 
 6. Dysmenorrhea: The treatment is directed toward any 
 existing constitutional condition, and pain is relieved by 
 hyoscin, chloral, bromids, etc. Anteflexion and stenosis 
 will require dilatation of the cervix. Endometritis usually 
 needs curetment. Pelvic inflammation requires appropriate 
 treatment. 
 
 7. See Rose and Carless' "Surgery" (1908), page 1258; 
 or Da Costa's "Surgery" (1908), page 1198. 
 
 8. See French's "Practice of Medicine" (1907), page 895; 
 or Osier's "Practice of Medicine" (1909). page 690. 
 
 9. See French's "Practice of Medicine" (1907), page 738; 
 or Osier's "Practice of Medicine" (1909), page 463. 
 
 10. See French's "Practice of Medicine" (1907), page 
 751; or Osier's "Practice of Medicine" (1909), page 477. 
 
 BACTERIOLOGY AND PATHOLOGY. 
 
 i. Aerobic bacteria are such as require the presence of 
 oxygen as an essential to their growth. 
 
 Anaerobic bacteria are such as require the absence of 
 oxygen as an essential to their growth. 
 
 2. Three most important culture media: Bouillon, gela- 
 tin, and agar-agar. 
 
 3. In catarrhal appendicitis: The musoca will be found 
 swollen and eroded, granulation tissue may be found; the 
 muscularis is thickened and edematous; the serosa is con- 
 gested and edematous but not extensively; the contents 
 
 609 
 
MEDICAL RECORD. 
 
 are more or less mucopurulent and are retained in the 
 appendix. 
 
 4. The typhoid bacilli find their way to the gall blad- 
 der, and there cause a catarrhal inflammation which modi- 
 fies the chemical composition of the bile and brings about 
 first an excessive secretion and then a precipitation of 
 cholesterin and salts. These latter, with the bacilli and 
 epithelial debris tend to cause gall-stone formation. 
 
 5. In fatty degeneration the fat is formed by changes 
 in the protoplasm of the cells; while in fatty infiltration 
 the fat is brought by the blood to the cells, and is there 
 deposited. 
 
 PRACTICE OF MEDICINE AND DISEASES OF CHILDREN. 
 
 i. Melancholia "is a variety of mental alienation, charac- 
 terized by more or less profound depression, with either 
 no marked intellectual disturbance or the presence of more 
 or less incoherence, and hallucinations and delusions. ^ The 
 cerebral mechanism develops a condition of supersensitive- 
 ness, all impressions being exaggerated, and a state of ab- 
 normal self-consciousness existing." 
 
 Hypochondria "is a peculiar mental condition, charac- 
 terized by inordinate attention on the part of the patient 
 to some real or supposed bodily ailment or sensation." — 
 (Hughes' Practice of Medicine.) 
 
 2. (a) Cardiac arrhythmia has no particular clinical 
 significance, unless it accompanies some disease. Accord- 
 ing to Butler (Diagnostics of Internal Medicine), search 
 should be made for one or more of the following: (1) 
 Valvular cardiac disease, especially mitral lesions, in which 
 it is usually, but not always, a sign of beginning failure 
 of compensation, passing in many instances into delirium 
 cordis; simple dilatation, chronic myocarditis, sclerosis of 
 the coronary arteries, and fatty degeneration ; possibly ob- 
 scure changes in the cardiac ganglia, and overstrain or 
 impaired nutrition in wasting diseases or long-continued 
 fevers. (2) Poisons circulating in the blood, such as al- 
 cohol, coffee, tea, tobacco, digitalis, aconite, and belladonna, 
 or the toxins of the infectious diseases, especially of ty- 
 phoid fever and pneumonia. (3) Diseases of the intracra- 
 nial contents, meningitis, hemorrhage, abscess, softening, 
 concussion, and not infrequently mental excitement. (4) 
 Neurasthenic conditions resulting from excesses or over- 
 strain. Brief attacks of moderate arrhythmia are not un- 
 common in neurotic individuals, following even a slight 
 departure from their usual habits in food, drink, or exer- 
 tion. (5) Digestive disturbances, acute or chronic, and 
 jaundice or constipation, particularly if associated with an 
 unusually hypochondriacal frame of mind. (6) More 
 
 610 
 
MEDICAL RECORD 
 
 rarely arthritis deformans, exophthalmic goiter, and renal 
 disease. 
 
 (b) The symptoms of true angina pectoris are: Excru- 
 ciating pain radiating from the heart to the neck, shoulder 
 and arm (generally the left) ; a sense of impending death; 
 cardiac constriction; the face is anxious and pale; cold 
 perspiration and sometimes dyspnea. 
 
 The treatment: Inhalation of 3 to 5 minims of amyl 
 nitrite; spirit of nitrous ether, or morphine (gr. ]/ A hypo- 
 dermatically), or inhalation of chloroform may be given; 
 heat may be applied over the region of the heart, and 
 stimulants should be given after the attack. During the 
 intervals severe mental or muscular exercise must be 
 avoided. 
 
 3. (a) The possible sequelce of pneumonia, are : Chronic 
 pneumonia, gangrene of the lung, phthisis, empyema, 
 nephritis. 
 
 (b) Incipient pulmonary tuberculosis may be suspected 
 from: (1) Physical signs: Deficient chest expansion, the 
 phthisical chest, slight dullness or impaired resonance over 
 one apex, fine moist rales at end of inspiration, expiration 
 prolonged or high pitched, breathing interrupted. (2) 
 Symptoms: General weakness, lassitude, dyspnea on ex- 
 ertion, pallor, anorexia, loss of weight, slight fever, and 
 night sweats, hemoptysis. 
 
 4. The causes of anemia, are as follows: (1) Of the 
 primary anemias: The cause is unknown, probably it is 
 some form of intoxication. Predisposing causes are : In- 
 sufficient and improper food; nervous disturbances, such 
 as violent shock ; pregnancy and lactation ; gastrointestinal 
 diseases, such as atrophy of the stomach and interstitial 
 gastritis; parasitic diseases, such as ankylostomiasis and 
 bothriocephaliasis ; frequently repeated hemorrhages; gen- 
 eral diseases, infectious diseases, and intoxications. (2) 
 Of the secondary anemias: Bad hygienic surroundings, as 
 insufficient food or food of bad character, inspiration of 
 noxious gases, overwork and crowding; parasitic diseases; 
 exhausting diseases, as cardiac, renal, or gastrointestinal 
 diseases, cirrhosis of the liver, rickets, scurvy; chronic in- 
 fectious diseases, as tuberculosis, syphilis, leprosy, malaria ; 
 frequently repeated small losses of blood; overlactation 
 and gestation; toxemia, as Saturnism, mercurialism, and 
 jaundice. — (From Macfarland's Pathology.) 
 
 5. See French's "Practice of Medicine" (1907), page 
 903; or Osier's "Practice of Medicine" (1909), page 697. 
 
 6. See French's "Practice of Medicine" (1907), pages 
 252, 2$4, and 258; or Osier's "Practice of Medicine" (1909), 
 pages 5 and 244. 
 
 7. The diagnosis is gastric ulcer with perforation.— 
 
 611 
 
MEDICAL RECORD 
 
 (From Cabot's Case Teaching in Medicine, from which the 
 question is taken.) 
 
 8. See French's "Practice of Medicine" (1907), pages 317 
 and 320; or Osier's "Practice of Medicine" (1909), pages 
 132 and 134. 
 
 9. For a child four months old, 4 per cent, of fat and 1.5 
 per cent, of proteid should be prescribed. 
 
 Take the upper 15 ounces from a quart of milk 16 hours 
 after milking; add. 6y 2 teaspoonfuls of milk sugar, 4 ounces 
 of lime water, filtered water enough to make one quart. 
 Give 5 to 6 ounces at each feeding. — (From Winters.) 
 
 10. Causes of Convulsions in children, are : Overeating, 
 especially of indigestible food; rachitis, debility from ex- 
 hausting diarrheal diseases ; high fever, especially at the 
 onset of the acute specific infections; very seldom denti- 
 tion, phimosis, and acute middle-ear inflammation; injuries 
 to the brain at birth, infantile hemiplegia, meningitis, and 
 tumor of the brain; rarely of spinal cord disease.— (From 
 Butler's Diagnostics of Internal Medicine.) 
 
 Causes of vomiting in children, are: An overloaded 
 stomach; acute gastric indigestion; acute intestinal ob- 
 struction ; the onset of the acute infectious diseases, as 
 scarlet fever, malaria, pneumonia; toxemia, peritonitis; 
 acute meningitis ; cerebral tumor. 
 
 OBSTETRICS AND DISEASES OF WOMEN. 
 
 1. Conditions with which pregnancy may be confounded, 
 are: Retained menses, ovarian tumors or cysts, uterine 
 fibroids, ascites, obesity, hematometra, physometra, hydro- 
 metra, tympanites, subinvolution of uterus, retroversion of 
 uterus, pseudocyesis. 
 
 2. See Williams' "Obstetrics" (1909), pages 811, 813, 814, 
 and 815; or Hirst's "Obstetrics" (1909), pages 574, 576, 
 and 577. 
 
 3. See Williams' "Obstetrics" (1909), page 821; or Hirst's 
 "Obstetrics" (1909), page 587. 
 
 4. Eclampsia. The symptoms are: "Headache, nausea, 
 and vomiting, epigastric pain, vertigo, ringing in the ears, 
 flashes of light or darkness, double vision, blindness, deaf- 
 ness, mental disturbance, defective memory, somnolence ; 
 symptoms easily explained by the circulation of toxic 
 blood through the nerve centers. These may be preceded 
 by lassitude, and accompanied by constipation, or by diar- 
 rhea. Headache is perhaps the most significant and com- 
 mon warning symptom. In bad cases the urine is reduced 
 in quantity (almost suppressed), very dark in -color, 
 its albumin greatly increased, so that it becomes solid 
 on boiling. Next comes the final catastrophe of convul-. 
 sions. The convulsive fit begins with twitching of the 
 facial muscles, rolling and fixation of the eyeballs, puck- 
 
 612 
 
MEDICAL RECORD 
 
 ering of the lips, fixation of the jaws, protrusion of the 
 tongue, etc., soon followed by violent spasms of the mus- 
 cles of the trunk and limbs, including those of respiration; 
 hence lividity of the face and stertorous breathing, biting 
 of the tongue, opisthotonus, etc. The fit lasts fifteen or 
 twenty seconds, ending in partial or complete coma, pos- 
 sibly death; or consciousness may return, to be followed 
 by other convulsions." — King's Manual of Obstetrics.) 
 
 Preventive Treatment: (i) The amount of nitrogenous 
 food should be diminished to a minimum; (2) the produc- 
 tion and absorption of poisonous materials in the intestines 
 and body tissues should be limited and their elimination 
 should be aided by improving the action of the bowels, the 
 kidneys, the liver, the skin, and the lungs; (3) the source 
 of the fetal metabolic products and the peripheral irrita- 
 tion in the uterus should, if necessary, be removed by 
 evacuating that organ. 
 
 5. See Williams' "Obstetrics" (1909), page 804. 
 
 6. See Williams' "Obstetrics" (1909), pages 301 and 477; 
 or Hirst's "Obstetrics" (1909), page 435. 
 
 7. Conditions warranting the induction of premature 
 labor: (1) Certain pelvic deformities, (2) placenta prsevia, 
 
 (3) pernicious anemia, (4) toxemia of pregnancy, (5) 
 habitual death of the fetus toward the end of pregnancy, 
 (6) hydatidiform mole, (7) habitually large fetal head. 
 
 8. Twin pregnancy may be diagnosed by the following 
 signs: (1) The abdomen may be irregular in shape and 
 may show a sulcus indicating the space between the two 
 fetal sacs; (2) persistent and increased tension of the 
 uterine walls; (3) two fetal heart sounds may be heard; 
 
 (4) multiplicity of small parts ; (5) two fetal heads or 
 backs may be palpated; (6) diminished fetal mobility. 
 Sometimes it is difficult to diagnose the condition before 
 the birth of one child. 
 
 9. Curettage. Dangers: Sepsis, perforation of uterus, 
 hemorrhage, abortion, inflammation of uterus, or adnexa. 
 Procedure: All antiseptic and aseptic precautions are 
 necessary, the patient should be in the dorsal position, the 
 vagina is to be disinfected, and the cervical canal dilated; 
 a speculum is introduced into the vagina and the cervix 
 is drawn down with volsella ; the uterine cavity is irri- 
 gated with creolin or lysol ; a curette is inserted to the 
 fundus and moved down to the internal os ; the operator 
 should begin at one cornu and go in the same direction 
 all around till he reaches the starting point, and if neces- 
 sary repeat till no more spongy or hyperplastic tissue ap- 
 pears ; the fundus should be scraped separately by moving 
 the curette along it from side to side ; in going towards 
 the tundus no scraping should be done, and care must 
 be "taken not to perforate the uterus ; should this happen 
 
 613 
 
MEDICAL RECORD. 
 
 no fluid must be injected; otherwise the uterus and va- 
 gina are again irrigated, and one or more strips of iodo- 
 form gauze are inserted into the cavity to act either as a 
 hemostatic plug or as a drain, which is diminished with 
 two days' interval and withdrawn on the sixth day. A 
 hemostatic tampon should be placed in the vagina and 
 withdrawn the following day. If any fever arises, the tam- 
 pon is at once removed and the vagina douched with anti- 
 septic fluid every three hours. If not, the vagina is only 
 swabbed with the same every day, and packed loosely with 
 iodoform gauze. After the final removal of the gauze the 
 antiseptic douche is given twice a day until there is no 
 more discharge. The patient should remain in bed for a 
 week. 
 
 10. Gonorrhea. Possible results: Cystitis, urethritis, vul- 
 vitis, endometritis, salpingitis, septic peritonitis, sterility, 
 condylomata of vulva, abscess of Bartholin's glands. 
 
 surgery. 
 
 i and 2. Six important points to promote primary union 
 of a wound: (i) Stop the bleeding; (2) remove foreign 
 bodies; (3) asepticize; (4) coapt the edges; (5) provide 
 for drainage (if necessary) ; (6) rest the injured part. 
 
 Any interference with the above will retard, interfere 
 with, or prevent the healing of the wound. 
 
 3. Four notable phenomena in inflammation of a visible 
 part: (1) Redness; (2) swelling; (3) heat; (4) tender- 
 ness. 
 
 4. Bedsores, (i) Causes: Undue pressure and irri- 
 tating secretions; a crease or fold in a sheet, a crumb 
 of bread, a feather, or a bit of string on the sheet may 
 cause them. Especially is this so when the skin is irritable 
 from excessive perspiration, inefficient washing, or invol- 
 untary passages of urine. Bedsores are particularly com- 
 mon in spinal affections and in wasting diseases. 
 
 (2) Prevention consists in reducing the pressure, care- 
 ful repeated washing, drying, and dusting with zinc oxide, 
 and subsequent protection with lint or cotton-wool, etc. 
 Leather-backed adhesive plaster may be applied over bony 
 prominences, or, if seen early, collodion may be used. 
 Frequent rubbing with alcohol may prove a preventive. 
 When congestion appears, a water-bed or air-cushion may 
 be used. Spirits of camphor or glycerol of tannin may 
 be rubbed in twice daily, to harden the skin. Salt and 
 alcohol (two drams to the pint) may also be used. 
 
 (3) Treatment: A solution of silver nitrate may be 
 used when the skin is about to break, in the strength of 
 gr. 20 to the ounce; and in solution of gr. 10, daily, when 
 the skin breaks. The sloughs should be removed as fast 
 as they form. Stimulation, good nourishment, and sleep 
 
 614 
 
MEDICAL RECORD. 
 
 are valuable in treatment. — (From Gould and Pyle's Cy- 
 clopedia of Medicine and Surgery.) 
 
 5. See Rose and Carless' "Surgery" (1908), page 1257; 
 or Da Costa's "Surgery" (1908), page 1198. 
 
 6. See Rose and Carless' "Surgery" (1908), page 93; or 
 Da Costa's "Surgery" (1908), pagre 159. 
 
 7. See Rose and Carless' "Surgery" (1908), page 620; 
 or Da Costa's "Surgery" (1908), page 589. 
 
 8. See Rose and Carless "Surgery" (1908), page 546; 
 or Da Costa's "Surgery" (1908), page 490. 
 
 9. See Rose and Carless' "Surgery" (1908), page 574; 
 or Da Costa's "Surgery" (1908), page 437. 
 
 10. See Rose and Carless' "Surgery" (1908), pages 1313 
 and 274; or Da Costa's "Surgery" (1908), page 1219. 
 
 PRACTICAL HYGIENE, SANITARY SCIENCE, STATE MEDICINE. 
 
 1. See French's "Practice of Medicine" (1907) ; or Os- 
 ier's "Practice of Medicine (1909), Index, under name 
 of "Disease." 
 
 2. See Williams' "Obstetrics" (1909), pages 199 and 340; 
 or Hirst's "Obstetrics" (1909), pages 188 and 364. 
 
 3. Meat should be condemned which has any of the fol- 
 lowing diseases : Tuberculosis, actinomycosis, glanders, 
 anthrax, swine-fever, contagious pleuro-pneumonia, septi- 
 cemia, cattle plague, and several parasitical diseases. 
 
 For milk: The inspection should include: the color, re- 
 action, specific gravity, sediment, taste, odor, total quan- 
 tity of solids and of water; the percentage of cream, fats, 
 lactose, casein, and ash; the presence or absence of preser- 
 vatives, coloring matter, added solids, and dilution. There 
 should also be thorough investigation as to its source, the 
 cows and their environment, the method employed in car- 
 ing for, milking, storing and transporting the milk. 
 
 4. Infectious diseases which may be conveyed through 
 the medium of the air: Tuberculosis, pneumonia, diphthe- 
 ria, measles, scarlet fever, whooping cough, erysipelas, 
 influenza. 
 
 Through the medium of water: Typhoid, dysentery, 
 cholera, yellow fever, scarlet fever, diphtheria. 
 
 Through the medium of food: Tuberculosis, diphtheria, 
 typhoid, scarlet fever, cholera. 
 
 5. "The continued use of tobacco, by smoking or chew- 
 ing it to excess, produces granular inflammation of the 
 fauces and pharynx, atrophy of the retina, dyspepsia, low- 
 ered sexual power, sudden faints, nervous depression, car- 
 diac irritability, and occasionally angina pectoris. Used 
 by the young, it hinders the development of the higher 
 nerve centers and impairs the nutrition of the body by in- 
 terfering with processes of digestion and assimilation." — 
 (P.otter's Materia Medico, etc.) 
 
 615 
 
MEDICAL RECORD. 
 
 6. The principal means of preventing the spread of con- 
 tagious diseases in schools are : Regular and efficient in- 
 spection by physicians; prompt exclusion and isolation of 
 anyone suffering from a contagious disease, or coming from 
 a house where such disease is; compulsory vaccination; 
 compulsory notification of all infections and contagious 
 disease; individual towels, drinking vessels, and other im- 
 plements ; children who have had a contagious or infectious 
 disease, or who have come from a house where such disease 
 prevailed, should not be readmitted to school until suffi- 
 cient time has elapsed since the occurrence of the last 
 case to insure safety. 
 
 7. Between 70 and 80 per cent, relative humidity. 
 
 8. Anything above 77.5 per cent, relative humidity. 
 
 9. See Williams' "Obstetrics" (1909), page 347; or Hirst's 
 "Obstetrics" (1909), page 928. 
 
 10. See Question and Answer 1. 
 
 MEDICAL JURISPRUDENCE. 
 
 1. After death from asphyxia, I would expect to find the 
 lungs, kidneys, and heart, congested. Occasionally, in 
 young persons, the lungs are anemic and emphysematous; 
 the right side of the heart and lungs is usually gorged 
 with dark-colored blood. 
 
 2. In burns produced before death: there is usually a 
 blister, with a bright, red base, and containing a serous 
 fluid, which is albuminous ; occasionally, there will be no 
 blister if there has been excessive shock; also, there will 
 be a red line of demarcation between the injured and the 
 uninjured parts, and this, being a vital process, is only de- 
 veloped during life. 
 
 In burns produced after death there is no true blister, 
 no red base, and gas is present in place of serous fluid. 
 
 3. Taking charge of a case gratuitously causes no ex- 
 emption from the charge of malpractice, in case of neglect 
 or improper treatment. 
 
 4. Rigor Mortis is supposed to be due to the coagula- 
 tion of the myosin in the muscles. 
 
 5. In women, the last of the internal organs to putrefy, 
 is the uterus. 
 
 6. The duty of the physician, when it is necessary for 
 him to take down a dying declaration, is: (1) To explain 
 to the patient the hopelessness of the case; (2) to satisfy 
 himself as to the patient's soundness of mind; (3) to 
 write down the exact words of the dying person, without 
 adding any comment or explanation of his own ; (4) to 
 read the declaration over to the dying person, and, if pos- 
 sible, have him sign it; (5) the statement should be per- 
 fectly voluntary. 
 
 7. Application of Hydrostatic Test. — Having opened 
 
 616 
 
MEDICAL RECORD. 
 
 chest, note position of lungs (before respiration they occupy 
 a small space at upper and posterior parts of thorax) ; their 
 volume (of course increased after breathing) ; their shape 
 (before respiration, borders sharp or pointed; after it. 
 rounded); their color (before breathing, brownish-red: 
 after it, pale red or pink) ; their appearance as regards dis- 
 ease and putrefaction; and whether they crepitate on pres- 
 sure (as they will after respiration). 
 
 '"Take out lungs, with heart attached, and place them in 
 pure water having temperature of surrounding air. Note 
 whether they float (high or low), or sink (slowly or rapid- 
 ly). Separate them from the heart; weigh them accurately, 
 and then place them in water again, and note sinking or 
 floating as before. Subject each lung to pressure with 
 the hand, and note sinking or floating again. Cut each lung 
 in pieces and test floating again. Take out each piece, 
 wrap it in a cloth, and compress with fingers as hard as 
 possible, and test floating, etc., as before. The crucial test 
 of perfect respiration is each piece floating after the most 
 vigorous compression;" — (King's Manual of Obstetrics.) 
 
 8. By feticide is meant the unlawful destruction of a 
 fetus before it is born. The criminality is the same 
 whether done before or after quickening. 
 
 9. "Idiocy differs from other states of insanity in the 
 fact that it is marked by a congenital deficiency of the 
 mental faculties. There is not here a perversion or a 
 loss of what has once been acquired, but a state in which, 
 from defective structure of the brain, the individual has 
 never been able to acquire any degree of intellectual 
 power to fit him for his social position. It commences 
 with life and continues through it." — (Taylor's Medical 
 Jurisprudence.) 
 
 10. In death by lightning: the heart may be (1) un- 
 altered, or (2) congested, or (3) full of blood, or (4) 
 empty. The other internal organs are congested. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Board or Medical Examiners of South Dakota. 
 
 anatomy. 
 
 1. Give the fundamental principles of an animal cell. 
 Describe briefly four classifications of cells. 
 
 2. What is cartilage? Name and describe the several 
 kinds. 
 
 3. Define : Mulberry mass, primitive streak, ectoderm. 
 What structures are formed from the mesoblastic layer? 
 
 4. Describe a complete uriniferous tubule, showing the 
 blood supply and various kinds of epithelium. 
 
 617 
 
MEDICAL RECORD. 
 
 5. Give origin and insertion: Psoas magnus; Serratus 
 magnus; Teres major; Deltoid. 
 
 6. Give a description of the arteries and veins of the 
 rectum. 
 
 7. Describe and trace the course of the lymphatics of the 
 mammary gland. 
 
 8. What displacement occurs in an intracapsular fracture 
 of the femur? Why? 
 
 9. Name and describe the ligaments of the knee joint. 
 10. Describe a hepatic lobule. 
 
 PHYSIOLOGY. 
 
 1. Where, in the human body, are the following sub- 
 stances found? (a) Fibrin; (b) mucin; (c) leucin; (d) 
 chondrin. 
 
 2. Describe the nervous mechanism of muscular con- 
 traction. 
 
 3. Define stammering, and state the cause. 
 
 4. Describe the blood, and compare arterial with venous 
 blood. 
 
 5. What is the physiologic function of the liver? 
 
 6. What is the rate of circulation of the blood in the 
 (a) arteries, (b) veins, (c) capillaries? 
 
 7. Describe the physical properties of (a) lymph, and (b) 
 chyle. 
 
 8. Define reflex nervous impulses, and give examples. 
 
 9. Explain the difference between human and cows' milk. 
 10. Define secretion, and name some of its products. 
 
 CHEMISTRY. 
 
 1. (a) What is chemistry? (&)W r hat is meant by chem- 
 ical force or affinity? 
 
 2. (a) Give a definition of a crystallized substance, (b) 
 Under what condition will matter crystallize ? 
 
 3. What is meant by the terms amorphous, polymorphous, 
 isomorphous? 
 
 4. (a) Explain the term quantivalent. (b) Mention 
 some univalent, bivalent, trivalent, and quadrivalent ele- 
 ment. 
 
 5. If a certain volume of hydrogen weigh twenty grains, 
 how much will a like volume of oxygen weigh ? 
 
 6. State the difference between inspired and expired air, 
 and explain how this is brought about. 
 
 7. Give chemical composition and general properties of 
 bismuth subnitrate. Explain the dark color of the stools 
 following its therapeutic use. Name its most dangerous 
 impurity and give test for same. 
 
 8. (a) What substances might be indicated if a specimen 
 of neutral or slightly acid urine show a precipitate upon 
 boiling? (b) How would you differentiate between them? 
 
 618 
 
MEDICAL RECORD. 
 
 9. (a) Give a test to detect sugar in the urine. (&) Give 
 in detail a quantitative test for sugar in the urine. 
 
 10. State if the following prescription is chemically com- 
 patible. If not, why? 
 
 Tinct. ferri chloridi, 3vi. 
 Ext. buchu fl., 3s s. 
 Potassi citratis, 3vi. 
 Aquae dest. qs. ad, 3iv. 
 M. et. Sig. Take a teaspoonful every four hours with 
 a glass of water. 
 
 BACTERIOLOGY. 
 
 1. What is understood by ptomains? Toxins? 
 
 2. How do bacteria multiply? 
 
 3. When called to a case where diphtheria is suspected, 
 describe fully the technique of taking a culture ; the prefer- 
 able culture medium and stain, and process of staining. 
 
 4. Name three conditions essential to bacterial growth. 
 What are the most common microorganisms of suppura- 
 tion? 
 
 5. What is the supposed microorganism of cerebrospinal 
 meningitis? How is the bacteriological diagnosis of this 
 disease made? 
 
 PATHOLOGY. 
 
 1. Contrast hyperemia and passive congestion. 
 
 2. What is the pathology of arteriosclerosis? 
 
 3. Define osteomyelitis. 
 
 4. Give the technique of an examination of the sputum. 
 
 5. Give a brief outline of Ehrlich's side chain theory. 
 
 6. Describe "healing by second intention." 
 
 7. Give causes, symptoms, macroscopic, and microscopic 
 findings in atrophic cirrhosis of the liver. 
 
 8. Define embolus, thrombus. 
 
 9. Give the pathology of urticaria. 
 
 10. Name three forms of nucleated red blood cell. 
 
 PRACTICE AND THERAPEUTICS. 
 
 1. What are the clinical forms of acute gastrointestinal 
 catarrh of childhood? 
 
 2. What is varicella? Variola? Give differential diag- 
 nosis of same. 
 
 _ 3. Define idiopathic anemia. Give symptoms. Differen- 
 tiate idiopathic anemia and progressive pernicious anemia. 
 
 4. What is acute chorea? Give pathology, symptoms and 
 treatment. 
 
 5. Describe neurosis of bladder. Give symptoms and 
 treatment. Jn what way does neurosis of bladder differ 
 from cystitis? 
 
 619 
 
MEDICAL RECORD. 
 
 6. What is ascites? Give symptoms, physical signs, and 
 treatment. What is liable to be mistaken for it? 
 
 7. Define bronchopneumonia. Lobar pneumonia. Give 
 differential diagnosis. 
 
 8. (a) What are the modes of administering drugs? (b) 
 Give therapeutic uses and contraindications of chloral 
 hydrate. 
 
 9. Give symptoms of intestinal obstruction and name the 
 different types- 
 
 10. Give therapeutic uses and contraindication of digitalis. 
 Describe poisoning from digitalis. 
 
 OBSTETRICS. 
 
 1. Describe ovulation. 
 
 2. Describe a case of pregnancy at beginning of fourth 
 month. 
 
 3. When would you apply the forceps? When would you 
 not apply the forceps? 
 
 4. Give causes, symptoms, and dangers of a premature 
 detachment of the placenta, and treatment. 
 
 5. Phlegmasia alba dolens. Give symptoms, treatment, 
 and results. 
 
 6. What precautions do you take to prevent rupture of 
 the perineum? If considerably torn, what do you do, when 
 and how? 
 
 7. With right shoulder presenting, arm straight, and hand 
 born, palm of the hand facing the right thigh of mother, 
 thumb backward, what would be position of child in utero, 
 and what would you do? 
 
 8. What is meant by the "stages of labor"? 
 
 9. How would you prevent mastitis? 
 
 10. Describe care of the mother for first three days after 
 the birth. 
 
 DISEASES OF WOMEN. 
 
 1. Describe the contents of the female pelvic cavity, and 
 show relations. 
 
 2. Give treatment in detail of a submucous fibroma. 
 
 3. Give the symptoms and treatment of a chronic retro- 
 version of the uterus; (a) medical; (b) surgical, giving 
 details of one operation. 
 
 4. Etiology and treatment of (a) cystocele ; (b) rectocele. 
 
 5. Etiology, symptoms, and treatment of pelvic adhesions. 
 
 SURGERY. 
 
 1. Diagnose and treat a case of acute serous synovitis in 
 its most frequent location. 
 
 2. Describe a case of cellulitis of the hand. Give treat- 
 ment for same. What does it often accompany? 
 
 3. Give cause and treatment of varicose veins of the 
 lower extremities. 
 
 620 
 
MEDICAL RECORD. 
 
 4. Give the most common seat of fracture of the inferior 
 maxillary, and its treatment. 
 
 5. Give cause and treatment for hallux valgus. 
 
 6. Describe Bassini's operation for the radical cure for 
 inguinal hernia. 
 
 7. Diagnose a movable kidney. What operation would 
 you perform for its relief? Describe the operation. 
 
 8. Diagnose an ischiorectal abscess. Give etiology and 
 treatment. 
 
 9. Name the most common dislocation of the shoulder 
 joint and give method of reduction. 
 
 10. Describe an operation for the radical cure of hydro- 
 cele. 
 
 EYE AND EAR. 
 
 1. (a) Give diagnosis of iritis, (b) Name, describe, and 
 treat five common pathological conditions of the eye. 
 
 2. (a) Name all the bones which form the orbital cavity. 
 (b) Which are common to both orbits? 
 
 3. What do you understand by the following : Hypopyon, 
 Argyll-Robertson pupil, mydriasis, presbyopia, ptosis? 
 
 4. Where would you look for the cause of much of the 
 ear trouble in children? Discuss briefly. 
 
 5. Describe and treat five pathological conditions of the 
 ear. 
 
 JURISPRUDENCE. 
 
 i. Differentiate between antemortem and postmortem 
 wounds. 
 
 2. What would guide you in determining whether a gun- 
 shot wound was self-inflicted? 
 
 3. Describe briefly duties of coroner when finding of 
 dead body is reported to him. 
 
 4. Whatdo you understand by abortion, infanticide, de- 
 mentia, poison, syncope, catalepsy? 
 
 5. (a) Treat a case of opium poisoning, (b) Differenti- 
 ate between poisoning from strychnine and arsenic. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Board of Medical Examiners of South Dakota. 
 
 ANATOMY. 
 
 1. A typical cell is the ultimate element of structure; it 
 enters into the formation of all tissues. It consists of a 
 tiny mass of protoplasm, and contains a nucleus and. an 
 attraction sphere, but as a rule no cell wall. Cells vary in 
 shape and size (from about 1-3000 to 1-300 of an inch in 
 diameter), and are characterized by power of. movement, 
 
 621 
 
MEDICAL RECORD. 
 
 assimilation, growth, excretion, and reproduction. Prop- 
 erties of cells: (i) Irritability, or power of responding to 
 a stimulus; (2) power of movement; (3) power of assimi- 
 lation; (4) power of growth; (5) power of excretion, and 
 (6) power of reproduction. Cells may be classified as: (1) 
 Epithelial; (2) connective tissue; (3) muscle, and (4) 
 nerve cells. 
 
 2. Cartilage is a form of connective tissue; it is firm and 
 elastic; opaque, and of a bluish color. The varieties are: 
 (1) Hyaline, in which the cells are relatively few and are 
 imbedded in a quantity of ground substance. (2) White 
 fibro cartilage, in which the ground substance contains 
 bundles or layers of white fibers, between which are en- 
 capsulated cells. (3) Yellow iibro cartilage, in which the 
 ground substance contains a network of yellow, elastic 
 fibers, and the cartilage cells are in the meshes of this net- 
 work. 
 
 3. Mulberry mass is the more or less globular mass of 
 cells, the result of repeated segmentation of the fertilized 
 ovum. Primitive streak is a linear marking appearing at 
 the end of the germinal disc, and indicating the first trace 
 of the embryo. Ectoderm is the outer layer of the blasto- 
 derm. From the mesoblastic layer are derived : The skele- 
 ton, connective tissues, muscles and bones, heart, blood- 
 vessels, lymphatics, and spleen; the urinary and generative 
 organs. 
 
 4. See Cunningham's "Anatomy" (1909), page 1139; or 
 Gray's "Anatomy" (1908), page 1427. 
 
 5. Psoas magnus. Origin: Transverse processes of 
 lumbar vertebrae ; also from bodies of last thoracic and all 
 lumbar vertebrae, with the intervertebral substance. Inser- 
 tion: Lesser trochanter of femur. Serratus magnus. 
 Origin: Eight upper ribs and aponeurosis over intercostal 
 muscles. Insertion: Vertebral border of costal surface of 
 scapula. Teres major. Origin: Inferior angle of scapula 
 and lower one-third of axillary border of scapula. Inser- 
 tion: Inner edge of bicipital groove of humerus. Deltoid. 
 Origin: From the outer third of anterior border and upper 
 surface of the clavicle, from the outer margin and upper 
 surface of the acromion process, and from the lower edge 
 of the spine of the scapula. Insertion: Into- the deltoid 
 impression on the middle of the outer side of the shaft of 
 the humerus. 
 
 6. Arteries which supply the rectum: (1) Superior 
 hemorrhoidal (from inferior mesenteric) \ (2) middle 
 hemorrhoidal (from internal iliac), and (3) inferior hem- 
 orrhoidal (from internal pudic). The veins correspond to 
 the arteries, and commence in a plexus around the anus 
 from this plexus vessels ascend between the muscular and 
 mucous coat. 
 
 622 
 
iMEDICAL RECORD 
 
 7. See Cunningham's "Anatomy" (1909), page 923; or 
 Gray's "Anatomy" (1908), page 810. 
 
 8. In intracapsular fracture of the femur: (1) The 
 lower fragment is drawn upward by the glutei, the rectus, 
 the biceps, semimembranosus, and semitendinosus ; (2) the 
 limb is everted; this is due to the force of gravity (and 
 external rotators). 
 
 9. Ligaments of the knee-joint: Anterior, or Ligamen- 
 tum patellae; posterior; internal lateral; two external lat- 
 erals; capsular; external crucial; internal crucial; trans- 
 verse; coronary; Ligamentum mucosum, and Ligamenta 
 alaria. For a description of these ligaments, see Cunning- 
 ham's "Anatomy" (1909), page 298; or Gray's "Anatomy" 
 (1908), page 337. 
 
 10. A lobule of the liver is about 1-20 to 1-12 inch in 
 diameter. It has a darkish red center and a lighter circum- 
 ference. The center is occupied by an intralobular vein 
 which collects the blood from the capillaries of the lobule, 
 and flows into the sublobular vein, which latter opens into 
 the hepatic vein. Around the lobules are the interlobular 
 veins; these are branches of the portal system; capillaries 
 passing from the circumference to the center of the lobule 
 connect the interlobular and intralobular veins. Between 
 the network of capillaries in the lobule the hepatic cells 
 are packed. 
 
 PHYSIOLOGY. 
 
 1. (a) Fibrin is found in the blood and lymph; (b) 
 mucin, in saliva and synovial fluid; (c) leucin, in the pan- 
 creas and spleen; (d)chondrin, in bone and cartilage. 
 
 2. The impulse causing ordinary muscular contractions 
 originates in the centers of the brain or spinal cord, and 
 then travels by the nerves going to the particular muscles. 
 As such nerve enters a muscle it breaks up into a number 
 of branches, which are distributed to all parts of the 
 muscle. The terminal ends of the nerve are scattered in 
 great numbers throughout the muscle, and the impulse 
 carried by the nerve is transmitted by the end plates to 
 the various muscle fibers. Sometimes the muscular con- 
 traction may be reflex. (See below, Question 8.) 
 
 3. Stammering is defined as faltering and interrupted 
 speech, especially hesitancy and interruption in speech from 
 difficulty in enunciating certain letters properly. Cause: 
 According to Kirkes, "stammering depends on a want of 
 harmony between the action of the muscles (chiefly abdom- 
 inal) which expel air through the larynx and that of the 
 muscles which guard the orifice (rima glottidis) by which 
 it escapes, and of those (of tongue, palate, etc.) which 
 modulate the sound to the form of speech. Over either of 
 these groups of muscles, by itself, a stammerer may have 
 
 623 
 
MEDICAL RECORD. 
 
 as much power as other people, but he cannot harmoniously 
 arrange their conjoint actions." 
 
 4. The blood is fluid, somewhat viscid, red, specific grav- 
 ity from 1055 to 1062, alkaline reaction, saltish taste, char- 
 acteristic odor, variable temperature (average about ioo° 
 F.). The constituents are plasma and corpuscles. The 
 plasma consists of water and solids (proteids, extractives, 
 and inorganic salts). The red corpuscles consist of water 
 and solids (hemoglobin, proteins, fat, and inorganic salts). 
 The white corpuscles consist of water and solids (protein, 
 leuconuclein, lecithin, histon,.etc). The red cells are bicon- 
 cave discs, about 1-3200 of an inch in diameter; they are 
 nonnucleated, and there are about 4,500,000 or 5,000,000 of 
 them in each cubic millimeter of blood. They are elastic 
 and soft, and their shape is changed by pressure, but is 
 promptly regained on the removal of the pressure. Their 
 color is yellowish. They contain hemoglobin. They carry 
 oxygen from the lungs to the tissues. The white blood 
 cells are spheroidal masses, varying in size, having no cell 
 wall, and containing one or more nuclei ; there are about 
 7,000 to 10,000 of them in each cubic millimeter of blood. 
 They differ much in appearance, and are divided into (1) 
 small mononuclear leucocytes, or lymphocytes ; (2) large 
 mononuclear; (3) transitional; (4) polynuclear, or poly- 
 morphonuclear, or neutrophile, and (5) eosinophile. They 
 are all more or less granular, particularly the last two 
 varieties named. They are probably formed in the spleen, 
 lymphatic glands, and lymphoid tissues. Their fate is un- 
 certain; it has been asserted that they are converted into 
 red blood cells; they play a part in the formation of fibrin 
 ferment; they are sometimes converted into pus cells. 
 Their functions are (1) to serve as a protection to the 
 body from the incursions of pathogenic microorganisms ; 
 (2) they take some part in the process of the coagulation 
 of the blood; (3) they aid in the absorption of fats and 
 peptones from the intestine, and (4) they help to maintain 
 the proper proteid content of the blood plasma. 
 
 There are also platelets, which are very small, colorless, 
 irregular shaped bodies; they are about one-fourth the 
 diameter of a red corpuscle. Their function is not deter- 
 mined ; it is possible that they take some part in the coagu- 
 lation of the blood. In number they vary from about 
 200,000 to more than 500,000 in each cubic millimeter of 
 blood. Plasma conveys nutriment to the tissue ; it holds in 
 solution the carbon dioxide and water which it receives 
 from the tissues, and takes them to be eliminated by the 
 lungs, kidneys, and skin ; it also holds in solution urea and 
 other nitrogenous substances that are taken to and excreted 
 by the liver or kidneys. Arterial blood is bright red in 
 color, contains more oxygen, less carbon dioxide, more 
 
 624 
 
MEDICAL RECORD. 
 
 water, and is slightly warmer; venous blood is purple in 
 color, contains less oxygen, more carbon dioxide, less 
 water, and is slightly cooler (except in the hepatic vein). 
 
 5. The functions of the liver are: (1) The secretion of 
 bile; (2) the formation of glycogen; (3) the formation of 
 urea and uric acid; (4) the manufacture of heat, and (5) 
 the conversion of poisonous and harmful into inert 
 material. 
 
 6. The rate of circulation in the arteries is about twelve 
 inches in one second ; in the capillaries, about one or two 
 inches a minute ; in the veins, about nine inches in a second. 
 
 7. Lymph is an albuminous, straw-colored fluid, contain- 
 ing lymph corpuscles ; it is alkaline in reaction, has a spe- 
 cific gravity of about 1015, has a salty taste, and no odor; 
 it clots in the same manner as blood. Chyle is much the 
 same, but contains fat; it is opaque and whitish. 
 
 8. Reflex actions are involuntary or unconscious move- 
 ments, due to suitable stimuli. They depend upon the in- 
 tegrity of the reflex arc, which is a complex made up of : 
 (1) A surface capable of receiving an impression; (2) an 
 afferent nerve; (3) a nerve cell capable of receiving and 
 also of sending out impulses ; (4) an efferent nerve, and 
 (5) a surface capable of responding in some way to the 
 impulse conveyed by the efferent nerve. Reflexes are classi- 
 fied as: (1) Superficial, (2) deep, and (3) visceral. Ex- 
 ample: The patellar reflex consists of a contraction of the 
 extensor muscles of the leg and a movement of the foot 
 forward when the Ligamentum patellae is struck; the quad- 
 riceps extensor must first be slightly stretched by putting 
 one knee over the other. Its integrity depends upon a 
 healthy condition of the entire reflex arc, consisting of 
 tendon, afferent or sensory nerve, posterior roots, and ante- 
 rior horn of the spinal cord, the efferent or motor nerve, 
 and the muscle itself. 
 
 9. Human milk contains less proteids and fats and salts 
 then cow's milk, and at the same time contains more sugar 
 and more water. 
 
 10. Secretion means the process by which some of the 
 constituents of the blood are separated from the blood 
 stream (by the activities of the capillary endothelium, as 
 the blood passes through the capillaries) and elaborated 
 into other material. The products of secretion vary with 
 the gland or membrane where it occurs. Thus : Saliva, 
 tears, milk, bile, gastric juice, synovial fluid, serous fluid, 
 pancreatic juice. 
 
 CHEMISTRY. 
 
 i. (a) Chemistry is that' branch of science which treats 
 of the composition of bodies, their changes in composition, 
 and the laws governing such changes, (b) Chemical affln- 
 
 62$ 
 
MEDICAL RECORD. 
 
 ity is the force that binds atoms together to form mole- 
 cules. 
 
 2. (a) Crystalline substances are solid bodies of a defi- 
 nite geometrical shape, which conduct heat more readily in 
 some directions than in others; when broken, separate in 
 certain directions (called planes of cleavage) more readily 
 than in others, and modify the course of light according to 
 the direction in which the rays pass through it. {^Condi- 
 tions under which matter will crystallize : There must be 
 the possibility of the freest motion of the smallest parti- 
 cles of the matter to be crystallized; hence the substances 
 must be heated (melted) or dissolved in some suitable 
 agent, or must be in the gaseous state. Some substances 
 will never crystallize. 
 
 3. An amorphous substance is one that is not crystalline. 
 A polymorphous substance is one that can crystallize in 
 more than one system. Isomorphous substances are differ- 
 ent substances which will crystallize in forms identical 
 with each other. 
 
 4. (a) Quantivalence is the combining power of an ele- 
 ment or radicle expressed in terms of the number of hydro- 
 gen atoms it can unite with or replace. (&) Univalent: 
 Hydrogen, chlorin, bromin, iodin, sodium, potassium, 
 silver. Bivalent: Oxygen, sulphur, calcium, barium, lead, 
 mercury. Trivalent: Nitrogen, phosphorus, arsenic, anti- 
 mony, boron, bismuth. Quadrivalent: Carbon, silicon, tin, 
 platinum. 
 
 5. If a certain volume of hydrogen weigh twenty grains, 
 a like volume of oxygen will weigh sixteen times as much, 
 namely, three hundred and twenty grains. 
 
 6. 
 
 
 INSPIRED AIR 
 
 EXPIRED AIR 
 
 Oxvsren 
 
 21 per cent. 
 79 per cent. 
 0.04 per cent. 
 Rare. 
 Variable. 
 Variable. 
 Varies. 
 
 Always present. 
 Always present. 
 
 16.6 per cent. 
 
 Nitrogen 
 
 79 per cent. 
 
 Carbon dioxide. . . 
 
 Other gases 
 
 Watery vapor 
 
 Temperature 
 
 Volume 
 
 4.4 per cent. 
 Often present. 
 Saturated. 
 That of body. 
 Diminished. 
 
 Bacteria 
 
 Dust 
 
 None. 
 None. 
 
 In inspiration, oxygen is taken in; it then combines with 
 the hemoglobin of the blood, and is carried round to the 
 tissues. The carbon dioxide is given off in the tissues to the 
 plasma of the blood, by which it is carried round to the 
 lungs and given off in expiration. 
 
 7. Bismuth subnitrate has the chemical composition 
 BiONOs. It is a heavy, white powder, odorless, almost 
 
 626 
 
MEDICAL RECORD. 
 
 tasteless, slightly acid in reaction ; it is decomposed by pure 
 water. They blacken the stools by forming bismuth sul- 
 phide with the hydrogen sulphide of the intestine. Its most 
 dangerous impurity is arsenic. This may be detected by the 
 Reinisch test, which is conducted as follows : Make a 
 solution of the bismuth subnitrate, then add a little pure 
 HC1; suspend in the fluid a small strip of bright copper 
 foil, and boil. If a deposit forms on the copper, remove 
 the copper, wash it with pure water, dry on filter paper, but 
 be careful not to rub off the deposit. Coil up the copper 
 and put it into a clean, dry glass tube, open at both ends, 
 and apply heat at the part where the copper is. If arsenic 
 is present there will appear in the cold part of the tube a 
 mirror, which will be found on microscopical examination 
 to consist of octahedral crystals of arsenic trioxide. 
 
 8. (a) Phosphates and albumin, (b) Add a little nitric 
 acid; this will dissolve the phosphates, but will not affect 
 the albumin. 
 
 9. (a) Fermentation test: Three Smith's fermentation 
 tubes are used, each containing a little compressed yeast, 
 one filled with the liquid to be tested, the second with pure 
 water, and the third with a dilute solution of glucose, and 
 the three are put in a warm place over night. If gas col- 
 lects in the first and third tubes, but not in the second, the 
 liquid contains sugar ; if gas collects in the third only it 
 does not; under any other circumstances the yeast is at 
 fault. 
 
 (b) Fehling's method for the quantitative estimation: 
 The solution is made as follows: (1) Dissolve cupric sul- 
 phate 51.98 gra., in water to 500.00 c.c. ; (2) dissolve Ro- 
 chelle salt, 259.0 gm., in sodium hydroxide soln. sp. gr. 1.12 
 to 1000 c.c. When required for use, one volume of 1 is to be 
 mixed with two volumes of 2. The copper contained in 
 10 c.c. of this mixture is precipitated completely, as cuprous 
 oxide, by 0.05 gm. of glucose. "To determine the quantity 
 of sugar, place 10 c.c. of the mixed soln. in a flask of about 
 250 c.c. capacity ; dilute with H 2 to about 30 c.c, and heat 
 to boiling. On the other hand, the urine to be tested is 
 diluted and thoroughly mixed with four volumes of H 2 
 if it be poor in sugar, or with nine volumes of H 2 if 
 highly saccharine, and a burette filled with the mixture. 
 When the Fehling soln. boils, add a few gtt. NH 4 HO and 
 then 5 c.c. of the urine from the burette, boil again, and 
 continue the alternate addition of diluted urine and boiling 
 of the mixture until the blue color is quite faint. Now add 
 the diluted urine in quantities of 1 c.c. at a time, boiling 
 after each addition until the blue color just disappears. 
 Have ready a small filter, and, having filtered through it a 
 few gtt. of the hot mixture, acidulate the filtrate with acetic 
 acid, and add to it 1 gtt. soln. of potassium ferrocyanide. 
 
 627 
 
MEDICAL RECORD. 
 
 If a brownish tinge be produced, add another y 2 c.c. of dil. 
 urine to the flask, boil, and test with ferrocyanide as be- 
 fore. Continue this proceeding until no brown tinge is 
 produced. The burette reading, taken at this point, gives 
 the number of c.c. of dilute urine containing 0.05 gm. glu- 
 cose, and this divided by 5 or 10, according as the urine 
 was diluted with 4 or 9 volumes of H 2 0, gives the nmber of 
 c.c. of urine containing 0.05 gm. sugar. The number of c.c. 
 urine passed in twenty-four hours divided by twenty times 
 the number of c.c. containing 0.5 gm. glucose gives the 
 elimination of glucose in twenty-four hours in grams. 
 
 10. The prescription is incompatible. The water will 
 cause the fluid extract to throw down a precipitate. 
 
 BACTERIOLOGY. 
 
 1. Ptomains are the putrefaction products of dead animal 
 tissues or fluids. Toxins are the poisonous products of 
 pathogenic bacteria. 
 
 2. Bacteria multiply by fission. A bacterium about to 
 divide seems to be larger than normal, and if it is a coccus 
 it becomes more ovoid; changes occur first in the nucleus, 
 and the bacterium just falls in two. Cocci may divide in 
 one, two, or three directions of space; bacilli divide trans- 
 versely to their long axis, and spirilla divide transversely 
 to their long diameter. 
 
 3. A sterile swab is rubbed over any visible membrane 
 on the tonsils or throat, and is then immediately passed 
 over the surface of the serum in a culture tube. The tube 
 of culture, thus inoculated, is placed in an incubator at 37 
 C. for about twelve hours, when it is ready for examina- 
 tion. A sterile platinum wire is inserted into the culture 
 tube, and a number of colonies of a whitish color are 
 removed by it and placed on a clean cover slip and smeared 
 over its surface. The smear is allowed to dry, is passed 
 two or three times through a flame to fix the bacteria, and 
 is then covered for about five or six minutes with a Loef- 
 fler's methylene-blue solution. The cover slip is then rinsed 
 in clean water, dried, and mounted. The bacilli of diph- 
 theria appear as short, thick rods with rounded ends ; irreg- 
 ular forms are characteristic of this bacillus, and the stain- 
 ing will appear pronounced in some parts of the bacilli and 
 deficient in other parts. Methods of culture: The bacillus 
 of diphtheria grows upon all the ordinary culture media, 
 and can be readily obtained in pure culture. Loeffler's blood 
 serum, particularly with the addition of a little glucose, is 
 an admirable medium for the rapid growth of this bacillus. 
 The medium should be alkaline and not less than 20 C. 
 Method of staining: It stains with any aqueous solution of 
 an anilin dye, and quite characteristically with Loeffler's 
 alkaline methylene blue. Neisser's stain is also recognized. 
 The bacilli also stain well by Gram's method. 
 
 628 
 
MEDICAL RECORD 
 
 4. Three conditions essential to bacterial growth: Rest, 
 moisture, neutral or feebly alkaline reaction. The most 
 common microorganisms of suppuration are: Staphylo- 
 coccus pyogenes aureus, Staphylococcus pyogenes albus, 
 Staphylococcus pyogenes citreus, Streptococcus pyogenes. 
 
 5. The supposed microorganism of cerebrospinal menin- 
 gitis is the Diplococcus intra cellular is meningitidis. Lum- 
 bar puncture is performed, and about 10 c.c. of the cerebro- 
 spinal fluid is withdrawn. About 1 c.c. of this is dropped 
 into sterile test tubes. It is cultivated on agar plates or 
 Loeffler's blood serum mixture, and recoognized with the 
 microscope. 
 
 PATHOLOGY. 
 
 1. Active hyperemia means that there is an excess of 
 arterial blood in a part, and is generally accompanied by an 
 increase in the rate of blood flow. In passive congestion 
 there is still an excess of blood, but it is in the veins and 
 capillaries, and the blood flow is retarded. 
 
 2. In arteriosclerosis it is mainly the innner coat which 
 is affected ; this becomes thickened by layers of fibrous 
 tissue owing to the proliferation of the subendothelial con- 
 nective tissue cells. This thickening is not uniform. The 
 elastic layer becomes granular, and it may be partially de- 
 stroyed. Where high arterial tension exists the media is 
 affected, and the muscle fibers become hypertrophied ; some- 
 times degeneration occurs here. The vessels increase in 
 length and thickness, becoming tortuous ; they also feel 
 resistant and cord-like. 
 
 3. Osteomyelitis is inflammation of bone and marrow. 
 
 4. As the sputum is generally examined for tubercle 
 bacilli, that will be described. The sputum must be recent, 
 free from particles of food or other foreign matter ; select 
 a cheesy-looking nodule and smear it on a slide, making the 
 smear as thin as possible. Then cover it with some carbol- 
 fuchsin and let it steam over a small flame for about two 
 minutes, care being taken that it does not boil. Wash it 
 thoroughly in water and then decolorize by immersing it in 
 a solution of any dilute mineral acid for about a minute. 
 Then make a contrast stain with solution of Loeffler's 
 methylene blue for about a minute ; wash it again and ex- 
 amine with oil immersion lens. The tubercle bacilli will 
 appear as thin red rods, while all other bacteria will appear 
 blue. 
 
 5. "Ehrlich's side chain theory of immunity is based on 
 the idea that the toxin destroys a cell by entering into 
 chemical union with it. The molecule of toxin contains at 
 least two groups of atoms, a toxophore group, in which the 
 poisonous principle resides, and a haptophore group, which 
 brings the toxophore group into touch with the cell and 
 through which chemical combination takes place. Similarly, 
 
 629 
 
MEDICAL RECORD. 
 
 the cell contains a haptophore group, but the toxophore 
 group of the toxin can only unite with it and destroy it 
 when its haptophore companion has affinity with that of the 
 cell. If that affinity does not exist, the two haptophore 
 groups do not unite, the toxophore group does not come 
 into contact with the cell, and the animal is immune. Such 
 is natural immunity. If there is affinity and the cell can 
 throw off a haptophore group (antitoxin), which in its 
 detached condition unites with the haptophore group of 
 the toxin, the toxophore group has then nothing with which 
 it can unite and the animal is immunized. When the indi- 
 vidual has to contend with a bacterium as well as its toxin, 
 the same principle obtains. Immunity is established by the 
 production of a double haptophore group, one for the 
 bacterium, the other for its toxin." — (Stenhouse's Path- 
 ology.) 
 
 6. Healing by second intention or granulation occurs 
 when the edges of the wound have not been brought to- 
 gether. "Exudation of plasma and leucocytes occurs, fol- 
 lowed by fibroblasts and budding from the capillaries, thus 
 forming granulation tissue. The dead tissues or sloughs 
 are separated, and a red area of granulation is then ex- 
 posed. The deeper layer of granulation tissue is con- 
 verted into fibrocicatricial tissue, which contracts, and so 
 the wound gradually lessens in size. In the meantime epi- 
 thelium spreads in from the edge over the surface, and so 
 the scar is completed. ,, — {Aids to Surgery.) 
 
 7. Atrophic cirrhosis of the liver is caused by: Poisons, 
 alcohol, fatty acids, specific fevers, microorganisms ab- 
 sorbed from the intestine, and syphilis. Symptoms: Dys- 
 pepsia, furred tongue, high colored urine, hematemesis, 
 ascites. Pathology: The liver is shrunken and indurated, 
 rough, and of a pale or yellow color ; a growth of new con- 
 nective tissue is disposed in broad bands which run in 
 various directions, and by their contraction divide the liver 
 into numerous irregular lobes. Many acini may be affected 
 at one time. The capsule may be thickened, or adherent to 
 the diaphragm. Jaundice is slight, and comes on late; 
 ascites is pronounced and may occur early. 
 
 8. An embolus is a body which plugs up a blood-vessel, 
 and is carried there from some other part of the circula- 
 tion. A thrombus is a clot in a blood-vessel during life. 
 
 9. In urticaria the wheal is produced by some disturb- 
 ance to the vasomotor nervous apparatus. It is circum- 
 scribed, and consists of an edema of the epidermis. There 
 may be dilatation of the cutaneous vessels, with exudation 
 of serum and white blood cells. This exudation may cause 
 a pressure anemia, which produces the white appearance of 
 the skin; around this is a red areola, due to the engage- 
 ment of the peripheral vessels. 
 
 630 
 
MEDICAL RECORD. 
 
 io. (i) Normoblast, same size as normal red blood cell; 
 (2) microblast, which is smaller; (3) megaloblast, which 
 is larger than the normal red cell. 
 
 PRACTICE AND THERAPEUTICS. 
 
 i. (1) Simple, and (2) cholera infantum. 
 
 2. Varicella is chickenpox; variola is smallpox. 
 
 (1) Very young children are attacked with varicella, 
 whereas variola usually shows itself in adults. (2) Vacci- 
 nated children readily take varicella; not so variola, even 
 in the modified form. (3) Children who have had varicella 
 may contract variola, even soon afterward; or the two dis- 
 eases may co-exist. (4) Varicella is not inoculable, where- 
 as variola is notoriously so. (5) The eruption of varicella 
 appears in twenty-four hours ; that of variola not till the 
 third day. (6) The febrile symptoms continue after the 
 eruption appears in varicella; those of variola subside. (7) 
 In varicella the spots come out in successive crops ; this is 
 never seen in variola. (8) The spots in varicella are uni- 
 locular, and collapse on being punctured ; the spots in vari- 
 ola are multilocular, and do not collapse on being punc- 
 tured. (9) In varicella the eruption is very irregular, and 
 appears over the body generally; in variola it appears in 
 groups of threes and fives, and is always seen on the limbs. 
 (10) The papule in varicella is soft, and disappears on 
 stretching the skin; in variola it is hard and snotty, and 
 does not disappear on stretching the skin. 
 
 3. See French's "Practice of Medicine" (1907), pages 508 
 and 510; or Osier's "Practice of Medicine ,, (1909), pages 
 724 and 726. Idiopathic anemia and progressive pernicious 
 anemia are one and the same disease. 
 
 4. See French's "Practice of Medicine" (1907), page 1117; 
 or Osier's "Practice of Medicine" (1909), page 1045. 
 
 5. Neurosis of the bladder is the name which includes a 
 number of conditions, such as : Hyperesthesia, neuralgia, 
 atony, paralysis, and hysteria of the bladder; also incon- 
 tinence of urine. Cystitis is inflammation of the blad- 
 der. See Rose and Carters' "Surgery" (1908), pages 1192, 
 1201 ; or De Costa's "Surgery" (1908), pages 1130, 1135. 
 
 6. Ascites. Symptoms, etc.: Generally of gradual onset ; 
 abdominal distention, sense of weight and fulness; dyspnea; 
 gastrointestinal disturbances; linese albicantes, presence of 
 fluid may be detected by palpation, percussion or aspira- 
 tion. If due to heart or lung disease, ascites will occur 
 elsewhere, and the legs are generally affected first; in 
 hepatic disorders the abdominal distention is marked and 
 appears early; in renal disease, the abdominal fluid is 
 generally small in amount. Treatment: Tapping, drainage, 
 incision, and administration of cathartics have all been 
 recommended. Ovarian tumor, pregnancy, distended blad- 
 
 631 
 
MEDICAL RECORD 
 
 der, pancreatic cyst, and echinococcus cyst may be mistaken 
 for it. 
 
 7. Bronchopneumonia is an acute inflammation of the 
 terminal bronchi, air cells, and interstitial tissue of isolated 
 lobules of the lungs, or groups of globules. Lobar pneu- 
 monia is an acute infectious disease of the lungs, with in- 
 flammation and consolidation of one or more lobes of the 
 lung. 
 
 LOBAR PNEUMONIA 
 
 Generally a primary disease. 
 
 Age has little influence. 
 
 Sudden onset. 
 
 Fever is high and regular. 
 
 Ends by crisis between sixth 
 and tenth day. 
 
 Generally only one lung af- 
 fected. 
 
 The physical signs are dis- 
 tinct, and there is a large 
 area of consolidation. 
 
 Sputum is rusty. 
 
 BRONCHOPNEUMONIA 
 
 Generally secondary (to 
 bronchitis or an infectious 
 disease). 
 
 Generally found in very 
 young or very old. 
 
 Gradual onset. 
 
 Fever is not so high, and is 
 irregular. 
 
 Ends by lysis, at no partic- 
 ular date. 
 
 Generally both lungs af- 
 fected. 
 
 Physical signs indistinct, and 
 the evidences of consolida- 
 tion are indefinite. 
 
 Sputum is rather streaked 
 with blood. 
 
 8. (a) By mouth, inhalation, skin, rectum, vagina, 
 hypodermic, and in veins, (b) Chloral hydrate is used 
 as an antiseptic, counterirritant, hypnotic, and to alleviate 
 whooping cough, tetanus, and strychnine poisoning. It is 
 contraindicated in diseases of heart, lungs, stomach, and 
 bowels. 
 
 9- 
 
 STRANGULATION. 
 
 INTUSSUSCEPTION. 
 
 TWISTS 
 
 (volvulus). 
 
 Subjective 
 
 Subjective 
 
 Subjective 
 
 Symptoms. 
 
 Symptoms. 
 
 Symptoms. 
 
 1. Generally oc- 
 
 1. Most frequent 
 
 1. Most frequent 
 
 curs after age 
 
 in childhood. 
 
 after age of 30. 
 
 of 20. 
 
 
 
 2. Pain localized, 
 
 2. Constant .tenes- 
 
 2. Pain diffuse. 
 
 rapid collapse. 
 
 mus. 
 
 
 3. Pain intense, 
 
 3. Pain develops 
 
 3. Pain paroxys- 
 
 paroxysmal in 
 
 suddenly and 
 
 mal; recurs 
 
 character. 
 
 is continuous. 
 
 less often than 
 in strangula- 
 
 
 
 tion. 
 
 632 
 
MEDICAL RECORD. 
 
 STRANGULATION. 
 
 4. Constipation 
 complete. 
 
 Objective 
 Symptoms. 
 
 1. Tern peratu re 
 
 often subnor- 
 mal. 
 
 2. Pulse very 
 
 weak. 
 
 3. Stercoraceous 
 
 vomiting 
 comes on early. 
 
 4. Location in small 
 
 intestine. 
 
 INTUSSUSCEPTION. 
 
 4. Frequent diar- 
 rhea,passageof 
 bloody mucus. 
 
 Objective Symp- 
 toms. 
 
 1. Temperature 
 
 normal or sub- 
 normal. 
 
 2. S a m e as in 
 
 strangulation. 
 
 3. Same as in 
 
 strangulation. 
 
 4. Localization in 
 
 small -i ntes- 
 tine ; bowel 
 frequently pro- 
 trudes at rec- 
 tum. 
 
 TWISTS 
 
 (volvulus) 
 
 \. Constipation 
 complete. 
 
 Objective Symp- 
 toms. 
 
 1. Temperature 
 
 slightly e 1 e - 
 vated. 
 
 2, Same as in 
 
 strangulation. 
 
 Same as in 
 
 strangulation. 
 
 3- 
 
 Location, small 
 intestine ; ab- 
 domen often 
 protrudes, in 
 certain areas, 
 giving dull- 
 ness on per- 
 cussion. 
 
 10. Digitalis is indicated in diseases of the heart: (1) 
 when the heart action is rapid and feeble, with low arterial 
 tension; (2) in mitral lesions when compensation has be- 
 gun to fail; (3) in nonvalvular cardiac affections; (4) in 
 irritable heart, due to nerve exhaustion. Digitalis is con- 
 traindicated in diseases of the heart: (1) in aortic lesions 
 when uncombined with mitral lesions; (2) when the heart 
 action is strong, and arterial tension high. Digitalis is also 
 a diuretic; and it is also used in some forms of nephritis, 
 exophthalmic goiter, pneumonia, chronic bronchitis, etc. 
 In poisoning there are: Nausea and vomiting, sometimes 
 colic and diarrhea, slow pulse, dyspnea, cold extremities, 
 headache, vertigo, somnolence, and syncope : death may occur. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), page 83; or Hirst's 
 "Obstetrics" (19C9), page 61. 
 
 2. See Williams' "Obstetrics" (1909), pages 180 and 190; 
 or Hirst's "Obstetrics" (1909), pages 189 and 204. 
 
 3. Indications for the use of forceps are: (1) Forces at 
 fault: Inertia uteri in the presence of conditions likely to 
 jeopardize the interests of mother or child, (a) Impending 
 exhaustion; (b) arrest of head, from feeble pains. (2) 
 Passages at fault: Moderate narrowing, 354 to s 3 A inches, 
 
 633 
 
MEDICAL RECORD. 
 
 true conjugate; moderate obstruction in the soft parts. (3) 
 Passenger at fault: A. Dystocia due to (a) occipito-poste- 
 rior; (b) mentoanterior face; (c) breech arrested in cav- 
 ity. B. Evidence of fetal exhaustion (pulse above 160 or 
 below 100 per minute). (4) Accidental complications: 
 Hemorrhage; prolapse funis; eclampsia. All acute or 
 chronic diseases or complications in which immediate de- 
 livery is required in the interest of mother or child, or 
 both. Contraindications: Mechanical obstruction in the 
 parturient canal; .incomplete dilatation of the os; non- 
 rupture of membranes; non-engagement of the presenting 
 part; the fetal head being too large or too small; distended 
 bladder or rectum. 
 
 4. See Williams' "Obstetrics" (1909), pages 289 and 805; 
 or Hirst's "Obstetrics" (1909), page 583. 
 
 5. See Williams' "Obstetrics" (1909), pages 865 and 898; 
 or Hirst's "Obstetrics" (1909), page 761. 
 
 6. See Williams' "Obstetrics" (1909), pages 316, 317, and 
 325; or Hirst's "Obstetrics" (1909), pages 333 and 607. 
 
 7. Position is L.Scap.A. The head of the fetus is in the 
 left iliac fossa, back anterior, extremities, on right side in 
 upper part of abdomen. Do not replace the arm ; version : 
 if impaction is present, decapitation or cesarean section. 
 
 8. See Williams' "Obstetrics" (1909), page 226; or 
 Hirst's "Obstetrics" (1909), page 320. 
 
 9. See Williams' "Obstetrics" (1909), page 914; or 
 Hirst's "Obstetrics" (1909), page 708. 
 
 10. See Williams' "Obstetrics" (1909), page 340; or 
 Hirst's "Obstetrics" (1909), page 364. 
 
 DISEASES OF WOMEN. 
 
 1. See Gray's "Anatomy" (1908), pages 1440 and 1495. 
 
 2. It may become polypoid, and project from the os 
 uteri; it should then be removed, and if possible the pedicle 
 should be first twisted. If large, the fibroid may have to be 
 removed piecemeal, and the hemorrhage can be stopped by 
 pressure and packing, or by a clamp forceps. If the tumor 
 is entirely within the uterine cavity, the cervix must be 
 dilated and the fibroid then removed, care being taken not 
 to perforate the wall of the uterus. The patient should be 
 in the lithotomy position, and proper antiseptic and aseptic 
 precautions must be observed. 
 
 3. Symptoms: Pain^ or a feeling of weight and fullness 
 in the pelvis, constipation or discomfort during defecation, 
 tubes and ovaries are dragged upon and the latter may be 
 prolapsed, dyspareunia, dysmenorrhea, possibly sterility, 
 metrorrhagia, leucorrhea, and reflex disturbances. Treat- 
 ment: (a) Replace the uterus with fingers, or sound; keep 
 it in place with pessary or tampons (adhesions if present 
 must have been broken up) ; (b) shorten round ligament, 
 
 634 
 
iMEDICAL RECORD. 
 
 or perform hysteropexy. See Rose and Carless' "Surgery'' 
 (1908), page 1278. 
 
 4. Etiology: Relaxation of vaginal walls; generally due 
 to partruition, and torn perineum; lax uterine supports; 
 subinvolution of uterus; prolapse of uterus. Treatment: 
 Mend perineum, replace uterus, shorten round ligament if 
 latter are too lax, colponhaphy. 
 
 SURGERY. 
 
 1. The knee is the joint most frequently affected. See 
 Rose and Carless' "Surgery" (1908), page 642; or Da 
 Costa's "Surgery" (1908), page 546. 
 
 2. See Rose and Carless' "Surgery" (1908), page 76; or 
 Da Costa's "Surgery" (1908), page 203. It often accom- 
 panies a wound or abrasion. 
 
 3. See Rose and Carless' "Surgery" (1908), page 350; or 
 Da Costa's "Surgery" (1908), page 351. 
 
 4. See Rose and Carless' "Surgery" (1908), page 448; or 
 Da Costa's "Surgery" (1908), page 472. 
 
 5. See Rose and Carless' "Surgery" (1908), page 461; or 
 Da Costa's "Surgery" (1908), page 664. 
 
 6. See Rose and Carless' "Surgery" (1908), page 1081 ; 
 or Da Costa's "Surgery" (1908), page 978. 
 
 7. See Rose and Carless' "Surgery" (1908), page 1159; 
 or Da Costa's "Surgery" (1908), page 1101. 
 
 8. See Rose and Carless' "Surgery" (1908), page 1132; 
 or Da Costa's "Surgery" (1908), page 1008. 
 
 9. The subcoracoid is the most common. See Rose and 
 Carless' "Surgery" (1908), page 622; or Da Costa's "Sur- 
 gery" (1908), page 590. 
 
