COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX641 23367 R C79 . L96 1 905 Answers to questions RECAP ANSWERS TO QUESTIONS PRESCRIBED MEDICAL STATE BOARDS. ROBERT B. LUDY, M.D., LAI n (llM, \^ :STANT SURGEON, U.S. A.; LECTURER ON PRACTICE OP MEDICINE IN TI COr.LBCK ( F PHILADELPHIA ; AUTHOR OF " ANSWERS TO QUESTIONS PRESCRIBED BY DENTAL STATE BOARDS," ETC. SECOND EDITION, REWRITTEN AND ENLARGED. PHILADELPHIA : JOHN JOS. McVEY. 1905 He PREFACE. The indorsement of the first edition of this book by teach- ers and students, as shown by numerous expressions of ap- proval, as well as by its rapid sale, is extremely gratifying to the author and seems to warrant its continuance. All new State Board questions which have appeared since the publication of the first edition have been added. It is hoped that the careful revision to which the work has been subjected has eliminated the errors which appeared in the first edition. Everything has been sacrificed to brevity and accuracy, so that students will find the book indispensable in preparing for college, hospital, army and navy examinations in the shortest possible time. Many persons having an adequate knowledge of the subject in which they are tested, fail because of their inability to interpret properly the intents and purposes of the questions to be answered by them. To aid in this, as well as to afford a convenient manual for the general preparation of medical students in their work, is the sole object of this book. Having collected a large number of questions from differ- ent states, it was found that duplications occurred ranging from 30% to 80%, varying according to the several subjects Thus a comprehensive knowledge of these questions and an- swers will serve excellently in the preparation of future ex- aminations before such Boards. In order to secure a critical interpretation of the questions, and concise, yet complete, answers to the same, the author has been favored by the assistance of well-known specialists in their several lines, whose competence and experience give (iii) iv PREFACE. to the work a range and value impossible of attainment in the product of a single author. It has been deemed advisable to unite all questions from the different States under their respective headings, so that undue repetitions of similar questions might be avoided. Although standard literature has necessarily been consulted, yet in a work of this character references would only prove cumbersome ; hence they have been generally omitted. To Drs. Babcock, Boom, Coley, Dorland, Good, Northrop and Thomas the author makes grateful acknowledgment. The high value of their carefully-prepared answers is fully appre- ciated by him, and will be by those into whose hands the work is committed. Robert B. Ludy. SPECIAL AUTHORS. Herbert L. Northrop, 31. D. Professor of Anatomy, and Associate Professor of Surgery in Hahne- mann Medical College of Philadelphia. Wm. Harmar Good, A. 31., 31. D. Demonstrator in Physiology at the Medico-Chirurgical College of Philadelphia. Henry H. Boom, 31. 1). Professor of Chemistry, Physics and Metallurgy in the Philadelphia Dental College. W, Wayne Babcoek, 31. D. Professor of Surgery and Clinical Surgery in Temple College of Philadelphia; Assistant Pathologist to the Philadelphia Hospital, and Joint Author of Vol. V., Cohen's System of Physiologic Therapeutics. W. Hersey Thomas, 31. D. Lecturer on Surgery, Medico-Chirurgical College; Assistant Surgeon , Medico-' birurgical 1 [ospital. W. A. Newman Dot-land, M. D. Associate in Gynecology, Philadelphia Polyclinic; Assistant Obstet- rician, Hospital of the University of Pennsylvania; Author of " Mod- ern ( >bstetrics," System of American Medical Dictionaries, etc. Thomas L. Coley, 31. D. Assistant Visiting Physician and Chief of Medical Dispensary, Methodigl Episcopal Hospital; Associate Editor Therapeutic Monthly. (v) CONTENTS. PAGE I. Anatomy 1 By Herbert L. Northrop, M. D. II. Physiology 65 By Wm. Harniar Good, A. M., M. D. III. Hygiene 127 By Robert B. Ludy, M. D. IV. Chemistry 163 By Henry H. Boom, M. D. V. Pathology and Bacteriology 303 By W. AVayne Babcock, M. D. VI. Surgery 335 By W. Hersey Thomas, M. D. VII. Obstetrics and Gynecology 429 By W. A. Newman Dorland, M. D. VIII. Therapeutics and Materia Medica 515 By Thomas L. Coley, M. D. IX. Practice of Medicine 609 By Robert B. Ludy, M. D. ( vii ) Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/answerstoquestioOOIudy ANATOMY. Mention the sutures at the vertex of the skull and state what bones they unite. Sagittal suture, uniting the two parietal bones; lambdoid, uniting occipital with both parietals; coronal, uniting both parietals behind with frontal anteriorly. Mention and describe the salivary glands. Parotid, submaxillary, sublingual. Parotid, largest, placed in front of ear, behind ramus of mandible; duct (Steno's) passes across masseter muscle, perforates buccinator muscle, terminates in cheek wall opposite upper middle molar. Par- otid has facial nerve, external carotid artery, temporo-maxil- lary vein passing through it. Submaxillary gland is located upon inner side of body of mandible posteriorly, is crossed by facial artery; duct (Whar- ton's) passes forward, terminating close to framuni lingua?. Sublingual gland, located in shallow fossa upon inner side of body of mandible, near symphysis, is covered by mucous membrane of mouth; ducts (Bartholin's) terminate near fraenum linguae. Mention any one muscle which moves the humerus (a) forward, (b) backward, (c) inward. (.a) Coraco-brachialis ; (b) posterior fibres of deltoid; (c) latissimus dorsi. What would be the collateral circulation if the brachial artery were ligated below its profunda branches? Superior and inferior profunda above, anastomotic;! magna, radial and ulnar (anterior and posterior) recurrent below. (1) 2 ANATOMY. Describe the Meibomian glands. Sebaceous glands embedded in posterior surface of tarsal plates of eyelids, consisting of single duct with closely at- tached acini, orifices of ducts terminating in single row of apertures along posterior lid-margin. Give location and a description of the tubercula quad= rigemina. Located upon upper surface of crura cerebri, just behind third ventricle and beneath posterior part of velum inter- positum ; nates anterior to testes. They consist of gray mat- ter externally, white internally, and are connected with bra- chia of optic tracts. Describe the renal blood circulation. Arterial blood enters sinus through hilum by means of renal artery, branches of which pass between Malpighian pyramids to cortico-medullary junction, where they form transverse branches which send arterioles into cortical and medullary portions of kidney, forming glomeruli in the former, and plexuses around the uriniferous tubules in the latter. The veins collect the blood from these parts, form cortico-medul- lary branches and pass through medullary portion between pyramids, kaving kidney through sinus as renal vein. Mention the muscles attached to the great trochanter of the femur. Gluteus medius and minimus, pyriformis, obturator inter- nus, gemellus superior and inferior, obturator externus. What arteries, muscles and nerves would be severed in a cross=section at the middle of the humerus? Brachial, superior and inferior profunda; biceps, triceps, insertions of deltoid and coraco-brachialis, origin of brachi- alis anticus: musculo-cutaneous. internal cutaneous, median, ulnar, musculo-spiral. ANATOMY. 3 State origin, course, and distribution of sixth cranial nerve. Superficial origin, from groove between medulla and pons; course, forward through cavernous sinus, exit from cranial cavity by sphenoidal fissure; distribution to external rectus of eye. Give the relations of the right kidney. Rests upon quadratus lumborum and psoas magnus muscles, is in contact with under surface of right lobe of liver, has duodenum and ascending colon in front. Describe the right ventricle of the heart. Is placed mostly upon anterior aspect of heart, does not extend to apex, is crescentic in cross-section, contains tricuspid valve, which guards right auriculo-ventricular opening, to left and front of which is conus arteriosus leading up to pul- monary orifice, which is guarded by pulmonary semilunar valves, contains columna? carnese, musculi papillares and chordae tendinea?. Describe endothelium. Irregular, flattened (squamous) cells, attached edge to edge, resting on basement membrane. Describe the external carotid artery. One of the two terminal branches of common carotid, given off at level of upper border of thyroid cartilage, extends up neck, passes into parotid gland, where it terminates by divid- ing into superficial temporal and internal maxillary arteries. Branches are : Ascending pharyngeal, to lateral wall of pharynx; superior thyroid, to Larynx and thyroid body; lin- gual, to tongue; facial, to superficial parts of face; occipital. to post-cervical and occipital regions; posterior auricular, to external and middle ear; superficial temporal, to scalp; in- ternal maxillary, to deep parts of face and by middle menin- geal (through foramen spinosum of summit of bladder without cover- ing it.s anterior wall, thus forming prevesical space (space of Retzhia . I \ U ANATOMY. Describe the endocardium. Is continuous with the tunica intima of the vessels at the base of the heart, lines both auricles and both ventricles, and forms, strengthened by fibrous tissue, the several valves of the heart. What parts of the brain does the Pons Varolii connect? Cerebellum with posterior quadrigeminal bodies (testes), one cerebellar hemisphere with the other, parts below (cord and medulla) with cerebral hemisphere above. Name the ganglia connected with the 5th pair of cranial nerves. ' one of the five. Deltoid, coraco-bradiialis, biceps, triceps, teres major. Biceps takes origin by two heads, one from coracoid process of scapula, the other from upper margin of glenoid fossa, this tendon passing through shoulder-joint to reach bicipital groove; insertion is into deep fascia of forearm by semilunar (bicipital) fascia, and into bicipital tuberosity of radius; action is to flex forearm upon arm, and to supinate hand. Give the origin, course and branches of any one of the following arteries: brachial, temporal, left common carotid. Left common carotid arises from arch of aorta, courses upward and outward in line drawn from sterno-clavicular joint to mastoid, dividing a1 Level of upper border of thyroid cartilage into its only branches, external and internal carotids. 34 ANATOMY. Describe the hemispheres and lobes of the brain. The cerebral hemispheres are ovoid, convex upon superior and lateral surfaces, partially separated from each other by longitudinal fissure, but connected by corpus callosum. Frontal lobe occupies anterior fossa of cranial cavity, sepa- rated from parietal lobe by fissure of Rolando, and from anterior part of temporal lobe by Sylvian fissure; parietal lobe is bounded by fissure of Rolando anteriorly, parieto- occipital fissure posteriorly, Sylvian fissure inferiorly, great longitudinal fissure superiorly ; occipital lobe is found behind parietooccipital fissure ; temporal lobe is below fissure Sylvius, and rests in middle cranial fossa. Where m the topography of the abdomen is the sigmoid flexure located? The appendix vermiformis? (a) In left inguinal and hypogastric regions, (b) In right inguinal region. Give the surgical anatomy of femoral hernia. Neck of sac is at femoral, or crural, ring formed by Gim- bernat's ligament on inner side, femoral vein on outer, Pou- part's ligament in front, and horizontal ramus of pubic bone behind ; is closed by septum crurale ; crural canal is narrow interval between femoral vein and femoral sheath on inner side of vein, and extends from crural ring above to upper margin of saphenous opening below. Saphenous opening is closed by cribriform fascia. Describe the esophagus. Extends from lower margin of cricoid cartilage to stomach, is ten inches long, situated behind trachea in neck and in posterior mediastinum in thorax; curves forward to esopha- geal opening in diaphragm, through which it passes, accom- panied by pneumogastric nerves; wall consists of external longitudinal and internal circular muscle fibres, a submucosa and a mucous membrane, which is thrown into longitudinal folds, and is made up of stratified epithelial cells. ANATOMY. 35 What is connective tissue? Where in the body is con- nective tissue found? Connective, or areolar, tissue consists of branched cells, or connective tissue corpuscles, the fibres of which interlace and form spaces or areolse. It is freely distributed throughout the body, forms sheaths of muscles, blood vessels, nerves, etc., binds parts together and forms a generally evenly spread-out layer beneath the skin, the superficial fascia. Into what and how far from the pyloric orifice of the stomach does the ductus communis choledochus normally open? Into the duodenum upon its concave side f descending por- tion) three or four inches below the pyloric orifice. Give the course, relations and structure of the ureter. Begins in the upper expanded portion, the "pelvis of the kidney," passes downward behind the peritoneum upon the psoas magnus muscle, over the brim of the pelvis into pelvic cavity, forward to base of bladder, between rectum and blad- der in male, V2 inch from cervix in female, then between vagina and bladder, terminating at posterior angle of trigone. It consists of three coats, fibrous, muscular and mucous. What constitutes the brachial plexus? The 5th, 6th, 7th and 8th cervical nerves and 1st thoracic nerve. Mention the ligaments, fissures and lobes of the liver. Ligaments are five in number, falciform (suspensory), round, coronary, right and left lateral; fissures are five in number, fissure for round ligament (obliterated umbilical vein), for gall-bladder, for ductus venosu-. for inferior cava and transverse fissure; lobes are five in number, right, left, quadrate, Spigelian, caudate. Mention the abdominal muscles. Describe any one of these muscles. Externa] and internal oblique, transversalis, recti, pyra- 36 ANATOMY. midales. (Quadratus lumborum, psoas magnus and parvus, and iliaeus might be included) . Internal oblique takes origin from outer half of Poupart's ligament, from anterior two- thirds of middle lip of iliac crest, from lumbar aponeurosis, from last three ribs; is inserted into linea alba and inner extremity of ilio-pectineal line behind Gimbernat's ligament. Its aponeurosis divides to form sheath of rectus for its upper three- fourths, passing in front of rectus for its lower fourth. The line of this division of internal oblique is called linea semilunaris ; internal oblique unites with transversalis to form conjoined tendon. Action is to flex thorax upon pelvis, or vice versa, to rotate trunk toward same side, and to compress abdominal viscera. Locate the principal groups of lymphatic glands. Inguinal (superior and inferior), axillary and cervical (superficial and deep). Give the anatomy of the true vocal cords. Are two in number, formed by crico-thyroid membrane, attached to retiring angle of thyroid cartilage anteriorly and to vocal process of arytenoid cartilage posteriorly; have thy ro- arytenoid muscle along their outer side. They are covered by mucous membrane, which is closely attached and thin, and consisting of stratified, squamous epithelial cells. Give the point of opening of the parotid duct, of the submaxillary duct and of the sublingual duct. Parotid duct, in cheek wall opposite middle upper molar tooth; of submaxillary duct, in frsenum lingua?; sublingual duct, close to frsenum linguae. Describe the ischiorectal fossae and their contents. Are located between the lower part of the rectum and the ischial tuberosities; are triangular in shape, bounded inter- nally by sphincter ani, levator ani and coccygeus muscles ; externally by tuberosity of ischium; are filled with adipose tissue; in outer wall is internal pudic artery; crossing the space are inferior hemorrhoidal vessels and nerves. ANATOMY. 37 Give the origin, insertion and action of any one of the following muscles: digastric, sacrolumbalis, rectus ab- dominis. Rectus abdominis takes its origin from body of pubic bone and from anterior ligaments of pubic symphysis of opposite side, is inserted into costal cartilages of 5th, 6th and 7th ribs ; contains three transverse lines (linese transversa^) , which extend in zigzag style across the muscle in its upper part ; action is to flex thorax upon pelvis, or vice versa, and to compress abdominal viscera. Give four principal points of distribution of the pneu- mogastric or par vagum nerve. Pharynx (motor), larynx (motor and sensory), heart (superficial and deep cardiac plexuses), stomach (uniting with sympathetic system). What is contained in the middle mediastinum? Heart and pericardium, ascending aorta, lower part of superior cava, vena azygos major, both bronchi, pulmonary artery and veins, phrenic nerves. What anatomical parts are involved in the descent of the testes? I iiibernaculum testes, visceral and parietal layers of peri- toneum, transversalis fascia, inguinal canal and rings, internal oblique muscle (cremaster muscle and cremasteric fascia), intercolumnar fascia. Describe the bones forming the ossa innominata. riiuni lias curved crest extending from anterior superior to posterior spine; internally is iliac fossa (false pelvis, limited below by ilio-pectineal line) ; externally are superior, middle and inferior gluteal lines; greater sciatic notch is behind, partly formed by ischium; anterior inferior spine I'm- rectus femoris and ilio-femoral I V I Ligament is below anterior supe- rior spine; ilium forms pari of true pelvis and two-fifths of 38 ANATOMY. acetabulum; fuses with os pubis and ischium at 18th to 20th year; articulates with sacrum by auricular surface. Ischium has a body above, with spine of ischium projecting backward and inward, and separating greater from lesser sciatic notches ; lesser sciatic notch is on ischium below spine ; tuberosity of ischium is lowest part, from which ramus as- cends toward pubic bone and partially bounds obturator foramen; ischium forms two-fifths of acetabulum and part of true pelvis. Os pubis has body (articulates with opposite bone, forming symphysis pubis) ; horizontal and descending ramus, bound- ing obturator foramen; pubic spine for Poupart's ligament; ilio-pectineal line extending from body along horizontal ramus; on under surface of latter is groove for obturator vessels and nerve. Describe the sternum, its articulations and the import- ant muscles attached to it. Consists of manubrium, gladiolus and ensiform appendix; suprasternal notch is above, between clavicles; notches are found along lateral borders for articulation of first seven pairs of ribs (costal cartilages), and at upper outer angles of manubrium for clavicles; transverse ridge (subcutaneous landmark) exists at line of junction of manubrium and gladi- olus, marking level of third rib; ensiform varies in size and shape. Important muscles attached are sterno-cleido-mastoid and pectoralis major; rectus abdominis and diaphragm are attached to ensiform. What portion of the bladder is uncovered by perito- neum? The anterior wall, which is separated from symphysis pubis by prevesical space (cavum Retzii). Describe the spinal cord. Is contained in neural canal, and extends from lower mar- gin of foramen magnum to body of second lumbar vertebra; constitutes 2 per cent, of cerebro-spinal axis; is surrounded ANATOMY. 39 by dura, arachnoid and pia; has two enlargements, cervical and lumbar, which mark points of origin of large nerve trunks for upper and lower extremities respectively (brachial and sacral plexuses) ; white nerve matter surrounds gray, which is arranged like two inverted commas (or capital "H"), connected by transverse band (gray commissure) ; anterior horn of gray matter contains large multipolar cells continuous with motor nerves, which appear upon surface of cord at antero-lateral aspect; posterior gray horn is continuous with sensory nerves, which appear upon postero-lateral aspect of cord. Describe the hyoid bone. Is U-shaped, placed, with convexity forward, above thyroid cartilage; consists of centrally located body, two greater cor- nua directed backward and two lesser cornua projecting up- ward at point of junction of body and greater cornua. Hyoid bone serves for attachment of thyro-hyoid membrane and ligament and stylo-hyoid ligament; of sterno-hyoid, thyro- hyoid, omo-hyoid, genio-hyoid, genio-hyoglossus. hyoglossus, mylohyoid, stylo-hyoid and digastric muscles. Name the articulations of the superior maxillary bone. Frontal, lachrymal, nasal, malar, palate, ethmoid, inferior turbinal, vomer and opposite maxilla. Give the origin and distribution of the olfactory nerve. Olfactory tract appears upon surface of cerebrum at ante- rior perforated space, extends forward, terminating in olfac- tory bulb, which rests upon cribriform plate of ethmoid: from under surface of bulb 20 to 30 nerves descend, enter superior nasal meatus, _ r rooving perpendicular plate and superior ami middle turbinal processes of ethmoid, and are distributed to nasal mucous membrane covering these parts. Describe the mammary glands. Two hemispherical, lobulated glands placed upon anterior thoracic wall over pectoralis major muscle, covering a s; 40 ANATOMY. from the second to the sixth rib, and from margin of sternum to anterior margin of axilla. Nipple, sensitive and pigmented, projects from center, and contains orifices of lactiferous ducts; areola, also pigmented, surrounds nipple; gland substance is arranged in lobules (10 to 20), each of which is a compound, racemose gland, and all are surrounded and supported by fibrous tissue, forming a capsule. Describe each of the tunics of the eye and the different parts of each. Sclerotic is outermost, consisting of bundles of fibrous tissue closely interlaced, is perforated to nasal side of pos- terior pole by optic nerve, and is continuous with cornea anteriorly. Six ocular muscles are inserted into it. Cornea is transparent, consists of bundles of fibrous tissue enclosing corneal spaces, in which are lodged corneal corpuscles; is covered by conjunctival epithelium and lined by Descemet's membrane ; is richly supplied by sensory nerve fibres, but is non-vascular. Uveal tract consists of choroid, ciliary -body and iris, is vascular and pigmented ; choroid is perforated by optic nerve behind; ciliary body is made up of ciliary pro- cesses and ciliary muscle ; iris is placed in front of lens in anterior chamber, and is perforated at its center (pupil). Retina is innermost tunic, made up of nerve cells and fibres, representing an expansion of the optic nerve; macula lutea is point of most acute vision, and is located to temporal side of optic disk, or point of entrance of optic nerve; retina is supplied by arteria centralis retina?, branch of ophthalmic artery, and drained by central vein of retina into ophthalmic vein. What are the vesiculae seminales? Two dilated pouches placed between bladder and rectum, uniting with vasa deferentia to form ejaculatory ducts. Give the course of the posterior tibial artery. Extends from lower border of popliteus muscle down leg between superficial and deep layers of muscles to inner side ANATOMY. 41 of ankle, where it divides into internal and external plantar branches. Which of the cranial nerves has the widest distribution? Pneumogastric (10th). Describe the origin and distribution of the ninth pair of cranial nerves. Ninth, or glosso-pharyngeal, nerve has superficial origin from groove between olivary and restiform bodies of medulla ; is distributed to pharynx (sensory) and to posterior third of tongue, especially to circumvallate papillae. Give the distribution of the radial nerve below the wrist. To radial half of dorsum of hand, and dorsum of thumb, index, middle and middle-finger half of ring linger, except, distal segments of digits, which are supplied by median nerve. What is the linea alba and how is it formed? Is the line of fusion of aponeuroses of external and in- ternal oblique and transversalis muscles, extending from en- siform above to symphysis below; just below its center is umbilicus. Describe the sphincter ani. Are two in number, internal, or involuntary, and external, or voluntary. Internal is farmed by circular fibers of rectal wall; external is attached to tip of coccyx, surrounds anal opening, and is inserted into median line of perineum. Describe the periosteum. Is closely adherent to outer surface of bone and consists of two layers, an outer, fibrous Layer, and an inner, vascular layer. In young and growing bones the inner is called the osteogenetic layer. Nerves and lymphatics are also present in periosteum. Give the origin, insertion and action of any one of the 42 ANATOMY. following muscles: tibialis anticus, pronator radii teres, gracilis. Tibialis anticus arises from upper % of outer surface of shaft and under surface of outer tuberosity of tibia, from interosseous membrane; is inserted into internal cuneiform and first metatarsal bones; action, to flex and invert foot; to strengthen and help maintain antero-posterior arch of foot. Give a general description of the cerebral veins. Remarkable for thinness of their walls due to lack of muscu- lar tissue; they have no valves; superficial cerebral veins are lodged in sulci between convolutions, receive blood from sub- stance of brain and terminate in the sinuses, opening into them in the opposite direction to which blood is flowing ; deep cerebral veins drain the ventricles into straight sinus ; at base basilar vein drains interpeduncular space and basal ganglia. Relate the differences between a virgin uterus and the uterus of a multipara. Uterus of multipara is larger (especially body), arbor vitoe uterinae of cervix is more or less effaced, external os is irregular, or perhaps stellate, instead of being a smoothly outlined, transversely directed slit. Describe a hair follicle in its relations to the skin. A hair follicle is an involution of epidermis, forming a funnel-shaped depression sometimes extending into subcu- taneous cellular tissue; is usually placed obliquely and be- comes enlarged at bottom to accommodate hair bulb, part of which is vascular papilla derived from dermal lining of follicle; opening into follicle are ducts of one or more se- baceous glands. What are the Wormian bones? Bones developed from separate centers of ossification to fill in gaps between certain of the cranial bones; they are found most frequently in lambdoid suture, occasionally oc- cupying position of fontanelles, especially posterior. ANATOMY. 43 Name the humors of the eyeball. Aqueous humor, contained in anterior chamber, consists of 98.6% water, and small quantities of extractives and pro- teids ; vitreous humor, occupying the large posterior chamber, has about the same composition as aqueous humor. State the origin of the sensory division of the fifth pair of cranial nerves. Superficial origin is from under surface of pons, close to anterior border. What is the function of the third cranial nerve? To supply with motor influence all ocular muscles except superior oblique and external rectus, and to furnish motor root to ophthalmic ganglion. Describe the ramus of the jaw. Mention the muscles and ligaments attached to the ramus of the jaw. / Ramus extends upward and slightly backward, forming angle of jaw by its junction with the body; is surmounted by coronoid process anteriorly and condyle posteriorly, be- tween which is sigmoid notch ; upon inner surface is inferior dental foramen. Muscles and ligaments attached are : Temporal, external and internal pterygoids, masseter; capsular and internal lateral ligament of temporo-mandibular articulation, stylo-mandibu- lar ligament. Describe the arytenoid cartilages. Are pyramidal in shape, rest upon upper, posterior part of cricoid cartilage by their bases, have true vocal cord (thyro- aretynoid ligaments) attached to vocal process anteriorly; lateral crico-arvtenoid, posterior cricoarytenoid, arytenoid and thyro-arytenoid muscles are also attached. The arytenoid cartilages are covered with mucous membrane and between them is the Lnterarytenoid space. 44 ANATOMY. Give the course and relations of the external jugular vein. Is formed near angle of jaw by union of temporo-maxillary and posterior auricular veins, runs downward and outward upon sternoniastoid muscle and under platysma myoides, to empty into subclavian vein at middle of clavicle. Mention the branches of the internal iliac artery. Anterior trunk: Superior, middle and inferior vesical, ob- turator, middle hemorrhoidal, uterine, vaginal, internal pudic and sciatic. From posterior trunk : Ilio-lumbar, gluteal, lateral sacral. Give the course of the female ureters. Rest upon psoas magnus muscles, pass over brim of pelvis into cavity of same to base of broad ligaments, then !/2 inch from cervix uteri, laterally, obliquely forward and inward in anterior vaginal wall to base of bladder. What nerves form the pharyngeal plexus? Glosso-pharyngeal, pneumogastric and cervical sympathetic. What structures are severed in tracheotomy? Skin, superficial and deep cervical fascia and trachea ; per- haps anterior jugular vein, or branches, and thyroid isthmus. Describe the phrenic nerve. Is formed by the fourth cervical nerve, chiefly, passes down- ward upon anterior surface of scalenus anticus muscle, enters superior, then middle mediastinum and perforates diaphragm to supply its under surface. Describe the ulnar artery as to (a) origin, (b) course, (c) distribution. (a) Is one of terminal branches of brachial; (b) is beneath superficial flexors of forearm, passes obliquely to ulnar border, having ulnar nerve to ulnar side of it for lower % of its extent, then curves across palm near lower border of anterior annular ligament (superficial palmar arch), first sending ANATOMY. 45 communicating branch to deep arch, (c) Is distributed to structures around internal aspect, of elbow, to ulnar side of forearm, to interosseous membrane, anteriorly and posteriorly. and adjacent muscles, and to palm and flexor surface of fingers. How are the saphenous veins formed? Where do the saphenous veins empty? Internal saphenous is formed upon dorsal surface of foot and inner border: external saphenous is formed upon dorsum and outer border of foot. Internal saphenous vein empties into femoral at saphenous opening in fascia lata; external saphenous terminates in popliteal vein. Give the situation of the lymphatic glands of the thorax. Intercostal spaces posteriorly, anterior and posterior medi- astina. around bronchial tubes. Give the boundaries and mention the contents of the posterior mediastinum. Is bounded in front by pericardium and roots of lungs, behind by vertebral column and on either side by pleura. It contains descending thoracic aorta, greater and lesser azygos veins, pneumogastric and splanchnic nerves, esophagus, thor- acic duct and lymphatic glands. Describe the internal abdominal ring. I- oval in shape, long axis directed vertically, located in transversalis fascia y 2 inch above Poupart's ligament and midway between anterior superior iliac and pubic spines. Structures of spermatic cord pass through it in male, round ligament in female. Infundibuliform fascia is attached to its margin; deep epigastric artery courses along inner margin. Give a method by which the fissures of Sylvius and Rolando may be approximately mapped out on the sur- face of the skull. are of Sylvius: Draw a line from a point one inch and a quarter horizontally behind externa] angular process of 16 ANATOMY. frontal bone to a point % of an inch below parietal eminence. Fissure of Rolando: From a point y 2 inch behind mid-point of line between glabella and external occipital protuberance, draw a line for 3% inches over side of head at angle of 67° with median line. Locate and describe Peyer's glands. Are located in wall of ilium, more numerous at lower part; are more or less oval bodies collected together; con- sist of adenoid (lymphoid) tissue. Describe the tonsils and name some of the arteries which supply them with blood. Are placed between anterior and posterior palatine arches, in tonsillar recess, close to base of tongue, vary greatly in size and shape, surface is irregular and marked by numerous depressions leading into crypts in substance of tonsil, and are surrounded by closed follicles of lymphoid tissue. Arteries: Dorsalis linguae, ascending palatine and tonsillar of facial, descending palatine of internal maxillary, ascending pharyn- geal. Describe the male urethra and state its divisions. Divided into prostatic, membranous and spongy portions; prostatic passes through prostate gland, has veru montanum and orifices of ejaculatory duets in its floor, upon either side of which are prostatic sinuses with orifices of prostatic glands; membranous portion is shortest of the three, is con- tained between the two layers of triangular ligament, and surrounded by compressor urethrae muscle; spongy portion is contained in corpus spongiosum, terminates at meatus urin- arius externus (least dilatable part of urethra) and has several depressions in mucous membrane of roof, largest of which, just behind fossa navicularis, which is close to meatus, is named lacuna magna. What is the origin and course of the pulmonary artery? Origin is from right ventricle; course is upward and ANATOMY. 47 slightly to left to under surface of transverse portion of aortic arch, where it divides into right and left pulmonary arteries for right and left lungs respectively. Give the names of the principal muscles of the back. Trapezius, latissimus dorsi, rhomboideus major and minor, erector spinse. Locate and describe the rectum. Extends from third piece of sacrum to anus, with forward curve, is covered by peritoneum in front and on the sides only; longitudinal and circular muscular fibers pronounced: mucous membrane thick, presenting several permanent, trans- verse folds, plicce recti, or valves of Houston ; is supplied by superior, middle and inferior hemorrhoidal arteries; is be- hind bladder and prostate in male and vagina in female. Where does the abdominal aorta commence and where does it terminate? Commences at aortic opening in diaphragm upon body of twelfth thoracic vertebra; terminates upon body of fourth lumbar vertebra, just to left of median line. Where is the foramen ovale of the heart and what purpose does it serve? In the wall between the auricles; permits passage of blood in the foetus from right to left auricle, deflecting i1 from right ventricle and pulmonary circulation into general circulation. What are the lymphatic glands? Parts of lymphatic system consisting of adenoid tissue, enclosed in capsule, having afferent and efferent lymphatic els; lymph passes through them. Describe the changes in the vascular system at birth. Blood ceases to flow through umbilical vein and ductus venosus into inferior cava; hypogastric arteries become ob- literated; foramen ovale <-h>ses and blood then 'Iocs not pass 48 ANATOMY. from right to left auricle; ductus arteriosus, connecting pul- monary artery with arch of aorta becomes impervious and pulmonary circulation is actively established. In the anatomy of the brain what is the corpus callo- sum? Describe its connections. The great transverse commissure consisting of fibers which pass from one hemisphere to the other, connecting different parts of the cortex of one with that of the other, is located nearer the base than the top and forms the roof of the lateral ventricles. Mention a muscle (a) which moves the thumb outward, (b) which moves the head forward, (c) which moves the foot inward. (a) Abductor pollicis; (b) sterno-cleido-mastoid (rectus capitis anticus major) ; (c) tibialis anticus. What is the composition of intervertebral substance? How much of the spinal column does this substance form? Is made up of fibro-cartilage ; constitutes about V A of the spinal column. Give the boundaries of the anterior mediastinum. In front by the sternum, behind by the pericardium, later- ally by the pleuras. What are the ciliary processes in the eye? Where are they placed and what is their average number? Folds of middle tunic (uveal tract) consisting of con- nective tissue, blood vessels and pigment; are placed around periphery of lens close to edge, posteriorly, and number about seventy. State the action of each of the following muscles: mas- seter, tibialis anticus, gluteus maximus. Masseter, to bring lower jaw up against upper jaw; tibialis anticus, to flex foot upon leg and elevate and adduct inner border of foot ; gluteus maximus, to extend trunk upon thigh, or thigh upon trunk. ANATOMY. 49 Give a general description of the peritoneum. Name the principal organs covered by it. Is a closed sac | except in female, at orifices of Fallopian tubes) which lines abdominal wall (parietal layer) and partially or completely surrounds viscera (visceral layer), constituting their serous coat: it forms omenta: < ! astro-colic, or great omentum, gastro-hepatic, or lesser omentum, and gastro-splenic ; it forms mesenteries: Mesentery (proper), of small intestine, mesocolon (ascending, transverse, descending, sigmoid, mesoappendix) ; principal organs covered by peri- toneum are: Liver, stomach, spleen, small intestine, large intestine. Fallopian tubes, nterus, bladder. Describe the thymus gland. Is first found during second month of intrauterine life, is largest when child is two or three years old, and usually disappears before puberty; is located in anterior mediastinum and lower part of neck, between lungs, in front of heart and great vessels and trachea; consists of two lobes made up of lobules, which are essentially lymphatic in character. What are the suprarenal capsules and what are their relations to adjacent organs and parts? Are two in number, one placed upon the upper pole of each kidney; each consists of cortex and medulla with vessels entering and leaving at a hilum; cortex is yellowish in color and contains granular, polyhedral cells arranged in columns; medulla is darker in color, from presence of bloodvessels which are closely related to groups of large cells. Suprarenal bodies are partially covered by peritoneum and are in rela- tion, right with under surface of liver, left with spleen, stomach and pancreas. Describe the medulla oblongata. Is a part, of encephalon, continuous with spinal cord be- low and with pons above; it rests upon basilar process of occipital hone, consists of white nerve matter externally and gray matter arranged irregularly internally, the latter 1 50 ANATOMY. appearing upon the surface in floor of fourth ventricle, the lower half of which is formed by upper surface of medulla; upon ventral surface is anterior median fissure, partially obliterated below by decussation of crossed pyramidal tracts; near anterior part of inferior surface are olivary bodies; posterior columns diverge to form calamus scriptorius and to bound fourth ventricle laterally for its lower half; postero- laterally are restiform bodies which can be traced upward into cerebellum, forming inferior peduncles of latter. Cranial nerves from seventh to eleventh inclusive arise from side of medulla, while twelfth appears upon surface in groove between olivary body and anterior pyramid. Locate and describe the lachrymal gland. Is located in upper, outer and anterior part of orbit, to inner side of external angular process; is made up of lobules, or clusters of acini, arranged around the ducts, six to twelve in number, which empty into outer part of superior con- junctival fornix. Describe the lungs. Each is pyramidal in shape, base resting upon diaphragm, apex extending into superior aperture of thorax, lateral, con- vex surface being applied to thoracic wall and inner, mesial and irregularly concave surface looking toward mediastinum ; each possesses a root, placed upon inner surface, near pos- terior, thickened margin, and consisting of bronchus, pulmon- ary artery and vein, bronchial artery, nerves and lymphatics ; right lung has three lobes, left has two; each is made up of lobules consisting of a terminal bronchiole, around which are arranged clusters of air cells; each lung is invested by visceral layer of pleura, whose parietal layer lines thoracic wall. Describe the structure of the knee-joint. Bones: Femur, tibia, patella; ligaments: Internal and ex- ternal lateral, ligamentum patellae, posterior; these are strengthened and supported by aponeuroses of vastus externus and internal antero-laterally, semimembranosus posteriorly; ANATOMY. 51 chief internal ligaments are crucial, anterior and posterior; joint contains two semilunar cartilages which are attached to non-articular area upon upper surface of tibia; synovial mem- brane is extensive and complicated; movements: Flexion, ex- tension, slight rotation. Bound the popliteal space. Mention its contents. Above by outer and inner hamstrings, below by outer and inner heads of gastrocnemius muscle, with plantaris upon outer side; contents are: Internal and external popliteal nerves, popliteal vein and popliteal artery, termination of short saphenous vein and small lymphatic glands. Mention the principal branches of the coeliac axis. Gastric, hepatic and splenic arteries. What are the nerves of the eyeball? Optic, motor oculi and ophthalmic division of fifth (both through ophthalmic ganglion) and sympathetic fibers from cavernous plexus (also to ganglion). Describe the aural labyrinth. Osseous labyrinth, whose divisions are three semicircular canals posteriorly placed, a vestibule in middle, and cochlea anteriorly, all containing membranous labyrinth upon which terminal filaments of auditory nerve and its special neuro- epithelium are found. Describe the popliteal artery and give its branches. Is a continuation downward of femoral from opening in ad- ductor magnus .and divides at lower border of popliteus muscle into anterior and posterior tibial arteries; ii lies upon femur, posterior ligament of knee-joint, tibia, and fascia cov- ering popliteus muscle; it enters popliteal space at upper inner margin, and bisects it longitudinally; popliteal vein is superficial to it; branches are superior and inferior internal and externa! articular, azygos articular, sural (muscular to calf), and anterior and posterior tibial. 52 ANATOMY. What are the blood=vessels which supply the arteries called? Whence are the nerves of the arteries derived? (a) Vasa vasorum. (b) Vasomotor, from sympathetic system. Mention the varieties of epithelium. Squamous, columnar, ciliated, glandular, transitional, pig- mented, and neuro-epithelium. The first three may occur in a single layer, when it is named "simple;" or, in several lay- ers, when it is called "stratified." Describe the muscular tissue. Muscular tissue is of mesodermic origin and consists prin- cipally of elongated cells (fibrous cells) which have the in- herent power of contracting. The muscle fibers contain nuclei and, sometimes, that which corresponds to a cell wall, the sarcolemma. Voluntary and cardiac muscles are striated, due to the arrangement of alternate light and dark discs. Non-striated muscle is involuntary. Microscopically, they may be differentiated as follows: Striated. Non=Striated. Cardiac. Fibers striated trans- No striations. Striated longitudinally versely- and transversely. Has sarcolemma. Hyaline sheath. No sarcolemma. Nucleus beneath sarco- Nucleus in center. Nucleus oval and in lemma. center. Fibers do not branch, Fibers short. except in the tongue. Fibers branch freely. Describe a Haversian system. A Haversian system occurs in compact bone and consists of a system of channels through which the nutrient fluids pass. It consists of the following : A centrally placed canal, the Haversian canal, which is surrounded by concentric lay- ers or plates of bone, the lamellae. Between the plates of bone are irregular clefts, the lacunae, which communicate with each other and with the Haversian canal by means of radially placed canals — the canaliculi. ANATOMY. 53 Describe the formation of the teeth. The teeth are composed of three substances — the enamel, the dentine and the cementum. The enamel covers the ex- posed part of the tooth, the crown of the tooth. The ce- mentum covers the part of the tooth within the alveolus of the jaw. The junction of the enamel with the cementum is called the neck of the tooth. The bulk of the tooth is made up of the dentine, which extends from the root to the crown. Each tooth contains a cavity, the pulp cavity, which communicates with the exterior through a small aperture at the apex of the root, the apical foramen. The cavity con- tains a soft connective tissue — the pulp, rich in vessels and nerves. The fang, or root of the tooth has a fibrous invest- ment called the peridental membrane, or periosteum. Give a brief description of the facial nerve. The 7th cranial nerve, after passing through facial canal (aqueductus Fallopii) of temporal bone, emerges at the stylo- mastoid foramen, and enters substance of parotid gland. Here it divides into 2 sets of branches, temporo-facial and cervico-facial, supplying muscles of expression. Its chorda tympani branch traverses inner surface of membrana tym- pani, after leaving main trunk in facial canal, and emerg- ing through one end of the Gasserian fissure unites with lin- gual branch of 5th and accompanies it to submaxillary gland and ganglion and anterior % of mucous membrane of tongue. Describe the elbo\v=joint. Is a ginglymus, or hinge-joint, made up of lower end of humerus and upper ends of radius and ulna: head <•! radius articulalrs with eapitellum, and greater sigmoid cavity of ulna with trochlear surface of humerus. Its capsule is divided into anterior and posterior, internal and external lateral ligaments. It permits of flexion and extension. It is Lubricated by synovial membrane lining its capsule. Describe the superior vena cava. [> formed by union of right and left innominate (jugulo- 54 ANATOMY. cephalic) veins, just below cartilage of 1st rib (close to right border of sternum) ; is nearly three inches long and terminates in right auricle; it receives vena azygos major. Describe the temporo=maxillary articulation, mentioning the ligaments. Bony parts are glenoid fossa and articulating eminence of temporal bone, and condyle of mandible; ligaments form a capsule, much stronger externally and posteriorly; external lateral ligament extends between tubercle of zygoma and neck of condyle; associated ligamentous bands are spheno- mandibular and stylo-mandibular ; an interartieular cartilage contained within the joint cavity has tendon of insertion of external pterygoid muscle attached to it. Movements per- mitted are depression and elevation of jaw around a trans- verse axis, and a sliding forward of both sides, protruding chin, or of one side at a time, producing a triturating movement. Describe the maxillary sinus (or antrum of Highmore). Is a triangular cavity contained in body of maxilla, lined with mucous membrane and communicating with middle meatus of nose through one or two small openings; apex of cavity is formed by malar process of maxilla; base is formed by outer wall of nose ; in its posterior wall are posterior dental canals for posterior dental vessels and nerves to the teeth ; in floor are usually seen several elevations, correspond- ing to roots of 1st and 2d molar teeth. Describe the aorta. Springs from left ventricle, anteriorly, extends upward to upper border of right 2d costal cartilage, then arches backward to left and descends through thorax, resting upon vertebral bodies, passes through aortic opening in diaphragm and courses through abdominal cavity as far as body of 4th lumbar vertebra. Branches are : Two coronary from ascending portion ; in- nominate, left common .carotid and left subclavian from arch ; ANATOMY. 55 bronchial, intercostal, pericardiac, esophageal and posterior mediastinal from thoracic portion; 2 phrenic, lumbar, sacra media (parietal branches), celiac axis (gastric, hepatic, splenic), superior mesenteric, inferior mesenteric (single branches from front), suprarenal, renal, spermatic (or ovarian) (lateral paired branches) from abdominal portion. Describe the trachea and give its anatomical relations. It extends from the larynx to the bronchi, and consists of a series of transversely directed, incomplete rings of cartilage united by an elastic membrane which contains involuntary muscle-fiber posteriorly, where the cartilaginous ring is de- ficient; it is lined with a mucous membrane which is covered with ciliated columnar epithelial cells. The trachea rests upon the esophagus, being flattened pos- teriorly; in the groove between these two structures is the recurrent laryngeal nerve, upon each side; the common caro- tid artery, internal jugular vein and pneumogastric nerve are close to it at its lower portion, while the isthmus of the thyroid body crosses it upon its second and third rings, and the lobes of the same rest upon it laterally. Describe the pulmonary veins. They are four in number, usually, 2 for each lung, and return arterial blood from lungs to left auricle of heart. Describe the spinal column. It consists of 33 separate vertebrae, distributed as follows: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal. Sacral and coccygeal coalesce early in life by ossification of inter- vertebral substances; cervical segment possesses curve with convexity forward, thoracic with convexity backward, lum- bar with convexity forward, sacral with convexity backward; line of gravity passes through chords of these curves. Special or i iiliar vertebra? are: Atlas, axis, 7th cervical (vertebra prominens) ; ribs articulate with thoracic series; ilia articulate with sacrum. Spinal column contains neural canal I'm' spinal cord. 56 ANATOMY. Give the minute anatomy of the skin. The skin consists of the cutis vera, formed of fibrous tissue, the superficial layer being raised into numerous papillae. This is the vascular layer of the skin. The end bulbs of the sensory nerves are found here also. Covering the cutis vera is the epidermis, formed of numerous layers of epithelium. There are four strata of the epithelium: The outer, horny, or stratum corneum; the stratum lucidum; the stratum granu- losum, and the inner or stratum mucosum. Give a general description of the alimentary canal, nam= ing its successive divisions. Its parts, in order, are: Mouth, pharynx, esophagus, stomach, small intestine (duodenum, jejuno-ileum) , large in- testine (cecum, ascending, transverse, descending and sigmoid colons, rectum and anal canal) . Mouth is composed of upper and lower jaws covered by cheek walls, with buccal orifice directed transversely; con- tains tongue, at base of which are fauces with anterior and posterior pillars and tonsils. Pharynx joins esophagus at lower border of cricoid carti- lage; esophagus is 10 inches long and passes through dia- phragm to be continued into stomach. Stomach occupies epigastric and left hypochondriac regions and presents a cardiac and a pyloric extremity and a greater and lesser curvature. Its wall consists of 4 coats, viz., serous, muscular, areolar and mucous. Duodenum is fixed and curved around head of pancreas; common bile and pancreatic ducts open into it; jejuno-ileum, attached to posterior abdominal wall by mesentery, extends for 20 feet, or more, to ileo-cecal junction, where it joins large intestine; vermiform appendix is attached to cecum (usually inner side), below ileo-cecal valve; ascending colon passes to liver, forms hepatic flexure; transverse colon, with great omentum attached, crosses to spleen and forms splenic flexure ; descending colon reaches left iliac fossa and is continued into sigmoid which curves around into pelvis, resting on sacrum; ANATOMY. 