 10. See Rose and Carless' "Surgery" (1908), page 1267; 
 or Da Costa's "Surgery" (1908), page 1202. 
 
 (a) 
 
 EYE AND EAR. 
 
 ACUTE IRITIS. 
 
 1. Pupil: small, 
 
 sluggish, irreg- 
 ular after at- 
 ropine. 
 
 2. Iris: swollen, 
 
 dirty, lymph 
 on surface. 
 
 3. Anterior cham- 
 
 ber : normal 
 (or deeper, 
 with turbid 
 contents). 
 
 ACUTE CONJUNC- 
 TIVITIS. 
 
 Normal. 
 
 Clean and bright. 
 
 Normal. 
 
 ACUTE GLAUCOMA. 
 
 Dilated, oval, fixed. 
 
 Swollen and dis- 
 colored. 
 
 Shallow. 
 
 635 
 
MEDICAL RECORD 
 
 
 ACUTE IRITIS. 
 
 ACUTE CONJUNC- 
 TIVITIS. 
 
 ACUTE GLAUCOMA. 
 
 4- 
 
 Cornea : clear 
 
 Clear. 
 
 Steamy ; anesthet- 
 
 
 (or with de- 
 
 
 ic. 
 
 
 posits on 
 
 
 
 
 back). 
 
 
 
 5. 
 
 Ciliary region : 
 injected. 
 
 Not injected. 
 
 Injected. 
 
 6. 
 
 Conjunctiva :' 
 
 Red, opaque, per- 
 
 Great congestion, 
 
 
 usually some 
 
 haps swollen. 
 
 perhaps chem- 
 
 
 injection. 
 
 
 osis. 
 
 7- 
 
 Discharge : tears 
 only. 
 
 Muco-pus. 
 
 Tears only. 
 
 8. 
 
 Palpation : ten- 
 
 Tension normal, 
 
 Tension -f- 2 to 3, 
 
 
 sion normal 
 
 not tender. 
 
 very tender. 
 
 
 (occasionally 
 
 
 
 
 -j- i) ; tender 
 
 
 
 
 in ciliary re- 
 
 
 
 
 gion. 
 
 
 
 9. 
 
 Pain : over fore- 
 
 Sand or grit in 
 
 Intense neuralgia 
 
 
 head and nose, 
 
 eyes. 
 
 in and about 
 
 
 worse at night. 
 
 
 eyes, nausea, 
 vomiting. 
 
 10 
 
 . Vision : cloud- 
 
 Scarcely affected. 
 
 Rapidly lost; field 
 
 
 ed. 
 
 
 extremely lim- 
 ited ; "rainbow 
 rings" seen. 
 
 II 
 
 . Disc: if seen, 
 
 Normal. 
 
 If seen, cupped, 
 
 
 normal. 
 
 
 and arterial 
 pulsation. 
 
 (b) (1) Trachoma is a chronic disease of the conjunc- 
 tiva, marked by granulation of the eyelids, later by atrophy, 
 and cicatricial contraction. Treatment: Astringents, ex- 
 pression, or excision. (2) Glaucoma a condition charac- 
 terized by increased ocular tension, dilatation of pupil, dim- 
 inution of sight, and atrophy of the optic disc. Treatment: 
 Iridectomy. (3) Ophthalmia neonatorum is an infectious, 
 purulent inflammation of the conjunctiva in the newborn, 
 due to the gonococcus or other pyogenic germ ; produced 
 by contact of the eye with the vaginal secretion of the 
 mother during labor, or infected fingers, or instruments, 
 etc. Treatment: Wash the eyes carefully every half hour 
 with a saturated solution of boric acid; pus must not be 
 allowed to accumulate. Two drops of a 2 per cent, solu- 
 tion of nitrate of silver must also be dropped on to the 
 cornea every night and morning. The eyes must be cov- 
 ered with a light, cold, wet compress. The patient must be 
 isolated, and all cloths and compresses used must be burnt. 
 
 636 
 
MEDICAL RECORD. 
 
 (4) and (5) Iritis and Conjunctivitis: See above, Q. 1 (a). 
 Treatment of iritis is causal, abstraction of blood from tem- 
 ples, atropine, diaphoresis, shielding the eye from light. 
 Treatment of conjunctivitis: If there is much swelling and 
 scanty secretion, compresses (iced or hot), instillation of 
 boric acid or bichloride solution; in profuse secretion with 
 relaxed conjunctiva, silver nitrate solution ; in phlyctenular 
 conjunctivitis, calomel or ointment of yellow oxide of mer- 
 cury; or alum or tannic acid solutions. 
 
 2. (a) Frontal, ethmoid, sphenoid, lachrymal, malar, pal- 
 ate, superior maxillary, (b) Frontal ethmoid, sphenoid. 
 
 3. Hypopyon is a collection of pus in the bottom of the 
 anterior chamber of the eye. Argyll-Robertson pupil is a 
 condition in which the pupil accommodates for distance 
 but not for light. Mydriasis is dilatation of .the pupil. 
 Presbyopia is loss of accommodative power of the eye, oc- 
 curring normally in advanced life. Ptosis is drooping of 
 the upper eyelid. 
 
 4. In the nasopharynx. Adenoids may be the cause; 
 they may cause deafness, they may occlude the Eustachian 
 tube, or excite a catarrhal inflammation which may spread 
 through the tube to the ear, or infection may spread by the 
 same route, causing otitis or other troubles. 
 
 5. (1) Impacted cerumen. Disintegrate it with hydrogen 
 peroxide, which is left in the ear a few minutes, and fol- 
 lowed by an irrigation of warm water. (2) Furuncle. 
 Hot applications; cleansing with hydrogen peroxide; mor- 
 phine, and calcium sulphide internally; incision. (3) For- 
 eign bodies: First see that there is a foreign body. In- 
 sects may be removed by warm water or chloroform oil. 
 Careful syringing may remove other bodies. (4) Rupture 
 of membrane from explosion of guns, or sudden condensa- 
 tion of air : Rest, cleanse the meatus, gentle irrigation with 
 warm bichloride solution (1:10.000). (5) Stricture of 
 Eustachian tube: Application of bougie, and inflation with 
 superheated air may promote absorption of the new tissue. 
 
 JURISPRUDENCE. 
 
 1. Ante-mortem wounds generally show hemorrhage, co- 
 agulated blood, eversion of the edges and retraction of the 
 sides; pus, gangrene, or beginning cicatrization also in- 
 dicate that the wound was inflicted during life. Post- 
 mortem wounds, the reverse of all this. 
 
 2. The location of the wound, the presence or absence 
 of weapons, character of wound, the burning or charring 
 of skin or clothing. 
 
 3. If cause of death is unknown or suspicious (possi- 
 bility of either homicide, or suicide, or other crime), it is 
 the duty to discover the cause of death (it is no part of his 
 business to discover the individual who caused it). He 
 
 697 
 
MEDICAL RECORD. 
 
 calls a jury to view the body and establish its identity; an 
 inquest is held, witnesses are examined, possibly an autopsy 
 is performed, and the jury renders a verdict. 
 
 4. Abortion is expulsion of the fetus before the term of 
 gestation is complete. Infanticide is destruction of life of 
 a newborn child. Dementia is a condition of mental en- 
 feeblement, gradually progressing to mental decay. Poison 
 is a substance which on being in solution in the blood will 
 cause death or serious bodily harm. Syncope is suspended 
 animation, due to sudden failure of the action of the heart. 
 Catalepsy is a condition in which there is abolition of 
 sensation and motion, with rigidity of muscles and slow 
 pulse. 
 
 5. For opium poisoning: Wash into the stomach with a 
 dilute solution of potassium permanganate, leaving about 
 500 c.c. in the stomach. Maintain respiration. Keep the 
 patient moving. Strong coffee may be given. The urine 
 should be drawn off by catheter. In poisoning by strych- 
 nine: Sense of suffocation, twitchings of muscles, followed 
 by tetanic convulsions and opisthonotos. Mental faculties 
 unaffected, face congested and anxious; eyes staring, lips 
 livid; much thirst. In poisoning by arsenic: Faintness, 
 nausea, incessant vomiting, epigastric pain, headache, diar- 
 rhea, tightness and heat of throat and fauces, thirst, catch- 
 ing in the breath, restlessness, debility, cramp in the legs, 
 and convulsive twitchings. The skin becomes cold and 
 clammy. In some cases the symptoms are those of col- 
 lapse, with but little pain, vomiting, or diarrhea. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Tennessee State Board of Medical Examiners, 
 materia medica. 
 
 1. Name two emetics, antipyretics (other than the coal- 
 tar derivatives), antithelmintics, emmenagogues, diuretics, 
 arterial sedatives, giving the dose of each, and the indica- 
 tions for the use of each. 
 
 2. What are antiseptics (internal)? Name two. Give 
 the dose of each and the best mode of administering 
 them. 
 
 3. What preparation of veratrum viride would you use? 
 In what pathological lesions and in what dose would you 
 administer? 
 
 4. Name one alkaloid each of cinchona, belladonna, 
 jaborandi, hyoscyamus, opium, and hydrastis. Give the 
 dose of each and indications for use. 
 
 5. What is the physiological action of podophyllin? 
 
 6. How would you prepare a normal salt solution and 
 under what conditions, would you use it? 
 
 fe* „ •-*** 638 
 
MEDICAL RECORD. 
 
 7. How is Fowler's solution prepared? 
 
 & How is the tincture of iodine prepared? 
 
 ANATOMY. 
 
 1. Name the muscles of the face and of the forearm. 
 
 2. Name the bones of the face and of the wrist. 
 
 3. Describe the external carotid artery, point of origin, 
 and general course. 
 
 4. Describe the femoral artery. Give the point of 
 origin and the important branches given off in its course. 
 
 5. Describe the diaphragm, its openings, the different 
 organs in contact with or separated by it. 
 
 6. Describe the scrotum. 
 
 7. Name the largest muscle in the human body. Give 
 origin and insertion. 
 
 8. Name the ligaments of the shoulder and elbow 
 joints. 
 
 CHEMISTRY. 
 
 1. (a) What is a urmometer? Of what does it con- 
 sist? How graduated? (b) With what is urine com- 
 pared? What is needed for an ordinary uranalysis? (c) 
 If upon boiling urine you get a cloudy precipitate, how 
 would you determine the nature of the precipitate? 
 
 2. (a) State methods of obtaining urinary sediments. 
 (b) What is a centrifuge and how is it used? 
 
 3. Tell what you know r about oxygen. (Do not write 
 more than one page.) 
 
 4. The stomach of a person supposed to have been 
 poisoned with arsenic is brought to you; give ii detail 
 your method of determining the presence or absence of 
 that poison. 
 
 5. Give symptoms of strychnine poisoning and treat- 
 ment of same. Differentiate its symptoms from those of 
 other convulsive disorders. In case of death from strych- 
 nine poisoning, why is it more difficult to prove than 
 arsenical poisoning? 
 
 6. Heat, (a) Define and explain expansion, conduc- 
 tion, and transmission, (b) What changes of state are 
 produced by heat? (c) What is specific heat? (d) Give 
 sources of heat. 
 
 7. State how, and the methods employed, and the 
 source from which iodine is obtained. Common medicinal 
 preparations used? How used? Doses and effects? 
 
 8. Define: (a) Static electricity, (b) Dynamic elec- 
 tricity. State uses of each. Define terms volt, ohm, and 
 ampere. 
 
 SURGERY. 
 
 i. Define the terms "Science" and "Art" of surgery. 
 
 639 
 
MEDICAL RECORD. 
 
 What is aseptic surgery? What is antiseptic surgery? 
 Illustrate the two latter. 
 
 2. Describe a Pott's fracture. How caused? Give 
 treatment for (a) simple, (b) compound, (c) comminuted 
 Pott's fracture, (d) Describe a Colles' fracture and give 
 treatment, (e) What is a common result of almost 
 any fracture of a long bone? 
 
 3. Diagnose fecal impaction from invagination of a 
 gut, and give method of treating the first. 
 
 4. What is osteomyelitis? Diagnose. Give causation 
 and treatment. 
 
 5. Give diagnosis and treatment of cancer of the breast. 
 
 6. Define perineorraphy and trachelorraphy, and de- 
 scribe the operation for each. 
 
 7. Describe in detail a curettement of the uterus. 
 
 8. Define (a) prostatectomy, (b) cystotomy, (c) 
 nephrectomy, (d) nephrotomy, (e) lithotomy. Give in de- 
 tail your method of enucleating an eye. 
 
 PRACTICE. 
 
 1. Do you expect to have any puerperal fever in 
 your practice? If you do, what will be the cause? De- 
 fine puerperal fever, and give treatment. 
 
 2. Give symptoms, diagnosis, prognosis, and treatment 
 of acute Bright's disease. Should you have uremic con- 
 vulsions, what would be the cause, and how would you 
 treat them? 
 
 3. What do you understand by gallstones? What is 
 the technical name. Give diagnosis and treatment. 
 
 4. Give diagnosis and treatment of hereditary syphilis. 
 
 5. (a) Write a prescription for general debility, (b) 
 one for an acute bronchial cough, (c) one for chronic 
 constipation, (d) one for chronic diarrhea. 
 
 6. Define acute rheumatic fever. Give symptoms and 
 treatment. What is the most frequent complication? 
 
 7. Give symptoms, diagnosis, prognosis and treatment 
 of enterocolitis 
 
 8. Give symptoms, prognosis, and treatment of pur- 
 pura hoemorrhagica. 
 
 PATHOLOGY. 
 
 1. What is the meaning of active, and what of passive 
 pathological changes? 
 
 2. What pathological changes take place in the kidneys 
 during an attack of acute congestion? 
 
 3. What pathological changes take place in the kidneys 
 during an attack of acute nephritis? 
 
 4. What pathological changes take place in the liver 
 during an attack of acute catarrhal jaundice? 
 
 640 
 
MEDICAL RECORD. 
 
 5. What pathological changes take place in catarrhal 
 pneumonia ? 
 
 6. Give pathology of diphtheria. 
 
 7. What pathological changes take place in the spleen 
 during an attack of malarial fever? 
 
 8. What is the pathology of erysipelas? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Tennessee State Board of Medical Examiners. 
 
 materia medica. 
 
 1. Two emetics: Apomorphine hydrochloride, dose gr. 
 1-10 (hypodermically) ; Antimon> and potassium tartrate, 
 dose gr. j. 
 
 Two antipyretics : Quinine sulphate, dose gr. v. ; Tinc- 
 ture of aconite, dose TTRx. 
 
 Two anthelmintics: Oleoresina Aspidii, dose gr. xxx. ; 
 Pelletierine taunate, dose gr. x. 
 
 Two emmenagogues : Pill of aloes and iron, dose 2 pills; 
 Black oxide of Manganese, dose gr. ij. 
 
 Two diuretics : Infusion of Digitalis, dose 3ij ; Sparteine 
 Sulphate, dose gr. ij. 
 
 Two arterial sedatives: Tincture of Aconite, dose Tlftx; 
 Tincture of Veratrum, dose ff#xv. 
 
 2. Internal antiseptics are drugs which, when swal- 
 lowed or inhaled are supposed either to destroy or inhibit 
 the growth of microorganisms. 
 
 Two internal antiseptics: Creosote, dose TTJ^iij ; best ad- 
 ministered in the form of an emulsion with codliver oil. 
 Betanaphthol, dose gr. iv; best administered in keratin- 
 coated pills if its action is desired on the intestines. 
 
 3. The preparation of veratrum viride to be used, is the 
 tincture; dose TT^xv. Uses: As a circulatory depressant in 
 pneumonia, in puerperal convulsions, tonsillitis, puerperal 
 inflammations in general, mania, and as a rule very much 
 as aconite. 
 
 4- 
 
 One alkaloid. 
 
 Cinchona Quinine 
 Belladonna Atropine 
 Jaborandi (Pilocarpine 
 Hyoscyamus ] Hyoscine 
 
 Dose. 
 
 gr. iv (of the Sulphate) 
 gr. 1/150 (of the Sulphate) 
 gr. 1/5 (of the Hydrochloride) 
 gr. 1/150 (of the Hydrobromide) 
 Opium I Morphine |gr. 1/4 (of the Sulphate) 
 
 Hydrastis jHydrastine gr. ss (of the Hydrochloride) 
 
 641 
 
MEDICAL RECORD. 
 
 5. The physiological action of podophyllin: It is a 
 gastrointestinal irritant; it has a drastic and cholagogue 
 purgative action. 
 
 6. Normal salt solution is prepared by adding six 
 drachms of sterilized sodium chloride to a liter of dis- 
 tilled water in a sterilized glass flask. 
 
 It is used to irrigate fresh wounds, to remove blood 
 or foreign bodies, for cleansing mucous or serous sur- 
 faces; it also is used for intravenous injection when the 
 circulation is failing; by hypodermoclysis it is used also 
 when the circulation is rapidly failing, and after profuse 
 hemorrhage, in cases of shock, septicemia, and uremia. 
 
 7. Fowler's solution is prepared by boiling ten grams 
 of arsenic trioxide, twenty grams of potassium bicarbonate, 
 and thirty grams of compound tincture of lavender in suf- 
 ficient distilled water to make one liter. 
 
 8. Tincture of iodine is prepared by dissolving seventy 
 grams of iodine and fifty grams of potassium iodide 
 in alcohol enough to make one liter. 
 
 ANATOMY. 
 
 1. See Cunningham's "Anatomy" (1909), pages 397 and 
 336; or Gray's "Anatomy" (1908), pages 368, and 481 to 
 492. 
 
 2. See Cunningham's "Anatomy" (1909), pages 133 and 
 201; or Gray's "Anatomy" (1908), pages 71 and 195. 
 
 3. See Cunningham's "Anatomy" (1909), page 803; or 
 Gray's "Anatomy" (1908), page 602. 
 
 4. See Cunningham's "Anatomy" (1909), page 858; or 
 Gray's "Anatomy" (1908), page 698. 
 
 5. See Cunningham's "Anatomy" (1909), page 417; or 
 Gray's "Anatomy" (1908), page 429. 
 
 6. See Cunningham's "Anatomy" (1909), page 1 169; or 
 Gray's "Anatomy" (1908), page 1472. 
 
 CHEMISTRY. 
 
 1. (a) A Urinometer is a form of hydrometer, used 
 for determining the specific gravity of the urine. 
 
 It consists of a cylinder and a spindle. 
 
 The graduation on a urinometer is so constructed that 
 the spindle sinks to the zero point when it is immersed in 
 water at a given temperature. The denser the fluid into 
 which the spindle is immersed, the higher it rises. The 
 ordinary urinometer is graduated from o or 1,000 to 60 
 or 1,060. 
 
 (b) Urine is compared (for purposes of specific grav- 
 ity) with distilled water at a certain temperature which is 
 indicated for each instrument (generally 6o° F.). 
 
 For an ordinary urinalysis, there are needed: A gradu- 
 ated cylinder in which to measure the quantity of urine; 
 
 642 
 
MEDICAL RECORD. 
 
 litmus paper ; a "color scale" ; urinometer ; test-tubes, test- 
 tube holder, test-tube stand; ureometer ; albuminimeter ; 
 burette; pipettes; glass funnel; beakers; filter papers ; al- 
 cohol lamp; centrifuge; slides and cover slips; stains; 
 microscope ; nitric acid ; Fehling's solution ; hypobromite 
 solution, for ureometer ; acetic acid ; sodium hydroxide 
 solution, potassium hydroxide solution. 
 
 (c) The cloudy precipitate may be due to urates, phos- 
 phates, or albumin. If it is due to phosphates, it will clear 
 upon the addition of a few drops of nitric acid; if it is 
 due to urates, it will disappear on being heated. 
 
 2. (a) Urinary sediments may be obtained (i) by al- 
 lowing the urine to stand; (2) by centrifuging. 
 
 (b) A centrifuge is an apparatus by means of which 
 the solids in a fluid are separated by centrifugal force. 
 
 3. Oxygen is the most abundant of the elements, and is 
 an essential element in the air and in water; it composes 
 more than half of the earth's surface. It is a colorless, 
 odorless, tasteless gas, necessary to respiration (and there- 
 fore to life) ; it is combustible^ and a supporter of com- 
 bustion. It combines readily with all the elements except 
 fluorine. It has a valance of two, atomic weight 16, and 
 molecular weight of 32. It is prepared by heating potas- 
 sium chlorate: 
 
 2KCIO3 + heat = 2KCI + 3O2 
 
 4. "The stomach should first be carefully examined as 
 to its pathological condition, and also for the presence of 
 solid particles of the poison. It should then be cut up 
 into small fragments with scissors known to be perfectly 
 clean, and, together with its contents, placed in a clean 
 porcelain evaporating dish ; distilled water added in suffi- 
 cient quantity, together with about one-sixth the bulk of 
 pure hydrochloric acid, and heated gently for about an 
 hour, when most of the solid portions will have become 
 disintegrated. After cooling, the mixture is thrown upon 
 a muslin strainer and the solid matters washed several 
 times with pure water and squeezed. The strainer and 
 contents should be preserved for subsequent examination. 
 The filtrate should be concentrated by evaporation over 
 a water-bath and then filtered through paper." (Reese.) 
 
 After this, the Reinsch test can be applied, as follows: 
 To the suspected fluid add a little pure HC1; suspend in 
 the fluid a small strip of bright copper foil, and boil. If 
 a deposit forms on the copper, remove the copper, wash it 
 with pure water, dry on filter paper, but be careful not to 
 rub off the deposit. Coil up the copper, and put it into a 
 clean dry glass tube, open at both ends, and apply heat at 
 the part where the copper is. If arsenic is present there 
 will appear in the cold part of the tube a mirror, which 
 
 643 
 
MEDICAL RECORD. 
 
 will be found on microscopical examination to consist of 
 octahedral crystals of arsenic trioxide. 
 
 5. The symptoms of strychnine poisoning are as fol- 
 lows : " Strychnine produces a sense of suffocation, thirst, 
 tetanic spasms, usually opisthotonos, sometimes emprostho- 
 tonos, occasionally vomiting, contraction of the pupils dur- 
 ing the spasms, and death, either by asphyxia during a 
 paroxysm, or by exhaustion during a remission. The 
 symptoms appear in from a few minutes to an hour after 
 taking the poison, usually in less than twenty minutes ; and 
 death in from five minutes to six hours, usually within 
 two hours. 
 
 Treatment : ''The convulsions are to be arrested or miti- 
 gated by bringing the patient under the influence of chloral 
 or chloroform as rapidly as possible; the stomach is to be 
 washed out, and the patient is to be kept as quiet as pos- 
 sible." (Witthaus' Essentials of Chemistry.) 
 
 Tetanus is the principal condition from which strychnine 
 poisoning is to be differentiated. In tetanus, the onset is 
 gradual, is apt to begin with trismus, swallowing is diffi- 
 cult or impossible, the condition is persistent, conscious- 
 ness is dulled or lost, and there is history of a wound or 
 injury. In strychnine poisoning, the onset is more sudden, 
 the muscles of the jaw and neck are generally the last 
 to be affected, there are marked remissions with muscular 
 relaxation, consciousness is retained, and there is no his- 
 tory of a wound or injury. 
 
 Strychnine poisoning is more difficult to prove than 
 arsenic poisoning, because in the latter the poison is not 
 decomposed, and in spite of any chemical change the ele- 
 ment arsenic remains, and may be demcnstrated. This 
 would not be possible in the case of strychnine. 
 
 6. (a) As a rule, all bodies expand when heated, and 
 diminish in volume on losing heat. 
 
 Conduction of heat is its transmission from one mole- 
 cule to the neighboring molecule. 
 
 Transmission of heat may take place by conduction, con- 
 vection, and radiation. 
 
 (b) By heat, substances can be converted from the solid 
 state to the liquid state, and from the liquid to the gaseous 
 state, as ice can be converted by heat to water, and then 
 to steam. 
 
 (c) Specific heat is the amount of heat required to raise 
 the temperature of a substance a given number of degrees. 
 
 (d) Sources of heat, are: The sun, the interior of the 
 earth, friction, pressure, electricity, chemical action, com- 
 bustion. 
 
 7. Iodine is obtained from sea-weed. Sea-weed is burnt, 
 and the ashes (called kelp) are extracted with water and the 
 solution is then evaporated. The mother liquor is then 
 
 644 
 
MEDICAL RECORD. 
 
 distilled with manganese dioxide and sulphuric acid, 4 or 
 the iodine is obtained by passing chlorine in, and heating. 
 
 The common medicinal preparations, with doses, are : 
 Tincture of iodine, TTJ^ij ; Lugol's solution, rrgij ; potassium 
 iodide, gr. vij ; sodium iodide, gr. vij ; ammonium iodide, 
 gr. iv. 
 
 8. (a) Static electricity is electricity at rest; and is 
 usually produced by friction. 
 
 (b) Dynamic electricity is electricity in motion; it is 
 also . called current electricity. 
 
 A volt is that electromotive force, which, acting steadily 
 through a conductor having a resistance of one ohm, will 
 produce a current of one ampere. 
 
 An ohm is the amount of resistance shown by a column 
 of mercury 106.3 centimeters long with a base of one mil- 
 limeter square, at 0°C. 
 
 An ampere is such a current of electricity as would be 
 given with an electromotive force of one volt through a 
 wire with the resistance of one ohm. 
 
 SURGERY. 
 
 1. By the term Science of Surgery is meant the prin- 
 ciples which underlie the practice of surgery. The Art 
 of Surgery is the practical application of these principles. 
 
 In Aseptic Surgery everything that is to come in con- 
 tact with the wound is previously made free from germs, 
 and all possibility of infecting the wound is avoided. 
 
 In Antiseptic Surgery antiseptic solutions are used to 
 kill the bacteria that may be present or that may enter 
 during the course of the operation. 
 
 2. Potfs fracture consists of a fracture of the lower 
 end of the fibula, about three inches above the tip of the 
 malleolus ; and a fracture of the internal malleolus. The 
 foot is twisted outward, the sole everted, and the heel 
 drawn up ; there is a depression at the site of the frac- 
 ture, the inner malleolus either projects prominently or 
 the fragment can be felt and crepitus elicited; the foot is 
 shortened, and the ankle is swollen and widened. 
 
 Pott's fracture is usually caused by twisting the foot. 
 
 Colles' fracture is a fracture of the lower end of the 
 radius ; it is generally transverse, and is usually within an 
 inch or an inch and a half of the articular surface. There 
 is a characteristic deformity caused by the lower frag- 
 ment and the carpus forming a prominence on the dorsal 
 surface; at the same time there is a projection on the 
 palmar surface just above the wrist, caused by the upper 
 fragment. The hand is abducted and pronated, and the 
 styloid process of the ulna becomes very prominent. 
 
 A. common result of almost any fracture of a long bone, 
 is shortening of the limb. 
 
 645 
 
MEDICAL RECORD. 
 
 3. In fecal impaction, there is a history of long con- 
 tinued and increasing constipation, feeling of languor and 
 depression, anorexia ; the abdomen becomes distended 
 gradually, and the symptoms develop slowly; pain comes 
 on gradually, and later becomes continuous; there is usu- 
 ally a tumor in sigmoid flexure or cecum, it is doughy 
 and firm; constipation is absolute. 
 
 In invagination of the intestine, there is a sudden onset, 
 with severe pain which later tends to subside; rarely con- 
 stipation, but often diarrhea may be present, accompanied 
 with tenesmus ; there is apt to be marked prostration or 
 collapse; a movable tumor can often be felt in line of 
 the colon, or in the rectum ; in extreme case the invagina- 
 tion may protrude from the anus. 
 
 Method of treating fecal impaction : "The best means 
 of relief are afforded by copious enemata of warm water 
 administered in the knee-and-elbow position. Continuous 
 irrigation by the siphon syringe is very efficacious, and, 
 if employed for half an hour at a time, the hardest mass 
 softens and gradually becomes disintegrated. The stream 
 of water should be directed against the obstructing mass 
 by means of a rectal tube. Before enemata are com- 
 menced it is often advisable to inject a few ounces of olive 
 oil. Some physicians recommend copious injections of 
 sweet oil with spirits of turpentine in the proportion of 
 one drachm to the pint of oil. Metallic mercury has been 
 strongly advocated. Occasionally, when low down, the 
 fecal mass may be removed by scoop or spoon." (From 
 Reference Handbook of the Medical Sciences.) 
 
 4. Osteomyelitis is inflammation of the bone and mar- 
 row ; the term is often used now for inflammation of bone. 
 
 It is caused by infection, the bacteria gaining entrance 
 either through a wound, or by extension from neighboring 
 tissues, or they may be brought by the blood. 
 
 It is to be diagnosed from (1) Rheumatism, in which 
 more than one joint is affected and the tenderness is in 
 the joint and not near it. (2) Tubercular arthritis, in 
 which the onset is slow, and the trouble starts in the 
 epiphysis rather than in the diaphysis. (3) Cellulitis, in 
 which the bone and periosteum are not affected, and in 
 which there is always a wound. 
 
 In osteomyelitis, the treatment connsts in relieving the 
 constitutional symptoms, and preventing the bone from 
 necrosing. An incision down to the bone is made; if pus 
 is beneath the periosteum, the latter is also incised; a 
 piece of bone is removed by chisel or trephine, pus is re- 
 moved, the endosteum is hurt as little as possible, the 
 wound is irrigated with hot bichloride solution, and packed 
 with gauze; the soft parts are closed and the wound well 
 drained. In case this fails, amputation may be necessary. 
 
 646 
 
MEDICAL RECORD. 
 
 5. See Rose and Carless' "Surgery" (1908), pages 954 
 and 955; or Da Costa's "Surgery" (1908), pages 1234 and 
 1236. 
 
 6. Perineorrhaphy is the operation of suturing a lacer- 
 ated perineum. See Rose and Carless' "Surgery" (1908), 
 page 1280. 
 
 Trachelorrhaphy is the operation of suturing a lacerated 
 cervix uteri. See Hirst's "Obstetrics" (1909), page 898. 
 
 7. Curettage. Procedure: All antiseptic and aseptic pre- 
 cautions are necessary, the patient should be in the dorsal 
 position, the vagina is to be disinfected, and the cervical 
 canal dilated ; a speculus is introduced into the vagina and 
 the cervix is drawn down with volsella ; the uterine cavity 
 is irrigated with creolin or lysol ; a curette is inserted to 
 the fundus and moved down to the internal os ; the oper- 
 ator should begin at one cornu, and go in the same direc- 
 tion all around till he reaches the starting point, and if 
 necessary repeat till no more spongy or hyperplastic tissue 
 appears; the fundus should be scraped separately by mov- 
 ing the curette along it from side to side ; in going to- 
 wards the fundus no scraping should be done, and care 
 must be taken not to perforate the uterus ; should this hap- 
 pen no fluid must be injected ; otherwise the uterus and 
 vagina are again irrigated, and one or more strips of iodo- 
 form gauze are inserted into the cavity to act either as a 
 hemostatic plug or as a drain, which is diminished with 
 two days' interval and withdrawn on the sixth day. A 
 hemostatic tampon should be placed in the vagina and 
 withdrawn the following day. If any fever arises, the 
 tampon is at once removed and the vagina douched with 
 antiseptic fluid every three hours. If not, the vagina is 
 only swabbed with the same every day, and packed looselv 
 with iodoform gauze. After the final removal of the gauze 
 the antiseptic douche is given twice a day until there is no 
 more discharge. The patient should remain in bed for a 
 week. 
 
 8. (a) Prostatectomy is the operation of removing the 
 prostate gland, entirely or in part. 
 
 (b) Cystotomy is the operation of making an incision 
 into the urinary bladder. 
 
 (c) Nephrectomy is the operation of removing a kidney. 
 
 (d) Nephrotomy is the operation of making an incision 
 into the kidney. 
 
 (e) Lithotomy is the operation of removing a calculus 
 by cutting into the urinary bladder. 
 
 Enucleation of the eyeball is performed as follows: "A 
 general anesthetic is generally given. After introduction 
 of the speculum, the conjunctiva is divided all around the 
 cornea, as close to its border as possible, and dissected 
 back as far as the insertions of the recti muscles. A 
 
 647 
 
MEDICAL RECORD. 
 
 squint hook is passed beneath the tendon of the internal 
 rectus, and the latter is divided with the strabismus scis- 
 sors close to its insertion; then the other straight mus- 
 cles are cut in the same way, together with the subcon- 
 junctival connective tissue for some distance beyond the 
 equator. The points of the scissors must always be di- 
 rected toward the eyeball and the latter stripped as clean 
 as possible to avoid any unnecessary removal of orbital 
 tissue. Instead of commencing with a circumcorneal divis- 
 ion of the conjunctiva, we may begin with a tenotomy 
 of the internal rectus and then divide the conjunctiva as 
 we pass from tendon to tendon. The hook is passed 
 around the globe to make sure that the attachments of the 
 muscles have been completely divided. The eyeball is 
 then dislocated forward by pressing the speculum back- 
 ward, and thus the optic nerve is put on the stretch. A 
 pair of enucleation scissors, closed, are passed between 
 sclera and conjunctiva, feeling for the optic nerve; they 
 are withdrawn, slightly opened, and the nerve is divided 
 close to the sclera. The eyeball is held between the thumb 
 and index finger of the left hand, and the oblique muscles 
 and other unsevered attachments are divided. The orbit 
 is plugged for a few minutes to control hemorrhage, and 
 the conjunctiva is usually closed with a single suture, 
 which is passed through its edge at intervals and tied like 
 the string of a pouch. The eye is bandaged and the patient 
 kept in bed for a day." (May, Diseases of the Eye.) 
 
 PRACTICE. 
 
 i. I don't expect to have any puerperal fever in my 
 practice, due to any want of care on my part. 
 
 The causes of puerperal fever are : Pathogenic bacteria 
 which may be introduced into the woman in several ways, 
 such as by the hands of the physician, nurse, midwife, or of 
 the patient herself; by unclean instruments and catheters; 
 by coitus during the time immediately preceding labor; by 
 contact with secretions from wounds of any kind, no matter 
 where situated ; by general unhygienic surroundings, and 
 contact with a patient suffering from scarlet fever or ery- 
 sipelas on the part of any one attending on the woman. 
 The percentage of such cases will depend on the care exer- 
 cised by doctor, nurse, etc. ; when infection does occur, it 
 is generally streptococcic infection, either pure or mixed 
 with other germs. 
 
 Puerperal Fever is a fever beginning within a week 
 after labor, attended with acute inflammation of the re- 
 productive organs, and with septic infection of the blood 
 and general system. 
 
 Treatment: See Williams' "Obstetrics" (1909), page 
 383; or Hirst's "Obstetrics" (1909), pages 732 and 737. 
 
 2. See French's "Practice of Medicine" (1907), pages 
 
 648 
 
xMEDICAL RECORD 
 
 893, 887, and 891 ; or Osier's "Practice of Medicine" (1909), 
 pages 688, 683, and 702. 
 
 3. Gallstones are calculi formed in or found in the gall- 
 bladder or bile ducts. 
 
 The technical name is Cholelithiasis. 
 
 The diagnosis is made by (1) the intense and sudden 
 pain, radiating from the right hypochondriac region to the 
 right shoulder. (2) Cold sweat, feeble pulse, vomiting, 
 and collapse may be present. (3) Chill and fever are 
 present at the onset. (4) The calculus may be found in 
 the feces. 
 
 Treatment. Prophylaxis includes: Plain and easily di- 
 gested food, the ingestion of plenty of good drinking water 
 between meals, sufficient outdoor exercise, salines, and the 
 avoidance of indigestion. 
 
 During an attack : Inhalation of chloroform, a hypo- 
 dermic of morphine (gr. 1/4) and atropine (gr. 1/120), 
 application of heat, and diffusible stimulants if shock is 
 present. 
 
 Cholecystotomy may be performed, and the stones re- 
 moved. 
 
 4. See French's "Practice of Medicine" (1907), pages 
 424 and 429; or Osier's "Practice of Medicine" (1909), 
 pages 269 and 280. 
 
 5. (a) For General Debility: 
 R. Strychninae sulphatis, gr. j. 
 
 Quininae sulphatis, 3j. 
 Tincturae ferri chloridi, 3iij. 
 Acidi phosphorici diluti, 3y. 
 Glycerini q.s. ad Jv. Misce. 
 Signa : One teaspoonf ul after each meal. 
 
 (b) For Acute Bronchial Cough: 
 IJ. Ammonii carbonatis, gr. xxxij. 
 
 FL extr. senegae. 
 Fl. extr. scillae, aa 3j. 
 Tincturae opii camphoratae, 3vj. 
 Aquae destillatae, 3iv. 
 Syrupi Tolutani q.s. ad Jiv. Misce. 
 Signa : One teaspoonful every three hours. 
 
 (c) For Chronic Constipation : 
 
 It. Fl. extr. cascarae sagradae, Jss. 
 
 Tincturse nucis vomicae, 3v. 
 
 Tincturae belladonnae, 3ij. 
 
 Glycerini q.s. ad 3ij- Misce. 
 Signa : One teaspoonful three times a day. 
 
 (d) For Chronic Diarrhea: 
 B. Morphinae sulphatis, gr. j. 
 
 Bismuthi subnitratis, 3j. Misce. 
 Et fiat in chart, no. xij. 
 Signa : I ake one powder three or four times a day. 
 
 649 
 
MEDICAL RECORD. 
 
 6. See French's "Practice of Medicine" (1907), pages 
 222, 225, and 230; or Osier's "Practice of Medicine" (1909)* 
 pages 219, 221, 223, and 226. 
 
 7. See French's "Practice of Medicine" (1907), page 
 784; or Osier's "Practice of Medicine" (1909), page 508. 
 
 8. See French's "Practice of Medicine" (1907), page 
 528; or Osier's "Practice of Medicine" (1909), page 745. 
 
 PATHOLOGY. 
 
 1. By active pathological change is understood that con- 
 dition in which formation exceeds waste, and growth re- 
 sults. Examples : Hypertrophy, Tumor-formation, Regen- 
 eration. 
 
 By passive pathological change, is understood that con- 
 dition in which morbid processes are attended by arrest 
 or impairment of nutrition. Examples : Atrophy, Degen- 
 erations, Infiltrations, Necrosis. 
 
 2. See French's "Practice of Medicine" (1907), page 878; 
 or Osier's "Practice of Medicine" (1909), page 667. 
 
 3. See French's "Practice of Medicine" (1907), page 892; 
 or Osier's "Practice of Medicine" ^ (1909), page 687. 
 
 4. The bile capillaries in the liver are distended with 
 bile, and the hepatic cells are pigmented. 
 
 5. See French's "Practice of Medicine" (1907), page 671; 
 or Osier's "Practice of Medicine" (1909), page 622. 
 
 6. See French's "Practice of Medicine" (1907), page 182; 
 or Osier's "Practice of Medicine" (1909), pages 194 and 
 198. 
 
 7. In malaria, the spleen is much enlarged, and is of a 
 brownish color, with areas of deep pigmentation; the 
 capsule is thickened. 
 
 8. See French's "Practice of Medicine" (1907), page 219; 
 or Osier's "Practice of Medicine" (1909), page 210. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Texas State Board of Medical Examiners. 
 
 anatomy. 
 
 1. Describe the tibia and name the muscles attached. 
 
 2. Describe the collateral circulation around the knee. 
 
 3. Describe the kidney. 
 
 4. Name the muscles of the femoral region. 
 
 5. Give subdivision of the large intestines and source 
 of blood supply to each. 
 
 6. Give origin, course and distributien of the ulnar 
 nerve. 
 
 7. Give origin, course and distribution of the radial 
 artery. 
 
 650 
 
xMEDICAL RECORD. 
 
 8. Give the origin, course and distribution of the dor- 
 salis pedis artery. 
 
 9. Describe Hunter's canal, naming the structures found 
 therein, and their relation to each other. 
 
 10. What structures would you cut through in an am- 
 putation at the middle of the humerus? 
 
 HISTOLOGY. 
 
 1. Give the divisions of the urethra and give histology 
 of the prostatic portion. 
 
 2. What is the pelvis of the kidney? 
 
 3. Describe nonstriated muscular tissue and name its 
 principal locations in the body. 
 
 4. Give histology of arteries, veins and capillaries. 
 
 5. Name the tunics of the eyeball and give its re- 
 fractive media. 
 
 6. Describe a lobule of the lung. 
 
 7. For description the olfactory organ is divided into 
 three regions; name them, and give histology of the 
 Schneiderian membrane. 
 
 8. Name the three divisions of ear, and the bones 
 of the middle ear. 
 
 9. Describe the musculature of the uterus. 
 
 10. Describe the mucosa of the stomach. 
 
 PHYSIOLOGY. 
 
 1. Name the glands secreting the saliva. 
 
 2. Give specific gravity, chemical reaction, and physi- 
 ological reaction of saliva. 
 
 3. Give name, origin, distribution, and function of the 
 fifth cranial nerve. 
 
 4. Where are the following cerebral nerve centers: 
 (a) saliary, (b) visual, (c) respiratory, (d) mastication, 
 and (e) micturition? 
 
 5. Given an exposed artery and vein in the living sub- 
 ject, how would you distinguish them without reference 
 to anatomical landmarks ? 
 
 6. What portion of the spinal cord is affected (in 
 volved) in locomotor ataxia? 
 
 7. Describe the physiologic functions of the kidneys. 
 
 8. Name the four divisions of the circulatory system 
 and describe the circulation of the blood. 
 
 9. Describe the portal circulation ; name vessels carry- 
 ing the blood to and from the liver and into what does 
 the latter empty? 
 
 10. Define (a) hyperopia, (b) heterophonia, (c) eu- 
 thanasia (d) myopia, (e) necremia, (/) hydremia, (g) 
 diopter, (h) aphasia, (t) astigmatism, (/) chyluria. 
 
 CHEMISTRY. 
 
 i. Describe the chemical change in starch during di- 
 gestion. 
 
 651 
 
MEDICAL RECORD 
 
 2. Describe oxygen. 
 
 3. What are the symptoms of acute arsenic poisoning? 
 
 4. Give chemistry of respiration. 
 
 5. Give the chemical formula for alcohol ; for ether. 
 
 6. To what salts do most cathartic mineral waters owe 
 their virtue? 
 
 7. Give two chemical tests for albumin in the urine. 
 
 8. Give two chemical tests for sugar in the urine. 
 
 9. Give the formula and properties of chloroform. 
 
 10. Define an alkaloid and name several used in medi- 
 cine. 
 
 BACTERIOLOGY. 
 
 1. Name and give classification of fungi that are con- 
 nected with diseases in man. 
 
 2. Name chief forms of bacteria. 
 
 3. Name the most important surgical microorganisms, 
 i.e. those most frequently met with in surgical work. 
 
 4. What bacteria are likely to be mistaken for the 
 tubercle bacillus, and how may this error be avoided? 
 
 5. Describe ptomains and name three sources of 
 ptomain poisoning. 
 
 6. Give detailed description of Widal's microscopical 
 test in typhoid fever. 
 
 7. Name and describe a malarial parasite. 
 
 8. Define (a) phagocytosis, (h) chemotaxis, (c) op- 
 sonin. 
 
 9. State accurately the steps you would take to stain, 
 mount and examine a specimen of sputum from an ad- 
 vanced case of tuberculosis. 
 
 10. Define (a) aerobic, (b) anaerobic, (c) diplococci. 
 
 PATHOLOGY. 
 
 1. What are the pathological changes that take place 
 in the blood in malarial fever? 
 
 2. Lobar pneumonia; name its different stages and 
 describe each. 
 
 3. Describe the characteristic lesions of typhoid fever. 
 
 4. Pathology of empyema. 
 
 5. Pathology of erysipelas. 
 
 6. Pathology of acute gastroenteritis. 
 
 7. Pathology of diphtheria. 
 
 8. Describe union by first intention; describe union by 
 second intention. 
 
 9. Hernia — Name three varieties of external hernia, 
 and give usual contents of the sac in oblique inguinal. 
 
 10. W T hat is the pathology of rheumatism? 
 
 PRACTICE OF MEDICINE. 
 
 I. Give diagnostic significance from topographical oc- 
 currence of edema. 
 
 652 
 
MEDICAL RECORD 
 
 2. State clinical significance of arrhythmia (irregular 
 pulse), and its principal varieties. 
 
 3. Describe symptoms of aneurysm of ascending aorta. 
 
 4. Differentiate between acute pericarditis, acute endo- 
 carditis, and acute myocarditis. 
 
 5. Differentiate between acute pneumonia and exudat- 
 ive pleuritis. 
 
 6. Differentiate between hypertrophy and dilatation of 
 heart. 
 
 7. Differentiate between acute miliary tuberculosis and 
 enteric fever. 
 
 8. State symptoms of gastroptosis. 
 
 9. Discuss acute yellow atrophy of liver. 
 
 10. Differentiate carcinoma of stomach and chronic 
 pancreatitis. 
 
 OBSTETRICS. 
 
 1. Describe fertilization of the ovum. 
 
 2. Describe the placenta and give its functions. 
 
 3. Give normal duration of pregnancy and method of 
 calculating duration. 
 
 4. Give some of the most reliable signs of pregnancy. 
 
 5. Differentiate between a first and a subsequent preg- 
 nancy as regards changes in the uterus. 
 
 6. Give causes of vomiting in pregnancy. 
 
 7. What conditions in pregnancy are dangerous to the 
 life of mother and child? 
 
 8. Define placenta previa; classify, and give treatment. 
 
 9. What is the significance of albuminuria in preg- 
 nancy? And give treatment. 
 
 10. Name some conditions which might complicate 
 pregnancy or be mistaken for it. 
 
 GYNECOLOGY. 
 
 1. Give blood supply, and nerve supply, and lymphatics 
 of the womb and ovaries. 
 
 2. Define kraurosis vulvae. 
 
 3. Give cause of inversion of the uterus, its diagnosis. 
 
 4. W T hat are symptoms, and cause of pudendal hema- 
 tocele? 
 
 5. What is caruncle of the urethra? 
 
 6. Give differential diagnosis of tuberculous and gonor- 
 rheal cystitis. 
 
 7. What are the causes of pelvic peritonitis? 
 
 8. Give differential diagnosis of acute salpingitis, 
 oophoritis, and appendicitis. 
 
 9. What is pathology of (a) hydrosalpinx, (b) hema- 
 tosalpinx? Give diagnosis. 
 
 10. What is acute parametritis? Give its etiology, 
 pathology. 
 
 6'^ 
 
MEDICAL RECORD. 
 
 SURGERY. 
 
 i. What is an aneurysm? 
 
 2. What is a fracture? 
 
 3. What is a contused and lacerated wound? 
 
 4. Describe Colles' fracture and give treatment. 
 
 5. What is your treatment in Pott's fracture? 
 
 6. Describe an amputation of lower third of thigh. 
 
 7. How would you treat a case of wry neck? 
 
 8. What is fistula in ano, and how treat it? 
 
 9. Describe technique of appendectomy. 
 
 10. Give symptoms and operative technique for gall- 
 stones. 
 
 HYGIENE. 
 
 1. Mention and describe the diseases of animals that 
 are communicable to man, and state the means that 
 should be employed for the prevention of these diseases 
 in man. 
 
 2. What are the alimentary principles of food, their 
 functions, the object of cooking food? 
 
 3. What is the object of clothing, its virtue in different 
 seasons; with reference to material, color, texture, and 
 hygroscopic quality? 
 
 4. Give the best methods of disinfecting a room and 
 contents after exposure to the contagion of smallpox. 
 
 5. When are diseases said to be "epidemic," "pandemic," 
 "endemic" ? 
 
 6. Classify the following diseases, whether contagious 
 or infectious : typhoid fever, typhus fever, cholera, scar- 
 let fever, smallpox, yellow fever. Give method of stamp- 
 ing them out. 
 
 7. What is the difference between fermentation, oxida- 
 tion, and putrefaction? 
 
 8. What deleterious gases accumulate in an imperfectly 
 ventilated schoolroom ? State amount of fresh air required 
 per minute for each child. ^ Also state the evil effects 
 from inhaling air rendered impure by respiration. 
 
 9. Define ptomain. Give sources of origin and de- 
 scribe their agency in inducing diseases and give the 
 symptom produced by them. 
 
 10. How would you guard against the bowel disturb- 
 ance of infants during their first and second summers? 
 
 MEDICAL JURISPRUDENCE. 
 
 i. What is meant by last sickness, and what are its 
 relations to the law? 
 
 2. How may human hairs be distinguished from fibers 
 or the hair of the other animals? 
 
 3. What are the most important questions arising in 
 connection with gunshot wounds? 
 
 654 
 
MEDICAL RECORD. 
 
 4. What is the cause of death following burns? 
 
 5. How is it possible to distinguish false from true 
 pregnancy? 
 
 6. How do you distinguish between injuries to the 
 head, produced during delivery by accident, and those 
 made with criminal intent? 
 
 7. What is meant by the age of consent? 
 
 8. What is meant by the expectation of life? 
 
 9. Describe the coroner system. 
 
 10. What is a wound and what are the most important 
 questions that arise in connection with wounds? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Texas State Board of Medical Examiners. 
 
 anatomy. 
 
 1. For description of tibia, see Cunningham's "Anatomy" 
 (1909), page 230; or Gray's "Anatomy" (1908), page 234. 
 Muscles attached are: Semimenbranosus, tibialis anticus, 
 extensor longus digitorum, biceps, sartorius, gracilis, semi- 
 tendinosus, tibialis anticus, popliteus, soleus, flexor longus 
 digitorum, and tibialis posticus. 
 
 2. The arterial anastomosis about the knee-joint is 
 formed as follows: (1) The superior external articular 
 artery anastomoses with the descending branch of the 
 external circumflex, the inferior external articular, the 
 anastomotica magna and the superior internal articular. 
 (2) The superior internal articular artery anastomoses with 
 the anastomotica magna, the inferior internal articular, 
 and the superior external articular. (3) The inferior ex- 
 ternal articular artery anastomoses with the inferior in- 
 ternal articular, the superior external articular, and the 
 anterior recurrent branch of the anterior tibial. (4) The 
 inferior internal articular artery anastomoses with the in- 
 ferior external articular, and the superior internal articular. 
 The whole forms a superficial and deep plexus ; the former 
 being situated between the fascia and skin round the patella, 
 and the latter on the articular surfaces of the lower end 
 of the femur and the upper end of the tibia. 
 
 3. See Cunningham's "Anatomy" (1909), page 1130; or 
 Gray's "Anatomy" (1908), page 1419. 
 
 4. Muscles of the femoral region, are: Tensor vaginae 
 femoris, Sartorius, Quadriceps extensor femoris (Vastus 
 externus, Vastus internus, Rectus femoris, Crureus), Sub- 
 crureus, Gracilis, Pectineus, Adductor longus, Adductor 
 magnus, and Adductor brevis. 
 
 655 
 
MEDICAL RECORD. 
 
 5- 
 
 SUBDIVISIONS OF 
 
 LARGE INTES- 
 
 TINES. 
 
 Ileocecal valve 
 Cecum \- 
 
 (Appendix) j 
 
 Ascending colon 
 Transverse colon 
 Descending colon 
 Sigmoid flexure 
 
 Rectum 
 
 ARTERIAL SUPPLY. 
 
 Ileocolic 
 and 
 
 Right colic 
 
 Right colic 
 
 Middle colic 
 
 Left colic 
 
 Sigmoid 
 
 Superior hemor- 
 rhoidal 
 
 Middle hemor- 
 rhoidal 
 
 Inferior hemor- 
 rhoidal 
 
 BRANCH OF 
 
 > Superior mesen- 
 teric 
 
 Inferior mesen- 
 teric 
 
 Internal iliac 
 
 Internal pudic 
 
 6. See Cunningham's "Anatomy" (1909), page 629; or 
 Gray's "Anatomy" (1908), page 1005. 
 
 7. See Cunningham's "Anatomy" (1909), page 831; or 
 Gray's "Anatomy" (1908), page 659. 
 
 8. See Cunningham's "Anatomy" (1909), page 868; or 
 Gray's "Anatomy" (1908), page 713. 
 
 9. Hunter's canal occupies the middle third of the 
 thigh, beginning at the apex of Scarpa's triangle, and ex- 
 tending to the femoral opening in the Adductor magnus 
 muscle. It is bounded externally by the Vastus inter- 
 nus ; internally by the Adductors longus and magnus. It is 
 covered in by a fibrous expansion from the Vastus internus 
 to the Adductors ; over this roof lies the Sartorius. It con- 
 tains the femoral artery, and femoral vein, in a sheath; 
 and the long saphenous nerve outside the sheath. The 
 vein is behind and external to the artery; the nerve is at 
 first external to the vessels, then it crosses over them. 
 
 10. Structures cut in an amputation at the middle third 
 of the humerus, are : Skin ; fascia ; muscles : biceps, coraco- 
 brachial, brachialis anticus, triceps ; arteries : brachial, 
 superior profunda, inferior profunda; veins: basilic, ce- 
 phalic, brachial, superior profunda, inferior profunda; 
 nerves : median, ulnar, musculo-spiral, internal cutaneous, 
 musculo -cutaneous ; bone : humerus. 
 
 HISTOLOGY. 
 
 1. See Cunningham's "Anatomy" (1909), page 1177; or 
 Gray's "Anatomy" (1908), page 1450. 
 
 2. See Cunningham's "Anatomy" (1909), page 1141; or 
 Gray's "Anatomy" (1908), page 1424. 
 
 3. Nonstriated muscular tissue "is the simplest form of 
 muscular tissue. The cells are nononucleated, elongated, 
 
 656 
 
MEDICAL RECORD 
 
 or spindle shaped, and vary in length from 40 to 200 
 microns. The nucleus occupies the center of the cell, is 
 rich in chromatin, and oval, with blunt ends or cigar- 
 shaped. The cytoplasm is longitudinally striated, the stria- 
 tions being due to fibrils or sarcostyles, which are, struc- 
 turally, probably analogous to the spongioplasm. Between 
 the fibrils there is a homogeneous substance, the sarco- 
 plasm, which is analogous to the hyaloplasm. These cells 
 are enclosed in a delicate cement layer usually not de- 
 scribed as a cell wall. The ends overlap each other and 
 are held together by a delicate cement substance. Nerve 
 fibers from the sympathetic nervous system reach the mus- 
 cle cells and terminate in small granules upon the muscle 
 cytoplasm/' 
 
 "It is found in the wall of the alimentary tract, trachea 
 and bronchi, bladder, ureter, uterus, Fallopian tubes, 
 urethra, vas deferens, blood-vessels, lymph-vessels, large 
 ducts of glands, nipple, hair-follicles, Eustachian tube, 
 spleen, prostate gland, ciliary muscles, and iris of the eye." 
 — (Hill's Histology.) 
 
 4. See Cunningham's "Anatomy" (1909), page 780; or 
 Gray's "Anatomy" (1908), pages 586, and 722. 
 
 5. The tunics of the eye, are: (1) Sclerotic and cornea; 
 (2) choroid, ciliary body, and iris; (3) retina. The re- 
 fracting media are: (1) Aqueous humor; (2) vitreous 
 body; (3) crystalline lens. 
 
 6. See Cunningham's "Anatomy" (1009), page 990; or 
 Gray's "Anatomy" (1908), page 1404. 
 
 7. The three regions of the olfactory organ, are: (1) 
 The vestibule; (2) the respiratory part; (3) the olfactory 
 part. For Schneiderian membrane, see Cunningham's 
 "Anatomy" (1909), page 722 ; or Gray's "Anatomy" (1008), 
 page 1 1 10. 
 
 8. ihree divisions of the ear: (1) External ear; (2) 
 middle ear. or tympanum; (3) internal ear, or labyrinth. 
 Bones of middle ear: Malleus, incus, and stapes. 
 
 9. See Cunningham's "Anatomy" (1909), page 1191; or 
 Gray's '"Anatomy" (1908), page 1504. 
 
 10. See Cunningham's "Anatomy" (1909), page 1059; or 
 Gray's "Anatomy" (1908), page 1283. 
 
 PHYSIOLOGY. 
 
 1. The glands secreting the saliva, are: The parotid, 
 submaxillary and sublingual glands (and the small mucous 
 and serous glands of the mouth). 
 
 2. Saliva. Specific gravity: about 1002 to 1006. Chem- 
 ical reaction: Alkaline. Physiological reaction: Through 
 the ptyalin which it contains, il begins to convert starch 
 into maltose. 
 
 657 
 
MEDICAL RECORD. 
 
 3. Fifth Cranial Nerve. Name: Trigeminal, or tri- 
 facial nerve. 
 
 Origin: (1) Superficial — from the side of the pons 
 varolii; (2) Deep — from the medulla, and the floor of the 
 fourth ventricle. 
 
 Distribution: First, or ophthalmic branch, to conjunc- 
 tiva, and skin of upper eyelid, cornea, skin of forehead, 
 and nose, lachrymal gland, and skin of nose. Second, of 
 superior maxillary branch, to skin and conjunctiva of lower 
 eyelid, nose, cheek, upper lip, upper teeth, and palate. 
 Third, or inferior maxillary branch, to external auditory 
 meatus, side of head, mucous membrane of mouth, anterior 
 two-thirds of tongue, lower teeth, and skin of lower part 
 of face. Also to muscles as indicated under Function. 
 
 Function: It supplies sensation to all the parts mentioned 
 above; but, in addition, the Inferior maxillary branch sup- 
 plies motion to the muscles of mastication (Masseter, Tem- 
 poral, External, and Internal Pterygoids), and the Mylo- 
 hyoid, and anterior belly of the Digastric. 
 
 4. (a) The salivary center, is in the medulla; (b) visual 
 center, is in the occipital lobes; (c) respiratory center, is 
 in the medulla; (d) center for mastication, is in the me- 
 dulla; (e) center for micturition, is in the lumbar enlarge- 
 ment of the spinal cord. 
 
 5. Arteries are recognized by: (1) their pulsation, when 
 no proximal constriction is used; (2) their swelling prox- 
 imally when compressed distally (where no constrictor is 
 used); (3) their firm, round, resisting, elastic, cord-like 
 feeling; (4) their peculiar sensation when compressed be- 
 tween the fingers, presenting a central depression and two 
 lateral, elevated ridges; (5) their thicker walls; (6) their 
 rubber-tube-like feeling when touched and tendency to glide 
 from beneath the fingers; (7) the force required to com- 
 press them; (8) their regular outline; (9) their pinkish 
 or pinkish-yellow color. 
 
 Veins are recognized by: (1) not pulsating (where no 
 Esmarch is used) ; (2) by having thinner coats ; (3) by 
 swelling toward the periphery when compressed centrally 
 (no constrictor being used) ; (4) by being softer and less 
 resisting to touch; (5) by the flat, ribbon-like feeling 
 throughout their whole width when compressed between 
 the fingers; (6) by their purplish color; (7) by their 
 wavy, irregular contour; (8) by their accompanying the 
 arteries, in many regions, in pairs or companion veins; 
 
 (9) by their larger size than the corresponding arteries; 
 
 (10) by the ease with which they are compressed. (From 
 Bickham's Operative Surgery.) 
 
 6. The posterior columns of the spinal cord are in- 
 volved in locomotor ataxia. 
 
 7. The function of the kidneys, is: (1) To secrete (or 
 
 658 
 
MEDICAL RECORD. 
 
 excrete) urine; (2) the production of an internal secre- 
 tion. 
 
 The mechanism of the secretion of urine by the kidneys 
 is twofold: (1) By filtration, most, if not all, of the fluid 
 is eliminated, and also inorganic salts; this depends upon 
 blood pressure, and takes place in the glomeruli. (2) By 
 cell activity and selection, in the cells of the convoluted 
 tubules, the urea and principal solids are eliminated. 
 
 8. The four divisions of the circulatory system, are: (1) 
 The heart; (2) arteries; (3) capillaries, and (4) veins. 
 And see Gray's "Anatomy'' (1908), page 557. 
 
 The circulation of the blood is regulated in (a) the 
 arteries by: (1) The elasticity and tone of the arteries, 
 
 (2) the force and frequency of the cardiac contractions, 
 
 (3) the resistance in the capillaries; (b) in the capillaries 
 it is regulated by (1) the action of the heart, (2) the ac- 
 tion of the arteries; (c) in the veins it is regulated by (1) 
 the action of the heart, (2) aspiration of the thorax, (3) 
 the contraction of the muscles, and (4) slightly by the 
 valves in the veins. 
 
 g. The vessels that carry blood to the liver, are the 
 hepatic artery and the portal vein ; the vessels that carry 
 blood from the liver, are the hepatic veins, which empty 
 into the inferior vena cava. And see Cunningham's "An- 
 atomy" (1909), pages 902 and 1120; or Gray's "Anatomy" 
 (1908), pages 768 and 1346. 
 
 10. (a) Hyperopia is a condition in which the antero- 
 posterior axis of the eye is abnormally short, and parallel 
 rays are focused behind the retina. 
 
 (b) Heterophoria is a condition in which the visual 
 axes of the eyes tend to deviate. 
 
 (c) Euthanasia is painless and easy death. 
 
 (d) Myopia is a condition in which the anteroposterior 
 axis of the eye is abnormally long, and parallel rays are 
 focused in front of the retina. 
 
 (e) Necremia is death of the blood. 
 
 (/) Hydremia is a watery condition of the blood. 
 
 (g) Diopter is the unit of measurement for refractive 
 power; it represents the refractive power of a lens at a 
 focal distance of one meter. 
 
 (h) Aphasia is loss of the power of expression by 
 speech or writing. 
 
 («) Astigmatism is a condition in which owing to a 
 greater curvature of the eye in one meridian than in 
 others, the refractive power of the eye varies. 
 
 (/) Chyluria is a condition in which the urine appears 
 to be milky, from the presence of fat. 
 
 CHEMISTRY. 
 
 i. During digestion, starch (by means of the ptyalin of 
 
 659 
 
MEDICAL RECORD. 
 
 the saliva, and the amylopsin of the pancreatic juice) is 
 converted into dextrin and maltose. The dextrin is after- 
 ward converted into maltose also. 
 
 2. Oxygen is a colorless, odorless, tasteless gas, heavier 
 than air, slightly soluble in water, has an intense affinity 
 for other elements, combining with almost all of them 
 except fluorine. It is necessary to life, and is a supporter 
 of combustion. It occurs free in the air and in combina- 
 tion in water, rocks, minerals, etc. It is more abundant 
 than any other element, forming about 40 per cent, of the 
 total weight of the earth. 
 
 3. The symptoms of acute arsenical poisoning: "In 
 acute cases the symptoms usually begin in from twenty to 
 forty-five minutes. Nausea and faintness. Violent,, burn- 
 ing pain in the stomach, which becomes more and more 
 intense, and increases on pressure. Persisting and dis- 
 tressing vomiting of matters, sometimes brown or gray, 
 or streaked with blood, or green (Paris green). Purging. 
 More or less severe cramps in the lower extremities." 
 (Witthaus' Essentials of Chemistry.) 
 
 4. The chemical changes produced in the air by respira- 
 tion are : 
 
 Oxygen 
 
 Nitrogen 
 
 Carbon dioxide . . 
 
 Other gases 
 
 Watery vapor 
 
 INSPIRED AIR. 
 
 21 per cent. 
 79 per cent. 
 0.04 per cent 
 Rare. 
 Variable. 
 
 EXPIRED AIR. 
 
 16.6 per cent. 
 79 per cent. 
 4.4 per cent 
 Often present. 
 Saturated. 
 
 In the blood the chemical changes are: (1) The giving 
 up of the CO a by the venous blood; (2) the absorption of 
 oxygen during inspiration, and (3) the blood loses a small 
 amount of watery vapor. 
 
 5. The chemical formula for alcohol, is C2H5OH ; for 
 ether, is (C 2 H 6 )2 O. 
 
 6. Most cathartic mineral waters owe their virtue to 
 the following salts : Magnesium sulphate, sodium sulphate. 
 
 7. TWO TESTS FOR THE DETECTION OF ALBUMIN IN THE 
 
 urine: "The urine must be perfectly clear. # If not so, it 
 is to be filtered, and if this does not render it transparent, 
 it is to be treated with a few drops of magnesia mixture 
 and again filtered." 
 
 I. — The heat test: 'The reaction is first observed. If 
 it be acid, the urine is simply heated to near the boiling 
 point. If the urine be neutral or alkaline, it is rendered 
 faintly acid by the addition of dilute acetic acid, and 
 heated. If albumin be present, ^ a coagulum is formed, 
 varying in quantity from a faint cloudiness to entire 
 solidification, according to the quantity of albumin present. 
 
 660 
 
MEDICAL RECORD. 
 
 The coagulum is not redissolved upon the addition of 
 HNO.." 
 
 II. — Hellers modification of the nitric acid test: "Place 
 in a test-tube^ a layer of HNG 3 about 2 centim. in thick- 
 ness ; then, with a pipette carefully float upon the surface 
 of this a layer of the urine in such a manner that the 
 liquids do not mix. If albumin be present, a cloudy ring 
 appears at the point of junction of the two layers, the 
 borders of the cloud being sharply defined. A cloudy ring 
 may be formed by the presence of an excess of urates, 
 but in this case it is not at, but above, the point of junc- 
 tion of the layers, and its upper border is not sharply de- 
 fined, but fades oft gradually." (Witthaus' Essentials of 
 Chemistry.) 
 
 8. TWO TESTS FOR THE DETECTION OF SUCAR IN THE 
 
 urine : The urine should first be tested for albumin. If 
 this be present, it should be removed by heating the urine 
 to near the boiling point, and filtering from the coagulum. 
 
 (1) Fcliling's test: Place in a test-tube a few c.c. of 
 the liquid prepared as stated below, and boil; no reddish 
 tinge should be observable, even after five minutes' re- 
 pose. Add the liquid under examination gradually, and 
 boil after each addition. In the presence of sugar a 
 yellow or red precipitate is formed. In the presence of 
 traces of glucose, only a small amount of precipitate is 
 produced, which adheres to the glass, and is best seen 
 when the blue liquid is poured out. 
 
 [The reagent must be kept in two solutions, which are 
 to be mixed immediately before use. Solution I consists 
 of 34.653 gms. of crystallized CuS0 4 , dissolved in water 
 to 500 c.c. ; and solution II of 130 gms. of Rochelle salt 
 dissolved to 500 c.c. in NaHO solution of sp. gr. 1.12. 
 When required for use equal volumes of the two solu- 
 tions are mixed, and the mixture diluted with four vol- 
 umes of water.] - 
 
 (2) Boettger J s test: Render the urine strongly alkaline 
 by addition of Na^COs. Divide about 6 c. c. of the alkaline 
 liquid in two test-tubes. To one test-tube add a very 
 minute quantity of powdered subnitrate of bismuth, to the 
 other as much powdered litharge. Boil the contents of 
 both tubes. The presence of glucose is indicated by the 
 dark or black color of the bismuth powder, the litharge 
 retaining its natural color. (From Witthaus' Essentials 
 of Chemistry.) 
 
 9. Chloroform. Formula: CHCls. Properties: It is 
 a colorless liquid, volatile, with a sweet taste, and agree- 
 able odor. It is heavier than water; is a good solvent for 
 fats and other substances ; it mixes with alcohol, and 
 ether, but not with water. 
 
 10. An alkaloid is a basic nitrogenous substance of alka- 
 
 661 
 
MEDICAL RECORD. 
 
 line reaction and capable of combining with an acid to 
 form salts in the same way that ammonia does. 
 
 Several alkaloids used in medicine: Strychnine, quinine, 
 cocaine, atropine, morphine, codeine, pilocarpine, apomor- 
 phine, aconitine, eserine. 
 
 BACTERIOLOGY. 
 
 1. The fungi which are connected with diseases in man, 
 are: 
 
 (i) The Blastomycetes, or yeasts. 
 
 (2) The Hyphomycetes, or moulds; and 
 
 (3) The Schizomycetes, or bacteria. 
 
 2. The three basic forms of bacteria are: (i)^ The 
 coccus, which is round or oval, and may appear singly, 
 in pairs, in groups of four, in chains, or in bunches. (2) 
 The bacillus, which is rod shaped, with the longer sides 
 parallel, and the short ends either straight, rounded, or 
 concave. (3) The spirillum, which is spiral. 
 
 3. The most important surgical microorganisms, are: 
 Staphylococcus pyogenes aureus, staphylococcus pyogenes 
 albus, staphylococcus pyogenes citreus, staphylococcus ce- 
 reus aureus, staphylococcus cereus albus, staphylococcus ce- 
 reus flavus ; streptococcus pyogenes ; micrococcus tetrage- 
 nus, micrococcus pyogenes tenuis ; gonococcus ; pneumoc- 
 occus; bacillus pyocyaneus, bacillus typhosus, bacillus tu- 
 berculosis; streptococcus of erysipelas; bacillus of tetanus; 
 bacillus of anthrax; bacillus coli communis; and spirocheta 
 pallida. 
 
 4. The bacteria liable to be mistaken for the tubercle 
 bacillus, are: the bacillus of leprosy, the bacillus of the 
 smegma, and Lustgarten's bacillus. "The differential diag- 
 nosis between these four organisms depends upon the fol- 
 lowing reactions : When stained by the carbol-fuchsin 
 method, commonly employed in staining the tubercle bacil- 
 lus, the Lustgarten's bacillus becomes almost instantly de- 
 colorized by treatment with mineral acids, particularly sul- 
 phuric acid ; whereas the smegma bacillus resists such 
 treatment for a much longer time, and the lepra and tuber- 
 cle bacillus for a still longer time. On the other hand, 
 if decolorization is practised with alcohol instead of acids, 
 the smegma bacillus is the first to lose color. The bacillus 
 tuberculosis and the bacillus of leprosy are both very re- 
 tentive of their color, even after treatment with acids and 
 alcohol. If, then, we treat the preparation, stained with 
 carbol-fuchsin, with sulphuric acid, Lustgarten's bacillus 
 becomes almost at once decolorized. If it is not imme- 
 diately decolorized, heat with alcohol ; if it is then decol- 
 orized, it is the smegma bacillus. If it is still not decol- 
 orized, it is either the leprosy or the tubercle bacillus." 
 (From Park's Pathogenic Bacteria.) 
 
 662 
 
MEDICAL RECORD. 
 
 5. Ptomains are basic, nitrogenous organic substances 
 produced from protein material by the bacteria which 
 cause putrefaction. "Owing to the wide variations in 
 the chemical constitution of the ptomains, they possess no 
 characters by which they can be distinguished as a class. 
 Some are strongly alkaline and basic, others only feebly 
 so. Some are liquid, oily and volatile, others fixed and crys- 
 talline. Some are very prone to oxidation, and are active 
 reducing agents, others are quite stable. For the same rea- 
 son, no analytical method is possible by which vegetable 
 alkaloids and ptomains can be separated from each other 
 en masse, nor are any reactions known to which all pto- 
 mains respond while vegetable alkaloids do not, or the 
 reverse." (Witthaus' Manual of Chemistry.) 
 
 Three sources of ptomain poisoning: Canned meats, ice- 
 cream, and decomposing fish. 
 
 6. Widal's test in typhoid fever "depends upon the fact 
 that serum from the blood of one ill with typhoid fever, 
 mixed with a recent culture, will cause the typhoid bacilli 
 to lose their motility and gather in groups, the whole 
 called 'clumping/ Three drops of blood are taken from 
 the well-washed aseptic finger tip or lobe of the ear, and 
 each lies by itself on a sterile slide, passed through a 
 flame and cooled just before use ; this slide may be wrapped 
 in cotton and transported for examination at the labora- 
 tory. Here one drop is mixed with a large drop of sterile 
 water, to redissolve it. A drop from the summit of this is 
 then mixed with six drops of fresh broth culture of the 
 bacillus (not over twenty-four hours old) on a sterile slide. 
 From this a small drop of mingled culture and blood is 
 placed in the middle of a sterile cover-glass, and this is 
 inverted over a sterile hollow-ground slide and examined. 
 * * * A positive reaction is obtained when all the bacilli 
 present gather in one or two masses or clumps and cease 
 their rapid movement inside of twenty minutes." (From 
 Thayer's Pathology.) 
 
 7. See French's "Practice of Medicine" (1907), page 233; 
 or Osier's "Practice of Medicine" (1909), page 12. 
 
 8. (a) Phagocytosis is the faculty of certain cells 
 (notably the mononuclear and polynuclear leucocytes) to 
 take up and destroy bacteria. 
 
 (b) Chemotaxis is. the property by virtue of which cer- 
 tain living cells approach (positive chemotaxis) or move 
 away from (negative chemotaxis) certain other cells or 
 substances. 
 
 (c) Opsonin is that quality of a serum which makes a 
 microorganism more susceptible to phagocytosis. 
 
 9. To demonstrate the existence of tubercle bacilli in 
 the- sputum: The sputum must be recent, free from par- 
 ticles of food or other foreign matter; select a cheesy- 
 
 663 
 
MEDICAL RECORD. 
 
 looking nodule and smear it on a slide, making the smear 
 as thin as possible. Then cover it with some carbol-fuch- 
 sin, and let it steam over a small flame for about two 
 minutes, care being taken that it does not boil. Wash it 
 thoroughly in water and then decolorize by immersing^ it 
 in a soludon of any dilute mineral acid for about a min- 
 ute. Then make a contrast stain with solution of Loeffler's 
 methylene blue for about a minute ; wash it again and ex- 
 amine with oil immersion lens. The tubercle bacilli will 
 appear as thin red rods, while all other bacteria will ap- 
 pear blue. 
 
 10. (a) Aerobic is a term which denotes that a micro- 
 organism requires the presence of oxygen as an essential 
 to its growth. 
 
 (b) Anaerobic is a term which denotes that a micro- 
 organism requires the absence of oxygen as an essential to 
 its growth. 
 
 (c) Diplococci are cocci (see Answer 2 above) associ- 
 ated in pairs. 
 
 PATHOLOGY. 
 
 1. The pathological changes that take place in the blood 
 in malarial fever, are: The red cells are destroyed, and 
 therefore reduced in number; the red cells lose their col- 
 oring matter; the serum is colored with hemoglobin; 
 granular pigment appears in the blood; the Plasmodium 
 malariae may be found in the blood; the white cells may 
 be diminished; the total quantity of the blood is dimin- 
 ished; the specific gravity of the blood decreases. 
 
 2. See French's "Practice of Medicine" (1907), page 154; 
 or Osier's "Practice of Medicine" (1909), page 170. 
 
 3. See French's "Practice of Medicine" (1907), page 70; 
 or Osier's "Practice of Medicine" (1909), page 65. 
 
 4. See French's "Practice of Medicine" (1907), page 695; 
 or Osier's "Practice of Medicine" (1909), page 649. 
 
 5. See French's "Practice of Medicine" (1907), page 219; 
 or Osier's "Practice of Medicine" (1909), page 211. 
 
 6. See French's "Practice of Medicine" (1907), page 780. 
 
 7. See French's "Practice of Medicine" (1907), page 182; 
 or Osier's "Practice of Medicine" (1909), page 198. 
 
 8. Healing by first intention: "Exudation of plasma from 
 the neighboring blood-vessels occurs, and its fibrinogen is 
 converted into fibrin, so gluing the edges of the wound 
 together, leucocytes are poured out and infiltrate the 
 wound, absorbing any blood clot present. These are fol- 
 lowed by fibroblasts (connective-tissue cells), which take 
 their place. New capillaries form by budding out from 
 adjacent ones, and vascularize the new tissue. Fibrous 
 tissue is formed by intercellular exudation from the fibro- 
 blasts and so the fibrocicatrical union is complete, for at 
 
 664 
 
MEDICAL RECORD. 
 
 the same time epithelium is spreading over the narrow sur- 
 face line." 
 
 Healing by granulation or second intention occurs when 
 the ede-es of the wound have not been brought together. 
 "Exudation of plasma and leucocytes occurs, followed by 
 fibroblasts and budding from the capillaries, thus forming 
 granulation tissue. The dead tissues or sloughs are sep- 
 arated, and a red area of granulation is then exposed. The 
 deeper layer of granulation tissue is converted into fibro- 
 cicatricial tissue, which contracts, and so the wound grad- 
 ually lessens in size. In the meantime epithelium spreads 
 in from the edge over the surface, and so the scar is com- 
 pleted."— (A ids to Surgery.) 
 
 9. Three varieties of external hernia: Inguinal, femoral, 
 and umbilical. 
 
 Usual contents of the sac in oblique inguinal hernia: 
 Intestine and omentum. 
 
 10. See French's "Practice of Medicine" (igoy), page 
 224; or Osier's "Practice of Medicine" (1909), page 221. 
 
 PRACTICE OF MEDICINE. 
 
 i. Topographical occurrence of edema. A. General 
 edema: (1) Beginning at the feet and extending upwards — 
 cardiac weakness or disease. (2) Beginning in the face 
 and extending downwards — renal disease. (3) Beri-beri, 
 multiple peripheral neuritis, trichinosis, and lymphedema. 
 
 B. Edema of upper half of body: (1) In early stage 
 of renal dropsy. (2) Of arms, head, and neck, in thoracic 
 aneurysm, large double hydrothorax, and mediastinal 
 tumor. (3) Edema of one arm, in enlarged lymphatic 
 glands and tumors, and thrombosis of axillary vein. 
 
 C. Edema of lower half of body: (1) In early stage 
 of cardiac dropsy. (2) Hepatic cirrhosis. (3) Abdom- 
 inal tumors, enlarged liver, spleen, pancreas, or mesenteric 
 glands. (4) Chronic malarial poisoning, anemias, cachexia, 
 wasting diseases, long continued slight hemorrhages, throm- 
 bosis of femoral vein, lymphedema. 
 
 D. Circumscribed, and usually single swellings: (1) 
 Over precordial space, in purulent pericarditis. (2) Over 
 affected side, in empyema. (3) Over mastoid process, in 
 mastoiditis. (4) Over parotid gland, in mumps or parotid 
 suppuration. (5) In right hypochondrium, in hepatic ab- 
 scess. (6) Over posterior lumbar region, in perinephritic 
 abscess. 
 
 E. Circumscribed multiple swellings: In angioneurotic 
 edema, purpuric edema, and giant urticaria. (Condensed 
 from Butler's Diagnostics of Internal Medicine.) 
 
 2. Cardiac arrhythmia has no particular clinical sig- 
 nificance, unless it accompanies some disease. According 
 to Butler (Diagnostics of Internal Medicine), search should 
 
 665 
 
MEDICAL RECORD. 
 
 be made for one or more of the following: (i) Valvular 
 cardiac disease, especially mitral lesions, in which it is 
 usually, but not always, a sign of beginning failure of com- 
 pensation, passing in many instances into delirium cordis; 
 simple dilatation, chronic myocarditis, sclerosis of the cor- 
 onary arteries, and fatty degeneration; possibly obscure 
 changes in the cardiac ganglia, and overstrain or impaired 
 nutrition in wasting diseases or long-continued fevers. (2) 
 Poisons circulating in the blood, such as alcohol, coffee, 
 tea, tobacco, digitalis, aconite, and belladonna, or the tox- 
 ines of the infectious diseases, especially of typhoid fever 
 and pneumonia. (3) Diseases of the intracranial contents, 
 meningitis, hemorrhage, abscess, softening, concussion, and 
 not infrequently mental excitement. (4) Neurasthenic 
 conditions resulting from excesses or overstrain. Brief at- 
 tacks of moderate arrhythmia are not uncommon in neu- 
 rotic individuals, following even a slight departure from 
 their usual habits in food, drink, or exertion. (5) Diges- 
 tive disturbances, acute or chronic, and jaundice or consti- 
 pation, particularly if associated with an unusually hypo- 
 chondriacal frame of mind. (6) More rarely arthritis de- 
 formans, exophthalmic goiter, and renal disease. 
 
 3. See French's "Practice of Medicine" (1907), page 630; 
 or Osier's Practice of Medicine" (1909), page 855. 
 
 4. See French's "Practice of Medicine" (1907), pages 
 562, 571, and 603; or Osier's "Practice of Medicine" (1909), 
 pages 777, 781, 791, and 824. 
 
 5. 
 
 ACUTE PNEUMONIA. 
 
 Onset very sudden and sym- 
 toms severe — convulsions, 
 etc., cough first, followed 
 by pain in the side. 
 
 Temperature very high, 104 
 or often 105 F. 
 
 Pulse - respiration ratio 
 greatly disturbed. 
 
 Bright crimson flush on the 
 cheeks, and the muscular 
 prostration is considera- 
 ble. 
 
 Cough is short and hacking 
 or in paroxysms; and the 
 sputum, when brought up 
 is rusty and tenacious. 
 
 Organs not displaced. 
 
 Dullness on percussion not 
 complete, and the sense 
 of resistance almost nil. 
 
 EXUDATIVE PLEURISY. 
 
 Onset moderately sudden, 
 and symptoms not severe 
 — chilliness and pain in 
 the side, followed by 
 cough. 
 
 Temperature not high, 
 101.5 or 102 F. 
 
 Pulse-respiration ratio not 
 disturbed. 
 
 Face is pale, and there is 
 little loss of muscular 
 power. 
 
 Cough is dry and painful, 
 and patient tries to re- 
 press it. 
 
 Organs displaced. 
 Dulness complete, with 
 sense of great resistance. 
 
 666 
 
MEDICAL RECORD. 
 
 ACUTE PNEUMONIA. 
 
 Respiratory sounds tubular, 
 and fine crepitation heard 
 at border of consolidation. 
 
 Vocal resonance increased. 
 
 Vocal fremitus increased. 
 
 The physical signs are lim- 
 ited to the front or back 
 of the chest. 
 
 EXUDATIVE PLEURISY. 
 
 Respiratory sounds much 
 diminished, and friction 
 heard at upper margin of 
 effusion. 
 
 Vocal resonance greatly di- 
 minished. 
 
 Vocal fremitus diminished 
 or absent. 
 
 The physical signs are 
 found both at the back 
 and front of the affected 
 side. 
 
 6. See French's "Practice 
 598 and 602; or Osier's "P 
 page 820. 
 
 7- 
 
 of ILedicine" (1907), pages 
 ractice of Medicine" (1909), 
 
 ACUTE MILIARY TUBERCULOSIS. 
 
 Temperature curve is ir- 
 regular. 
 
 Diarrhea is not common. 
 
 Roseolar eruption not 
 common. 
 
 Widal reaction is negative. 
 
 No typhoid bacilli in blood, 
 
 urine or feces. 
 Tubercles may be found in 
 
 the choroid. 
 Pulse and respiration are 
 
 usually much more rapid. 
 Epistaxis is rare. 
 
 ENTERIC FEVER. 
 
 Temperature curve is char- 
 acteristic. 
 
 Diarrhea is common. 
 
 Roseolar eruption is gen- 
 erally present. 
 
 Widal reaction is usually 
 positive. 
 
 Typhoid bacilli in blood, 
 urine, and feces. 
 
 No tubercles in the choroid. 
 
 Pulse and respiration rapid. 
 Epistaxis is common. 
 
 8. Symptoms of gastro ptosis: "The patient complains 
 of dyspepsia, abdominal distress and pain after eating, 
 eructations of gases, anorexia, various nervous symptoms, 
 weakness, and constipation. In the standing position the 
 lower part 01 the abdomen projects and the upper part 
 sinks in. In the recumbent position the abdomen shows 
 a lateral extension. Aortic pulsation is frequent. There 
 is often "a ridge lying across the abdomen" to be deter- 
 mined by palpation. Inflation of the stomach often detects 
 its prolapsed position with a lowered gastric splashing. 
 The .r-ray, with the aid of a bismuth subnitrate solution, 
 will determine the location of the oreran." — (Hughes' Prac- 
 tice of Medicine.') 
 
 9. See French's "Practice of Medicine" (1907), page 821; 
 or -Osier's "Practice of Medicine" (1909), page 538. 
 
 10. See French's "Practice of Medicine" (1907), pages 
 
 667 
 
MEDICAL RECORD. 
 
 759 and 860; or Osier's "Practice of Medicine" (1909), 
 pages 485 and 577. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics'' (1909), page 94; or Hirst's 
 "Obstetrics" (1909), page 73. 
 
 2. At full term the placenta is a soft, spongy mass, 
 roughly saucer-shaped, from six to nine inches in diameter, 
 about three-quarters of an inch in thickness at the central 
 point, and weighs about one pound. Its functions are : 
 (1) To supply nourishment to the fetus; (2) to act as 
 a respiratory organ for the fetus; (3) to act as an excret- 
 ory organ for the fetus. 
 
 3. See Williams' "Obstetrics" (1909), page 194; or Hirst's 
 "Obstetrics" (1909), page 210. 
 
 4. The most reliable signs of pregnancy, are: (1) Hear- 
 ing the fetal heart sounds; (2) active movements of the 
 fetus; (3) ballottement ; (4) outlining the fetus in whole 
 or part by palpation ; and (5) hearing the umbilical or 
 funic souffle. 
 
 VIRGIN UTERUS. 
 
 The cavity is of normal 
 length — about two and a | 
 half inches, and normal 
 (triangular) in shape. 
 
 The cervix is small, hard, 
 and cartilaginous, and of 
 the same length as the 
 body. 
 
 The external os appears as a 
 transverse slit or pinhole 
 orifice with smooth edges. 
 
 The uterine sound shows 
 that the sides of the cav- 
 ity of the body are con- 
 vex inward. 
 
 The uterus is normally 
 anteflexed. 
 
 There is more or less flat- | 
 tening of the anterior and I 
 posterior uterine surfaces. 1 
 
 The fundus is nearly flat. 
 The internal os is closed. 
 
 UTERUS OF MULTIPARA. 
 
 The cavity is increased in 
 length — three inches or 
 more, and is oval in 
 shape. 
 
 The cervix is large and 
 soft; it is nearly one inch 
 in length, while the body 
 of the uterus measures 
 nearly two inches. 
 
 The external os is irregular 
 and its edges are fissured. 
 
 The sides of the cavity of 
 the body are convex out- 
 ward. 
 
 The axis of the uterus is 
 apt to be straighter, or 
 the uterus may even be 
 retrodisplaced. 
 
 The contour of the body of 
 the uterus is more round- 
 ed, while its diameters are 
 increased. 
 
 The fundus is convex. 
 
 The internal os is partially 
 patulous. 
 
 — (From Dorland's Obstetrics.) 
 668 
 
MEDICAL RECORD. 
 
 6. Causes of vomiting in pregnancy, are: (i) Reflex 
 disturbance, due to rapid growth and excessive distention 
 of the uterus; (2) disease or displacement of uterus, 
 tubes and ovaries; (3) disease of pelvis or gastrointes- 
 tinal tract; (4) excessive sexual intercourse; (5) renal 
 disease or disturbance. 
 
 7. See Williams' "Obstetrics" (1909), pages 480, etc.; or 
 Hirst's "Obstetrics" (1909), pages 215, etc. 
 
 8. See Williams' "Obstetrics" (1909), page 809; or Hirst's 
 "Obstetrics" (1909), page 572. 
 
 9. See Williams' "Obstetrics" (1909), pages 174 and 520; 
 or Hirst's "Obstetrics" (1909), page 254. 
 
 10. See Williams' "Obstetrics" (1909), pages xii and 190; 
 or Hirst's "Obstetrics" (1909),. pages 13 and 204. 
 
 GYNECOLOGY. 
 
 1. See Cunningham's "Anatomy" (1909), pages 1192 and 
 1 185 ; or Gray's "Anatomy" (1908), pages 1515 and 1507. 
 
 2. Kraurosis valvce is a progressive atrophic shrinking 
 of the tissues of the vulva. 
 
 3. Inversion of uterus. Causes: Childbirth and tumors 
 of fundus of uterus. Diagnosis: In the case of polypus 
 the body and fundus of the uterus are in their normal posi- 
 tion in the abdomen, a sound can be passed into the uterus, 
 the uterine and cervical canals are not obliterated, the 
 polypus does not bleed easily, and. is not particularly sen- 
 sible to pain. The inverted uterus shows : Absence of body 
 and fundus from normal position, will not permit passage 
 of a sound into uterine cavity, the uterine and cervical 
 canals are absent, the inverted uterus tends to bleed easily, 
 and is very sensible to pain. 
 
 4. Pudendal hematocele. Symptoms: Sharp, tearing 
 pain accompanied by more or less faintness. If the effu- 
 sion is large, it may press on the urethra, causing difficulty 
 in micturition. Causes: Blows, falls, pregnancy, tumors. 
 It frequently occurs after labor, or from strong bearing 
 down after sewing a lacerated perineum, or it may arise 
 from any condition producing or accompanied by a dilata- 
 tion of the vessels about the vulva. 
 
 5. Caruncle of the urethra is a small, red, fleshy growth, 
 situated generally on the posterior part of the meatus of 
 the urethra. 
 
 6. 
 
 tuberculous cystitis. 
 
 1. Located chiefly about the 
 
 trigone. 
 
 2. Inflammatory reaction 
 
 zone absent. 
 
 gonorrheal cystitis. 
 
 1. Not at all so confined. 
 
 2. Clear inflammatory reac- 
 
 tion zone, later chang- 
 ing to dull brown color. 
 
 660 
 
MEDICAL RECORD 
 
 TUBERCULOUS CYSTITIS. 
 
 3. Local tuberculous cystitis 
 
 not very common; gen- 
 eral tuberculous cystitis 
 very rare. 
 
 4. Characterized by pres- 
 
 ence of small tubercles 
 situated about the trig- 
 one and ureteral orifices. 
 
 5. No projecting tufts of 
 pus. 
 
 6. No subperitoneal extra- 
 
 vasation of blood. 
 
 7. Bacillus tuberculosis. 
 
 8. Often extension from 
 
 kidney and from gen- 
 eral tuberculosis. 
 g. History of tuberculosis. 
 Great pain; hematuria. 
 
 GONORRHEAL CYSTITIS. 
 
 3. Of common occurrence 
 both local and general. 
 
 4. Characterized early by 
 
 insular areas of reac- 
 tive inflammation, with 
 healthy or nearly 
 healthy intermediate 
 mucosa. Later insular 
 areas becomes confluent 
 and extend over whole 
 mucosa. 
 
 5. Projecting tufts of gon- 
 
 orrheal pus are apt to 
 be present. In chronic 
 stage regions of eleva- 
 tion may be excavated 
 by ulceration. 
 
 6. In very acute stage there 
 
 is subperitoneal extra- 
 vasation of blood. 
 
 7. Gonococcus. 
 
 8. Extension from vulva, 
 
 vagina, or urethra. 
 
 9. History of gonorrhea. 
 
 Less pain ; seldom blood 
 in urine. 
 
 — (Dudley's Gynecology.) 
 
 7. The causes of pelvic peritonitis are infection (generally 
 puerperal) and gonorrhea. 
 
 8. Salpingitis is diagnosed by; A dragging sensation in 
 the neighborhood of the affected tube; colicky pain, which 
 is increased on exertion or even on standing; abdominal 
 tenderness ; menstrual disorders, as amenorrhea, metror- 
 rhagia, dysmenorrhea, menorrhagia ; dyspareunia ; there 
 may be septic symptoms and peritonitis; sterility generally 
 ensues. On examination there will be found a fullness in 
 Douglas' pouch and one or both lateral fornices; in these 
 latter will be felt either the tubes, distorted and possibly 
 adherent, or a sausage-shaped tumor, which is very painful; 
 the uterus is retroverted or retroflexed, and may be bound 
 down by adhesions ; there may be an intermittent expul- 
 sion of pus accompanied and preceded by a burning pelvic 
 pain. 
 
 Tn appendicitis the pain is of sudden onset and is local- 
 
 670 
 
MEDICAL RECORD. 
 
 ized in the right iliac fossa; there is abdominal rigidity, 
 chiefly of the right rectus muscle, and tenderness at Mc- 
 Burney's point; there are usually fever, nausea, vomiting, 
 and constipation. 
 
 In oophoritis the pain is not localized, but may be bilat- 
 eral, and spreads to the vagina and rectum ; there is no 
 tenderness at McBurney's point; it is usually worse just 
 before the menstrual period, which sometimes affords re- 
 lief ; on vaginal examination the ovary is found to be 
 tender. 
 
 o. Hydrosalpinx: "The Fallopian tube is distended with 
 serous fluid, which has accumulated therein in consequence 
 of occlusion of the abdominal ostium as the result of a 
 previous attack of salpingitis. The walls are thin, and are 
 usually free from adhesions. The condition may be secon- 
 dary to pyosalpinx. The sac may attain a considerable 
 size (tuboovarian hydrocele). In hydrosalpinx proper the 
 ovary is felt as a distinct body at some spot on the bulging 
 wall of the cyst. This serves to disinguish it from cystic 
 distension of the ovary, in which the ovarian tissue is 
 spread out and cannot be readily identified. In one form 
 of hydrosalpinx the fluid escapes at intervals through the 
 uterine ostium. This condition is described as intermittent 
 hydrosalpinx. It is worthy of note that the uterine end 
 of the Fallopian tube is rarely obliterated in simple sal- 
 pingitis. 
 
 Hematosalpinx: "This term has hitherto been applied 
 to a condition now recognized to be due to tubal pregnancy. 
 In its present restricted sense it is applied to a distended 
 non-gravid Fallopian tube, containing blood or blood- 
 stained fluid. It is necessary to remember that bleeding 
 from the Fallopian tubes occurs from other causes than 
 tubal pregnancy, and that mere hemorrhage from a tube 
 does not constitute hematosalpinx. Hematosalpinx proper 
 may be due to regurgitation of blood from the uterus, or 
 to exudation from the mucous membrane, as in purpura, 
 scurvy, etc." — (From Aids to Gynecology.) 
 
 The diagnosis between hydrosalpinx and hematosalpinx 
 is as follows : 
 
 HYDROSALPINX. 
 
 i. Walls smooth and elastic. 
 
 2. Slower development. 
 
 3. Rupture may give relief. 
 
 HEMATOSALPINX. 
 
 i. Wall smooth and less 
 elastic. 
 
 2. Sudden development. 
 
 3. Rupture may cause dan- 
 
 gerous hemorrhage. 
 
 — (From Dudley's Gynecology.) 
 10. Parametritis is inflammation of the connective tissue 
 
 671 
 
MEDICAL RECORD. 
 
 surrounding the uterus, between the folds of the broad 
 ligaments. It is generally associated with some local 
 peritonitis. Causes: "(i) Septic infection after parturi- 
 tion or abortion. (2) Secondary to inflammatory affections 
 of uterus, tubes, or ovaries. (3) Direct injury (lacera- 
 tions) from the use of the uterine sound, caustics, pes- 
 saries, or tents, and after operations. 
 
 Symptoms: "It is ushered in by a chill, followed by 
 severe intrapelvic pain and tension, constitutional disturb- 
 ance, and fever (ioo° to 102 ). Defecation may be pain- 
 ful, the bowels may be constipated, or there may be un- 
 controllable diarrhea (the latter especially in puerperal 
 cases), with rectal tenesmus. Micturition may be difficult 
 and painful. Nausea, vomiting, and hiccough are com- 
 mon symptoms. If consequent on parturition, the lacteal 
 secretion is arrested, and the lochia cease, or become scanty 
 and fetid, or there may be hemorrhage. The patient lies 
 on the back, with the leg on affected side (or both) drawn 
 up. The mouth is dry; there is thirst and anorexia, and 
 the tongue becomes dry and brown. On examination the 
 vagina is hot, the os uteri is lower than normal, and in 
 post-partum cases it is patulous. It may be deviated from 
 its usual position to the opposite side to that on which 
 the effusion has taken place. The uterus is fixed and im- 
 movable, and the sensation has been likened to that of its 
 being embedded in plaster of Paris, the exudation extend- 
 ing downwards along the vaginal wall. There is much 
 tenderness, and the examination must be conducted with 
 gentleness. The induration may subsequently develop areas 
 of softening indicative of suppuration (pelvic abscess, ab- 
 scess of the broad ligament)." — (From Aids to Gynecol- 
 ogy.) 
 
 SURGERY. 
 
 i. An aneurysm is a pulsating sac containing blood, and 
 communicating with the lumen of an artery. 
 
 2. A fracture is a sudden solution in the continuity of a 
 bone or cartilage. 
 
 3. See Rose and Carless' "Surgery" (1908), page 235; or 
 Da Costa's "Surgery" (1908), pages 250 and 251. 
 
 4. See Rose and Carless' "Surgery" (1908), page 521; or 
 Da Costa's "Surgery" (1908), page 506. 
 
 5. See Rose and Carless' "Surgery" (1908), page 558; 
 or Da Costa's "Surgery" (1908), page 542. 
 
 6. See Rose and Carless' "Surgery" (1908), page 1315; 
 or Da Costa's "Surgery" (1908), page 1221. 
 
 7. See Rose and Carless' "Surgery" (1908), page 430; 
 or Da Costa's "Surgery" (1908), page 659. 
 
 8. See Rose and Carless' "Surgery" (1908), page 1134; 
 or Da Costa's "Surgery" (1908), page 1009. 
 
 672 
 
MEDICAL RECORD. 
 
 9. See Rose and Carless' "Surgery" (1908), page 1045; 
 or Da Costa's "Surgery" (1908), page 910. 
 
 10. See Rose and Carless' "Surgery" (1908). page 1059: 
 or Da Costa's "Surgery" (1908), page £qt. 
 
 HYGIENE. 
 
 1. *" Among the most common of the diseases and para- 
 s of animals which are communicable to man are: (1) 
 
 Glanders, a disease of the genus Eqitus, generally fatal 
 when contracted by man; (2) anthrax, a disease of horses, 
 cattle, sheep, and swine, appearing in man either as malig- 
 nant pustule or as internal anthrax, and often fatal; (3) 
 tuberculosis, a disease common in cattle and swine, but 
 also occurring in horses, sheep, goats, dogs, poultry, cage 
 birds, and menagerie animals; (4) rabies, a disease of the 
 genus Can is, communicable to all warm-blooded animals 
 and to man; (5) epizootic aphtha, commonly known as 
 foot-and-mouth disease, a very infectious malady of cattle, 
 sometimes communicated to the consumers of the milk of 
 diseased cattle; (6) Cysticerous bovis, found in cattle, 
 is the larval form of the tapeworm of man known as Tenia 
 saginata; (7) Cysticerous cellulose?, found in swine, is the 
 larval form of the tapeworm of man known as Tccnia 
 solium; (8) the Trichina spiralis, a common parasite of 
 swine, may develop in man and sometimes produces fatal 
 results; (9) the Echinococcus, found in the lungs, liver, 
 and other organs of the meat-producing animals, is the 
 cystic phase of the Tccnia echinococcus of the dog. 
 
 It is evident that the most satisfactory way of protecting 
 man from this source of danger is to eradicate these dis- 
 eases and parasites so far as possible from the domesticated 
 lals. As complete eradication cannot be accomplished 
 for many years and in some cases not at all, there must 
 be constant efforts for repression and control. People 
 must be made familiar with the dangers; too close asso- 
 ciation with animals should be avoided ; the inspection of 
 meat and of dairy cows should be universal ; swine tlesh 
 should be well cooked; hides, wool, and hair, often in- 
 fected with the anthrax bacillus, should be handled with 
 able precautions: biological products used for the pre- 
 vention or cure of human diseases should be surrounded 
 with everv safeguard to avoid contamination." — (Refer- 
 ence Handbook of the Medical Sciences.) 
 
 2. The alimentary principles of food, are: 
 
 I. Inorganic { ggf ■ 
 IT. Organic Kitrogenous-Proteids.^, 
 
 itroj 
 
 673 
 
 Non-Nitrogenous. { Carbohydrates. 
 
MEDICAL RECORD. 
 
 The function (and constituents) are shown in the fol- 
 lowing table, adapted from Notter and Firth's Hygiene: 
 
 FOOD. 
 
 Proteids. 
 
 i. All substances containing 
 nitrogen, of a compo- 
 position identical with, 
 or nearly that of albu- 
 min ; proportion of N to 
 C being nearly as 2 to 7. 
 
 FUNCTIONS. 
 
 2. 
 
 3> 
 
 Substances containing a 
 larger proportion of N 
 are apparently less nu- 
 tritious ; proportion of 
 N to C about 2 to 5J4. 
 
 Extractive matters, such 
 as are contained in the 
 jurce of the flesh. 
 
 Carbohydrates. 
 Substances containing no 
 N, but made up of C, H 
 and O ; the O being ex- 
 actly sufficient to con- 
 vert all the H into H 2 0. 
 Fats. 
 Substances containing no N, 
 but made up of C, H 
 and O; the proportion 
 of O being less than 
 sufficient to convert all 
 the H into H 2 0. 
 Salts. 
 
 Formation and repair of 
 tissues and fluids of the 
 body. 
 
 Regulation of the absorp- 
 tion and utilization of 
 oxygen. 
 
 May also form fat and car- 
 bohydrate, and yield en- 
 ergy sometimes. 
 
 In most foods the above, 
 both animal and vegeta- 
 ble, are largely convert- 
 ed into albumoses and 
 peptones during diges- 
 tion. 
 
 These perform the above 
 functions less perfectly, 
 or only under particular 
 circumstances. 
 
 These substances appear es- 
 sentially as regulators 
 of digestion and assimi- 
 lation, especially with 
 reference to the gelatin 
 group. 
 
 Production of energy and 
 animal heat by oxida- 
 tion. Form fats and 
 possibly some proteids. 
 
 Supply of fatty tissues, nu- 
 trition of nervous sys- 
 tem; supply of energy, 
 and animal heat by oxi- 
 dation. 
 
 Support of bony skeleton, 
 supply of HC1 for di- 
 gestion, regulation of 
 energy and nutrition. 
 
 The objects of cooking, are: (1) To destroy parasites, 
 and so avoid danger of infection ; (2) to break up the 
 starch grains, and so allow the digestive juices to come 
 in contact with the granulose; (3) to loosen the fibers of 
 
 674 
 
MEDICAL RECORD. 
 
 the meats, and so render them more accessible to the 
 digestive juices; also to convert the insoluble collagen into 
 soluble gelatin ; (4) to make the food more palatable, more 
 desirable and more digestible. 
 
 3. "The objects of clothing are, aside from motives of 
 decency, to protect the body from the sun's rays in hot 
 weather, from the chilling influence of winds in all 
 weathers, from rain and other forms of wet, and from 
 mechanical and other external injuries and discomforts; 
 to conserve the body temperature and prevent interference 
 with the natural functions of the skin; and, finally, to 
 adorn the persons." — (Harrington's Practical Hygiene.) 
 
 Cotton is durable, does not shrink, is non-absorbent, 
 and rapidly conducts away heat; hence it soaks up per- 
 spiration and becomes wet, and the moisture being re- 
 evaporated the surface of the body becomes chilled. 
 
 Linen is much the same, but worse. 
 
 Wool is a bad conductor of heat, is very absorbent of 
 moisture; so the body is not chilled. Its disadvantages are 
 that it gets hard, shrinks, and may absorb dirt. 
 
 Silk is a bad conductor of heat, is less absorbent than 
 wool, but more cleanly ; it shrinks less, and is less irritating 
 than wool ; it is expensive and not durable. 
 
 With regard to color: Black is the most absorbent of 
 heat, and white the least; in between are blue, green, red, 
 and yellow. Heat is reflected most by white, then by yel- 
 low, red, green, blue, and black. The color of underwear 
 is of no consequence. 
 
 Texture: The looser the texture the more the body 
 heat is preserved. Impermeable materials are very warm, 
 but retain the body moisture and excretions of the skin: 
 they are protective. 
 
 4. See French's "Practice of Medicine" (1907), page 309. 
 
 5. See French's "Practice of Medicine" (1907), page 5. 
 
 6. Typhoid is infectious; Typhus is infectious and con- 
 tagious ; Cholera is infectious ; Scarlet fever is infectious 
 and contagious; Smallpox is infectious and contagious; 
 Yellow fever is infectious. See index to French's or Osier's 
 "Practice," under heading of the various diseases. 
 
 7. Both fermentation and putrefaction are forms of de- 
 composition of organic matter under certain favorable con- 
 ditions. Y\ nen the organic matter is composed of carbon, 
 hydrogen, and oxygen only, the process is called fermenta- 
 tion ; when nitrogen and sulphur are also present, putre- 
 faction is said to occur. 
 
 Y\ nen a substance combines with oxygen the process is 
 called oxidation. 
 
 8. Deleterious gases which accumulate in an imperfectly 
 ventilated school room: Carbon dioxide, carbon monoxide, 
 marsh gas, ammonia. Three thousand cubic feet of fresh 
 
 675 
 
MEDICAL RECORD. 
 
 air is required per hour, or 500 cubic feet per minute. 
 Evil effects of inhaling impure air: Heaviness, headache, 
 nausea, listlessness, anemia, chlorosis, loss of appetite and 
 strength ; tendency to phthisis and other lung troubles, 
 and increased liability to acute infectious diseases. 
 
 9. Ptomains are basic compounds containing nitrogen. 
 and produced from proteid material by the bacteria which 
 cause putrefaction. They are found in decaying animal 
 tissues and fluids. 
 
 The chief poisonous ptomains are : Tyrotoxicon, myti- 
 lotoxin, cholin, neurin, neuridin, putrescin, cadaverin, ga- 
 dinin, muscarin, tetanin, typhotoxin. 
 
 The general symptoms of ptomain poisoning are: Onset 
 in less than twenty-four hours after the ingestion of the 
 noxious "food/' chilliness, vertigo, headache, thrist, ab- 
 dominal pains, nausea, vomiting, diarrhea, cyanosis, weak 
 and rapid pulse, cutaneous eruption sometimes, subnormal 
 temperature at times, convulsions. 
 
 10. See French's "Practice of Medicine" (1907), page 781. 
 
 MEDICAL JURISPRUDENCE. 
 
 1. By "last sickness'' is meant the time preceding death 
 when a person is so enfeebled (as the result of disease or 
 accident) that he does not temporarily recover, and which 
 is followed sooner or later by death. The expenses of 
 the last sickness are usually preferred debts, and the med- 
 ical attendant is, so far, a preferred creditor. 
 
 2. Human hair may be distinguished from fibers by mi- 
 croscopical examination. The hair will show the medul- 
 lary canal and lateral markings. From hair of other 
 animals: Animal hair is generally thicker, shorter, and 
 coarser than human hair. "In animals the medulla is 
 always present to an appreciable extent, and may occupy 
 sa large a portion of the hair as to leave the cortex very- 
 thin, while in man the medullary substance is much less 
 in proportion, and may be nearly, if not quite, absent. In 
 man the transverse lines are much more marked than in 
 animals." — ( Dwight. ) 
 
 3. The most important questions arising in connection 
 with gunshot wounds are: (1) Whether it was suicidal, 
 accidental, or homicidal ; (2) the location of the wound : 
 (3) the distance at which the shot was fired; (4) the 
 wound of entrance and of exit; (5) the deflection of the 
 course of the bullet; (6) the location of the bullet; (7) 
 the position of the individual when shot. 
 
 4. Death following burns may be due to : Asphyxia from 
 smoke or other vapors, absence of oxygen, inhalation of 
 flame, fright or injuries, shock, or direct destruction of 
 large part of the body. 
 
 676 
 
MEDICAL RECORD 
 
 5. To distinguish false from true pregnancy: Examine 
 the patient when she is under the influence of an anesthetic ; 
 the apparent tumor and muscular contractions will dis- 
 appear if it is a case of false pregnancy. 
 
 6. It may be very difficult or impossible to distinguish 
 between injuries to the head produced by accident during 
 delivery and those made with criminal intent. In the 
 former case the frontal and parietal bones are commonly 
 affected, on the vertex of the skull is a swelling containing 
 blood, there may be an effusion of blood into the cranial 
 cavity. In the latter case the fracture may affect any 
 bones, it is apt to be greater in extent, and the external 
 signs of violence are greater and more evident. 
 
 7. "Age of consent" is the age, fixed by law, under which 
 any carnal knowledge (or attempt at the same) of a 
 female, is rape ; no matter whether she consents or even 
 solicits. 
 
 8. "Expectation of life" means the number of years 
 which an individual of a given age, class, and profession. 
 or mode of life may expect to live. 
 
 9. "The duties of a coroner are both ministerial and 
 judicial — ministerial, as to become, ex-officio, sheriff when 
 the office of the latter has been vacated ; or to act as a 
 substitute for the sheriff, as when the latter officer is a 
 party himself. The duties, rights, and powers of the 
 sheriff will devolve upon the coroner when he assumes 
 these responsibilities. The judicial authority of the coroner 
 relates to inquiries into the unknown or unexplained causes 
 of sudden or violent death, by a jury of inquest, super 
 visum corporis. He can compel the attendance of wit- 
 nesses, and at the inquest he is fortified with all of the 
 ordinary power of a judicial officer. The common law 
 gives him authority to compel obedience to his subpenas. 
 The authority to .hold inquests extends beyond the terri- 
 torial jurisdiction of the coroner. For example, an in- 
 dividual dies in one county and is buried in another, and if. 
 on account of the suspicious nature of the death, an in- 
 quest becomes necessary, the coroner of the latter county 
 is the proper officer to conduct the proceedings. Besides 
 these duties the coroner is also invested with the further 
 power to inquire of other felonies, of treasure-trove, and 
 of wrecks. In the United States the coroner is elected 
 for a term of several years. The common law does not 
 permit of the appointment of a deputy coroner, though 
 most States in the Union have established statutory pro- 
 visions whereby the coroner has the power to make such 
 appointments. Coroners are excused from serving in 
 offices which might interfere with their duties of coroner, 
 and are further privileged from serving on juries, and from 
 arrest when employed in their official duties. On the other 
 
 677 
 
MEDICAL RECORD 
 
 hand, they are liable to punishment for wilful neglect of 
 duty and for wilful misconduct in the execution of their 
 office; in fact, they may be indicted. At any rate, they 
 make themselves liable to a criminal information for any 
 misconduct in taking an inquisition/' — (Herold's Legal 
 Medicine.^ 
 
 10. A wound (medicolegal) is an injury or lesion caused 
 by mechanical or chemical means. The most important 
 questions that arise in connection with wounds are: (i) 
 Was the wound the cause of death directly or indirectly? 
 (2) Was the wound accidental, suicidal, or homicidal, if 
 death results ; and if the patient does not die, was it acci- 
 dental, self-inflicted, or inflicted by another? (3) What 
 was the nature of the instrument by which the wound 
 was caused? (4) Was the wound made before or after 
 death?— (D wight.) 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Vermont State Board of Medical Registration. 
 
 anatomy. 
 
 1. Describe the bony pelvis, and state what bounds the 
 cavity of the true pelvis above. 
 
 2. Give the anatomy of the hip- joint. 
 
 3. Give origin, insertion, nerve supply, and action of the 
 pronator radii teres muscle. 
 
 4. Describe the circle of Willis. 
 
 5. Describe the peritoneum and its reflections. 
 
 6. Bound the axillary space, and name its contents. 
 
 7. Describe and bound the fourth ventricle. 
 
 8. Describe the prostate gland and give its relations. 
 
 9. Describe the male urethra. 
 
 10. Name the coverings of femoral hernia. 
 
 BACTERIOLOGY. 
 
 1. Classify bacteria, and name the two most -common 
 pyogenic bacteria. 
 
 2. Differentiate the gonococcus from other diplococci. 
 
 3. By what culture characteristics may the colon bacillus 
 be distinguished from the typhoid bacillus? 
 
 4. Describe the bacillus of Eberth, and give Widal's test 
 for typhoid fever. 
 
 5. What bacteria are liable to be mistaken for the tubercle 
 bacillus, and how may this error be avoided? 
 
 PHYSIOLOGY. 
 
 1. Describe ciliated epithelium and (a) state where it is 
 
 678 
 
MEDICAL RECORD. 
 
 found most abundant; (b) what is the function of ciliated 
 
 epithelium? 
 
 2. Name some of the bodily states which lessen the alka- 
 linity of the blood. 
 
 3. What is the office of the columnar carneae? 
 
 4. What post-mortem tests should be applied to prove 
 that air has entered the lungs of a supposedly stillborn 
 child? 
 
 5. Describe (a) the functions, and (b) secretions of the 
 stomach. 
 
 6. What is the function in digestion of (a) saliva, (b) 
 bile? 
 
 7. How do the products of digestion find their way into 
 the blood? 
 
 8. What is the cerebrospinal system of nerves, and to 
 what parts of the body are its fibers chiefly distributed? 
 
 9. State where in the human economy the following sub- 
 stances are found : fibrin, mucin, chondrin, leucin, hippuric 
 acid. 
 
 10. Name the structures in the body whose functions are 
 doubtful or unknown. 
 
 HYGIENE. 
 
 i. Into what general classes are foods divided? Give 
 examples of each. 
 
 2. Describe the physiological action of alcohol. 
 
 3. What hygienic precautions should be observed by a 
 pregnant woman? 
 
 4. If a chemical analysis of water revealed the presence 
 of nitrates and nitrites (a) would this condemn it for 
 drinking purposes? (b) If so, why? 
 
 5. Describe the preparation of patient, surgeon, instru- 
 ments, and surroundings for operative procedures. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 1. State properties, action, and preparations of tannic 
 acid. 
 
 2. Name four spinal stimulants and state the action of 
 such drugs. 
 
 3. Write a prescription for asthma, Basedow's disease, 
 infantile bronchitis. 
 
 4. How wouM you proceed if called to see a child (one 
 year) in convulsions? 
 
 5. Name three hypnotics, state action of each, and when 
 indicated. 
 
 6. Name varieties of expectorants, name three drugs 
 under each, and give dose of same. 
 
 7. How would you manage a case of (a) Lobar pneu- 
 monia in an adult? (b) Catarrhal pneumonia in a child 
 (six months) ? 
 
 679 
 
MEDICAL RECORD. 
 
 8. How would you manage a case of diabetes mellitus ? 
 
 9. Give your treatment, prophylactic and medicinal, for 
 a dilated heart. 
 
 10. Name three preparations of the following and state 
 incompatibles and indications for same : hydrastis, cinchona, 
 creosote, bromides. 
 
 11. Outline the general principles of treatment in a case 
 of poisoning. 
 
 CHEMISTRY. 
 
 Answer any five questions. 
 
 1. (a) State the physical and chemical properties of O. 
 (b) Mention four methods by which O may be obtained. 
 
 2. (a) How many oxides of N are known? Which forms 
 acid? (b) State composition properties and test for car 
 bonic acid. 
 
 3. (a) What elements does magnesium resemble? (b) 
 Complete MgC0 3 +H 2 S0 4 . 
 
 4. (a) What are alums and state four important ones. 
 (b) Describe and give diagnostic importance of Ehrlich's 
 diazo-reaction. 
 
 5 (a) State characteristics of the arsenic group of 
 metals, (b) Show by equations the formation of dibasic 
 acids from monobasic acid, from alcohol. 
 
 6. How is urea formed in the body. 
 
 7. What is acholia? W r hat is cystin? 
 
 PATHOLOGY. 
 
 1. (a) What are the causes of fever? (b) What are the 
 effects of fever? 
 
 2. (a) Mention all the pathological conditions which may 
 produce hemoptysis, (b) The same of hematemesis. 
 
 3. Give the pathology of tubercle. 
 
 4. Explain the propagation of tapeworm. 
 
 5. Mention the different varieties of goiter and give 
 their pathological differences. 
 
 PRACTICE OF MEDICINE. 
 
 i. How would you diagnose typhoid fever? 
 
 2. Give differential diagnosis between smallpox and 
 chickenpox. 
 
 3. Discuss the treatment of pulmonary tuberculosis 
 among the poor. 
 
 4. Give treatment for the different pleural effusions. 
 
 5. Give treatment for the two commonest of the valvular 
 heart lesions. 
 
 6. Discuss prognoses in cerebral embolism and cerebral 
 hemorrhage. 
 
 7. Write a short article on epilepsy. 
 
 8. Discuss intestinal neuroses. 
 
 680 
 
MEDICAL RECORD. 
 
 9. How would you manage a case of nervous prostra- 
 tion in a very poor family. 
 
 10. What are the comparative urinary findings in the 
 first stages of chronic parenchymatous and chronic inter- 
 stitial nephritis. 
 
 OBSTETRICS. 
 
 1. Describe the changes which occur in the external 
 genitals during pregnancy. 
 
 2. Give presumptive signs of pregnancy. Give positive 
 signs. How early during pregnancy would you expect to 
 be able to make a positive diagnosis? 
 
 3. Give symptoms and treatment of albuminuria of 
 pregnancy. 
 
 4. Describe in detail the preparation of the patient pend- 
 ing labor. 
 
 5. How would you resuscitate a child apparently still- 
 born? 
 
 6. Give diagnosis and management of a case of occipito- 
 posterior presentation. 
 
 7. In a tedious but otherwise normal labor, what are the 
 symptoms which would lead you to interfere? What would 
 you do? 
 
 8. Describe the varieties of placenta praevia. To what 
 dangers does the condition expose the mother and child? 
 How would you manage a case? 
 
 9. Give symptoms of impending eclampsia. How would 
 you treat a case? What would be your treatment should 
 convulsions ensue? 
 
 10. Name the more common pathogenic bacteria that 
 may infect a woman during the puerperium. To what con- 
 ditions may such infection give rise? 
 
 GYNECOLOGY. 
 
 1. Give symptoms of imperforate hymen. How would 
 you manage a case of long-retained discharges due to such 
 conditions? 
 
 2. Differentiate simple catarrh from gonorrheal vaginitis. 
 
 3. Define rectocele, cystocele, enterocele. 
 
 4. Give etiology, symptoms, and treatment of chronic 
 ovaritis. 
 
 5. What are the causes of uterine displacements? Which 
 one is of the greatest interest from the obstetrician's stand- 
 point? 
 
 SURGERY. 
 
 1. Name the different tumors of the breast, and describe 
 Halstead's operation for the removal of carcinoma of the 
 breast. 
 
 2. Diagnose fistula in ano and describe operation for its 
 
 cure. 
 
 681 
 
MEDICAL RECORD. 
 
 3. Give the symptoms of strangulated inguinal hernia. 
 What is taxis? How long should it be continued and how 
 soon abandoned? Describe Bassini's operation for the rad- 
 ical cure of inguinal hernia. 
 
 4. Give the etiology, pathology, and symptoms of em- 
 pyema and describe best operation for its cure. 
 
 5. Mention the articles you would require in administer- 
 ing ether, the accidents likely to occur, and methods for 
 their relief. 
 
 6. Differentiate hernia cerebri from caput succedaneum. 
 Give treatment of the latter. 
 
 7. Diagnose fracture of the patella and describe methods 
 of treatment. 
 
 8. Describe the various dislocations of the shoulder. 
 Give method for reducing one variety. 
 
 9. Give the symptoms and treatment for fracture at the 
 base of the skull. 
 
 10. Define osteomalacia and state its significance in 
 surgery. 
 
 LEGAL MEDICINE. 
 
 1. Define the term railway spine. 
 
 2. Describe the general characteristics of gunshot 
 wounds. 
 
 3. Differentiate paranoia and dementia paralytica. 
 
 4. What postmortem appearance would lead you to pro- 
 nounce that death was due to drowning? 
 
 5. What is rigor mortis, and tell how it is produced; 
 how long after death does it appear, and when does it 
 disappear? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Vermont State Board of Medical Registration. 
 
 anatomy. 
 
 1. See Cunningham's "Anatomy'' (1909), page 219; or 
 Gray's "Anatomy" (1908), page 209. 
 
 2. The hip-joint is an enarthrodial joint, formed by the 
 head of the femur and the acetabulum. The articular sur- 
 faces are covered with cartilage. Near the center of the 
 head of the femur is attached the ligamentum teres. The 
 ligaments are: (1) The capsular, which embraces the 
 margin of the acetabulum above, and the neck of the 
 femur below. (2) The ileo-femoral or Y ligament, which 
 passes obliquely across the front of the joint, and is at- 
 tached above to the anterior inferior spine of the ileum, 
 and bel^w to the anterior intertrochanteric line. (3) The 
 
 682 
 
MEDICAL RECORD 
 
 ligamentum teres. (4) The cotyloid ligament, which 
 deepens the acetabulum, and bridges over the cotyloid 
 notch, being there called (5) the transverse ligament. The 
 joint has a very extensive synoviol membrane. It is ca- 
 pable of the following movements : Flexion, extension, ab- 
 duction, adduction, circumduction, and rotation. 
 
 3. Pronator radii teres. Origin: Internal condyle and 
 supracondylar ridge of humerus, and the coronoid process 
 of ulna. Insertion: Middle of outer surface of radius. 
 Nerve supply: Median. Action: Pronation of hand, by 
 rotating radius upon ulna ; also slight flexion of forearm. 
 
 4. The Circle of Willis is formed : In front by the two 
 anterior cerebral arteries (branches of the internal caro- 
 tid), which are connected by the anterior communicating 
 artery; behind, by the two posterior cerebrals (branches 
 of the basilar artery), which are connected to the internal 
 carotid on each side by the posterior communicating artery. 
 
 5. See Cunningham's "Anatomy" (1909), page 1097; or 
 Gray's "Anatomy" (1908), page 1256. 
 
 6. The axillary space is bounded: Anteriorly, by the 
 clavicle, Subclavius, Pectoralis major, costocoracoid mem- 
 brane, Pectoralis minor; posteriorly, by the Subscapularis, 
 Teres major, and Latissimus dorsi; internally, by the first 
 four ribs, first three Intercostal muscles, Serratus magnus; 
 externally, by the humerus, Coracobrachialis, and Biceps. 
 
 Contents: Axillary vessels; brachial plexus of nerves, 
 and branches; some branches of the upper intercostal 
 nerves ; lymphatic glands, fat, and loose areolar tissue. 
 
 7. The fourth ventricle is the expanded portion of the 
 entral canal of the spinal cord; it is a diamond-shaped 
 
 cavity situated between the cerebellum behind, and the 
 posterior surface of the pons and medulla in front. It 
 is bounded: Above, by the valve of Vieussens and the 
 cerebellum. Below by the pons and medulla. Laterally, 
 by the superior peduncles of the cerebellum, restiform 
 bodies. 
 
 8. The prostate gland adjoins the neck of the bladder 
 and surrounds the beginning of the urethra, which is 
 placed nearer the anterior than the posterior surface of the 
 gland. It is said to resemble a horse-chestnut in shape, 
 with the apex directed downwards. It measures about 1^ 
 inches across its base and 1% inches in depth, and 1 inch 
 from before backwards, and is held in position by the 
 anterior true ligaments of the bladder. 
 
 The gland consists of three lobes, two lateral and one 
 middle, and is perforated from base to apex by the urethra. 
 The common seminal ducts open into the prostatic portion 
 of the urethra, and are placed between the middle and 
 lateral lobes. 
 
 683 
 
MEDICAL RECORD. 
 
 Relations: laterally, 
 
 anterior or pubic surface. Levator ani. 
 Symphysis pubis. base. 
 
 Anterior ligaments of blad- Surrounds bladder-neck. 
 
 der. Vesiculae seminales. 
 
 Branches of dorsal vein of Vasa deferentia. 
 
 penis. apex. 
 
 posterior surface. Rests on upper layer of tri- 
 
 Rectum. angular ligament. 
 
 9. See Cunningham's "Anatomy" (1909), page 1177; or 
 Gray's "Anatomy" (1908), page 1450. 
 
 10. The coverings of a femoral hernia, from without in- 
 ward, are : Skin, superficial fascia, cribriform fascia, crural 
 sheath, septum crurale, subserous areolar tissue, and perito- 
 neum. 
 
 BACTERIOLOGY. 
 
 1. Bacteria are classified: (1) Cocci; (2) Bacilli; and 
 (3) Spirilla. 
 
 Two most common pyogenic bacteria: Staphylococcus 
 pyogenes aureus and Streptococcus pyogenes. 
 
 2. The gonococcus is Gram-negative, is found inside the 
 pus cells, and will not grow on the ordinary media, but 
 only on serum. All of these will differentiate it from other 
 diplococci (except the meningococcus, and this latter may 
 be differentiated by its growth on ordinary media). 
 
 3. Cultural characteristics that differentiate the colon 
 bacillus and the typhoid bacillus: (1) On gelatin plates the 
 colonies of typhoid develop more slowly than those of 
 :olon bacillus. 
 
 (2) The colon bacillus causes fermentation with produc- 
 tion of gas in media which contain sugar; the typhoid 
 bacillus does not. 
 
 (3) The colon bacillus produces a strong acid reaction 
 and coagulates milk within twenty-four to forty-eight 
 hours ; the typhoid bacillus does not coagulate milk. 
 
 (4) In peptone solution the colon bacillus produces in- 
 dol ; the typhoid bacillus does not. 
 
 (5) The typhoid bacillus gives the Widal reaction with 
 typhoid serum ; the colon bacillus does not. 
 
 4. EbertWs bacillus is a rod-shaped organism, with 
 rounded ends, is from 2 to 4 mikrons in length, and about 
 three-fourths of a mikron in breadth ; it does not stain by 
 Gram's method, but stains with all the anilin dyes; it has 
 flagella, no spores, is aerobic and facultative anaerobic, and 
 is motile. 
 
 Widal's test: Three drops of blood are taken from the 
 well-washed aseptic finger tip or lobe of the ear, and each 
 lies by itself on a sterile slide, passed through a flame and 
 cooled just before use; this slide may be wrapped in cotton 
 and transported for examination at the laboratory. Here 
 
 684 
 
MEDICAL RECORD. 
 
 one drop is mixed with a large drop of sterile water, to re- 
 dissolve it. A drop from the summit of this is then mixed 
 with six drops of fresh broth culture of the bacillus (not 
 over twenty-four hours old) on a sterile slide. From this 
 a small drop of mingled culture and blood is placed in the 
 middle of a sterile cover-glass, and this is inverted over a 
 sterile hollow-ground slide and examined. A positive re- 
 action is obtained when all the bacilli present gather in one 
 or two masses or clumps, and cease their rapid movements 
 inside of twenty minutes. 
 
 5. The bacteria liable to be mistaken for the tubercle 
 bacillus are : The bacillus of leprosy, the bacillus of the 
 smegma, and Lustgarten's bacillus. "The differential diag- 
 nosis between these four organisms depends upon the fol- 
 lowing reactions : When stained by the carbol-fuchsin 
 method, commonly employed in staining the tubercle bacil- 
 lus, the Lustgarten's bacillus becomes almost instantly de- 
 colorized by treatment with mineral acids, particularly sul- 
 phuric acid ; whereas the smegma bacillus resists such 
 treatment for a much longer time, and the lepra and tuber- 
 cle bacillus for a still longer time. On the other hand, ii 
 decolorization is practised with alcohol instead of acids, the 
 smegma bacillus is the first to lose color. The bacillus 
 tuberculosis and the bacillus of leprosy are both very re- 
 tentive of their color, even after treatment with acids and 
 alcohol. If, then, we treat the preparation, stained with 
 carbol-fuchsin, with sulphuric acid, Lustgarten's bacillus be- 
 comes almost at once decolorized. If it is not immediately 
 decolorized, heat with alcohol ; if it is then decolorized, it 
 is the smegma bacillus. If it is still not decolorized, it is 
 either the leprosy or the tubercle bacillus/' — (From Park's 
 Pathogenic Bacteria.) 
 
 PHYSIOLOGY. 
 
 1. Ciliated epithelium generally consists of columnar 
 epithelial cells surmounted by fine, tapering filaments or 
 cilia ; these latter move to and fro, and produce a current. 
 
 (a) They are found in the upper air passages, Fallopian 
 tubes, ventricles of the brain, central canal of the spinal 
 cord, vasa efferentia, and the tail of the spermotozoon. 
 
 (b) Functions: To keep foreign particles out of the 
 respiratory tract, to assist the ovum in the Fallopian tube 
 onwards to the uterus, to enable the spermatozoa to pro- 
 gress ; generally — protection and motion. 
 
 2. The alkalinity of the blood is lessened by: Muscular 
 exertion, anemia, uremia, high fever, diabetes, and rheu- 
 matism. 
 
 3. The office of the Columnce carnece is: To prevent too 
 great dictation of the ventricles, to regulate their contrac- 
 tion, and to prevent the auriculo-ventricular valves from 
 being turned into the auricles. 
 
 68=; 
 
MEDICAL RECORD. 
 
 4. The hydrostatic test: "For the purpose of these tests 
 the lungs, heart, pericardium, and thymus should be re- 
 moved in mass and placed in a vessel containing water 
 several inches in depth, and the height to which the whole 
 mass floats noted. In thoroughly distended lungs there 
 will be sufficient buoyancy to float the entire mass, includ- 
 ing the heart and thymus. In purely fetal lungs the whole 
 mass will sink to the bottom. They are then held under 
 water, and with a sharp knife incisions are made into 
 various portions of the lung substance. If air or gas is 
 present small bubbles will be seen arising from the cut 
 surface through the water. The lungs are then detached 
 from the other organs and their buoyancy noted. In case 
 of fetal lungs they will still sink to the bottom. If the 
 buoyancy be not sufficient to float all of the organs in mass, 
 it may be just enough to float the lungs by themselves. 
 The lungs are then cut with scissors into small frag- 
 ments, perhaps one-half inch in diameter, and the buoy- 
 ancy of the separate fragments is noted. Those portions 
 which contain gas or air will now float; while if any 
 pieces are present which are in the fetal condition they 
 will sink. Those portions which have floated are then col- 
 lected in a towel or other cloth and a considerable amount 
 of pressure applied to them as by treading, in order 
 to see whether it is possible to express by this pressure 
 the gas or air which is contained in them, and they are 
 placed again in water. If they float now, it has been proved 
 that air or gas has thoroughly permeated the small bronchi 
 and air vessels." — (D wight's Medical Jurisprudence.) 
 
 5. Stomach, (a) Functions: To receive the food, to 
 secrete gastric juice, to mix the gastric juice with the food, 
 to digest the proteids, and to absorb such portion of the 
 food as is ready for absorption. 
 
 (b) Secretions: The gastric juice. This is a thin, color- 
 less fluid, acid in reaction owing to the presence of hydro- 
 chloric acid, specific gravity 1001 to 1010, and contains 
 about 1 per cent, of solids (pepsin, hydrochloric acid, a 
 curdling ferment, mucin, and salts). 
 
 6. The saliva (by its ptyalin) converts starches into 
 dextrose. The bile assists in emulsifying and saponifying 
 fats, and also in the absorption of fats; it also aids the 
 pancreatic secretion. 
 
 7. The products of digestion find their way into the 
 blood by two routes: (1) By the blood vessels of the 
 gastrointestinal tract, which unite to form the portal vein, 
 and (2) by the lymph vessels of the small intestine, which 
 converge to empty into the thoracic duct. The water, 
 inorganic salts, proteids, and sugar go by way of the portal 
 vein to the ascending vena cava; the fats go by way of the 
 
 686 
 
MEDICAL RECORD. 
 
 thoracic duct to the junction of the left subclavian and 
 internal jugular veins. 
 
 8. The cerebrospinal system of nerves consists of the 
 brain, spinal cord, and all the nerves connected with the 
 brain and spinal cord; i.e. all except the sympathetic 
 nervous system. 
 
 Its fibers are distributed to the voluntary muscles, the 
 organs of special sense, and the parts endowed with 
 sensibility. 
 
 9. Fibrin is found in the blood and lymph; mucin, in 
 saliva and syuovial fluid; chondrin, in bone and cartilage; 
 leucin, in the pancreas and spleen; hippuric acid, in the 
 urine. 
 
 10. Structures of doubtful or unknown function: Spleen, 
 thyroid, thymus, parathyroids, suprarenals, pituitary body, 
 carotid and coccygeal glands. 
 
 HYGIENE. 
 
 i. Foods are divided into: 
 I. Inorganic. / Water. 
 * Salts. 
 
 Non-nitrogenous, < Carbohydrates. 
 II. Organic. \ { Fats. 
 
 ( Nitrogenous — Proteids. 
 
 Example of each : Carbohydrate, sugar ; Fat, fat of 
 meat; Proteid, flesh of animals; Salt, sodium of chloride. 
 
 2. Physiological action of alcohol. Nervous system: 
 Alcohol is first a powerful excitant, afterward a depres- 
 sant ; it increases the reflex activity of spinal cord, muscles, 
 and nerves; in large doses it produces lack of co-ordina- 
 tion. Circulatory system: It stimulates the heart muscle 
 and increases the rapidity and force of the heart beat; 
 there is a rise of arterial pressure. Respiration is stimu- 
 lated by small doses, and decreased by large ones. Tem- 
 perature: Alcohol produces a sensation of warmth, and 
 warms the extremities by causing the heart to pump hot 
 blood from the center of the body to the cold parts. If 
 used in excess the temperature rapidly falls, owing to in- 
 crease of heat radiation and to depression of vital power. 
 Bodily metabolism: Elimination of C0 2 is generally in- 
 creased ; the effect on absorption of O is not known. It 
 adds force but not tissue to the body. Elimination: It is 
 largely burnt up in the body, but in excessive doses it is 
 eliminated by the breath, skin, kidneys, and intestines. 
 Digestion is aided by moderate doses, but is disordered by 
 large amounts. (From Hare's Therapeutics.) 
 
 3. See Williams' "Obstetrics" (1909), page 199; or Hirst's 
 "Obstetrics'' (1909), page 188. 
 
 4. Nitrates are generally due to the oxidation of organic 
 matter of animal origin. 
 
 687 
 
MEDICAL RECORD. 
 
 Nitrites generally indicate sewage contamination. The 
 presence of nitrites should condemn the water; so should 
 a marked amount of nitrates. 
 
 5. See Rose and Carless' "Surgery" (1908), page 264; or 
 Da Costa's "Surgery" (1908), page 50. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. Tannic acid. Properties: A light amorphous powder, 
 with slight odor and astringent taste; it gets darker on 
 exposure to air and light. 
 
 Action: Astringent and hemostatic; it will precipitate 
 albumins ; it is an antidote to antimony and some alkaloids. 
 
 Preparations: Glycerite of tannic acid, ointment of 
 tannic acid, troches of tannic acid, and styptic collodion. 
 
 2. Four spinal stimulants: Strychnine, brucine, ammonia, 
 and thebaine. 
 
 The action: They increase the irritability of the anterior 
 cornua of the spinal cord. 
 
 3. For asthma: 
 ]$. Sodii iodidi. 
 
 Tincturae belladonnas foliorum. 
 Tincturse hyoscyami. 
 Tincturas lobeliae, aa 3ij. 
 Syrupi pruni virginianse, q.s. ad Jiij. M. 
 Signa: Take one teaspoonful, in water, four times 
 a day. 
 For Basedow's disease: 
 #. Extracti opii, gr. v. 
 
 Extracti belladonnas foliorum, gr. iv. 
 Extracti ergotas, 3jss. M. 
 Fiat massa in pilulas no. xx dividenda. 
 Signa : Take one pill after each meal. 
 For infantile bronchitis: 
 
 #. Antimonii et potassii tartratis, gr. J^. 
 Pulveris ipecacuanhas, gr. J4. 
 Ammonii chloridi, gr. v. M. 
 Ft. in chart, no. xx. 
 
 Signa: Take one every two hours (eight in twenty- 
 four hours). 
 
 4. See French's "Practice of Medicine" (1907), P a & e 
 1 124; or Osier's "Practice of Medicine" (1909), page 1058. 
 
 5. Three important hypnotics: (1) Chloral hydrate; 
 (2) Sulphonal; (3) Trional. 
 
 Indications: They are all used to produce sleep (when 
 no pain is present). 
 
 Chloral hydrate produces a natural sleep, acts promptly, 
 but is of no service if pain is present; it also lowers the 
 body temperature. It can be given for a long time without 
 deleterious effect, but it may irritate the tissues and weaken 
 the heart. 
 
 688 
 
MEDICAL RECORD. 
 
 Sulphonal produces a natural sleep, but is of slow action, 
 requiring three or four hours to take effect ; it is of no use 
 if pain is present, does not irritate the tissues and weaken 
 the heart, but is probably not so good for continuous use 
 as chloral hydrate, though the two may replace each other 
 for a time. 
 
 Trional is very similar to sulphonal, but is more soluble, 
 and acts quicker. Both sulphonal and trional are supposed 
 to be safer than chloral. 
 
 6. Expectorants are classified as : 
 
 (i) Xauseating or Sedative, as Tartar emetic, dose gr. 
 y 2 ; apomorphine hydrochloride, dose % ; and ipecac, dose 
 TT£xx (of the fluid extract). 
 
 (2) Stimulating, as Ammonium chloride, dose gr. viij ; 
 balsam of Tolu, dose gr. xx; senega, dose gr. xv. 
 
 7. See French's "Practice of Medicine" (1907), pages 
 174 and 674; or Osier's "Practice of Medicine" (1909). 
 pages 189 and 626. 
 
 8. See French's "Practice of Medicine" (1907), page 944; 
 or Osier's "Practice of Medicine" (1909), page 420. 
 
 9. See French's "Practice of Medicine" (1907), page 602; 
 or Osier's "Practice of Medicine" (1909), page 828. 
 
 10. Hydrastis. Three preparations: Fluidextract, tinc- 
 ture, and glycerite. Incompatibles: Alkalies, mineral acids, 
 tannic acid, and other vegetable acids. Indications: Non- 
 acute inflammations of mucous membranes, catarrh of 
 stomach or intestines, dysmenorrhea, menorrhagia. intes- 
 tinal indigestion. 
 
 Cinchona. Three preparations: Quinine sulphate, bisul- 
 phate, and hydrobromide. Incompatibles: Tannic acid, 
 alkalies, alkaline earths, iodine. Indications: Malaria, 
 hay fever, whooping cough, chronic cystitis, digestive dis- 
 turbances. 
 
 Creosote. Preparation: The water is the only oflicial 
 preparation. Incompatibles: Sulphuric and nitric acids, sil- 
 ver salts. Indications: As an antipruritic, phthisis, chronic 
 bronchitis, congestion of trachea or larynx. 
 
 Bromides. Preparations: Potassium, sodium, ammo- 
 nium, lithium, calcium, zinc, and strontium bromides ; di- 
 luted hydrobromic acid and bromoform. Incompatibles: 
 Acids, acid salts, metallic salts (spirit of nitrous ether is 
 incompatible with ammonium bromide). Indications: Epi- 
 lepsy, insomnia, nervousness, neuralgia, hysteria, migraine, 
 delirium tremens, sea-sickness. 
 
 11. General principles of treatment in poisoning: "(1) 
 Lose no time. (2) Use the best remedy obtainable at 
 once. (3) Get rid of the poison. (4) Stop its action. 
 (5) Remedy the mischief already done. (6) Fight against 
 the tendency to death (Tanner). In the treatment of 
 
 689 
 
MEDICAL RECORD. 
 
 poisoning, whether by mineral or vegetable substances, if 
 the poison is known the first indication is to administer 
 the proper chemical antidote, so as to render it harmless 
 or comparatively so. Next, the stomach should be emptied 
 and washed out, lest the newly formed compound be ab- 
 sorbed after a time, also to remove any poison which may 
 have escaped the action of the antidote. Next, the ap- 
 propriate antagonist should be administered to counteract 
 the effects of such portion of the poison as may have been 
 absorbed. Lastly, such antagonistic measures should ^ be 
 employed as may sustain the action of any organic function 
 showing signs of failure. In most cases of alkaloid poison- 
 ing absorption has proceeded so far before professional 
 assistance is obtained that antidotes are of no value, hence 
 reliance can be placed only upon the physiological antagon- 
 ist and such supporting measures as will tend to maintain 
 vitality until the poison can be eliminated by the natural 
 channels. "—(Potter's Materia Medica, etc.) 
 