57 rectum curves forward and anal canal, guarded by internal in voluntary) and external (voluntary) sphincters, opens downward and slightly backward. State the origin and exit of the pneumogastric nerve. Superficial origin, from side of medulla in groove between olivary and restiform bodies; exit, through jugular foramen. Describe the mastoid portion of the temporal bone. Mastoid bone is placed behind, is rough and convex exter- nally and projects downward and forward as mastoid process; beneath are digastric fossa for posterior belly of digastric muscle, and occipital groove for occipital artery; within sub- stance of mastoid are mastoid cells, the largest of which is called mastoid antrum, which communicates with middle ear; upon cerebral surface of mastoid is sigmoid groove for lateral sinus. Describe the lateral sinuses. Right and left lateral sinuses commence at internal occi- pital protuberance, right being formed by superior longitu- dinal sinus, left by straight sinus; are located in attached margin of tentorium, grooving occipital, parietal, mastoid and occipital bone again, leaving cranial cavity through jugular foramen, just outside of which they unite with inferior pe- trosal sinus to form internal jugular vein. Give the origin and insertion of the muscles which form the anterior triangles of the neck. The anterior common triangle is hounded above by the lower border of the mandible and a line extending backward from the angle of the mandible to the mastoid process of the temporal hone; in front, by the median line of the neck; behind, by the anterior border of the Bterno-mastoid muscle. This common triangle is divided into the submaxillary, su- perior carotid and inferior carotid triangles, by the posterior belly of the digastric muscle above and the anterior belly of the omo-hyoid below. Sterno-mastoid muscle : I Origin, from anterior surface of up 58 ANATOMY. per part of manubrium sterni and inner third of anterior border of clavicle; insertion, into mastoid process of temporal and outer Half of superior curved line of occipital bone. Omo-hyoid muscle: Origin, from upper border of scapula to inner side of suprascapular notch; insertion, into body of hyoid bone. Digastric muscle : Origin of posterior belly is from digastric fossa of mastoid portion of temporal bone, and of anterior belly from lower border of mandible close to symphysis; in- sertion, into central tendon, which is attached to body and greater cornu of hyoid bone. Name and describe the course of the arteries supplying the hand. Radial and ulnar arteries. Course of radial artery is from just below bend of elbow down radial border of forearm to outer side of wrist, where it turns over on to dorsum of hand, passes down through proximal end of first interosseous space to reach palm, now passing transversely across deep part of palm to anastomose with deep communicating branch of ulnar artery. Course of ulnar artery is from near head of radius in a curve over to ulnar border of forearm, thence along ulnar border to radial side of pisiform bone, where it divides into a superficial branch, to form superficial palmar arch and a deep branch to complete deep arch. Locate and describe the ovaries. The ovaries are located ordinarily close to lateral part of true pelvic brim, attached to posterior layer of broad ligament. They somewhat resemble a broad almond, are IV. inches in length, whitish in color, with an uneven, puckered surface, and consist of a covering of germinal epithelium, and a stroma which encloses ovisacs, vessels and nerves. Locate and describe the principal convolutions of the brain. Ascending frontal convolution bounds the fissure of Rolando Q i> ANATOMY. 59 anteriorly, and belongs to the frontal lobe; ascending parietal convolution bounds the fissure of Rolando posteriorly, and is a part of the parietal lobe. In these convolutions are located important motor nerve-centers, controlling nerves which are distributed to the opposite side of the body. The cuneus is a convolution belonging to the mesial surface of the occipital lobe, between the internal parieto-occipital and calcarine fissures; in it. are located the cortical centers of sight. Describe the palmar fascia. It consists of a central and two lateral portions. Central portion is thick and binds down tendons and protects vessels and nerves; it is narrow above where it is attached to an- terior annular ligament ; below it is broad and divides into 4 slips for the four fingers, these being attached to under surface of skin at base of fingers, to sides of metacarpo-phalan- geal joints and to sides of metacarpal bones near their distal ends. Give the origin and insertion of the muscles of the scapulohumeral joint. Supraspinatus, infraspinatus, teres minor, subscapularis, deltoid, biceps and triceps. Supraspinatus: Origin, from inner % of supraspinous fossa j insertion, into highest facet of greater tuberosity of humerus, and blending intimately with capsular ligament of shoulder joint. [infraspinatus: Origin, from inner % of infraspinous fossa; insertion, into middle facet of greater tuberosity, also blend- ing with capsular ligament. Teres minor: Origin, from upper - ;; of axillary border of scapula; insertion, into lowest facet of greater tuberosity, also blending with capsular ligament. Subscapularis: Origin, from greater pari of subscapular fossa; insertion, into lesser tuberosity of humerus, its tendon of insertion also blending closely with capsular Ligament. 60 ANATOMY. Deltoid : Origin, from outer % of anterior border of clavicle, from outer margin of acromion and lower border of spine of scapula; insertion, into rough, triangular area on outer side of shaft of humerus near its middle. Biceps : Origin, from coracoid process and from upper mar- gin of glenoid cavity (short and long heads, respectively) ; insertion, into bicipital tuberosity of radius and by bicipital (or semilunar) fascia, into deep fascia of forearm. Triceps : Origin, from axillary border of scapula just be- low glenoid cavity (long, or scapular head), and from pos- terior surface of humerus, one head above, the other below, the musculo-spiral groove (2 short or humeral heads) ; inser- tion, into olecranon process of ulna. Describe the nasal fossae. Are 2 irregular cavities in middle of face, on either side of median line, separated from each other by mesially placed nasal septum ; they extend upward to anterior floor of cranial cavity, and downward to roof of mouth ; they open anteriorly by 2 large apertures, the anterior nares, and communicate with naso-pharynx by posterior nares. Roof is narrow, and formed in center by cribriform plate of ethmoid, anteriorly by nasal bones and nasal spine of frontal, posteriorly by under surface of body of sphenoid. Roof contains apertures in cribriform plate for olfactory nerves; behind are openings leading into sphenoidal sinuses. Floor is smooth, wider in middle than at either end, and is formed by palate process of maxilla, anteriorly, and by palate process of palate bone posteriorly. Inner wall consists of septum, which is made up of crest of nasal bones and spine of frontal, by perpendicular plate of ethmoid, by vomer and by rostrum of sphenoid, and below by crests of maxillary and palate bones. A large notch at an- terior extremity of bony septum receives the septal cartilage. Outer wall is formed, in front, by lachrymal bone and nasal process of maxilla; in the middle, by ethmoid, inner surface of maxilla, and inferior turbinated ; behind, by vertical plate ANATOMY. 61 of palate bone and internal pterygoid plate of sphenoid. The outer wall contains 3 irregular, longitudinal passages, viz., superior, middle and inferior nieati ; the superior meatus (smallest) is located at upper and back part of nasal fossa, is between superior and middle turbinated bones, and com- municates with spheno-maxillary fossa by spheno-palatine foramen, and with posterior ethmoidal cells by an opening in its outer wall. (Opening for sphenoidal sinus is above and behind superior turbinated bone). Middle meatus is situ- ated between middle and inferior turbinated bones. It con- tains, anteriorly, the orifice of the infundibulum, by which the middle meatus is placed in communication with the an- terior ethmoidal cells and the frontal sinuses; the middle ethmoidal cells and maxillary antrum also open into middle meatus. Inferior meatus is the largest, is formed by inferior turbinated above and floor of nasal fossa below; it contains, under cover of the inferior turbinated, anteriorly, the termin- ation of the naso-lachrymal duct. Name and locate the accessory sinuses of the face and describe their outlets. Frontal sinuses, contained between outer and inner tables of frontal bone above supraorbital arch, communicate through infundibulum with anterior ethmoidal cells ami middle nasal meatus. Ethmoidal cells, comprising greater part of lateral mass of ethmoid bone, and divided into anterior, middle and pos- terior. Anterior ami middle ethmoidal cells open into middle nasal meatus ; posterior ethmoidal cells open into superior nasal meatus. Sphenoidal cells for sinuses) arc contained within body of sphenoid bone and communicate with upper, hack part of nasal EbSSfL Maxillary sinus (antrum of Highmore) is situated in body of maxilla; its outlet is an aperture communicating with middle meatus of nose. 62 ANATOMY. Describe the iris, giving relations, nerve and blood supply. It is an elastic, contractile diaphragm, forming the anterior extremity of the middle, pigmented and vascular tunic of the eyeball. By its peripheral attached border it is directly continuous with the ciliary body; it is placed in front of the crystalline lens, and incompletely divides the anterior cham- ber into two compartments. Near its center is a circular opening, the pupil, which varies greatly in size. In structure the iris consists of a stroma of delicate fibrous and elastic tissue, with perhaps some involuntary muscle fibers. It is supplied by the ciliary nerves. The long and anterior ciliary arteries anastomose and form a vascular circle around the attached margin of the iris, sending branches in toward the pupillary margin. Describe the course and distribution of the nerves of the palm of the hand. Median, from outer and inner cords of brachial plexus, ac- companies brachial artery, rests upon flexor profundus digi- torum in forearm, passes beneath annular ligament into palm. It supplies all anterior forearm muscles except flexor carpi ulnaris and ulnar half of flexor profundus digitorum; cuta- neous branches supply palm, thumb, index, middle and half of ring fingers on their palmar aspect and nail-beds, and outer two lumbricales. Ulnar, from inner cord, descends along inner border of arm, behind inner condyle of humerus, then between flexor carpi ulnaris and flexor profundus, both of which it supplies ; it crosses anterior annular ligament with ulnar artery and divides to supply short muscles of little finger, all interossei, inner two lumbricales and flexor brevis and adductor pollicis; cutaneous distribution is to dorsum and palm of hand on ulnar side, and to little finger and ulnar half of ring finger. If the femoral artery were obstructed at the apex of ANATOMY. 63 Scarpa's triangle, through what channels would the blood flow to reach the tibial artery? Through profunda femoris and its branches, anastomosing with articular branches of popliteal. Name the structures that maintain the bladder in posi= tion, male and female. Recto- vesical fascia, folds of peritoneum, in both sexes; rectum in male, uterus ami vagina in female. Where are the ventricles of the larynx? Between the true and false vocal cords. Describe the triangle of the elbow and name the struc= tures that pass through it. Base directed upward, formed by line drawn between the two condyles, outer side bounded by supinator longus, inner side by pronator radii teres; floor is formed by brachialis a nt i cus and supinator brevis. It contains brachial artery and venae oomites. radial and ulnar arteries, median and musculo-spiral nerves, and tendon of biceps. Name the abdominal viscera partially covered by peri= toneum. Righl and left suprarenal bodies, right and left kidneys, pancreas, duodenum, ascending and descending colons, rec- tum, bladder, uterus. Describe the arteries and veins passing to and from the kidneys. Elena) artery, branch of abdominal aorta, enters hilum, breaks up into branches which pass between Malpighian pyra- mids to cortico-medullary junction, then sending branches into cortex and 1 lnlla.. Veins arc similarly arranged, be- Luniiiii'_ r in interior of kidney: they Leave by passing through sinus and hilum. known as renal vein, to join inferior cava. 64 ANATOMY. Give the anatomy of the bladder, including blood and nerve supply. A reservoir in the pelvis, partially covered by peritoneum, consisting of involuntary muscular fibers extending in longi- tudinal and circular directions, a submucosa and a mucous membrane, the latter possessing transitional, squamous epithe- lial cells. Blood supply is from internal iliac artery, through superior, middle and inferior vesical branches; nerve supply is from pelvic plexus of sympathetic and from 3rd and 4th sacral nerves. Describe the testes. They are two seminal glands contained within the scrotal cavity, suspended by the spermatic cord, and surrounded by a peritoneal process, the tunica vaginalis testis. Each gland consists of a fibrous stroma, the tunica albuginea, dividing the interior into compartments which contain the seminiferous tubules, the latter converging toward the posterior part of the gland, and emerging to constitute the epididymis. PHYSIOLOGY. Explain the physiological circuit essential to a reflex action. The essentials are an afferent nerve, a nerve center, an efferent nerve and the peripheral organ which it supplies. Mechanical irritation of the sensory fibers of the vagus in the mucous membrane of the stomach causes an increased flow of saliva by irritation of the salivary center in the medulla and consequent passage of efferent impulses to the salivary glands. What is the function of the sixth (abducens) nerve? The abducens is the motor nerve of the external rectus. Describe the respiratory function of the red blood cor- puscles. When the venous blood reaches the capillaries sur- rounding the air vesicles of the lung, the hemoglobin found in the red corpuscles rapidly combines with the absorbed oxygen to form oxyhemoglobin. This is carried back to the heart and then into the systemic circulation, finally reaching the capillaries. Here the tissues take the oxygen from the loosely combined oxyhemoglobin. The hemoglobin is then carried back to the lungs to be reoxygenated. The cor- puscles also carry small amounts of carbon dioxide from the tissues to the lungs. Describe the normal pulse; state the factors active in its maintenance, and give the average rate during infancy, youth and adult age. The pulse is the transmission of the cardiac impulse through 5 65 66 PHYSIOLOGY. out the arterial system. A normal pulse should be full, of moderate tension, regular and of the right frequency. It is ordinarily examined over the radial artery at the wrist, because in this position there is a hard surface against which we can press the artery. The factors active in its maintenance are the normal action of the heart and of the vasomotor system. The average rate during infancy is 130 to 140; during youth 80 to 90 ; during adult life 70 to 75. Name the active principles of the digestive secretions and state how each affects the food. Ptyalin of saliva changes starch into maltose. Pepsin, when hydrochloric acid is present, changes pro- teids into peptones. R/ennin changes caseinogen into casein. Amylopsin changes starch into maltose. Steapsin splits up fat into fatty acid and glycerin. Trypsin, in an alkaline medium, changes proteids into peptones. Invertin changes maltose into dextrose, and saccharose into equal parts of dextrose and levulose. Bile contains no ferment, but aids the pancreatic secretion in the emulsification of fats. From what portions of the cortex cerebri do the arm, face and leg receive their motor impulses? The motor area is along the fissure of Rolando in the as- cending frontal, ascending parietal and paracentral convolu- tions. The leg center is the uppermost, the arm center next, and the face center the lowermost. Describe the position of the vocal chords during phona= tion and name the factors concerned. The chink of the glottis during phonation is narrowed, the arytenoid cartilages are approximated and the vocal cords are stretched. The arytenoid muscle approximates the ary- tenoid cartilages, and with the help of the lateral crico-ary- PHYSIOLOGY. 67 tenoids and the internal part of the thyroarytenoids closes the glottis. The vocal ' cords are made tense by the crico- thyroids and external part of the thy ro- arytenoids. Give the origin of normal fat in the human body and name examples of the types of food from which it is elaborated. The normal fat of the body is derived from food ingested. Any excess of food is stored up as fat. Fat may be elabor- ated from fats ingested as olein, from carbohydrates as starch, or from proteids as casein. Describe a complete physiological revolution of the heart. During diastole the blood from the auricles passes into the ventricles. Toward the end of diastole the auricles contract, forcing the blood remaining in them into their respective ventricles; the ventricles now contract, the auriculo- ventricular valves are closed and the blood is forced into the pulmonary artery and aorta throusrh the open semilunar valves; the ventricles now relax, the semilunar valves clos- ing with a snap and the auriculo-ventricular valves being opened by the force of blood in the auricles and by the nega- tive pressure in the ventricles. If the cardiac revolution were divided into tenths, the first or systolic sound would occupy four-tenths, the short silence one-tenth, the second or diastolic Bound two-tenths, and the long silence three-tenths. Describe the process of respiration. Respiration is the function of taking in oxygen and the tli rowing off carbon dioxide. This exchange of gases take- place in the air vesicles where the blood and atmospheric air are separated by but a single layer of squamous epithelium. Three factors are concerned in this exchange -the law of pressure of gases, chemical affinity, ami the vital activity of tin- epithelium. in tissue respiration the pxygen passes through the endo- 68 PHYSIOLOGY. thelium forming the capillary wall, into the tissue, where it is used up. The carbon dioxide so formed passes from the tis- sues into the capillaries and thence to the lungs. What are the functions of the blood=vessels? Through the blood-vessels the blood is forced to the various parts of the body, carrying nutritive products to the tissues and waste from the tissues to the organs that excrete it. By their muscular wall they regulate the amount of blood going to various portions of the body, and together with the elastic tissue they contain also reduce the amount of work thrown on the heart. Through the capillary wall osmosis and diape- desis take place. Name and describe the normal respiratory sounds of the lungs and bronchi. The vesicular sound is a distant, soft, breezy sound, of low pitch, with the inspiration three or four times longer than expiration. It is caused by air passing through the bronchi, the sound being modified by the air vesicles. The bronchial sound is caused by the air rushing in and out of the bronchi. It is high pitched, loud, tubular in quality, the expiration being to inspiration as seven is to six. Of the functions of vision, what is understood by ac= commodation? By accommodation is meant the increasing of the curvature of the anterior surface of the crystalline lens to focus near objects on the retina. Describe the action of the kidneys, and give the normal constituents of the urine. The kidneys are compound tubular glands that pick out from blood certain waste material which passes down the tubules into the pelvis of the kidneys and then into the bladder. But one constituent of the urine is formed in the kidney and that is hippuric acid. PHYSIOLOGY. 69 The water filters through the glomeruli principally, while the urea is picked out by the rodded epithelium of the con- voluted tubules. No proper secretory nerves have as yet been found for the kidneys, which seem rather to be controlled by the vasomotor system. The kidneys have possibly an in- ternal secretion also. The normal constituents of the urine are — water, urea, uric acid, hippuric acid, sodium chloride, potassium and sodium sulphates, conjugate sulphate as indican, earthy and alkaline phosphates, sometimes carbonates and oxalates, and the coloring matters urochrome, urobilin and uroerythrin. Describe gastric digestion, with special reference to the changes effected upon the types of food. AYhen the food reaches the stomach the two openings close and the involuntary muscle contracts down on the mass and starts up a churning-like movement, by which fresh portions of food are constantly brought to the surface. At the end of an hour the pyloric orifice gradually relaxes, allowing some of the more liquid chyme to pass into the duodenum, and by the end of three or four hours even the larger pieces of un- digested food are forced into the duodenum. During this time the gastric juice is being poured out from the mucous membrane. The act of mastication and deglutition and the irritation of sensory vagi endings in the stomach by the food act as powerful reflex excitants to this secretion. The ptyalin of the saliva continues to change starch into maltose until the increasing acidity of the gastric juice stops its action. The fats are liquified, but it is upon the proteids that the chief action takes place. The rennin changes caseinogen into casein. The pepsin in the presence of the hydrochloric acid changes the proteids into proteoses and peptones. Describe the process of segmentation of the ovum. The impregnated ovum first divides into two cells by in- direct division or karyokincsis, these again subdivide, con- tinuing until finally a single layer of cells surrounding a 70 PHYSIOLOGY. central cavity is formed. One group of cells proliferates more rapidly than the other and as a result they become sur- rounded by the other layer; thus two leaves are formed. Between these a third layer or mesoblast is formed. From this blastoderm the animal is now developed. What is the relation of the capillaries to the circulation? The capillaries connect the small arterioles with the small- est veins. They are situated at the periphery. What precautions should be taken in the ingestion of vegetable foods? Give the reasons for taking these pre= cautions. Vegetable foods should be well cooked so as to burst the cellulose covering of the starch granules; they should be well chewed so as to break up the cellulose covering. Some fatty food should be taken -with them as they are deficient in fats. As some of them contain but little nutritive ma- terial, they should be taken in large quantities for obvious reasons. Describe the process of osmosis and give examples in the human economy. Osmosis is the diffusion of liquids through a porous mem- brane. For osmosis to take place the liquids must be miscible, of different natures, capable of wetting the membrane without acting on it chemically, and the substance must be able to pass through the membrane, that is, be crystalloidal in nature. Heat, increase of pressure and electricity aid osmosis. The following are examples of osmosis: (1) The passage of some of the plasma throitgh the capillary wall into the tissues. (2) The passage of glucose from the intestine into the portal circulation. Name the secretions of the alimentary canal and give the functions of each. Saliva changes starch into maltose, dissolves soluble sub- PHYSIOLOGY. 71 stances, thus allowing them to be tasted, lubricates the bolus of food and aids in speech. Gastric juice changes caseinogen into casein, and proteids into proteoses and peptones. It also destroys many micro- organisms swallowed in the food. Pancreatic secretion changes proteids into peptones, starch into maltose, caseinogen into casein, and splits up. saponifies and emulsifies fats. Bile neutralizes the acid chyme precipitating the pepsin, aids in the emulsification and absorption of fats, increases peristalsis, prevents excessive putrefaction, and contains some waste thrown off by the liver. Succus entericus changes maltose into glucose, and sac- charose into invert sugar. The alimentary canal has also the usual protecting and lubricating secretion of mucus. Describe urea, its occurrence, variations in the quantity excreted and recognition in the voided urine. Urea, CO(NH 2 ) 2 , the great nitrogenous waste, is a crystal- lizable substance soluble in alcohol and water, neutral in reaction and forming with nitric acid urea nitrate. About 500 grains daily are thrown off in the urine by the kidneys. It is formed in the liver ( |) and in the intestines (},). It varies principally with the amount of nitrogenous food in the diet. Muscular exercise does not increase it to any marked extent. It is recognized by adding nitric acid to a concen- trated urine when urea nitrate separates out in a crystalline mass, also by the hypobromite test. What is rigor mortis? What is tetanus? Rigor mortis is the post-mortem rigidity of the muscles due to Hie coagulation of the myosinogen. Tetanus is a state of continued contraction of a living muscle. Give the varied functions of the sympathetic nerve. The function of the sympathetic system is mainly vaso- 72 PHYSIOLOGY. motor. It also supplies the heart with accelerating fibers, the intestines with inhibitory and some motor fibers; dilates the pupil, and causes a bulging of the eyeball. It also has an influence on the salivary secretion. How are the phenomena of ventriloquism produced? Instead of the usual expiratory blast, an inspiratory blast is used in producing the vocal sounds. At the same time the operator directs the attention of the onlookers to some object. Describe the mechanism of micturition. Usually it is a mixture of a voluntary and involuntary re- flex act. The reflex center is situated in the lumbar cord. Stimulation of this center is ordinarily caused by a full bladder or by the escape of a drop of urine into the urethra, but may be excited by irritation of sensory nerves of other surfaces, as the intestinal mucous membrane by worms. Ordinarily the sphincter of the bladder is inhibited, the muscular wall contracts, and aided by the abdominal and other expiratory muscles forces the urine out through the urethra. There are higher centers that have control over the lower reflex centers. Name the ferments that are the essential constituents of each digestive fluid. Ptyalin is found in saliva; pepsin and rennin in gastric juice; amylopsin, steapsin, trypsin and a milk-curdling fer- ment in the pancreatic juice ; invertin in the succus entericus ; and the micro-organisms or organized ferments in the in- testines. Bile contains no ferment. What are the functions of the spinal cord? The spinal cord is the great motor and sensory pathway to and from the periphery. In the anterior horns are found the cells concerned in the muscular reflexes, and also the trophic centers for the muscles. Beside the muscular reflex- centers, the cord contains the following centers : Anospinal, PHYSIOLOGY. 