 CHEMISTRY. 
 
 I. Oxygen. Properties: Oxygen is a colorless, odorless, 
 tasteless gas, slightly soluble in water, heavier than air. 
 It has a strong tendency to combine with other elements, 
 and forms binary compounds with all elements except 
 fluorine and bromine. Oxygen is necessary to the processes 
 of life and combustion. 
 
 Preparation: (i) By heating potassium chlorate: 
 
 2KC10 3 =:2KCl + 30 2 
 
 (2) By heating manganese dioxide: 
 
 3Mn0 2 = Mn 8 0* + O a 
 
 (3) By the action of sulphuric acid on manganese 
 dioxide : 
 
 2Mn0 2 + 2H 2 S04 = 2MnS0* + 2H a O + 2 
 
 (4) By the action of water upon sodium dioxide : 
 
 2Na 2 O a + 2H 2 = 4NaHO + 2 
 2 (a) There are five oxides of nitrogen known : Nitro- 
 gen monoxide, N 2 ; nitrogen dioxide, N a 2 , or NO ; nitro- 
 gen trioxide, N 2 3 ; nitrogen tetroxide, N a 4 , and nitrogen 
 pentoxide, N2O5. Of these, the trioxide and the pentoxide 
 form acids. 
 
 (b) Carbonic acid, formula H 2 COs, does not exist free, 
 but is decomposed as soon as liberated into C0 2 and H 2 0. 
 Carbon dioxide, CO a , is often (improperly) called car- 
 bonic acid ; but this could hardly happen on an examination 
 paper in chemistry. 
 
 3. Magnesium resembles zinc and cadium : 
 
 MgCOa + H.SO* = MgSO* + CO. + H a O 
 
 4. (a) Alums are double sulphates of the alkaline metals 
 and the aluminum or iron group. 
 
 Four important alums: Aluminum potassium sulphate; 
 
 690 
 
MEDICAL RECORD 
 
 aluminum ammonium sulphate; ferric sodium sulphate, 
 and chromic ammonium sulphate. 
 
 (b) For Ehrlich's diazo reaction two solutions are re- 
 quired: (i) A saturated solution of sulphanilic acid in a 
 mixture of 50 c.c. of hydrochloric acid and 950 c.c. of 
 water, and (2) a 0.5 per cent, solution of sodium nitrite. 
 
 To make the test, 1 c.c. of (2) is added to 40 c.c. of (1), 
 and the mixture thoroughly shaken. Equal quantities of 
 this mixture and the urine to be tested are shaken to- 
 gether in a test tube, and 1 c.c. of ammonia is then floated 
 upon the surface, when, in an affirmative result, a red band 
 is formed at the junction of the fluids. 
 
 Its diagnostic value is uncertain. Von Jaksch "disclaims 
 tor this test any clinical _ importance whatever." Others 
 have claimed that the reaction is pathognomonic of typhoid, 
 but it has been found in other diseases besides typhoid — 
 namely, phthisis, pneumonia, measles, scarlet fever, small- 
 pox and malaria. 
 
 5. (a) The answer to this question will depend upon the 
 text book used by the student (or examiner). Witthaus 
 puts arsenic in the same group with nitrogen, phosphorus, 
 and antimony; Remsen, in the same group with nitrogen, 
 phosphorus, antimony, and bismuth; Simon, in the same 
 group with antimony, tin, gold, platinum, and molybdenum ; 
 Holland, in the same group with antimony and tin. 
 
 According to the first of these groupings the arsenic 
 group is trivalent or quinquivalent; with hydrogen non- 
 acid compounds are formed, composed of one atom of the 
 element in the gaseous state with three atoms of hydrogen ; 
 two oxides are formed, the trioxide and the pentoxide ; 
 they are poisonous. 
 (b) 2CR2 Br. COOH + Ag 2 — 2AgBr + C 2 H 4 (COOH) 2 
 (Bromacetic acid) (Succinic acid) 
 
 CH 2 OH. CH 2 OH + 2O2 = 2H 2 + COOH. COOH 
 (Ethene glycol) - (Oxalic acid) 
 
 6. Urea is the end product of the proteid metabolism of 
 the body. This metabolism is chiefly carried on in the 
 muscles. It is not known in what form nitrogen leaves the 
 muscles, but it is believed that the final products of muscle 
 metabolism are ammonia and sarcolactic acid. Hence it is 
 probable that nitrogen leaves the muscles as ammonium 
 lactate. The tissues convert combinations of organic acids 
 and ammonia into carbonates; these are dehydrated in the 
 liver, so that ammonium carbonate becomes ammonium 
 carbamate, and this by further dehydration becomes urea. 
 The following formulae show this relationship, and how 
 the loss of one molecule of water converts ammonium car- 
 bonate into carbamate, and the loss of a second molecule 
 of water produces urea : 
 
 691 
 
MEDICAL RECORD. 
 
 rn /O.NH4 rn /NH 2 m/ NH ^ 
 
 NH 4 Carbonate. NH 4 Carbamate. Urea. 
 
 7. Acholia is absence of the secretion of bile. 
 Cystin is (chemically) diamido-beta-dithio-dilactic acid. 
 It is found in urinary sediments and calculi. 
 
 PATHOLOGY. 
 
 1. (a) Causes of fever: Disturbance of the heat-regulat- 
 ing centers, either directly or by toxic substances circulating 
 in the blood. These latter may come from bacteria, or 
 may be due to disordered metabolism, or to chemical or 
 mechanical injury of the tissues. 
 
 (b) Effects of fever: Loss of appetite, thirst, emacia- 
 tion, disturbance of function, the alkalinity of the blood is 
 lessened; degenerative changes such as cloudy swelling, 
 fatty degeneration, and coagulation necrosis may occur in 
 the tissues, particularly in the heart, liver, kidneys, and 
 muscles. 
 
 2. (a) The causes of Hemoptysis: Traumatism; certain 
 organic diseases of the lung, especially tuberculosis, lobar 
 pneumonia, bronchiectasis, gangrene, infarct, and cancer. 
 Passive congestion, the result of heart disease, especially 
 mitral lesions ; rupture of aortic aneurysm ; diseases pro- 
 foundly affecting the blood, such as purpura, hemophilia, 
 scurvy, and leukemia; ulcers, traumatic, syphilitic, or ma- 
 lignant of the trachea or larynx; and vicarious menstrua- 
 tion (very rare). 
 
 (b) The causes of Hematemesis: Traumatism; gastric 
 ulcer; gastric cancer; venous engorgement of the stomach 
 following cirrhosis of the liver, primary splenomegaly, or 
 chronic heart disease; acute gastritis; blood dyscrasia, as 
 in scurvy, purpura, severe infections, and grave anemias ; 
 rupture of aneurysm; swallowing of blood from nose, 
 mouth, or throat; vicarious menstruation; hysteria. — (From 
 Steven's Practice.) 
 
 3. See Rose and Carless' ''Surgery" (1908), page 166; 
 or Da Costa's "Surgery" (1908), page 213. 
 
 4. See French's "Practice of Medicine" (1907), page 473. 
 
 5. See French's "Practice of Medicine" (1907), page 546; 
 or Osier's "Practice of Medicine" (1909), page 763. 
 
 PRACTICE OF MEDICINE. 
 
 i. See French's "Practice of Medicine" (1907), page 101 ; 
 or Osier's "Practice of Medicine" U909), page 93. 
 
 2. (1) Very young children are attacked with varicella, 
 whereas variola usually shows itself in adults. (2) Vac- 
 cinated children readily take varicella ; not so variola, even 
 in the modified form. (3) Children who have had varicella 
 may contract variola, even soon afterwards; or the two 
 
 692 
 
MEDICAL RECORD. 
 
 diseases may coexist. (4) Varicella is noninoculable, 
 whereas variola is notoriously so. (5) The eruption of 
 varicella appears in twenty-four hours; that of variola not 
 till the third day. (6) The febrile symptoms continue after 
 the eruption appears in varicella; those of variola subside. 
 (7) In varicella the spots come out in successive crops; 
 this is never seen in variola. (8) The spots in varicella 
 are unilocular, and collapse on being punctured; the spots 
 in variola are multilocular, and do not collapse on being 
 punctured. (9) In varicella the eruption is very irregular, 
 and appears over the body generally; in variola it appears 
 in groups of threes and fives, and is always seen on the 
 limbs; (10) The papule in varicella is soft, and disappears 
 on stretching the skin ; in variola it is hard and shotty, and 
 does not disappear on stretching the skin. — (From J. W. 
 Moore's work on Variola and Varicella.) 
 
 3. See French's ''Practice of Medicine" (1907), page 391; 
 or Osier's "Practice of Medicine" (1909), page 352. 
 
 4. See French's ''Practice of Medicine" (1907), page 
 699; or Osier's "Practice of Medicine" (1909), page 653. 
 
 5. See French's "Practice of Medicine" (1907), page 592; 
 or Osier's "Practice of Medicine" (1909), page 816. 
 
 6. See French's "Practice of Medicine" (1907), pages 
 1076 and 1082; or Osier's "Practice of Medicine" (1909), 
 page 9/6. 
 
 7. See French's "Practice of Medicine" (1907), page 
 1125; or Osier's "Practice of Medicine" (1909), page 1058. 
 
 8. See French's "Practice of Medicine" (1907), page 
 
 -78. 
 
 9. See French's "Practice of Medicine" (1907), page 
 1 150; or Osier's "Practice of Medicine" (1909), page 1093. 
 
 10. See French's "Practice of Medicine" (1907), pages 
 899 and 903; or Osier's "Practice of Medicine" (1909). 
 pages 693 and 697. , 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), page 169; or Hirst's 
 "Obstetrics" (1909), page 185. 
 
 2. Presumptive signs of pregnancy: (1) Progressive en- 
 largement of the uterus; (2) Hegar's sign; (3) Braxton 
 Hick's sign; (4) uterine murmur; (5) cessation of men- 
 struation; (6) changes in the breasts; (7) discoloration of 
 the vagina and cervix; (8) pigmentation and striae: (9) 
 morning sickness. 
 
 Positive signs of pregnancy: (1) Hearing the fetal heart 
 sound; (2) active movements of the fetus; (3) ballotte- 
 ment; (4) outlining the fetus in whole or part by palpa- 
 tion; and (5) the umbilical or funic souffle. 
 
 A "positive diagnosis can very rarely be made before the 
 
 693 
 
MEDICAL RECORD. 
 
 sixteenth week; often not till the eighteenth or twentieth 
 week. 
 
 3. See Williams' "Obstetrics" (1909), pages 520 and 172; 
 or Hirst's "Obstetrics" (1909), page 253. 
 
 4. See Williams' "Obstetrics" (1909), page 303; or Hirst's 
 "Obstetrics" (1909), page 326. 
 
 5. See Williams' "Obstetrics" (1909), page 846; or Hirst's 
 ''Obstetrics" (1909), page 939. 
 
 6. A diagnosis of occipito-posterior position may be based 
 on : Finding the sagittal suture in the oblique diameter of 
 the pelvis, the posterior fontanelle in the posterior half 
 of the pelvis, the anterior fontanelle is easily accessible; 
 the fetal heart sounds are heard far back in the flank, 
 between the ribs and the crest of the ilium ; the fetal head 
 may be felt above the pelvic brim, and the fetal small parts 
 are felt through the anterior abdominal walls of the mother, 
 while the fetal back is not felt. 
 
 Management: See Williams' "Obstetrics" (1909), page 
 267; or Hirst's "Obstetrics" (1909), page 407. 
 
 7. See Williams' "Obstetrics" (1909), page 658; or Hirst's 
 "Obstetrics" (1909), page 439. 
 
 8. See Williams' "Obstetrics" (1909), page 809; or Hirst's 
 "Obstetrics" (1909), page 572. 
 
 9. The danger signals of impending eclampsia are : Head- 
 ache ; tinnitus aurium ; dizziness ; pain over stomach ; diges- 
 tive, visual, and nervous disturbances; general debility; 
 insomnia, vomiting, and vertigo. For preventive treatment: 
 (1) The amount of nitrogenous food should be diminished 
 to a minimum; (2) the production and absorption of 
 poisonous materials in the intestines and body tissues 
 should be limited and their elimination should be aided 
 by improving the action of the bowels, the kidneys, the 
 liver, the skin, and the lungs; (3) the source of the fetal 
 metabolic products and the peripheral irritation ^ in the 
 uterus should, if necessary, be removed by evacuating that 
 organ. The curative treatment includes: (1) Controlling 
 the convulsions (by chloroform, veratrum, or chloral) ; (2) 
 elimination of the poison or poisons which are presumed 
 to cause the convulsions ; (3) emptying the uterus under 
 deep anesthesia, by some method that is rapid and that 
 will cause as little injury to the woman as possible. 
 
 10. See Williams' "Obstetrics" (1909), page 857; or 
 Hirst's "Obstetrics" (1909), page 725. 
 
 GYNECOLOGY. 
 
 1. Imperforate hymen. Symptoms: Non-appearance of 
 menstruation ; presence of a bulging tumor in perineum, 
 extending to vagina and uterus ; severe pain at menstrual 
 period. Treatment : Conical incision, edges of which should 
 
 694 
 
MEDICAL RECORD. 
 
 be united by a running catgut suture; followed by anti- 
 septic douche. 
 
 2. Gonorrheal vaginitis is diagnosed by the finding of the 
 gonococci in the discharge. 
 
 3. Cystocele is a hernia of part of the bladder into the 
 vagina, covered by the mucous membrane of the anterior 
 vaginal wall. Rectocele is a hernia of the rectum into the 
 vagina, covered by the mucous membrane of the posterior 
 vaginal wall. The two conditions are generally found to- 
 gether. Enterocele is a hernia of the small intestine. 
 
 4. Chronic ovaritis. Etiology: Continuance of the acute 
 form. Excessive or violent sexual intercourse. Masturba- 
 tion. Suppressed menstruation. Operations upon the cer- 
 vix. Symptoms: A constant dragging pain, increased be- 
 fore menstruation, particularly on motion, riding, or mak- 
 ing a misstep. The pain is greatest over the affected 
 ovary, but radiates to the lumbar region, along the spine, 
 down the thighs, and frequently in one or both mammary 
 glands. Headache is an almost constant symptom. Pain- 
 ful micturition, defecation, and sexual intercourse usually 
 appear also as symptoms. The menstruation is increased, 
 amounting to menorrhagia. Hysteria or hysteroepilepsy 
 is not uncommon. When both ovaries are diseased sterility 
 occurs. Treatment: Rest in bed, particularly during the 
 menstrual periods. Abstinence from sexual intercourse. 
 Copious vaginal injections of hot water twice daily are 
 of service in reducing congestion, and to further aid in 
 this object the cervix and vaginal vault should be painted 
 with iodine twice or thrice a week. Leeches may be ap- 
 plied to the abdomen over the affected ovary or to the 
 cervix, if pain is great. Blisters over the ovaries or mer- 
 curial inunctions frequently do good. Internally, the ad- 
 ministration of iodid or chlorate of potassium or the 
 bromids are of service. — (From Wells* Compend of Gyne- 
 cology.) 
 
 5. Uterine displacements may be due to: Relaxation of 
 uterine ligaments ; increased weight of fundus ; subinvolu- 
 tion ; ovarian or other tumor pressing on uterus ; distended 
 bladder ; peritonitis or cystitis ; prolonged dorsal decubitus ; 
 tight bandaging in the puerperium. Tight lacing and tight 
 clothine: congenital conditions; metritis and parametritis 
 with adhesions ; atonic conditions of the uterus following 
 labor, and errors of development. Retroversion and retro- 
 flexion are of the greatest obstetrical interest. 
 
 surgery. 
 
 1. See Rose and Carless' "Surgery" (1908), pages 945 
 and 956: or Da Costa's "Surgery" (1908), pages 1231 and 
 1236.* 
 
 095 
 
MEDICAL RECORD. 
 
 2. See Rose and Carless' "Surgery" (1908), page 1134; 
 or Da Costa's "Surgery" (1908), page 1009. 
 
 3. See Rose and Carless' "Surgery" (1908), pages 1096, 
 1099, 1 100, and 1 081 ; or Da Costa's "Surgery" (1908), 
 pages 992, 995, and 978. 
 
 4. Empyema. Etiology : Wounds, injuries, pleuropneu- 
 monia, direct extension of a suppurative process in the 
 lung, abdomen, or neck. The bacteria will vary with the 
 cause; Diplococc'us pneumonia is the commonest; tubercle 
 bacillus, staphylococcus, streptococcus, Colon bacillus may 
 also be present. 
 
 Pathology: The organisms causing it are pneumococci, 
 streptococci, staphylococci, tubercle bacilli, Bacillus coli t 
 and actinomycosis. 
 
 The physical signs are those of fluid in the pleural cavity; 
 that side does not move well, the percussion note is dull, 
 there is absence of breath sounds, vocal fremitus and reso- 
 nance are diminished. Left alone, an empyema may burst 
 through an intercostal space, usually the fifth. The lung is 
 collapsed in extent according to the amount of pus. The 
 pleura, at first covered with lymph, soon becomes covered 
 with layers of granulation tissue, the deeper part of which 
 is converted into fibrocicatricial tissue, and the lung itself 
 also undergoes some fibroid change. If the pus is let out 
 early the lung and pleura soon expand, but if allowed to 
 go on the infiltration of the lung and the density of the 
 scar tissue covering it hinder expansion. Nature attempts 
 to remedy this in various ways. (1) The other lung ex- 
 pands and pushes the heart over to the opposite side; (2) 
 the chest wall falls in, the intercostal spaces are obliterated, 
 and the spine is curved, with its concavity toward that 
 side; (3) the abdominal viscera are pushed up; and (4) 
 exuberant granulations form on the pleura. If a cavity 
 still remains an operation is necessary. 
 
 Symptoms: Fever, sweats, chill, diminished breath 
 sounds and vocal fremitus, impaired mobility of chest, 
 dullness on affected side, heart displaced to opposite side, 
 leucocytosis. 
 
 Treatment: Aspiration, drainage, irrigation, resection 
 of ribs (Estlander's operation), or resection of chest wall 
 (Schede's operation). 
 
 5. See Rose and Carless' "Surgery" (1908), pages 1323, 
 etc.; or Da Costa's "Surgery" (1908), pages 1031 and 1034. 
 
 6. See Rose and Carless' "Surgery" (1908), page 791; 
 and Da Costa's "Surgery" (1908), page 690. 
 
 7. See Rose and Carless' "Surgery" (1908), page 550; 
 or Da Costa's "Surgery" (1908), page 533. 
 
 8. The various dislocations of the shoulder joint are: 
 (1) Subcoracoid — forward, inward, and downward. (2) 
 Subglenoid — downward, forward, and inward. (3) Sub- 
 
 696 
 
MEDICAL RECORD. 
 
 spinous — backward, inward, and downward. (4) Subclav- 
 icular — forward, inward, and upward. 
 
 The special diagnostic signs are: (1) Subcoracoid: The 
 head of the humerus is felt below the outer end of the 
 clavicle ; there is little or no shortening of the limb ; the 
 elbow is directed outward and backward. 
 
 (2) Subglenoid: The head of the humerus can be felt 
 in the axilla ; the arm is decidedly lengthened ; the elbow 
 is flexed, and there are signs of pressure on vessels and 
 nerves 
 
 (3) Subspinous : The head of the humerus is felt below 
 the acromion process and behind; the arm is rotated in- 
 ward, and the elbow is displaced outward. 
 
 (4) Subclavicular: The head of the humerus is felt 
 below the clavicle; the elbow is far from the side, and the 
 limb may be shortened. 
 
 Kocher's method of reduction is : to flex the forearm, 
 press the elbow to the side, rotate the arm outward. Bring 
 the arm forward and upward to a right angle with the 
 body, then rotate inward, while the elbow is brought down 
 over the body so that the fingers sweep the opposite 
 shoulder. 
 
 9. See Rose and Carless ? "Surgery" (1908), page 745; or 
 Da Costa's "Surgery" (1908), page 709. 
 
 10. Osteomalacia consists in a softening of the bone tis- 
 sues; it is found in the fully formed adult bones; there is 
 great possibility of bending or fracture of bones, with con- 
 siderable deformity. It may prove a serious obstacle to 
 parturition. 
 
 LEGAL MEDICINE. 
 
 i. Railway spine is defined as "the series of nervous 
 symptoms developed from shock produced by a railway 
 accident, or from the concussion produced by constant 
 travel." 
 
 2. Gunshot wounds "differ from ordinary punctured and 
 penetrating wounds in that the tissues immediately sur- 
 rounding the canal through which the projectile passed 
 are so contused and injured as to result in their death. 
 For this reason the canal resulting from a gunshot wound 
 does not heal by first intention, and is particularly liable to 
 infection and sloughing. Gunshot wounds, on account of 
 the velocity of the projectile and the degree of propelling 
 force, are associated with a greater amount of shock than 
 would result from the same wound from other causes." — 
 (Dwight's Medical Jurisprudence.) 
 
 3. Paranoia "is a form of insanity which comes espe- 
 cially under the class of degenerative diseases. It is essen- 
 tially characterized by a delusion or delusions of a fixed 
 and "systematized character. They are usually indeed of 
 
 697 
 
MEDICAL RECORD 
 
 one kind, and the disease has perhaps for this reason been 
 called monomania. This is, however, an unfortunate term, 
 as we find this symptom not infrequently in other forms 
 oi insanity, as melancholia, where we always observe de- 
 cidedly fixed ideas of depression. The main fundamental 
 characteristic of this disease is a delusion which has be- 
 come a part of the belief of the individual, and which he 
 believes himself able to explain and defend." — (Witthaus 
 and Becker's Medical Jurisprudence, etc.) 
 
 For dementia paralytica see French's "Practice of Medi- 
 cine'' f-mn7), page 1092. 
 
 4. There will be the signs of death from asphyxiation, 
 viz. : The right side of the heart and the venous system 
 full of blood ; congestion of the mucous membrane of 
 the bronchial tubes ; the sinuses of the brain are filled 
 with blood; the brain, liver, spleen, and kidneys will be 
 congested; the blood is usually dark colored. 
 
 5. Rigor mortis is the condition of rigidity or contraction 
 into which the muscles of the body pass after death. It 
 begins at a period varying from about fifteen minutes to 
 about six hours. It usually begins in the muscles of the 
 eye, neck, and jaw ; then the muscles of the chest and 
 upper extremity, and last of all those of the abdomen and 
 lower extremity are affected. It passes off in the same 
 order in about twenty- four hours. It is said to be due to 
 the coagulation of the muscle plasma. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Medical Examining Board of Virginia. 
 
 anatomy and embryology. 
 
 1. Describe briefly the nasal cavity and the bones which 
 enter into its formation. 
 
 2. Describe the sacrum and tell what passes through the 
 openings in it. 
 
 3. (a) What membranes envelop the brain? (b) What 
 processes are formed by the outer one? 
 
 4. Name the bones which form the foot, and give the 
 articulation of each. 
 
 5. Give the course and relations of the ureter in the 
 female pelvis. 
 
 6. What nerves supply the tongue? 
 
 7. Name the muscles attached to the scapula. 
 
 8. Describe the abdominal aorta. Name its branches and 
 give their general distribution. 
 
 9. Give boundaries and contents of Scarpa's triangle. 
 10. Give the course and relations of the colon. 
 
 698 
 
MEDICAL RECORD. 
 
 PHYSIOLOGY. 
 
 i. Describe the digestive processes which take place in 
 the mouth and stomach. 
 
 2. What changes take place in the blood in its passage 
 through the lungs? What is tidal air and residual air? 
 
 3. Which portion of the glandular structure of the kidney 
 excretes the salts, and which the watery constituent of the 
 urine? Describe normal urine. 
 
 4. What nerves form the solar plexus, and what organs 
 (viscera) does it supply? 
 
 5. Give the origin, function, and distribution of the 
 seventh cranial nerve. 
 
 6. Name the varieties and respective functions of the 
 glands of the skin. Where is the breathing center located? 
 
 MATERIA MEDICA. 
 
 i. Name the preparations of manganese. Give dose and 
 physiological action of each preparation. 
 
 2. Describe the physiological effects of emetine. 
 
 3. Compare the effects of hyoscyamus, belladonna, and 
 stramonium. 
 
 4. Describe the toxic action of and give the antidotes to 
 the salts of mercury. 
 
 5. What is ergot? What are its effects upon the partu- 
 rient uterus? Give dose of the fluid extract. 
 
 6. Name the principal alkaloids of opium. Compare their 
 effects and give the antagonists to opium poisoning. 
 
 CHEMISTRY. 
 
 1. Describe iodine. From what source is it chiefly ob- 
 tained? What are its uses? Give a simple test for iodine. 
 
 2. What elements are known as the alkali-metals? Give 
 some of their common properties. 
 
 3. Give formulae of three official potassium salts, indicat- 
 ing the uses of each. 
 
 4. To what does potassium permanganate owe its disin- 
 fectant properties? Explain this reaction. 
 
 5. Give the formulae of mercurous chloride and mercuric 
 chloride. Describe the difference between them as regards 
 their physical appearance and medicinal properties and uses. 
 
 6. Give formula of chloral hydrate. How is it prepared ? 
 Give uses. 
 
 TOXICOLOGY. 
 
 1. Give symptoms and treatment of acute arsenical 
 poisoning. 
 
 2. Give symptoms and treatment of chronic arsenical 
 poisoning. 
 
 3. What is trichiniasis? How produced, and how may it 
 be recognized ? 
 
 699 
 
MEDICAL RECORD. 
 
 MEDICAL JURISPRUDENCE. 
 
 1. Give medicolegal definition of wound. 
 
 2. Describe following kinds of wounds: Incised, punc- 
 tured, lacerated, contused. What is coma? Mention three 
 causes of coma. 
 
 THERAPEUTICS. 
 
 1. What are the therapeutic uses of the silver prepara- 
 tions ? 
 
 2. What are the indications for the use of strophanthus, 
 of sparteine sulphate? 
 
 3. Give the methods of administering turpentine, the in- 
 dications for its use, and the caution to be observed in its 
 application. 
 
 4. Give therapeutic uses of salicylic acid. 
 
 5. Give the drugs applicable in the treatment of influenza 
 and state how they should be used. 
 
 6. Give the general therapy of the preparations of am- 
 monia. 
 
 PRACTICE, ETIOLOGY, AND DIAGNOSIS. 
 
 1. What is parotis? Give symptoms. State most usual 
 complications and how managed. 
 
 2. Give cause and treatment of myxedema. 
 
 3. Give symptoms, appearance, and treatment of herpes 
 zoster. 
 
 4. Give physical and clinical symptoms of chronic cardiac 
 dilatation. 
 
 5. What inferences should be drawn from persistent 
 scanty urination? 
 
 6. What are the two varieties of jaundice, and to what 
 is each due? 
 
 7. How would you distinguish between ascites and other 
 abdominal enlargements ? 
 
 8. Give symptoms, dangers, and management of arterio- 
 sclerosis. 
 
 9. What are the earliest noticeable indications of tuber- 
 culous invasion? 
 
 10. In what condition is gastric lavage indicated, and 
 when is it contraindicated ? 
 
 11. Differentiate between tetanus and tetany. 
 
 12. In what condition do we find: (a) temporary, and 
 (b) persistent, enlargement of the lymphatic glands. 
 
 OBSTETRICS, GYNECOLOGY, AND PEDIATRICS. 
 
 i. (a) How many cases of labor have you delivered? 
 (b) How many have you seen delivered? (c) Describe 
 the delivery of the most difficult case you have seen. 
 
 2. Inevitable abortion at the fourth month of pregnancy : 
 (a) Diagnosis, (b) Management in detail. 
 
 3. Define the following: (a) hydatidiform mole; (b) 
 
 700 
 
MEDICAL RECORD 
 
 Placenta succenturiata ; (c) Caput succedaneum ; (d) 
 Vernix caseosa; (e) Melena. 
 
 4. Management of the third stage of labor. 
 
 5. Active treatment of (a) Sapremia; (b) Septic endo- 
 metritis. 
 
 6. Necessity for and the technique of repairing second 
 degree lacerations of the perineum following labor. 
 
 7. Cancer of breast: (a) Early diagnosis; (b) Indica- 
 tions for operation. 
 
 8. Radical operation for the cure of cancer of breast: 
 (a) Technique; (b) What constitutes a permanent cure? 
 
 9. Pertussis: (a) diagnosis; (b) complications; (c) 
 prognosis; (d) prophylaxis. 
 
 10. Acute rheumatic infection in children; (a) manifesta- 
 tions; (b) treatment. 
 
 SURGERY. 
 
 1. What is meant by physiological and pathological hy- 
 pertrophy, physiological and pathological atrophy? 
 
 2. What is meant by infection, and mention chief sources 
 of infection? 
 
 3. Mention the chief complications of gonorrhea. 
 
 4. Define asepsis, antisepsis, disinfectant, sterile deo 
 dorant. 
 
 5. Differentiate fracture near a joint from a dislocation. 
 
 6. What is Pott's fracture, and how should it be dressed? 
 
 7. After a clean abdominal section, what would lead you 
 to suspect infection? 
 
 8. Give diagnosis of empyema and treatment for same. 
 
 PATHOLOGY. 
 
 1. Name the varieties of degeneration. Name the form 
 of degeneration that tubercle undergoes in chronic cases of 
 tuberculosis. 
 
 2. What is infection? How do bacteria gain entrance 
 into the body? What is suppuration? 
 
 3. Give the etiology and pathology of acute endocarditis. 
 What are its results if patient survives the acute attack? 
 
 4. What is endarteritis (endoarteritis) ? What is en- 
 darteritis obliterans, and what are its ultimate results to 
 the tissues supplied? 
 
 5. What is granulation tissue, and under what conditions 
 is it formed? 
 
 6. Name the blood changes in leukemia. What is the 
 condition of the spleen and lymphatic glands in this dis- 
 ease? 
 
 BACTERIOLOGY. 
 
 1. Explain the terms obligate aerobe and facultative 
 anaerobe. Define the terms germicide, disinfectant, anti- 
 septic, and aseptic. 
 
 701 
 
MEDICAL RECORD. 
 
 2. Describe (tell all you know about) the tubercle ba- 
 cillus. 
 
 3. Name a motile, pathogenic microorganism. To what 
 is the power of motion in certain bacteria due? Classify 
 the most common pyogenic microorganisms. Name a 
 pathogenic diplococcus. 
 
 NEUROLOGY. 
 
 i. Define the terms neurasthenia, psychasthenia, tic, and 
 tonic and clonic as applied to the character of spasms. 
 
 2. Give the symptomatology of acute anterior poliomye- 
 litis (infantile paralysis). 
 
 3. Give the diagnosis and treatment of locomotor ataxia 
 (tabes dorsalis). 
 
 HYGIENE. 
 
 1. Name the dangers attendant upon the use of spring 
 and well water for drinking purposes. What precautions 
 should be taken to protect the water from these sources? 
 
 2. Describe the hygienic treatment of pulmonary tuber- 
 culosis. 
 
 3. Name the diseases of animals that are communicable 
 to man. Name the chief impurities of the air in large cities. 
 
 HISTOLOGY. 
 
 1. Give the histological structure of a nerve. 
 
 2. Give the histological structure of Peyer's patches and 
 that of an artery. 
 
 LARYNGOLOGY. 
 
 i. What symptoms would cause you to suspect adenoids 
 in children? 
 
 2. Define aphonia, and give its common causes. 
 
 3. What is the essential cause of diphtheria? What of 
 pseudomembranous or true croup? Give the most impor- 
 tant points in differential diagnosis between follicular ton- 
 silitis and diphtheria. 
 
 RHINOLOGY. 
 
 1. State four local and four general causes of epistaxis. 
 
 2. What structures are involved in hypertrophic catarrh? 
 Give symptoms and treatment. Give symptoms and treat- 
 ment of chronic atrophic catarrh. What is it usually called, 
 and why so called? 
 
 OPHTHALMOLOGY. 
 
 1. Define ptosis; strabismus; diplopia; myopia; hyper- 
 metropia; presbyopia; chalazion. 
 
 2. State etiology, symptoms, and treatment of acute con- 
 junctivitis ; also its common name when it becomes conta- 
 gious. 
 
 3. Give etiology, symptoms, and treatment, both preven- 
 tive and remedial, of ophthalmia neonatorum. 
 
 702 
 
MEDICAL RECORD 
 
 OTOLOGY. 
 
 i. Give three methods of removing foreign bodies or 
 impacted wax from the ear. 
 
 2. Give etiology, symptoms, and treatment of acute mas- 
 toiditis; name three of its most common and serious 
 results. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 Medical Examining Board of Virginia, 
 anatomy and embryology. 
 
 1. The nasal cavities are two large, irregular shaped cav- 
 ities, situated one on each side of the middle line of the 
 face, extending from the base of the skull to the roof of 
 the mouth, and separated from each other by a median 
 septum. They open in front by the anterior nares, with the 
 face; and behind, by the posterior nares, with the naso- 
 pharynx. They are wider below than above. Bones enter- 
 ing into their formation are: Frontal, sphenoid, ethmoid, 
 iacrymal, nasal, palate, superior maxillary, vomer, and 
 inferior turbinated. 
 
 2. For description of sacrum, see any text-book on 
 anatomy. The sacral nerves pass through the foramina in 
 the sacrum. 
 
 3. (a) Membranes which envelop the brain: Dura, 
 arachnoid, and pia. (b) The processes of the dura: Falx 
 cerebri, falx cerebelli, tentorium cerebelli, and diaphragma 
 sellse. 
 
 4. The os calcis articulates with the astragalus and cu- 
 boid ; the astragalus with the tibia, fibula, os calcis, and 
 navicular; cuboid with the os calcis, external cuneiform, 
 fourth and fifth metatarsals ; navicular with the astragalus 
 and third cuneiform; internal cuneiform with the navicu- 
 lar, middle cuneiform, first and second metatarsals ; middle 
 cuneiform with the navicular, internal and external cunei- 
 form, and second metatarsal ; external cuneiform with the 
 navicular, middle cuneiform, cuboid, and second, third, and 
 fourth metatarsal ; the metatarsals articulate with the tarsal 
 bones by one extremity and by the other with the first 
 row of phalanges ; the number of tarsal bones with which 
 each metatarsal articulates is one for the first, three for 
 the second, one for the third, two for the fourth, and one 
 for the fifth ; the phalanges of the first row, with the meta- 
 tarsal bones behind and second phalanges in front ; the 
 second row of the four outer toes, with the first and third 
 phalanges; of the great toe, with the first phalanx; the 
 third row of the four outer toes, with the second phalanges. 
 
 703 
 
MEDICAL RECORD. 
 
 5. The ureter, in the female pelvis, runs downward in 
 front of the sacroiliac synchondrosis, then upon the Obtu- 
 rator internus and its fascia, lying behind and below the 
 Psoas; it then enters the uterovesical fold below the oblit- 
 erated hypogastric artery. It passes down parallel with the 
 cervix uteri and the upper part of the vagina, behind the 
 uterine artery, through the uterine plexus of veins, and 
 below the broad ligament; it crosses the upper third of the 
 vagina to reach the vesicovaginal interspace, and enters the 
 bladder opposite the center of the vagina. 
 
 6. The nerves which supply the tongue are: (1) The 
 lingual branch of the inferior maxillary division of the 
 trigeminus (sensation) ; (2) chorda tympani (taste) ; (3) 
 lingual branch of the glossopharyngeal (taste and sensa- 
 tion) ; (4) hypoglossal (motor). 
 
 7. The muscles attached to the scapula are : Subscapu- 
 laris, Supraspinatus, Infraspinatus, Trapezius, Deltoid, 
 Omohyoid, Serratus magnus, Levator anguli scapulae, 
 Rhomboideus major and minor, Triceps, Teres major and 
 minor, Biceps, Coracobrachialis, and Pectoralis minor. 
 
 8. The abdominal aorta begins at the aortic opening in 
 the diaphragm and extends to left side of the fourth lum- 
 bar vertebra, where it divides into the two common iliacs. 
 It lies to the left side of the inferior vena cava. 
 
 Its branches art: (1) Phrenic, to diaphragm. (2) Celiac 
 axis, to stomach, liver, and spleen (also to esophagus, pan- 
 creas, and omentum). (3) Superior mesenteric, to small 
 intestine, ascending and transverse colon. (4) Inferior 
 mesenteric, to descending colon, sigmoid flexure, and rec- 
 tum. (5) Suprarenal, to suprarenal body. (6) Renal, to 
 kidney and ureter. (7) Spermatic or ovarian, to testes or 
 ovaries, and round ligament. _ (8) Lumbar, to muscular 
 wall and skin of abdominal cavity. (9) Middle sacral. 
 
 9. Scarpa's triangle is bounded above by Poupart's liga- 
 ment, externally by the sartorius, and internally by the 
 inner margin of the adductor longus; its apex is formed 
 by the junction of the adductor longus and sartorius. The 
 floor is formed, from without inward, by the iliacus, psoas, 
 pectineus, adductor brevis, and adductor longus. Contents: 
 The femoral vessels pass from about the center of the 
 base to the apex, the artery being on the outer side of 
 the vein ; the artery gives off the superficial and profunda 
 branches, and the vein receives the deep femoral and in- 
 ternal saphenous; the anterior crural nerve lies to the 
 outer side of the femoral artery; the external cutaneous 
 nerve is still further external, lying in the outer corner of 
 the space; just to the outer side of the femoral artery, and 
 in the sheath with it, is the crural branch of the genito- 
 crural nerve. At the apex the vein (which at the base 
 
 704 
 
MEDICAL RECORD 
 
 was internal to the artery) lies behind the artery. The 
 triangle also contains fat and lymphatics. 
 
 10. The colon is divided into ascending, transverse de- 
 scending, iliac, and pelvic. 
 
 The ascending colon extends from the cecum to the 
 under surface of the liver to the right of the gall-bladder, 
 where it turns to the left, forming the hepatic flexure. It 
 lies in the right iliac and right hypochondriac regions. The 
 peritoneum covers the anterior and lateral surfaces. 
 Length, 8 inches. Relations. — In front: The convolutions 
 of the ileum; behind: Iliacus, quadratus lumborum, outer 
 side of right kidney. 
 
 The transverse colon passes from right to left, from the 
 gall-bladder to the spleen. It forms an arch, convex ante- 
 riorly and below ; the transverse arch of the colon. It is 
 entirely surrounded by peritoneum, which is attached poste- 
 riorly to the spine, forming the mesocolon. Length, 20 
 inches. Relations. — Above: Liver, gall-bladder, large cur- 
 vature of stomach, lower end of spleen; below: small 
 intestines; anteriorly: anterior layers of great omentum, 
 anterior abdominal wall; posteriorly: right kidney, second 
 part of duodenum, transverse mesocolon, pancreas, and 
 small intestines. 
 
 The descending colon passes from the end of the trans- 
 verse colon by a bend, the splenic flexure. Between the 
 splenic flexure and the diaphragm, opposite the tenth left 
 rib, is a fold of the peritoneum, the costocolic ligament, 
 which slings up the spleen. The gut then passes down- 
 ward to the iliac crest, ending in the iliac colon. The peri- 
 toneum invests its anterior and lateral surfaces. Length, 
 4 to 6 inches. Relations.— Behind: Left crus, left kidney, 
 quadratus lumborum, and psoas; in front: small intestines; 
 inner side: outer border of left kidney. 
 
 The iliac colon is continuous with the descending colon 
 at the left iliac crest, and ends at the inner border of the 
 left psoas. Peritoneum invests its anterior and lateral 
 surfaces ; it has no mesentery. Length, 5 to 6 inches. Rela- 
 tions.— In front: Small intestines; when distended, the an- 
 terior abdominal wall; behind: left iliopsoas. 
 
 The pelvic colon extends from the inner border of the 
 psoas to the level of the third sacral vertebra. Length, 16 
 or 17 inches; very variable. It has an extensive mesen- 
 tery. Relations.— Passing over left brim of pelvis, it 
 crosses the left external iliac vessels and left ureter, and 
 passes to right margin of pelvis, resting on bladder in male 
 and uterus in female ; above lie coils of small intestine. It 
 then turns back to midline on posterior wall of pelvis, 
 and, forming a second bend, descends to end in the rec- 
 tum.—- (From Aids to Anatomy.) 
 
 705 
 
MEDICAL RECORD. 
 
 PHYSIOLOGY. 
 
 i. In the mouth: The food is crushed, mixed with 
 saliva, and reduced to a pulp; it is rendered slightly alka- 
 line, and a small amount of starch is converted into mal- 
 tose; the proteids and fats are unaltered. In the stomach, 
 where the contents are rendered acid, conversion of starch 
 into sugar ceases, connective tissue of fats is dissolved and 
 fats are set free.' Proteids are dissolved and peptones 
 formed. The albuminous foods are dissolved for the most 
 part, and a grumous mixture of peptones, liquid fats, and 
 starches is formed, which is termed chyme, and is gradu- 
 ally passed through the pylorus into the intestine. 
 
 2. In its passage through the lungs, the blood (i) be- 
 comes cooled; (2) becomes a brighter red color; (3) gains 
 oxygen (about 10 or 12 volumes) ; (4) loses carbon diox- 
 ide (about 7 volumes). 
 
 Tidal air is the air which is constantly passing in and 
 out of the lungs during ordinary calm respiration. It 
 measures about 30 cubic inches. Residual air is the air 
 which still remains in the lungs after the deepest expira- 
 tions. It measures about 100 cubic inches. 
 
 3. The salts and also the watery constituent of the urine 
 are both excreted by the glomerulus of the kidney. 
 
 Urine is a yellowish liquid, acid in reaction, specific 
 gravity from about 1015 to 1025. About fifty ounces are 
 excreted in twenty-four hours. Its normal constituents 
 are : Water, urea, uric acid, urates, hippuric acid, kreatinin, 
 xanthin, hypoxanthin, sulphates, chlorides, and phosphates 
 c T sodiutn and potassium, phosphates of magnesium and 
 nlcium, nitrogen, and carbon dioxide. 
 
 4. The solar plexus is formed by the great, small, and 
 least splanchnic nerves of both sides, and by the right 
 pneumogastric nerve; the two semilunar ganglia, and other 
 ganglia, also enter into its composition. It supplies all the 
 viscera in the abdominal cavity. 
 
 5. The seventh cranial or facial nerve has its superficial 
 origin in the upper end of the medulla oblongata, in the 
 groove between the olivary and restiform bodies. It passes 
 "forward and outward to enter the internal auditory 
 meatus; it lies upon a groove on the auditory nerve, with 
 portio intermedia of Wrisberg between, and at the bottom 
 of the meatus it enters the aqueductus Fallopii, along which 
 it runs first outward between cochlea and vestibule as far 
 as hiatus Fallopii ; then backward in internal wall of tympa- 
 num, just above fenestra ovalis, at the turn presenting a 
 swelling, the geniculate ganglion; and finally it passes 
 downward to emerge from the bone at the stylomastoid 
 foramen ; it then passes outward and forward in the paro- 
 tid, dividing behind the ramus of the jaw into temporo- 
 
 706 
 
MEDICAL RECORD. 
 
 facial and cervicofacial branches, which further subdivide 
 and intercommunicate, forming the pes anserinus." — {Aids 
 to Anatomy.) 
 
 Function: The facial nerve is the motor nerve of the 
 muscles of expression, also of the platysma and the bucci- 
 nator; it also supplies the muscles of the external ear, the 
 stylohyoid, and the posterior belly of the digastric. Through 
 the chorda tympani it is a nerve of taste and a vasodilator 
 of the vessels of the submaxillary and sublingual glands. 
 
 6. The glands connected with the skin are the sweat 
 glands and the sebaceous glands. The sweat glands secrete 
 the sweat or perspiration, whose function is (i) excre- 
 tion of water, carbon dioxide, and urea; (2) to cool the 
 surface of the body; and (3) to regulate the body heat. 
 The sebaceous glands secrete sebrum, whose function is : 
 To lubricate the skin and keep # it flexible ; to prevent undue 
 absorption, and to keep the skin from getting macerated. 
 
 The respiratory center is in the medulla, at the apex of 
 the calamus scriptorius. (Subsidiary centers are also found 
 in the spinal cord.) 
 
 MATERIA MEDICA. 
 
 i. Preparations of manganese: (1) Precipitated man- 
 ganese dioxide; dose, gr. iv. It has an astringent action. 
 (2) Manganese hypophosphite ; dose, gr. iij. It has little or 
 no physiological action. (3)^ Manganese sulphate; dose, 
 gr. iv. Its action is first astringent, later emetic and pur- 
 gative, (a) Potassium permanganate; dose, gr. j. It is a 
 deodorant and disinfectant; also irritant. 
 
 2. Emetine is, in small doses, a gastric stimulant; it then 
 acts on the vomiting center in the medulla, and is thus an 
 indirect emetic; it produces but slight nausea and depres- 
 sion; it stimulates the bronchi to increased secretion, mod- 
 erately depresses the circulation, is a slight diaphoretic, 
 and acts on the liver as a direct cholagogue. 
 
 3. "The action of hyoscyamus is almost identical with 
 that of belladonna and stramonium. The following are the 
 chief points of difference: (1) Hyoscyamus contains in 
 addition hyoscine in minute quantities. This is a powerful 
 cerebral and spinal sedative, and therefore the excitation 
 and delirium occasioned by the atropine in belladonna are 
 not so evident when hyoscyamus is given; indeed, that may, 
 owing to the hyoscine in it, distinctly depress the higher 
 functions of the brain. The heart is not quite so power- 
 fully affected by hyoscyamus as by belladonna, for hyo- 
 scine has a comparatively feeble cardiac influence. Still, it 
 is, of course, affected by the hyoscyamine, which acts like 
 atropine. (2) Hyoscyamus increases the peristaltic con- 
 tractions of the intestines more powerfully than bella- 
 donna, and at the same time it is more efficient in relieving 
 
 707 ^ 
 
MEDICAL RECORD. 
 
 the griping of other purgatives. (3) Hyoscyamus has a 
 more markedly sedative action on the urinary unstriped 
 muscle than belladonna." — (White & Wilcox's Materia 
 Me die a, etc.) 
 
 4. The toxic action of the salts of mercury is indicated 
 by: Pain in mouth and stomach, gastroenteritis, hemate- 
 mesis, bloody stools, scanty and albuminous urine with 
 casts, salivation. 
 
 Antidote: White of egg in moderate quantity, followed 
 by an emetic. 
 
 5. Ergot is the sclerotium of the claviceps purpurea. It 
 excites contractions in the parturient uterus. The dose of 
 the fluid extract is thirty minims. 
 
 6. The principal alkaloids of opium are: Morphine, co- 
 deine, thebaine, narcotine, narceine, papaverine. In sopo- 
 rific effects, beginning with the most powerful, they rank: 
 Narcotine, morphine, codeine; in tetanizing action: The- 
 baine, papaverine, narcotine, codeine, morphine; in toxic 
 action: Thebaine, codeine, papaverine, narceine, morphine, 
 narcotine. 
 
 Antagonists: Potassium permanganate, atropine, caf- 
 feine, and strychnine. 
 
 CHEMISTRY. 
 
 1. Iodine is a solid crystalline substance, having a blue- 
 gray color and metallic luster ; the vapor has a violet color 
 and a peculiar odor, and is very irriating to the eyes and 
 nose. It stains the skin, and is poisonous. It is only slightly 
 soluble in water. It is obtained from seaweed. 
 
 Test for iodine: Add starch paste; in the presence of 
 iodine it becomes blue. 
 
 2. The alkali metals are: Lithium, sodium, potassium, 
 rubidium, cesium (and silver). They are all solids, uni- 
 valent; their hydroxides are more or less alkaline and are 
 basic; they form one chloride and one or more oxides. 
 
 3. Potassium iodide. KI. Potassium permanganate, 
 K 2 Mn 2 0s. Potassium chlorate, KC10 3 . The first is used 
 in the third stage of syphilis, gonorrheal rheumatism, 
 aneurysm, pleurisy, asthma, pericarditis.^ The second ^ is 
 used as a disinfectant, deodorant, and antiseptic. The third 
 is used in sore throat, tonsillitis, and stomatitis. 
 
 4. Potassium permanganate is a very active oxidizing 
 agent, and its action as a disinfectant is due to the oxida- 
 tion of the organic matter with which it comes in contact. 
 The splitting up of potassium permanganate and the prompt 
 liberation of the oxygen is shown in the following equa- 
 tion : 2K 2 Mn 2 8 + 2H 2 = 4Mn0 2 + 4KHO + 30 2 . 
 
 5. Mercuric chloride, HgCl 2 , corrosive sublimate, is 
 heavy, white, and crystalline; it has a strong, acrid, styptic 
 taste and is soluble in water, in alcohol, and in ether; it is 
 
 708 
 
MEDICAL RECORD. 
 
 decomposed by exposure to light. It is used as a disin- 
 fectant, antiseptic, antiparasiticide, and as a cholagogue. 
 
 Mercurous chloride, Hg 2 Cl 2 , calomel, is a heavy, white 
 powder, amorphous, tasteless, and odorless ; it is insoluble 
 in cold water and in alcohol, and very slightly soluble in boil- 
 ing water; when exposed to the light it becomes discolored 
 (first yellow, then gray) and partially decomposed; it sub- 
 limes without fusing; it is incompatible with the mineral 
 acids, with the alkaline chlorides, bromides, and iodides. It 
 is used as a laxative, purgative, diuretic ; in cases of vomit- 
 ing, liver congestion or cirrhosis, and as a dusting powder. 
 
 6. Chloral hydrate. Formula, CC1 3 CH(0H) 2 . It is pre- 
 pared by adding a little water to chloral. It is used as a 
 hypnotic and sedative; as a solvent for resins, starch, etc.; 
 also in alcoholism, mania, high arterial tension, tetanus, 
 and strychnine poisoning. 
 
 TOXICOLOGY. 
 
 i. The symptoms of acute arsenical poisoning: Nausea 
 and f aintness, severe burning pain in the stomach, persistent 
 vomiting of matters, sometimes brown or gray, or streaked 
 with blood, or green; purging, and cramps in the legs. 
 Treatment: Induce vomiting, by zinc sulphate; use stom- 
 ach tube. The chemical antidote is freshly prepared ferric 
 hydroxide. The ferric hydroxide changes the arsenic into 
 ferrous arsenate, which is nonpoisonous. 
 
 2. Symptoms of chronic arsenical poisoning: Inflamma- 
 tion of the conjunctivae, with intolerance of light. Irritation 
 of the skin, accompanied by an eruption (eczema arseni- 
 cale) ; local paralyses; great weakness and emaciation; ex- 
 foliation of the cuticle and falling out of the hair. Treat- 
 ment: Remove the patient from the exposure and treat the 
 symptoms as they arise ; potassium iodide has been rec- 
 ommended. 
 
 3. Trichuriasis is the condition resulting from eating 
 pork containing Trichina spiralis. It is characterized by 
 gastrointestinal irritation, diarrhea, colicky pains, vomit- 
 ing, fever, sweating, edema of the face and eyelids, great 
 prostration, muscular soreness, emaciation, pronounced 
 leucocytosis, especially increase of the eosinophiles. The 
 trichina may be found in pieces of muscle excised for pur- 
 poses of examination, or in the stools. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. A wound (medicolegal) is any injury or lesion caused 
 by mechanical or chemical means. 
 
 2. Incised wounds are made by sharp-cutting instru- 
 ments ; the hemorrhage is free, the wound gapes, there is 
 no bruising of the margins. Punctured wounds are deep 
 wounds with a small orifice ; they are made by narrow in- 
 
 709 
 
MEDICAL RECORD. 
 
 struments. Lacerated and contused wounds are made by 
 blunt instruments and by crushing; the soft parts are torn, 
 the edges are bruised and ragged, the deep parts are infil- 
 trated with blood ; there is little free bleeding. 
 
 Coma is a condition of profound insensibility, chiefly due 
 to a changed condition of the brain. Three causes of coma: 
 Apoplexy, opium, alcohol. 
 
 THERAPEUTICS. 
 
 1. Therapeutic uses of silver preparations: As a caustic ; 
 for septic processes, boils, and phlebitis; for gonorrhea; 
 for bedsores ; in gonorrheal ophthalmia ; also as a prophy- 
 lactic; in dysentery or diarrhea; for ulcers of mouth, 
 stomach, or intestines. 
 
 2. Indications for strophanthus: As a cardiac stimulant ; 
 in mitral or aortic obstruction; in cardiac dilatation; pal- 
 pitation; alcoholism; exophthalmic goiter; nephritis; when 
 heart action is feeble but rapid, and accompanied by low 
 arterial tension ; in general, same as digitalis. 
 
 Indications for sparteine sulphate: As a diuretic, in 
 cardiac or renal dropsy; also in uncompensated mitral or 
 other cardiac lesions. 
 
 3. Turpentine can be administered: Locally, as a lini- 
 ment, as a stupe, by enema, in emulsion, in capsules, on 
 cut sugar, by inhalation, as a spray. Indications: As^ a 
 rubefacient or counterirritant ; sciatica, lumbago, neuralgia, 
 chronic rheumatism, sprains, dysentery, hemorrhage of 
 intestines; as a vermifuge against tapeworm; chronic 
 bronchial affections and chronic affections of the genito- 
 urinary tract. Caution: Too large doses may produce 
 gastroenteritis, diarrhea, vomiting, suppression of urine, 
 hematuria, strangury; it acts, in toxic doses, as a narcotic 
 poison. 
 
 4. Therapeutic uses of salicylic acid: "Externally as 
 antiseptic and stimulating applications and for the check- 
 ing of abnormal perspiration; also in parasitic and other 
 skin diseases. Internally, rheumatic fever (in which it 
 seems to act as a specific) ; gout; migraine; sciatica; dia- 
 betes; cholelithiasis." — (Wilcox, Materia Medica.) 
 
 5. For influenza: The following (among many) have 
 been recommended: Ammonium chloride, alkaline drinks, 
 antipyrin, antiseptics, aperients, arsenic, bismuth, cam- 
 phor, chloroform, Dover's powder, heroin, hydrocyanic 
 acid, morphine, phenacetin, quinine, salicin, strychnine, 
 aconite, sweet spirit of niter, alcohol, belladonna, bromides, 
 cannalis indica, chloral or sulphonal, ergot. 
 
 6. Ammonium preparations. — Externally : Rubefacient, 
 vesicant, for bites of insects. Internally: As a gastric, 
 cardiac, or general stimulant; as an expectorant; hepatic 
 disorders; muscular rheumatism; diaphoretic and diuretic. 
 
 710 
 
MEDICAL RECORD. 
 
 PRACTICE, ETIOLOGY, AND DIAGNOSIS. 
 
 i. Symptoms of parotitis: Chilliness, malaise, moderate 
 fever, pain and swelling of parotid gland, which becomes 
 tender and elastic, but shows no fluctuation; deglutition 
 and mastication are painful; both sides may be affected. 
 Complications: Unilateral orchitis, which may be fol- 
 lowed by atrophy of testicle; in the female, mastitis or 
 edema of vulva or ovaritis. Management: Keep patient in 
 bed : isolate him ; salines, hot fomentations, and antiseptic 
 mouth wash. The orchitis will need rest, suspension, and 
 an application of guaiacol ointment or lead and laudanum; 
 afterward mercury and belladonna ointment. 
 
 2. Myxedema. — Cause: Loss of function of thyroid 
 gland; heredity is supposed to have some influence; it is 
 most common in women. Treatment : Keep patient warm, 
 give nourishing food, and administration of sheep's thy- 
 roid. 
 
 3. Herpes zoster. — Symptoms and appearance: Malaise, 
 slight fever; vesicles, in cluster, and on inflammatory 
 base, usually along the course of intercostal nerves, but 
 may be in other locations; it occupies areas which repre- 
 sent the distribution of nerve fibers that enter a single 
 posterior root ganglion; as a rule it is unilateral and 
 accompanied with sharp neuralgic pain. Treatment: Zinc 
 phosphide, morphine, and phenacetin have been given; 
 locally, menthol or collodion may be applied. 
 
 4. In cardiac dilatation: "The symptoms are those of 
 failing circulation: precordial anxiety, palpitation, head- 
 ache, vertigo, syncope, pallor, cough, dyspnea, venous con- 
 gestion, and dropsy. The cardiac impulse is feeble and dif- 
 fused, and usually displaced to the left. The area of cardiac 
 percussion-dullness is increased. The first sound is weak- 
 ened in correspondence with the disproportion between the 
 enlargement of the cardiac chambers and the thickness of 
 their walls; the second is little changed. If the dilatation 
 has been great enough to so enlarge the orifices or weaken 
 the muscles that the valves are no longer competent to 
 effect complete closure, regurgitant murmurs may be de- 
 veloped, even in the absence of structural alterations in the 
 valves. Such murmurs are usually rather soft and may be 
 inconstant. The action of the heart may be rapid and irreg- 
 ular. The pulse is small and soft." 
 
 5. Persistent, scanty urination may denote : Heart dis- 
 ease, with broken compensation; degeneration of cardiac 
 muscle ; parenchymatous nephritis ; chronic diseases of the 
 respiratory apparatus; chronic uterine or liver disease; 
 mechanical obstructions, such as compression of the ure- 
 ters by tumors, or an enlarged prostate gland. 
 
 6. The two varieties of jaundice are (1) obstructive 
 and (2) nonobstructive, or toxemic. 
 
 711 
 
MEDICAL RECORD. 
 
 Obstructive jaundice may be due to: Gastroduodenal 
 catarrh; catarrh of the bile ducts; lodgment of gallstones 
 or round worms in the common duct; pressure on or clo- 
 sure of the duct by tumor of the liver, stomach, kidney, 
 omentum, and especially of the pancreas ; and new growths 
 or cicatricial tissue producing stricture or obliteration of 
 the lumen of the duct. Nonobstructive or toxemic jaun- 
 dice may be due to : "Influenza, malaria, pneumonia, typhoid, 
 typhus, scarlet fever, yellow fever, pyemia, ulcerative en- 
 docarditis, acute yellow atrophy of the liver, WeiFs dis- 
 ease, snake venom, antimony, arsenic, chloral hydrate, 
 chloroform, ether, copper, mercury, phosphorus, and potas- 
 sium chlorate/' — (From Butler's Diagnostics of Internal 
 Medicine.) 
 
 7. Ascites is characterized by: Enlargement of the abdo- 
 men, most marked in the flanks when the patient is lying 
 on his back, and in the hypogastrium, when he is standing 
 up ; there are dilated superficial veins on the abdomen, and 
 the skin is tense ; the umbilicus is prominent ; there are 
 fluctuation and vibration on palpation ; dullness is found 
 on percussion over the fluid, while the center of the abdo- 
 men is resonant. 
 
 8. Arteriosclerosis. Symptoms: "Increased tension in 
 the pulse, causing a hardness, often feeling like 'pipe- 
 stems/ Great hypertrophy of the cardiac muscle ensues. 
 The coronary arteries may be involved, leading to fibroid 
 degeneration, fatty degeneration, and the symptoms of 
 angina pectoris, absence of compensation, dyspnea, scanty 
 urine, and other symptoms. The cerebral arteries may be 
 involved, and hence apoplexy is common. The kidneys 
 may next suffer, giving rise to interstitial nephritis or con- 
 tracted kidney." Dangers: Cardiac, renal or cerebral 
 troubles. Management: "Seek diligently for any predis- 
 posing cause. Alcohol in any form should be absolutely 
 interdicted. Attacks of gout and rheumatism should be 
 prevented as far as possible by the restriction of animal 
 foods, tea, and coffee. In these cases a vegetable diet is 
 best. If due to heart disease, kidney disease, or syphilis, 
 each will require its special line of treatment. The kidneys 
 may be kept active by diuretics. At the same time the skin 
 should be kept active by proper amount of exercise, hot 
 baths, and thorough massage." — (Gould & Pyle's Pocket 
 Cyclopedia.) 
 
 9. The early manifestations of pulmonary tuberculosis 
 are: (1) Physical signs: Deficient chest expansion, the 
 phthisical chest, slight dullness or impaired resonance over 
 one apex, fine moist rales at end of inspiration, expiration 
 prolonged or high pitched, breathing interrupted. (2) 
 Symptoms: General weakness, lassitude, dyspnea on exer- 
 
 712 
 
MEDICAL RECORD. 
 
 tion, pallor, anorexia, loss of weight, slight fever, and 
 night sweats, hemoptysis. 
 
 10. Lavage is said to be indicated in : Gastric dilatation 
 and chronic gastritis. It is contraindicated in : "Marked 
 prostration, continued fevers, or cachectic states ; broken 
 compensation of heart lesions; advanced fibrous or fatty 
 degenerations of the heart, and angina pectoris; thoracic 
 aneurysm and advanced general arteriosclerosis ; last stages 
 of pulmonary tuberculosis, emphysema, bronchitis, and 
 recent hemoptysis; gastric ulcer with recent hematemesis 
 or tarry stools; recent intracranial, renal, vesical, or rectal 
 hemorrhages; and pregnancy and old age." — (Butler's 
 Diagnostics of Internal Medicine.) 
 
 ii. Tetanus is a condition of persistent tonic spasm of 
 voluntary muscles; also a disease due to a specific bacillus. 
 Tetany is a bilateral, tonic spasm of the extremities. 
 
 12. Enlarged lymphatic glands, (a) Temporary, in: 
 Diphtheria, tonsillitis, scarlet fever, measles, erysipelas, 
 variola, suppurative ear disease, gonorrhea, chancroid, (b) 
 Persistent, in : Leukemia, Hodgkin's disease, tuberculosis, 
 syphilis, filaria, malignant disease. 
 
 OBSTETRICS, GYNECOLOGY, AND PEDIATRICS. 
 
 2. Inevitable abortion, (a) Diagnosis: Hemorrhage 
 profuse and continuous, clotted and dark colored ; pain 
 cramp-like and severe ; cervical canal dilated ; uterus soft 
 and enlarged, and the angle between the upper and lower 
 uterine segments is effaced ; the discharge consists of dark 
 blood, clots, and portions of ovum; signs of pregnancy 
 present, except amenorrhea. 
 
 (b) Management: "Two methods of treatment have 
 been advised for these cases. The first is the expectant 
 plan: Place the patient in bed, and if the bleeding is pro- 
 fuse, insert a tampon of iodoform gauze (one yard) well 
 up against the cervix. If this fails to control the hemor- 
 rhage, reinforce it by another yard or two of gauze and a 
 perineal pad and binder. Small doses (3^) of the fluid 
 extract of ergot should now be given every two or three 
 hours. At the end of from eight to twelve hours remove 
 the tampon, when the ovum may be found extruded from 
 the cervix; if not, a vaginal douche of mercuric chloride 
 (i 14000) must be given, and another tampon introduced. 
 If, upon the removal of this second tampon at the end of 
 ten or twelve hours, the ovum is not discharged, then more 
 vigorous methods to secure its expulsion must be adopted. 
 Active plan: The physician's hands and instruments are 
 sterilized ; the patient is etherized and placed on an appro- 
 priate table ; the genitalia are thoroughly cleansed and a 
 vaginal douche of mercuric chloride (i 14000) is given; the 
 anterior lip of the cervix is brought down to the vulvar 
 
 713 
 
MEDICAL RECORD. 
 
 orifice; the cervix is dilated if necessary; the placental for- 
 ceps is introduced into the uterus, and as much as possible 
 of the ovum is removed; the uterus is thoroughly curetted, 
 and an intrauterine douche of sterile water is given. A 
 light tampon of iodoform gauze is placed in the vagina; 
 the patient is then returned to bed. A strip of gauze may 
 be placed in the uterus in cases of sharp retroflexion, to 
 secure free drainage, and occasionally an intrauterine tam- 
 pon will be necessary when the uterus refuses to contract 
 and hemorrhage persists after the use of the curette." — 
 (Gould & Pyle's Pocket Cyclopedia.) 
 
 3. (a) Hydatidiform mole is a product of conception 
 which has undergone degeneration, and in which the chor- 
 ionic villi have proliferated so as to produce a mass of 
 cysts somewhat resembling a duster of grapes. (&) Pla- 
 centa succenturiata is a subsidiary placenta, occasionally 
 found, in addition to the ordinary placenta, (c) Caput suc- 
 cedaneum is a tumor formed during labor upon the pre- 
 senting part of the fetus; it is due to the absence of 
 pressure at that part, (d) Vernix caseosa is a greasy sub- 
 stance made up of sebum and desquamated epithelium; 
 it is found on the skin of the fetus at birth, (e) Melena 
 is the discharge of feces colored black by blood which has 
 undergone changes in the stomach or intestines. 
 
 4. For the management of the third stage of labor, see 
 any text-book on obstetrics. 
 
 5. (a) Sapremia is treated: Removal of the decompos- 
 ing matter by finger, curette, or douche; drainage and 
 asepticizing the affected area; purgatives and diuretics are 
 given; also diaphoretics and stimulants; saline by hypo- 
 dermoclysis or # infusion ; ^ food must be fluid concen- 
 trated, and nourishing; tonics are indicated; symptoms are 
 treated as they arise, (b) Septic endometritis is treated: 
 Disinfection of the genital canal, as far as possible; sterile 
 water, saline solution, antiseptic fluids, and curette are all 
 useful; tamponade may be advisable; general treatment as 
 in sapremia. 
 
 6. All tears should be repaired as soon as possible (un- 
 less there are contraindications). A primary operation is 
 best, because the edges are fresh and can be approximated ; 
 little (if any more) anesthetic is wanted; the woman has 
 to lie in bed, and therefore only one absence from house- 
 hold work is requisite ; infection is less likely. In any case, 
 operation may prevent rectocele, cystocele, prolapse of 
 uterus, and general weakness, malaise, and disability. 
 For technique, see any text-book on obstetrics or 
 gynecology. 
 
 7. Cancer of breast. Early diagnosis: Is only conjec- 
 tural without microscopical examination of a piece of the 
 growth ; but a hard nodule, generally painless, steadily in- 
 
 714 
 
MEDICAL RECORD. 
 
 creasing in size and incorporated with the gland tissue, 
 should lead one to suspect cancer. Later on the skin is 
 dimpled and may ulcerate, the nipple may be retracted, 
 pain is present, and the breast cannot be freely moved. 
 Indications for operation: As soon as diagnosed, and the 
 earlier and more thorough the better. 
 
 8. (a) For technique of radical operation, see any text- 
 book on surgery, (b) The case is considered "cured" 
 if there is no return within three years of the opera- 
 tion. 
 
 9. Pertussis, (a) Diagnosis: Paroxysms of short, spas- 
 modic coughs followed by a long-drawn inspiration and a 
 "whoop"; the paroxysm may cause puffiness of the face 
 and end in vomiting; the eyes are suffused, (b) Compli- 
 cations: Convulsions, vomiting, bronchopneumonia, col- 
 lapse of lung, emphysema, nasal or conjunctival hemor- 
 rhage, cancrum oris, paralysis of various kinds, (c) Prog- 
 nosis: Guardedly favorable; when complications are pres- 
 ent the prognosis is more grave; the character of the epi- 
 demic, the age of the child, the care it receives, the number 
 and severity of the paroxysms are all factors to be noticed. 
 (d) Prophylaxis: Isolation of patient, disinfection of all 
 articles used by him, quarantine while the cough lasts. 
 
 10. _ Rheumatic manifestations in children : Fever, sour 
 perspiration, scanty, high-colored urine, arthritis, cardiac 
 lesions with murmur (soft, systolic), accentuation of sec- 
 ond heart sound, anemia, night terrors, chorea, quickened 
 pulse, tonsillitis, pericarditis, pleurisy, pneumonia, (b) 
 Treatment: Rest in bed between flannels and blankets, 
 milk diet; swollen joints should be wrapped in wool; 
 calomel, sodium salicylate, "alkaline treatment" are the 
 main indications. 
 
 SURGERY. 
 
 1. Hypertrophy is said to be physiological when it occurs 
 as a phase of the normal life history of the body (such as 
 enlargement of uterus during pregnancy, enlargement of 
 female breast at puberty, and in connection with pregnancy 
 and lactation). All other hypertrophies are pathological. 
 Atrophy is said to be physiological when it occurs as a 
 phase of the normal life history of the body (such as 
 involution of the uterus after parturition; atrophy 
 of the thymus in childhood). All other atrophies are 
 pathological. 
 
 2. By infection is meant the invasion of the living tissues 
 by bacteria, in such a manner as to produce local or gen- 
 eral disease. Chief sources of infection: Dust, polluted 
 food or water; wounds of all sorts; unclean implements, 
 sueh as knives, spoons, cups, dental or surgical instru- 
 
 715 
 
MEDICAL RECORD. 
 
 ments; fomites; urine, feces, sputum; clothes, dressings; 
 discharges. 
 
 3. The chief complications of gonorrhea may be : Cysti- 
 tis, epididymitis, prostatis, vesiculitis, periurethritis, bubo, 
 retention of urine, stricture, gonorrheal rheumatism, and 
 arthritis. 
 
 In the female: Cystitis, labial abscess, vaginitis, endo- 
 metritis, salpingitis, ovaritis, peritonitis, and sterility. 
 
 4. Asepsis is/ the absence of infection. Antisepsis is de- 
 struction or arrest of growth of infective germs. Disin- 
 fectant is an agent which restrains infectious diseases by 
 destroying or removing their specific poisons. Sterile 
 means having no living microorganisms. Deodorants are 
 substances which destroy the odorous products of putre- 
 faction. 
 
 FRACTURE. 
 
 1. Crepitus may be present. 
 
 2. Preternatural mobility. 
 
 3. Easily reduced — but 
 
 4. Deformity more liable to 
 
 recur after reduction. 
 
 5. The head of the bone is 
 
 in its proper place. 
 