73 vesicospinal, genitospinal, uterospinal, sweat, minor vaso- motor and possibly ciliospinal. What post=mortem tests should be applied to prove that air has entered the lungs of a supposedly still=born child? Tie the trachea, take out the lungs and place them in water. If they float, air has entered the lungs. The thorax is not as flat after respiration has started and the diaphragm is displaced further downward. The lungs are brighter in color and are crepitant after air has once entered. Wherein does the temperature of the body in advanced age differ from its temperature in middle life? In advanced age the temperature has a tendency to be- come subnormal from the slightest cause. Give in language or by drawing the sphygmographic tracing in aortic insufficiency. In aortic insufficiency there is the so-called "trip hammer pulse." In the sphygmogram there is a very high, quick up stroke and an almost as quick downstroke due to the rapid decrease in pressure caused by the regurgitation. On the downstroke a small dicrotic wave is seen. What are amyloid foods, proteid foods? Give three ex- amples of each. The amyloid foods are the carbohydrates in the molecule of which are six or multiple of six atoms of carbon, and hydrogen and oxygen in the proportion to form water. Starch, cane sugar and glycogen are amyloids. Proteids are highly complex bodies containing carbon, hydrogen, oxygen, nitrogen, sulphur and sometimes phos- phorus. Egg albumen, casein and gluten are proteids. How is cartilage (a) developed, (b) nourished? Cartilage is developed from the mesoblast The cells are not branched. By karyokinetic changes they divide and subdivide. Each cell is surrounded by a capsule which helps 74 PHYSIOLOGY. to form a portion of the matrix. But beside this, other material is deposited in the intercellular spaces. Cartilage is nourished by the perichondrium except arti- cular cartilage, which is nourished from the underlying bone. Describe nerve cells and nerve fibers. The nerve cells are nucleated masses of granular proto- plasm with one or more protoplasmic prolongations called dendrons. Passing off from most nerve cells is a long fiber or axis cylinder. The nerve fibers are either medullated or non-medullated. The medullated fibers consist of an axis cylinder or neur- axon, surrounded by the myelin or white substance of Schwann, which in turn is covered with the neurilemma or sheath of Schwann. An internal layer of protoplasm sepa- rates the myelin from the neuraxon, and an external layer separates the myelin from the neurilemma. Here and there along the course of the nerve are found the nodes of Ranvier. The non-medullated fibers contain no myelin. What experiments have been made to prove the glyco= genie function of the liver? The blood of the portal vein during active digestion of a carbohydrate meal contains more sugar than the hepatic vein, showing the arrest of dextrose in the liver. The hepatic vein in the intervals of digestion contains twice as much dextrose as that in the blood entering the liver. If a rabbit that has been fed on carrots is killed and the liver rapidly removed, cut into small pieces and thrown into boiling water, it yields an extract rich in glycogen and al- most free of dextrose. If another animal is treated the same but the liver al- lowed to stand for some time before making an extract, the extract will contain much dextrose and but little glycogen. The carbohydrate of blood is dextrose and not glycogen. Under the microscope, glycogen granules are found in the protoplasm of the liver cells. PHYSIOLOGY. 75 In what glands of the body is the function undeter= mined? With the exception of being able to say that they are all probably connected with general metabolism, the functions of the following glands are undetermined : Pituitary body, thymus, coccygeal gland. But little is known about, the adrenals and thyroids. What is the normal ratio of respirations to heart pul= sation? In a healthy adult there are four pulse beats to one re- spiration. Give the foramen of exit, the distribution and the func= tion of the oculomotor nerve. The oculomotor nerve leaves the skull through sphenoidal fissure. It supplies motor filaments to the superior, in- ternal and inferior recti, the inferior oblique, the levator palpebrae, the ciliary muscle and the constricting fibers of the iris. What office does the Eustachian tube perform? It equalizes the pressure of the air on the membrana- tympani, thus facilitating hearing. Define leucomain. Leucomains are alkaloidal or basic substances formed in the living tissue by metabolism, waste in nature, some of them toxic. Give the present physiologic conclusions in respect to the presence of the corpus Iuteum as a sign of pregnancy. According to Tidy, "there may be pregnancy without the presence of a true corpus Iuteum, and also bodies indis- tinguishable from true corpora luten may be found where there has been no pregnancy." The presence of the true corpus Iuteum nevertheless is usually a sii, r n of pregnancy. 76 PHYSIOLOGY. What effects are produced in the system by the removal of the thyroid gland? Removal of the thyroid gland is followed by peculiar de- praved condition of metabolism called cachexia strumipriva. Give the principal characteristics of gastric juice in man. Gastric juice is an acid limpid secretion with a specific gravity of about 1005, quantity ten pints daily. It contains especially pepsin, rennin and hydrochloric acid. How can fresh blood stains be distinguished from older blood stains? Fresh blood stains are brighter in color and the clot is flexible ; the older stain is darker and the clot is fragile. Describe color blindness and name the colors which the subject commonly fails to distinguish. Color blindness is the inability to perceive certain colors. The colors commonly indistinguishable are red and green. What are the functions of the brain membranes? The dura mater is tough and protecting, and also acts as internal periosteum to the bones of the head. The arachnoid is a thin spider-like membrane covered with endothelial cells that secrete cerebrospinal fluid. The pia mater is a vascular membrane dipping down into the sulci and carrying blood to the cortex. Name the solids in the urine and state the approximate amount of each voided daily by an adult. "Urea 500 grains; chloride of sodium 180 grains; sulphates (sodium and potassium) 30 grains; phosphate (earthy and alkaline) 45 grains; uric acid 7 grains; hippuric acid 7 grains; and small quantities of various pigments and other organic matter. Describe the factors which cause the heart sounds. The first sound is due to the sound of muscular contraction and to the closure of the auriculo-ventricular valves, as the PHYSIOLOGY. 11 blood tends to regurgitate into the auricles during ventri- cular systole. The second sound is due to the closure of the semilunar valves, as caused by the blood tending to regurgitate into the ventricles during diastole. What is the effect of an excessive meat diet? An excessive meat diet disturbs the general metabolism, causing diseased conditions associated with an increase in uric acid, as gout, rheumatism and migraine. Explain how the seminal fluid is conveyed to the vesi= culae seminales. It is conveyed to the vesiculae seminales by the vas deferens, which is the prolongation of the tube forming the epididymis. The vas deferens passes up from the testicles through the external and internal abdominal rings and to the vesiculae seminales on the posterior surface of the bladder. How and why is hearing affected by rupture of the membrana tympani? The membrana tympani, on account of its shape and the action of the tensor tympani, is capable of responding to many vibrations, and thus aids in the acuity of hearing. Describe cell growth. Cell growth is that peculiarity winch living cells have of taking in new material and incorporating it into themselves, thus increasing in size. Describe the phenomena of (a) asphyxia, (b) syncope, (c) sleep. Asphyxia is the condition caused by a deficient supply of oxygen. In the complete shutting off of the supply of oxygen we have three stages. First, the stage of marked in- spiratory efforts or dyspnoea, Lasting about one minute; second, the stage of convulsions with marked expiratory spasms, lasting about one minute; and third, the stage of ex lumstion and finally death. 78 PHYSIOLOGY. During the first stage the blood pressure begins to rise and heart becomes somewhat slower. During the second stage this rise in blood pressure is well marked and also the slow- ing of the heart. Toward the end of this stage as the re- spiratory movements cease unconsciousness ensues, the blood pressure falls and the heart becomes still slower, until death stops everything. Syncope is that condition of unconsciousness following a sudden depression of the vasomotor and cardiac nervous mechanism, causing anaemia of the brain. Sleep is a physiological condition of unconsciousness, due to a periodical need of the nervous system of rest. It is also due in part to the absence of external stimuli. It is ac- companied by an anaemia of the brain. Name, locate, and give the function of each of the vari= eties of epithelia. Epithelium secretes and protects the underlying tissues. Squamous epithelium, found in the mouth, protects the under- lying structures. Columnar epithelium, found in the intes- tinal mucosa, aids in the absorption of digested food products. Ciliated epithelium, found in the bronchial mucosa, forces dust and mucus up into the trachea to be coughed out. Cuboidal epithelium, found in the salivary glands, secretes saliva. Goblet-shaped epithelium, found in the mucous mem- branes, forms the mucous secretion. Stratified epithelium is composed of several layers, the uppermost generally squa- mous, and lowermost columnar. It forms the epidermis. Describe the lymphatic system. The lymphatic system consists of numerous small thin- walled vessels with many valves, commencing in the tissues as lymph capillaries and emptying into two large vessels that carry the contained lymph to the subclavian veins. In certain places along the course of the lymphatics, as in axilla and groin, are found groups of little glands called lymphatic glands. These consist of a cortical portion and 1'ILYSLOLOGY. 79 a medulla which is made of lymphoid tissue, in the center of which are a number of cells rapidly undergoing karyokinesis. All the lymphatics (including the lacteals of the intestine) with the exception of right half of the body from the dia- phragm upward, empty into the thoracic duct. This vessel, about the diameter of a goose quill, empties into the left subclavian vein. The lymphatics of the right side of the body from the diaphragm upward empty through a smaller vessel into the right subclavian vein. Describe the olfactory apparatus. What part of the olfactory apparatus is the seat of smell? The nasal cavities are divided into a lower or respiratory portion and an upper or olfactory portion. We find in the upper portion some broad supporting epithe- lial cells, and projecting upward from cells between these are little hair-like processes. The olfactory nerve ends in these specialized cells. The olfactory nerve passes from these cells through the olfactory bulbs and backward through three tracts to the cerebrum, ending for the most part in the uncus of the same side. What is the physiology of the so=cal!ed rest cure? The rest cure corrects faulty metabolism and brings the tissues again to their normal conditions. How is the descent of the testicle to the scrotum ac= complished? The descent of the testicle is now generally thought to be due simply to the arrangement, of the organs due to the process of development and not to the traction of muscular cord, as formerly thought. Describe the growth and the development of the teeth. The first step in the formation of the teeth is the down ward growth of the epithelium covering the rudimentary jaw. This forms the enamel germ, which develops especially al eer tain points. A little vascular papilla imw grows upward / 80 PHYSIOLOGY. into this enamel germ; thus we have the rudimentary teeth. The adamantoblasts of the enamel germ form the enamel, and the odontoblasts form the dentine which covers in the dental pulp. The crusta petrosa is formed from the cells forming the dental periosteum. What is the condition of the eyeball in myopia? How may it be corrected? In myopia the eyeball is too deep, causing the rays of light to be brought to a focus in front of the retina. It is corrected by a concave lens. Define physiologically the term cell. How are cells re» produced? A cell is a nucleated mass of protoplasm. Cells are reproduced by direct division, indirect division or karyokinesis, and endogenous nuclear multiplication. Describe the physical characteristics of cartilage. What is temporary cartilage, permanent cartilage? Illustrate. Cartilage is a firm, elastic, white or yellow-white sub- stance. Temporary cartilage is that which afterward is formed into bone, as the fetal femur. Permanent cartilage is that which remains as cartilage dur- ing life, as articular cartilage. Describe the white blood corpuscles, giving source, com= position and properties. The white blood corpuscles are nucleated masses of granu- lar protoplasm, about -rhns i n - m diameter and capable of amoeboid movement and phagocytic action. As to the varieties, we find the small lymphocyte, the larger transitional, the polymorpho-nuclear, and eosinophile con- taining large granules staining readily with eosin. Occas- ionally a basophile can be found. The white cells are developed from the lymphatic tissues, the spleen and the marrow of bone. Chemically they con- tain nuclei n. a globulin, fat, glycogen and a nucleoproteid. PHYSIOLOGY. 81 What changes are produced in the air and in the blood by respiration? The expired air contains less oxygen and more carbon dioxide, nitrogen, and water than inspired air. It also con- tains certain volatile organic substances and is warmer than the inspired air. The blood leaving the lungs contains more oxygen and less carbon dioxide and nitrogen than that entering the lungs. Define aphonia, aphasia. Give the cause of one of these conditions. Aphonia is the loss of voice, or the power of phonation. Aphasia is the inability to give the proper word symbol. Motor aphasia is due to a lesion of the left lower frontal convolution or of the fibers coming from it. Describe the normal heart sounds. The first sound is twice as long as the second, lower in pitch and with a prolonged dull, somewhat booming quality. It is caused by the closure of the auriculo-ventricular valves and the sound of contracting muscular walls of the ventricles. It is heard best at the apex, and is systolic in time. The second sound follows the first after a short interval. It is short, snapping in quality and is higher pitched than the first. It is caused by the closure of the semilunar valves and is diastolic in time. It is heard best at the base of the heart. State the physiologic uses of the large intestine. Into the large intestine the crypts of Lieberkuhn pour in some secretion and the microbic digestion goes on. Although no villi are found here part of the food not already absorbed is taken up. The feces are concentrated and collected in the lower end of the intestine, to be expelled during the act of defecation. 82 PHYSIOLOGY. Define (a) tonic muscular contraction, (b) clonic mus- cular contraction. Give an example of each. Tonic muscular contraction is a continued contraction, as the action of sphincter ani. Clonic muscular contraction is an intermittent or remittent muscular contraction as seen in the jerking movements of a convulsion. Define reserve air, residual air, complemental air, tidal air. Reserve air is the amount of air that can he expired after an ordinary expiration, about 100 cubic inches. Residual air is the amount of air left in the lungs after the most forcible expiration, about 100 cubic inches. Complemental air is the amount of air that can be taken in after an ordinary inspiration, about 100 cubic inches. Tidal air is the amount of air taken in with each ordinary inspiration, about 30 cubic inches. What are the respective functions of the anterior and of the posterior cornua of the spinal cord? The anterior cornua are motor in function and are the trophic centers for the muscles. The posterior cornua are mostly relay stations on the sen- sory pathway. What explanation may be given for enlargement of the spleen in leucocythemia? The spleen is one of the organs in which white corpuscles are formed. Give the difference between the temperature of a new= born child and that of an adult, between the temperature of a person intoxicated by alcoholic drink and his tem= perature after the first stimulating drink of liquor. Immediately after birth the temperature is somewhat above normal, but soon becomes subnormal. At the end of twenty- four hours it has again reached normal and remains so. A PHYSIOLOGY. 83 small dose of alcohol causes a slight rise in temperature; large doses, as in one intoxicated, cause a subnormal temperature. In a healthy man, what time is consumed in the diges* tion of an ordinary meal of meat, vegetables and bread? The food remains from two to four hours in the stomach and about six hours in the small intestine. Digestion is practically finished before it leaves the small intestine. Define human physiology. Human physiology is the study of the phenomena of the living human body. Give the causes of muscular fatigue. Muscular fatigue is caused by the accumulation of waste products in the muscles. The seat of fatigue, as we ordinarily speak of it, is first in the central nervous system, then in the motor end plates, then the muscle and finally the nerve trunks. What effect is produced on the heart's action by stimu- lation of the cardioinhibitory center? There is a slowing of the heart, or, if the stimulus is great enough, a stoppage of the heart in diastole. Why does blood remain fluid in the body in life, and coagulate when shed? The intima has some unknown peculiar action on the blood. The blood does not clot until the disintegration of the white corpuscles sets free the fibrin ferment. What conditions produce variations in the normal tem- perature of the body? Anything that will disturb the proper balance of heat pro- duction and heal malaise, headaches, anaemia and Blowing of the heart's action. It also interferes with the digestion and absorption of fats, allows of an excess of putre- 7 98 PHYSIOLOGY. factive substances being formed in the intestines, and also causes constipation. State the function of the third cranial nerve. What is the effect of division of the third cranial nerve? The third nerve is the motor nerve for the internal rectus,, superior rectus, inferior rectus, inferior oblique, levator palpe- brarum, ciliary muscle and the constrictor of the pupil. Sec- tion of this nerve causes loss of accommodation, ptosis, ex- ternal or divergent squint and diplopia. What are the movements of the eyeball? Mention the muscles concerned in each of the movements. Protrusion — caused by the muscular fibers in the capsule of Tenon. Retraction — caused by the tight closing of the lids or para- lysis of the muscular fibers in the capsule of Tenon. Upward movement — caused by contraction of superior rec- tus and inferior oblique. Downward movement — caused by contraction of inferior rectus and superior oblique. Inward movement — caused by contraction of internal rectus. Outward movement — caused by contraction of external rectus. Rotary movement — caused by contraction of either of the two oblique muscles. What are the accepted theories as to the origin of (a) the red blood corpuscles, (b) the white corpuscles? The red corpuscles are formed in the red marrow of bones and in the spleen. The white corpuscles are formed in the lymphatic system, the spleen and the marrow of bones. How is the diaphragm affected in expiration? State cause. The central tendon of the diaphragm is drawn upward into PHYSIOLOGY. 99 the thorax during expiration by elastic recoil of the lungs, tending to produce a vacuum in the pleural cavity. Define secretion, excretion, protoplasm, assimilation. A secretion is that product of glandular activity needed in the various processes of the living organism. An excretion is that product of glandular activity con- taining waste of no further use to the organism. Protoplasm is the living substance surrounding a specially formed element called the nucleus. Assimilation is the conversion into protoplasm of nutrient material or food ingested. What are the causes of the apex beat of the heart? The apex being free it is brought forward to strike against the chest wall by the contraction of the ventricle. The shock of the contracting muscle also contributes to it. What special use does each of the following serve in the body after ingestion: proteids, fats, carbohydrates, alco= hoi, tea, and coffee? Proteids repair the tissues, fats are used for body fuel and as a reserve, carbohydrates are the body fuel, alcohol in small doses is a general stimulant and by irritating ihe mucous membrane causes an increased flow of gastric juice. Tea and coffee are stimulants, increasing the flow of the various secretions and stimulating peristalsis. State the functions of the fifth cranial nerve. The fifth nerve is the sensory nerve of the face, mouth and nasal cavities, and the motor nerve of the muscles of mastication. What effect, if any, results from the division of (a) a vasoconstrictor nerve, (b) a vasodilator nerve? Division of a vasoconstrictor nerve causes a vasodilation in the part it supplies. Division of a vasodilator nerve usually has no effect. If il In- in action at tin- time a vasoconstriction would follow. 100 PHYSIOLOGY. Describe the vermicular movement of the stomach and intestines. What purpose does this movement serve? The movement of the stomach causes the food there to be thoroughly mixed, the peculiar contraction causing a current down along the fundus to the pylorus and back again along the lesser curvature. The movement of the intestine is a true peristaltic one, that is, one segment of the intestinal walls contracts after the preceding segments ; thus a wave of contraction passes down, mixing and pressing the food on downward. Differentiate white fibrous tissue and yellow elastic tissue as to (a) structure, (b) distribution. White fibrous tissue consists of white fibers arranged in parallel bundles, the connective tissue cells also being ar- ranged in this way. Yellow elastic tissue is a connective tissue in which the yellow fibers predominate. These fibers are larger than the white and are bound together with areolar tissue. The white fibrous tissue is found where strength and inelasticity is needed, as in the ligaments and tendons. The yellow fibrous tissue is found where elasticity is needed, as in the coats of the blood vessels, in the lungs, and vocal cords. Explain the action of the anospinal center in defecation. The anospinal center is the reflex center for defecation. Irritation of the mucous membrane of the rectum sends an impression to the anospinal center, which then causes a re- laxation of the sphincter muscles and an increase in peris- talsis. This center is under the control of the will to a great extent. How is the venous blood current maintained? What arteries carry venous blood? The venous flow is maintained by the vis a tergo, or force of the heart carried through the capillaries, by the play of the valves in the veins during muscular movements, and by PHYSIOLOGY. 101 thoracic and intracardiac action. The pulmonary arteries carry venous blood. What causes the difference in pitch between male and female voices? What causes the voice of the youth at the period of puberty to " crack "? The male vocal cords are longer, hence the lower pitched voice. The cause of the cracking of voice at puberty is the change from the childish treble to the lower adult voice, causing now and then a treble tone to be put in. What is the function of connective tissue? The connective tissue acts as a binding, supporting, con- necting and protecting tissue for the more delicate tissues and organs. What is (a) an efferent nerve, (b) an afferent nerve? Illustrate. An efferent nerve is one carrying impulses from the cen- tral nervous system to the various parts of the body. The facial nerve carries motor impulses from the central nervous system to the muscles of expression. An afferent nerve is one carrying impulses to the central nervous system from the various parts of the body. The optic nerve carries impressions received on the retina to the brain. Describe the glands and villi of the intestines. In the intestines we find two sets of glands, B runner's and Lieberkuhn 's. The glands of Brunner are branched convoluted tubular glands found dipping down in the mucous membrane of the duodenum only. The crypts of Lieberkuhn are little tubular depressions in the mucous membrane of both the small and large intestines. They are larger in the large intestine. They consist of a basement membrane lined with columnar and goblet-shaped epithelial cells. 