 6. The socket containing the 
 
 head of the bone is not 
 empty. 
 
 7. When rotated the bone 
 
 does not move as one 
 piece. 
 
 DISLOCATION. 
 
 7- 
 
 Crepitus never present. 
 
 Rigidity rather than mo- 
 bility. 
 
 Difficult to reduce — but 
 
 Deformity less liable to 
 recur after reduction. 
 
 The head of the bone is 
 not in its proper place. 
 
 The socket which should 
 contain the head of the 
 bone is empty. 
 
 When rotated the bone 
 moves as one piece. 
 
 6. Pott's fracture is a fracture of the lower end of the 
 fibula, with outward displacement of the ankle. Dressing: 
 After reducing the displacement by extension and manipu- 
 lation, the limb should be placed in a fracture-box pro- 
 vided with a soft pillow, the foot should be secured to the 
 footboard, and a pad of oakum or cotton should be placed 
 under the tendo Achillis; before bringing up the sides 
 of the box and securing them, two firm compresses of lint 
 or oakum should be placed in contact with the leg and 
 foot, one just above the inner malleolus, the other just 
 below the outer malleolus. The sides of the box are next 
 brought up and secured, and by the pressure of these 
 compresses the foot is brought into an inverted position 
 and the deformity is corrected. The after-dressing of 
 this fracture consists in letting down the sides of the box, 
 and in inspecting the parts to see that the foot is kept in 
 the proper position, and care should be taken that undue 
 
 716 
 
MEDICAL RECORD 
 
 pressure is not made upon the skin by the compresses, 
 which might result in ulceration ; this may be avoided by 
 sponging the skin with alcohol and changing the positions 
 of the compresses slightly at each dressing. At the ex- 
 piration of ten days the fracture-box and compresses may 
 be removed and the limb put up in a plaster-of-Paris dress- 
 ing, including the foot and leg, up to the knee. The pa- 
 tient may then be allowed to go about on crutches, and at 
 the end of five weeks all dressings may be dispensed with." 
 — (Wharton's Minor Surgery.) 
 
 7. After clean abdominal section, infection may be sus- 
 pected : If the body temperature is high, if there are chills, 
 exhaustion, marked leucocytosis, night sweats, emaciation. 
 
 8. Empyema. Symptoms: Fever, sweats, chill, dimin- 
 ished breath sounds and vocal fremitus, impaired mobility 
 of chest, dullness on affected side, heart displaced to oppo- 
 site side, leucocytosis. Diagnosis is made by respiration, 
 showing the fluid to be pus. Treatment: Aspiration, drain- 
 age, irrigation, resection of ribs (Estlander's operation), or 
 resection of chest wall (Schede's operation). 
 
 PATHOLOGY. 
 
 i. The varieties of degeneration are : Fatty, amyloid, 
 mucoid, hyaline, cheesy or caseous, colloid, hydropic, and 
 cloudy swelling. Tubercle, in chronic cases of tuberculo- 
 sis, undergoes cheesy or caseous degeneration. 
 
 2. See above, Surgery, number 2. Suppuration is necro- 
 sis and liquefaction of living tissues; it is bacterial in 
 origin, and usually begins as inflammation. 
 
 3. Acute endocarditis. Etiology: Microorganisms 
 (chiefly Staphylococcus pyogenes aureus, Streptococcus 
 pyogenes, Diplococcus pneumoniae, gonococcus, and others) ; 
 acute articular rheumatism, pneumonia, scarlet fever, puer- 
 peral sepsis, nephritis, etc., are said to be etiological factors. 
 Pathology: The valves (mitral, aortic, and pulmonary), 
 and endocardium of ventricles and left auricle are chiefly 
 involved. The valves are affected on a line very near to 
 the free edge ; the chordae tendinece also suffer, and the 
 endocardium of the left ventricle, near the septum. Opac- 
 ity, roughness, nodular elevations, fibrous deposit, ulcera- 
 tion have all been observed. Results: Calcification, de- 
 struction of chordae tendinece or valve, myocarditis, peri- 
 carditis, embolism, infarcts or metastatic abscesses in 
 spleen, brain, or kidneys. 
 
 4. Endarteritis is inflammation of the inner coat of an 
 artery. Endarteritis obliterans is endarteritis in which the 
 lumen of the affected vessel is almost obliterated. . Ulti- 
 mate results to tissues: The blood supply is cut off; in the 
 brain, cerebral softening and paralysis result; neuralgia 
 may occur ; hemorrhage is prevented. 
 
 717 
 
MEDICAL RECORD. 
 
 5. Granulation tissue is embryonic tissue consisting of 
 loops of new formed capillaries covered by round cells, 
 and sometimes also by giant cells. It is formed as a 
 result of inflammation during the repair of wounds when 
 apposition is not perfect. 
 
 6. In leukemia, the blood is light in color, specific gravity 
 is lowered, coagulation is slow, the white corpuscles are 
 much increased in number (there may be from 150,000 to 
 500,000 per c. mm., or even more) ; myelocytes are present 
 in large numbers in the splenomedullary type; red cells 
 may be moderately diminished, and some may be nucleated. 
 The spleen and lymphatic glands are enlarged. 
 
 BACTERIOLOGY. 
 
 1. Obligate aerobe is a term applied to such bacteria as 
 cannot exist without oxygen. Facultative anaerobe is a 
 term applied to such bacteria as thrive better without 
 oxygen, but still can manage to exist in oxygen. Germi- 
 cides are agents which destroy bacteria and their germs. 
 Disinfectants are agents which restrain infectious diseases 
 by destroying or removing their specific poisons. Anti- 
 septics are agents which destroy infection. Aseptic means 
 absence of infection, or freedom from germs. 
 
 2. The tubercle bacillus is rod shaped, is from 1^2 to 
 S T A mikrons in length, and about one-third to one half a 
 mikron in breadth, is a strict parasite, is not motile, and has 
 no flagella. It is slightly curved, does not form spores, 
 is not liquefying, and nonchromogenic, is aerobic; it re- 
 sists acids: it grows well on blood serum; stains well by 
 Ehrlich's, Ziehl-Nielsen's, or Gabbett's method; it is Gram- 
 positive. 
 
 3. A motile pathogenic microorganism: Bacillus typho- 
 sus. The power of motion is due to flagella. The most 
 common pyogenic microorganisms: Staphylococcus pyo- 
 genes aureus, Staphylococcus pyogenes albus, Staphylococ- 
 cus pyogenes citreus, and Streptococcus pyogenes. A path- 
 ogenic diplococcus : The gonococcus. 
 
 NEUROLOGY. 
 
 1. Neurasthenia is a condition in which nervous energy 
 is diminished, and sensitiveness to external impressions is 
 increased. Psychasthenia is mental fatigue. A tic is a 
 spasmodic and involuntary contraction of the (facial) 
 muscles ; also a neurosis.^ In tonic spasms, the contractions 
 are continuous. In clonic spasms, the contractions are in- 
 termittent. 
 
 2. Symptoms of acute anterior poliomyelitis: Some 
 fevef, chills, and convulsions may precede the paralysis, 
 or the onset may be sudden; certain groups of muscles 
 (generally in the extremities) are paralyzed; hemiplegia is 
 
 7i8 
 
MEDICAL RECORD. 
 
 rare; the reflexes are generally lost; the paralysis is ir- 
 regular in its distribution, and tends to ameliorate, but the 
 recovery is only partial; the affected muscles waste, and 
 the limb is cold and livid. 
 
 3. Locomotor Ataxia. Symptoms: Loss of coordina- 
 tion; characteristic and unsteady gait; tendency to stagger 
 when standing up with feet together and eyes closed; 
 sharp and paroxysmal pain, called crises; girdle sensa- 
 tion; loss of knee-jerk and other reflexes; Argyll-Robert- 
 son pupil. The diagnostic features are : A slow onset ; the 
 loss of the patellar reflexes; Argyll-Robertson pupil; light- 
 ning pains; incoordination. Treatment: Rest, tonics 
 (strychnine, arsenic, iron, and phosphorus) ; easily digest- 
 ible food; hydrotherapy; massage; electricity; reeducation 
 of muscles; avoidance of all excesses, cautery; anodynes. 
 
 HYGIENE. 
 
 1. Dangers incident to drinking spring and well water: 
 Surface water, filth, sewage, and, indeed, anything may be 
 conducted into these waters. Hence, the possibility of 
 disease being caused by drinking this water. The wells 
 and springs should be at a distance from dwelling houses, 
 especially from outhouses, privies, etc.; they should be 
 well protected and covered, so that no extraneous matter 
 can enter them. All shallow wells should be protected with 
 good coping stones and good masonry for several feet 
 below the surface. 
 
 2. Hygienic precautions to be taken in treating a case 
 of tuberculosis: "The patient's quarters should be free 
 from dust, and admit of spending many hours daily in the 
 open air in all weathers, properly sheltered, and, if very ill, 
 lying wrapped in a hammock or reclining chair. His bed- 
 room should be well aired at night, draughts being avoided. 
 The room should be uncarpeted and free from hangings. 
 It should be often cleaned and periodically disinfected. All 
 sputum should be collected in paper spit-cups, which should 
 be burned daily. Smoking should be forbidden. Harm is 
 done by any exercise which results in fatigue, and while 
 fever exists it should not be attempted at all. Patients 
 should be taught the necessity of practising lung gymnas- 
 tics and breathing only through the nose, which should be 
 kept clear and free from occlusion by secretions, or an 
 hypertrophied catarrhal mucosa. . . . The clothing 
 should be woolen, but not too heavy, or sweating is in- 
 creased ; and a flannel nightgown and loosely knit leggings 
 should be worn at night in cool weather. The skin should 
 be cleansed by daily sponge-baths of lukewarm alcohol and 
 water/' — (Thompson's Practical Medicine.) 
 
 3. Diseases of animals communicable to man: Glanders, 
 anthrax, tuberculosis, rabies, aphtha, tapeworm and^ other 
 intestinal parasites, ringworm, echinococcus, diphtheria. 
 
 719 
 
MEDICAL RECORD. 
 
 J 
 
 Chief impurities of air in large cities: Mineral matters, 
 as silica, calcium, iron; coal dust; spores of moulds and 
 bacteria; organic matter; ammonia; fibers of cotton, wool, 
 or silk; dust and fibers from industrial processes; gases, 
 products of combustion. 
 
 HISTOLOGY. 
 
 1. A nerve consists of a bundle of fibers bound together 
 by a sheath called the epineurium; it contains blood-vessels, 
 lymphatics, connective tissue cells; each nerve bundle is 
 surrounded also by a sheath called the perineurium. Med- 
 ullated fibers consist of a neurilemma, medullary sheath, 
 and axis cylinder. Nonmedullated fibers have an axis cyl- 
 inder, but no sheath. Nerve cells have cell-body, nucleus, 
 and one or more processes (axis cylinders and dendrites). 
 
 2. Peyer's patches are clumps of solitary glands covered 
 with mucous membrane and surrounded by crypts of Lie- 
 berkiihn. Each of these solitary glands is a lymph nodule 
 consisting of retiform tissue, lymph corpuscles, and capil- 
 laries. They are situated in the mucous and submucous 
 tissue of the small intestine, chiefly the ileum. 
 
 Arteries consist of three coats: (i) Tunica intima, con- 
 sisting of fenestrated membrane of Henle, and a fine line 
 of white fibrous tissue; (2) Tunica media, consisting of 
 elastic fibers and involuntary muscles; (3) Tunica ad- 
 ventitia, consisting of white fibrous tissue and a few elastic 
 fibers. The middle coat is the thickest. 
 
 LARYNGOLOGY. 
 
 i. The symptoms of adenoids in children are : Mouth- 
 breathing ; snoring ; open-mouth ; a vacant, dull expression 
 of the face; modification of the voice. Effects: Otitis, 
 coryza, mental deficiency, stunted growth, and various 
 neuroses. 
 
 2. Aphonia is loss of voice, caused by: Laryngitis, 
 edema or tumor of larynx, improper use of the voice, retro- 
 pharyngeal abscess, paralysis, fixation of the vocal cords, 
 by cicatricial contractions, ulceration of the vocal cords, 
 foreign bodies in the larynx, and hysteria. 
 
 3. The essential cause of diphtheria is the Klebs-Loefiler 
 bacillus. The essential cause of true croup is either the 
 Klebs-Loeffier bacillus, or the Streptococcus pyogenes. ' In 
 diphtheria the onset is more gradual ; the temperature rises 
 to about 101 to 103 F. ; the tonsils are not much enlarged; 
 there is an exudate of a thick grayish membrane which is 
 very adherent, is removed only with difficulty, and leaves a 
 bleeding surface; this membrane soon re-forms, and may 
 be found on the fauces and pharynx as well as on the 
 tonsil; in the exudate the Klebs-Loeffier bacilli may be 
 found. In follicular tonsillitis the onset is more sudden ; 
 
 720 
 
MEDICAL RECORD. 
 
 the temperature may be a little higher than that of diphthe- 
 ria ; there is no membrane, but the tonsils are red and 
 swollen, and in the crypts are seen white cheesy spots or 
 plugs, which consist of broken-down epithelium, and are 
 easily brushed away; Klebs-Loeffler bacilli are never found. 
 
 RHINOLCGY. 
 
 1. Local: Trauma, caries of nasal bones, ulceration, new 
 growths. General: Purpura hemorrhagica, hemophilia, 
 scurvy, pernicious anemia. 
 
 2. Mucosa of nasal cavity, especially of inferior turbi- 
 nated bones. Symptoms: Increased secretion, obstruction, 
 sneezing, loss of resonance of voice, impaired olfaction, 
 bad breath. Treatment : Cleansing alkaline spray, astrin- 
 gent spray, cauterization, incision, or turbinectomy. 
 
 Chronic atrophic catarrh. Symptoms: Blocking of 
 the nose with thick, offensive crusts ; nasal fossae dilated ; 
 anosmia. Treatment : A warm, alkaline, cleansing douche; 
 the crusts must be removed ; tampons with ichthyol, fol- 
 lowed by an oil spray, have been recommended. It is 
 usually called ozena, on account of the offensive fetid 
 smell. 
 
 , OPHTHALMOLOGY. 
 
 \J / 
 
 1. Ptosis is a drooping of the upper eyelid. Strabisnius 
 is a perceptible deviation of one of the eyes from the 
 proper direction, diplopia is the condition in which an 
 object appears double. ^Myopia is a condition in Avhich the 
 parallel rays are focused in front of the retina. Hyperme- 
 tropia is a condition in which the parallel rays are focused 
 behind the retina. ^Presbyopia is a physiological change in 
 which there is progressive loss of the accommodative 
 power of the eye as age advances.* Chalazion is a tumor in 
 the eyelid, due to obstruction of the duct in a Meibomian 
 gland. 
 
 2. Etiology: Irritation, a foreign body, cold, exposure to 
 strong light or heat, eyestrain. Symptoms: Hyperemia, 
 lacrymation, epiphora, discharge, photophobia, sensation of 
 sand in the eye. Treatment : Remove cause; use astrin- 
 gent and antiseptic washes ; anoint the lids with vaseline. 
 When it becomes contagious, its common name is "pink 
 eye." 
 
 3. Ophthalmia neonatorum. Causes: The gonococcus 
 or some other pyogenic microorganism ; the secretions of 
 the mother contain the infecting agent, and transmission 
 may occur directly during parturition, or indirectly by the 
 fingers of physician or nurse, cloths, instruments, etc. 
 Symptoms: Swollen eyelids, with copious purulent dis- 
 charge; ulceration of the cornea may ensue. Prophylaxis: 
 Whenever there is the possibility of infection, or in every 
 
 721 
 
MEDICAL RECORD 
 
 case, wash the eyelids of the newborn child with clean 
 warm water, and drop on the cornea of each eye one drop 
 of a i per cent, solution of nitrate of silver, immediately 
 after birth. Treatment: Wash the eyes carefully every 
 half hour with a saturated solution of boric acid; pus must 
 not be allowed to accumulate. Two drops of a 2 per cent, 
 solution of nitrate of silver must also be dropped on to the 
 cornea every night and morning. The eyes must be covered 
 with a light, cold, wet compress. The patient must be 
 isolated, and all cloths and compresses used must be burnt. 
 
 OTOLOGY. 
 
 1. (1) Insects, by warm water or chloroform oil; (2) by 
 syringing; (3) wax may be removed by disintegrating it 
 with hydrogen dioxide, followed by warm water irrigation. 
 
 2. Etiology: Infection from nasopharynx or ear, exan- 
 themata, grippe. Symptoms: Tenderness, pain, swelling 
 and redness over the mastoid ; bulging of the superior and 
 posterior parts of the auditory canal ; temperature variable, 
 from normal up to about 104 F. Treatment: Hot water, 
 or cold water, or ice; leeches, purgatives; light diet ^in- 
 cision or mastoid operation. Three common and serious 
 results: Meningitis, sinus phlebitis, abscess of the brain. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 Board of Medical Examiners of the State of Washing- 
 ton. 
 
 ANATOMY. 
 
 1. Name muscles attached to the great trochanter of the 
 femur. 
 
 2. Into what two classes are muscles divided? Describe 
 each. 
 
 3. Describe Poupart's ligament; name anatomical rela- 
 tions and what passes beneath it. 
 
 4. Name the twelve pairs of cranial nerves. 
 
 5. Name bones articulating with humerus. 
 
 6. Describe diaphragm, its principal openings and nerve 
 supply. 
 
 7. What forms the internal hamstring? 
 
 8. What constitutes the brachial plexus ? 
 
 9. Name the cranial nerve having greatest distribution. 
 
 10. Locate and describe Peyer's glands. 
 
 11. Name the nerves of the eyeball. 
 
 12. Describe the spinal column, special and peculiar 
 vertebra. 
 
 PHYSIOLOGY. 
 
 1. Describe how nature stops the flow of blood from a 
 wound, and tell how you would assist her. 
 
 722 
 
MEDICAL RECORD. 
 
 2. What is meant by "physiological leucocytosis," and 
 under what conditions found? 
 
 3. What is the difference between lymph and serum? 
 Is the former a product of the lymphatic glands? 
 
 4. Name at least four functions of the liver. 
 
 5. Explain anabolism and katabolism. 
 
 6. How can we afford the greatest voluntary assistance 
 to the entrance of venous blood into the heart? 
 
 7. Give the nervous control of the heart. 
 
 8. What do you understand by "phagocytosis" ? 
 
 9. Describe the pancreatic juice, giving the ferments and 
 their specific action. 
 
 10. What is food? Classify and give its function. 
 
 11. Compare the path followed by a motor nerve im- 
 pulse passing to a skeletal muscle with that of an impulse 
 which reaches an involuntary muscle. 
 
 12. Give various causes for the flow of saliva. 
 
 CHEMISTRY AND TOXICOLOGY. 
 
 (Answer ten questions only.) 
 
 1. Give two tests for albumin in urine. What is the spe- 
 cific gravity of normal urine, and how is it determined? 
 
 2. How would you test for sugar in urine that is strongly 
 acid? Which kind of sugar is reduced in the test? 
 
 3. Give methods of detecting bile in urine. 
 
 4. What are the active principles in saliva, gastric juice, 
 pancreatic juice? What is their chemical function in diges- 
 tive economy? 
 
 5. What substances may be present in a good drinking 
 water? What substances would you consider harmful or 
 undesirable? 
 
 6. Give the chemical composition of pure air. In respi- 
 ration, what is inhaled and what is exhaled? How do the 
 gases enter and leave the body? 
 
 7. What is the poison in (a) paris green? (b) in "rough 
 on rats"? Differentiate between poisoning by arsenic and 
 phosphorus. 
 
 8. Give antidotes for poisoning by belladonna, corrosive 
 sublimate, and carbolic acid. 
 
 9. What are ptomains? When would you suspect pto- 
 main poisoning? What is the cause of milk and ice cream 
 poisoning? 
 
 10. W T hat parts of the body would you prepare for the 
 toxicological chemist, and how? 
 
 11. What is the poison in most headache powders? Its 
 effect? Antidote? 
 
 12. A patient has died in convulsions; poison is suspected. 
 What poisons might be looked for? 
 
 723 
 
MEDICAL RECORD. 
 
 HISTOLOGY. 
 
 (Answer ten questions only.) 
 i. Describe the blood. 
 
 2. Give the histological structure of a nerve. 
 
 3. Describe cartilage and name varieties. 
 
 4. Differentiate the histological structure of arteries and 
 veins. 
 
 5. Name and describe the membranes of the brain and 
 give function of each. 
 
 6. Differentiate white fibrous tissue and yellow elastic 
 tissue as to structure and function. 
 
 7. Describe a red blood corpuscle. Where do they have 
 their origin? 
 
 8. Give the histological structure of the human skin. 
 
 9. Describe normal urine. 
 
 10. Give the histological structure of the walls of the 
 stomach. 
 
 11. Describe the microscopic appearance of the liver in 
 a healthy adult. 
 
 12. Name three types of epithelium and give location of 
 each. 
 
 GENERAL DIAGNOSIS. 
 
 1. What is the normal position of the apex beat, and how 
 is it affected by disease of the heart? What are the two 
 kinds of cardiac murmurs? Name and define the areas 
 over which they are best heard. 
 
 2. Define acute anterior poliomyelitis. Give pathology, 
 symptoms, prognosis, and differential diagnosis. 
 
 3. Describe a fracture of the upper third of the humerus 
 in a patient at fifteen years of age, and distinguish from 
 other conditions in this region following trauma. 
 
 4. Give the differential diagnosis between iritis, corneal 
 ulcer, and conjunctivitis. Give the causes and sequelae of 
 each. 
 
 5. Give the symptomatology of tuberculosis of the kidney 
 and the differential diagnosis between it and renal calculus, 
 hydronephrosis, and pyelitis. 
 
 6. Give definition of acute osteomyelitis, the pathology, 
 symptomatology, and differential diagnosis between it and 
 acute rheumatism. 
 
 7. Give the symptoms and physical signs of broncho- 
 pneumonia and differentiate from lobar pneumonia and 
 bronchitis. 
 
 8. Name the varieties and give the signs of dislocation of 
 the head of the radius, and exclude other conditions about 
 the elbow following an injury. 
 
 9. In syphilis, when is the cerebral involvement usually 
 manifested? What structures are involved? Give the 
 symptoms, sequelae, and differential diagnosis. 
 
 724 
 
MEDICAL RECORD. 
 
 io. Give the pathology and symptoms of intussusception, 
 and differentiate this condition from volvulus, fecal impac- 
 tion, appendicitis, and mesenteric thrombosis. 
 
 ii. Give the period of incubation, describe the rash of 
 scarlet fever, and differentiate from other eruptions simu- 
 lating it. What are the most frequent complications and 
 sequelae of this disease? 
 
 12. Trichiniasis ; describe the parasite, its habitat, and 
 mode of infection. Give the symptoms and prophylaxis. 
 
 PATHOLOGY. 
 
 {Answer ten questions only.) 
 
 i. Describe the macroscopic and microscopic appearance 
 of an epithelioma of the lip. 
 
 2. Describe the pathological changes in a case of cerebro- 
 spinal meningitis. 
 
 3. Name varieties of casts found in the urine, and give 
 their clinical significance. 
 
 4. Define anemia, hyperemia, leukemia, and leukopenia. 
 
 5. What pathological changes usually take place in 
 chronic inflammation of the bones? 
 
 6. What is (a) an embolus, (b) a thrombus, (c) an in- 
 farct? 
 
 7. Describe the formation of an acute abscess. 
 
 8. Differentiate sarcoma and carcinoma, and give diag- 
 nostic pathology of each. 
 
 9. State by what two methods the tubercle bacillus pro- 
 duces its specific tissue changes. 
 
 10. Give pathology of locomotor ataxia. 
 
 11. Name the intestinal lesions of typhoid fever, and give 
 pathology of each. 
 
 12. Name stages of syphilis, and give their pathology. 
 
 OBSTETRICS. 
 
 i. Name and define the five principal diameters of the 
 fetal head. Tell which is the longest and which plane in a 
 normal labor is in relation to the successive planes of the 
 pelvis. 
 
 2. What is meant by placenta praevia? What are the 
 types, symptoms, physical signs, and dangers? 
 
 3. What is eclampsia? Give its etiology, symptomatology 
 (both prodromal and during the attack), and diagnosis. 
 
 4. Define the term puerperium. Name and give the 
 causes of the principal pathologic processes that may affect 
 the mother during that period. 
 
 5. Name and give the causes of the principal disease, 
 both hereditary and acquired, which may affect the new- 
 born infant. 
 
 725 
 
MEDICAL RECORD. 
 
 6. Give the mode of onset and symptoms of a puerperal 
 infection, and discuss the prognosis. 
 
 7. How would you diagnose a left sacroposterior posi- 
 tion, and what are the dangers of the delivery? 
 
 8. What do you mean by the mechanism of the second 
 stage of labor? What are the various movements in a 
 normal labor? Discuss each briefly. 
 
 9. Describe the changes in nutrition, digestion, urine, and 
 nervous system which may occur in a normal pregnancy. 
 
 10. From what conditions would you have to diagnose a 
 pregnancy at the end of the third month? Give the symp- 
 toms and signs of pregnancy at that time, and give the dis- 
 tinguishing features in each case. 
 
 11. Define presentation, position, and posture. Give each 
 in normal labor, and tell what causes are most liable to 
 modify each and so cause an abnormal labor. 
 
 12. Define menstruation, ovulation, placenta, chorion, 
 amnion, allantois, decidua vera, meconium, caput succe- 
 daneum, cephalhematoma. 
 
 GYNECOLOGY. 
 
 1. Name the contents of the female pelvis; their normal 
 positions and relations. 
 
 2. Give anatomy of floor of pelvis and the results of its 
 destruction. 
 
 3. State the uterine displacements most commonly met. 
 Give their chief clinical symptoms. 
 
 4. Give some of the most common causes of menor- 
 rhagia and metrorrhagia — local, constitutional, and vas- 
 cular. 
 
 5. Gonorrheal infection in the female, acute and latent; 
 give parts involved, symptoms objective and subjective, and 
 other diagnostic methods; give dangers immediate and 
 remote of the disease. 
 
 6. Give hygienic regulations for girl at puberty. 
 
 7. Give etiology of sterility in the female. 
 
 8. Give causes of pruritus vulvae. 
 
 9. Differentiate extrauterine pregnancy from appendi- 
 citis and salpingitis. 
 
 10. Give effects on general health by fibroid tumors; 
 their subjective symptoms, prognosis, and degenerative 
 changes that may occur. 
 
 11. Give diagnostic signs and symptoms of cancer of the 
 fundus of the uterus, and from what is it to be differen- 
 tiated ? 
 
 12. From what is a large ovarian cyst to be differen- 
 tiated, and how done? 
 
 726 
 
MEDICAL RECORD. 
 
 HYGIENE. 
 
 (Answer ten questions only.) 
 i. Give a few important rules for the care and control of 
 tuberculosis. 
 
 2. What are the methods of transmission of the more 
 important infectious and contagious diseases? Give illus- 
 trations of each. 
 
 3. What are the most common sources of infection in 
 diphtheria, and what hygienic precautions should be em- 
 ployed ? 
 
 4. W T hat measures would you employ for the prevention 
 of the spread of contagious diseases? 
 
 5. Differentiate between endemic and epidemic diseases. 
 
 6. Through what media is the typhoid infection usually 
 communicated? 
 
 7. What gases are most efficient as disinfectants? 
 
 8. How would you disinfect (1) rooms, (2) clothing, (3) 
 hands, (4) urine and feces, water closets, etc.? 
 
 9. What diseases are incident to school life, and how 
 prevented? 
 
 10. What are (a) toxins, (b) antitoxins? 
 
 11. If a chemical analysis of water revealed the presence 
 of nitrites and nitrates, would this condemn it for drink- 
 ing? If so, why? 
 
 12. Mention the principal diseases that should be quaran- 
 tined? And how would you determine the length of time 
 in each? 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Board of Medical Examiners of the State of Washing- 
 ton. 
 
 ANATOMY. 
 
 1. Gluteus medius, gluteus minimus, pyriformis, obturator 
 externus, obturator internus, superior gemellus, inferior 
 gemellus. 
 
 2. Striated, unstriated, and cardiac. See Gray's "Anat- 
 omy" (1908), page 363. 
 
 3. See Cunningham's "Anatomy" (1909), page 422; or, 
 Gray's "Anatomy" (1908), page 438. 
 
 4. The twelve pairs of cranial nerves are: (1) Olfactory. 
 (2) Optic. (3 Motor oculi. (4) Trochlear or Pathetic. 
 (5) Trifacial. (6) Abducens. (7) Facial. (8) Auditory 
 (g) Glossopharyngeal. (10) Pneumogastric or Vagus. (11) 
 Spinal Accessory. (12) Hypoglossal. 
 
 -5. Scapula, ulna, and radius. 
 
 727 
 
MEDICAL RECORD. 
 
 6. The diaphragm is a musculofibrous septum which di- 
 vides the thoracic from the abdominal cavity; it is fan- 
 shaped; the broad, elliptical portion is horizontal, and the 
 crura are vertical. It is attached to the ensiform, to the 
 internal surfaces of the lower six costal cartilages, to 
 bodies and intervertebral substances of first, second, and 
 third lumber vertebrae. Its openings are: (i) The aortic, 
 (2) the esophageal, (3) the opening for the vena cava, (4) 
 the right crural, (5) the left crural. Nerve supply: Phre- 
 nic, lower intercostal, and sympathetic. 
 
 7. The tendons of the Semimembranosus, Semitendi- 
 nosus, Gracilis, and Sartorius. 
 
 8. The brachial plexus is formed by the union and subse- 
 quent division of the anterior divisions of the fifth, sixth, 
 seventh, and eighth cervical and the first dorsal nerves. 
 The union of the fifth and sixth makes the upper trunk ; 
 the seventh forms the middle trunk, and the eighth cervical 
 and first dorsal make the lower trunk. Each of these trunks 
 is divided into an anterior and a posterior branch. The 
 anterior branches, from the upper and middle trunks, make 
 the upper or outer cord of the plexus ; the anterior branch 
 of the lower trunk becomes the lower or inner cord ; the 
 three posterior branches unite to form the posterior or 
 middle cord. The plexus lies between the Scalenus anticus 
 and medius. 
 
 9. The tenth, or pneumogastric. 
 
 10. See Cunningham's -"Anatomy" (1909), page 1064; or, 
 Gray's "Anatomy" (1908), page 1304. 
 
 11. Sensory, from branches of the first division of the 
 fifth cranial nerves ; motor, from third, fourth, and sixth 
 cranial nerves. 
 
 12. See Cunningham's "Anatomy" (1909), pages 88, 75, 
 79, etc.; or, Gray's "Anatomy" (1908), pages 67, 50, etc. 
 
 PHYSIOLOGY. 
 
 1. Nature's way of stopping the flow of blood from a 
 wound is by the coagulation of the blood. This may be 
 helped by anything that aids coagulation, such as styptics 
 or the application of gauze, bandages, etc. 
 
 2. Physiological leucocytosis is an increase in the number 
 of the white blood corpuscles occurring under normal or 
 physiological conditions, such as : Digestion, exercise, after 
 a cold bath, or during pregnancy. 
 
 3. Lymph is diluted blood without the red corpuscles; 
 serum is practically blood plasma, with the exception of 
 the substances which enter into the formation of fibrin. 
 Lymph is not a product of the lymphatic glands. 
 
 4. The functions of the liver are: (1) The secretion of 
 bile; (2) the formation of glycogen; (3) the formation of 
 urea and uric acid; (4) the manufacture of heat, and (5) 
 
 728 
 
MEDICAL RECORD. 
 
 the conversion of poisonous and harmful into inert 
 material. 
 
 5. Metabolism is the entire series of changes that occur 
 in a cell or organism during the processes of nutrition. It 
 is of two kinds : (1) Assimilative, or constructive (anabol- 
 ism), and (2) destructive (katabolism). 
 
 6. By taking deep inspirations. 
 
 7. The nerves which control the heart are: (1) The 
 pneumogastric nerve, which slows or inhibits the heart 
 beats; (2) the sympathetic nerves, which accelerate or aug- 
 ment the beats; and (3) the intrinsic cardiac ganglia, which 
 enable the heart to continue beating for some time after 
 it is removed from the body. 
 
 8. Phagocytosis is the faculty of certain cells (notably 
 the mononuclear and polynuclear leucocytes) to take up 
 and destroy bacteria. 
 
 9. The pancreatic juice is a colorless, viscid, odorless, 
 salty fluid, alkaline in reaction, and of a specific gravity of 
 about 1030. Composition: Water and solids, the latter con- 
 sisting of three enzymes (trypsin, amylopsin, and steap- 
 sin), proteid material, soaps, fats, lecithin, and inorganic 
 salts (carbonate of sodium, chloride of sodium, and phos- 
 phates of sodium, calcium, and magnesium). 
 
 Ferments: (1) trypsin, which changes proteids into pro- 
 teoses and peptones, and afterward decomposes them into 
 leucin and tyrosin ; (2) amylopsin, which converts starch 
 into maltose; (3) steapsin, which emulsifies and saponifies 
 fats ; and (4) a milk-curdling ferment. All of these act in 
 an alkaline medium only. 
 
 10. Food is material which, after being taken into the 
 body, is capable of building up the body, of repairing tissue 
 waste, and of supplying heat and energy. Foods are classi- 
 fied as : 
 
 T T . ( Water. 
 
 I. Inorganic. J Salts> 
 
 tt Dr^n,v 1 Nitrogenous — Proteids. f ~ . , , 
 
 li. Organic ' ° f Carbohydrates. 
 
 I Aon-Jsitrogenous. jp * 
 
 Function of proteids: Formation and repair of tissues 
 and fluids of the body, regulation of the absorption and 
 utilization of oxygen, formation of fats and carbohydrates, 
 production of energy. Function of carbohydrates: Produc- 
 tion of heat and energy, and formation of fats. Function 
 of fats: Supply of heat and energy, supply of fatty tissues, 
 nutrition of nervous system. Function of salts: Support 
 of bony skeleton, supply of HC1 for digestion, regulation 
 of nutrition and energy. Function of water: It enters into 
 the composition of all the tissues and fluids of the body, it 
 moistens the surfaces and membranes of the body, it keeps 
 the fluids of the body at their proper degree of dilution, it 
 
 729 
 
MEDICAL RECORD. 
 
 removes waste matters, distributes and regulate body heat. 
 
 ii. To a skeletal muscle the motor nerve impulses start 
 in the cortex cerebri, and pass through the corona radiata, 
 internal capsule, crus, pons, medulla, crossed and direct 
 pyramidal columns to motor cells of anterior horn of 
 spinal column, thence through nerve root and motor nerve 
 to muscle. To involuntary muscle: The efferent fibers of 
 the sympathetic nervous system arise in the intermedio- 
 lateral column of gray cells. They pass out by the anterior 
 root from the spinal chord. From here they go by a white 
 ramus to a sympathetic ganglion. From the sympathetic 
 ganglion they may pass in two directions: (i) they may 
 form synapses about these cells and from these cells new 
 axons may arise and pass outwards in the visceral nerves, 
 or back through the gray ramus connected to the ganglion, 
 into the spinal or somatic nerve to the blood-vessels as 
 vasomotor nerves, or sweatglands as secretory nerves, or 
 to hairs as pilomotor nerves; (2) or they may pass 
 through the ganglion on to one situated more towards the 
 periphery, in which they form synapses and are continued 
 onward by new axons." 
 
 12. Causes of How of saliva: The taste, sight, or smell 
 of food ; the hearing of sounds associated with the prepara- 
 ton of food, various drugs (sialagogues), section of 
 chorda tympani, or stimulation of its peripheral end when 
 divided; section of sympathetic nerves supplying the sali- 
 vary glands, or stimulation of the peripheral end, when 
 divided; the thought of savory food; the feeling of nau- 
 sea which precedes vomiting. 
 
 CHEMISTRY AND TOXICOLOGY. 
 I. TWO TESTS FOR THE DETECTION OF ALBUMIN IN THE 
 
 urine: "The urine must be perfectly clear. If not so, it is 
 to be filtered, and if this does not render it transparent it 
 is to be treated with a few drops of magnesia mixture and 
 again filter ed." I. — The heat test: "The reaction is first 
 observed. If it be acid, the urine is simply heated to near 
 the boiling point. If the urine be neutral or alkaline, it is 
 rendered faintly acid by the addition of dilute acetic acid 
 and heated. If albumin be present, a coagulum is formed, 
 varying in quantity from a faint cloudiness to entire solidi- 
 fication, according to the quantity of albumin present. The 
 coagulum is not redissolved upon the addition of HNO*." 
 II. — Heller's modification of the nitric acid test: "Place 
 in a test-tube a layer of HN0 3 about 2 c. in thickness; 
 then with a pipette, carefully float upon the surface of 
 this a layer of the urine in such a manner that the liquids 
 do not mix. If albumin be present, a cloudy ring appears at 
 the point of junction of the two layers, the borders of the 
 cloud being sharply defined. A cloudy ring may be formed 
 
 730 
 
MEDICAL RECORD. 
 
 by the presence of an excess of urates, but in this case it 
 is not at, but above, the point of junction of the layers, and 
 its upper border is not sharply defined, but fades off grad- 
 ually." (Witthaus' Essentials of Chemistry.) 
 
 The specific gravity is about 1015 to 1025, and is deter- 
 mined by means of a urinometer. 
 
 2. Boettger's test for sugar: Render the urine strongly 
 alkaline by addition of Na 2 C0 3 . Divide about 6 c.c. of the 
 alkaline liquid in two test-tubes. To one test-tube add a 
 very minute quantity of powdered subnitrate of bismuth, to 
 the other as much powdered litharge. Boil the contents of 
 both tubes. The presence of glucose is indicated by a dark 
 or black color of the bismuth powder, the litharge retaining 
 its natural color. The kind of sugar reduced is glucose. 
 
 3. Test for bile pigment in the urine: Put 3 c.c. HNO* 
 in a test-tube ; add a piece of wood, and heat until the acid 
 is yellow; cool. When cold, float some of the urine to be 
 tested upon the surface of the acid. A green band is formed 
 at the junction of the liquid, which gradually rises, and is 
 succeeded from below by blue, reddish-violet, and yellow. 
 
 4- 
 
 SECRETIONS 
 
 Sal 
 
 iva 
 
 Gastric juice. 
 
 Pancreatic juice 
 
 ACTIVE 
 PRINCIPLES 
 
 Ptyalin. 
 Pepsin. 
 
 ^A curdling 
 f e! ment. 
 Tiypsin. 
 
 Amylopsin. 
 Steapsin. 
 
 A curdling 
 
 L ferment. 
 
 FUNCTION. 
 
 Changes starches into 
 dextrin and sugar. 
 
 Changes proteids into 
 proteoses and peptones 
 in an acid medium. 
 
 Curdles the casein of 
 milk. 
 
 Changes proteids into 
 proteoses and peptones, 
 and afterward decom- 
 poses them into leucin 
 and tyrosin ; in an alka- 
 line medium. 
 
 Converts starches into 
 maltose. 
 
 Emulsifies and saponifies 
 fats. 
 
 Curdles the casein of 
 milk. 
 
 5. Good drinking water may contain the following in 
 very small amounts : Free ammonia, albuminoid ammonia, 
 nitrogen as nitrates, nitrogen as nitrites, and chlorine. 
 Harmful or undesirable substances would include all the 
 above in larger quantities, and the following: Sewage, 
 leaves, surface washings, manufacturing refuse, lead, other 
 
 731 
 
MEDICAL RECORD. 
 
 metals, leakage from gas pipes, insects, fungi, bacteria, 
 entozoa. 
 6. 
 
 Oxygen , 
 
 Nitrogen 
 
 Carbon dioxide. 
 
 Other gases 
 
 Watery vapor. . 
 Temperature . . , 
 
 Volume , 
 
 Bacteria 
 
 Dust 
 
 INSPIRED AIR 
 
 21 per cent. 
 79 per cent. 
 0.04 per cent. 
 Rare. 
 Variable. 
 Variable. 
 Varies. 
 
 Always present. 
 Always present. 
 
 EXPIRED AIR. 
 
 16.6 per cent. 
 79 per cent. 
 4.4 per cent. 
 Often present. 
 Saturated. 
 That of body. 
 Diminished. 
 None. 
 None. 
 
 The gases enter and leave the body by the process of 
 diffusion, or differences in pressure in the alveoli of 
 the lungs. 
 
 7. The poison in Paris green is arsenic; in Rough on 
 Rats, is phosphorus. Arsenic: The symptoms usually begin 
 in from twenty to forty-five minutes ; nausea and f aintness ; 
 violent, burning pain in the stomach, which becomes more 
 and more intense, and increases on pressure. Persistent 
 and distressing vomiting of matters, sometimes brown or 
 gray, or streaked with blood, or green (Paris green) ; purg- 
 ing ; more or less severe cramps in the lower extremities. 
 
 Phosphorus: Eructation of gas having the odor of 
 garlic. The mouth, when observed in the dark, is frequently 
 faintly luminous (phosphorescent). After several hours, 
 pain in the throat, a sense of heat in the epigastrium, 
 nausea, and vomiting. The vomited matters are sometimes 
 bloody, and frequently luminous when agitated in the dark. 
 The abdomen is tender, and there are diarrhea and colicky 
 pains. After one or two days these symptoms cease, there 
 remaining only pain in the back and limbs and a feeble 
 pulse. Death sometimes occurs suddenly in from two to 
 four days. Usually about the fourth day the patient becomes 
 jaundiced, suffers from headache, insomnia, and retention 
 of urine, rapidly becomes delirious and comatose, and dies. 
 (From Witthaus' Essentials of Chemistry and Toxicology.) 
 
 8. Antidote for belladonna, none; pilocarpine and mor- 
 phine are often given. For corrosive sublimate, milk or 
 white of Qgg in moderate quantity, followed by an emetic. 
 For carbolic acid, a soluble sulphate, such as sodium or 
 magnesium sulphate, or alcohol. 
 
 9. Ptomains are basic nitrogenous compounds, produced 
 from protein material by the bacteria which cause putre- 
 faction. They are found in protein foods which have partly 
 undergone decomposition. Ptomain poisoning. Symptoms: 
 Chilliness, headache, vertigo, muscular twitchings, halluci- 
 
 732 
 
MEDICAL RECORD. 
 
 nations, imperfect vision, weak and rapid pulse, nausea, 
 vomiting, diarrhea, cyanosis, early dyspnea, often subnor- 
 mal temperature, and occasionally cutaneous eruptions. The 
 cause of milk and ice-cream poisoning is tyrotoxicon. 
 
 10. In case of suspected homicidal poisoning, the follow- 
 ing parts of the cadaver should be preserved : "The ali- 
 mentary canal from the cardia to the middle of the rec- 
 tum, unopened, and the contents enclosed by ligatures at 
 the esophagus, duodenum, and lower end of gut; the liver, 
 including the gall-bladder; one kidney; the spleen; a piece 
 of muscular tissue from the leg; the brain, and any urine 
 which may remain in the bladder. 
 
 "They are to be placed in clean and new glass jars, closed 
 with glass or cork covers or stoppers. Jars with metallic 
 caps should never be used. Tapes or cords should be tied 
 about the jar and cap, to which they should be attached by 
 sealing wax bearing impressions of a seal, in such a man- 
 ner that access can only be had to the interior after break- 
 ing the seals or cutting the tapes or cords. Great care must 
 be exercised that no sealing wax can get into the jars. Each 
 portion should be placed in a jar by itself." (Witthaus' 
 Essentials of Chemistry.) 
 
 ii. Acetanilide. Effect: Chilliness, cold sweat; nausea; 
 pulse is soft, slow, and feeble; respirations slow and shal- 
 low. Treatment: Lavage, diffusible stimulants, application 
 of heat, coffee or strychnine, inhalation of oxygen, or 
 saline infusion. 
 
 12. Convulsions occur in poisoning by : Strychnine and 
 picrotoxin. 
 
 HISTOLOGY. 
 
 1. The blood is a fluid somewhat viscid, red, specific 
 gravity from 1055 to 1062, alkaline reaction, saltish taste, 
 characteristic odor, variable temperature (average about 
 ioo° F.) The constituents of the blood are plasma and 
 corpuscles. The plasma consists of water and solids (pro- 
 teids, extractives, and inorganic salts). The red corpuscles 
 consist of water and solids (hemoglobin, proteids, fat, and 
 inorganic salts). The white corpuscles consist of water 
 and solids (proteid, leuconuclein, lecithin, histon, etc.). 
 There are also platelets, which are very small, colorless, 
 irregular shaped bodies, about one-fourth the size of the 
 red corpuscle. 
 
 2. See Cunningham's "Anatomy" (1909), page 444; or, 
 Gray's "Anatomy" (1908), page 819. 
 
 3. Cartilage is a form of connective tissue; it is firm and 
 elastic; opaque, and of a bluish color. The varieties are: 
 (1) Hyaline, in which the cells are relatively few and are 
 imbedded in a quantity of ground substance. (2) White 
 fibro cartilage, in which the ground substance contains 
 
 733 
 
MEDICAL RECORD. 
 
 bundles or layers of white fibers, between which are en- 
 capsulated cells. (3) Yellow fibro cartilage, in which the 
 ground substance contains a network of yellow, elastic 
 fibers, and the cartilage cells are in the meshes of this net- 
 work. 
 
 4. See Cunningham's "Anatomy" (1909), page 781; or, 
 Gray's "Anatomy" (1908), page 586. 
 
 5. See Cunningham's "Anatomy" (1909), page 597; or, 
 Gray's "Anatomy" (1908), page 972. 
 
 6. The function of the dura is protection : It forms the 
 internal periosteum of the skull ; it forms three partitions 
 for the support of the parts of the brain; it forms sinuses 
 or venous channels for the return of the blood from the 
 brain, and it forms sheaths for the nerves as they leave the 
 skull. The function of the arachnoid is lymph supply; of 
 the pia, blood supply and nutrition. 
 
 7. The red blood corpuscles are biconcave discs, about 
 1-3200 of an inch in diameter; they are nonnucleated, and 
 there are about 4,500,000 or 5,000,000 of them in each cubic 
 millimeter of blood. They are elastic and soft, and their 
 shape is changed by pressure, but is promptly regained on 
 the removal of the pressure. Their color is yellowish. They 
 contain hemoglobin. They originate in the marrow of the 
 long bones. 
 
 8. See Cunningham's "Anatomy" (1909), page J72; or, 
 Gray's "Anatomy" (1908), page 1190. 
 
 9. Normal urine is a straw- or amber-colored fluid, with 
 specific gravity from about 1015 to 1025; its chemical reac- 
 tion is acid. The normal constituents are : Water urea, 
 uric acid, urates, hippuric acid, kreatin, kreatinin, xanthin, 
 hypoxanthin, sulphates, chlorides, and phosphates of 
 sodium and potassium; phosphates of magnesium and cal- 
 cium, nitrogen and carbon dioxide. The average quantity 
 voided in twenty-four hours is about fifty ounces. 
 
 10. See Cunningham's "Anatomy" (1909), page 1058; or, 
 Gray's "Anatomy" (1908), page 1281. 
 
 11. See Cunningham's "Anatomy" (1909), page 1121; or, 
 Gray's "Anatomy" (1908), page 1345. 
 
 12. (1) Columnar epithelium; in stomach, intestines, and 
 ducts of most secreting glands. (2) Cubical epithelium ; in 
 thyroid, testis, and some of the glands. (3) Ciliated epithe 
 Hum ; in upper air passages, Fallopian tubes, ventricles of 
 brain, Central canal of spinal cord, vasa efferentia, and 
 tail of spermatozoa. 
 
 GENERAL DIAGNOSIS. 
 
 I. The apex beat is normally in the fifth left intercostal 
 space, about three inches to the left of the midsternal line. 
 It may be displaced (upward, downward, to left, to right; 
 the impulse may be increased, weakened, or absent; the 
 
 734 
 
MEDICAL RECORD. 
 
 frequently may be increased or decreased; the extent may 
 vary). The two kinds of cardiac murmurs are: (i) 
 Hemic, and (2) Organic. The former is heard best over 
 the base ; the latter, generally over the apex or sternum, 
 sometimes at base (the exact location varying with the 
 valve affected). 
 
 2. See French's "Practice" (1907), page 1034; or, Osier's 
 "Practice" (1909), page 914. 
 
 3. See Rose and Carless' "Surgery" (1908), page 5502; 
 or, Da Costa's "Surgery" (1908), page 486. 
 
 4. 
 
 CONJUNCTIVITIS 
 
 1. No change in iris. 
 
 2. Pupil normal. 
 
 3. Anterior chamber nor- 
 mal. 
 
 4. Conjunctival injection, 
 coarse meshes, most pro- 
 nounced in fornix and fad- 
 ing toward the cornea. 
 
 5. Mucous or mucopuru- 
 lent secretion. 
 
 6. Discomfort, but no real 
 pain. 
 
 7. Conjunctiva reddened 
 and opaque. 
 
 8. No interference with 
 vision. 
 
 iritis 
 
 1. Discolored and altered 
 iris. 
 
 2. Pupil small, gray, slug- 
 gish, irregular after use of 
 atropine. 
 
 3. Exudation in anterior 
 chamber. 
 
 4. Ciliary (circumcorneal) 
 injection; pink zone of fine 
 vessels surrounding cornea 
 and fading toward fornix. 
 
 5. ^ Lacrymation, but no se- 
 cretion. 
 
 6. Pain, worse at night. 
 
 7. Conjunctiva usually 
 transparent. 
 
 8. Vision diminished in 
 acuteness. 
 
 Conjunctivitis. Causes: Foreign body, irritation, heat 
 or cold, exposure to light, eyestrain, infection. Sequela: 
 Scars, ulceration, perforation, staphyloma. Iritis. Causes: 
 Syphilis, gout, rheumatism, tuberculosis, diabetes, nephritis, 
 infections, traumatism, inflammations. Sequela: Opacities, 
 synechias Corneal ulcer. Causes: Traumatism, extension 
 of inflammation. Diagnosis : It is detected by oblique illu- 
 mination, the ophthalmoscope, or convex lens, and by 
 dropping fluorescin upon the cornea, the denuded area be- 
 ing colored green. Pain, photophobia, lacrimation^ swelling 
 of the lids and conjunctiva, and destruction of tissue are 
 symptoms. Sequela: Corneal opacities, staphyloma, per- 
 foration, adherent leukoma, atrophy of the eyeball, and 
 prolapse of the lens and vitreous. 
 
 5. See French's "Practice" (1907), pages 383, 911, 910, 
 and 907; or, Osier's "Practice" (1909), pages 346, 710, 707 
 and 704. 
 
 735 
 
MEDICAL RECORD. 
 
 6. See Rose and Carless' "Surgery" (1908), page 570; or, 
 Da Costa's "Surgery" (1908), page 440. In acute rheuma- 
 tism there is successive involvement of many joints; the 
 tenderness, pain, and swelling are over the joints, and not 
 over the bones; profuse sweats are present, and the condi- 
 tion responds to treatment by salicylates. 
 
 7. See French's "Practice" (1907), page 672; or, Osier's 
 "Practice" (1909), page 624. 
 
 8. See Rose and Carless' "Surgery" (1908), page 625; or, 
 Da Costa's "Surgery" (1908), page 594. 
 
 9. See French's "Practice" (1907), page 423; or, Osier's 
 "Practice" (1909), page 271. 
 
 10. See French's "Practice" (1907), page 799; or, Osier's 
 "Practice" (1909), page 519; or, Rose and Carless' "Sur- 
 gery" (1908), pages 1 1 19 and 1123; or, Da Costa's "Sur- 
 gery" (1908), page 837. 
 
 n. See French's "Practice" (1907), page 315; or, Osier's 
 "Practice" (1909), page 130. 
 
 12. See French's "Practice" (1907), page 492; or, Osier's 
 "Practice" (1909), page 39. 
 
 PATHOLOGY. 
 
 1. See Rose and Carless' "Surgery" (1908), pages 211 
 and 801. 
 
 2. See French's "Practice" (1907), page 141; or, Osier's 
 "Practice" (1909), page 159. 
 
 3. Hyaline casts occur in all forms of nephritis, in con- 
 gestion of the kidneys, in jaundice; waxy casts, in chronic 
 parenchymatous nephritis; epithelial casts, in acute paren- 
 chymatous nephritis ; granular casts, in chronic nephritis 
 and in acute nephritis ; fatty casts, in cnronic parenchy- 
 matous nephritis; blood casts, in hemorrhagic nephritis; 
 pus and bacterial casts, in suppurative nephritis. 
 
 4. Anemia denotes a condition in which there is reduction 
 of the quantity or quality of the blood (generally used with 
 reference to the red corpuscles). Hyperemia denotes ex- 
 cessive blood in a part. Leukemia is a condition in which 
 the white blood corpuscles are increased in number, and is 
 accompanied by pathological changes in the spleen, lym- 
 phatic glands, and bone marrow. Leukopenia is a condition 
 in which the number of white blood corpuscles in the 
 peripheral circulation is below the normal. 
 
 5. See Rose and Carless' "Surgery" (1908), page 57& 
 
 6. An embolus is a plug in a blood vessel brought thither 
 by the blood current. A thrombus is a blood clot formed in 
 the blood vessels during life. An infarct is an area of 
 tissue in which, owing to the plugging up of an end artery 
 or terminal artery, nutrition is prevented. 
 
 7. See Rose and Carless' "Surgery" (1908), page 627; or, 
 Da Costa's "Surgery" (1908), page 132. 
 
 736 
 
MEDICAL RECORD. 
 
 8. Carcinoma is apt to occur at a later age ; is found in 
 structures derived from the epiblast or hypoblast; pos- 
 sesses a fibrous stroma, in which are found both blood 
 vessels and lymphatics ; metastasis is by the lymphatics. 
 
 Sarcoma is apt to occur earlier; is found in structures 
 derived from the mesoblast; there is no stroma between 
 the cells ; the blood vessels are in direct contact with the 
 tumor cells; there are no lymphatics; metastasis is by the 
 blood vessels. 
 
 9. Irritation and degeneration. 
 
 10. In locomotor ataxia the posterior columns of the 
 spinal cord and the posterior nerve roots are 'involved 
 
 The posterior columns of the spinal cord are gray and 
 shrunken, and show considerable overgrowth of connective 
 tissue in the columns of Goll, Burdach, and Lissauer; this 
 process extends upward from the lumbosacral region; the 
 posterior nerve roots degenerate and become atrophic. The 
 meninges over the affected parts become opaque and adhe- 
 rent. Some of the cranial nerves may also atrophy, notably 
 the optic, but also the motor oculi and vagus. 
 
 The process is destructive and progressive ; it is not a 
 simple wasting, although the nerve fibers are atrophied, but 
 it is characterized by irritation, changes in the axis cylin- 
 ders, overgrowth of the connective tissue, and sometimes 
 congestion ; the spinal ganglia may be affected. 
 
 11. See French's "Practice" (1907), page 85; or, Osier's 
 "Practice" (1909), page 65. 
 
 12. See French's "Practice" (1907), page 420; or, Osier's 
 "Practice" (1909), page 267. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), page 153; or, 
 Hirst's "Obstetrics" (1909), page 92. 
 
 2. See Williams' "Obstetrics" (1909), page 809; or, 
 Hirst's "Obstetrics" (1909), page 572. 
 
 3. See Williams* "Obstetrics" (1909), page 524; or, 
 Hirst's "Obstetrics" (1909), page 628. 
 
 4. See Williams' "Obstetrics" (1909), pages 332 and 
 851; or, Hirst's "Obstetrics" (1909), pages 347 and 644. 
 
 5. See Williams' "Obstetrics" (1909), page 599; or, 
 Hirst's "Obstetrics" (1909)* page 155. 
 
 6. See Williams' "Obstetrics" (1909), page 852; or, 
 Hirst's "Obstetrics" (1909), page 712. 
 
 7. See Williams' "Obstetrics" (1909), page 284; or, 
 Hirst's "Obstetrics" (1909), page 419. 
 
 8. See Williams' "Obstetrics" (1909), page 256; or, 
 Hirst's "Obstetrics" (1909), page 396. 
 
 9. See Williams' "Obstetrics" (1909), page 173; or, 
 Hirst's "Obstetrics" (1909), page 186. 
 
 737 
 
MEDICAL RECORD 
 
 io. See Williams' "Obstetrics" (1909), page 190; or, 
 Hirst's "Obstetrics" (1909), page 204. 
 
 11. See Williams' "Obstetrics" (1909), pages 205 and 207; 
 or, Hirst's "Obstetrics" (1909), page 388. Posture is the 
 altitude of the fetus in the uterus. 
 
 12. Menstruation is a periodical disturbance in the female 
 characterized by a bloody mucous discharge from the 
 uterine cavity ; it lasts during the period of woman's sexual 
 activity, but is temporarily suspended during pregnancy and 
 early lactation. Ovulation is the development and ripening 
 of ovules in the ovary and their discharge therefrom. 
 Placenta is an organ on the internal wall of the pregnant 
 uterus, to which the fetus is attached by means of the 
 umbilical cord. Chorion is the outermost of the three fetal 
 membranes. Amnion is the innermost of the fetal mem- 
 branes. Allantois is one of the fetal membranes, which 
 enters into the formation of the true chorion and the pla- 
 centa. Decidua vera is that portion of the decidua (or 
 hypertrophied mucous membrane) which lines the uterine 
 wall during pregnancy. Meconium is the greenish-black 
 stools of the newborn infant; it consists of intestinal 
 mucus, bile, epithelium, vernix caseosa, cholestrin, phos- 
 phates, and fat. Caput succedaneum is the edematous swell- 
 ing developed on the presenting part of the fetus during 
 birth. Cephalhematoma is a swelling occurring on the head 
 of a newborn infant, due to subpericranial hemorrhage. 
 
 GYNECOLOGY. 
 
 1. See Cunningham's "Anatomy" (1909), page 1181, etc.; 
 or, Gray's "Anatomy" (1908), pages 1440, 1498, etc. 
 
 2. The pelvic floor is composed chiefly of fascia, muscles, 
 and connective tissue. Its superior surface is lined by peri- 
 toneum. Next below, and in close contact with the peri- 
 toneum, comes the "internal pelvic fascia." Immediately 
 below the internal pelvic fascia are two thin muscles, viz. : 
 (1) The levator ani, each half of which arises from the 
 body and horizontal ramus of the pubes and from the arcus 
 tendineus, and passes downward ana inward to meet its 
 fellow of the opposite side in the median line, where it is 
 inserted into a tendinous raphe extending from the coccyx 
 to the rectum, while some fibers pass between and to the 
 sides of the bladder and rectum, and to the vaginal and 
 rectal sphincters. (2) The coccygeus t which is a narrow, 
 triangular slip, situated parallel with and posterior to the 
 levator ani, closing in a little space which the latter muscle 
 failed to cover. Below these muscles the pelvic floor is 
 further strengthened by the perineal fascia. Its posterior 
 portion consists of a single layer, while its anterior part is 
 divisible into three layers. Within these latter layers are 
 lodged the pudic vessels and nerves, and the superficial 
 
 738 
 
MEDICAL RECORD 
 
 muscles of the perineum. These muscles are the constrictor 
 vagina, the sphincter ani, and the transversus perinei, and 
 to these structures must be added the integument and the 
 very numerous interstitial layers of elastic connective tis- 
 sue, which latter weld the parts together and add strength 
 and elasticity to the whole fabric. — (From King's Obstet- 
 rics.) 
 
 "Tears of the perineum destroy the integrity of the pelvic 
 floor and result eventually in rectocele, cystocele, hemor- 
 rhoids, and displacements of the pelvic organs. If the tear 
 involves the sphincter ani, incontinence also results. Lacer- 
 ations of the cervix retard or check involution of the uterus 
 and predispose to endometritis, menorrhagia, displacements, 
 eversion of the cervical mucous membrane, cystic degen- 
 eration, and malignant disease. Deep lacerations of the 
 vaginal vault may open into the base of the broad ligaments, 
 and in the majority of instances genitourinary fistulas are 
 caused by traumatisms of labor. All lacerations are imme- 
 diately dangerous on account of the increased liability to 
 sepsis, while the remote results are generally due to inter- 
 ference with involution or the pelvic circulation and to the 
 destruction of the normal supports of the pelvis." (Ash- 
 ton's Gynecology.) 
 
 3. The common displacements of the uterus are : Retro- 
 version, retroflexion, anteflexion, and descent or prolapse. 
 The following symptoms may follow displacements of the 
 uterus : Backache, bearing-down pains, a feeling of pres- 
 sure in the pelvis, constipation, hemorrhoids, frequent or 
 painful urination, leucorrhea, menstrual disturbances, as 
 dysmenorrhea or menorrhagia, sterility; there may also be 
 general symptoms, as headache, indigestion, nausea, anor- 
 exia, neurasthenia, and general malaise. 
 
 4. Common Causes of Menorrhagia. Constitutional: 
 Purpura, scorbutus, hemophilia, hepatic cirrhosis, over in- 
 dulgence in food and alcoholic drinks. Local and Vascular: 
 Uterine congestion and displacement, endometritis, subin- 
 volution, fibroids, and other tumors. Common Causes of 
 Metrorrhagia. Constitutional: None. Local and Vascu- 
 lar: Disease of uterus or appendages, polyps, extrauterine 
 gestation, the hemorrhages in connection with pregnancy. 
 
 5. Parts involved are : Vagina, vulva, and urethra ; uterus, 
 tubes, ovaries, peritonenn; rectum. Diagnosis is made by 
 finding the gonococcus characteristically grouped in the 
 cells of the secretion. Symptoms are : Pain, discharge, 
 painful urination, tenderness, redness, inflammation of parts 
 affected. Dangers: Spread of the disease to adjoining 
 parts or tissues, sterility, peritonitis, blindness, and spread 
 of the gonorrhea to others. 
 
 6.. Hygiene of Puberty: Constipation must be remedied; 
 
 739 
 
MEDICAL RECORD. 
 
 diet must be nutritious but simple; frequent rest, moderate 
 amusements, and adequate exercise are necessary; the girl 
 should be instructed with regard to menstruation and the 
 menstrual periods; overwork at school, and nervous excit- 
 ability, late hours, and much company should be avoided; 
 books, amusements, and associates should be carefully 
 selected. 
 
 7. Etiology of Sterility in the Female: Gonorrhea, 
 absence or errors- in development of any part of the genital 
 tract, malformations of genitals, fistulae, lacerations, 
 obesity, alcoholism, pelvic inflammations, dyspareunia, 
 inflammations of uterus, tubes, or ovaries, elongated cervix. 
 
 8. Pruritus vulva may be caused by: Parasites; diseases 
 of the vulva, as inflammation, edema, vegetations, conges- 
 tion; irritating discharges; lack of cleanliness; diabetic 
 urine ; it may also be of nervous origin, or idiopathic. 
 
 9. In extrauterine pregnancy, there will be signs of early 
 pregnancy, hypogastric or inguinal pains, probable history 
 of a previous sterility, probable expulsion of decidual mem- 
 brane or shreds, softening of the cervix, enlargement of 
 the uterus, presence of a distended tube, contractions of 
 the wall of the gestation sac; if rupture occurs, there will 
 be sudden, excruciating pains over the lower abdomen and 
 on the affected side, shock, collapse, and symptoms of 
 internal hemorrhage. In appendicitis, there are no signs of 
 pregnancy, there are sudden pain and tenderness in the 
 right iliac fossa, rigidity of right rectus muscle, fever, 
 nausea, vomiting, constipation, no history of menstrual 
 irregularities. In salpingitis, the tubes are inflamed usually 
 secondary to inflammation of uterus or to infection (either 
 gonorrheal or puerperal), backache, pain in lower abdo- 
 men, history of menstrual irregularity, leucorrhea, tube is 
 enlarged and tender. 
 
 10. Fibroids. General effect: Health deteriorates from 
 the hemorrhage, pain, leucorrhea, and pressure on neighbor- 
 ing organs; anemia, constipation, loss of weight, edema, 
 and hepatic troubles may ensue. Symptoms: Hemorrhage, 
 leucorrhea, pain, vesical symptoms, hemorrhoids, constipa- 
 tion, and enlargement of abdomen. Prognosis: Variable; 
 fibroids may cease to trouble at the menopause; but they 
 may also degenerate, and they certainly cause much invalid- 
 ism. The prognosis is better after early operation. Degen- 
 erative changes: Fatty mucoid, and cystic degeneration; 
 calcification ; septic infection ; malignant changes. 
 
 11. Cancer of fundus of uterus is diagnosed by the pres- 
 ence of tumor, cachexia, hemorrhage, pain, and offensive 
 discharge ; microscopic examination big aid in the diagnosis. 
 It is to be differentiated from: Polypi, fibroids, retained 
 placenta, and chronic endometritis. 
 
 740 
 
MEDICAL RECORD. 
 
 12. Large ovarian cyst may be differentiated from: 
 
 Pregnancy, ascites, and possibly uterine tumors. Preg- 
 nancy gives history and signs of the condition. 
 
 ASCITES 
 
 1. Previous history of 
 visceral disease. 
 
 2. Enlargement compara- 
 tively sudden. 
 
 3. Face puffy ; color 
 waxy; early anemia. 
 
 4. Patient on back, en- 
 largement symmetrical; flat 
 in front. 
 
 5. Sitting up, abdomen 
 bulges below. 
 
 6. Navel prominent and 
 thinned. 
 
 7. Fluctuation decidedly 
 clear, diffuse throughout 
 abdomen, but avoids highest 
 parts in all positions, and 
 always has a hydrostatic 
 level. 
 
 8. Intestines float on top 
 of fluid; hence percussion 
 gives clear tympanitic note 
 over the highest parts of 
 abdominal cavity, and dul- 
 ness in lowest parts for all 
 positions — i.e. areas of res- 
 onance and dullness change 
 with position. 
 
 9. Vaginal touch detects 
 fluctuation, bulging into va- 
 gina. 
 
 10. Uterus in prolapsed 
 location, but position un- 
 changed. Size and mobility 
 unchanged. 
 
 1 1. Hydragogues and diu- 
 retics temporarily remove 
 the fluid. 
 
 12. Fluid light straw 
 color and thin. Coagulates 
 spontaneously. 
 
 OVARIAN CYST 
 
 i. No such history. 
 
 2. Gradual. 
 
 3. Facies ovariana. Ane- 
 mia absent, or later. 
 
 4. Asymmetrical until tu- 
 mor is quite large; promi- 
 nent in front. 
 
 5. No appreciable change. 
 
 6. Navel usually un- 
 changed. 
 
 7. Less clear; limited to 
 cyst; not modified by 
 change of position. No 
 hydrostatic level. 
 
 8. No change in areas of 
 dullness and resonance with 
 change of position. Dull- 
 ness over cyst. Clear res- 
 onant note in all parts be- 
 yond cyst limits, i.e. in 
 flanks and toward the dia- 
 phragm. 
 
 9. Vaginal fluctuation less 
 clear or absent. 
 
 10. Uterus displaced for- 
 ward or backward, or later- 
 ally by pressure of cyst. 
 
 11. Medicines have no ef- 
 fect. 
 
 12. Fluid light or dark 
 and of varying consistency : 
 albuminous, but does not 
 coagulate spontaneously ; 
 may contain colloid matter. 
 
 (From Dudley's Gynecology.) 
 741 
 
MEDICAL RECORD. 
 
 
 HYGIENE. 
 
 1. "The preventive measures which may be taken to 
 reduce tuberculosis may be summarized as follows: (i) 
 The compulsory notification of phthisis. (2) The removal 
 of those conditions of domicile and of occupation which 
 are known to promote the incidence of the disease, includ- 
 ing the regulation of certain dusty trades. (3) The dif- 
 fusion of knowledge (by medical men, leaflets, etc.) 
 regarding the nature and modes of spread of the disease, 
 and the precautions which should be taken in order to pre- 
 vent its extension. (4) The testing of sputum and other 
 suspected discharges, and of milk, meat, etc., supposed to 
 be tuberculous — reports to be furnished free of charge. 
 (5) Local authorities to undertake, without charge, the 
 disinfection of houses recently occupied by phthisical per- 
 sons. (6) The establishment of sanatoria and isolation 
 accommodation for the cure of phthisical patients, and the 
 isolation of those who are a distinct source of danger to 
 fellow lodgers or workers. (7) The enforcement of meas- 
 ures against spitting in public conveyances and in places 
 of public resort. (8) The efficient sanitary supervision of 
 dairy farms, dairies, and milkshops. The periodical vet- 
 erinary inspection and testing (by tuberculin) of milch 
 cows, and the slaughter of tuberculous animals. The pro- 
 hibition of the sale of milk of cows affected with tuber- 
 culosis. (9) The proper inspection of meat in public 
 abattoirs, and the adoption of due precautions for the con- 
 trol of imported meat and milk." (Parkes' Practical 
 Hygiene.) 
 
 2. Disease may be transmitted by: (1) Air, as tubercu- 
 losis; (2) Food, as tuberculosis; (3) Insects, as malaria, 
 yellow fever; (4) Milk, as typhoid; (5) Fomites, as 
 measles, scarlet fever; (6) Contact, as syphilis, gonorrhea; 
 (7) Wounds, as tetanus. 
 
 3. Diphtheria is conveyed through the air, or by the 
 mouth, and occasionally through wounds. Hygienic pre- 
 cautions should include isolation of the patient, strict 
 antiseptic precautions on behalf of all who come in con- 
 tact with the patient, and fumigation with sulphur or 
 formaldehyde. 
 
 4. Isolation ; quarantine ; asepsis and antisepsis ; common 
 sense; cooperation with health boards; vaccination, anti- 
 toxin or other similar prophylactic. 
 
 5. Endemic disease is one found in a given locality more 
 or less constantly. Epidemic disease is one which affects 
 a very large part or the whole of a certain community. 
 