102 PHYSIOLOGY. The villi are small nipple-like projections from the mucous membrane of the small intestines about one-thirtieth of an inch long. A villus consists of a mass of adenoid tissue covered with a layer of columnar epithelium resting on a basement mem- brane. In the center of this adenoid tissue we find a little lymphatic called a lacteal. We also find in the adenoid tissue many capillaries which coalesce to form the venules of the mesenteric veins. Describe the movements of the blood corpuscles in the capillaries and explain the phenomena of diapedesis. The capillaries are on an average just large enough to al- low the red corpuscles to pass through. In passing through some of the capillaries they are altered somewhat in shape, but on account of their elastic stroma immediately resume their shape when the pressure is removed. As they have to flow along in single file at juncture of two capillaries to form one, they take alternate turns in passing into it. The white corpuscles tend to adhere to the wall and do not move as rapidly as the red ones. In diapedesis the white corpuscle pushes one of its pseu- dopodia through the cement substance of the cells of the capillary wall, and then pulls the rest of the body through after it. Mention three varieties of cells according to situation in the body. Epithelial cells are found in the skin. White blood corpuscles are found in the blood. Nerve cells are found in the central nervous system. What is the mode of production of heat in the body? Heat is produced by the chemical action going on in the tissues, especially in the muscular and glandular tissues. Describe cholesterin, giving its origin and function. Cholesterin is a monatomic alcohol found especially in the PHYSIOLOGY. 103 nervous tissue, and thrown off in small quantities from the body in bile. It is possibly a waste product of the nervous tissue. Mention and describe three varieties of cells according to shape. Involuntary muscular fibers are small spindle-shaped cells, containing about their center an oval nucleus. They are faintly longitudinally striated. Squamous epithelial cells are flat scale-like cells, having a, small nucleus near their center. White blood corpuscles are nucleated granular masses of protoplasm, about one twenty-five-hundredth . of an inch in diameter. At rest they are globular, but during ameboid movement are irregular in shape. Mention the ductless glands and give the theory as to the function of any one of them. The ductless glands are the thyroid, thymus, adrenals, spleen, pituitary body, coccygeal and carotid. Many other organs have also internal secretion. The adrenal secretion has a marked influence over vaso- motor and general muscular tone. How is the sensation of sound conveyed to the brain? It is conveyed from the cochlea by the auditory nerve to the medulla, then to the superior olive, through lateral fillet to the posterior quadrigeminal bodies to the cerebral cort«\. What matters are excreted by the skin? How may the function of the skin be affected as to the amount of ex- cretion? The sweat contains one per cent, of solid matter, in which we find sodium chloride and other inorganic salts, urea, fatty acids and coloring matter. The function of the skin may be affected physiologically by increased urination and diarrhoea, by reflex irritation of sweat centers, by the emotions, by increase of body tempera- 104 PHYSIOLOGY. ture calling for more heat dissipation, and by the accumula- tion of carbon dioxide in the blood. Ingestion of many drugs also affects the excretion. Mention some of the exercises that injuriously affect the heart. State the reasons for your conclusion. Among exercises that injuriously affect the heart are wrestling, long-distance racing, bicycle racing and rowing matches, the bad effect being due to the sudden strain which causes dilatation and hypertrophy of the heart. State the function of the retina. The retina is the receptive nervous organ of sight. What are the physiologic characteristics of protoplasm? Protoplasm has the power of nutrition, growth, reproduc- tion, movement and response to stimuli. What is the usual difference in shape between the red corpuscles of the blood in the mammalia and those in the ovipara? With the exception of the camels, mammalian red cor- puscles are non-nucleated, biconcave, circular discs. In the ovipara they are nucleated, oval and biconvex. State the changes in the diameter of the chest in in- spiration and expiration. In inspiration the vertical diameter is increased by the descent of the diaphragm; the anteroposterior and trans- verse diameters are increased by the raising and rotation of the ribs anteriorly and laterally. The reverse occurs during expiration. The circumference of the chest is increased in forced in- spiration from 2 to 5 or 6 inches over forced expiration. Explain the anatomic and physiologic difference between mucous, serous, and synovial membrane. Mucous membranes are secreting membranes lining cavities opening into the air and composed of one or more layers of epithelial cells. PHYSIOLOGY. 105 Serous membranes are those lining closed sacks belonging to the lymphatic system and composed of a single layer of flat endothelial cells on a basement membrane. Synovial membranes are those lining closed sacks or bursa; in joints or over tendons. They secrete synovia, which al- lows free motion by preventing friction. Describe the physical properties of healthy urine. Healthy urine is a straw yellow, acid, clear liquid, with a specific gravity of 1015 to 1025, and with a peculiar odor. On standing, a slight sediment collects in the lower part of the liquid. Describe the changes in form and volume, and in physi= cal and chemical properties, occurring in the contraction of a muscle. The muscle becomes shorter, but the volume remains the same. It becomes acid in reaction, more oxygen is used up and more carbon dioxide given off, sarcolactic acid is gen- erated, glycogen is used up, and the muscle substances soluble in water are diminished in amount, while those soluble in alcohol are increased. Locate in the brain, the seat of the special sense of sight, hearing and smell. Sight has its seat in the gyrus angularis, cuneus, and in the occipital lobes; hearing in the superior temporal; smell in the uncus. Explain the phenomena and causation of auditory ver- tigo or Meniere's disease. It is due to some disturbance or abnormal irritation of the endings of the vestibular branch of the auditory nerve. This branch normally sends impressions to the nucleus fastigii in the cerebellum which help to control the balancing and co- ordination of the muscles of the body. How do the striped and unstriped muscular fibers differ in response to stimuli? The unstriped muscular fibers are much slower in response. 106 PHYSIOLOGY. What is the order of occurrence of rigor mortis in the different parts of the body? Rigor mortis usually begins in the muscles of the eye, passing to the jaw and neck muscles, and in turn to the chest, arms, abdomen and lower extremities. What relation does the nervous system bear to the ex= cretion of perspiration? The nervous system through the sweat centers regulates the excretion of perspiration. What portion of the cerebrum comprises the motor area? The motor area is found along the fissure of Rolando in the ascending parietal, ascending frontal and paracentral con- volutions and contiguous parts of the superior frontal. Give the presumptions of survivorship and reasons therefor in the following from Casper: A is killed by a thrust of a saber on the head; B by that of a bayonet in the heart; and C by a shot which has torn open the jug- ular vein. If A's injury involved especially the base of the brain the shock of the injury would probably cause instant death. B would probably be the second to die, probably living at least a half hour until the giving out of the heart from pressure of the blood in the pericardium. C would be the last to die, as lacerated wounds of even large vessels often stop spontaneously, and his bleeding might be checked by pressure until surgical help arrived. Define the function of the mucous membrane of the respiratory tract. The mucous membrane of the respiratory tract secretes a protecting mucus, and because of its ciliated epithelial cells keeps the lungs clear of accumulation of mucus and small dirt particles entering in the inspired air. The vital activity of the squamous cells lining the air vesicles aids in the ex- change of the respiratory gases. PHYSIOLOGY. 107 What is the composition of human milk? Milk contains 112 parts of solid matter to the thousand. Of these, sixty parts are the carbohydrate, lactose; thirty are fats, olein, palmitin, stearin and butyrin; twenty are proteids, caseinogen, lactalbumin and lacglobulin; and two parts are salts, especially sodium chloride and calcium phos- phate. What are the uses of perspiration? Through the perspiration we get rid of certain waste pro- ducts, supplementing somewhat the action of the kidneys. Through it we also throw off large quantities of heat. It also keeps the skin moist. What conditions increase the amount of solids in the urine? Increased ingestion of salts will increase the amount of salts excreted. Diarrhoea, free perspiration and limiting the ingestion of fluids, will cause a relative increase of solids. Excessive muscular exercise will also cause a small increase in the amount of solids. What are the functions of the pneumogastric nerve? Among its many functions the pneumogastric is motor and sensory to the larynx, motor to the pharynx and oesophagus, motor, sensory and secretory to the stomach, inhibitory of the heart, motor and sensory to the lungs, and sends some fila- ments through the sympathetic system to the pancreas, liver and intestines. How are the sensations of color produced? According to the Young-Helmholtz theory there are three sets of retinal fibers, each responding to the stimulation of one of the primary colors, green, red and violet. Stimula- tion of these in different degrees causes the various shades. According to the Hering theory there is one set of fibers, while there are three chemical substances found in visual 108 PHYSIOLOGY. purple. The anabolism of these causes white, red and yellow ; katabolism, black, green and blue. Various combinations cause various shades. Describe the portal circulation; the renal circulation. The blood collected from the capillaries of the spleen, stomach and intestines by the splenic, gastric, inferior and superior mesenteric veins is carried by the portal vein to the liver. Here this vein breaks up into smaller vessels running between the lobules, called the interlobular vessels. These break into a set of capillaries, called the lobular capil- laries, which coalesce to form the intralobular veins. These empty into the sublobular veins, which in turn form the hepatic vein which carries the blood into the inferior vena cava. The hepatic artery supplies especially the capsule of the liver. In the kidneys we find three sets of capillaries. One set is that of the vasa recta, short vessels given off from the arterial trunks and supplying the medullary portion. Then we have the arteries or the cortex forming the set of capil- laries of the glomeruli. The vessels passing out from the glomeruli are called the efferent vessels, and again break up into a set of capillaries around the convoluted portion of the tubules. The blood is then collected by the renal venules and passes out through the renal vein. What circumstances and conditions favor gastric diges- tion? Among the many circumstances favoring gastric digestion are thorough mastication, slow eating, pleasant taste to the food, swallowing in small mouthfuls, normal amount of con- diments, muscular and mental quietude, and a general healthy condition of the various parts of the body. Describe the physiology of vomiting. Vomiting is the spasmodic rejection of the contents of the stomach. It may occur from an abnormal condition of the vomiting center in the medulla, or reflexly from the irrita- PHYSIOLOGY. 109 tion of many nerves, as the glossopharyngeal in the posterior surface of the larynx, or the pneumogastric in the stomach, or from the sight of disgusting objects, disgusting tastes or smells, or from irritation of other mucous membranes, as the uterus. During the act of vomiting the diaphragm is fixed, the cardiac orifice of the stomach is opened by the longitudinal fibers and the abdominal muscles contract, causing the con- tents of stomach to be forced into the mouth. What would be the effect on digestion if the pancreatic duct were obstructed? As the pancreatic secretion acts on all classes of food, there would be a marked decrease in the whole digestive function, especially on the fats and proteids. Discuss bacteria in the intestines. The bacteria found in the intestines may be divided into three groups, — fermentative, chromogenic and pathogenic. The first class is very useful, forming peptones, dextrose and fatty acids, and breaking up some poisonous principles, as choline, into simpler bodies. Unless putrefaction becomes excessive, it is perfectly normal. Among other substances formed during microbic diges- tion are indol, skatol, phenol, carbon dioxide, leucin, tyrosin. hydrogen sulphide and ammonia. Give the relative activity of absorption in the alimen- tary canal, the skin and the lungs. The relative activity of absorption is first through the lungs, then through the alimentary canal, and third through the skin. Give the process of replacement of temporary by per- manent teeth. As the j;i\vs grow and can accommodate the larger per- manent teeth, the little immature permanent teeth budded oil' from the temporary set begin to grow upward. As they 110 PHYSIOLOGY. grow, the fangs of the temporary teeth are gradually ab- sorbed, the crown falls off, and then the permanent erupt. What conditions retard, suspend or prevent the coagu- lation of blood? The conditions retarding, suspending or preventing coagu- lation are — addition of oxalates, proteoses, peptones or leech extract ; low temperature ; contact with living vascular walls ; the covering of the surface with oil ; addition of large quan- tities of neutral salts; excess of carbon dioxide; death by lightning ; and the diseased condition, hemophilia. What is the function of the superior laryngeal nerves? The superior laryngeal nerves are the motor for the crico- thyroid muscles and the sensory for the larynx. Discuss the effect of the cooking of food as a means of rendering it more digestible. It is especially on the starchy foods that cooking has a good effect by breaking up the cellulose covering of the starch granules and forming some of the starch into dextrine. The fats in the cells are also liberated. Upon the proteids cooking has rather a detrimental effect, especially if the temperature is raised very high. For in- stance, the uncooked egg albumin is more readily digested than the coagulated cooked albumin. What agencies induce the flow of lymph to the point of discharge in the veins? The flow of lymph is induced by the vis a tergo or pressure in the tissues, by muscular action and the play of the numer- ous lymphatic valves, by muscular tissue in the lymphatic vessels, and by thoracic suction. Name some of the involuntary muscles and the function with which each is concerned. The uterus is the organ for the carrying of the developing embryo and foetus. The muscle is used for the expulsion of the foetus at the end of intra-uterine life. • PHYSIOLOGY. Ill The muscular wall of the intestine is used for mixing and passing on downward the food received from the stomach. The tunica media of the arteries contains many muscular fibers that control the supply of blood to the various parts of the body. What do you understand by blood pressure? Blood pressure is the pressure to which the blood is sub- jected in the circulatory system. In man it is about 110 millimeters of mercury. What effect does an excessive starchy diet produce? [t produces excessive flatulency and may lead to an ali- mentary glycosuria. Give the mechanism of the organs of hearing. The sound waves are converged by the auricle, pass through the external auditory meatus, striking then against the mem- brana tympani, which sets into movement the ossicles, malleus, incus and stapes. The base of the stapes fits into the oval window. Thus the sound waves cause a movement of the ossicles, which in turn, through the base of the stapes, cause vibrations to be set up in the perilymph of the vestibule ; then they are conveyed through the scala vestibuli and through the helicotrema to the perilymph of the scala tympani, and out through the round window to be dispersed. The vibration of the perilymph in the cochlea sets up vibration in the scala media containing the organs of Corti. which are the special receptive apparatus of hearing. The impressions received here are carried by the cochlear branch of the auditory nerve to the cerebrum. What is meant by digestion? The nutrient material or food ingested has to be so changed that it can be absorbed. This changing of the food is called digestion. What influence has the nervous system on the process of secretion? The nervous system controls the process of secretion by 112 PHYSIOLOGY. the various secretory centers and nerves, and by controlling the amount of blood to the various organs of the body. Name the refracting media of the eye and the effect that each has on the rays of light. The refracting media of the eye are the cornea, aqueous humor, crystalline lens, and the vitreous humor. They all converge the rays of light, the cornea being the most potent, the crystalline lens coming next, then the vitreous and finally the aqueous humor. What is the location of the center for articulate speech? The center for articulate speech is in Broca's convolution, the left lower frontal in right-handed people. How is the sensation of pain produced? Stimulation of the special endings of the pain nerves in the skin, or stimulation of the trunk of the nerve, causes an impression to be sent to the special area of the brain pre- siding over pain sensations. When this center is so stimu- lated we feel pain. What kinds of food would you recommend in cases of obesity? The whole diet including water should be restricted and the relative amount of proteids greatly increased in cases of obesity. Give the reactions of the following fluids and state the cause of the reaction in each case: blood, gastric juice and pancreatic juice. Blood is alkaline from its contained alkaline phosphates and carbonates. Gastric juice is acid from the hydrochloric acid in it. Pancreatic juice is alkaline from the sodium carbonate it contains. Do variations in the rate and force of respiration affect the heart, and if so, in what manner? Increase in the rate and force of respiration increases the PHYSIOLOGY. . 113 number and force of the heart-beats. A deep inspiration held for some time will reduce the rate of a rapid heart. Name the organs of the special senses. The organs of special sense are the eye, ear, upper por- tion of nasal cavity, the taste bulbs on the tongue, and the tactile end organs. Describe the functions of spinal nerves. The spinal nerves carry the afferent and efferent impulses of the body and of the back of head to and from the central nervous system. Among the afferent impulses we have those of pain, tem- perature, tactile, pressure and muscular sense. Among the efferent, we have the motor, trophic, secretory and vasomotor. Describe the effect of a transverse section of the spinal cord in the mid=dorsal region. A transverse dorsal section would cause paralysis of mo- tion and of sensation of the parts below the section, paralysis of bladder and rectum, and exaggerated reflexes of the legs. What is meant by the condition of tetanus in a muscle? When a muscle goes into a state of continued contraction, it is said to be tetanized. Describe the digestion in the stomach of a meal of bread and milk. The ptyalin of saliva continues for some time in the stomach to change the starch of the bread into maltose. The hydro- chloric acid also has some action on the starch. The gluten of the bread is changed by pepsin into gluten peptone. The caseinogen is changed into casein by the rennin, and then the pepsin changes it into casein proteose and peptone. The lactalbumin and globulin arc ;iN<> changed into pro- teoses and peptones. The soluble sails are dissolved and the fats melted. 8 114 PHYSIOLOGY. What variations of temperature are found in the differ- ent parts of the body? Mention the reasons for such variations. The highest temperature is found in the blood leaving the liver, and is due to the amount of heat formed in this large gland. The tip of the nose is said to be the coldest part of the body, due to its exposed position and to the thinness of its walls. The skin surface is always cooler than the internal or- gans, due to the radiation of the heat of the blood from the skin, the evaporation of sweat from the skin and the in- creased amount of heat produced in the internal organs. Describe the mechanism in the opening and closing of the aortic valve. The three leaflets of the aortic valve are placed with their concavity toward the aorta. During systole the pressure in the ventricles forces the blood past the aortic valve into the aorta. As the ventricle begins to dilate in diastole the pres- sure of the blood in the aorta tends to force the blood back into the ventricle. This force fills up the pockets of the aortic leaflets and forces their free edges together, thus closing the orifice. Define life and death. "Life is that obscure principle whereby organized beings are peculiarly endowed with certain powers and functions not associated with inorganic matter. ' ' "Death is the cessation of life." (Dorland). Describe the physiology of rectal feeding. Small quantities of food, especially if predigested, when placed in the rectum are readily absorbed and will sustain life as long as the rectum does not become so irritable as not to retain the food. The food should preferably be predi- gested, but even egg albumin can be absorbed. PHYSIOLOGY. 115 Name the excretory glands of the body and the function of each. The excretory glands are the kidneys, which excrete urine: the sweat glands, which excrete sweat and dissipate heat by Hweating; and the liver, which throws off through the bile some waste matter. The lungs are also excretory organs, throwing off carbon dioxide and nitrogen. Describe the origin of a tear as the result of pain. The pain causes reflexly a stimulation of the lachrymal gland, causing an increased secretion. More secretion is poured out than can be carried off by the lachrymal canal, the excess pouring over the cheek as tears. What is the office of the columnae carneae? They give strength to the ventricular wall and prevent the auriculo-ventricular valves from being pressed into the auricles. Describe the physiologic causes of obesity. The physiologic causes of obesity are overfeeding, espec- ially with -carbohydrates, lack of proper exercise, and cer- tain peculiarities of the cells of an individual. Name some of the bodily states which lessen the alka- linity of the blood. There is a decrease of alkalinity in rheumatism, gout, mi- graine, and while living on a diet deficient, in the alkaline mineral matters, or living on a proteid diet. What is the influence of diet on nutrition? For nutrition to go on properly the diet must contain the various classes of foods in proper proportion. Proteids and salts are absolutely necessary. Nothing but proteids can replace the used-up proteids of tissue. Salts are needed especially to neutralize the acids formed during proteid katabolism, and to form a part in the secretions, like the hydrochloric acid of the gastric juice. 116 PHYSIOLOGY. Describe the physiologic process by which the bite of a venomous snake or the hypodermic injection of the virus causes death. The poison injected under the skin is carried by the lymphatics to the right or left subclavian vein. Having thus reached the general circulation, it is distributed to the vari- ous organs, and so perverts the function of certain ones as to cause death. Name the bile salts, and state the physiologic function of bile. The bile salts are sodium glycocholate and sodium tauro- cholate. Bile aids in the emulsification and absorption of fats, neu- tralizes the acid chyme precipitating the pepsin, increases peristalsis, is antiseptic, and contains some waste matter thrown off by the liver. Describe the offices and the characteristics of the gray matter of the brain. The gray matter of the cerebral cortex is arranged in six alternate gray and white layers, the most important of which is the deep gray layer of large pyramidal cells. The gray matter of the cerebrum is the center of sensa- tion, volition and ideation ; that is, it receives the sensations, sends out all voluntary impulses and is the part of the nervous system in which thought goes on. Enumerate the physiologic advantage of natural sleep and state at what period of life the least sleep is required. Natural sleep allows the fatigued nervous system to re- gain its tone, causes a relaxation of the vasomotor system, thus giving the heart a chance to rest. In fact, sleep causes a relaxation of all the bodily functions, thus allowing the tissue to recuperate and waste matter to be carried off. During mature adult life the body can stand the lack of sleep better than at any other time. PHYSIOLOGY. 117 Give the function of the epiglottis. The epiglottis is used in vocalization, especially of the lower-pitched tones. What differences of function exist between the white and gray matter of the encephalon? The gray matter is composed of cells, which are the ter- minals that receive sensations, classify the knowledge thus received and send out impulses. The white matter is made up of fibers that transmit the impulses, connecting the cells with each other and with the periphery. Describe the ileocecal function. The ileocecal valve is composed of two semilunar folds of mucous membrane, containing the circular fibers. When the cecum is distended this valve is closed, and thus re- gurgitation into the small intestine is prevented. State the approximate time of eruption of the tempo- rary teeth. The lower central incisors erupt about the 5th or 6th month, followed rapidly by the other six incisors. About the 11th or 12th month the first molars appear. From the 18th to 20th month the canines erupt, followed from the 24th to 30th month by the second molars. State what are, under normal conditions, the (a) adult number of respirations per minute; (b) body tempera- ture; (c) average respiratory capacity. Respiratory rate is eighteen per minute; the body tem- perature is 98.4° Fahr. ; the average respiratory capacity is 230 cubic inches. Name two circumstances influencing secretion. Among circumstances influencing secretion are the supply of blood to the gland and the proper action of the normal reflex excitants. 