 6. Food, fingers, flies, milk, water, and "typhoid carriers." 
 
 7. Formaldehyde and sulphur dioxide. 
 
 8. For disinfection of: (1) Rooms, use formaldehyde 
 
 742 
 
MEDICAL RECORD. 
 
 gas; (2) Clothing, use solution of phenol (5 per cent.) for 
 an hour, then boil for an hour; (3) Hands, wash in soap 
 and water, and immerse in cresol or carbolic acid solution; 
 (4) Urine and feces, etc., should be passed into vessels 
 containing dilute solution of formalin. Water closets, 
 dilute formalin solution. 
 
 9. Diseases incident to school life: Measles, scarlet 
 fever, chicken pox, mumps, diphtheria, adenoids, ring- 
 worm, pediculi, myopia, trachoma, strabismus, smallpox, 
 spinal curvature. For prevention see index in French's or 
 Osier's "Practice." 
 
 10. Toxins are harmful or poisonous products of bac- 
 teria. Antitoxins are substances formed in the body, of a 
 protective character, and capable of rendering inert the 
 poisonous products of bacteria. 
 
 11. Nitrates are generally due to the oxidation of 
 organic matter of animal origin. Nitrites generally indi- 
 cate sewage contamination. The presence of nitrites should 
 condemn the water ; so should a marked amount of nitrates. 
 
 12. Quarantinable diseases: Cholera, yellow fever, small- 
 pox, plague, typhus, leprosy, diphtheria, scarlet fever, 
 measles, mumps, chicken pox, erysipelas. For length of 
 time, see index in French's or Osier's "Practice." 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 West Virginia State Board of Health. 
 
 anatomy and embryology. 
 
 i. Give the general characteristics of a vertebra. De- 
 •cribe the atlas. 
 
 2. Describe the branches of the arch of the aorta. 
 
 3. Describe the course of the fibers in the optic com- 
 missure. 
 
 4. Name and describe the ducts of the liver. 
 
 5. Give origin and insertion of sartorius muscle; give 
 function. 
 
 6. Give blood supply of leg, mentioning venous compen- 
 sation. 
 
 7. Give foramen of exit of the cranial nerves. 
 
 8. Name muscles of deglutition. 
 
 9. Tell what you know of fetal development from the 
 time of contact of the spermatozoon with the ovum during 
 the first six weeks of development. 
 
 10. Describe the palmar arches and mention their sur- 
 gical significance. 
 
 PHYSIOLOGY AND HISTOLOGY. 
 
 r. Give origin and functions of the bile. 
 
 743 
 
MEDICAL RECORD. 
 
 v- 
 
 2. Give functions of the liver. 
 
 3. Give the amount of saliva secreted in twenty-four 
 hours in the adult; also give functions of the saliva. 
 
 4. Give the amount of blood (in pounds) in the body 
 and state the functions of the red corpuscles. 
 
 5. Give the amount of water and solids in the body of 
 a person weighing 145 pounds. 
 
 6. Name the organs of digestion in the order in which 
 they belong. 
 
 7. Locate, describe, and give functions of the spleen. 
 
 8. Locate, describe, and give functions of the pancreas. 
 
 9. Describe a Peyer's patch and tell where it is found. 
 
 10. Describe a lobule of the liver. 
 
 CHEMISTRY AND MEDICAL JURISPRUDENCE. 
 
 1. What is an element, and how many are there? 
 
 2. Give chemical antidote for silver nitrate, mercury 
 bichloride, tincture of iodine; what is formed? 
 
 3. Give Fehling's test for sugar. What is the chemical 
 change as shown by reaction? 
 
 4. Would you treat burns with acids or alkalies, and 
 why? 
 
 5. Define electrolysis. 
 
 6. Define oxidation; where does it occur in the body? 
 
 7. What are some of the certain signs of death? 
 
 8. Differentiate between dementia and hysteria. 
 
 9. Having visited a case, can the physician quit before 
 its termination? 
 
 10. What are the legal requirements to practise medicine 
 in West Virginia? 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 1. Mention the therapeutic uses of ergot. Give the 
 physiological action. 
 
 2. Name four coal-tar products used to reduce tempera- 
 ^ [ \> ture ; give dose of each. 
 
 U? / ^ 3- Correct the following prescription: 
 
 \J Atrophia sulphate, gr. i ss. 
 
 Potassium iodid, 3ss. 
 Infusa Digitalis, qs. ad. oz. ii. 
 M-Sig. Teaspoonful in water four times daily. 
 4. Name four alkaloids of opium; give dose of each. 
 ^ Name three indications for their use. What is the effect 
 
 , & ^ of a full dose of opium on respiration? 
 
 g 5. How many grains of cocaine are contained in an 
 
 v ounce of a 20 per cent, solution? How many drops would 
 
 ** you give an adult hypodermically? 
 
 6. Give dose of tincture of aconite root, tincture of 
 digitalis, tincture of hyoscyamus (last edition of the Phar- 
 macopoeia). What active principles are found in each? 
 Give dose. 
 
 744 
 
 * r 
 
 SJ 
 
MEDICAL RECORD. 
 
 7. State therapeutic uses of Pulvis jalapae compositus 
 and give composition. 
 
 8. Mention eight drugs the use of any one of which 
 may cause skin eruptions. 
 
 9. Give the composition and the chief use of lotio 
 hydrargyri nigra. 
 
 10. What are the therapeutic uses of ammonium muriati- 
 cum? 
 
 BACTERIOLOGY AND HYGIENE. 
 
 i. What is mixed infection? Illustrate. 
 
 2. Mention four of the most useful culture media. What 
 should the reaction of a culture medium be? 
 
 3. Name the microorganism of erysipelas? What tissues 
 does this microorganism chiefly effect? 
 
 4. Describe the method of staining sputum containing 
 tubercle bacilli. 
 
 5. How do cells multiply? 
 
 6. Describe the modern system of ventilation. 
 
 7. What reasons can you give for not using personal 
 clothing or toilet articles used by other people? 
 
 8. What diseases are known to be carried by animals and 
 insects? 
 
 9. How would you manage a case of scarlet fever to 
 prevent its spread, and what precautions would you take to 
 avoid conveying it on your own clothing or person? 
 
 10. Give in detail the hygienic rules to be followed in 
 every case of tuberculosis. 
 
 SURGERY. 
 
 1. What is inflammation? How does it extend? How 
 does it terminate? 
 
 2. What is an abscess? Define acute and chronic ab- 
 scess. 
 
 3. What is a carbuncle? Give treatment. 
 
 4. Define septicemia. Define pyemia. 
 
 5. Make a diagnosis between apoplexy, uremic coma, in- 
 toxication, and head injury. 
 
 6. What is lupus? Treatment? 
 
 7. Treatment of epistaxis? 
 
 8. Name and describe the different kinds of posture. 
 
 9. Describe and treat Colles's fracture. 
 10. What is orchitis? Treatment? 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 i. In what way does the fetus receive its nourishment? 
 Describe the placenta. 
 
 2. Cause, symptoms, and treatment of puerperal septi- 
 cemia. 
 
 3. What are the dangers of a prolonged labor after the 
 first stage is completed? 
 
 745 
 
MEDICAL RECORD. 
 
 4. Menopause : What is it ? Symptoms and treatment ? 
 Is it a physiological or pathological condition? 
 
 5. How long would you remain with patient after deliv- 
 ery, and why? 
 
 6. Explain the action of the abdominal muscles in labor. 
 
 7. What changes take place in the female at puberty? 
 
 8. How would you proceed in case of puerperal eclamp- 
 sia? Cause? 
 
 9. Describe operation for perineal laceration. When and 
 why should it be done? 
 
 10. Give early symptoms and treatment of cancer of the 
 cervix uteri. 
 
 PRACTICE OF MEDICINE AND PEDIATRICS. 
 
 1. Give the cause and treatment of deficiency in excre- 
 tion of urea. 
 
 2. Diagnose, treat, and give the cause of cholera in- 
 fantum in an infant. 
 
 3. Etiology, symptoms, and treatment erf acute lobar 
 pneumonia. 
 
 4. Give the causes, symptoms, and treatment of Bright' s 
 disease. 
 
 5. Give the cause, symptoms, and treatment of hemiple- 
 gia in a person over sixty years of age. 
 
 6. Tonsillitis: Differentiate from diphtheria; give symp- 
 toms and treatment. 
 
 7. Intussusception : Define, diagnose, and treat. 
 
 8. Symptoms and treatment of empyema. 
 
 9. Give the etiology, pathology, duration, and treatment 
 of typhoid fever, 
 
 10. Etiology, symptoms, and treatment of hysteria. 
 
 SPECIAL PRACTICE. 
 
 i. Give symptoms and diagnosis of chronic pleurisy with 
 effusion. 
 
 2. Give symptoms and methods for early diagnosis of 
 hip-joint disease. 
 
 3. Describe simple chronic laryngitis, giving diagnosis 
 and treatment. 
 
 4. Diagnose and treat laryngeal diphtheria. 
 
 5. Give etiology, symptoms, diagnosis, and treatment of 
 frontal sinus infection. 
 
 6. Diagnose and treat atrophic nasopharyngitis. 
 
 7. Describe the normal eye-ground as seen through the 
 ophthalmoscope. 
 
 8. Describe eye conditions associated with chronic 
 Bright's disease and diabetes mellitus. 
 
 9. Describe the normal knee-jerk. Give diagnostic sig- 
 nificance of loss and exaggeration. 
 
 10. What is multiple neuritis? Give etiology and treat- 
 ment. 
 
 746 
 
MEDICAL RECORD 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 West Virginia State Board of Health. 
 
 anatomy and embryology. 
 
 i. The general characters of a vertebra are : Body or 
 Centrum, and Neural arch. The latter consists of two 
 pedicles, two laminae, and seven processes (four articular, 
 two transverse, and 5he spinous). For atlas, see Cunning- 
 ham's "Anatomy" (1909), page 79; or Gray's "Anatomy" 
 (1908), page 50. 
 
 2. See Cunningham's "Anatomy" (1909), page 800; or 
 Gray's "Anatomy" (1908), page 595. 
 
 3. See Cunningham's "Anatomy" (1909), page 676; or 
 Gray's "Anatomy" (1908), page 1038. 
 
 4. See Cunningham's "Anatomy" (1909), page 11 18; or 
 Gray's "Anatomy" (1908), page 1349. 
 
 5. Origin: Anterior superior spine of ilium and part of 
 notch below. Insertion: Inner side of tibia near tubercle. 
 Function: Flex leg on thigh, and thigh on pelvis; and 
 rotate thigh outward. 
 
 6. See Cunningham's "Anatomy" (1909), pages 863 and 
 897; or Gray's "Anatomy" (1908), pages 707 and 756. 
 
 7. First through foramina in cribriform plate of eth- 
 moid. Second, through optic foramen. Third, through 
 sphenoidal fissure. Fourth, through sphenoidal fissure. 
 Fifth, through sphenoidal fissure, foramen rotundum, and 
 foramen ovale. Sixth, through sphenoidal fissure. Sev- 
 enth, through stylomastoid foramen. Eighth, through in- 
 ternal auditory meatus. Ninth, tenth, and eleventh, through 
 jugular foramen. Twelfth, through anterior condyloid 
 foramen. 
 
 8. Hyoglossi, styloglossi, palatoglossi, palatopharyngei, 
 azygos uvulae, tensores palati, levatores palati, stylopharyn- 
 gei, stylohyoids, geniohyoids, mylohyoids, thyrohyoids, 
 digastrics, constrictors of the pharynx, and intrinsic mus- 
 cles of tongue. 
 
 9. See Cunningham's "Anatomy" (1909), page 16; or 
 Gray's "Anatomy" (1908), page 1559. 
 
 10. The superficial palmar arch is formed by the ulnar 
 artery, and is completed by the ulnar artery anastomosing 
 with a branch of the radial (superficial volar or princeps 
 pollicis). It gives off the four digital branches. The sur- 
 face marking is a line drawn transversely across the palm 
 from a point where the web of the thumb joins the palm. 
 The deep palmar arch is formed by the radial artery, and 
 is completed by the radial artery anastomosing with a deep 
 branch of the ulnar. Its branches are the palmar interos- 
 
 747 
 
MEDICAL RECORD. 
 
 seous, perforating, and palmar recurrent arteries. The 
 surface marking is a line drawn transversely across the 
 palm, one-half inch nearer the wrist than the superficial 
 arch. Wounds in this region are dangerous on account of 
 the difficulty in checking the hemorrhage, and also on ac- 
 count of the important structures of the palm that may be 
 damaged. In incision in the palm the line of these arteries 
 should be avoided as far as possible. 
 
 PHYSIOLOGY AND HISTOLOGY. 
 
 i. The bile originates in the liver. The functions of the 
 bile are: (i) To assist in the emulsification and saponifi- 
 cation of fats; (2) to aid in the absorption of fats; (3) to 
 stimulate the cells of the intestine to increased secretory 
 activity, and so promote peristalsis, and at the same time 
 tend to keep the feces moist; (4) to eliminate waste prod- 
 ucts of metabolism, such as lecithin and cholesterin; (5) 
 it has a slight action in converting starch into sugar; (6) 
 it neutralizes the acid chyme from the stomach, and thus 
 inhibits peptic digestion; (7) it has a very feeble antiseptic 
 action. 
 
 2. The functions of the liver are: (1) The secretion of 
 bile; (2) the formation of glycogen; (3) the formation of 
 urea and uric acid; (4) the manufacture of heat, and (5) 
 the conversion of poisonous and harmful into inert mate- 
 rial. 
 
 3. Probably from two and one-half to three pounds of 
 saliva are secreted daily by an adult. The functions of the 
 saliva are: (1) To moisten the mouth; (2) to assist in 
 the solution of the soluble portions of the food, and thus 
 (3) to administer to the sense of taste; (4) to lubricate 
 the bolus of food, and thus (5) to facilitate the acts of 
 mastication and deglutition, and (6) to change starches 
 into dextrin and sugar. 
 
 4. The blood is about one-thirteenth of the body weight. 
 The function of the red corpuscles is to carry oxygen to 
 the tissues. 
 
 5. Water being about two-thirds and solids one-third, 
 there will be about 97 pounds water and 48 pounds solids. 
 
 6. Mouth (with tongue, teeth, and salivary glands), 
 pharynx, esophagus, stomach, small intestine (duodenum, 
 jejunum, ileum), large intestsine (cecum, ascending colon, 
 transverse colon, descending colon, sigmoid flexure, and 
 rectum), with liver and pancreas. 
 
 7. The function of the spleen: The following theories 
 have been held: (1) It is a source of production of the 
 white blood corpuscles; (2) it is a source of production of 
 the red blood corpuscles during fetal life; (3) it is a place 
 where the red blood corpuscles are destroyed; (4) uric 
 
 748 
 
MEDICAL RECORD. 
 
 acid is produced in the spleen; (5) an enzyme is produced 
 in the spleen and is carried by the blood to the pancreas, 
 where it converts the trypsinogen into trypsin. For loca- 
 tion and description, see Cunningham's "Anatomy" (1909), 
 page 1210; or Gray's "Anatomy" (1908), page 1361. 
 
 8. The functions of the pancreas are : (a) The secre- 
 tion of the pancreatic juice, which (1) changes proteids 
 into proteoses and peptones, and afterward decomposes 
 them into leucin and tyrosin ; (2) converts starch into 
 maltose; (3) emulsifies and saponifies fats, and (4) causes 
 milk to curdle, (b) The manufacture of an internal secre- 
 tion. For location and description, see Cunningham's 
 "Anatomy" (1909), page 1124; or Gray's "Anatomy" 
 (1908), page 1355. 
 
 9. See Cunningham's "Anatomy" (1909), page 1064; or 
 Gray's "Anatomy" (1908), page 1304. 
 
 id. A lobule of the liver is about 1-20 to 1-12 inch in 
 diameter. It has a darkish red center and a lighter cir- 
 cumference. The center is occupied by an intralobular 
 vein which collects the blood from the capillaries of the 
 lobule, and flows into the sublobular vein, which latter 
 opens into the hepatic vein. Around the lobules are the 
 interlobular veins; these are branches of the portal sys- 
 tem; capillaries passing from the circumference to the 
 center of the lobule connect the interlobular and intra- 
 lobular veins. Between the network of capillaries in the 
 lobule the heptaic cells are packed. 
 
 CHEMISTRY AND MEDICAL JURISPRUDENCE. 
 
 1. An element is a substance which cannot, by any known 
 means, be split up into two or more other kinds of sub- 
 stance. There are 80 or 81 elements. 
 
 2. (1) For silver nitrate, sodium chloride; (2) for mer- 
 cury bichloride, white of egg; (3) for tincture of iodine, 
 no chemical antidote; but starch is given. There are 
 formed (1) silver chloride, (2) mercury albuminate, (3) a 
 blue color. 
 
 3. Fehling's test: Place in a test-tube a few c.c. of the 
 liquid prepared as stated below, and boil ; no reddish tinge 
 should be observable, even after five minutes' repose. Add 
 the liquid under examination gradually, and boil after each 
 addition. In the presence of sugar a yellow or red precipi- 
 tate is formed. In the presence of traces of glucose, only 
 a small amount of precipitate is produced, which adheres 
 to the glass, and is best seen when the blue liquid is poured 
 out. [The reagent must be kept in two solutions, which 
 are to be mixed immediately before use. Solution I con- 
 sists of 34.653 gms. of crystallized CuS0 4 , dissolved in 
 water to 500 c.c, and solution II of 130 gms. of Rochelle 
 
 749 
 
MEDICAL RECORD. 
 
 salt dissolved to 500 c.c. in NaHO solution of sp. gr. 1.12. 
 When required for use equal volumes of the two solutions 
 are mixed, and the mixture diluted with four volumes of 
 water.] The copper sulphate is reduced to copper oxide. 
 
 5. Electrolysis is the process of electrical conduction 
 accompanied by the separation of the constituents of the 
 electrolyte or the decomposition of a chemical compound 
 by passing an electric current through it. 
 
 6. By oxidation is meant the act of union of oxygen 
 with another element or compound. It occurs in all (or 
 nearly all) the tissues of the body, chiefly in the lungs. 
 
 7. The complete and permanent cessation of respiration 
 and circulation, rigor mortis, loss of body heat, pallor of 
 the body, putrefaction. 
 
 8. Dementia is a condition of mental enfeeblement which 
 gradually increases until absolute mental decay ensues. 
 Hysteria is a morbid condition of the nervous system 
 which may show every variety of nervous system due to 
 deranged function of the cerebral and spinal centers, and 
 associated with lowered will power and exaggerated emo- 
 tional tendencies. 
 
 9. Yes; a physician can quit, provided he gives ample 
 notice of his intention, so that the patient can obtain the 
 services of another physician. 
 
 10. Graduation from a reputable medical college, recog- 
 nized as such by the State Board of Health, and a certifi- 
 cate giving license to practise, issued by the said State 
 Board of Health. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 1. Ergot. Therapeutic uses: To promote uterine con- 
 tractions during third stage of labor; fibroids, menor- 
 rhagia, postpartum hemorrhage. Some forms of amenor- 
 rhea and dysmenorrhea, dysentery, arterial hemorrhage, 
 congestive headaches, laxity of sphincters, of bladder or 
 rectum, hemorrhoids, aneurysm, diabetes, urinary incon- 
 tinence, direct paralysis of the sphincter vesicae, atonic sper- 
 matorrhea. Physiological action: Ergot stimulates and 
 causes contraction of involuntary muscle fibers, hence it is 
 a vasoconstrictor, hemostatic, and oxytocic. It is also a 
 cardiac sedative; it raises the blood pressure, it increases 
 peristalsis, and is an emmenagogue. 
 
 2. Acetanilide, gr. iv; antipyrin, gr. iv; phenacetin, gr. 
 vijss ; exalgin, gr. ij. 
 
 3. 5. Atropinae sulphatis, gr. 1/6. 
 
 Potassii iodide, 3ss. 
 Infusi digitalis q. s. ad 5ij. M. 
 Sig : One teaspoonful in water four times a day. 
 
 4. Morphine, gr. 1/5; codeine, gr. 1/2; narcotine (hydro- 
 
 750 
 
MEDICAL RECORD 
 
 chlorid), gr. v; the other alkaloids are not used medicinally. 
 Indications: To relieve pain; to produce sleep; to alloy 
 irritation. Respiration is slowed. 
 
 5. Ninety-six grains. About one and a half minims; but 
 I would not use a 20 per cent, solution. 
 6. 
 
 TINCTURE OF 
 
 DOSE 
 
 ACTIVE PRINCIPLES 
 
 DOSE 
 
 Aconite. 
 
 TT£x. 
 
 Aconitine. 
 
 gr. 1/400. 
 
 Digitalis. 
 
 TTgxv. 
 
 Digitalin. 
 
 gr. 1/150. 
 
 
 
 Digitalein. 
 
 gr. 1/100. 
 
 
 
 Digitin. 
 
 
 
 
 Digitonin. 
 
 gr. 1/200 
 
 
 
 Digitoxin. 
 
 gr. 1/150. 
 
 Hyoscyamus. 
 
 TT#xv. 
 
 Hyoscyamine. 
 
 gr. 1/128. 
 
 
 
 Hyoscine. 
 
 gr. 1/128. 
 
 7. As a hydragogue purge, in dropsy and cerebral con- 
 gestion. It is composed of 35 parts of jalap and 65 parts 
 of potassium bitartrate. 
 
 8. Belladonna, quinine, bromides, chloral, copeiba, cubebs, 
 morphine, mercury. 
 
 9. It is made by adding one dram of calomel to a pint of 
 lime water. It is chiefly used as a wash for syphilitic sores. 
 
 10. It stimulates the respiratory mucous membranes, and 
 so is used in bronchitis and pneumonia; also in torpid and 
 other liver conditions and ovarian neuralgia. 
 
 BACTERIOLOGY AND HYGIENE. 
 
 1. A mixed infection is one in which more than one kind 
 of microorganism is present — as tetanus bacillus, which 
 thrives in the presence of saprophytic organisms which 
 absorb the oxygen. 
 
 2. Gelatin, agar, blood-serum, bouillon. The reaction 
 should be faintly alkaline or neutral. 
 
 3. Streptococcus erysipelatis: It chiefly affects the skin 
 and connective tissues (lymph spaces and cellular tissues). 
 
 4. The sputum must be recent, free from particles of 
 food or other foreign matter; select a cheesy-looking 
 nodule and smear it on a slide, making the smear as thin 
 as possible. Then cover it with some carbolfuchsin and let 
 it steam over a small flame for about two minutes, care 
 being taken that it does not boil. Wash it thoroughly in 
 water and then decolorize by immersing it in a solution of 
 any dilute mineral acid for about a minute. Then make a 
 contrast stain with solution of Loeffler's methylene blue for 
 about a minute ; wash it again and examine with oil immer- 
 sion lens. The tubercle bacilli will appear as thin red rods, 
 while all other bacteria will appear blue. 
 
 5. Cells multiply by : (1) Amitosis, and (2) karyokinesis. 
 
 751 
 
MEDICAL RECORD. 
 
 6. "In the plenum system the air is drawn into a box, in 
 which the revolving blades of a fan are located, and it is 
 then driven into a central conduit and from there through 
 appropriate shafts to the spaces for which it is intended. 
 In the vacuum system the air is extracted from the vari- 
 ous rooms through pipes leading to a central shaft, where 
 it is drawn into the fan and discharged outwardly." 
 
 7. (i) It is a dirty habit; (2) it is also a dangerous 
 habit, as disease- may be conveyed in this way. 
 
 8. Malaria, yellow fever, filariasis, bubonic plague, ty- 
 phoid, cholera, leprosy, tuberculosis, smallpox, ringworm, 
 sleeping-sickness, hook-worm disease, diphtheria, measles, 
 scarlet fever, pneumonia, intestinal parasites, glanders, 
 echinococcus, anthrax, rabies. 
 
 9. Complete isolation and quarantine, followed by rigid 
 disinfection; special care must be taken during period of 
 desquamation. On entering the room the physician should 
 put on a sterilized gown over his clothes, and leave the 
 gown behind him when he leaves ; he should also wash his 
 hands with a disinfectant. 
 
 10. "The patient's quarters should be free from dust, and 
 admit of spending many hours daily in the open air in all 
 weathers, properly sheltered, and, if very ill, lying wrapped 
 in a hammock or reclining chair. His bedroom should be 
 well aired at night, draughts being avoided. The room 
 should be uncarpeted and free from hangings. It should 
 be often cleaned and periodically disinfected. All sputum 
 should be collected in paper spit-cups, which should be 
 burned daily. Smoking should be forbidden. Harm is done 
 by any exercise which results in fatigue, and while fever 
 exists it should not be attempted at all. Patients should 
 be taught the necessity of practising lung gymnastics and 
 breathing only through the nose, which should be kept 
 clear and free from occlusion by secretions, or an hyper- 
 trophied catarrhal mucosa. . . . The clothing should 
 be woolen, but not too heavy, or sweating is increased ; 
 and a flannel nightgown and loosely knit leggings should 
 be worn at night in cool weather. The skin should be 
 cleansed by daily sponge-baths of lukewarm alcohol and 
 water." 
 
 SURGERY. 
 
 I. Inflammation is the succession of changes which oc- 
 cur in a part as the result of some kind of injury, pro- 
 vided that this injury is not sufficient to immediately de- 
 stroy the vitality of the part. It extends by the blood 
 vessels, lymphatics, and continuity of tissue. It terminates 
 in return of the tissues to health (by resolution or organ- 
 ization or new growth), or by death of tissue (by suppu- 
 ration, ulceration, or gangrene). 
 
 752 
 
MEDICAL RECORD. 
 
 2. An abscess is a circumscribed collection of a pus in a 
 cavity of new formation. Acute abscesses are marked by 
 inflammatory symptoms, pain, and heat, and by rapid de- 
 velopment; chronic abscesses, by the absence of pain and 
 heat, and by their sluggish course. 
 
 3. A carbuncle is a localized inflammation of the sub- 
 cutaneous tissue, with fibrinous exudation and multiple 
 necrotic foci. Treatment: Tonics, stimulants, good diet, 
 free, crucial incisions with curetting of the sloughs, and 
 swabbing with pure carbolic acid. 
 
 4. Septicemia is a condition due to microorganisms mul- 
 tiplying in the blood, and is characterized by high tempera- 
 ture, but not relieved by getting rid of the original source 
 of infection. Pyemia is due to particles of blood clot car- 
 rying microorganisms to parts distant from the original 
 source and there setting up metastatic abscesses. 
 
 753 
 
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MEDICAL RECORD. 
 
 6. Lupus vulgaris is a tuberculous infection of the skin; 
 it is generally found upon the face, particularly the nose 
 and cheeks. It begins as pinkish nodule which is painless, 
 and spreads to other nodules, and generally ends in ulcera- 
 tion, with destruction of mucous membrane or cartilage. 
 
 Treatment: In the early stages the small nodule may be 
 excised. If not seen till later, curettage with a sharp spoon, 
 followed by cauterization with pure carbolic acid, has been 
 recommended. This can be repeated at intervals of threte 
 or four weeks, if necessary. Finsen light and tuberculin 
 have also been used. 
 
 7. To arrest epistaxis: (1) Try to cauterize the bleeding 
 point; (2) plug the nasal cavity with gauze soaked in 
 adrenalin; (3) inject into the nares a solution of peroxide 
 of hydrogen; (4) plugging the nares, anteriorly and poste- 
 riorly; (5) an inflating plug may be used. 
 
 8. Postures. Dorsal, one in which the patient lies on the 
 back; knee-chest, or genupectoral, one in which the patient 
 rests upon the knees and chest, the arms being crossed 
 above the head; knee-elbow, or genucubital, one in which 
 the patient lies upon the knees and elbows, the head resting 
 upon the hands ; lithotomy, one in which the patient lies on 
 the back with the legs flexed on the thighs, and the thighs 
 flexed on the abdomen and abducted; Sim's, one in which 
 the patient lies on the left side, with the right knee and 
 thigh drawn up and the left arm placed along the back; 
 the chest is inclined forward so that the patient rests upon 
 it; EdebohVs, one in which the patient lies on the back, 
 with the legs flexed on the thighs and the thighs on the 
 abdomen, the hips being elevated and the thigh strongly 
 abducted ; Trendelenburg's, one in which the patient lies on 
 the back, on a plane inclined about 45 , the feet and legs 
 hanging over the end of the table. 
 
 9. Colles' fracture is a fracture of the lower end of the 
 radius; it is generally transverse, and is usually within an 
 inch or an inch and a half of the articular surface. There 
 is a characteristic deformity caused by the lower fragment, 
 and the carpus forming a prominence on the dorsal surface ; 
 at the same time there is a projection on the palmar sur- 
 face just above the wrist, caused by the upper fragment. 
 The hand is abducted and pronated, and the styloid process 
 of the ulna becomes very prominent. It is generally caused 
 by a fall on the outstretched palm. For treatment, see 
 Rose and Carless' "Surgery" (1908), page 522; or Da 
 Costa's "Surgery" (1908), page 507. 
 
 10. Orchitis is inflammation of the testicle. Treatment: 
 Rest in bed ; elevation of the parts ; hot or cold applications ; 
 nain is to be relieved by opiates or leeches ; lead water and 
 laudanum should be applied ; salines or cathartics are to be 
 
 755 
 
MEDICAL RECORD. 
 
 administered. Sometimes strapping the testicle is of ser- 
 vice ; so, too, is the application of ichthyol and lanolin. 
 
 OBSTETRICS AND GYNECOLOGY. 
 
 i. Nutrition of fetus: "(i) At first the ovum absorbs 
 nutriment simply through the vitelline membrane, while 
 passing through the Fallopian tube. The nutrient material 
 is supplied by the secretion of the tube itself, or may con- 
 sist in part of seminal fluid introduced from without. (2) 
 The vitellus is absorbed by the entoderm lining the umbil- 
 ical vesicle and alimentary canal, and later it is absorbed 
 and conveyed into the body of the embryo by the blood- 
 vessels of the area vasculosa. (3) When the contents of 
 the umbilical vesicle are exhausted the chorial villi appear 
 and take up nourishment from the uterine decidua, with 
 which they are in contact. (4) With the disappearance of 
 villi in the chorion leve, the villi of the decidual serotina 
 develop into the placenta, where they take up nutriment 
 from the maternal blood with which they are surrounded." 
 
 At full term the placenta is a soft, spongy mass, roughly 
 saucer-shaped, from six to nine inches in diameter, about 
 three-quarters of an inch in thickness at the central point, 
 and weighs about one pound. 
 
 2. See Williams' "Obstetrics" (1909), page 852; or Hirst's 
 "Obstetrics" (1909), page 764. 
 
 3. Asphyxiation of fetus; inspiration-pneumonia of fe- 
 tus ; death or exhaustion of mother ; pressure necrosis for- 
 mation of fistulse; sepsis; and post-partum hemorrhage. 
 
 4. Menopause is the period when menstruation ceases; it 
 usually occurs between the fortieth and fiftieth years; it is 
 attended by disturbances of digestion, flashes of heat, ner- 
 vous troubles; treatment is symptomatic, dietetic, and 
 hygienic. It is a physiological condition normally, but may 
 become pathological. 
 
 5. At least one hour; longer if necessary; for fear of 
 post-partum hemorrhage ; the uterine contraction should be 
 good and the pulse below 100 before the physician leaves. 
 
 6. See Williams' "Obstetrics" (1909), page 286; or Hirst's 
 "Obstetrics" (1909), page 333. 
 
 7. Development of the reproductive organs, enlargement 
 of the breast, hair on pubis and axilla; the form becomes 
 rounded, the hips widen, menstruation occurs ; there are 
 certain mental and emotional changes, and^ "the develop- 
 ment of those womanly beauties physiologically designed 
 to attract the male." 
 
 8. Puerperal eclampsia. Preventive treatment: (1) 
 The amount of nitrogenous food should be diminished to a 
 minimum; (2) the production and absorption of poisonous 
 materials in the intestines and body tissues should be lim- 
 
 _ 756 
 
MEDICAL RECORD. 
 
 ited and their elimination should be aided by improving the 
 action of the bowels, the kidneys, the liver, the skin, and 
 the lungs; (3) the source of the fetal metabolic products 
 and the peripheral irritation in the uterus should, if neces- 
 sary, be removed by evacuating that organ. Curative treat- 
 ment: (1) Controlling the convulsions (by chloroform, 
 veratrum, or chloral) ; (2) elimination of the poison or 
 poisons which are presumed to cause the convulsions; (3) 
 emptying the uterus under deep anesthesia, by some method 
 that is rapid and that will cause as little injury to the 
 woman as possible. The causes may be : Uremia, albumin- 
 uria, imperfect elimination of carbon dioxide by the lungs, 
 medicinal poisons, septic infection; predisposing causes are 
 renal disease and imperfect elimination by the skin, bowels, 
 and kidneys. 
 
 9. See Williams' "Obstetrics" (1909), page 325; or 
 Hirst's "Obstetrics" (1909), pages 609 and 868. 
 
 10. Cancer of the cervix. Early symptoms: Pain, 
 hemorrhage, offensive discharge, wasting; the cervix is 
 enlarged and breaks down. Treatment : Removal of the 
 uterus. 
 
 PRACTICE OF MEDICINE AND PEDIATRICS. 
 
 1. Causes: Carcinoma, cirrhosis of liver, acute febrile 
 jaundice, nephritis, Addison's disease, lead poisoning. 
 Treatment: Purgatives (elatorium, calomel, compound 
 jalap powder), hot bath, amylnitrite, liquid diet. And see 
 answer to Obstetrics, 8. 
 
 2. See French's "Practice" (1907), page 782; or Osier's 
 "Practice" (1909), page 507. 
 
 3. See French's "Practice" (1907), page 151; or Osier's 
 "Practice" (1909), page 165. 
 
 4. See French's "Practice" (1907), page 892; or Osier's 
 "Practice" (1909), page 686. 
 
 5. See French's "Practice" (1907), page 1071 ; or Osier's 
 "Practice" (1909), page 966. 
 
 6. In diphtheria the onset is more gradual ; the tempera- 
 ture rises to about 101 to 103 F. ; the tonsils are not 
 much enlarged ; there is an exudate of a thick, grayish 
 membrane which is very adherent, is removed only with 
 difficulty, and leaves a bleeding surface; this membrane 
 soon reforms and may be found on the fauces and pharynx 
 as well as on the tonsils ; in the exudate the Klebs-Loef- 
 fler bacilli may be found. In follicular tonsillitis the onset 
 is more sudden; the temperature may be a little higher 
 than that of diphtheria; there is no membrane, but the 
 tonsils are read and swollen, and in the crypts are seen 
 white, cheesy spots or plugs, which consist of broken- 
 down epithelium, and are easily brushed away; Klebs- 
 
 757 
 
MEDICAL RECORD. 
 
 Loeffler bacilli are never found. See French's "Practice' 
 (1907), page 719; or Osier's "Practice" (1909), page 445. 
 
 7. 
 
 STRANGULATION 
 
 Subjective 
 Symptoms. 
 
 1. Generally occurs 
 
 after age of 20. 
 
 2. Pain localized, 
 
 rapid collapse. 
 
 3. Pain intense, 
 
 paroxysmal in 
 character. 
 
 4. C o n s t i p ation 
 complete. 
 
 Objective 
 Symptoms. 
 
 Temper ature 
 often subnor- 
 mal. 
 
 Pulse very weak. 
 
 S t e r coraceous 
 vomiting 
 comes on ear- 
 
 Location in 
 small intestine. 
 
 INTUSSUSCEPTION. 
 
 Subjective 
 Symptoms. 
 
 1. Most frequent 
 
 in childhood. 
 
 2. Constant tenes- 
 
 mus. 
 
 3. Pain develops 
 
 suddenly and 
 is continuous. 
 
 4. Frequent diar- 
 rhea, passage 
 of bloody mu- 
 cous. 
 Objective 
 Symptoms. 
 
 1. Temper ature 
 
 normal or sub- 
 normal. 
 
 2. Same as in 
 
 strangulation. 
 
 3. Same as in 
 
 strangulation. 
 
 4. Localization in 
 small intes- 
 tine; bowel 
 frequent ly 
 protrudes a t 
 rectum. 
 
 TWISTS 
 
 (volvulus) 
 
 Subjective 
 Symptoms. 
 
 1. Most frequent 
 
 after age of 30. 
 
 2. Pain diffuse. 
 
 3. Pain paroxys- 
 
 mal ; recurs 
 less often than 
 in strangula- 
 tion. 
 
 4. Constipation 
 
 complete. 
 
 Objective 
 
 Symptoms. 
 Temperature 
 
 slightly e 1 e - 
 
 vated. 
 Same as in 
 
 strangulation. 
 S am e as in 
 
 strangulation. 
 
 4. Location, small 
 intestine ; ab- 
 domen often 
 protrudes, in 
 certain areas, 
 giving dull- 
 ness on per- 
 cussion. 
 
 — See French's "Practice" (1907), page 799; or Osier's 
 "Practice" (1909), page 519. 
 8. Empyema. Symptoms: High and irregular fever, 
 sweats, chill, diminished breath sounds and vocal femitus, 
 impaired mobility of chest, dullness on affected side, heart 
 displaced to opposite side, leucocytosis. Absolute diagnosis 
 is made by aspiration, showing the fluid to be pus. Treat- 
 ment: Aspiration, drainage, irrigation, resection of ribs 
 
 758 
 
MEDICAL RECORD. 
 
 (Estlander's operation), or resection of chest wall 
 (Schede's operation). 
 
 9. See French's "Practice" (1907), page 65; or Osier's 
 "Practice" (1909), page 57. 
 
 10. See French's "Practice" (1907), page 1140; or Osier's 
 "Practice" (1909), page 1076. 
 
 SPECIAL PRACTICE. 
 
 1. See French's "Practice" (1907), page 701; or Osier's 
 "Practice" (1909), page 655. 
 
 2. The early symptoms of hip-joint disease are: Night 
 cries (in a child) ; lameness in the morning; a slight limp; 
 tendency to become tired on slight exertion; wasting; 
 spasm* pain; swelling; and deformity (either real or ap- 
 parent). 
 
 3. Simple chronic laryngitis may follow an acute at- 
 tack, and be due to the same causes. The symptoms are 
 tickling in the throat, hoarseness, persistent cough, and 
 thick, tenacious, mucoid expectoration. Physical examina- 
 tion reveals congestion and granulations on the mucous 
 membrane. The general treatment is largely dietetic, 
 stimulant, and hygienic. The local treatment consists in 
 removing erosions or enlarged follicles under cocaine by 
 means of silver nitrate or the galvanocautery, and the 
 use of stimulating inhalations and applications. Silver 
 nitrate (gr. 10-20 to 3 1 )* glycerite of tannin, or boro- 
 glycerid (50 per cent.) may be used as application. Alka- 
 line sprays and nasal douches may be employed. Guaiac 
 may be administered in lozenge form. 
 
 4. See French's "Practice" (1907), page 188; or Osier's 
 "Practice" (1909), page 202. 
 
 5. Frontal sinus infection. Etiology: Extension from 
 ethmoid cells, or obstruction of the nasofrontal duct; or 
 hypertrophic inflammation of the mucosa or growths within 
 the nose. Symptoms and diagnosis: Throbbing pain in 
 frontal cells, discharge of offensive mucopurulent pus from 
 one or both sides; transillumination will be diminished 
 on the affected side. Treatment consists in laying open the 
 cavity, through an incision along the inner part of the 
 eyebrow, and trephining. The wall is curetted^ the in- 
 fundibulum enlarged, and a drainage tube left in it for 
 two or three days. The cavity is then washed out daily 
 through the nose till all discharge has ceased. 
 
 6. Atrophic nasopharyngitis. Symptoms: Characteris- 
 tic burning, itching sensation, and an extremely dry feeling 
 in the throat. There is usually a dry hacking cough, very 
 little expectoration except what accumulates in the post- 
 nasal space, and is removed by hawking it up. The secre- 
 tions of the glands are changed in quality; they become 
 thick and tend to stick to the pharynx, forming dry crusts 
 
 759 
 
MEDICAL RECORD. 
 
 and scabs which are very hard to remove. The membrane 
 may look dry, parched, and glazed, with here and there a 
 nodular condition. If the secretions are examined, a great 
 variety of bacteria may be found. Treatment: Remove 
 any constitutional causes as quickly as possible. Get the 
 general health into good condition, and keep the parts 
 thoroughly clean with a gargle or spray. If there are any 
 congested spots, correct these by applications of nitrate of 
 silver^ Give cathartics if necessary, and attend to the 
 digestive tract and to the hygienic surroundings. 
 
 7. "In carrying out a complete examination of the fundus 
 the two landmarks which should be first found are the 
 optic nerve and the macula (yellow spot). The former 
 appears as an oval pinkish-white disk. A pit with sloping 
 sides is in the center (physiological excavation), with the 
 mottled appearance of the lamina cribrosa at its bottom. 
 A white ring of varying breadth (scleral ring) surrounds 
 the disk, and outside of this more or less pigment (choroi- 
 dal ring). From the nerve comes the central artery of the 
 retina as a single trunk, or already divided, and it then 
 divides and subdivides on the retina. The veins follow 
 in general the same course as the arteries, The color, 
 amount of blood supply, sharpness of outline, and swelling 
 of the disk should not escape notice. The presence of an 
 excavation with sharp sides, over which the vessels seem 
 to fall (cupped disk), may denote glaucoma. The other 
 landmark — the macula — which is very difficult to see when 
 the pupil is small, is an area of deeper color than the sur- 
 rounding fundus, and shows a pit in its center with a 
 bright reflex (fovea centralis). The retinal vessels should 
 be followed from the nerve over the fundus and changes 
 in them noted. The general appearance of the fundus is 
 variable with the amount of pigment, depending on the 
 complexion of the individual." 
 
 8. In chronic Bright 's disease there may be albuminuric 
 retinitis, with serious swelling of the disk and surrounding 
 retina, hemorrhagic extravasations, dilatation of capillaries 
 and veins, with fatty or hyaline degeneration of the ves- 
 sel walls. In diabetes mellitus the vessels of the retina may 
 be dilated, the retina may atrophy, the fundus is light 
 yellow in color; amblyopia, presbyopia, and loss of accom- 
 modation may occur. 
 
 9. When the thigh is supported and the leg flexed at the 
 knee, a tap on the tendon just below the patella causes the 
 leg to be suddenly extended. It is lost in locomotor ataxia, 
 transverse myelitis, poliomyelitis, peripheral neuritis, spinal 
 meningitis, epilepsy, and chorea. It is exaggerated in 
 apoplexy, sclerosis, paraplegia, unilateral lesions of spinal 
 cord, tetanus, cerebellar ataxia. 
 
 10. Multiple neuritis is a neuritis (inflammation of 
 
 760 
 
MEDICAL RECORD. 
 
 bundles of nerve fibers) in which several nerves are in- 
 volved. Etiology: Poisons of infectious diseases, or or- 
 ganic or mineral poisons, cachectic conditions, exposure to 
 cold, overexertion. Treatment: Rest in bed, morphine or 
 hot applications, strychnine, arsenic, and heat (and re- 
 move) the cause. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 Wisconsin Board of Medical Examiners. 
 
 ANATOMY. 
 
 1. Name the bones of the head (including the facial). 
 
 2. About how many bones are there in the human body? 
 
 3. Name each cranial nerve and give its foramen of exit. 
 
 4. Describe the spinal nerves. 
 
 5. Describe the eyeball. 
 
 6. What are the lymphatics? 
 
 7. Describe the aorta. 
 
 8. Describe the ossicles of the tympanum. 
 
 PEDIATRICS. 
 
 1. Give symptoms and treatment of intussusception. 
 
 2. Give the symptomatology and treatment of hereditary 
 syphilis. 
 
 3. Give etiology and treatment of enuresis. 
 
 4. Give synonyms, symptoms, and treatment of mem- 
 branous laryngitis. 
 
 PATHOLOGY, HISTOLOGY, BACTERIOLOGY. 
 
 i. Define degeneration. Give causes of fatty and amyloid 
 degeneration. 
 
 2. Name types of infarcts. Give description of one type. 
 
 3. Differentiate transudate and exudate. 
 
 4. Give classification of inflammations, and describe one 
 form. 
 
 5. Give pathology of atrophic cirrhosis of liver. 
 
 6. Give pathology of parenchymatous nephritis in detail. 
 
 7. (a) Name the tumors of connective tissue origin, (b) 
 What determines the malignancy of tumors? 
 
 8. What are the causes of arteriosclerosis? Give patho- 
 logical histology. 
 
 9. Name the diseases due to bacteria. How are these 
 diseases communicated? 
 
 10. (a) Give method of staining the tubercle bacillus. 
 (b) Give method of making a Widal reaction. 
 
 11. Differentiate the mucosa of the gastrointestinal tract 
 from mouth to anus. 
 
 12. Describe blood-supply of liver in detail. 
 
 761 
 
MEDICAL RECORD. 
 
 PRINCIPLES AND PRACTICE. 
 
 i. Name four organic heart lesions and give the physical 
 signs in two of them. 
 
 2. Describe a typical case of typhoid fever. 
 
 3. Give the diagnosis of acute lobar pneumonia. Give the 
 treatment of first stage. 
 
 4. Give diagnosis of entrocolitis. 
 
 5. Give diagnosis and treatment of round ulcer of the 
 stomach. 
 
 6. What is amyloid liver? Give diagnosis. 
 
 7. Give etiology and diagnosis of arteriosclerosis. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 i. Name six antiseptics in the order of their power to 
 destroy bacteria. 
 
 2. What are the physiological actions and therapeutical 
 uses of arsenic? 
 
 3. What anthelmintics are used against the different in- 
 testinal parasites respectively? 
 
 4. Name five preparations of mercury, with the doses of 
 each. 
 
 5. Give the physiological actions of strychnine in poison- 
 ous doses, and tell why it destroys life. 
 
 6. How would you treat a case of strychnine poisoning? 
 
 7. Name six preparations of iron, with the doses of each. 
 
 OBSTETRICS. 
 
 1. Give the physiology of pregnancy. 
 
 2. Give hygiene of pregnancy. 
 
 3. Explain the mechanism of labor. 
 
 4. Give etiology and treatment of hyperemesis gravi- 
 darum. 
 
 5. Explain the reasons for the rarity of conception in a 
 prolapsed uterus. If pregnancy does occur in complete 
 prolapse, what is the result? 
 
 6. Give diagnosis and treatment of hydatid mole during 
 pregnancy. 
 
 7. Give etiology and symptomatology of puerperal 
 eclampsia. 
 
 8. Name the causes and give treatment for postpartum 
 hemorrhage. 
 
 GYNECOLOGY. 
 
 1. Give the pathology of menstruation. 
 
 2. State cause and treatment of sterility. 
 
 3. Give symptoms, course, and diagnosis of metritis. 
 
 4. What are the indications for curettage of the uterine 
 cavity. Describe method of procedure and dangers to be 
 avoided. 
 
 762 
 
MEDICAL RECORD. 
 
 NEUROLOGY, DIETETICS, MEDICAL- JURISPRUDENCE, 
 
 i. (a) What is the structural and functional unit of the 
 nervous system? (b) Give brief description of same, (c) 
 What area of the cord is affected in acute anterior polio- 
 myelitis? 
 
 2. (a) Describe briefly the spinal cord and name from 
 within out its three protective membranes, (b) At what 
 level of the spine does the cord terminate? (c) In locomo- 
 tor ataxia, where is the primary degeneration? 
 
 3. (a) Give names of the seventh, eighth, tenth, and 
 twelfth pairs of cranial nerves, (b) Give function and 
 distribution of any two mentioned, (c) Locate the Gas- 
 serian ganglion. 
 
 4. (a) Give origin, course, and distribution of the great 
 sciatic nerve, (b) What are the names of the two large 
 branches into which it divides? (c) At about what point 
 does the division take place? 
 
 5. (a) Name the nerves which, under normal circum- 
 stances, control the action of the heart, (b) Explain how 
 these nerves differ in their function. 
 
 6. Differentiate between criminal and justifiable abortion. 
 
 7. What is the difference between expert testimony and 
 other testimony. Give four positive signs of death. 
 
 8. Mention the steps necessary and on what basis may a 
 patient be committed to an insane asylum. 
 
 9. Name three articles of diet which are tissue formers. 
 Name four articles of diet which are work and heat pro- 
 ducers. 
 
 10. Give dietetic treatment for typhoid fever from first 
 day of positive diagnosis. 
 
 11. About how much water should be consumed during 
 twenty-four hours by a person weighing 150 pounds, aside 
 from what he obtains from his food. Name four func- 
 tions of water in the system. 
 
 12. Name the chief source from which the body obtains 
 its fat. Give dietetic treatment for apoplexy, and give your 
 reasons for same. 
 
 PHYSIOLOGY, OPHTHALMOLOGY, AND LARYNGOLOGY. 
 
 i. Give origin, distribution, and function of the pneumo- 
 gastric nerve. 
 
 2. What is the effect of alcohol on brain tissue, hepatic 
 tissue, and stomach? 
 
 3. Write a detailed description of the function of the 
 seventh cranial nerve. 
 
 4. Discuss briefly the physiology of the liver. 
 
 5. What would be the results of eating in excess of 
 albuminous, oleaginous, and farinaceous foods? 
 
 763 
 
MEDICAL RECORD. 
 
 6. (a) Discuss inflammation, (b) What are the functions 
 of the skin? 
 
 7. Give function and composition of saliva, gastric juice, 
 and bile. 
 
 8. Describe manner of using the ophthalmoscope, and 
 name some of the diseases that can be diagnosed by its use. 
 
 9. Give diagnosis and treatment of iritis and keratitis. 
 
 10. Define hordeolum, chalazion, ptosis, astigmatism, 
 myopia, glaucoma, and refraction. 
 
 11. Differentiate diphtheria and follicular tonsillitis. 
 
 12. Differentiate chronic laryngitis and tuberculous 
 laryngitis, and give treatment of each. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 Wisconsin Board of Medical Examiners, 
 anatomy. 
 
 1. Occipital, 2 parietal, 2 temporal, frontal, ethmoid, 
 sphenoid, 2 lacrymal, 2 malar, 2 nasal, 2 palate, 2 superior 
 maxillary, 2 inferior turbinate, vomer, and inferior maxil- 
 lary. 
 
 2. There are 206 named bones in the human body. 
 
 3. First, or olfactory, through foramina in cribriform 
 plate of ethmoid. Second, or optic, through optic fora- 
 men. Third, or motor oculi, through sphenoidal fissure. 
 Fourth, or trochlear, through sphenoidal fissure. Fifth, or 
 trigeminus, through sphenoidal fissure, foramen rotundum, 
 and foramen ovale. Sixth, or abducens, through sphenoidal 
 fissure. Seventh, or facial, through stylomastoid foramen. 
 Eighth, or auditory, through internal auditory meatus. 
 Ninth, or glossopharyngeal; tenth, or pneumogastric, and 
 eleventh, or spinal accessory, through jugular foramen. 
 Twelfth, or hypoglossal, through anterior condyloid 
 foramen. 
 
 4. See Cunningham's Anatomy (1909), page 607; or 
 Gray's Anatomy (1908), page 982. 
 
 5. See Cunningham's Anatomy (1909), page 723; or 
 Gray's Anatomy (1908), page 11 13. 
 
 6. See Cunningham's Anatomy (1909), page 905; or 
 Gray's Anatomy (1908), page 772. 
 
 7. See Cunningham's Anatomy (1909), page 797; or 
 Gray's Anatomy (1908), pages 589, 593, 667 and 670. 
 
 8. See Cunningham's Anatomy (1909), page 754; or 
 Gray's Anatomy (1908), page 1168. 
 
 PEDIATRICS. 
 
 1. See French's Practice (1907), page 799; or Osier's 
 Practice (1909), pages 519 and 524. 
 
 764 
 
MEDICAL RECORD. 
 
 2. See French's Practice (1907), pages 424 and 429; or 
 Osier's Practice (1909), pages 269 and 289. 
 
 3. Enuresis. Etiology: Irritation of bladder, phimosis, 
 adherent prepuce, caruncle, threadworms in rectum, fissure, 
 overloaded rectum, stone in bladder, very acid or alkaline 
 urine, paralysis, hip-joint disease, drinking too much fluid 
 before bed time. Treatment: Remove cause, if possible; 
 light diet, restricted fluids before bed time, light bed 
 clothes, regular habits of urination and defecation, raising 
 the foot of the bed, cold sponging, electricity; belladonna, 
 bromides, ergot, cantharides and potassium nitrate have all 
 been used for the relief of this condition. 
 
 4. Membranous laryngitis is practically diphtheria. See 
 French's Practice (1907), page 184; or Osier's Practice 
 (1909), page 200. Synonyms: Croup, membranous croup, 
 angina membranacea, cynanche maligna, putrid sore throat, 
 angina maligna, etc. 
 
 PATHOLOGY, HISTOLOGY, BACTERIOLOGY. 
 
 1. Degeneration is a pathological process in which abnor- 
 mal substances are formed within living cells, or the entire 
 cells are transformed into abnormal material. Causes of 
 fatty degeneration: Excess of oxidizable material, heredity, 
 diminished oxidation, high temperature, atrophy of the 
 liver, poisons, anemia, cachexia, diabetes. Causes of amy- 
 loid degeneration: Suppuration, ulceration, tuberculosis, 
 syphilis, gastroenteritis. 
 
 2. Types: Red or hemorrhagic, and white or anemic. 
 Red infarcts are blackish red in color; have a slightly 
 raised base; are surrounded by a hyperemic zone (if re- 
 cent) ; are commonly found in lungs, spleen, and kidneys ; 
 the area of infarction is cone shaped, with the base at the 
 surface of the organ, the apex pointing towards the center, 
 and corresponding to the point of entrance and exit of the 
 artery and vein. The blood-vessels are overfilled, due to 
 either a backflow of blood from the veins, or to a free 
 capillary anastomosis. 
 
 3. When the accumulation of fluid is due to circulatory 
 disturbances it is called a transudate ; when it is due to 
 inflammation it is called exudate. Transudates do not, as 
 a rule, coagulate, but may become slightly turbid on heat- 
 ing; and their specific gravity is usually below 1015. Exu- 
 dates are rich in albumin, and so coagulate on heating; 
 they are also rich in fibrin, and so may coagulate sponta- 
 neously ; their specific gravity is usually above 1018. 
 
 4. See Rose and Carless' "Surgery" (1908), page 40; or 
 Da Costa's "Surgery" (1908), page 81. 
 
 5. In atrophic cirrhosis: The liver is shrunken and in- 
 durated, rough, and of a pale or yellow color; a growth of 
 new. connective tissue is disposed in broad bands which 
 
 765 
 
MEDICAL RECORD. 
 
 run in various directions, and by their contraction divide 
 the liver into numerous irregular lobes. Many acini may 
 be affected at one time. The capsule may be thickened, 
 or adherent to the diaphragm. Jaundice is slight, and comes 
 on late; ascites is pronounced and may occur early. 
 
 6. In chronic parenchymatous nephritis, "both degenera- 
 tive and proliferative changes are seen. The tubular 
 epithelium is always more or less affected, showing signs 
 of cloudy swellirig, fatty degeneration, desquamation, and 
 disintegration, most marked in the convoluted tubules, but 
 also present in the loops and collecting tubules. The dis- 
 tribution of these changes is usually patchy, giving rise 
 to mottling of the cortex. The lumen of the tubes may 
 be dilated, and contain granular and fatty matters, and 
 hyaline casts, the latter formed by coagulation of exuda- 
 tion in the tubules. The glomeruli may occasionally appear 
 normal, but there is almost always some swelling and hya- 
 line degeneration, together with some proliferation and 
 desquamation, of the epithelium, so that they become highly 
 cellular. Occasionally the glomerular changes may be 
 more marked than the tubular; fatty degeneration of the 
 glomerular and capsular epithelium may be prominent, or 
 there may be swelling, proliferation, and desquamation of 
 the epithelium, or both these changes may be combined. 
 The glomerular vessels may be compressed, their endo- 
 thelium degenerate, and they may be obstructed by leuco- 
 cytes or by hyaline thrombi, and finally obliterated. In- 
 terstitial changes, though present, are not conspicuous, and 
 consist of edema, and scattered foci of round-celled in- 
 filtration about the glomeruli and veins. Sometimes hemor- 
 rhages are evident in some of the glomeruli and the cor- 
 responding tubules. Lardaceous infiltration frequently ac- 
 companies parenchymatous nephritis." 
 
 7. (a) Lipoma, myoma, neuroma, chondroma, fibroma, 
 osteoma, odontoma, myxoma, glioma, angioma, sarcoma. 
 
 (b) Malignant tumors are not encapsulated, tend to in- 
 filtrate the surrounding tissues, give rise to metastatic 
 growths, have a tendency to recur after removal, give a 
 cachexia, have a fatal tendency. 
 
 8. The causes of arteriosclerosis are: Increased blood- 
 pressure, old age, overeating, alcohol, lead poisoning, gout, 
 syphilis, high pressure of modern life, renal disease. 
 
 In arteriosclerosis it is mainly the inner coat which is 
 affected; this becomes thickened by layers of fibrous tissue 
 owing to the proliferation of the subendothelial connective 
 tissue cells. This thickening is not uniform. The elastic 
 layer becomes granular, and it may be partially destroyed. 
 Where high arterial tension exists the media is affected, 
 and the muscle fibers become hypertrophied ; sometimes 
 degeneration occurs here. The vessels increase in length 
 
 766 
 
MEDICAL RECORD 
 
 and thickness, becoming tortuous; they also feel resistant 
 and cord-like. 
 
 9. Diseases due to bacteria: Typhoid, dysentery, syphilis, 
 relapsing fever, Malta fever, influenza, bubonic plague, 
 anthrax, cholera, diphtheria, tetanus, glanders, leprosy, 
 tuberculosis, pneumonia, gonorrhea, cerebrospinal menin- 
 gitis; and probably: mumps, rabies, yellow fever, whooping 
 cough, scarlet fever, smallpox, typhus, vaccine, chicken- 
 pox, rubella, dengue, rheumatism, beri-beri, glandular 
 fever. 
 
 Communication may he by: Air, food, drink, contact, 
 fomites, insects. 
 
 10. (a) To demonstrate the existence of tubercle bacilli 
 in the sputum : The sputum must be recent, free from par- 
 ticles of food or other foreign matter; select a cheesy- 
 looking nodule and smear it on a slide, making the smear 
 as thin as possible. Then cover it with some carbolfuch- 
 sin, and let it steam over a small flame for about two 
 minutes, care being taken that it does not boil. Wash it 
 thoroughly in water and then decolorize by immersing it 
 in a solution of any dilute mineral acid for about a minute. 
 Then make a contrast stain with solution of Loeffler's 
 methylene blue for about a minute ; wash it again and 
 examine with oil immersion lens. The tubercle bacilli will 
 appear as thin red rods, while all other bacteria will appear 
 blue. 
 
 (b) The Widal reaction: "Three drops of blood are 
 taken from the well-washed aseptic finger tip or lobe of 
 the ear, and each lies by itself on a sterile slide, passed 
 through a flame and cooled just before use; this slide may 
 be wrapped in cotton and transported for examination at 
 the laboratory. Here one drop is mixed with a large drop 
 of sterile water, to redissolve it. A drop from the summit 
 of this is then mixed with six drops of fresh broth culture 
 of the bacillus (not over twenty-four hours old) on a 
 sterile slide. From this a small drop of mingled culture 
 and blood is placed in the middle of a sterile cover-glass, 
 and this is inverted over a sterile hollow-ground slide and 
 examined. ... A positive reaction is obtained when all 
 the bacilli present gather in one or two masses or clumps, 
 and cease their rapid movement inside of twenty minutes/' 
 (From Thayer's Pathology.) 
 
 11. The lips, mouth, tongue, pharynx, and esophagus 
 are all lined with stratified squamous epithelium; the 
 esophagus, further, has mucous glands; the stomach is 
 lined with columnar cells, has gastric glands, with shallow 
 crypts, and acid and peptic cells ; the small intestine is 
 lined with simple columnar cells, has also goblet cells, 
 Brunner's glands, crypts of Lieberkuhn, villi and valvulae 
 conniverites ; the large intestine is li-ed with simple colum- 
 
 767 
 
MEDICAL RECORD 
 
 nar epithelium, has goblet cells, crypts, but no villi or 
 valvulse connivents; the anus is lined with stratified 
 squamous epithelial cells. 
 
 12. See Cunningham's "Anatomy" (1909), page 1120; or 
 Gray's " Anatomy" (1908), page 1346. 
 
 PRINCIPLES AND PRACTICE. 
 
 1. Mitral regurgitation, mitral obstruction, aortic regur- 
 gitation, aortic obstruction. See French's "Practice" 
 (1907), page 576; or Osier's "Practice" (1909), page 796. 
 
 2. See French's "Practice" (1907), page 74; or Osier's 
 "Practice" (1909), page 70. 
 
 3. See French's "Practice" (1907), pages 156 and 174; 
 or Osier's "Practice" (1909), pages 172 and 189. 
 
 4. See French's "Practice" (1907), page 785; or Osier's 
 "Practice" (1909) page 508. 
 
 5. See French's "Practice" (1907), pages 748 and 751; 
 or Osier's "Practice" (1909), pages 473 and 477. 
 
 6. See French's "Practice" (1907), page 838; or Osier's 
 "Practice" (1909), page 571. 
 
 7. See French's "Practice" (1907), pages 623, 626, and 
 628; or Osier's "Practice" (1909), pages 848 and 851. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 1. Formalin, hydrogen dioxide, mercury bichloride, sil- 
 ver nitrate, creolin, and chromic acid. 
 
 2. Arsenic. Physiological action: Escharotic; irritant, 
 tonic ; increases cardiac action, respiratory power, intestinal 
 secretions, and peristalsis; produces edema, itching, diar- 
 rhea, epigastric pain, irritable and feeble heart. Thera- 
 peutic uses: In stomach disorders, bronchial and pulmon- 
 ary affections, diabetes, diarrhea, anemia, and chlorosis, 
 chorea, malaria, and chronic skin diseases. 
 
 3. Anthelmintics are given by Potter as follows: For 
 threadworm (Oxyuris vermicular is) — alum, ferrous sul- 
 phate, lime-water, quassia, sodium chloride, tannin, all by 
 enema. For roundworm (Ascaris lumbricoides) — santo- 
 nin, spigelia, chenopodium, azedarach, internally, with 
 senna or calomel. For tapeworms (Teniae, etc.) — aspidium 
 (filix mas), kamala, cusso, granatum (pelletierine), pepo, 
 turpentine, chloroform. For hookworm (Uncinaria, Anky- 
 lostomum) — thymol, aspidium. 
 
 4. (1) Hydrargyri chloridum corrosivum, gr. 1/20; (2) 
 hydiargyri iodidum rubrum, gr. 1/20: massa hydrargyri, 
 gr. iv; (4) hydrargyri chloridum mite, gr. ij ; (5) hydrar- 
 gyrum cum creta, gr. iv. 
 
 5. The symptoms of poisoning by strychnine are "a sense 
 of suffocation, thirst, tetanic spasms, usually opisthotonos, 
 sometimes emprosthotonos, occasionally vomiting, contrac- 
 tion of the pupils during the spasms, and death, either by 
 
 768 
 
MEDICAL RECORD 
 
 asphyxia during a paroxysm, or by exhaustion during a 
 remission. The symptoms appear in from a few minutes 
 to an hour after taking the poison, usually in less than 
 twenty minutes ; and death in from five minutes to six 
 hours, usually within two hours." 
 
 6. Treatment of strychnine poisoning: The convulsions 
 are to be arrested or mitigated by bringing the patient 
 under the influence of chloral or chloroform as rapidly as 
 possible; the stomach is to be washed out, and the patient 
 is to be kept as quiet as possible. 
 
 7. (1) Tincture of ferric cnloride, Tl£viij ; (2) Basham's 
 mixture, 3iv; (3) reduced iron, gr. j; (4) syrup of ferrous 
 iodide, n^xv; (5) tartarated iron, gr. iv; (6) dried sulphate 
 of iron, gr. ij. 
 
 OBSTETRICS. 
 
 1. See Williams' "Obstetrics" (1909), page 164; or 
 Hirst's "Obstetrics" (1909), page 180. 
 
 2. See Williams' "Obstetrics" (1909), page 199; or 
 Hirst's "Obstetrics" (1909), page 188. 
 
 3. See Williams' "Obstetrics" (1909), page 235; or 
 Hirst's "Obstetrics" (1909), page 3$&. 
 
 4. See Williams' "Obstetrics" (1909), page 509; or 
 Hirst's "Obstetrics" (1909), page 238. 
 
 5. See Williams' "Obstetrics" (1909), page 672; or 
 Hirst's "Obstetrics" (1909), page 221. 
 
 6. Diagnosis of hydatids: The pregnancy begins as in 
 normal cases, but in about the third month the uterus be- 
 comes suddenly and rapidly enlarged; irregular uterine 
 hemorrhages occur; and there is a discharge of fluid con- 
 taining the vesicular growths ; labor occurs, and the mass 
 of cysts is expelled. Treatment: Empty the uterus as 
 soon as possible, but beware of rupturing the uterine wall ; 
 and secure uterine contraction. 
 
 7. Puerperal eclampsia. Etiology: Uremia, albumi- 
 nuria, imperfect elimination of carbon dioxide by the lungs, 
 medicinal poisons, septic infection; predisposing causes are 
 renal disease and imperfect elimination by the skin, bowels, 
 and kidneys. Symptoms: Headache, nausea, and vomiting, 
 epigastric pain, vertigo, ringing in the ears, flashes of light 
 or darkness, double vision, blindness, deafness, mental 
 disturbance, defective memory, somnolence; symptoms 
 easily explained by the circulation of toxic blood through 
 the nerve centers. These may be preceded by lassitude, 
 and accompanied by constipation, or by diarrhea. Head- 
 ache is perhaps the most significant and common warning 
 symptom. In bad cases the urine is reduced in quantity 
 (almost suppressed), very dark in color, its albumin 
 greatly increased, so that it becomes solid on boiling. Next 
 comes the final catastrophe of convulsions. The convulsive 
 
 769 
 
MEDICAL RECORD 
 
 fit begins with twitching of the facial muscles, rolling and 
 fixation of the eyeballs, puckering of the lips, fixation of 
 the jaws, protrusion of the tongue, etc., soon followed, by 
 violent spasms of the muscles of the trunk and limbs, in- 
 cluding those of respiration ; hence lividity of the face 
 and stertorous breathing, biting of the tongue, opisthot- 
 onus, etc. The fit lasts fifteen or twenty seconds, ending 
 in partial or complete coma, possibly death; or conscious- 
 ness may return, to be followed by other convulsions. 
 
 8. See Williams' "Obstetrics" (1909), page 818; or 
 Hirst's "Obstetrics" (1909), page 585. 
 
 GYNECOLOGY. 
 
 1. The pathology of menstruation includes: (1) Pre- 
 mature or precocious menstruation ; (2) protracted men- 
 struation; (3) absence of menstruation (amenorrhea) ; (4) 
 profuse menstruation (menorrhagia) ; (5) flow in between 
 periods (metrorrhagia) ; (6) painful menstruation (dys- 
 menorrhea) ; (7) vicarious menstruation; (8) regular in- 
 termenstrual pain. 
 
 2. The most common causes of sterility in woman are : 
 Gonorrhea, absence or errors in development of any part 
 of the genital tract, malformations of genitals, fistulse, 
 lacerations, obesity, alcoholism, pelvic inflammations, dys- 
 pareunia, inflammations of uterus, tubes, or ovaries, elon 
 gated cervix. Treatment consists in removing the cause, if 
 possible; curettage has been recommended; in the pres- 
 ence of developmental errors little or nothing can be done : 
 atresia of cervix can be treated by dilatation ; if the uterus 
 is misplaced it must be replaced. 
 
 3. Metritis. Symptoms: Constitutional disturbances, 
 temperature from ioo° to 105 F., chills, pelvic pain, and 
 discharge which may be profuse, offensive, purulent, or 
 blood-stained. The vagina is hot; the uterus is tender, 
 heavy, and bulky ; later it may become fixed ; the cervix is 
 first soft, then hard and firm. Course: If of puerperal 
 origin it may be fatal; otherwise the tendency is to re- 
 covery, after a slow and protracted course. As complica- 
 tions there may be : Pelvic peritonitis and cellulitis, pyosal- 
 pinx, and sterility. The disease may produce backache, 
 leucorrhea, uterine displacements, dysmenorrhea, and steril- 
 ity. Diagnosis can be made from above symptoms and 
 course. 
 
 4. Curettage, Indications: For diagnosis, to remove 
 pieces of retained placenta or decidua, endometritis, mucous 
 polypi, hemorrhage, dysmenorrhea, endocervicitis. Dangers: 
 Sepsis, perforation of uterus, hemorrhage, abortion, in- 
 flammation of uterus or adnexa. Procedure: All anti- 
 septic and aseptic precautions are necessary, the patient 
 should be in the dorsal position, the vagina is to be disin- 
 
 770 
 
MEDICAL RECORD. 
 
 fected, and the cervical canal dilated; a speculum is in- 
 troduced into the vagina and the cervix is drawn down 
 with volsella ; the uterine cavity is irrigated with creolin 
 or lysol ; a curette is inserted to the fundus and moved 
 down to the internal os ; the operator should begin at 
 one cornu, and go in the same direction all around till he 
 reaches the starting point, and if necessary repeat till no 
 more spongy or hyperplastic tissue appears ; the fundus 
 should be scraped separately by moving the curette along 
 it from side to side; in going towards the fundus no 
 scraping should be done, and care must be taken not to 
 perforate the uterus; should this happen no fluid must 
 be injected; otherwise the uterus and vagina are again 
 irrigated,, and one or more strips of iodoform gauze are 
 inserted into the cavity to act either .as a hemostatic plug 
 or as a drain, which is diminished with two days' inter- 
 val and withdrawn on the sixth day. A hemostatic tampon 
 should be placed in the vagina and withdrawn the follow- 
 ing day. If any fever arises, the tampon is at once re- 
 moved and the vagina douched with antiseptic fluid every 
 three hours. If not, the vagina is only swabbed with the 
 same every day, and packed loosely with iodoform gauze. 
 After the final removal of the gauze the antiseptic douche 
 is given twice a day until there is no more discharge. 
 