118 PHYSIOLOGY. What is the function of (a) sudoriferous glands; (b) the sebaceous glands? The function of the sudoriferous glands is to excrete sweat; that of the sebaceous glands to secrete sebum. Name the principal centers of organic function in the medulla oblongata. The principal centers in the medulla are the respiratory, cardio-inhibitory, cardio-accelerator, vasomotor, salivation, mastication, deglutition, vomiting and diabetic. Account for the contraction and dilatation of the pupil. The contraction and dilatation of the pupil is a reflex phenomenon regulating the amount of light and sharpening the image for near objects. There are two sets of muscular fibers in the iris — circular or contracting and radiating or dilating. Give the composition of normal feces. The feces contain 70 to 80% of water. Of the solid mat- ter there are indigestible substances as cellulose, mucin and keratin; some undigested matter as uncooked starch and elastin; products of microbic digestion as indol, skatol, phenol, fatty acids and leucin; bacteria; cholesterin; color- ing matters, stercobilin; and intestinal debris as cells and mucus. They are alkaline in reaction, quantity, 6 to 8 ounces in 24 hours. Describe the disturbances of function produced by the excessive imbibition of alcohol. Excessive imbibition of alcohol causes congestion of the stomach with altered gastric secretion, precipitation of pepsin during gastric digestion, congestion of liver and finally de- struction of many of the liver cells. On entering the cir- culation it acts as an irritant to the whole vascular system and to the kidneys. It also causes subnormal temperature. How are cells connected? Cells are connected by the intercellular substances. PHYSIOLOGY. 119 Give the relative food value and ease of digestion of meat, milk, eggs, leguminous fruits. According to relative food value the order is — meat, eggs, milk and leguminous fruits. According to relative ease of digestion the order is niilk, eggs, meat and leguminous fruits. What are the effects of removal of the cerebrum in the lower animals? A decerebrated animal loses all power of voluntary move- ment, remaining quiescent until some external stimulus brings out a reflex movement. Thus, food may be placed before him, but he will not take it; if it is placed in his mouth, he will swallow it. If turned on his back, he will right him- self. He shows no fear. What conditions are necessary for properly exercising the sense of smell? For the proper exercise of the sense of smell, the sub- stance must be volatile, the air in the nasal cavity must be in motion, and the olfactory apparatus must be in normal condition. How would digestion be affected were the ductus com- munis choledochus obstructed? In obstruction of the ductus communis choledochus the feces contain large quantities of undigested fats, the stools become hard and fetid, and finally death ensues from ab- sorption of putrefactive products from the intestines. Give the mechanism of the diaphragm in (a) respiration, (b) hiccough. During rest or relaxation the diaphragm is domed upward. During inspiration, the muscle contracts, the central tendon is pulled down and thus the vertical diameter of the thorax is increased. During expiration, the muscle relaxes and the diaphragm resumes its domed position. Hiccough is caused by a sudden spasmodic contraction of 120 PHYSIOLOGY. the diaphragm, the inspiration thus caused being arrested by a sudden closure of the glottis. How does the nervous system influence gastric diges- tion? Through the vagi the secretion of the stomach is con- trolled from the central nervous system. The vasomotor nerves of the stomach also influence secretion by controlling the amount of blood to the stomach. Give the physiology of (a) hunger, (b) thirst. Hunger is the constitutional need of the body for food with the eccentric symptoms in the epigastrium. The im- poverishment and changes in the blood so affect the central nervous system as to cause the sensation. Thirst is the constitutional need of the body for water with the eccentric symptom in the pharynx. The lack of water in the blood so affects the nervous system as to cause this dryness of the throat. Give the foramen of exit, the distribution and the func- tion of the pathetic (fourth cranial) nerve. The pathetic or trochlear nerve passes out through the sphenoidal fissure and is the motor nerve of the superior oblique. Give the process of development of the parietal bone. The parietal bone is formed between membranes and is not preceded by the temporary cartilage. The membrane is formed of an external fibrous layer and an internal layer, which becomes the periosteum and consists of a layer of osteoblasts. Starting from a point called the center of ossification, little spicules of bone are deposited in all directions in the inter- cellular substances. As they become more numerous, they completely enclose the osteoblasts, which remain permanently in the bone. This process spreads in all directions and thus the bone is formed. PHYSIOLOGY. 121 What changes take place in the composition of blood as it passes through the kidneys? During the passage of the blood through the kidneys, these organs pick out of it large quantities of urea, uric acid, sodium chloride, alkaline and earthy phosphates, sodium and potassium sulphates, indican, extractives and water. The blood also becomes venous, losing oxygen and adding more carbon dioxide. How are the vocal sounds produced? The vocal sounds are produced by vibrations of the vocal cords, modified in the case of vowels by peculiarities in the shape of the resonating cavities above, mouth, pharynx and nasal cavities. In the case of consonants the vibrations are modified by a more or less complete interference with the outgoing flow of air. What would be the effect on the saliva and on digestion if Stenson's duct should be divided? If Stenson's duct should be divided, the other parotid would probably hypertrophy somewhat to make up for the loss of secretion. There would be comparatively little effect on the saliva or digestion. At first mixed 6aliva would possi- bly be less watery and the digestion of starch somewhat retarded. Describe the physiologic aspect of atavism. Atavism is the peculiarity of the offspring of taking on the characteristics of the parent. Certain characteristics, inherent in the ovum and spermato- zoon and derived from the parents, cause special develop- ment in the certain lines, thus causing the offspring to take on peculiarities of the parents. Give the extremes of slowness and rapidity of the heart's action which are consistent with physical vigor, and with ability to perform manual labor. The extremes would probably be from fifty to a hundred 122 PHYSIOLOGY. beats per minute; nevertheless, no definite extremes can be given. Give the process of regeneration of uterine mucous membrane following pregnancy. Following pregnancy the mucous membrane of the uterus is regenerated from the epithelium of the deep glandular layer. Around the mouth of the glands proliferation goes on rapidly, the groups of new cells spreading out and finally coalescing with each other. About the end of the fifth week this new membrane is complete. All cells and shreds of decidual tissue not concerned undergo fatty degeneration and are thrown off through the lochial discharge. In what manner, physiologically, does a largely dis= tended stomach produce death? A largely distended stomach may cause death by interfer- ence with normal digestion, causing excessive fermentation and auto-intoxication. Or, pressure on the surrounding or- gans causes interference with the circulation and the func- tions of the organs. The venous stasis causes hypertrophy and dilatation of the heart, which finally gives out, death ensuing. Give the physiological properties of the facial nerve. The facial nerve is the motor nerve for the muscles of expression of the face. Describe hemoglobin and mention its derivatives. Hemoglobin is a proteid-like body, readily crystallizable and containing iron. It readily unites with oxygen and other gases and has a peculiar spectrum. On the addition of an acid or alkali, it is broken up into hematin and globin, a pro- teid of the globulin group. Hematin, hematoidin, hemin, hematoporphyrin and methe- moglobin are derivatives of hemoglobin. Define and give the physiologic significance of (a) dys- pnoea, (b) dysphagia, (c) apnoea. Dyspnoea, or difficult rapid breathing, is caused by a de- ficient supply of oxygen to the tissues. PHYSIOLOGY. 123 Dysphagia, or difficult or painful deglutition, may be caused by obstruction in the esophagus, reflex spasm, or by painful affections of the pharynx. Apnoea, or cessation of breathing, is caused by the blood being overcharged with oxygen, or by a reflex inhibition of the respiratory center. What prevents digestion of the stomach by its own juices? The reason that the stomach is not digested by its own juices is not known, so it is said to be due to a vital act. Neither the alkalinity of the mucous membrane, nor the alkalinity of the blood will explain it. Give the physiology of (a) blushing, (b) pallor, (c) tear shedding. Blushing is a reflex dilatation of the bloodvessels of the skin. Some emotional disturbance so stimulates the vasodi- lator center in the medulla as to cause a vasodilatation of the skin vessels. Pallor is a reflex vasoconstriction of the bloodvessels of the skin. It is caused by a reflex excitation of the vaso- constrictor center in the medulla. Certain emotions so reflexly stimulate the lachrymal glands through the central nervous system as to cause the glands to secrete more fluid than can be carried off through the nasal duct. The excess runs over the cheeks and is called tears. What causes (a) circulation of the blood, (b) the beat- ing of the pulse? The circulation of the blood is caused by the action of the heart, aided by the vasomotor system. The beating of the pulse is caused by the transmission of the cardiac impulse through the elastic arterial system. What are the functions of the pancreas? The pancreas secretes the pancreatic juice. In addition 124 PHYSIOLOGY. to this, it has an internal secretion, because extirpation of the pancreas causes diabetes. What substances are absorbed principally in (a) the stomach, (b) the duodenum? Alcohol, water and soluble salts are absorbed in large quantities by the stomach. The fats, proteids and glucose are absorbed in the duodenum and in the rest of the small intestines. Describe the conditions within normal physiological limits which increase arterial blood pressure. Anything that will directly or indirectly cause stimulation of the vasomotor center will cause an increase in arterial pressure. Among these causes we have digestion, muscular exercise, various emotions, as fear and joy, increased resistance in the capillary system, dyspnoea and asphyxia. Name the inorganic proximate principles that enter into the formation of the human body. The inorganic proximate principles entering into the for- mation of the human body are water and the various salts, as sodium chloride, potassium sulphate, calcium fluoride and magnesium phosphate. What do you understand by the term nutrition, and what processes are comprised under it? By nutrition is meant the taking-in of nutrient material, its conversion into living protoplasm, and the throwing-off of waste matter from the cell. It includes digestion, absorption, metabolism and excretion. What are the Wolffian bodies? When do they appear and into what organs do they ultimately develop? The Wolffian bodies are the temporary kidneys of early mtra-uterine life, appearing about the third week. In the female they become the parovarium; and in the male, form the globus major, vas efferentia and coni vasculosi. PHYSIOLOGY. 125 Name the functions of the chorda tympani, sufficiently detailing each to clearly define its character. The chorda tympani contains the vasodilator fibers, but no vasoconstrictor fibers, for the anterior tongue and sub- maxillary gland. It contains the secretory fibers to the sub- maxillary gland, and also the teste fibers for the anterior two- thirds of the tongue. Name the groups of food stuffs constituting the source of muscular energy. Designate the most important and state what stored product is utilized. Carbohydrates are the most important, but fats and pro- teids may be used in the production of muscular energy. Glycogen is the stored product that is utilized. State the function of the nervus opticus, and explain by description or diagram the distribution of the fibers com= posing the chiasma and the effect thereof upon vision. The nervus opticus is the nerve of the special sense, sight. At the chiasma, the inner half of each optic nerve crosses to the opposite side ; therefore, in loss of function of one optic nerve from injury or pressure back of the chiasma, there is blindness of the temporal side of retina of the same eye and of the nasal side of opposite eye. Stimulation of one retina by light causes a reflex contraction of both pupils. Describe metabolism. Metabolism is the chemical change going on in organized tissue. There are two divisions — anabolism or building up, and katabolism or tearing down. This chemical change is usually a hydration, dehydration, reduction or oxidation. In the metabolism of proteids of the tissue, proteid food must be used to repair the loss. The carbohydrates are the substances most readily broken up to supply heat and energy, the fate being next in order. The salts are needed in the various processes, but especially to combine with the acids, sulphuric and phosphoric, formed in proteid katabolism. 126 PHYSIOLOGY. What is the normal proportion of blood in the human body and how is it renewed after hemorrhage? About one-thirteenth of the body weight is blood. The water and other constituents of plasma are renewed from the ingested food. The corpuscles are renewed by the bone mar- row, spleen and lymphatic tissues. State the effects of battery currents on the normal human nerves. The faradic current stimulates them. A nerve during the passage of a constant current through it, is said to be in a state of electrotonus. There is an in- crease of excitability at the negative pole or kathode, and decrease of excitability at the positive or anode. HYGIENE. Mention eight satisfactory disinfectants and give indi- cations for their use. Formaldehyde ( 1 pound of formaline for every 1000 cu. ft. of space), sulphur (3 pounds for every 1000 cu. ft. of space) or bleaching powder (3 pounds for every 5000 cu. ft. of space) to fumigate a room. If sulphur or bleaching powder are used, it is necessary to steam the room before beginning to fumigate. Chloride of lime to disinfect excrementitious matter from typhoid fever, cholera, dysentery, etc. Carbolic acid (5% solution) or moist heat (steam and boiling water) to disinfect clothing. Bichloride of mercuiy or permanga- nate of potassium and oxalic acid to disinfect the skin. What are the most common sources of infection in diphtheria? By direct contact with the sputum or shreds of membrane from the patient. By inhaling the air in the vicinity of the patient. By fomities, as clothing, books, drinking-cups, etc. What conditions are essential to a good water supply? Purity at its source, and adequate subsequent protection from contamination. What hygienic measures should be observed by the nursing woman? An abundant diet; avoiding overfeeding; some form of outdoor exercise each day; monotony of life and overwork should be guarded against. Warm clothing, personal clean liness, abundant sleep, freedom from mental cares, fright or anger are necessary precautions. Each time the child is re- (127) 128 HYGIENE. moved from the breast the nipples should be washed with warm water and thoroughly dried. What precautions should a physician observe to avoid carrying contagious diseases? A linen duster and a tightly-fitting linen cap should be worn by the physician in the sick-room, and be removed after leaving the room. Immediately after manipulating the patient the physician should thoroughly wash and disinfect his hands and face. A bath and change of clothing before attending other patients are advisable. Describe the hygiene of the mouth and teeth. The teeth should be cleansed after each meal and on rising in the morning, and foreign matter between the teeth should be removed. Acidity of the saliva may be counteracted by weak alkaline mouth washes. What methods would you suggest for the hygienic care of the skin? Simple foods ; avoiding constipation ; daily exercise in the open air; plenty of sleep (at least eight hours daily) ; fre- quent warm baths and a cold sponge bath on rising each morning. What localities should be sought or avoided by rheu= matic patients? Warm, dry, equable climate should be sought. Alkaline or sulphur thermal springs are recommended. Damp valleys, shores of rivers, sea coasts and places which are much ex- posed to winds and sudden changes of temperature should be avoided. Name the kinds of food and the quantity of each for the daily use of the normal man. 4.5 ounces of proteids; 3.5 ounces of fats; 14 ounces of carbohydrates; 1 ounce of salts (Moleschott). Or 118 grains proteids; 56 grains fats; 500 grains carbohydrates (Voit). These quantities represent dry foods. If the diet is stated HYGIENE. 129 as so-called solid-food (not water-free) the above quantities must be doubled. 50 to 80 ounces of water in liquid form are also taken into the system. What is the object of the wet pack, and what unfavor- able results may occur from its use? The cold wet pack is used to lower temperature during fever. The warm wet pack is used to promote elimination of fluid, to relax muscular spasm, to promote sleep, and raise lowered vitality. The dangers to be guarded against are heart failure or fatigue, or excitement to weak patients. The cold pack may give the patient a nervous chill. Describe in detail the process of disinfection by formal- dehyde (formalin). Make the room as near air-tight as possible by closing all openings and cracks before beginning the process of disin- fection. All mattresses, pillows, clothing, books, etc., should be exposed as fully as possible to the action of the disin- fectant. Place one pound of formalin for every 1000 cu. ft. of air space in a "Novy" generator. Start the rapid vola- tilizing of the formaldehyde and allow the room to remain closed for one day. What hygienic means should be employed by persons prone to " catch cold "? A cold sponge bath followed by brisk rubbing on arising in the morning; daily muscular exercise in the open air and a Liberal (but not excessive) diet, largely of carbohydrates. Describe the necessary sanitary precautions during the prevalence of an epidemic of Asiatic cholera. Isolate all patients and attendants; observe strict quarantine of all infected houses or districts; disinfect and remove any accumulations of filth, excreta, etc.; cremate those who have died from this disease. The water supply should be guarded to prevent its contamination ; and insist upon householders i) 130 HYGIENE. boiling all water or milk before using the same. All gastric or intestinal diseases should be attended to at once. Restrict or prohibit the use of all fruits or uncooked foods from the district; and use all disinfectant precautions where cases exist, during continuance of case, and after its termination. What are the sanitary requirements of house plumbing? All pipes and connections, traps, etc., should be in view or easy of access. Each house must be directly connected by pipe with the common sewer. The pipes in the house must be of iron with leaded joints or screwed couplings. The drainage pipes should be laid with a gradient of at least one inch fall to every four feet of length; the main house drain must be provided with a trap after it has been carried beyond all house connecting pipes. Pipes from water-closet fixtures, bath-tubs, wash-basins and sinks must have traps close to each fixture. Soil pipes must extend open for at least two feet above the roof and air must be admitted to the main trap upon its house-side. Describe a simple form of ventilating the sick=room. Place a wooden strip about three inches wide and as long as the window frame under the lower sash; through the space between the top of the lower sash and the bottom of the upper, sufficient air will enter the room without producing a draught. What precautions should be taken in school=rooms to protect the sight of scholars? Pupils should not sit facing the windows (the light should come from behind or over left shoulder) ; blackboards should not have a glossy surface and should not be placed between windows. The walls of the room should be of a neutral tint. Text-books should be printed in clear, large type. Faulty posture in reading and writing should be corrected by the| teacher. If toilet accessories are supplied, no child suffering with an inflammatory disease of the eyes should be permitted HYGIENE. 131 the use of the general supply. Any imperfection in vision of a pupil should be reported to the parents. What are the chief sources of contamination to drink= ing water? The emptying of sewage into the stream from which the supply is obtained ; surface water in settled districts gaining entrance to the supply; sub-soil water, after passing through a filthy soil ; drainage from places of burial ; and water which has dissolved poisonous minerals. Describe the several methods of purifying drinking water. Sedimentation, occurring when collections of water remain at rest for a considerable time, removing, in part, at least, suspended matter. Sand filtration in which the water flows upon and through prepared beds of sand, gravel and broken stone, packed in separate layers, removes from it not only suspended matter, but also dissolved organic matter and bacteria, through the action of air (oxygen) in the interstices of the filter material, and the action of saprophytic bacteria. Boiling water will free it of pathogenic bacteria and tem- porary hardness, but such water, after boiling, should be aerated to fit it for use. What do you understand by the " dry earth system " as applied to excrementitious matter? The container under the privy seat contains the dry earth, and after the use of the privy fresh earth is always to be added to the receptacle. From time to time the contents are removed and buried or othei-wi.se disposed of. Contrast the incubative stages of measles and scarlet fever. The stage of incubation in measles is from one to three weeks (average 12 days) ; in scarlet fever from one to eight days (average 3 days). 132 HYGIENE. Mention some of the results of tobacco smoking in growing school boys in respect to the circulation, air passages, vision and mental application. It depresses the circulation and produces palpitation of the heart. It causes low grades of inflammatory processes in the upper air passages, catarrhal conjunctivitis, mental lethargy, with inability to sustained mental application. What habits of school children tend to produce myopia? Reading of small or imperfect print ; faulty positions while reading or writing in which the eyes are not far enough re- moved from the page ; reading or writing in insufficient light, or when fatigued. What should be the proper temperature for a living room in winter? 72° F. for old or weak persons ; 65° F. for the young and vigorous. What should be the diet of a child over two years of age? The food should consist principally of milk and bread, with rice, tapioca, some vegetables of easily digestible character, and sparingly of fruit, preferably cooked; but little meat should be allowed, and this preferably mutton. What hygienic precautions should be observed by a pregnant woman? Diet should be nutritious; clothing should be loose; mod- erate outdoor exercise should be taken each day; the marital relations should cease; the action of the skin should be stimulated by warm baths. After the sixth month the urine should be examined every few weeks. Constipation should be corrected by hygienic measures when possible. In late pregnancy the nipples, if necessary, may be developed by judicious manipulation. What is the most sanitary way of disposing of city garbage? Burn it, so that all noxious vapors are also consumed. HYGIENE. 133 Mention six desirable factors in the location of a resort for consumptives. Equable climate, high altitude, dry atmosphere, pure air, abundant sunshine and pine forests are climatic factors for consumptives. State the accepted belief in respect to the limitation of protection from vaccination. Five years, when revaccination should be attempted. Dur- ing a small-pox epidemic it is advisable to revaccinate all individuals who have not been vaccinated within two years. Mention some of the adulterations in preparations of ground coffee for sale in the shops. Chicory, peas, roasted cereals and legumes, date stones, acorns, sawdust, etc. What class of foods should predominate for persons over sixty years of age? Use eight-tenths the quantity of proteids that the vigorous adult requires; seven-tenths the quantity of carbohydrates; and one and two-tenths times the quantity of fats. Which in your judgment is to be preferred in vaccina- tion, animal or humanized lymph, and why? Animal lymph, because in its preparation greater care may be taken to secure its freedom from deleterious additions. Name some of the nuisances dangerous to health. Gases and dust of a poisonous or irritating nature arising from many manufacturing industries. Collections of stag- nant water, garbage and animal excreta exposed to air; leak- ing drains or sewers saturating the soil, or allowing the escape of gases. Industries giving rise to great noise or vibration in thickly settled communities. What is the best means for preventing the access of sewer gas in dwellings? Place a trap or water seal between the house drain and the 134 HYGIENE. sewer and provide an air inlet pipe to open into the drain pipe between this trap and the house. A ventilation pipe should extend from the house drain to a point above the roof. State the ordinary death rate of each of four cities having respectively a population of more than fifty thou= sand (50,000). Dublin, 39.9 ; St. Petersburg, 31. ; Berlin, 17. ; Amsterdam, 17.8 (1897). Name the diseases the predisposition to which is greatly increased by the habitual use of alcohol. Diseases of the heart and vascular system, the kidneys, brain and liver, and of the respiratory system, particularly pneumonia and asthma. Mention methods to be employed for preventing epi- demics of yellow fever in the tropics. Remove at once to high or new ground should the disease appear. Cremate all those who have died of the disease; disinfect and remove all filth and endeavor to destroy all mosquitoes and their larvae, and other insect pests by the use of petroleum, sub-soil drainage of damp places, and fill- ing all stagnant pools with clean dirt. Name four diseases that are communicable to man through cows' milk. Typhoid fever, scarlet fever, cholera and tuberculosis. To what is indigestion from excessive tea drinking attributable. State a formula for the preparation of good tea. The indigestion is caused chiefly by tannin; also by theo- bromin. Pour one pint of boiling water over a dram of the dried tea leaves and allow it to stand without applying further heat for five minutes. HYGIENE. 