 NEUROLOGY, DIETETICS, MEDICAL JURISPRUDENCE. 
 
 i. (a) The neuron, (b) The neuron consists of a nerve 
 cell of variable size, with nucleus, nucleolus, and one or 
 more processes (axis-cylinder or neuraxon, and den- 
 drites), there is no cell wall, and but little chromatin, (r) 
 In acute anterior poliomyelitis, the anterior cornua (espe- 
 cially of the lumbar and cervical enlargement) are specially 
 involved; the anterior roots atrophy. 
 
 2. (a) See Cunningham's "Anatomy" (1909), page 452; 
 or Gray's "Anatomy" (1908), page 834. Pia, arachnoid, 
 and dura, (b) To the disc between the first and second 
 lumbar vertebra, (c) In locomotor ataxia the posterior 
 columns, roots, and spinal ganglia are first involved. 
 
 3. (a) Seventh, facial; eighth, auditory; tenth, pneumo- 
 gastric; twelfth, hypoglossal, (b) See below, Physiology. 
 Questions 1 and 3. (r) The Gasserian ganglion is on the 
 fifth cranial nerve, and is situated in Meckel's hollow, 
 near the apex of the petrous portion of the temporal bone. 
 
 4. (a) See Cunningham's "Anatomy" (1909), page 648; 
 or Gray's "Anatomy" (1908), page 1030. (b) Internal and 
 external popliteal. (c) Anywhere between the sacral 
 plexus and the lower third of the thigh. 
 
 5. (a) The pneumogastric and the sympathetic, (b) 
 The- former is the inhibitory nerve and slows the heart ; 
 the latter augments or accelerates the beats. 
 
 771 
 
MEDICAL RECORD. 
 
 6. When abortion is undertaken by properly qualified 
 physicians after due consultation with other physicians, 
 and for the purpose of saving the life or health of the 
 mother, it is justifiable; under all other circumstances it 
 is criminal. The former is a perfectly lawful medical pro- 
 cedure; the latter is illegal. 
 
 7. In expert testimony, the witness may give his opinion 
 on facts or supposed facts as noted by himself or asserted 
 by others. Theoretically, this can be done only by those 
 perfectly familiar with the subject in question; but practi- 
 cally any (or almost any) physician with a license to prac- 
 tice is accepted as an expert witness. 
 
 In ordinary testimony, the witness testifies to facts which 
 he has seen, or heard, or with which he has become ac- 
 quainted by personal observation. 
 
 Four positive signs of death; (1) The permanent cessa- 
 tion of circulation; (2) the permanent cessation of respira- 
 tion; (3) rigor mortis; (4) putrefaction. 
 
 8. In Wisconsin : The words "insane persons" include 
 idiots, persons non compos mentis, lunatics, and distracted 
 persons. Any three citizens may apply to the county court 
 for a judicial enquiry and an order committing a person 
 to a State hospital. Two physicians are appointed as ex- 
 aminers in lunacy. The form of their report is prescribed. 
 Insane persons may also be admitted as voluntary patients 
 upon two physicians' certificates. — (From Witthaus and 
 Becker's Medical Jurisprudence, etc.) 
 
 9. Tissue formers: Lean meat, eggs, wheat. Work and 
 heat producers: Bread, butter, sugar, potatoes. 
 
 10. See French's "Practice" (1907), page ill; or Osier's 
 "Practice" (1909), page 99. 
 
 11. About 65 to 70 ounces of water are required, besides 
 what is obtained from the food. Four functions of water: 
 
 (1) It is the chief ingredient of the fluids of the body; 
 
 (2) it serves as a distributor of body heat; (3) it regu- 
 lates the body temperature (by means of absorptipn and 
 evaporation) ; and (4) it enters into the chemical com- 
 position of the tissues. 
 
 12. The fat of the body is obtained from fatty foods, 
 from carbohydrates, and from proteids. 
 
 In apoplexy the diet must be light, nutritious, and un- 
 stimulating, and consist chiefly of milk and farinaceous 
 foods. Animal food is best avoided, or limited to fish; 
 alcohol, tea, and coffee are also best avoided. A vegetarian 
 and milk diet is best, but individual peculiarities have to be 
 studied. Rectal feeding may be necessary. The reason for 
 the reduced diet is to reduce arterial tension, and so pre- 
 vent a recurrence of the hemorrhage. Intravascular pres- 
 sure must also be kept low, hence too little fluid must not 
 
 J72 
 
MEDICAL RECORD 
 
 be given, and the kidneys should be kept active with diu- 
 retics. 
 
 PHYSIOLOGY, OPHTHALMOLOGY, AND* LARYNGOLOGY. 
 
 i. Pneumogastric nerve. Superficial origin: Groove 
 between restiform and olivary bodies. Deep origin: Nuclei 
 in floor of fourth ventricle. Distribution is shown by the 
 names of the branches : Meningeal, auricular, pharyngeal, 
 superior and inferior laryngeal, cardiac, pulmonary, esopha- 
 geal, and gastric. Function: It supplies (i) motor influ- 
 ence to the pharynx and esophagus, stomach, and intestines, 
 to the larynx, trachea, bronchi, and lungs; (2) sensory 
 and, in part, (3) vasomotor influence, to the same regions; 
 (4) inhibitory influence to the heart; (5) inhibitory affe- 
 rent impulses to the vasomotor center; (6) excito-secre- 
 tory to the salivary glands; (7) excito-motor in coughing, 
 vomiting, etc. 
 
 2. Alcohol excites, then depresses the brain ; in small 
 doses it stimulates the stomach and may help digestion ; 
 later it congests the stomach and liver, over-stimulates the 
 gastric glands and hepatic cells, causes gastric catarrh, 
 produces pathological conditions, and impairs digestion. 
 
 3. The facial nerve is the motor nerve of the muscles 
 of expression, also of the platysma and the buccinator; it 
 also supplies the muscles of the external ear, the stylohy- 
 oid, and the posterior belly of the digastric. Through the 
 chorda tympani it is a nerve of taste and a vasodilator of 
 the vessels of the submaxillary and sublingual glands. 
 Hence section of the nerve would cause abolition of these 
 various functions ; notably, facial paralysis would ensue. 
 When it is paralyzed, the muscles of the face being 
 all powerless, the countenance acquires on the paralyzed 
 side a characteristic, vacant look, from the absence of 
 all expression ; the angle of the mouth is lower, and the 
 paralyzed half of the mouth looks longer than that on the 
 other side ; the eye has an unmeaning stare, owing to the 
 paralysis of the orbicularis palpebrarum. All these pecu- 
 liarities increase the longer the paralysis lasts, and their 
 appearance is exaggerated when at any time the muscles 
 of the opposite side of the face are made active in any 
 expression, or in any of their ordinary functions. In an 
 attempt to blow or whistle, one side of the mouth and 
 cheeks acts properly, but the other side is motionless, or 
 flaps loosely at the impulse of the expired air; so, in try- 
 ing to suck, one side only of the mouth acts; in feeding, 
 the lips and cheek are powerless, and, on account of paraly- 
 sis of the buccinator muscle, food lodges between the 
 cheek and gums. 
 
 4. A lobule of the liver is about 1-20 to 1-12 inch in 
 diameter. It has a darkish red center and a lighter cir- 
 
 773 
 
MEDICAL RECORD. 
 
 cumference. The center is occupied by an intralobular 
 vein which collects the blood from the capillaries of the 
 lobule, and flows # into the sublobular vein, which latter 
 opens into the hepatic vein. Around the lobules are the 
 interlobular veins; these are branches of the portal sys- 
 tem; capillaries passing from the circumference to the 
 center of the lobule connect the interlobular and intra- 
 lobular veins. Between the network of capillaries in the 
 lobule the hepatic cells are packed. 
 
 The functions of the liver are: (i) The secretion of 
 bile, (2) the formation of glycogen, (3) the formation of 
 urea and uric acid, (4) the manufacture of heat, and (5) 
 the conversion of poisonous and harmful into inert ma 
 terial. 
 
 5. Excess of albuminous food may cause : Congestion 
 and enlargement of the liver, plethora, imperfect oxidation 
 and elimination, delayed metabolism, fever, malaise, diar- 
 rhea, albuminuria, calculus, lithemia, torpor, and bilious- 
 ness. Excess of oleaginous food may cause : Delayed 
 nitrogenous assimilation, production of excessive fat. Ex- 
 cess of farinaceous food may cause : In addition to same 
 as excess of oleaginous food, acidity and flatulence, cor- 
 pulence, enfeebled heart action, dyspepsia, and glycosuria. 
 
 6. (a) Inflammation is the series of changes which occur 
 in a part as the result of injury, provided the injury is 
 not so severe as to destroy the tissues; it is the "reaction 
 of the tissues to injury." (h) The functions of the skin 
 are : Protection, sense of touch, excretion, regulation of 
 body temperature, absorption, and respiration. 
 
 7. Saliva. Functions: (1) To moisten the mouth; (2) 
 to assist in the solution of the soluble portions of the 
 food, and thus (3) to administer to the sense of taste; 
 (4) to lubricate the bolus of food, and thus (5) to facili- 
 tate the acts of mastication and deglutition, and (6) to 
 change starches into dextrin and sugar. Composition: 
 Water, mucin, ptyalin, potassium sulphocyanide, proteid, 
 sodium chloride, and other salts. 
 
 Gastric juice. Functions: To convert proteids into 
 proteoses and peptones, to curdle milk. Composition: 
 Water, pepsin, hydrochloric acid, chlorides, and phosphates. 
 
 Bile. Functions: (1) To assist in the emulsification and 
 saponification of fats; (2) to aid in the absorption of 
 fats; (3) to stimulate the cells of the intestine to increased 
 secretory activity, and so promote peristalsis, and at the 
 same time tend to keep the feces moist; (4) to eliminate 
 waste products of metabolism, such as lecithin and choles- 
 terin ; (5) it has a slight action in converting starch into 
 sugar ; (6) it neutralizes the acid chyme from the stomach, 
 and thus inhibits peptic digestion; (7) it has a very feeble 
 antiseptic action. Composition: Water, sodium glycocho- 
 
 774 
 
MEDICAL RECORD. 
 
 late, sodium taurocholate, lecithin, cholesterin, pigment. 
 and inorganic salts. 
 
 8. Use of the ophthalmoscope: "The patient is placed in 
 front of the source of illumination, and to the side of the 
 eye to be examined, the light behind him so that it shines 
 on his temple, just touching the tips of the outer lashes. 
 He is then told to look straight ahead to an object on a 
 level with his eyes across the room. To examine the 
 patient's right eye the surgeon sits or stands, and holds 
 his ophthalmoscope in his right hand before his own right 
 eye. To examine the patient's left eye he places himself 
 to the left of the patient and holds the ophthalmoscope in 
 his left hand before his own left eye. The ophthalmoscope 
 is brought close to the eye under examination, the mirror 
 of the ophthalmoscope having been inclined and the instru- 
 ment held in such position that the light from the source 
 of illumination will be reflected directly into the patient's 
 pupil ; then, if the media are clear, a red glare called the 
 fundus reflex is seen through the hole in the mirror. If 
 the examiner wears glasses, he need not remove them; in 
 fact, if he is astigmatic, he had better accustom himself to 
 working with his correcting lenses on." — (From Gould and 
 Pyle's Compend.) 
 
 Diseases which can ^ be diagnosed by its use: Brain 
 tumors, abscess of brain, anemia of brain, cerebral aneu- 
 rysm, tabes dorsalis, multiple sclerosis, exophthalmic goiter, 
 nephritis, diabetes, hypertrophy of the left ventricles of the 
 heart, fatty degeneration of the heart, syphilis, alcoholic 
 or tobacco poisoning. 
 
 g. Iritis. Symptoms: _ Pain, photophobia, small pupil, 
 ciliary congestion, discoloration of iris, exudate in anterior 
 chamber. Treatment: Causal, abstraction of blood from 
 temples, atropine, diaphoresis, shielding the eye from light. 
 Keratitis. Symptoms: Pain, photophobia, ciliary injection, 
 blepharospasm, impairment of vision, cornea may be per- 
 forated. Treatment: Causal, atropine, tonics, and sympto- 
 matic. 
 
 10. Hordeolum is an abscess or inflammation in the 
 tissues about the follicle of an eyelash. Chalazion is a 
 tumor in the eyelids due to obstruction of the duct in a 
 Meibomian gland. Ptosis is a drooping of the upper eye- 
 lid, generally due to paralysis. Astigmatism is a condition 
 in which, owing to a greater curvature of the eye in one 
 meridian than in others, the refractive power ot the eye 
 varies. Myopia is a condition in which the anteroposterior 
 axis of the eye is abnormally long, and parallel rays are 
 focused in front of the retina. Glaucoma is a disease of 
 the eye due to increased intraocular tension, and resulting 
 in .excavation and atrophy of the optic disc, and finally 
 blindness. Refraction is the deviation produced in the 
 
 775 
 
MEDICAL RECORD 
 
 course of a ray of light in its passage from one medium 
 to another. Also, the act or process of refracting. 
 
 n. In diphtheria the onset is more gradual; the tem- 
 perature rises to about ioi° F. ; the tonsils are not much 
 enlarged; there is an exudate of a thick, grayish membrane 
 which is very adherent, is removed only with difficulty, 
 and leaves a bleeding surface; this membrane soon re- 
 forms and may be found on the fauces and pharynx as 
 well as on the tonsils; in the exudate the Klebs-Loeffler 
 bacilli may be found. In follicular tonsillitis the onset is 
 more sudden; the temperature may be a little higher than 
 that of diphtheria ; there is no membrane, but the tonsils 
 are red and swollen, and in the crypts are seen white, 
 cheesy spots or plugs, which consist of broken-down 
 epithelium, and are easily brushed away; Klebs-Loeffler 
 bacilli are never found. 
 
 12. See French's "Practice" (1907), pages 645 and 360; 
 or Osier's " Practice" (1909), pages 597 and 600. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 College of Physicians and Surgeons of British 
 
 Columbia. 
 
 anatomy. 
 
 1. (a) Describe the pleura, (b) Give the "reflections 
 of the pleura" of the right side. 
 
 2. Name the bones which enter into the formation of 
 the orbit, and give the articulations of any one of them. 
 
 3. (a) Give the muscles attached to the great tro- 
 chanter of the femur, (b) Give the action and nerve sup- 
 ply of any two. 
 
 4. Trace the seventh nerve; what group of muscles 
 does it supply? 
 
 5. Describe the ligaments of the ankle joint and the 
 sternoclavicular joint. 
 
 6. Dissection necessary to expose the innominate artery. 
 
 chemistry and public health. 
 
 1. Antidotes—classify and give examples. What is the 
 antidote in a case of acute arsenical poisoning? Give 
 equation showing action. 
 
 2. In an analysis of drinking water you find chlorides 
 2 grs. per gallon. Discuss your results. 
 
 3. Describe minutely disinfection of a room occupied 
 by an advanced and careless consumptive. 
 
 4. Cows' milk, (a) Discuss its merits as a food, (b) 
 Show how it becomes dangerous for human use when im- 
 properly handled. 
 
 776 
 
MEDICAL RECORD. 
 
 5. Differentiate between varioloid and chickenpox. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 1. Name two drugs in each of the following orders, 
 stating doses and cases in which either would be used : 
 Emetics, hypnotics, stimulants, diuretics, diaphoretics. 
 
 2. Doses and uses : Potassium bromide, strontium 
 iodide, calomel, ichthyol, guaiacol. 
 
 3. State briefly in what disturbances of the circulatory 
 system you would use digitalis, adrenalin, strychnine, ergot. 
 
 4. Write prescriptions : Acute bronchitis in adult. 
 Acute rheumatism in adult. Acute nephritis, child, aged 12. 
 Diabetes. 
 
 5. Describe treatment for typhoid fever. 
 
 6. Serum therapy: Nature and value as far as known. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. Duties of a medical man when called to a case on 
 which rape is alleged to have been committed. 
 
 2. Distinguish between acute alcoholism and acute 
 mania. 
 
 3. A case of suspected poisoning. Describe proceed- 
 ings. 
 
 4. Antidotes for : Carbolic acid, corrosive sublimate, 
 chloral, arsenic, opium. 
 
 MIDWIFERY AND DISEASES CF WOMEN AND CHILDREN. 
 
 1. What are the causes of delay, from slow dilatation, 
 in the first stage of labor? Give the treatment in each 
 case. 
 
 2. Describe the normal anatomy of the Fallopian tube. 
 The varieties, causes, symptoms, prognosis, and treatment 
 of salpingitis. 
 
 3. Enumerate the causes of hemorrhage before and 
 after delivery. Give the varieties, causation, symptoms, 
 and treatment of placenta praevia. 
 
 4. Name the varieties of displacement of the uterus. 
 The causation and symptoms of retroflexion. Describe 
 the operations performed for retroflexion. 
 
 ^ 5. Give the etiology, pathology, symptoms, complica- 
 tions, and treatment of a case of cerebrospinal meningitis. 
 
 PHYSIOLOGY. 
 
 1. Describe the cardiac nervous mechanism. 
 
 2. What do you know of renal secretion? 
 
 3. Discuss absorption in the digestive tract. 
 
 4. - State the effect of cutting the third nerve. 
 
 " Account for the different forms of aphasia. 
 
MEDICAL RECORD 
 
 SURGERY. 
 
 i. Empyema. Give its causes and treatment. Describe 
 Schede's operation. 
 
 2. Prostatectomy. What conditions necessitate this? 
 Describe the technique of the perineal method. 
 
 3. Coxalgia. Describe the various stages with symp- 
 toms of each, and appropriate treatment. 
 
 4. Describe Sayre's method for fractured clavicle. 
 Give the principles of its action. 
 
 5. Hip-joint dislocations. Give the varieties, their 
 symptoms and treatment. 
 
 THEORY AND PRACTICE OF MEDICINE AND MEDICAL PATHOLOGY. 
 
 1. Epidemic cerebrospinal meningitis : Give etiology, 
 symptoms, and differential diagnosis. 
 
 2. What is uremia? With what conditions may uremic 
 coma be confused? Give differential diagnosis. 
 
 3. Mitral incompetency : Give physical signs and de 
 scribe symptoms as they may arise. 
 
 4. Asthma : Give symptoms and treatment. 
 
 5. Give pathology, symptoms, and treatment of a case 
 of tuberculous disease of the intestines. 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 
 QUESTIONS. 
 
 College of Physicians and Surgeons of British 
 
 Columbia. 
 
 anatomy. 
 
 1. "The pleura are two serous sacs enclosing and invest- 
 ing the lungs. Each pleura consists of a visceral and 
 parietal layer. The visceral portion covers the lung, and 
 the parietal layer lines the inner surface of the chest walls, 
 the upper surface of the diaphragm, and the sides of the 
 pericardium. The visceral and parietal layers of the corre- 
 sponding pleura become continuous in front and behind the 
 root of the lung ; and below the root a fold, the ligamentum 
 latum pulmonis, extends downward along the inner sur- 
 face of the lung to the diaphragm. The mediastina are 
 formed by the visceral layers of each side approaching one 
 another toward the median line. 
 
 "The limits of the parietal pleurae are as follows : Each 
 extends upward into the neck, forming a domelike process 
 over the apex of the lung about two inches above the first 
 costal arch ; from this the pleura passes downward and 
 forward to the posterior aspect of the sternoclavicular 
 joint of each side and meets its fellow in the midline at 
 the manubriogladiolar articulation ; they pass down to- 
 
 778 
 
MEDICAL RECORD 
 
 gether to level of fourth costal cartilages, where right 
 pleura passes vertically to level of seventh right costal 
 cartilage in midline ; then outward, crossing ninth rib in 
 midaxillary line; then downward and backward along 
 eleventh rib to reach spine at neck of twelfth rib. Behind, 
 it passes upward on the right side of the bodies of the 
 vertebrae to the apex." (Aids to Anatomy.) 
 
 2. The bones which enter into the formation of the orbit 
 are : The frontal, sphenoid, ethmoid, superior maxillary, 
 malar, lacrymal, and palate. Of these, the malar articu- 
 lates with : The frontal, sphenoid, temporal, and superior 
 maxillary. 
 
 3. (a) The muscles attached to the great trochanter of 
 the femur are : The Gluteus medius, Gluteus minimus, 
 Pyriformis, Obturator internus, Obturator externus, Ge- 
 mellus superior, Gemellus inferior, and Quadratus femoris. 
 
 (b) The Quadratus femoris rotates the thigh outward; 
 it is supplied by branches from the sacral plexus. 
 
 The Obturator internus rotates the thigh outward ; it is 
 supplied by branches from the sacral plexus. 
 
 4. The seventh or facial nerve has its superficial origin 
 in the upper end of the medulla oblongata, in the groove 
 between the olivary and restiform bodies. It passes "for- 
 ward and outward to enter the internal auditory meatus; 
 it lies upon a groove on the auditory nerve, with portio 
 intermedia of Wrisberg between, and at the bottom of the 
 meatus it enters the aqueductus Fallopii, along which it 
 runs first outward between cochlea and vestibule as far as 
 hiatus Fallopii; then backward in internal wall of tympa- 
 num, just above fenestra ovalis, at the turn presenting a 
 swelling, the geniculate ganglion; and finally it passes 
 downward, to emerge from the bone at the stylomastoid 
 foramen ; it then passes outward and forward in the 
 parotid, dividing behind the ramus of the jaw into temporo- 
 facial and cervico-facial branches, which further subdivide 
 and intercommunicate, forming the pes anserinus! } (Aids 
 to Anatomy.) 
 
 It supplies the muscles of expression in the face, the 
 muscles of the external ear, the Platysma, Buccinator. 
 Stylohyoid, and the posterior belly of the Digastric. 
 
 5. The ligaments of the ankle joint are : The anterior 
 tibio-tarsal, posterior tibio-tarsal, internal lateral, and 
 external lateral. 
 
 The ligaments of the sternoclavicular joint are : The 
 anterior sternoclavicular, posterior sternoclavicular, inter- 
 clavicular, costoclavicular, and interarticular fibrocartilage. 
 
 For description see Cunningham's "Anatomy" (1909). 
 pages 306 and 273; or Gray's "Anatomy" (1908), pages 
 349 and 299. 
 
 6. See Gray's "Anatomy" (1908), page 597. 
 
 779 
 
MEDICAL RECORD 
 
 CHEMISTRY AND PUBLIC HEALTH. 
 
 i. Antidotes are classified as: — (i) Chemical antidotes, 
 which act by uniting chemically with the poison and thus 
 converting it into a harmless or insoluble compound. Ex- 
 ample: Albumin, in mercurial poisoning; sodium sulphate, 
 in carbolic poisoning. 
 
 (2) Physiological antidotes, which act by combating one 
 (or more) of the physiological actions of the poison. 
 Example : Opium will counteract the dilated pupil caused 
 by belladonna. * 
 
 The antidote for acute arsenical poisoning is freshly 
 prepared solution of ferric hydroxide. The equation show- 
 ing the action is : 
 
 As 2 3 + 2 Fe 2 (OH) 6 = Fe(OH) 2 + 5 H 2 + Fe 3 (AsO*) 2 
 
 2. Two grains of chlorine per gallon is not an excessive 
 amount for many localities ; but some writers recommend 
 the condemnation of all waters containing more than one 
 grain to the gallon of water. As a rule the chlorine de- 
 notes animal organic impurities. 
 
 3. Room disinfection: 'This can only be carried out ef- 
 fectually when the room is unoccupied; therefore the first 
 essential is evacuation, next all articles that can be disin- 
 fected by moist or dry heat or by soaking in some chemical 
 disinfectant should be removed and treated accordingly. 
 All windows, chimneys, and orifices having been closed as 
 tightly as possible and all cupboards and drawers opened 
 and exposed, the space or chamber should be fumigated in 
 presence of moisture with either formaldehyde, chlorine, 
 or nitrous acid for at least three hours. On reentering, open 
 all doors and windows, and strip the walls of paper, burn 
 the pieces, have the ceiling well limewashed, and scrub all 
 floors, all woodwork and furniture with either plain hot 
 water and soft soap, or with bichloride of mercury (1 in 
 1000), or with formalin (2 per cent). In many cases ade- 
 quate disinfection will be secured by free perflation of air, 
 and, in place of fumigation, the free use of a spray of 
 either formalin or chinosol or mercuric chloride in proper 
 proportions to the surfaces of walls and furniture. We 
 are disposed to consider this application by sprays of these 
 disinfectants directly to infected surfaces as of far greater 
 value than attempts to disinfect by gaseous means; it is 
 the place itself, not the air of the place, we need to disin- 
 Lct; the air can be readily changed by free ventilation." 
 — (Notter and Firth's Hygiene.) 
 
 4. Cow's milk is a perfect food for very young children ; 
 but for those who are older, it is not so satisfactory, be- 
 cause such enormously large quantities would have to be 
 taken to ensure an adequate supply of nitrogen and carbon. 
 
 Diseases Connected with Milk— -Milk has the power 
 of absorbing gases and vapors to a great extent, and if 
 
 780 
 
MEDICAL RECORD. 
 
 these are offensive or noxious they will produce their 
 effects on the body. It also very readily passes through 
 the lactic and butyric fermentation to putrefaction. 
 
 Stomatitis, gastric and intestinal irritation, etc., are pro- 
 duced by milk containing lactic acid, or fungi, or pus, etc., 
 from an inflamed or suppurating udder. 
 
 The germs of tuberculosis, enteric fever, scarlatina, diph- 
 theria, anthrax, and foot-and-mouth disease, whether in- 
 troduced directly from the cow, from the hands of the 
 milkers, from the water used to wash the milk-cans or to 
 dilute the milk, or absorbed from the air — find in milk a 
 suitable culture medium in which they multiply and by 
 which they are conveyed. 
 
 Milk which has been kept for some time may develop 
 a ptomaine called tyrotoxine, or cheese poison ; it has 
 been detected in ice creams, which have proved to be 
 poisonous. 
 
 5. In varioloid: There is premonitory discomfort, no- 
 ticeably pain in the back; there may be a marked initiatory 
 fever; the rash does not appear till the third day, is shotty, 
 is most marked on the face and wrists ; vesicle formation 
 is delayed, the vesicles have a central depression which is 
 well marked; the fever subsides as the eruption appears. 
 
 In chickenpox : There is little or no premonitory dis- 
 comfort; fever is slight; the eruption appears in about 24 
 hours, is not shotty, is scattered generally all over the 
 body; vesicles form in a few hours, and umbilication 
 appears late or not at all, and the vesicles rapidly become 
 scabbed. 
 
 MATERIA MEDICA AND THERAPEUTICS. 
 
 I. 
 
 ORDERS 
 
 DRUGS 
 
 DOSE 
 
 Emetics. 
 
 1. 
 
 Apomorphine hy- 
 
 gr. 1/10 (hypodermic- 
 
 
 
 drochloride. 
 
 ally.) 
 
 
 2. 
 
 Wine of ipecac. 
 
 3ij — iv. 
 
 Hypnotics. 
 
 1. 
 
 Chloral hydrate. 
 
 gr. xxx. 
 
 
 2. 
 
 Sulphonal. 
 
 gr. xxx. 
 
 Stimulants. 
 
 1. 
 
 Aromatic spirit of 
 
 
 
 
 ammonia. 
 
 3j. 
 
 
 2. 
 
 Strychnine sulphate 
 
 gr. 1/30. 
 
 Diuretics. 
 
 1. 
 
 Potassium acetate. 
 
 gr. xxx. 
 
 
 2. 
 
 Citrated caffeine. 
 
 gr. v. 
 
 Diaphoretics. 
 
 1. 
 
 Pilocarpine hydro- 
 
 
 
 
 chloride. 
 
 gr. 1/5. 
 
 
 2. 
 
 Liquor ammonii 
 
 
 
 
 acetatis. 
 
 3iv. 
 
 2.- Potassium bromide, gr. xv. ; strontium iodide, gr. vij ; 
 calomel, gr. i; ichthyol. gr. x; guaiacol, ttpviij. 
 
 781 
 
MEDICAL RECORD 
 
 Potassium bromide is used in epilepsy, insomnia, hys- 
 teria, neuralgia, nervousness, migrane, seasickness, deli- 
 rium tremens. 
 
 Strontium iodide is used in syphilis, gonorrheal rheu- 
 matism, joint diseases, pleurisy, arteriosclerosis. 
 
 Calomel is used as a purgative, intestinal antiseptic, in in- 
 flammations, syphilis, as a dusting powder for venereal 
 ulcers. 
 
 Ichthyol is used for inflammations, swellings, eczema, 
 erysipelas, psoriasis, ulcers, burns. 
 
 Guaiacol is used in phthisis, diabetes, typhoid. 
 
 3. Digitalis is indicated in diseases of the heart, (1) 
 when the heart action is rapid and feeble, with low arterial 
 tension ; (2) in mitral lesions when compensation has 
 begun to fail; (3) in nonvalvnlar cardiac affections; (4) in 
 irritable heart, due to nerve exhaustion. Digitalis is con- 
 traindicated in diseases of the heart (1) in aortic lesions 
 when uncombined with mitral lesions; (2) when the heart 
 action is strong and arterial tension high. 
 
 Adrenalin is indicated in hemorrhage from different 
 parts, in purpura and in hemophilia. 
 
 Strychnine is indicated in cardiac failure and when a 
 cardiac stimulant is required. 
 
 Ergot is indicated in arterial hemorrhage (particularly 
 postpartum hemorrhage), hemoptysis, aneurysms, and it 
 also acts as a cardiac sedative. 
 
 4. For acute bronchitis : 
 
 B. Vini ipecacuanha? 3ij 
 
 Liquoris potassii citratis 3iv 
 
 Tincturse opii camphoratse. 
 
 Syrupi acaciae aa 5J Misce. 
 
 Signa — One tablespoon ful three times a day. 
 
 For acute articular rheumatism : 
 
 B. Sodii salicylatis . . . .3ijss 
 
 Fluidextracti glycyrrhizae. 
 
 Tincturse aurantii aa 5ijss 
 
 Aquae chloroformi q.s. ad Jviij Misce. 
 
 Signa: Take two tablespoonfuls every four hours. 
 
 For acute nephritis, in a child, aged 12 : 
 
 5- Tincturae jaborandi 5iv 
 
 Sodii benzoatis 3ii 
 
 Aquae chloroformi q.s. ad Jiij Misce. 
 
 Signa : One teaspoonfnl three times a day. 
 
 For diabetes : 
 
 ty„ Codeinae .= .■ .gr. xij 
 
 Extracti nucis vomicae gr. ii j 
 
 Extracti rhamni purshianae gr. vj 
 
 Misce., et fiat massa in pilulas no. xij dividenda. 
 
 Signa : Take one, three times a day, 
 
 782 
 
MEDICAL RECORD 
 
 5 See French's /'Practice of Medicine 55 (1907), page 109; 
 or Osier's "Practice of Medicine" (1909)5 page 99. 
 
 6. "Serum therapy proper is the prophylactic and cura- 
 tive treatment of certain infectious diseases by the subcu- 
 taneous or intravenous administration of a blood serum 
 containing an antibody which is specific to the particular 
 disease/ 5 (Potter's Materia Medica.) 
 
 Examples: (1) Diphtheria antitoxin; dose, 3,000 units; 
 immunizing dose, 500 units; indicated in diphtheria; (2) 
 antitetanic serum; dose, 3ijss to v; indicated in tetanus; 
 (3) antivenomous serum; dose, 3ijss to viij ; indicated in 
 snake bite. 
 
 MEDICAL JURISPRUDENCE. 
 
 i. The physician should note date and time when he is 
 called; he should (with her consent) examine the female, 
 and if possible also the accused, and note (1) marks of 
 violence about the woman's genital organs ; (2) wounds, 
 bruises, or other marks of injury on the woman or on the 
 accused; (3) blood stains and seminal stains on the person 
 or clothing of either party; and (4) the presence of any 
 venereal disease on either party. 
 
 He should be careful to say nothing, hear everything, 
 and, above all, to avoid saying a rape has or has not been 
 committed. The question of "consent" enters into the sub- 
 ject, and the physician has no means of knowing whether 
 or no this was given. 
 
 2. For symptoms of acute alcoholism, see French's 
 'Practice of Medicine" (1907), page 953. In mania, the 
 body temperature is generally raised, and the skin dry and 
 hot, the eye is apt to have a fixed and wild or brilliant 
 >tare. 
 
 3. "First of all, the physician should keep his suspicions 
 to himself. In the next place, he should himself test the 
 urine or feces, or both, and govern his treatment and his 
 actions toward the patient and those surrounding the 
 patient by the results of his examination. Should the case 
 terminate fatally, he should at once communicate his sus- 
 picions to the prosecuting officer, and require a post-mortem 
 investigation, which should, if at all possible, be conducted 
 in the presence of the chemist who is to conduct the 
 analysis, 
 
 "The following portions of the cadaver should be pre- 
 served : — The alimentary canal from the cardia to the 
 middle of the rectum, unopened, and the contents enclosed 
 by ligatures at the esophagus, duodenum, and lower end 
 of gut; the liver, including the gall-bladder; one kidney; 
 the spleen; a piece of muscular tissue from the leg; the 
 brain, and any urine which may remain in the bladder. 
 
 "Any inspected food articles, and any obtainable vomited 
 
 783 
 
MEDICAL RECORD. 
 
 matter, are to be also preserved. All of these are to be 
 placed in clean and new glass jars, closed with glass or 
 cork covers or stoppers. Jars with metallic caps should 
 never be used. Tapes or cords should be tied about the jar 
 and cap, to which they should be attached by sealing wax 
 bearing impressions of a seal, in such a manner that access 
 can be had to the interior only after breaking the seals or 
 cutting the tapes or cords. Great care must be exercised 
 that no sealing wax can get into the jars. Each portion 
 should be placed in a jar by itself. " (Witthaus' Essentials 
 of Chemistry and Toxicology.) 
 
 4. The antidote for carbolic acid is : A soluble sulphate, 
 or alcohol; for corrosive sublimate, white of egg in mod- 
 erate quantity; for chloral, there is no chemical antidote; 
 for arsenic, freshly prepared ferric hydroxide; for opium, 
 dilute solution of potassium permanganate. 
 
 MIDWIFERY, AND DISEASES OF WOMEN AND CHILDREN. 
 
 i. See Williams' "Obstetrics" (1909), page 658; or Hirst's 
 "Obstetrics" (1909), page 439. 
 
 2. See Cunningham's "Anatomy" (1909), page 1185; or 
 Gray's "Anatomy" (1908), page 1510. 
 
 " Salpingitis may be acute or chronic, and is usually due 
 to gonorrtea, septic infection, subinvolution, laceration of 
 the cervix, fibroid tumors, or uterine displacements. 
 
 ''The symptoms of the acute form are pain in the ovarian 
 region, rise of temperature, increased pulse-rate, and ten- 
 derness, fulness, and enlargement upon vaginal examina- 
 tion. The symptoms of the chronic form are pain, worse 
 upon exercise, defecation, coitus, or exertion of any kind, 
 dysmenorrhea, menorrhagia, and sometimes absolute ster- 
 ility. The uterus is usually displaced backward, and the 
 enlarged and indurated tube may be found behind or be- 
 side it. 
 
 "The treatment of the acute form consists in rest in bed, 
 free purgation with Rochelle salts (3 1 every hour), hot 
 vaginal douches, and hot applications to the abdomen. If 
 the symptoms become more severe, celiotomy is indicated. 
 The chronic form may be treated during the menstrual 
 period by rest in bed, free purgation, hot vaginal douches, 
 local applications of iodin to the cervix and vaginal vaults, 
 and ^lycerin tampons. If these measures fail, removal of 
 the tube and ovary and replacing the retroverted uterus, 
 etc., are necessary." — (Gould and Pyle's Pocket Cyclo- 
 pedia.) 
 
 Varieties: Hematosalpinx, when tubes are distended with 
 blood; pyosalpinx, when they contain pus; hydrosalpinx, 
 when they contain serous fluid or exudate. 
 
 3. The following (from Gould and Pyle's Cyclopedia of 
 
 784 
 
MEDICAL RECORD. 
 
 Medicine and Surgery) is a useful classification of the 
 hemorrhages in question : 
 
 A. Hemorrhages of Pregnancy: Caused by (i) placenta 
 prsevia; (2) premature separation of a normally situated 
 placenta; (3) apoplexy of the decidua or placenta. 
 
 B. Hemorrhages of Labor: Caused by (1) placenta 
 praevia; (2) premature separation of a normally situated 
 placenta; (3) relaxation of the uterus; (4) laceration of 
 the cervix; (5) rupture or inversion of the uterus. 
 
 C. Hemorrhages of the Puerperium: Caused by (1) 
 retained secundines ; (2) displaced uterus; (3) displaced 
 thrombi; (4) fibroid tumors; (5) hypertrophied decidua; 
 (6) carcinoma. 
 
 4. The varieties of displacement of the uterus are : Retro- 
 version, retroflexion, anteversion, anteflexion, lateral ver- 
 sion, lateral flexion, descent or prolapse, ascent, and mal- 
 location (to front, back, or one side). 
 
 The causes of retroflexion are : Distended bladder, retro- 
 uterine peritonitis ; chronic cystitis ; small fibroid in poste- 
 rior wall of uterus ; too long a period in the recumbent 
 position after labor, or too tight bandaging; tight lacing; 
 infection during puerperium; pressure of tumors; inflam- 
 mations of uterus and its appendages ; gonorrhea. 
 
 The symptoms of retroflexion are: Bladder disturbances; 
 constipation and painful defecation ; dysmenorrhea, or 
 amenorrhea, or hemorrhages from the uterus ; leucorrhea ; 
 sterility, or frequent abortion. 
 
 The operations performed for retroflexion are : Breaking 
 up any adhesions that may be present, and then shortening 
 the round ligaments (Alexanders operation, or some mod- 
 ification of it) ; suspension of the uterus (hysterorrhaphy, 
 hysteropexy, ventral fixation, abdominal fixation or sus- 
 pensio uteri) ; vaginal hysterorrhaphy is also done occa- 
 sionally. 
 
 5. ^ee French's "Practice of Medicine" (1907), page 139; 
 or Osier's "Practice of Medicine" (1909), page 158. 
 
 PHYSIOLOGY. 
 
 1. The nerves which control the heart are: (1) The 
 pneumogastric nerve, which slows or inhibits the heart 
 beats; (2) the sympathetic nerves, which accelerate or aug- 
 ment the beats ; and (3) the intrinsic cardiac ganglia, which 
 enable the heart to continue beating for some time after 
 it is removed from the body. 
 
 2. The mechanism of the secretion of urine by the kid- 
 neys is twofold: (1) By filtration, most, if not all, of the 
 fluid is eliminated, and also inorganic salts ; this depends 
 upon blood pressure, and takes place in the glomeruli. (2) 
 By cell activity and selection, in the cells of the convoluted 
 tubules, the urea and principal solids are eliminated. 
 
 785 
 
MEDICAL RECORD. 
 
 3. Substances that may be absorbed in the stomach are : 
 Water, alcohol, salts, sugars, and dextrins that may have 
 been converted from starch by the ptyalin of the saliva, 
 and proteoses and peptones resulting from peptic digestion 
 of proteids. 
 
 In the small intestine, sugars, proteoses, peptones, fats, 
 water, and salts are all absorbed. 
 
 In the large intestine, water, salt, sugars, proteids, and 
 fats are all absorbed. 
 
 4. Cutting the third nerve will produce: Ptosis of the 
 upper lid, external strabismus, slight prominence of the 
 eyeball, dilatation of the pupil, and loss of the power of 
 accommodation. 
 
 5. "The speech areas, four in number and in kind, are in 
 the left hemisphere in righthanded persons and in the right 
 in lefthanded persons. There are two types of aphasia, 
 which is the loss of the power of speech, known as motor 
 and sensory aphasia. The motor speech center lies in the 
 posterior part of the third frontal convolution (Broca's 
 convolution), just in front of the center of the muscles of 
 speech (hypoglossal and facial nerve centers). A lesion of 
 the motor speech center causes motor aphasia, in which 
 there is a loss of the word-forming power, although the 
 tongue is movable and the patient may understand spoken 
 and written language and knows what he wants to say. It 
 is as if memory of the motor combinations essential to 
 produce speech were lost. 
 
 "The power of writing is usually lost with motor speech. 
 The probable location of its cortical center is in the poste- 
 rior two-thirds of the first, and perhaps in the second, tem- 
 poral convolution. A lesion here causes 'word deafness/ a 
 sensory aphasia in which the memory of the sounds of 
 words is lost so that they are not understood, though hear- 
 ing may be normal. 
 
 "The visual speech center lies in the posterior part of the 
 angular gyrus in the outskirts of the higher visual or the 
 visuopsychic field. Word-blindness (alexia), or the loss of 
 memory of printed or written language, is caused by a 
 lesion here, though sight itself may be normal. 
 
 "Thus the basis of language is a series of memory pic- 
 tures (1) of the sound of words; (2) of their appear- 
 ance; (3) of the effort necessary to enunciate them, and 
 (4) to write their symbols. As these memory pictures are 
 connected with each other and with others that make up 
 the concept by subcortical asssociation fibers passing be- 
 tween them, a lesion in any of these association tracts also 
 leads to a defect of speech." (Woolsey, Applied Surgical 
 Anatomy.) 
 
 786 
 
MEDICAL RECORD. 
 
 SURGERY. 
 
 i. Empyema. — Causes: Wounds, injuries, pleuropneumo- 
 nia, direct extension of a suppurative process in the lung, 
 abdomen, or neck. The bacteria will vary with the cause ; 
 diplococcus pneumoniae is the commonest; tubercle bacillus, 
 staphylococcus, streptococcus, colon bacillus may also be 
 present. 
 
 Treatment: Aspiration, drainage, irrigation, resection of 
 ribs (Estlander's operation), or resection of chest wall 
 (Schede's operation). 
 
 See Rose and Carless' "Surgery'" (1908), page 929; or 
 Da Costa's "Surgery" (1908), page 786. 
 
 2. Conditions which necessitate prostatectomy : Marked 
 enlargement of the prostate gland (when catheterization is 
 painful, difficult, or impossible ; when cystitis is imminent, 
 and when the patient is comparatively young). 
 
 See Rose and Carless' "Surgery" (1908), page 1230; or 
 Da Costa's "Surgery" (1908), page 1191. 
 
 3. Coxalgia. — There are three stages. The first is the 
 stage of synovitis, prior to the development of pus in the 
 joint. The second is the stage of destruction of cartilage 
 and ligaments, and continues till the development of pus 
 outside the joint. The third is the stage of destruction of 
 the bone. 
 
 Symptoms of first stage: Night cries; lameness in the 
 morning; a slight limp; tendency to become tired on slight 
 exertion; wasting; spasm; pain; swelling; and deformity 
 (either real or apparent). 
 
 Symptoms of second stage: Abduction; limping; pain, 
 which is worse at night ; apparent lengthening of the limb ; 
 abscess ; atrophy of thigh muscles ; flexion of thigh ; effu- 
 sion into hip joint ; and there may be crepitation in the 
 joint. 
 
 Symptoms of third stage : Flexion, adduction, and short- 
 ening of the limb; the joint may be dislocated or anky- 
 losed, or suppuration may occur. 
 
 Treatment: See Rose and Carless' "Surgery" (1908), 
 page 685; or Da Costa's "Surgery" (1908), page 556. 
 
 4. Sayre's method for fractured clavicle : "Sayre's dress- 
 ing consists of two strips of adhesive plaster three and a 
 half inches wide and two yards in length. The first strip is 
 looped around the arm just below the axillary margin and 
 is pinned or sewed with the loop sufficiently open not to 
 constrict the arm. The arm is then drawn downward and 
 backward until the clavicular portion of the pectoralis 
 major muscle is put sufficiently upon the stretch to over 
 come the action of the sternocleidomastoid muscle, and 
 in this way draws the sternal fragment of the clavicle down 
 to its place. The strip of plaster is then carried completely 
 
 787 
 
MEDICAL RECORD. 
 
 around the body and pinned or stitched to itself on the 
 back. The second strip is next applied, commencing on the 
 front of the shoulder of the sound side ; thence it is car- 
 ried over the top of the shoulder diagonally across the back, 
 under the elbow, diagonally across the front of the chest 
 to the point of starting, where it is secured by pinning or 
 sewing. A slit is made in this strip to receive the point of 
 the elbow. Before the elbow is secured by the plaster it 
 should be pressed well forward and inward." (Wharton's 
 Minor Surgery, and Bandaging.) The action of the dress- 
 ing is simply to press the shoulder upward and backward. 
 
 5. Hip- Joint Dislocations. — Varieties — Backward: (1) 
 On to the dorsum ilii; (2) on to the sciatic notch. For- 
 ward: (3) On to the obturator foramen; (4) On to the 
 pubis. 
 
 Dorsal dislocation: Head of femur lies on the dorsum 
 ilii, and can be felt in the buttock. The obturator internus 
 is ruptured in most cases. The short rotator muscles are 
 lacerated. The trochanter lies well above Nelator's line 
 and approximated to the anterior superior iliac spine. The 
 leg is shortened two to three inches. The iliotibial band is 
 relaxed. The leg is flexed, adducted, and inverted. The 
 femur crosses the lower third of the opposite thigh. The 
 toe rests on the opposite instep. A hollow exists in Scarpa's 
 triangle. 
 
 Sciatic dislocation : Similar to the above, except in the 
 following: — The obturator internus tendon is intact and 
 lies over the neck of the femur, holding it down in the 
 sciatic notch. Shortening amounts only to one inch or 
 less. The axis of the femur crosses the opposite knee. The 
 great toe rests on the dorsum of the opposite great toe. 
 
 Treatment of the backward dislocations: Flex the knee 
 and thigh in position of adduction. Abduct the thigh and 
 evert simultaneously. Bring the leg down straight. "Lift 
 up, bend out, roll out." 
 
 Obturator dislocation : The head of the bone lies on the 
 obturator externus in the obturator foramen. The adductor 
 muscles are lacerated. The trochanter is obscured, the 
 iliotibial band is tense. The leg is lengthened, the toes 
 point forward and outward. Flexion, abduction, and rota- 
 tion outward are well marked. The head of the femur is 
 felt in the perineum. The capsule is torn in its lower part. 
 Pain referred to the distribution of the obturator nerve. 
 
 Pubic dislocation: Similar to the above except: The 
 femoral head is felt under Poupart's ligament. The leg is 
 shortened about one inch. Abduction and eversion are 
 more marked, the toes pointing outward. 
 
 Treatment of forward dislocations : Thigh is flexed in a 
 position of abduction. Adduct the thigh and then invert it. 
 
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MEDICAL RECORD. 
 
 Bring the thigh down straight, ''Lift up, bend in, roll in." 
 (From Groves* Synopsis of Surgery.) 
 
 THEORY AND PRACTICE OF MEDICINE, AND MEDICAL PATHOLOGY. 
 
 i. See French's "Practice of Medicine" (1907), page 139; 
 or Osier's "Practice of Medicine'' (1909), page 158. 
 
 2. See French's "Practice of Medicine" (1907), page 887; 
 or Osier's "Practice of Medicine" (1909)., page 683. 
 
 3. The table on page 789 (from Eisendrath's Surgical 
 Diagnosis) gives the diagnosis. 
 
 See French's "Practice of Medicine" (1907), page 577; 
 or Osier's "Practice of Medicine" (1909), page 805. 
 
 4. See French's "Practice of Medicine" (1907) page 659; 
 or Osier's "Practice of Medicine" (1909), page 610. 
 
 5. See French's "Practice of Medicine" (1907), pages 380 
 and 394; or Osier's "Practice of Medicine" (1909), pages 
 202. 340, and 352. 
 
 STATE BOARD EXAMINATION QUESTIONS. 
 
 College of Physicians and Surgeons of Ontario. 
 
 anatomy, descriptive. 
 
 (All questions of equal value. Any five questions to be 
 answered, but not more than five.) 
 
 1. Describe (a) the upper extremity, (b) the lower 
 extremity, (c) ossification of the ulna. 
 
 2. Describe the shoulder joint, as to (a) articulating 
 surfaces, (b) ligaments, (c) synovial membranes, (d) 
 nerve supply, (e) blood sugply, (/) movements. 
 
 3. Name and give origin; insertion, nerve supply, and 
 actions of the muscles of mastication. 
 
 4. Describe the lymphatic vessels, and lymphatic glands 
 of the thorax. 
 
 5. Describe the prostate gland under the following 
 heads: (a) size, (b) situation, (c) structure, (d) blood 
 supply, (e) relations. 
 
 6. Describe the middle ear. 
 
 7. Trace the course; give the relations; name and trace 
 the branches of the posterior tibial artery. 
 
 8. (a) Describe the sacral plexus and show its method 
 of formation, (b) Trace the great sciatic nerve to its ter- 
 mination. 
 
 9. Describe (a) the fornix, (b) corpora quadrigemina, 
 (c) opercula insulse, (d) velum interpositum. 
 
 10. Describe the capsules, as to (a) size, (b) situation, 
 (c) structure, (d) relations, (e) blood supply, (/) nerve 
 supply. 
 
 790 
 
MEDICAL RECORD 
 
 PHYSIOLOGY AND HISTOLOGY. 
 
 i. Give an account of the histological structure of the 
 retina. What portion of the retina is concerned in most 
 acute vision? What is the "blind spot"? 
 
 2. Give an account of the histological structure and 
 function of the suprarenal bodies. 
 
 3. Describe the development of the lungs. What if 
 meant by the terms residual air and vital capacity? 
 
 4. What physical and chemical changes take place in a 
 muscle during contra ::: : n ": 
 
 5. What is the normal arterial blood pressure? Discuss 
 the factors which maintain and alter this pressure. 
 
 CHEMISTRY. 
 
 (All questions of equal value. The first four questions 
 to be answered, and any two of the remaining four.) 
 
 1. Explain folly what is meant, when we say nitrogen 
 is a triad. What is the atomicity of the oxygen and the 
 ozone molecule, and why? 
 
 2. One gram of phosphorus is to be converted into the 
 pentachloride. how many litres of chlorine at 15 degrees 
 C. and 780 mm. are required ? 
 
 3. Compare the physical and chemical properties of 
 sodium and silver, mentioning the group of metals to which 
 each belongs, and why. 
 
 4- Define the term paraffin. Give the names of the 
 acids corresponding to the first, second, and third members 
 of the paraffins, and compare their percentage of compo- 
 sition. 
 
 5. Define an amine, an amide, and an imide, and men- 
 tion a member oi each group. 
 
 6. Give the names and chemical formulae for bluestone, 
 red precipitate, white vitriol, aqua fortis, mirbane, gun- 
 cotton, cresol, and urea. 
 
 7. To what series of organic acids do each of the fol- 
 lowing belong: name! tic oxalic, lactic, and tartaric 
 acid? Give the general formula for each series. 
 
 8. How vou proceed to estimate the total nitro- 
 gen in 10 c.c. of urine by either the Kjeldahl or the Gun- 
 ning method? Describe the procedure in detail of the 
 method you select, mentioning the apparatus and reagents 
 
 e:essary. 
 
 Atomic Weights.— Chlorine = 35. 5; phosporus = 31; 
 sodium = 2Z\ silver = 108; nitrogen = 14; hydrogen = 1 ; 
 oxygen = 16; carbon = 12.) 
 
 MATERIA MEDIC A AND PHARMACOLOGY. 
 
 :tions of equal value. Answer any five of the 
 six question 
 
MEDICAL RECORD 
 
 i. Give preparations of, with quantities: (a) A normal 
 salt solution, (b) A one to two thousand bichloride of 
 mercury solution, (c) A 2}4% solution of carbolic acid. 
 (d) Lime water, (e) A nutrient enema. 
 
 2. Define with example, styptic, specific, collyrium, 
 alkaloid, alterative. 
 
 3. Compare as hypnotics, morphine, chloral hydrate, and 
 sulphonal. Explain antagonism of morphine and atropine. 
 
 4. Outline a prescription containing a mineral acid, a 
 nux vomica preparation, and a pepsin preparation. 
 
 5. State ordinary or other names for phenol, acetanili- 
 dum, nitroglycerinum, hydrargyri subchloridum, pulvis 
 ipecacuanhas compositus. Give dosage and specific action 
 (shortly) of each. 
 
 6. Select a nitrate, a salicylate, a ferrum, an arsenicum, 
 and an iodidum preparation. Give dose and method in de- 
 tail of prescribing each. 
 
 THEORY AND PRACTICE OF MEDICINE. 
 
 i. Give the etiology, pathology, and symptoms of tabes 
 dorsalis. 
 
 2. Describe a Flint's murmur and the supposed carse of 
 its production. From what other murmur must it be dis- 
 tinguished, and how? 
 
 3. Describe chronic uremia, with reference to its oc- 
 currence, clinical features and treatment. 
 
 4. Give the causes and general symptoms of obstructive 
 jaundice. 
 
 5. Give the etiology, clinical history, and physical signs 
 of empyema. Name the chief modes of natural cure. 
 
 PATHOLOGY. 
 
 1. Discuss the causes and formation of stricture of the 
 urethra. Explain the pathological conditions which may 
 result from it. 
 
 2. What are the features which differentiate innocent 
 from malignant growths? Give the gross appearance and 
 microscopic structure of adenoma, or of a glioma. 
 
 3. Give the morbid anatomy of bone lesions in hereditary 
 syphilis, and differentiate these from rachitic and tuber- 
 culous lesions. 
 
 4. Discuss the forms of puerperal infection and the 
 usual modes of entry to the system. Name the lesions 
 which may be produced, and describe briefly the pathology 
 of any one of these lesions. 
 
 BACTERIOLOGY. 
 
 1. Explain the difference between active and passive 
 immunity. Illustrate by example how each may be ac- 
 quired. 
 
 792 
 
MEDICAL RECORD. 
 
 2. Describe Bacillus anthracis under the following 
 heads : morphology, staining, cultural characters, and patho- 
 genicity. 
 
 THERAPEUTICS. 
 
 i. Give the treatment of a case of acute rheumatic 
 fever. 
 
 2. State the therapeutic uses of ergot. Discuss its use 
 in (a) hemoptysis, (&) hematemesis. 
 
 3. Angina pectoris: Give treatment during paroxysm, 
 and in the intervals. 
 
 4. Give the treatment of a case of tuberculous peri- 
 tonitis. 
 
 MIDWIFERY, OPERATIVE. 
 
 1. The head is lying in the right oblique diameter of 
 pelvis, with the occiput pointing posteriorly: (a) Give the 
 position of all the landmarks on making a vaginal examina- 
 tion, (b) How may this case end? (c) Treat the case if 
 Nature's efforts are not successful. 
 
 2. Diagnose a breech. How would you break up a Frank 
 breech? 
 
 3. I have diagnosed a case as transverse presentation 
 with the back of the child pointing towards the mother's 
 feet. I am going to perform version: (a) What foot will 
 I grasp? Why? (b) How would you deliver this after- 
 coming head? 
 
 4. Give the symptoms of placenta prsevia, and prema- 
 ture separation of the normally implanted placenta. Make 
 a differential diagnosis. 
 
 MIDWIFERY, OTHER THAN OPERATIVE, AND PUERPERAL DISEASES. 
 
 1. Name the diseases in the mother liable to injure the 
 fetus in utero, and enumerate the supposed causes of labor 
 at full time. 
 
 2. Give the causes of post partum hemorrhage and the 
 systematic line of treatment to follow. 
 
 3. Give the necessary advice to a patient in a case where 
 you suspect eclampsia might supervene. 
 
 4. Treat a case of acute infantile colic. 
 
 5. What significance would you attach to the discharge 
 of amniotic fluid tinged with meconium : (a) Breech pres- 
 entations : (b) vertex presentations. 
 
 SURGERY, OPERATIVE. 
 
 (All questions of equal value. Any five questions to be 
 answered, but not more than five.) 
 
 1. Scirrhus of the mammary gland : Describe minutely 
 the operation necessary for complete removal. 
 
 2: For what conditions would you do excision of the 
 elbow? Describe the operation. 
 
 793 
 
MEDICAL RECORD 
 
 3. What symptoms in a movable kidney render opera- 
 tion advisable? Describe one method of operation for 
 same. 
 
 4. What conditions require, and what is the usual 
 method of performing (a) thoracentesis; (b) resection of 
 ribs. 
 
 5. Describe the suprapubic and perineal operations for 
 removal of enlarged prostate. Give reasons for your pref- 
 erence in choice of operation. 
 
 6. Describe one method of performing colostomy. Give 
 reasons for your choice of operation. State conditions for 
 which the operation may be required. 
 
 SURGERY., OTHER THAN OPERATIVE. 
 
 (All questions of equal value. Any five questions to be 
 answered, but not more than five.) 
 
 1. Define septicemia and pyemia. Distinguish between 
 them ; give bacteriology, clinical history, symptoms, diag- 
 nosis, and treatment of each. 
 
 2. What is tetanus? Give predisposing and exciting 
 causes, clinical history, diagnosis, and treatment. 
 
 3. Describe acute infective osteomyelitis. Discuss its 
 clinical history and treatment. 
 
 4. What is aneurysm? Describe its structure. Describe 
 popliteal aneurysm, and give its diagnosis and treatment. 
 
 5. What are the general principles governing the treat- 
 ment of fractures at or near joints? Describe Colles' frac- 
 ture, and give treatment. 
 
 6. Describe the clinical history of a case of enlarge- 
 ment of the prostate gland. Describe the general principles 
 of treatment, apart from the operative. 
 
 MEDICAL AND SURGICAL ANATOMY. 
 
 i. Where would you map out the position of the fol- 
 lowing structures on the surface of the skull : (a) the 
 middle meningeal artery, (b) the fissure of Rolando, (c) 
 lateral sinus. 
 
 2. Where are the reflex centers for the bladder, rectum, 
 ankle clonus, knee jerk, for wrist and elbow jerks? 
 
 3. What enters into the formation of the wrist joint? 
 
 4. Describe Colles' fracture, Pott's fracture, and de- 
 formity in each. 
 
 5. What anatomical relations may be determined under 
 normal conditions by a digital examination of the rectum? 
 (a) in the male, (b) in the female? 
 
 6. Give a description of the normal uterus with appen- 
 dages, as to size and position. 
 
 7. Give in some form, the parts cut through in ampu- 
 tation o f the leg, upper third, and name of main vessels 
 tied, and where found. 
 
 794 
 
MEDICAL RECORD. 
 
 8. What tumors may be found in the right and left 
 inguinal region and in hypogastric regions? 
 
 9. Describe Scarpa's triangle, boundaries, and of what 
 importance is it surgically? 
 
 10. Give the collateral circulation after ligature of the 
 femoral artery in Hunter's canal. 
 
 MEDICAL JURISPRUDENCE. 
 
 1. On opening the thorax for a postmortem, what pre- 
 caution is to be observed? 
 
 2. With regard to the external appearance of the heart, 
 what important condition is to be observed? 
 
 3. After the removal of the heart, how would you make 
 your incision to examine the interior? 
 
 4. Death by suffocation, how is it produced? 
 
 5. Give the average weight in an adult of brain, heart, 
 spleen, liver, and kidney. 
 
 TOXICOLOGY AND MENTAL DISEASES. 
 
 6. Give (a) Symptoms of a cocaine poisoning, (b) 
 Period when fatal, (c) Fatal quantity. 
 
 7. What are the special indications of mental weakness. 
 
 8. Distinguish between opium poisoning, acute alcohol- 
 ism, epilepsy, and cerebral hemorrhage. 
 
 SANITARY SCIENCE. 
 
 1. (a) What becomes of the rain that falls during the 
 year? (b) What are the objections to using rain water, 
 as it falls, for domestic purposes? 
 
 2. (a) What are the different sources for water sup- 
 ply? (b) Describe three different methods of purifying 
 water for domestic use. (c) Name objections to storing 
 water in cisterns, (d) How should a cistern be constructed 
 to permit of the safe use of water thus stored? 
 
 3. Name the diseases caused by the use of impure water. 
 
 4. What do you understand by the term inspection, 
 flushing, and ventilation of sewers? 
 
 5. Describe purification and utilization of sewage. 
 
 6. Name (only) the methods by which air is vitiated. 
 
 7. What are the advantages of a mountain climate, as 
 contrasted with those of the plains? 
 
 N. B. — Any of the above questions can be answered in 
 thirty words. 
 
 THERAPEUTICS. 
 
 I. What are the indications for the use of belladonna 
 (a) externally, (b) internally? Give the symptoms and 
 treatment of an overdose. 
 
 2.- Describe fully the treatment for ascites, giving rea- 
 sons for each measure employed. 
 
 795 
 
MEDICAL RECORD. 
 
 3. In a case of deranged heart action, state fully the 
 indications for the employment, respectively, of (a) digi- 
 talis, (b) strophanthus, (c) strychnine, (d) nitroglycerin. 
 
 4. Write prescription for each of the following condi- 
 tions : (a) pleurisy with effusion, (b) suppression of urine, 
 (c) sciatica, (d) alkaline cystitis. 
 
 , DISEASES OF WOMEN. 
 
 1. In making the incision to perform abdominal hyster- 
 ectomy, you accidentally open the urinary bladder for two 
 inches in extent. Describe in detail your method of repair. 
 What suture material would you use? Would you repair 
 immediately, or at the conclusion of the hysterectomy? 
 What after treatment would be necessary? 
 
 2. Give the causes and treatment of pruritus vulvae. 
 
 3. Describe the operation for, and the after-treatment 
 of, repair of complete perineal rupture — say eight months 
 after confinement. 
 
 4. A mass the size of a small orange is found in the 
 posterior cul-de-sac; differentiate between retrodisplaced 
 uterus, fibroid of the uterus, and ovarian cyst. 
 
 5. In using the uterine sound give the : (a) preliminary 
 preparation, (b) indications, (c) contraindications, and (d) 
 dangers. 
 
 DISEASES OF CHILDREN. 
 
 1. Define laryngismus stridulus (spasmodic croup), and 
 give the predisposing and exciting causes, symptoms, the 
 diseases for which it may be mistaken, and its treatment. 
 
 2. Discuss briefly the diagnostic values of Kernig's and 
 Babinski's reflexes. What change, if any, occurs in the 
 patellar reflex (knee jerk) in lobar pneumonia? 
 
 3. Diagnose and treat a case of acute rheumatic endo- 
 carditis in a child ten years old. 
 
 4. Acute osteomyelitis : (a) Name in order the three 
 most common infecting germs, (b) the three bones in 
 which it most frequently occurs, (c) and the diseases for 
 which it may be mistaken. What would be your treatment 
 of an acute attack of the very early stage of the disease, 
 as soon as you felt fairly sure of your diagnosis? 
 
 5. A child 4 years old receives a penetrating wound 
 of the brain from the tine of a pitchfork. The point of 
 entry is one inch above the meatus auditorius externus, and 
 the fork goes straight in, horizontally, to a depth of three 
 inches or half-way through the brain. Name in some 
 order the structures that would be pierced. What symp- 
 toms would likely follow and the treatment from the 
 beginning to the end of the case. 
 
 
 796 
 
MEDICAL RECORD 
 
 ANSWERS TO STATE BOARD EXAMINATION 
 QUESTIONS. 
 
 College of Physicians and Surgeons of Ontario. 
 
 anatomy, descriptive. 
 
 1. See Cunningham's "Anatomy" (1909), pages 1291, 
 1302, and 197; or Gray's "Anatomy" (1908), pages 169, 
 464, 208, 509, and 191. 
 
 2. See Cunningham's "Anatomy" (1909), page 276; or 
 Gray's "Anatomy''' (1908).. page 305. 
 
 3. See Cunningham's "Anatomy" (1909), page 401; or 
 Gray's "Anatomy" (1908). page 383. 
 
 4. See Cunningham's "Anatomy" (1909), page 923; or 
 Gray's "Anatomy" (1908). page 807. 
 
 5. See Cunningham's "Anatomy" (1909), page 1278; or 
 Gray's "Anatomy" (1908), page 1457. 
 
 6. See Cunningham's "Anatomy" (1909), page 748; or 
 Gray's "Anatomy" (1908),, page 1160. 
 
 7. See Cunningham's "Anatomy" (1909) page 864; or 
 Gray's "Anatomy" (1908"). page 715. 
 
 8. See Cunningham's "Anatomy" (1909), page 647; or 
 Gray's "Anatomy" (1908), pages 1026 and 1030. 
 
 9. See Cunningham's "Anatomy" (1909), pages 571, 531. 
 556, and 604; or Gray's "Anatomy" (1908),, pages 949, 905. 
 907, 925, and 946. 
 
 10. See Cunningham's "Anatomy" (1909), page 1213; or 
 Gray's "Anatomy" (1908). page 1437. 
 
 PHYSIOLOGY AND HISTOLOGY. 
 
 1. The retina is composed of several layers, from with- 
 out inwards, as follows: (1) layer of pigment cells; (2) 
 layer of rods and cones; (3) the external limiting mem- 
 brane; (4) the outer nuclear, or granular, layer; (5) the 
 outer molecular, or reticular, layer; (6) the inner nuclear, 
 or granular, layer; (7) the inner molecular, or reticular, 
 layer; (8) the layer of ganglion cells; (9) the layer of 
 nerve fibers; and (10) the internal limiting membrane. 
 
 These structures are bound together by sustentacular 
 fibers or neuroglia. 
 
 The portion concerned in most acute vision is the macula 
 lutea, and especially its central portion, the fovea. 
 
 The blind spot is that part of the retina at which the 
 optic nerve enters ; it is occupied entirely by fibers of the 
 optic nerve, and is devoid of any elements of the retina ; 
 it is insensitive to light. 
 
 2. For histological structure, see above, Anatomy, 10. 
 The function of the suprarenal bodies is not defi- 
 nitely settled : they produce an internal secretion which is 
 
 707 
 
MEDICAL RECORD. 
 
 probably necessary to life, which is also said to increase 
 the blood pressure by a vasomotor action on the arterioles ; 
 some tonic action on the cardiac muscle is also attributed 
 to them; and it is supposed that they are able to destroy 
 or remove some toxic substances. 
 
 3. For development of lungs, see Cunningham's "An- 
 atomy" (1909), page 992. 
 
 Residual air is the air which still remains in the lungs 
 after the deepest expirations. It measures about 100 cubic 
 inches. 
 
 Vital capacity is the amount of air which can be expelled 
 from the lungs by an extraordinary expiration after the 
 most forcible inspiration. It includes the tidal, comple- 
 mental, and reserve air, and measures about 225 to 230 
 cubic inches. 
 
 4. During contraction the following changes take place 
 in a muscle: 
 
 (1) It becomes shorter and thicker, but the volume re- 
 mains the same. 
 
 (2) It consumes oxygen. 
 
 (3) It sets free carbon dioxide. 
 
 (4) It forms sarcolactic acid. 
 
 (5) It becomes acid in reaction. 
 
 (6) It becomes more extensible and less elastic. 
 
 (7) There is an increase in heat production, and conse- 
 quently a rise of temperature. 
 
 (8) The electrical reaction becomes relatively negative. 
 
 5. The normal arterial blood pressure varies ; the systolic 
 pressure being about 120 to 150 mm. of mercury, and the 
 diastolic from about 90 to 120 mm. of mercury. 
 
 Blood pressure is maintained by the contraction of the 
 heart, the peripheral resistance, and the elasticity of the 
 arterial walls. 
 
 Blood pressure : 
 
 May be raised- 
 
 1. By the heart beating more 
 
 quickly. 
 
 2. By the heart beating more 
 
 powerfully. 
 
 3. By contraction of the ar- 
 
 terioles. 
 
 May be. lowered- 
 
 1. By the heart beating more 
 
 slowly. 
 
 2. By the heart beating more 
 
 feebly. 
 
 3. By dilatation of the ar- 
 
 terioles. 
 
 4. By deficient supply of 
 
 blood to the left ven- 
 tricle. 
 
 798 
 
MEDICAL RECORD 
 
 CHEMISTRY. 
 
 i. The combining power of one atom of nitrogen is 
 equal to three times that of an atom of hydrogen; or one 
 atom of nitrogen can combine with or replace three atoms 
 of hydrogen (or other univalent element). 
 
 The atomicity of the oxygen molecule is two, because one 
 molecule of oxygen (0 2 ) contains two atoms. 
 
 The atomicity of the ozone molecule is three, because one 
 molecule of ozone (O3) contains three atoms. 
 
 2. The equation is P 4 + 10 Cl 2 = 4 P CU. 
 
 (4X31) grams P require (10X22.4) liters CI. 
 
 124 grams P require 224 liters CI, at normal tempera- 
 ture and pressure. 
 
 224 
 
 . • . 1 gram P requires liters CI, at normal T 
 
 124 
 and P, but at 15 C. and 780 mm. pressure 
 
 S224 273 + 15 760 \ 
 
 1 gram P will require I X X 1 
 
 V124 273 780/ 
 
 liters 
 CI. 
 
 24 273 780 
 
 224 288 760 68096 
 
 = X X— — — — — =1.85 .. LITERS OF 
 
 124 273 780 36673 
 CHLORINE. 
 