135 Mention some of the advantages of carefully prepared artificial ice as compared with natural ice. It may be made from distilled water so as to be absolutely pure. It may be obtained in any size or shape and its tex- ture is more uniform. What precautions as to food and drink should be ob= served by those forced to work under the direct rays of the sun in summer weather? A small quantity of readily digestible food should be eaten before going to work. Liquids of a non-alcoholic character may be used liberally, provided perspiratory function is ac- tively performed. Very cold drinks should be avoided. Meat should be largely excluded from the diet. A law to prevent owners of land in the narrow streets of New York City from erecting buildings more than twelve stories in height is being agitated. Give sanitary and hygienic reasons for and against. Reasons favoring tall buildings: The persons using the upper floors are insured uninterrupted sunshine, good light, a pure air, comparatively free from street dust, and free- dom from ground air and water. Reasons against : Tall buildings prevent proper ventilation of lower buildings, and obscure sunlight from smaller build- ings and the street. Fire is difficult to extinguish in tall buildings. Their lower floors are often damp and generally dark, requiring the constant use of artificial illumination. They are, therefore, a menace to the lives of their occupants. What are the best methods of ventilating dwellings, and what sanitary principles are involved? The perflating action of wind should be utilized at least once each day for all rooms. One of the best methods em- ployed is the open fireplace, provided such fireplaces be sup- plied with properly constructed chimney exits. In lieu of this plan fresh air may be admitted through ventilators, or 136 HYGIENE. between the upper and lower window-sashes. The object sought in these devices is to admit cold air above the heads of the occupants of the room so that the fresh air may pass through the upper portions of the room and become heated before reaching the occupants. The usual outlet for foul air is the chimney flue, but when this is not present, it may be replaced by an opening for the exit of air placed near the floor of each room. When the incoming air is not heated the outlet should be at the top of the room. During cold weather the rate of interchange of air should not be greater than sufficient to change the air of the room three times an hour. The air which enters should not have a greater velocity than five feet per second, or about 3.4 miles per hour. What hygienic precautions should be observed in the care of the new=born child? The room should be kept at a temperature of about 72° Fahr. and well ventilated without draught. The child should be thoroughly cleansed, using a neutral fat to facilitate the removal of all fatty or sebaceous material before washing with warm water and eastile soap. The eyes and surround- ing parts should in particular be thoroughly cleansed; if possible, without the aid of soap. After thoroughly drying the infant, its navel should be properly dressed. The infant should then be warmly clad, kept dry and clean, and away from noise and strong light. What hygienic precautions are necessary to insure healthy sleep? A well-ventilated room, temperature about 60° F. Room and bed should be perfectly clean, and the covers of the bed not too heavy. The head of the person should be slightly elevated. Noise and light should be excluded from sleeping apartments. What deleterious gases accumulate in improperly ven= tilated sleeping rooms? Carbon dioxid; carbon monoxid, if rooms be heated; hy- HYGIENE. 137 drogen sulphid; ammonium sulphid, and many gases of an organic ammoniacal character. Does change in climate require any change in food; if so, what? Yes. In cold climates a greater quantity of food should be consumed than in hot climates. Food that is productive of the greatest number of heat units, as fats and meats, should be partaken of in cold climates. In hot climates the diet should consist almost entirely of well-cooked vegetables and ripe fruits, with the avoidance of alcoholic beverages. What are some of the dangers of the cold bath? In those of feeble circulation and at the two extremes of life, chilling of the surface of the body leading to internal congestion that may result in acute inflammation, particu- larly of the lungs, kidneys, stomach and bowels. Shock seri- ously affecting the heart; and the production of a persistently lowered temperature of the body. What effect has ground air and water on the health? Ground air is always impure, being contaminated with bacteria, carbonic dioxid and often with more poisonous gases. It occasions various degrees of ill-health, varying from slight general malaise to one of the acute infectious diseases or tuberculosis. Ground water from near the surface of pol- luted soils may be noxious. It causes dampness of the walls of houses, inviting rheumatic diseases and catarrhal inflam- mations. What hygienic principles should be observed in infant= feeding? Feed the child every two hours during the day, and about three times during the night till several months old ; then less frequently. If possible let the child receive its natural food from the mother, and in such cases take particular pains to see that the nipples and breasts of the mother are kept dry and clean bet ween the times of nursing. If the infant 138 HYGIENE. is to be given artificial feeding, the cow's milk selected must be from a healthy animal, must be diluted with water to give a relatively less proportion of casein, must be sweetened with milk sugar, and have a slight addition of fats in the form of cream added, when it will approach human milk in composition. A definite quantity of milk which should be warmed to the temperature of the body should be given at each feeding. Define the word " nuisance " in a broad hygienic sense. "Something which either actually injures, or is likely to injure health, and admits of a remedy either by the indi- vidual whose act or omission causes the nuisance, or by the local authority" (Wynter-Blyth). What should be the height, weight and chest measure of a typical man aged 25 years? Height 67.8 inches; weight 139 pounds; measurement of chest 34.5 inches. What injurious influences, if any, do cemeteries exert on the health of persons living in their vicinity? To most persons the mental effect is depressing. Water passing through the soil of cemeteries may contaminate the water supply of the neighborhood with organic material and micro-organisms. The constant turning of soil of cemeteries may set free imprisoned gases from organic decomposition, and lead to contamination of the surrounding air. What physical conditions would render the taking of a Turkish bath inadmissible? Atheromatous arteries generally, diseases of the lungs, and diseases of the heart. What gases and combination of gases are most efficient as disinfectants? Formaldehyde, Sulphur dioxid, Chlorin, Ozone. What care should be employed in exhumations? The exhumation of those dead of contagious or infectious HYGIENE. 139 diseases should not be allowed. When possible, the exhuma- tion should be deferred until cold weather. The presence of all persons except those absolutely needed should be forbidden. As the workmen approach the coffin the earth should have poured upon it a strong watery solution of creolin. The coffin containing the remains should not be opened, but be placed at once in a zinc-lined box and hermetically sealed. What are the hygienic requirements and the physio= logical effects of bathing? The bath should be taken to obtain personal cleanliness, as well as for its stimulation of the peripheral circulation. Bathing should be postponed until at least two hours after a meal, and should consume only twenty minutes. Never bathe when very hungry, or when the body is overheated. Unless experience has shown that good effects accrue from a cold bath, secure a temperature of about 65 to 75 degrees Fahr. of the water. The bath should be followed by a thorough drying and brisk rubbing. Effects following a bath are re- moval of dirt and of dead epithelium from the person, stim- ulation of the functional activities of the skin; a general improvement in the circulation and increased functional ac- tivity of the organs of elimination. How much fresh air is required for normal respiration during 24 hours? 3,000 cubic feet per hour, or 72,000 cubic feet of air in 24 hours. What is the best sanitary disposition of stable manure in large cities? The liquid portion of manure should be carried by prop- erly constructed trapped drains into the general sewer. The solid, dried manure, straw, etc., should be placed in well- covered pits, from which it could be removed at proper in- tervals in covered wagons, and cm ployed in the country as fertilizer; or drain the liquid manure into the sewer and cremate the solid manure. 140 HYGIENE. How may a privy in a city or country be kept while in use from becoming a nuisance? Have the privy emptied at frequent intervals. At inter- vals of five to seven days, pour into the privy vault milk of lime (about 20 grains of lime for each gallon of sewage), or strong solution of iron sulphate; or at frequent intervals add clean, dry earth to the privy contents, and provide a ventilating pipe extending high in the air and down into the privy vault. What explanation can be furnished for the greater prev- alence of diphtheria and small=pox in cold than in warm weather? During cold weather the houses are less perfectly venti- lated than in warm weather. Rooms are frequently over- crowded, less attention is paid to personal cleanliness and there are more sudden changes in temperature. Such condi- tions lower the vitality of the body and predispose to disease. What are the principal adulterations of milk? Addition of water and abstraction of cream; addition of coloring matter (annatto, caramel) ; preservatives (borax and boracic acid, salicylic acid, formaldehyde, chromates) ; gela- tine as a thickening for cream. What changes in food are effected by cooking? Parasites and germs are destroyed; the food is made more tender to facilitate mastication. The tough fibrous envelope of starch cells is softened, albumin is coagulated, the food is rendered more palatable, and the action of the different digestive fluids is aided. Give the sanitary dimensions of a school=room for fifty pupils. A room 15 feet high, 25 feet wide and 40 feet long would allow each pupil 300 cubic feet of space, which is the ade- quate amount for each child. HYGIENE. 141 State the advantages of cremation over earth burial. Complete destruction of specific disease germs. If crema- tion be well performed no obnoxious gases are given to the air, no gases of putrefaction contaminate the air, and there is no danger of contaminating the water supply through drainage from cemeteries. What are the respective merits of cotton, wool and silk when used as underwear? In a variable climate wool is preferable because from a larger amount of air enclosed in its texture it acts as a good non-conductor of heat, retaining the body temperature. As wool is hygroscopic it readily absorbs moisture from which it parts slowly, so preventing surface chill of the individual by too rapid evaporation. Next in order to retain the heat of the body we rank silk, and least valuable for the retention of body heat is cotton. If it be our purpose to supply a cool garment we would of course reverse this order of arrange- ment. If a chemical analysis of water revealed the presence of nitrites and nitrates, would this condemn it for drinking purposes? If so, why? Yes, particularly if nitrites be present. Organic matter, particularly sewage, is converted first into nitrites, and these into nitrates through the action of bacteria in the soil. These salts would, therefore, indicate a former pollution of the water with probably some of that polluted material still in the water. If nitrates only are present, and it can be shown that the organic matter is of a vegetable origin only, the water need not be condemned. To what diseases are negroes comparatively insuscep- tible? In the Middle States to what diseases are negroes more prone than whites? Dysentery, yellow fever, and diseases incident to exposure to summer heat. Negroes are more prone than whites to 142 HYGIENE. contract small-pox, diseases of the respiratory tract, fibroid tumors, keloid growths and venereal diseases. Give a medical and hygienic plan for the inspection of immigrants who have just arrived at a seaport. Examine the "Bill of Health" and clinical records of all cases treated during the voyage and the lists of passengers, crew and manifests, and, if desirable, the ship's log. Have crew and passengers mustered and compared with the lists, investigating any discrepancies and make a careful examina- tion of both crew and passengers. If a case of infectious disease has occurred during the voyage, disinfect all exposed baggage and freight and detain such members of the crew and passengers as have been exposed until the incubation period of the disease has passed. What conditions of ill health make residence in high altitudes dangerous? Why? Chronic Bright 's Disease, disease of the heart, emphysema, and old age. High altitudes occasion increased respiratory effort from the rarified condition of the atmosphere, causing increased heart action, and a lessened perspiratory function. State the physical conditions that make the practice of taking hot baths inadvisable. Acute inflammatory diseases, tuberculosis, organic diseases of the heart and brain, aneurism, cancer, and all diseases in which stimulation of the circulation is to be avoided. State some of the sequelae of (a) over=strain, (b) over= exertion, (c) over=training. (a) Parting of continuity of osseous, ligamentous, muscu- lar or blood-vessel structure leading to fractures, dislocations, rupture of muscles, hernia, rupture of heart muscle, disease of valves of heart or apoplexy. (b) May produce same conditions as overstrain and in addition cause general muscular relaxation, dyspnea, syn- cope, etc. HYGIENE. • 143 (c) Loss of appetite and of muscular power, successive crops of boils appear, individual loses mental power, as of concentration of thought, and digestive disturbances occur. What constitutes hard water and soft water? "Hardness is the capacity a water has for decomposing soap, and depends on the amount of salts of magnesia and calcium in solution." (Harrington.) Soft water contains little or no dissolved salts and rapidly forms a lather with soap. Mention the dangers of excessive shade about dwellings. Excessive shade interferes with the free movement of air, prevents penetration of the sun's rays, promotes dampness which is given off to the air by evaporation. It exerts a de- pressing mental action, promotes the growth of fungi aiid bacteria, and prevents the aspirating action of heat from the sun upon air and moisture in the soils. What is milk sterilization? How is it performed? Destruction of micro-organisms in the milk by heat. By continuous heating of the milk, under pressure, for two hours at 248° F. State the objections usually advanced against vaccina* tion as a preventive of small=pox. It is urged that it fails to protect from small-pox (which is false), that it may produce blood-poisoning, that constitu- tional diseases like syphilis, scrofula, etc., may be introduced by the vaccine virus, or in the operation. Also that tetanus may result, and that it is not right to deliberately inoculate a healthy person with the virus of vaccinia or of any disease. On what generally accepted theory are toxins used for the prevention and cure of disease? That their presence in the system renders the blood do longer able to support the lives of bacteria that occasion such toxins. 144 • HYGIENE. What infectious diseases may be due to impure drink= ing water? Typhoid fever, malarial fevers, cholera, relapsing fever, dysentery, parasitic diseases. Define humidity of the atmosphere. Why should a humid atmosphere cause rheumatic persons and persons suffering with the gout increased sensitiveness? The term humidity refers to vapor of water in the air. An increased humidity increases sensitiveness of gouty and rheu- matic patients by decreasing elimination from the skin of excretory organic matters and uric acid derivatives and thus leading to retention of such poisons in the system. What constitutes a thorough meat inspection? How should an inspection of milk be conducted? Meat should be inspected within 24 hours after the animal is killed. The following points are noted : The quantity of bone, for which 17 to 20 per cent, is to be allowed. The quantity and character of the fat, noting its color, consis- tency, and taste. Condition of the flesh. Condition of the marrow. Examination of the lungs, liver, kidneys for detec- tion of infectious disease manifestations. A microscopical examination of the flesh for detection of bacteria of path- ogenic character, trichina, tape-worm or other parasites. Where possible, it is well to investigate the surroundings in which the animal has lived and the methods employed for storage and refrigeration. An inspection of milk takes cognizance of its specific grav- ity, color, quantity of cream, presence of preservatives, pres- ence or absence of dilution, or addition of coloring matter, determination of total solids, of quantity and quality of ash, of fats, casein, lactose. The microscopical and bacteriological examinations are performed and finally an examination is made of the source, storage and distributing methods. HYGIENE. 145 Discuss the theory of hereditary tendencies as applied to tuberculosis. Children born of tuberculous parents present less power to combat and overcome the attacks of the tubercle bacilli than others of more healthy parents. Some ' theorists claim that this deficiency of resistance is in part due to an inherited small heart, and lessened circulatory power, thus favoring conditions of passive congestion or slow grades of inflamma- tory processes. Such subjects as a rule show lessened lung expansion, a flattened or a wedge-shaped chest, etc. Describe the physiological action of alcohol. Small or therapeutic doses increase the pulse rate and the arterial pressure by directly stimulating the heart. Over- doses directly depress and paralyze the heart muscle Large doses produce decided lowering of body temperature. It is probable that the use of alcohol diminishes the elimination of C0 2 . Alcohol causes a great lessening in the excretion of the products of tissue waste. It is probable that alcohol in not too large quantity is entirely destroyed in the body. In small doses alcohol acts as a cerebral stimulant, while larger doses greatly depress and abolish nervous activity, and check digestion. The habitual use of alcohol is accompanied by a disposition towards fatty degeneration, particularly of heart muscle, liver and kidneys, and an enlarged and dilated con- dition of the smaller blood-vessels and a degeneration of all nervous structures. Does alcohol possess a food action? On what do you base your answer? Yes. "In the sense that it is destroyed in the system and yields force which is utilized by the organism, and is when in sufficient quantity a retarder of tissue change, checking the excretion of nitrogen" (II. C. Wood). We see this in its administration in typhoid and other long-continued fevers. Yet it is not a true food, since it also exerts toxic effects, which foods do not. 10 146 HYGIENE. State your views on compulsory vaccination and relate the safeguard that should be employed in all cases of vaccination. The unprotected individual should be vaccinated as a pro- tection to himself and to those with whom he comes in contact. The virus employed must be free from contamination, and the instruments used should be perfectly sterile, and the operation should be performed on a clean surface. The wound should be adequately protected from irritation by clothing or from pathogenic germs. In the pursuit of what trades is there a predisposition to pulmonary diseases? Trades carried on in over-crowded, poorly ventilated rooms, in damp localities. Trades that give rise to much dust, par- ticularly if such dust be of fine, hard particles, to which file- makers, stone-cutters, grinders, etc., are subjected. Such trades as necessitate cramped positions of the workers pre- venting proper lung expansion. In vocations giving rise to poisonous or obnoxious vapors, and also where the individual is exposed to sudden changes of temperature. Under what condition is tyrotoxicon found in milk, cheese and other articles? Where milk, cheese, ice cream, etc., undergo decomposition in the presence of other organic matter, as rotting wood, mould, etc. The excavation of streets in cities is frequently fol- lowed by the outbreak of disease, such as diphtheria, typhoid fever. What is the cause? Pathogenic bacteria lie dormant in the soil of cities, and when such soil is exposed to the air, it becomes dried, and its contained bacteria taking on an active existence are liber- ated and carried by the air to susceptible individuals. Describe the agency of the ptomaines in inducing dis- eases and the disorders produced by them. Ptomaines are alkaloidal bodies resulting from decomposi- HYGIENE. 147 tion of nitrogenous substances. When absorbed into the blood they may give rise to fever, headache, torpor, fetid breath. They act like chemical poisons very soon after their introduction into the system. Many of them occasion dis- tinctive trains of symptoms. How long does a diphtheritic patient remain infective? How may it be proved that this infective period has ceased? About three weeks after local symptoms cease. Make fre- quent cultures of material from the affected site, and when such fail to show the specific germ, the patient will no longer be a source of infection. How may milk be the means of transmitting the germs of typhoid fever? Through water containing Eberth's bacillus gaining access to the milk, as through diluting the milk, washing milk re- ceptacles in polluted water. State the period of incubation in (a) vaccinia; (b) paro- titis; (c) pertussis; (d) varicella; (e) rotheln. (a) 3 to 7 days; (b) 14 to 22 days; (c) 2 to 8 days; (d) 4 to 14 days; (e) 12 to 20 days. Mention the effects of working in phosphorus, as in the manufacture of phosphorus matches. How can the dan= gers be limited or prevented? Inhaling phosphorus fumes produces a form of necrosis of the jaw, particularly in such as have imperfect teeth. To avoid its development persons with sound teeth and freedom from abrasion of the interior of the mouth should be em- ployed. The work-room should be large and well ventilated, with special air-shaft to force the fumes away from face of workers, the employees should have short working hours, and frequently use a mouth wash and gargle of lime water or carbonate of sodium. Turpentine and charcoal should be exposed in 1 lie room. 148 HYGIENE. What fruits are preferable in cases of habitual consti- pation? Apples, prunes, figs, tarmarinds, grapes and melons. Indicate a proper diet in the case of diabetes mellitus, obesity and early convalescence in typhoid fever. The diabetic should use only a small quantity of carbo- hydrate foods, with a relatively large quantity of proteid foods and fats. The patient suffering from obesity should use but little fluids or food containing much water. Food containing starch and sugar should be eaten sparingly, and alcoholic liquors and fats must be avoided entirely. He should eat lean meats, mutton, beef, lamb, chicken, eggs, stale bread or toast sparingly, tomatoes, lettuce, celery, asparagus, onions, ripe fruits of an acid nature but no sugar. In convalescence from typhoid fever the patient should use easily digestible food of a concentrated, nourishing character, of small bulk and without hard or irritating properties, as soups, broths, uncooked oysters, eggs, rice, wine, milk, calves' foot jelly, etc. What is the chief unsanitary condition of sea=going vessels? The presence of bilge water and a dirty hold. Describe the manner in which antitoxin is prepared. A virulent culture of the specific micro-organism, or a strong toxin is injected into the cellular tissue of the selected animal, under due precautions of aseptic operation. After the animal has recovered from the symptoms thus produced, another and stronger injection of the specific poison is given. Injection after injection of increasing strength is given at proper intervals, until the animal fails to show any further symptoms of the disease — after an injection. Blood is then taken from the jugular vein of the animal, the greatest care being observed to secure aseptic conditions. This blood re- ceived in sterilized flasks, which are then stoppered, is stored in refrigerators until separation of clot and serum occurs. HYGIENE. 