 3. Sodium is a silver- white metal, is waxy at ordinary 
 temperature, becomes quickly tarnished, and coated with 
 a yellow film in air. It oxidizes in air ; it burns with a 
 yellow flame ; it decomposes water with evolution of hy- 
 drogen. It is univalent, and has atomic weight of 23. 
 
 Silver is a white metal, soft, malleable, and ductile ; is 
 not acted on by pure air, but is blackened in air containing 
 H 2 S. It makes an alloy with many metals. It is an ex- 
 cellent conductor of heat and electricity. It is univalent, 
 and has atomic weight of 107. 
 
 Sodium belongs to the group of alkali metals (Li., Na., 
 K., Ce.) ; because the properties of these elements are 
 similar. 
 
 Silver resembles the members of the same group in 
 chemical properties, and therefore might be placed with 
 them ; but its physical properties are more like those of 
 copper, or gold, or mercury, and it has been classed by 
 various writers with each of these metals. 
 
 4. Paraffin is a name given to the members of the meth- 
 ane series of organic compounds. They are saturated 
 hydrocarbons, and have the general algebraic formula 
 
 Cfi Hsn + 2. 
 
 799 
 
MEDICAL RECORD. 
 
 ACIDS IN THIS 
 SERIES. 
 
 1. Formic acid. 
 
 2. Acetic acid. 
 
 3. Propionic acid. 
 
 FORMULA. 
 
 H, COOH. 
 CH 3 , COOH. 
 CH 3 , CH 2 , COOH. 
 
 ( 
 
 PERCENTAGE 
 IMPOSITION. 
 
 c 
 
 H 
 
 
 
 26.08 
 40.00 
 48.64 
 
 4-34 
 
 6.66 
 8.1 1 
 
 69.56 
 53.33 
 43.23 
 
 5. An amine is a substance derivable from ammonia by 
 
 the substitution of a hydrocarbon radical for part or all of 
 the hydrogen. 
 Example : — 
 
 H\ CH 3 \ 
 
 H-N H-N 
 
 H/ H/ 
 
 Ammonia. Methylamine. 
 
 An amide is a substance derivable from ammonia by the 
 substitution of an oxidized radical for part or all of the 
 hydrogen. 
 
 Example : — 
 
 H\ C 2 H 3 0\ 
 H— N H— N 
 
 H/ Hy 
 
 Ammonia. Acetamide. 
 
 An imide is a compound derived from a dicarboxylic 
 acid by the substitution of NH for 2 OH. 
 
 Example : — 
 
 COOH CO\ 
 
 I I NH 
 
 COOH CO/ 
 
 Oxalic acid. Oximide. 
 
 6. 
 
 Bluestone. 
 Red precipitate. 
 White vitriol. 
 Aqua fortis. 
 Mirbane. 
 Guncotton. 
 Cresol. 
 Urea. 
 
 NAME. 
 
 Cupric sulphate. 
 Mercuric oxide. 
 Zinc sulphate. 
 Nitric acid. 
 Nitrobenzene. 
 Hexanitrocellulose 
 Methyl phenol. 
 Carbamide. 
 
 CHEMICAL FORMULA 
 
 CuSO* 
 
 HgO 
 
 ZnSO* 
 
 HNOa 
 
 C 6 H 5 N0 2 
 
 C 12 H 14 (ON0 2 ) e 4 
 
 GH^OH.CH* 
 
 CON 2 H 4 
 
 800 
 
MEDICAL RECORD 
 
 7- 
 
 ACID. 
 
 Acetic. 
 Oxalic. 
 Lactic. 
 Tartaric. 
 
 SERIES, WITH GENERAL FORMULA OF SERIES. 
 
 CnH2n02 
 CnH2n-2U4 
 
 Paraffin monocarboxylic acids 
 
 Paraffin dicarboxylic acids. 
 
 Oxyacetic acids. CnH 2 «0 
 
 Dioxydicarboxylic acids. CwHjjn^Oo 
 
 8. "For the determination of total nitrogen 5 c.c. of urine 
 are placed in a long-necked Kjeldahl digesting flask along 
 with 0.5 gm. of CuSO* and 15 c.c. of concentrated H2SO4. 
 The flask is supported at 45 ° to the horizontal and gradu- 
 ally heated until white fumes are given off; 10 gm. of 
 K2SO4 are then added, and the contents of the flask heated 
 just short of boiling until almost colorless. After cooling, 
 the contents of the digesting flask are transferred and 
 washed into a distilling flask; the acid is nearly neutral- 
 ized by the slow addition of NaHO solution (sp. gr. 1.24) ; 
 a few pieces of granulated zinc are added, and then a 
 moderate excess of NaHO solution, whereupon the flask 
 is immediately connected with a bulb tube and condenser, 
 so arranged as to deliver the distillate into a recipient con- 
 taining 30 c.c. of N/5 H2SO4 and a little lacmoid as an in- 
 dicator. The distillation is continued until about two-thirds 
 of the liquid have passed over, when the excess of H2SO4 
 remaining in the recipient is determined by titration with 
 N/5 NaHO solution. Each c.c. of N/5 acid neutralized by 
 the ammonia formed in the process corresponds to 0.0028 
 gm. of nitrogen in the 5 c.c. of urine used. A blank proc- 
 ess must be conducted with reagents alone to guard against 
 error from nitrogen compounds in the reagents or in the 
 air." (Witthaus's Manual of Chemistry.) 
 
 To estimate the amount of nitrogen in 10 c.c. of urine, 
 multiply this result by two. 
 
 MATERIA MEDICA AND PHARMACOLOGY. 
 
 i. (a) A normal salt solution can be made by adding V/z 
 drams of sodium chloride to one quart of sterile water. 
 
 (b) A one to two thousand bichloride of mercury solu- 
 tion can be made by adding 7% grains of mercury bichlo- 
 ride to a liter of water. 
 
 (c) A 2.V2 per cent, solution of carbolic acid can be made 
 by adding 6 drams of carbolic acid to a liter of water. 
 
 (d) Lime water is a saturated solution of lime. It is 
 made by washing slaked lime and shaking it up in distilled 
 water, using about one grain of lime to each ounce of 
 water. After it settles the water is poured off from the 
 sediment and strained. 
 
 801 
 
MEDICAL RECORD. 
 
 (e) A nutrient enema can be made with 8 ounces of 
 milk, three eggs, and half a dram of salt. 
 
 2. Styptic is an agent which, on being applied locally, 
 stops bleeding. Example :-— Silver nitrate. 
 
 Specific is an agent which has a distinctly curative effect 
 on a particular disease. Example :— -Quinine, in malaria. 
 
 Collyrium is an eye wash. Example: — Boric acid in dis- 
 tilled water (gr. j, or ij to Jj). 
 
 Alkaloid is a basic nitrogenous substance of alkaline re- 
 action, and capable of combining with acids to form salts 
 in the same way that ammonia does. Example :— Morphine. 
 
 Alterative is an agent which modifies the course of a 
 disease for the better ; its action is not determined, but 
 probably it promotes waste and favorably modifies nutri- 
 tion. Example : — Arsenic. 
 
 3. Morphine is the best where pain is present ; it acts 
 quickly, but it is most apt to cause a habit formation, and 
 therefore should not be used unless necessary. 
 
 Chloral hydrate produces a natural sleep, acts promptly, 
 but is of no service if pain is present; it also lowers the 
 body temperature. It can be given for a long time with- 
 out deleterious effect, but it may irritate the tissues and 
 weaken the heart. 
 
 Sulphonal produces a natural sleep, but is of slow action, 
 requiring 3 or 4 hours to take effect ; it is of no use if pain 
 is present, does not irritate the tissues and weaken the 
 heart, but is probably not so good for continuous use as 
 chloral hydrate, though the two may replace each other 
 for a time. 
 
 "The antagonism between morphine and atropine is in 
 part real, such as their respective effects on the convolu- 
 tions, respiratory center and intestines. In part it is appar- 
 ent only. Thus, the contraction of the pupil caused by 
 morphine occurs through the pupillary center ; the dilatation 
 caused by atropine is referable to paralysis of the ciliary 
 branches of the third nerve. Morphine is diaphoretic 
 through the centers ; atropine is anhydrotic through the 
 terminal nerves of the glands. Both depress the Ireart and 
 reduce blood pressure in poisonous doses. Thus morphine 
 and atropine are not true antagonists, but the one may 
 prevent or relieve certain effects of the other, and may 
 therefore be (1) combined with the other for particular 
 medicinal purposes, or (2) given in the treatment of pois- 
 oning by the other under particular circumstances. " (J. 
 Mitchell Bruce, Materia Medica and Therapeutics.) 
 
 4. Glycerini pepsini 3J. 
 Tincture nucis vomicae. 
 
 Acidi hydrochlorici diluti aa 1T£xl. 
 Aquae destillatae q.s. ad ^iv. Misce. 
 Signa : — One tablespoonful three times a day., 
 
 802 
 
MEDICAL RECORD 
 
 Phenol. 
 
 Acetanilidum. 
 Xitroglycerinum. 
 
 ORDINARY, OR OTHER 
 NAME. 
 
 belie acid. 
 Antifebrin. 
 
 Glonoin. 
 
 DOSE. 
 
 Hydrargyri sub- i Calomel. 
 
 chloridum. 
 Pulvis ipecacuanhae . : . s • >wder. 
 
 compositus. 
 
 I to 3 grains. 
 ! I to 3 gra:: 
 i drop of a 
 
 solution. 
 : 2 to 5 grains. 
 
 i- 
 
 5 to 15 grains. 
 
 Phenol is an ant: and disinfectant Ace : is 
 
 an antipyretic. Xitroglycerinum dil: e blood ves : 
 
 and lowers arterial tension. Calomel is a purgative. Do* 
 Powder is a diaphoretic, and less lex irritation. 
 
 6. .: ate is given internally in pill form, in dose- 
 
 gr. 1/5. 
 
 gr, iv, in syi 
 Tincture of chloride of iron, dose HJJvij in glycerin. 
 Folder's Solution, dose flgiij, in water, after meals. 
 Potassium iodide, dose gr. vij, in Compound Syrup 
 rilla. 
 
 THEORY AND PRACTICE OF MEDICINE. 
 
 i. See French's "Pract Medicine" (1907). page 
 
 - : or 0- Practice of Medicine" (1909), page £86. 
 
 2. Flinfs murmu :lic murmur heard at the 
 x of the heart in some cases of aortic regurgitation. 
 
 sed to be due to the vibration of the anterior 
 ] of the mitral valve, as it lies between the regurgitat- 
 ing blood stream and that which is flowing into the left 
 ventricle from the left auricle. 
 
 It is to be distinguished from mitral stenosis. This is 
 best done t tidy of the pulse, which is very different 
 
 c two conditions. 
 
 3. See French's "Practice oi Medicine" ) . page S 
 Osier's "Practice of Medi page 683. 
 
 4. See French's "Practice oi Medicine" (1907). page 8 
 or Osier's "Practice of Medicine*' . page 534. 
 
 5. See French's "Practice of Me W), page & 
 or Os'er's "Practice of Medicine'' (1909), page ( 
 
 PATHOL 
 
 1. See Rose and Carless* ''Surgery" (1908), page 1234: or 
 Da Costa's "Surgery" (1908), page 1172. 
 
 2. Benign tumors are encapsulated, do not tend to in- 
 filtrate the surrounding tissues, do not give rise to metas- 
 
 803 
 
MEDICAL RECORD. 
 
 tatic growths, do not tend to recur after removal, do not 
 produce cachexia, and do not have a fatal tendency (ex- 
 cept from their location). 
 
 Malignant tumors are not encapsulated, tend to infiltrate 
 the surrounding tissues, give rise to metastatic growths, 
 have a tendency to recur after removal, give a cachexia, 
 have a fatal tendency. 
 
 Adenoma: See Rose and Carless' "Surgery'' (1908), page 
 208; or Da Costa's "Surgery" (1908), page 328. 
 
 Glioma is usually single, but may be multiple, is soft, 
 gelatinous, grayish or pink, according to the number of 
 blood-vessels in it, the outline is not distinct. Microscop- 
 ically, it contains glia cells, with a small amount of proto- 
 plasm, but large, round or oval nuclei, and many thin 
 fibrils which interlace with each other. 
 
 3. See Rose and Carless' "Surgery" (1908), pages 589, 
 593, and 580. 
 
 4. See Williams' "Obstetrics" (1909), page 852; or Hirst's 
 "Obstetrics" (1909), page 715. 
 
 BACTERIOLOGY. 
 
 1. "Active immunity follows an attack of a certain dis- 
 ease and secures immunity for that alone, which may last 
 but a short time (erysipelas, cholera) or for a longer 
 period (typhoid), or even for life (variola) ; or it follows 
 inoculation of a virus weaker than necessary to cause the 
 typical disease (vaccination against smallpox) ; or it fol- 
 lows inoculation by bacterial products apart from the 
 organisms themselves. 
 
 "Passive immunity is the term applied to the effect of a 
 serum derived from an immunized animal and injected 
 into one not immune, the theory being that in the blood 
 of the former there is a chemical substance (antitoxin) 
 which neutralizes the toxin in the donating animal, or 
 otherwise it would show symptoms, and by borrowing its 
 serum for the infected animal the toxin is opposed by the 
 alien antitoxin."-— (From Thayer's Pathology.) 
 
 2. Bacillus anthracis. Morphology: It is a large, rod- 
 shaped microorganism, with slightly thickened ends; it is 
 from 5 to 20 mikrons in length, and a little more than one 
 mikron in breadth ; it has a tendency to form long threads ; 
 it is nonmotile and nonflagellated ; it is aerobic. 
 
 Staining : — It stains by all the alkaline aniline dyes, and 
 also by Gram's method. 
 
 Cultural characters: — It grows on practically all media, 
 as a film on potato, in tree form in gelatin stab, it lique- 
 fies gelatin and also serum. 
 
 Pathogenicity: — It causes anthrax, splenic fever, malig- 
 nant pustule, and wo'olsorter's disease. Infection takes 
 
 804 
 
[MEDICAL R1XORD 
 
 place through wounds, or by the respiratory or alimentary 
 tract. The bacilli are probably destroyed by the gastric 
 juices, but not so the spores. 
 
 THERAPEUTICS. 
 
 1. See French's "Practice of Medicine" (1907), page 230; 
 or Osier's "Practice of Medicine"' (1909), page 226. 
 
 2. Therapeutic uses of ergot: Ergot stimulates and causes 
 contraction of involuntary muscle libers, hence it is a vaso- 
 constrictor, hemostatic, and oxytocic. It is also a cardiac 
 sedative, it raises the blood pressure, it increases peristal- 
 sis, and is an emmenagogue. 
 
 Indications: To promote uterine contractions during third 
 stage of labor; iibroids, menorrhagia, post-partum hemor- 
 rhage. Some forms of amenorrhea and dysmenorrhea, 
 dysentery, arterial hemorrhage, congestive headaches, laxity 
 of sphincters, of bladder or rectum, hemorrhoids, aneurysm, 
 diabetes, urinary incontinence, direct paralysis of the 
 sphincter vesicae, atonic spermatorrhea. 
 
 "While the efficacy of ergot in certain forms of metor- 
 rhagia has been conclusively proved, there is no satisfactory 
 evidence that the drug is of value in other forms of hem- 
 orrhage, such as hemoptysis, hematuria, or hematemesis. 
 On the contrary, our knowledge of its physiologic action in- 
 dicates that it may be productive of harm. Granting that 
 ergot can lessen the caliber of eroded, degenerated, or se- 
 riously wounded vessels, there is no reason for supposing 
 that its influence is restricted to the vessels concerned in 
 the bleeding, and if such is not the case, the universal con- 
 striction of the arterioles induced by the drug, and the 
 consequent rise in the general blood pressure must favor 
 the escape of blood from the injured vessels and militate 
 against the formation of an occluding thrombus."— 
 (Steven's Materia Medical 
 
 3. See French's "Practice of Medicine" (1907), page 621; 
 or Osier's "Practice of Medicine" (1909 V page 842. 
 
 4. See French's "Practice of Medicine" I 1007), page 400. 
 
 MIDWIFERY, OPERATIVE. 
 
 I. (a) The occiput is depressed and posterior, and points 
 to the right sacroiliac synchondrosis ; the smaller fonta- 
 nels is in the same locality. The sagittal suture runs 
 obliquely forward and to the left, in the line of the right 
 oblique pelvic diameter. The shoulders lie at right angles 
 to this, in the left oblique pelvic diameter. The anterior 
 fontanelle may be felt anteriorly, high up and to the left. 
 
 (b) The case may end: (1) By anterior rotation of 
 the" occiput, (2) the occiput may remain posteriorly in the 
 hollow of the sacrum; (3) a face presentation may result; 
 
 80; 
 
iMEDICAL RECORD. 
 
 (4) the labor may become arrested, or uterine inertia 
 may ensue. 
 
 (c) (1) Manual rotation and extraction by forceps may 
 be tried; or (2) forceps, rotation, and extraction; or (3) 
 forceps extraction, with the occiput remaining posterior. 
 
 2. See Williams' "Obstetrics" (1909), pages 285 and 290; 
 or Hirst's "Obstetrics" (1909), pages 419 and 425. 
 
 3. See Williams' "Obstetrics" (1909), page 438; or 
 Hirst's "Obstetrics" (1909), page 830. 
 
 4. The differential points between placenta prsevia and 
 premature separation of a normally attached placenta are 
 shown in the following table (from Dorland's Obstetrics) : 
 
 PLACENTA PREVIA. 
 
 Most commonly manifests 
 itself after the sixth 
 month of gestation, but 
 may occur as early as the 
 second month. 
 
 The hemorrhage is abrupt, 
 but painless. 
 
 There are generally repeat- 
 ed hemorrhages of in- 
 creasing severity. 
 
 There is an edematous con- 
 dition of the cervix and 
 lower uterine segment, 
 with marked pulsation. 
 
 Cervix is generally quite 
 patulous, and within may 
 be detected the placenta. 
 
 The placental bruit is situ- 
 ated low down. 
 
 PREMATURE DETACHMENT. 
 
 Most commonly occurs dur- 
 ing the first stage of la- 
 bor, but may occur at any 
 time during the last three 
 months of pregnancy. 
 
 The hemorrhage is sudden, 
 and generally is attended 
 with sharp pain. 
 
 Hemorrhage persists until 
 the uterine contents are 
 evacuated or the patient 
 perishes. 
 
 Vaginal examination re- 
 veals no deviation from 
 the condition normal to 
 pregnancy. 
 
 The cervix is perhaps (if 
 labor be initiated) slight- 
 ly patulous. 
 
 The placental bruit is in 
 normal position. 
 
 MIDWIFERY OTHER THAN OPERATIVE, AND PUERPERAL DISEASES. 
 
 I. The diseases of the mother liable to injure the fetus 
 in uter are: Malaria, relapsing fever, typhoid, typhus, 
 yellow fever, scarlet fever, measles, smallpox, cholera, 
 pneumonia, cardiac disease with inadequate compensation, 
 exophthalmic goiter, hepatic disease and jaundice, toxe- 
 mia, eclampsia, diabetes, and pernicious anemia. 
 
 The causes of labor at full term are not definitely known. 
 Among the theories held, or factors supposed to be in- 
 volved, are the following: (1) The gradual distention of 
 the uterus at the end of pregnancy, after it has reached the 
 physiological limit of its growth, while the contents still 
 
 806 
 
MEDICAL RECORD. 
 
 continue to grow; (2) the fetus becomes a "foreign body/' 
 and as such excites uterine contractions and is extruded; 
 
 (3) fatty degeneration of the placenta and of the decidua; 
 
 (4) the circulation of toxic products in the placental blood 
 acts upon a center in the medulla and so produces labor. 
 
 2. See Williams' "Obstetrics" (1909), pages 818 and 821 ; 
 or Hirst's ''Obstetrics" (1909), page 585. 
 
 3. See Williams' "Obstetrics" (1909), page 541; or 
 Hirst's "Obstetrics''' (19x9). page 635. 
 
 4. Treatment of infantile colic: ''The following formulas 
 will in most cases give relief: 
 
 IJ. Lime-water. 
 
 Comp. tincture of cardamom, each. Ji. 
 
 Give a teaspoon ful every half hour. 
 
 R. Spirits of chloroform gtt. 16 
 
 Aromatic spirits of ammonia 5 1 /? 
 
 Sodium bicarbonate gr. 16 
 
 Syrup - IV 2 
 
 Peppermint water q.s. §2 
 
 One teaspoonful, as necessary, for pain. 
 "In many cases the most efficient method of relieving 
 the pain is an enema of j^d of warm water and sodium 
 bicarbonate 3j^. A few r drops of gin in warm water may 
 be given by the mouth. Hot applications should be made 
 to the abdomen, and if symptoms of collapse appear, a hot 
 bath should be given." — (Gould and Pyle's Pocket Cyclo- 
 pedia.) 
 
 5. (a) In a breech presentaation the discharge of me- 
 conium has no significance. (M In a vertex presentation 
 it is a danger signal, and implies a compressed cord, or 
 fetal apoplexy, and delivery should be hastened. 
 
 SURGERY, OPERATIVE. 
 
 i. See Rose and Carless' "Surgery" (1908), page 956; or 
 Da Costa's "burgery" (1908). page 1236. 
 
 2. Excision of the elbow is performed for : Chronic 
 joint disease (generally tuberculosis); wounds; faulty 
 ankylosis, or other deformity; disease of the articular 
 ends of the bones : fracture dislocation ; compound com- 
 minuted fracture. 
 
 See Rose and Carless' "Surgery'' (1908'), page 692; or 
 Da Costa's "Surgery" (1908), page 625. 
 
 3. See Rose and Carless' "Surgery" (1908K page 1161; or 
 Da Costa's "Surgery" (1908), page 1105. 
 
 4. See Rose and Carless' "Surgery" (1908), pages 928. 
 929, 983. and 1055: or Da Costa's "Surgery" (1908), pages 
 786. 784, and 632. 
 
 5.- See Rose and Carless' "Surgery" (1908), pages 1229 
 and 1230; or Da Costa's "Surgery" (1908V page T190. 
 
 S07 
 
MEDICAL RECORD. 
 
 6. See Rose and Carless' "Surgery" (1908), pages 1024, 
 1027, and 1029; or Da Costa's "Surgery" (1908), page 963. 
 
 SURGERY OTHER THAN OPERATIVE. 
 
 i. See Rose and Carless' "Surgery" (1908), pages 83 and 
 86; or Da Costa's "Surgery" (1908), pages 195 and 198. 
 
 2. See Rose and Carless' "Surgery" (1908), page 124; or 
 Da Costa's "Surgery" (1908), page 204. 
 
 3. See Rose and Carless' "Surgery" (1908), page 570; or 
 Da Costa's "Surgery" (1908), page 440. 
 
 4. See Rose and Carless' "Surgery" (1908), pages 306, 
 313, and 2> 2 7\ or Da Costa's "Surgery" (1908), pages 356 
 and 364. 
 
 5. oee Rose and Carless' "Surgery" (1908), pages 482, 
 507, and 521; or Da Costa's "Surgery" (1908), pages 497 
 and 506. 
 
 6. See Rose and Carless' "Surgery" (1908), pages 1223 
 and 1227; or Da Costa's "Surgery" (1908), pages 1185 and 
 1 187. 
 
 MEDICAL AND SURGICAL ANATOMY. 
 
 1. (a) The middle meningeal artery crosses the anterior 
 inferior angle of the parietal bone at a point i*A inches 
 behind the external angular process of the frontal bone, 
 and the same distance above the zygoma. From this point 
 the anterior branch passes upward and somewhat back- 
 ward toward the sagittal suture, lying a little over half an 
 inch behind the coronal suture. The posterior branch 
 passes upward and backward over the squamous portion of 
 the temporal bone. 
 
 (b) To locate the fissure of Rolando on the scalp : Draw 
 a straight line over the top of the scalp from the inion to 
 the glabella; bisect this line, and half an inch posterior to 
 the midpoint draw a line downward and forward at an 
 angle of 67.5 for a distance of s J A inches. This line will 
 represent the location of the fissure of Rolando. 
 
 (c) The course of the lateral sinus is represented by a 
 line drawn from the external occipital protuberance to the 
 base of the mastoid process, and another line from the 
 base of the mastoid to its tip. 
 
 2. The refiex center for the bladder, in the lumbar en- 
 largement of the spinal cord; for the rectum, in the lumbar 
 enlargement of the spinal cord; for ankleclonus, in the 
 anterior horns of the third to fifth sacral segment of the 
 spinal cord; for knee jerk, in the anterior horns of the 
 second to fourth lumbar segments of the spinal cord; for 
 wi'ist jerk, in the anterior horns of the sixth to eighth 
 cervical segment of the spinal cord; for elbow jerk, in the 
 anterior horns of the sixth cervical segment of the spinal 
 cord. 
 
 808 
 
MEDICAL RECORD. 
 
 3. The parts entering into the formation of the wrist 
 joints are: The lower end of the radius, the under surface 
 of the interarticular fibrocartilage, and the scaphoid semi- 
 lunar and cuneiform bones; cartilage, anterior, posterior, 
 external lateral, and internal lateral ligaments, and syno- 
 vial membrane. 
 
 4. Colles's fracture is a fracture of the lower end of the 
 radius; it is generally transverse, and is usually within an 
 inch or an inch and a half of the articular surface. There 
 is a characteristic deformity caused by the lower fragment, 
 and the carpus forming a prominence on the dorsal sur- 
 face; at the same time there is a projection on the palmar 
 surface just above the wrist, caused by the upper frag- 
 ment. The hand is abducted and pronated, and the styloid 
 process of the ulna becomes very prominent. 
 
 Pott's fracture consists of a fracture of the lower end 
 of the fibula, about three inches above the tip of the malle- 
 olus; and a fracture of the internal malleolus. The foot 
 is twisted outward, the sole everted, and the heel drawn 
 up; there is a depression at the site of the fracture, the 
 inner malleolus either projects prominently or the frag- 
 ment can be felt and crepitus elicited ; the foot is shortened 
 and the ankle is swollen and widened. 
 
 5. By a digital examination of the rectum there can be 
 made out : The external sphincter, the internal sphincter, 
 the rectal insertion of the levatores ani, the anal canal, the 
 condition of the ischiorectal fossae, the coccyx, hollow of 
 sacrum, lower part of sacrum, tuberosity of ischium, wall 
 of pelvis, great sacrosciatic ligament. In addition, in the 
 male: The membranous urethra, the prostate, vasa defer- 
 entia, seminal vesicles, distended bladder. In the /v-male: 
 Perineal body, rectovaginal septum, os uteri, cervix uteri, 
 ovaries. 
 
 6. See Cunningham's "Anatomy'' (1909), page 1182; or 
 Gray's "Anatomy" (1908), page 1498. 
 
 7. The parts cut through in amputation at the upper 
 third of the leg are : Skin ; fascia ; bones, tibia, and fibula ; 
 interosseous membrane; muscles, tibialis anticus, tibialis 
 posticus, extensor longus digitorum, extensor proprius 
 hallucis, flexor longus hallucis, flexor longus digitorum, 
 peroneus longus, peroneus brevis, soleus, gastrocnemius, 
 and the tendon of the plantaris ; arteries, anterior tibial, 
 posterior tibial, peroneal; veins, the venae comites of the 
 arteries, external saphenous, internal saphenous ; nerves, 
 anterior tibial, posterior tibial, external saphenous, com- 
 municans peronei, musculocutaneous. 
 
 The main vessels tied are: The anterior tibial, in front 
 of the interosseous membrane ; the posterior tibial, be- 
 neath the deep transverse fascia and behind the tibia ; the 
 
 800. 
 
MEDICAL RECORD 
 
 peroneal, beneath the deep transverse fascia and behind 
 the fibula. 
 
 8. In the right inguinal region may be found: Ovarian 
 tumors, pelvic abscesses, diseases of the cecum and ap- 
 pendix, fecal impaction, hernia. 
 
 In the left inguinal region may be found: Tumor of 
 the sigmoid, ovarian tumors, pelvic abscesses, volvulus, 
 fecal impaction, hernia. 
 
 In the hypogastric region may be found: Distended 
 bladder, uterine tumors and cysts, pregnant uterus. 
 
 9. Scarpa's triangle is a triangular area or depression 
 situated just below the fold of the groin. It is bounded 
 above by Poupart's ligament, externally by the Sartorius. 
 and internally by the inner margin of the Adductor longus ; 
 its apex is formed by the junction of the Adductor longus 
 and Sartorius. The -floor is formed, from without inward, 
 by the Iliacus, Psoas, Pectineus, Adductor brevis, and 
 Adductor longus. Contents : The femoral vessels pass from 
 about the center of the base to the apex, the artery being 
 on the outer side of the vein ; the artery gives off the su- 
 perficial and profunda branches, and the vein receives the 
 deep femoral and internal saphenous; the anterior crural 
 nerve lies to the outer side of the femoral artery; the ex- 
 ternal cutaneous nerve is still further external, lying in 
 the outer corner of the space; just to the outer side of the 
 femoral artery, and in the sheath with it, is the crural 
 branch of the genitocrural nerve. At the apex, the vein 
 (which at the base was internal to the artery) lies behind 
 the artery. The triangle also contains fat and lymphatics. 
 Its surgical importance is due to the number of important 
 structures which it contains (see above). Its apex is the 
 point for ligating the femoral artery; digital pressure, or 
 ligation, is applied here in case of popliteal aneurysm; 
 femoral hernia appears in the upper part, and psoas 
 abscess often points here, too. 
 
 10. The collateral circulation after ligature of the fem- 
 oral artery in Hunter's canal: (1) The external circum- 
 flex; with the lower muscular branches of the femoral, 
 anastomotica magna, superior articular of the popliteal, 
 and anterior tibial recurrent. (2) The perforating and 
 terminating branches of the profunda ; with muscular 
 branches of the femoral, and muscular and superior artic- 
 ular branches of the popliteal. (3) The comes nervi ischia- 
 dici ; with the perforating branches of the profunda, and 
 the articular branch of the popliteal. 
 
 MEDICAL JURISPRUDENCE. 
 
 1. Avoid injuring the pericardium or other intrathoracic 
 tissues. 
 
 2. The presence or absence of dilatation or aneurysm. 
 
 8to 
 
MEDICAL RECORD 
 
 3. "Grasp the heart by the base and turn it up to expose 
 the posterior surface, estimate by the eye a line midway 
 between the anterior and posterior coronary arteries and 
 along this cut into the left ventricle from the base to the 
 apex with one long sweep of the knife; open the right 
 ventricle by a similar cut midway between the posterior 
 coronary and the right (really the inferior) margin of 
 the heart, the space being usually quite free from fat; as 
 the left ventricle is opened insert the index finger of the 
 left hand, put the thumb into the other cut — between the 
 two is the septum — and with that hold the heart is easily 
 managed in the further cutting; avoid pressing the septum 
 between thumb and finger. Lift the organ straight up and 
 cut the stretched vena cava inferior as long as possible just 
 as it enters the pericardium ; swing the heart to the right 
 side and cut the pulmonary veins on the other, reverse and 
 
 the remaining pulmonary veins and superior cava; only 
 the aorta holds it now and that is cut from below upward 
 
 he heart is lifted and carried toward the chin; if the 
 knife is sharp and clean long cuts are made, two or three 
 are enough and there is no spattering of blood." — (Thay- 
 er's Pathology.) 
 
 4. Death by suffocation is due to asphyxia ; that is, air 
 cannot get to the blood, and eventually the respiratory 
 center becomes paralyzed by the prolonged action of the 
 increasingly venous blood. 
 
 5. The average weight in an adult of the brain is : 
 male, 4972 ounces ; female, 44 ounces. Heart, male, 10 to 
 t2 ounces: female, 8 to 10 ounces. Spleen, about 7 ounces. 
 Liver, male, 50 to 60 ounces; female, 40 to 50 ounces. 
 Kidney, male, 472 to 6 ounces; female, 4 to s T 4 ounces. 
 
 TOXICOLOGY AND MENTAL DISEASES. 
 
 6. Cocaine Poisoning. (a) Symptoms: "When^ a 
 large dose has been taken the symptoms are not unlike 
 those of atropine poisoning. There is dryness of the throat, 
 tongue, and nose, difficulty of swallowing, faintness, and 
 sometimes nausea and vomiting. The pulse is usually in- 
 creased in fullness and frequency at first. The respiration 
 also becomes more rapid, and there is much general ner- 
 vous excitement, with general hyperesthesia. The eyes are 
 bright and staring and the pupils dilated. The patient 
 talks volubly and incoherently. Sometimes an erythema- 
 tous eruption appears on the skin. The stage of depression 
 soon comes on, when the breathing becomes shallow, the 
 heart's action more rapid, and the face pale or cyanotic. 
 The_ surface becomes anesthetic, and muscular twitchings 
 and" paralysis precede death, which is generally caused by 
 paralysis of respiration." 
 
 81 1 
 
MEDICAL RECORD. 
 
 (b) Period when fatal: — Less than one hour. If the 
 patient survive half an hour the prognosis is good. 
 
 (c) Fatal quantity: — 15 yi grains. The smallest fatal 
 dose on record is 1.2 grain for an adult. Twelve drops of a 
 4 per cent, solution hypodermically caused the death of a 
 girl eleven years of age in 40 seconds. Twenty-two grains 
 by the mouth and 10 grains hypodermically have been re- 
 covered from.— (Riley's Toxicology.) 
 
 7. The special indications of mental -weakness are :- — 
 Lack of attention, inability to concentrate the mind on 
 one's work, loss of memory, incoherence, personal untidi- 
 ness and neglect, hallucinations and illusions, lack of de- 
 cision and will power, irritability of temper and disposi- 
 tion, insomnia. 
 
 8. In opium poisoning the pupils are contracted, respira- 
 tion is slow, pulse slow and full, body temperature is 
 normal or subnormal, there may be the odor of laudanum 
 on the breath. 
 
 In acute alcoholism the patient can generally be aroused ; 
 the coma is not, as a rule, complete; the face may be 
 flushed ; the pupils are normal or dilated ; the respirations 
 are normal in frequency, but deep; the skin is cool and 
 moist, and the body temperature may be below normal; 
 there may be the odor of alcohol on the breath. 
 
 In epilepsy there will be a brief aura, sudden and com- 
 plete loss of consciousness, pupils dilated and rigid, the 
 tongue will be bitten (unless prevented), the sphincters 
 may be relaxed, there may be a slight rise of temperature. 
 
 In cerebral hemorrhage :— There are generally paralysis 
 of the head and upper limbs ; and in left-sided lesions there 
 may be aphasia; the pulse is slow and full; the respirations 
 are at first slow, regular, and stertorous, later on becoming 
 of the Cheyne-Stokes type. 
 
 SANITARY SCIENCE. 
 
 i. (a) Of the rain that falls: — Part is evaporated; part 
 flows off in streams and rivers; part sinks into the earth 
 through cracks and fissures and flows toward some water 
 channel or the sea; and part comes back to the surface 
 again in the form of springs. 
 
 (b) The objections to using rain water as it falls are: — 
 The rain takes up gases from the air (chiefly oxygen, 
 nitrogen, and carbon dioxide), but also ammonia, nitrous 
 and nitric acids ; also suspended matters which may be 
 floating in the air, such as soot. In this way impurities 
 may be present to the extent of 2^2 grains per gallon of 
 water. 
 
 2. (a) The sources of water supply are: Rain and 
 snow; (2) surface waters (rivers, lakes, and ponds); (3) 
 
 812 
 
MEDICAL RECORD. 
 
 subsoil or ground water; (4) deep waters (spring and 
 artesian well). 
 
 (b) Three methods of purifying water :— Distillation, 
 filtration, and boiling. 
 
 (c) Water stored in cisterns may become foul, it is stag- 
 nant, it absorbs impurities from the air, lead may be ab- 
 sorbed^ and sewer gases or coal gases or filth may be 
 drawn into the water. 
 
 (d) "A cistern should be placed at the top of the house, 
 and fed by a supply-pipe controlled by a ball-cock. It 
 must be large enough to contain at least a day's supply 
 and must not directly supply the water-closet. It may be 
 made of lead, lined with pitch or other protective coating, 
 or of galvanized iron, or of slate slabs set in cement. It 
 should be effectually covered, but ventilated, and provided 
 with an overflow discharging into the open air away from 
 any source of effluvia. Frequent inspection and cleansing 
 are necessary." — (Whittegge and Newman's Hygiene.) 
 
 3. Diseases caused by the use of impure water are :— 
 Typhoid, cholera, dysentery, diarrhea, goitre, intestinal 
 parasites, metallic poisoning, vesical calculi. 
 
 4. Inspection of sewers means a thorough testing of 
 drains, pipes, and sewers. Flushing is regular and thorough 
 washing out. Ventilation is a provision for the admission 
 and discharge of air, to prevent pressure of air or gas being 
 exercised upon the house-traps. 
 
 5. In Cameron's septic tank system "the sewage is first 
 led into a tank from which air and light are excluded. Di- 
 gestive changes take place in the sewage within this tank 
 as the result of anaerobic bacterial action, which is favored 
 by the darkness, the absence of air, and the perfect stillness 
 at which the sewage is maintained. Under these circum- 
 stances much of the solid matter is rendered soluble and 
 dissolved." — (Xotter and Firth's Hygiene.) 
 
 6. Air is vitiated by : — The respiration of men and ani- 
 mals ; the products of combustion and artificial lighting; 
 substances yielded by factories, workshops, mines, sewers, 
 marshes, cemeteries, etc.; organic products given off by 
 human beings. 
 
 7. The advantages of a mountain climate, as contrasted 
 with plains, are: — (1) Greater movement of air, strong 
 winds; (2) less humidity; (3) more sunlight; (4) less 
 suspended mattter in the air; (5) a lower temperature. 
 
 THERAPEUTICS. 
 
 1. Belladonna is used: "Locally, to relieve pain of all 
 kinds ; to relax spasm ; to promote the resolution of en- 
 larged glands; to check sweating, suppuration, and the se- 
 cretion of milk; atropine is used extensively in ophthal- 
 
MEDICAL RECORD. 
 
 mological practice. Internally, to check mercurial and 
 other ptyalism; night-sweats of phthisis and other abnor- 
 mal perspirations; serous diarrhea; intestinal, hepatic, and 
 renal colic; to prevent the griping of purgatives; with 
 opium in appendicitis or peritonitis; painful gastric affec- 
 tions; vomiting; sick-headache due to or accompanied by 
 spasm of the arterioles; cardiac disease; shock and col- 
 lapse; caseous pneumonia; acute coryza; whooping-cough 
 and other spasmodic affections of the respiratory passages ; 
 mastitis ; incontinence of urine ; seminal emissions ; vesical 
 spasm; chordee, erysipelas; scarlatina when the rash is 
 imperfectlv developed; the low, muttering delirium of 
 typhoid and typhus fevers ; certain forms of delirium tre- 
 mens; sciatica and neuralgia; epilepsy. In many conditions 
 atropine is most advantageously administered by hypoder- 
 matic injection and belladonna by suppository. The smoke 
 of belladonna leaves is inhaled for asthmatic attacks." — 
 ('Wilcox's Materia Medica.) 
 
 Symptoms of poisoning by belladonna: "In the rirst stage, 
 that of delirium, there are dryness of the throat, thirst, 
 difficulty of deglutition and spasms upon swallowing liquids, 
 face at first pale, afterwards highly reddened, pulse ex- 
 tremely rapid, eyes prominent, brilliant, with widely dilated 
 pupils, complete paralysis of accommodation, disturbances 
 of vision, attacks of giddiness and vertigo, with severe 
 headache, followed by delirium, occasionally silent or mut- 
 tering, but usually violent, noisy, and destructive, accom- 
 panied by the most fantastic delusions and hallucinations. 
 Usually the urine is retained, and the body temperature 
 is above the normal. The delirium gradually subsides, and 
 the second stage, that of coma, is established, with slow, 
 stertorous respiration, and gradually failing pulse, until 
 death occurs from respiratory or cardiac paralysis, or some- 
 times in an attack of syncope during apparent ameliora- 
 tion. 
 
 "Treatment: Lavage of the stomach; morphine may be 
 given cautiously during the period of violent excitement. 
 Maintain respiration ; strong coffee by the mouth or rec- 
 tum is beneficial. Pilocarpine may be given, in not too large 
 doses, to stimulate the secretion of saliva." — (From Witt- 
 haus' Essentials of Chemistry.) 
 
 2. See French's "Practice of Medicine" (1907), page 873 
 
 3. See French's "Practice of Medicine" (1907), page 594. 
 
 4. (a) For pleurisy with effusion: 
 
 ]J. Emplastri capsici 2x2 inches 
 
 Signa : Apply as directed. 
 (b) For suppression of urine: 
 R. i Triturationis* elaterini . .gr. ss 
 
 Signa : Take at once. 
 
 814 
 
MEDICAL KhCuKl) 
 
 (c) For sciatica: 
 
 I£. Linimenti chloroformi 3i y 
 
 Signa : Rub in well, along the course of the sciatic 
 nerve, every three hours. 
 (d) For alkaline cystitis: 
 
 R. Sodii benzoatis . . .5vj 
 
 Aquae menthse piperita^ 311 j. M. 
 
 Signa : L ake one teaspoonful in water every three 
 hours. 
 
 DISEASES OF WOMEN. 
 
 1. "The wound should be sutured at once and the urine 
 which has escaped into the peritoneal cavity removed with 
 a gauze sponge. Normal urine causes no irritation of the 
 peritoneum, but if cystitis is present the urinary secre- 
 tions are likely to produce infection and endanger the life 
 of the patient. If the wound has been properly sutured 
 there is no danger of subsequent leakage and drainage is 
 therefore not indicated. It may be necessary if the tear 
 is large to catheterize the patient every three or four 
 hours for the first day after operation, and then every six 
 hours for the next two days in order to avoid distention 
 and undue strain upon the sutures. A permanent catheter 
 should not be employed, as it is seldom indicated and may 
 cause cystitis. Operation: A vesical tear involving only 
 the outer coats of the bladder should be closed by a con- 
 tinuous Lembert suture of No. 2 braided silk, which is 
 carried upon a curved intestinal needle, and passed deep 
 enough to include the torn structures. A deep tear in- 
 volving all the coats and opening the cavity of the bladder 
 should be closed by two tiers or layers of sutures as fol- 
 lows : The first layer approximates the edges of the wound 
 and the second tier reinforces and buries these sutures, 
 thus guarding against the possibility of leakage. The 
 approximation layer consists of a continuous suture of 
 cumol catgut (No. 1), which is carried upon a curved 
 intestinal needle and passed through all the coats of the 
 bladder except the mucous membrane. The reinforcing 
 tier consists of a continuous Lembert suture of No. 2 
 braided silk which is also carried upon a curved needle 
 and passed through the peritoneum and the superncial por- 
 tion ot the muscular coat of the bladder. — (Ashton s 
 
 Gynecology.) 
 
 2. Pruritus vulvae may be caused by: Parasites; diseases 
 of the vulva, as inflammation, edema, vegetations, conges- 
 tion ; irritating discharges; lack of cleanliness ; diabetic 
 urine : it may also be of nervous origin, or idiopathic. 
 
 Treatment consists in removing the cause, if possible; 
 cleanliness, fresh air, tonics, and general attention to hy- 
 giene ; local applications of solution of bichloride of mer- 
 
 815 
 
MEDICAL RECORD 
 
 cury, i : 2,000; or carbolic acid, 1 : 100; or lead and opium; 
 dusting powders of bismuth subnitrate, calomel, or zinc 
 oxide are also useful. 
 
 3. "In the operation for complete laceration the rectovag- 
 inal septum is split laterally, thus separating the vagina 
 from the rectum for a short distance and thoroughly ex- 
 posing the ends of the sphincter ani. The wound in the 
 rectum is then closed by two layers of chromicized catgut 
 sutures, one for the mucous membrane and a second for 
 the outer coats. The sphincter ani is approximated by 
 two or three additional catgut sutures. The operation is 
 then completed as Emmet's, the lowest external suture 
 being passed through the sphincter ani. Emmet's operation 
 is as follows : 
 
 "With the patient in the lithotomy position, guide su- 
 tures or tenacula are passed through the apex of the reto- 
 cele, and through each labium ma jus at the lowest carun- 
 cula myrtiformis. By drawing on the lateral suture and 
 pulling the central suture downward and to the opposite 
 side, the lateral sulcus appears as a triangle with the apex 
 up in the vagina. This triangle is denuded of mucous 
 membrane by cutting off long strips by means of forceps 
 and scissors, or by dissecting the mucous membrane off in 
 one piece. The triangle on the opposite side is treated 
 in the same manner, and the denudation completed by 
 removing the mucous membrane between the bases of the 
 triangles and below the central suture. Each lateral tri- 
 angle is closed by interrupted sutures of chromicized cat- 
 gut or silkworm gut, the latter being shotted. The needle, 
 which should be curved, is entered near the margin of the 
 wound on the outer side, passed deeply to catch the fibers 
 of the levator ani, and brought out at the bottom of the 
 sulcus, at a point nearer the operator; it is then reinserted 
 at the bottom of the sulcus, and passed upwards and back- 
 wards in the rectocele, to emerge opposite the point of 
 the original insertion. The opposite triangle is treated in 
 the same manner, which leaves a small raw area externally 
 to be closed. The upper or "crown stitch" passes through 
 the skin of the perineum below the lateral guide suture, 
 then through the rectocele below the central guide suture, 
 and finally through the tissues below the opposite guide 
 stitch. As many sutures as may be necessary are inserted 
 below this. If silkworm gut is used, the stitches should be 
 removed on the tenth day. The external genitals are ir- 
 rigated with weak bichlorid of mercury solution after each 
 urination. Internal douches are not needed unless there 
 be infection." — (Stewart's Surgery,) 
 
 4. In the retro displaced uterus, the fundus of the uterus 
 is not found in its proper place, in the other conditions 
 
 816 
 
MEDICAL RECORD 
 
 the fundus would be against the bladder. In the ovarian 
 cyst, vaginal examination (with the help of a sound) 
 would show that the tumor was not connected with the 
 uterus. In the case of a fibroid, there would probably be 
 a uterine hemorrhage. 
 
 5. (a) Preliminary preparation includes all the usual 
 antiseptic and aseptic precautions. 
 
 (b) The uses of the uterine sound are: — (1) To dem- 
 onstrate the mobility of the uterus; (2) to show the size 
 of the uterus; (3) the presence of intrauterine growths; 
 (4) deviations in the cervical canal, and (5) as an aid in 
 the diagnosis of uterine displacements. 
 
 (c) Contraindications: — (1) The least suspicion of 
 even the possibility of pregnancy; (2) menstruation; (3) 
 acute endometritis ; (4) malignant disease of the uterus 
 or vagina; (5) acute pelvic inflammation. 
 
 (d) Dangers:— (1) Abortion; (2) sepsis; (3) periton- 
 itis; (4) hemorrhage; (5) perforation of the uterus. 
 
 DISEASES OF CHILDREN. 
 
 i. See French's 'Practice of Medicine" (1907), page 647; 
 or Osier's ''Practice of Medicine" (1909), page 598. 
 
 2. Kernig's reflex (or sign) is present in meningitis or 
 cerebrospinal fever in nearly every case. It is very rarely 
 present in other conditions, hence it is a sign of much 
 value. 
 
 Babinski's reflex is said to indicate disease of the pyra- 
 midal tract, except in children under two years of age, 
 when the reflex is normal. Its absence does not prove that 
 the pyramidal tracts are not diseased. There is still much 
 uncertainty as to the value of this reflex, its chief value 
 being in differentiating organic disease of the lateral col- 
 umns from so-called "functional" conditions. 
 
 In lobar pneumonia, if the toxic condition is very severe, 
 the patellar reflex may be exaggerated. 
 
 3. See French's ''Practice of Medicine" (1907), page 
 572; or Osier's "Practice of Medicine" (1909), page 791. 
 
 4. Acute osteomyelitis, (a) The three most common 
 infecting germs are : Staphylococcus pyogenes aureus, 
 Staphylococcus pyogenes albus, and Streptococcus py- 
 ogenes. 
 
 (b) The three bones most frequently affected: Femur, 
 tibia, and humerus (or radius). 
 
 (c) Diseases for which it may be mistaken : Rheuma- 
 tism, gonorrheal rheumatism, typhoid fever, tuberculous 
 arthritis, cellulitis, and infantile scurvy. 
 
 Treatment is immediate incision down through the peri- 
 osteum ; the surface of the bone must be opened with gouge 
 or chisel, pus evacuated, and drainage instituted ; irrigation 
 
 817 
 
MEDICAL RECORD. 
 
 with hot bichloride solution and packing with gauze. The 
 medulla of the bone must be freely exposed, and any sup- 
 purating material removed. Constitutional treatment and 
 rest, are, of course, indicated. 
 
 See Rose and Carless' "Surgery" (1908), pages 570. 
 etc.; or Da Costa's "Surgery" (1908), pages 442 and 440. 
 
 5. The structures that would be pierced, are : Skin, sub- 
 cutaneous fascia, epicranial aponeurosis, superficial tem- 
 poral aponeurosis, deep temporal aponeurosis, temporal 
 muscle, periosteum, squamous portion of temporal bone, 
 dura, arachnoid, pia, and third temporal convolution of 
 cerebrum. 
 
 Symptoms and Treatment : See Rose and Carless' "Sur- 
 gery" (1908), page 770; or Da Costa's "Surgery" (1908), 
 page 712. 
 
 REQUIREMENTS FOR MEDICAL LICENSURE 
 In the following table the States requiring of the can- 
 didate both a diploma from a recognized college and an 
 examination are printed in roman; those requiring either 
 diploma or an examination, in italics; those requiring an 
 examination only, in small caps. 
 
 State Fee State Fee 
 
 Alabama $10 . 00 Nebraska $25 .00 
 
 Arizona 10 . 00 Nevada 25 . 00 
 
 Arkansas 10 . 00 New Hampshire 10 . 00 
 
 California 25 . 00 New Tersey 25 .00 
 
 Colorado 25 . 00 New Mexico 25 . 00 
 
 Connecticut 15 .00 New York. 25 .00 
 
 Delaware 10 . 00 North Carolina 10 . 00 
 
 District of Columbia. . . . 10 . 00 North Dakota 20 . 00 
 
 Florida 15.00 Ohio 25.00 
 
 Georgia 10 . 00 Oklahoma 5 . 00 
 
 Idaho 25.00 Oregon 10.00 
 
 Illinois 10 . 00 Pennsylvania 25 . 00 
 
 Indiana 25.00 Rhode Island 10.00 
 
 Iowa 10 . 00 South Carolina 10 . 00 
 
 Kansas 15. 00 South Dakota 20 . 00 
 
 Kentuckv 10 . 00 Tennessee 10 . 00 
 
 Louisiana 10.00 Texas 15 .00 
 
 Maine 10.00 Utah 15.00 
 
 Maryland 15.00 Vermont 1 5 . 00 
 
 Massachusetts 20.00 Virginia '. . 10.00 
 
 Michigan 25 . 00 Washington 25 . 00 
 
 Minnesota 10 . 00 West Virginia 10 . 00 
 
 Mississippi 10.00 Wisconsin 10.00 
 
 Missouri 15 . 00 Wyoming 25 . 00 
 
 Montana 25.00 
 
 BULLETIN OF APPROACHING EXAMINATIONS! 
 state name and address of place and date of 
 
 secretary next examination 
 
 Alabama* W. H. Sanders, Montgomery. .Montgomery. . .Jan. 
 
 Arizona* Ancil Martin, Phoenix Phoenix Oct. 3 
 
 Arkansas F. T. Murphy, Brinkley Little Rock Nov. 8 
 
 California* Chas. L. Tisdale, 929 Butler 
 
 Building. San Francisco Los Angeles.. . .Dec. 6 
 
 818 
 
MEDICAL RECORD. 
 
 STATE NAME AND ADDRESS OF PLACE AND DATE OF 
 
 SECRETARY NEXT EXAMINATION 
 
 rado S. D. Van Meter. 1723 Tremont 
 
 Street. Denver Denver Oct. 4 
 
 necfcieut*....Chas. A. Tuttle. New Haven. . .New Haven. . . .Nov. 14 
 
 Delaware J. H. Wilson, Dover Dover Dec. 13 
 
 of Col'bia . Geo. C. Ober. Washington Washington. . . . Oct. 1 1 
 
 ia* I. D. Fernandez, Jacksonville.. Palatka Nov. 9 
 
 gia T. H. Goss. Athens Atlanta Oct. 11 
 
 Idaho* W. F. Howard. Pocatello Oct. 4 
 
 J. A. Egan. Springfield Chicago Oct ; 
 
 ~.na W. T. Gott, Crawfordsville. . . .Indianapolis.. .Jan. 10 
 
 Louis A. Thomas. Des Moines. . Des Moines 
 
 Kansas H. A. Dykes, Lebanon Topeka Oct. 1 1 
 
 Kentucky T. N. McCormack. Boiling 
 
 Green Louisville Dec. 15 
 
 Louisiana A. B. Brown. Xew Orleans. . . . Xew Orleans. . .Oct. IS 
 
 Maine F. W. Searle, Portland Portland Nov. 3 
 
 Maryland J. McP. Scott. Hagerstown. . . . Baltimore Dec. 13 
 
 Massachusetts*.]^. B. Harvey. State House. 
 
 Boston Boston Nov. 8 
 
 Michigan B. D. Hanson. 205 Whitney 
 
 Building, Detroit Lansing Oct. 11 
 
 a . . .W. S. Fullerton. St. Paul St. Paul Oct. 4 
 
 Mississippi. . 
 - :uri 
 
 Nebraska .... 
 
 Nevada 
 
 X. Hampshire 
 
 Xew Jersey 
 
 . S. H. McLean. Jackson Jackson Oct. 11 
 
 . Frank B. Hiller. Jerlerson Citv . Tefferson City . . 
 
 . Wm. C. Riddell. Helena Helena '. . . Oct. 4 
 
 .C. A. Carr. Lincoln Lincoln Nov. 9 
 
 .S. L. Lee. Carson City Carson City. . . .Xov. 2 
 
 .Henry C. Morrison, State Li- 
 brary. Concord Concord Jan. 3 
 
 .H. G. Xorton. Trenton Trenton Oct. 18 
 
 X'ew Mexico . . J. A. Massie. Santa Fe Santa Fe Oct. 10 
 
 Xew York 
 
 Xew York C.F.W'neelock. Univ. of State J Albany Jan. 31 
 
 of Xew York. Albanv ] Svracuse 
 
 . Buffalo j 
 
 X. Carolina B. K. Hays. Oxford Charlotte. ..... Tune 14 
 
 X. Dakota H. M. Wheeler. Grand Forks.. Grand Forks. . .Oct. 4 
 
 Ohio Geo. H. Matson; Columbus. . . .Columbus Dec. 13 
 
 Oklahoma*... . .F. P. Davis. Enid Guthrie Oct. 11 
 
 Oregon B. E. Miller. Portland Portland Jan. 3 
 
 Pennsylvania* . X. C. Shaeffer. Harrisburg Philadelphia.. . . Dec. 6 
 
 Rhode Island*. . G. T. Swarts. Providence Providence Oct. 6 
 
 S. Carolina H. H.. Wyman, Aiken Columbus June 13 
 
 S. Dahota F. W. Freyberg. Mitchel Aberdeen Jan. 11 
 
 ' Memphis ] 
 
 Tennessee C. A. Abernath\\ Pulaski. . . < Xashville. . . . > May 2 5 
 
 Knoxville. ... J 
 
 Texas R. H. McLeod, Palestine Palestine . Xov. 22 
 
 Utah R. W. Fisher. Salt Lake City . . Salt Lake City. .Oct. 5 
 
 Vermont W. Scott Nay, Underhill Montpelier Jan. 10 
 
 Virginia R . S. Martin, Stuart Lynchburg Dec. 20 
 
 Washington*. . . F. P. Witter. Spokane Spokane Tan. 5 
 
 W. Virginia . . H. A. Barbee, Point Pleasant..Morgantown. . .Xov. 14 
 
 Wisconsin J. M. Berlel, Milwaukee Milwaukee Jan. 10 
 
 Wyoming S. B. Miller, Laramie Laramie Oct. 12 
 
 *Xo reciprocity recognized by these States. 
 
 + Applicants should in every case write to the secretary for latest 
 details regarding the examination in any particular State. 
 
 8i9 
 
MEDICAL RECORD 
 
 Weekly Journal of Medicine and Surgery 
 
 Price, $5.00 a Year. 
 Single Copies, 15 cts 
 
 Started in 1 866, the Medical Record has for forty-four 
 years held the first place among medical weeklies in 
 America. Impartial, judicial, and scientific, its sin- 
 gle aim has been to furnish to the Medical Profes- 
 sion an independent, enterprising, and progressive 
 medical newspaper conserving the best interests of 
 the profession. 
 
 The Medical Record believes that the proper scope 
 of a medical newspaper is all that concerns the 
 Science and Practice of Medicine and Surgery, and 
 all that concerns the Physician and Surgeon. It is 
 conducted on the broadest lines, sparing no expense 
 in the employment of its Editorial Staff, in collecting 
 news, in maintaining correspondents in various parts 
 of the world, and in securing exclusive reports of 
 meetings by cable and telegraph. 
 
 The Medical Record is independent of the control 
 of any group of individuals or of any personal policy. 
 It is controlled by the best judgment that long ex- 
 perience of the needs of the better class of American 
 physicians can give. Such experience teaches that 
 the enlightened sentiment of the Profession is the 
 only safe guide in this respect. 
 
a oeu*osrre r*o4iMtia 
 
 MEDICAL RECORD 
 
 A Weekly Journal of Medicine and Surgery 
 
 WILLIAM WOOO AMD COMPANY PwMlahera. 01 fm* A»»f.o. New r«e» 
 
 $5.00 Per Annum. 
 
 Published at New York. Everv Saturday 
 
 Single Copies, 15c. 
 
 ORIGINAL ARTICLES. 
 
 Radium 'or the Treairneni of Cancer 
 ind Lupus By William Monoa 
 
 >I O N'ew York 
 
 Cutaneous Tuberculin "acrtnatton <1 
 the Diagnosis ol Tuberculosis. Sy 
 William 1 Sutler M D Chicago 
 
 Prevention of Death During Anesthesia 
 b> Chloroform *nd Ether B> Rober* 
 Reyburn. AM- HO Washington 
 D C 
 
 What Sfcan We r>> ••Itn Fat Advanced 
 Career of .he Large Botiel* By R C 
 Coffey H D- Portland. Ore 
 
 Sanitation ot th» Canai Zone. Br 
 Colonel William C Gorgas. M D 
 
 Vaginal Implantation of Adencrarc! 
 noma of Che Uterus Blood Metasta 
 sis <n Recurrent Care'.noma By Geo 
 W Kaan. M D Boston Man 
 
 Relation of Acrldents «o Functional 
 Nervous EN ceases and Psychoses 
 Medicolegal Considerations By \«- 
 frtyj Cordon M O . Philadelphia. Pa 
 
 Disease! of the G-strcintestlnal Tract 
 on the BorJenanci between 6urgery 
 and Internal Medirtm By John C 
 Hemmeter MD- Pa-D- LL-O- Baitl 
 more Md. 
 
 The Organic Fe.-tor In Htgn Blood 
 Pressure By Alcvandei Hale. MA. 
 M D Oxon. London 
 
 Primary Melanosis of the Palate Na- 
 sobuccal Fistula of Recent Sarcoma- 
 tous Origin By J N Roy. M D~ 
 Montreal. Canada ._...._. ._._.^_. 
 
 eoiToaiAt*. _ 
 
 CoMradlctorr Aiviee to Consumptives. 
 
 The Army Canteen 
 
 The Dangeroua Effects of Ether and 
 
 Oiioroform v... 
 
 Preventive Medicine 
 
 -. Care of Missed Labor 
 
 EDITORIAL NOT**. 
 
 TN Causation of Appendldiia ; — . 
 
 To Accelerate the Course of Labor — 
 The Period of Infection la Tvphold 
 
 KeKfr ,.. 
 
 Aseptic Operating 
 
 T:-.e Technique of Spinal Anesthesia-..' 
 
 Tii» Iniectlon of Scarlet Fevet 
 
 Tie Kffeet of Athletic Contest* on th* 
 
 Health ... 
 
 Treatment of Constipation by Abstl- 
 
 r.ente from Meat 
 
 The New Tu'jerculln Uea<-tlon» 
 
 (ration In Trenton — Codification 
 
 I Regulations of the Cfcrcage Health 
 Oepartment — Study o( Speech De- 
 I feci*— Vaccination Ruie Sustained in 
 Chicago— Confederation of Students' 
 Societies- -Makes Doctors His Vic- 
 .ims— Phk-sirlans' Bulging for Cleve- 
 land— Drjggls' Couvicted— The Nlch- 
 
 i o!a» senn Folate 
 
 CORRESPONDENCe. 
 
 I Our London tetter 
 
 I Our Parl» Letter 
 
 j Our Berlin Letter .. . 
 
 I Our Letter from the Philippines 
 
 I Our Leltet from Copenhagen 
 
 PROGRESS OK MEDICAL 6CIENCE 
 ■ Ace*lonuna and Laparotomy - Trypsin 
 
 I In the Treatment of Malignant T-jmor« 
 —Varices* Veins. Their Treatment b> 
 Multiple Short Incisions — Arterio- 
 sclerosis — Vppet Respiratory Obstruc- 
 tion «nd Oral Deformity 
 , tubaruto Poly-myosiUs- Dementi} Prs- 
 cos . 
 
 Mutual Relations of Upper- Air .Tract. 
 Ja»-a end Teeth— The Dtagnoste of 
 Appendicitis — Corneal Anesthesia In 
 Cerebrospinal Meningitis. ... . 
 
 The Vaiue of Vaccina Therapv to the 
 General Practitioner in the Treatment 
 
 of Bacterial Disease 
 
 BOOK REVIEWS. 
 
 American Practice of Surgery A Com- 
 plete System of the Science and Art 
 of Surgery by neprcs«ntatl\<= Sur- 
 Ceons of the United Stales and Can- 
 ed* Editors Josenh D- Bryan 
 M D. end Albert H Buck. M D Corn 
 plete In eight volumes 
 
 The Medical and Suigical Knowledge of 
 William Shakespeare With ExTilan- 
 etory Note*. 8y Jo'.-.n W Walnwrigl.L 
 M D 
 
 A Te*thooa of the Practice of Med'rir.e. 
 For Students and Practitioners. By 
 James Magoffin French. M D Third 
 llevtced Edition 13S Illustrations. US 
 Being Full -page Piatea la Tints and 
 Colors. 
 
 Manuel de Cynecologie pratique Par 
 J BhtoxzI Prefaoe de M L. G 
 
 Medical Jurisprudence Forensic Medt- 
 tin* and Toxicology By rt A Witt 
 hr.ua. AM . M.U. Prn'esw of Chen.- 
 b-trv, I'ltyxlf-m and TovicoIokj In Cor- 
 nell l"nlver*ltr . 
 
 Manual ot Hegietie and Sanitation. 
 By Keneca rghert. M.D Fourth Edi- 
 tion. Knlanred and Thorou«hi\ Ue- 
 «l«ed I'lustinu-d Kith Nln;t> .H::ee 
 Eru.-iarlruen 
 
 socirrv Rcf*ORT$. 
 
 M Yo'" 1 80elet) ' °* «*• 6ut * •*■ N «*» 
 General Meeting 
 
 American Medical Association. 
 
 Section on Practice of Medicine 
 Joint Meeting with Section on Ptitf' 
 
 maeology and Therapeutics. 
 American Laryngoloeical Association.. 
 American Public Health Association . 
 Sixth International Oermatoioglcal Con- 
 New York Academy of Medicine: ""*' 
 
 Section on Pediatric* . . i .. 
 
 Section on Surge-/ ... 
 
 Section on Obstetric* and Gynecclooy". 
 
 Section en Medicine 
 Mississippi Valley Medical Association* 
 
 Medical Section 
 
 Amer.;an Therapeutical Seelety 
 
 Pniiadelphia County Medical Society 
 Western 6ur s ical and Gy-ecologieal At- 
 
 sociation. .m .... . .<. 
 
 American Gastroenterological. Associa- ' 
 
 New York' Psychiatrical' Society' ..'.'. 
 Britith Medical Association 
 
 6ection of Tropical Oiseases 
 
 STATE MEDICAL LICENSING BOARDS. 
 State Board Examination Ouestlor.n. 
 
 University of the Slate of New York. 
 Ansmetx to Slate Board Examination 
 
 Questions University of the State of 
 
 New York 
 
 State Board tSamlnstlon QiesUdrw 
 
 I'llnols State Board of Health . 
 Answers to State Beam Examlnalitra 
 
 Question* Illinois Stale B-^ard of 
 
 Health . ...... 
 
 Bulletin of Approaching Exarnlr.aU-ni 
 
 6URGirAL tUGGEfiTJONS. 
 Orcumcislon— Mefhoc;.* Against Fle=s — 
 
 Urenital Kerr.orrliye — Slrangulauo 
 
 Hernia— Health Ueport 
 De:n.aio-V«r.ei-e«i Don'U — Burns— Ts- 
 
 Lerculou* petji.or.ltis— Skin Grafu-Tj 
 
 THERAPEUTIC HINTS. 
 
 Sweating Hinds 01 F*ei— Irt^uer.ia— 
 
 Alveolar A hs< ess— Ps'vSas"..' — Earache 
 
 »n Children— Catarrh* Pliary-ngitU 
 
 "NEW INSTRUMENTS. 
 
 A Metv Stethoscope Bv Dnnlag F 
 
 Penhallow M D . Bostor.. Mast, . 
 A, New Bone Drill end Bon» Wrench. 
 
 By Carl Beck M D- N»u York 
 
 MEDICAL ITEMS. 
 Crbntagioua D t s exiu » « Weekly Suterr.int 
 
 — Hea-ih iser-ifta . ... 
 
 OIRECTORV OF NATIONAL AND 
 
 STATE MEOICAL SOCIETIES 
 
 JUST PUBLISHED 
 
 TEXT-BOOK OF ANATOMY 
 
 £y D J CUNNINGHAM. f.R.S. 
 
 THIRD COITION 
 
 •'Royal Octave. U«? P 8 ***- ^^ Wood Engravings of which 40f> arelp tn : o or more cciors. 
 
 Muslin, $6.00 act. Half Morocco, $740 net. 
 
 URGENT SURGERY 
 
 „By" FELIX LEIARS Translated by WILLIAM S DICKIE, i 
 
 mOOl THE SIXTH frtCHCH COITION 
 
 Two .-rvuraes. UrftoctavorVol.One, Wl pafw Illustrated by <5»«nrravirg^. In o!ack amJ color*. : 
 MtisUn, tlit set, $14.00 net; Half Morocco, $16.00 set 
 
 R.C.S.. 
 
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 WILLIAM WOOD AND COMPANY. MeHlcal PoMisliers . . . 51 Flflli Avcnne, New York 
 
 C'MW'l '»»* *J W.t:,»tm Wtod tU C?*-t3*i?, tatmt si »»/• r»*Of<t .< Vrt. Yart ai Srem4<Uu ttturr. 
 
rhe American Journal of Obstetrics 
 
 and 
 Diseases of Women and Children 
 
 Price, $5.00 a Year (Issued Monthly) 
 
 Single Copies, 50 cts. 
 
 The recognized leading journal in Gynecology, 
 Abdominal Surgery, Obstetrics, and Pediatrics 
 
 The history of medical journalism shows no more 
 striking example of success than "The Journal's" 
 present popularity and wide circulation, and the 
 changes and improvements that have been made in 
 it since the date of its first issue, May, 1868. 
 
 The first volume contained 448 pages; now each 
 issue contains over 160 pages, or a total of over 
 2,000 pages for the twelve numbers in the year. 
 
 The Original Articles which have appeared in its 
 pages include the most important contributions to 
 medical literature in the departments concerned, by 
 the most celebrated physicians in the world. 
 
 The American Journal of Obstetrics is printed 
 and illustrated in a style of typographical excellence 
 superior to that of any other medical journal, con- 
 taining many plates, in black, tint, and colors, con- 
 forming with absolute fidelity to the original subject. 
 
$5.00 a Tear in Advance. Single Copies, so Cents. 
 
 AMERICAN 
 
 Journal of Obstetrics 
 
 AND 
 
 DISEASES OF WOMEN AND CHILDROL 
 
 A MONTHET JOUBKAL. 
 
 EDITED BY 
 BROOKS H. WELLS, M.D. 
 
 Professor of Gynecology at the New York Polyclinic and Gynecological Surgee» 
 
 to the New York Polyclinic Hospital; Consulting Gynecologist to Beth 
 
 IsraerHospital, New York; Consulting Abdominal Surgeon to th* 
 
 Brattleboro Memorial Hospital, Brattleboro, Vermont; Fellow 
 
 of the American Gynecological Society, the New York 
 
 Academy of Medicine, the New York Obstetrical Society ; 
 
 Member, American Medical Association. 
 
 DEPARTMENT OF PEDIATRICS 
 
 EDITED BY 
 THOMAS S. SOUTHWORTH, M.D. 
 
 Attending Physician Nursery and Childs Hospital- New York City Children* 
 Hospital (.Randalls Island); Tlxe Hospital for Scarlet Fever and Diph- 
 theria Patients; Physician Out-Patient Department, Babies Hos- 
 pital, Member, American Pediatric Society, American Medical 
 Association, New York Academy of Medicine. 
 
 WILLIAM WOOD & COMPANY 
 
 PUBLISHERS 
 
 MMm 
 
 Entered as second-class matter Jan. 2. 1908, at the Post Office at York. Pa., under the Act 
 of Congress of March a, 1879. 
 
 VOLUME LVII. Copyritkt, 1908, by W*t. Wood fir Co. WHOLE No. 364. 
 
,v 
 
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