149 The serum is now tested to determine its value as antitoxin and then, after the addition of a very small proportion of carbolic acid, is placed in small vials, which are then her- metically sealed. Each vial has marked upon it its strength in normal antitoxin units in each cubic centimeter, and usually contains one dose. Mention some of the objections to curbed or driven wells in streets or houses with respect to the purity of water coming from these wells. The curbing rarely affords protection to the well water from gases and other emanations from sewers, gas-pipes, drains, etc., and even though a driven piped well may take its water from far below the surface, yet in the streets of cities, with the ever-present sewer and gas pipes, the soil becomes so saturated with deleterious material as to greatjy endanger, through water carriage, the water from all forms of wells. From what disease may immunity be acquired in the case of persons who have once suffered from these dis- eases? How is knowledge of this fact utilized in the prevention of certain diseases? Yellow fever, small-pox, scarlet fever, measles, mumps, chicken-pox, pertussis, typhus fever, typhoid, cholera. We may prevent some of these diseases by the introduction into the patient's system of the particular antitoxin of the threatened disease. Describe the effect of a hot and moist climate on the human system, and state the class of diseases this atmos- phere is likely to induce. In hot and moist climates the inhabitants, as a rule, are of small stature and deficient in muscular development; of languid disposition and nervous temperament. The diseases most prevalent arc those affecting the liver and gastrointes- tinal tract; also various forms of malarial disease and yellow fever. 150 HYGIENE. What occupations are a menace to public health? Why? Those occupations that emit irritating, poisonous or nox- ious fumes and gases, from the vitiation of the atmosphere, as in fertilizing plants, chemical manufactories, bone-boiling establishments; also such occupations as give rise to much dust, especially if this be of sharp, hard character, as from cement-making, tool-making, in which the respiratory tract is subjected to irritation. Mention some of the objections to storage cisterns under ground. What are the objections to rain water as a drink? They often receive dust and dirt; sewer gas may gain entrance to the water when the "standing waste" or over- flow pipe of such a cistern is connected with the drain or soil pipe of a house. Storage cisterns cannot be properly vantilated, and are often difficult to clean. If the first part of the rain be collected, such water will contain dust, pollen, gases and other matters washed from the air. Mention some of the diseases to which artisans are especially liable. Painters, and those working in lead, copper and zinc, may suffer from metallic poisoning; match-makers from phos- phorus or sulphur poisoning; tool-makers and grinders from phthisis ; miners from affections of bronchi and lungs ; smelt- ers from arsenical poisoning. Give an opinion as to the sanitary effect of the different methods of heating houses. The most desirable method is by hot water heating by means of a complete plant with circulation of the hot water through radiators. Next in value to hot water heating is steam heating by radiators or by indirect radiation. The use of open fireplaces in the principal rooms is of great value in securing ventilation, but yields an unequal and insufficient supply of heat. Heating a house by hot air from basement heaters is efficient and gives good results, if the air supplied HYGIENE. 151 to the heater for distribution is pure and the house is not too large. State average weight of feces in 24 hours in a nor- mal man. What proportion is made up of liquid and what of solid contents? Six ounces, 75 per cent, of which is water. Name eight principal carbohydrates used as food. Starch, glucose, saccharose, lactose, dextrin, cellulose, mal- tose and dextrose. Name the class of foods which should be given to chil- dren between the first and second years of age. We should supply foods in about the proportion of 2 parts proteid, 3 parts fat. 6 parts carbohydrates, the proteid food preferably milk. How do forests benefit public health? Forests act as wind barriers, promote humidity of the air from the widespread surface they offer for evaporation. They afford shade in summer, and aid in decreasing the rela- tive quantity of carbon dioxid in the air. exhaling oxygen to the air. State in a general way the maximum number of hours that primary pupils in the public schools should be kept at their tasks, and how frequently and in what manner such tasks may be varied and broken. One-half hour at a given task is sufficient, when the char- acter of the mental work should be changed. When an hour's mental application has been enforced, then five or ten minutes should be given to light calisthenics. An intermis- sion of fifteen or twenty minutes in the open air should occur in the course of three hours' study. An intermission of two hours should then be allowed for luncheon and recrea- tion, at the end of which time a similar routine may be fol- lowed, aa stated above, for two hours. 152 HYGIENE. What abnormal condition of the eye is most common in school children? Myopia. What are some of the dangers involved in the domestic use of ice? Ice may contain pathogenic bacteria, and may, when re- moved from a sick-room transmit infectious disease to other members of the household. What is the expectation of life of a professional man in active practice at the age of 45 years? 24.82 years. Define the term " quarantine;" mention the principal quarantinable diseases, and give the rules for determining the length of time each should be quarantined. "The adoption of restrictive measures to prevent the in- troduction of diseases from one country or locality into an- other" (Wyman). Quarantinable diseases include cholera, small-pox, yellow fever, plague, scarlet fever, diphtheria, typhus fever, relaps- ing fever, cerebro-spinal meningitis, leprosy. In eruptive fevers isolation of the patient (quarantine) is continued for two weeks after the eruption has disappeared except in the case of small-pox where quarantine lasts 30 days. The quarantine in diphtheritic cases does not cease until cultures made from the throat of the patient fail to show the bacillus of diphtheria. State the best means of disinfecting sputum. Sputum should be burned or be received into vessels con- taining strong antiseptic solutions. What is understood by the germ theory of disease? Mention all diseases whose causes are known to be spe- cific micro=organisms. The germ theory of disease contends that the exciting cause of each infectious or contagious disease is some specific HYGLENE. 153 organism, and that these diseases are communicated only by the transference to and development of the particular para- site or germ within or upon the tissues of the infected in- dividual. Diseases due to specific micro-organisms are tuberculosis, diphtheria, cholera, typhoid fever, dysentery, pneumonia, glanders, leprosy, anthrax, erysipelas, gonorrhea, relapsing fever and tetanus. What diseases are incident to school life? How may these diseases be prevented? The infectious diseases, which should be prevented by early recognition and prompt removal of sick pupils. The room should be disinfected. Curvature of the spine should be cor- rected or prevented by properly constructed school furniture, and proper admission of light to the room. Myopia should be prevented by the use of clear, large print in text-books and corrections of improper positions in reading and writing, and a good supply of light admitted to the school-room to the left of the pupils. Contagious conjunctivitis, prevented by cleanliness and isolation of the patient. Chorea, prevented by removal of the afflicted and repres- sion of all the tendencies toward imitation. What is the value of preventive inoculation in cholera and diphtheria? Value in cholera not yet fixed. In diphtheria, antitoxin is both curative and prophylactic. Outline the construction of a camp hospital, especially providing for the care (with least danger to other patients, medical and surgical) of those suffering from contagious diseases. Obtain purity of internal atmosphere; abundance of pure air and Bunlighl within the building, facility of administra- tion and discipline. To obtain these requirements select a proper site of soil, not clay, and preferably on hillside, look- 154 HYGIENE. ing southward if in winter; use a simple plan of building, a sufficient number of wards, preferably on the detached or pavilion plan. In wards each patient should have at least 90 square feet of surface space, and 1,200 cubic feet of air space ; have provisions for burning all infected material, dis- charges, etc., to leeward of the hospital and at a suitable distance away. Can it be proved that the diminished death rate from diphtheria so generally announced is due to the use of diphtheria antitoxin? Give reasons. Yes. By comparing the death rate in hospitals treating the same class of patients, in the same community, during the same time, the one hospital using diptheritic antitoxin, the other depending upon other methods of combating the dis- ease. Where the antitoxin is used the death rate is much lower. Give the comparative nutritive value of sterilized or unsterilized cows' milk. The nutritive value of sterilized milk is less than of milk unsterilized. What evil consequences frequently result from the ex= cessive use of tobacco? Catarrhal inflammation of pharynx, tonsils and mouth. Nervous disorders of heart as palpitation, and insomnia also result. Derangements of stomach with loss of appetite, and impairment of vision together with paralysis of optic nerve, nervous tremors, and muscular twitchings may result. How should a patient who has been rendered uncon- scious by heat be treated? If the patient has a strong, full pulse and the face is red and congested, place him in a recumbent position with the head raised and apply ice until the high temperature falls to about 100 degrees Pahr. If the patient is pale, with a weak pulse, use stimulants, as ammonia, by inhalation; apply heat to the body and keep head, face and neck cool. HYGIENE. 155 State the value of public baths to the health of a large city. They give facilities to the poor for obtaining personal clean- liness, exerting a protective influence over the development and spread of filth diseases. They encourage the young to learn to swim, and apply an excellent form of exercise, pro- moting growth and development. When properly used their effects are both tonic and stimulating. What is sewer gas? How does the inhalation of sewer gas in large quantities affect the system? Sewer gas is a mixture of a number of gases, among which we find carbonic acid gas, light carburetted hydrogen, nitro- gen, hydrogen sulphid. ammonium sulphid. with fetid organic matter, the volatile and semi-volatile results of animal and vegetable decompositions. Sewer gas gaining entrance to house or room may exert a depressing influence upon the occupants, and may occasion vomiting, purging, severe headache, prostration, and through its carriage of germs cause infectious diseases. Yet sewer gas per se is sometimes almost innocuous. A chronic form of poisoning from sewer gas gives rise to pallor, languor, frequent headaches, loss of appetite, diarrhoea, generally im- paired health and anemia. Is green wall=paper objectionable; if so, why? Yes, because its color is often due to a compound of copper and arsenic, which after becoming damp dries, and is rubbed or blown from the walls, producing acute or, more often, chronic forms of arsenical poisoning as well as mechanical irritation of fauces, conjunctiva, etc. Contrast the incubative stages of variola and measles. The incubative stage of variola is from six to seven days by inoculation, and from ten to fourteen days by infection. In measles it is from seven to ten days by inoculation and from seven to twenty-one days by infection. 156 HYGIENE. What conditions and diseases in animals render their flesh unfit for food? "The flesh of all animals dead of internal diseases, or which have been killed while suffering from such diseases or animals killed by overdriving. The flesh of animals with contagious diseases that may be transmitted to man. The flesh of animals that have been poisoned. The flesh of ani- mals with severe infectious diseases, as pyaemia, etc. Flesh that contains parasites that may be transmitted to men. All putrid flesh" (Gerlach). Discuss detached wards versus many=storied buildings for a public hospital. Many wards in one building render the maintaining of dis- cipline and supervision easier. Quicker service, ease of com- munication, greater economy of administration are favored by many wards. Many-storied buildings prevent perfect iso- lation and ventilation, render diminished supply of sunlight, lead to danger, as in removal, should fire occur; so that the detached ward system seems preferable. Give a fair average death rate (a) in rural districts, (b) in towns of from 5,000 to 20,000, (c) in cities of over 100,000 inhabitants. (a) 14, (b) 17, (c) 19 to 22 per thousand. Mention five preventable diseases. Tuberculosis, typhoid fever, cholera, yellow fever and malaria. Give the special hygiene of factories in which women and children are employed. Each child or woman should be allotted sufficient space to supply 3,000 cubic feet of fresh air an hour by a not greater air movement than that which would change the air three times each hour. The temperature should be kept constant at about 65 degrees Fahr. Means should be employed to quickly remove dust or offensive and dangerous gases. Per- HYGIENE. 157 sonal cleanliness should be facilitated by properly equipped wash-rooms. The water-closet fixtures should be ample and of proper construction. An infirmary should be provided for immediate treatment of injuries and suddenly occurring illnesses. In the selection of a site for a dwelling what is the best sanitary soil, sub=soil and topography? A light, dry soil, as of gravel or sand, that contains no absorbed filth or sewage, with a nearly constant level of ground water, avoiding clay or impermeable material both in the soil and in the sub-soil. The location should not be in low-lying districts, nor in localities which from the geolog- ical formation act as collectors of underground water. The house should not be placed on the top of an elevation where it would be exposed to strong winds. All other conditions being favorable, the house should be built on the side of a hill so that it receives a maximum supply of air and sun- light, and in cold climates preferably with a southern ex- posure. What is the bubonic plague? What steps can be taken to limit or extinguish such a scourge? It is an acute contagious and infectious disease favored by filthy surroundings and at times occurring epidemically. It is due to a specific micro-organism and is characterized, among other symptoms, by glandular swelling terminating in abscess. Prevention depends upon isolation of the sick, thor- ough disinfection of the clothing, etc., and surroundings of the patient and the avoidance of overcrowding and filth, and the institution of rigid quarantine to prevent its dissemina- tion into a country. Name the principal adulterations of wine. Water, coloring agents (logwood, red beets, coal tar prod nets i. flavoring agents (prunes, peaches, raisins, dates, dried apples), preservatives (salicylic acid, formaldehyde), glycer- ine, alum and decolorizing agents. 158 HYGIENE. Give some of the requisites for the sanitary construc- tion of house foundations and cellars. To keep down the level of ground water subdrain if neces- sary to secure dryness. Coat the foundation inside and out with cement and provide a cement floor for the cellar. Admit plenty of air and sunlight into the cellar. What is your view concerning the propriety or neces- sity of inserting vaccine virus in multiple places? The duration of the protection from small-pox is said to be directly proportionate to the number and size of vaccine vesicles; so vaccinate in at least two different places and let the combined area of vesicle resultant measure over half an inch. Give the prophylaxis of the filth diseases. Sanitary inspection of all houses and buildings with im- mediate abatement of any nuisances. Thorough cleanliness applied to persons, habitations and the community, and to houses of public use. Examination of water and food sup- plies, with correction of all disease-exciting causes. Sewage and waste removal systems to be placed in perfect operation. Isolation of patients sick with these diseases, and disinfection of rooms and property of such patients, and the establishment of house, municipal, state or national quarantine. Prevent access of flies and other insects to food and drink. What is the physical training for a weak heart when no valvular lesions exist? Beginning with gentle calisthenics, exercise should be taken, preferably in the open air, and increased gradually, such exercise to be supervised by a competent physician. Later on climbing exercises of a very gradual degree of difficulty may be taken. How many cubic feet of fresh air per hour are required by an adult? Three thousand cubic feet. HYGIENE. 159 Describe the effects of a cereal diet. Many writers assert that, as a rule, such a diet produces a lessened muscular formation, with an increased fat produc- tion, and that it also causes a deficient production of red blood corpuscles, with an accompanying loss of oxidation and tissue removal ; but it is probable that such a diet is com- patible with good health provided it contains enough proteids. What is the lowest temperature of steam heat at which pus cocci are destroyed? At 240 degrees Fahr. such organisms are killed in a few minutes, while at 212 degrees Fahr. it requires an exposure to steam of from thirty to forty minutes. What physical training would you recommend to a per» son with weak respiration? Calisthenic exercises without apparatus directed to increas- ing the extrinsic and intrinsic muscles of respiration, accom- panied by deep and slow breathing. This should be followed by a course of light, well-regulated gymnastic work, with dumb-bells, Indian clubs and wands. After a proper interval of several months progressively difficult mountain climbing, then running exercises, and finally general apparatus work in a good gymnasium under proper instruction. Name three tests for detecting impurities in water. Nessler's test for detecting and estimating ammonia. Nitrate of silver for detecting and estimating chlorides. Barium nitrate for detecting and estimating sulphates. What is the best sanitary plan for the disposal of sewage? Collect the sewage in large tanks and to it add lime, alum or iron sulphate. Compress the solid materials after their subsidence or precipitation and cremate them. Allow the liquid sewage to flow upon specially prepared filter beds which are Bubdrained, and the water Sowing from these sub- soil pipes may then pass into a stream without greal danger of adding poisonous material or pathogenic bacteria. 160 HYGIENE. What is the temperature of tepid water, of hot water, of boiling water? Tepid water 75 to 85 degrees Fahr. Hot water 100 to 110 degrees Fahr. Boiling water 212 degrees Fahr. What diseases are propagated by drinking water? How can their spread be prevented? Infectious diseases, particularly cholera and typhoid fever; diseases due to gastric and intestinal irritation, as forms of dyspepsia, diarrhoea, dysentery; diseases due to animal para- sites; diseases due to metallic poisons. Prohibit the use of water containing any dissolved metal. Distil the water, or boil it for at least one-half hour, thus purifying it. Describe in detail the sanitary precautions necessary in typhoid fever. Expose urine, stools, vomitus and sputum for three hours to the action of a solution of chlorinated lime, of the strength of six ounces to a gallon of water, breaking up all solid masses. Place all towels, napkins and bed linen in a 5 per cent, solution of carbolic acid until convenient to boil the same for half an hour. Secure continuous ventilation of the sick room. Boil all water and milk before allowing its use by the patient or members of the household. Fumigate the room and contents after the patient leaves it. What hygienic precautions should be employed about diphtheria? Isolate the patient; refuse admission to the sick-room of all whose presence is not necessary; attendants should ob- serve the greatest personal cleanliness; all secretions should be collected upon cloths and burned. All articles should be disinfected before being removed from the sick-room. Mem- bers of the household should be quarantined. HYGIENE. 161 What principal hygienic direction should be given a patient suffering from tuberculosis? Always expectorate into or on such appliances as may, with their contents, be disinfected or burned. Avoid kissing. How can malarial districts be made healthy? Remove moisture from the locality by surface or sub-soil draining; by planting trees like the eucalyptus, which require much water for their growth; by preventing the development of the mosquito larva?, through the action of petroleum on water surfaces. Differentiate between endemic and epidemic diseases. An endemic disease is one constantly present in a com- munity. An epidemic disease is one which spreads rapidly, attacking many people at the same time State the results to animal life of the combustion of fuel in a room without chimney connection or other ventilation. Carbon-monoxid poisoning, suffocation due to excessive quantity of carbon dioxide and diminished amount of oxygen ; a systematic poisoning due to breathing products which are the result of partial burning of excretions thrown off in ex- halations. What is the best method of disposing of the bodies of those who have died of yellow fever? Cremate such bodies. What is meant by natural and acquired immunity from disease? Give an example of each. By natural immunity we mean "that inherited trail Erom immune ancestors which enables an organism to resist the attacks of bacteria and their toxic secretions." Thus, as a rule, the negro race do aol contract yellow Eever. By ac- quired immunity we understand that through a prc\ attack of an infectious disease, or by inoculation with an attenuated virus of that disease, the blood of the person 11 162 HYGIENE. undergoes such changes as to present a non-fertile soil to Ihe organism to whose presence the disease is due. Example,, vaccination in preventing small-pox. What are the principal measures which you would employ for the prevention of the spread of infectious diseases? Isolate the patient and attendants ; disinfect all substances removed from patient's room before their removal; establish the purity of water and food supplies ; disinfect the room and contents after patient's removal, and observe a precautionary quarantine. How would you prepare an artificial food for a new= born infant? Render cow's milk as alkaline as human milk. Dilute with water to reduce the quantity of casein to what it would be in maternal milk. Fat and sugar are increased by the addi- tion of cream and sugar of milk. To one pint of sterilized water 17% drachms of pure commercial sugar of milk are added and dissolved. This sugar water must be kept in a cool place and not be allowed to sour. When feeding time arrives two tablespoonfuls of cream, one of milk, two of lime water, and three of the milk-sugar water are mixed, and as soon as this mixture has been warmed to proper temperature it may be poured into a bottle and the food is ready for use. (Fisher.) What are the properties of oleomargarin compared with butter made in the usual way? Butter fat contains nearly 8% of the volatile fat; specific gravity never below 909.8 ; insoluble fatty acids form about 88% of the weight of butter fat; melting-point of fat is between 86° and 94° F. ; readily and completely soluble in ether. Oleomargarin fat contains about %% °f tlie volatile fats; specific gravity never above 904.5 ; insoluble fatty acids form about 95% of the total weight; melting-point rarely above 82° F. ; less soluble in ether and leaves a residue. CHEMISTRY. State the conditions favorable to crystallization. That the molecules should be free to move, as they are when the substance is in fluid condition. Then melt the substance, or dissolve the substance; when through cooling, or evap- oration of solvent, we obtain the body in crystal form. The substance crystallizes through the action of three great forces, mechanical, chemical and magnetic. What temperature Fahrenheit is equivalent to a tem= perature of 28 degrees centigrade? What temperature centigrade is equivalent to a temperature of 120 degrees Fahrenheit? 28 degrees C. X f = 50.4 plus 32 equals 82.4 Fahr. Ans. 120 degrees Fahrenheit minus 32 equals 88 X £ equals 48.8 C. Ans. Define atom, molecule. The atom is the smallest indivisible particle of simple matter that passes from one molecule to another in chemical interchanges. Not capable of existing alone. A molecule is the smallest subdivision of matter capable of existing alone and retaining its characteristic properties; it is composed of atoms. Give the names of two elements or radicals in each of the following groups: Univalent Bivalent. Trivalent. Quadrivalent Hydrogen, Oxygen, Boron, Carbon, Chlorin. Sulphate S0 4 . A.nrnm. Platinum. (163) 164 CHEMISTRY. Illustrate the comparative significance of the following affixes: ous, ic, ite, ate. An oxy-acid of stable composition, or of great importance to arts and industries, takes the termination ic, as H 2 S0 4 sulphuric acid. If an oxy-acid of the same elements contains less oxygen in its molecule it terminates in ous, as H 2 S0 3 sulphurous acid. Salts formed by replacing the hydrogen in part or wholly of an ic acid by a metal have their names terminating in ate, as ZnS0 4 zinc sulphate. Salts in which the hydrogen of an ous acid is replaced by a metal have their names ending in ite, as Na 2 S0 3 sodium sulphite. Compare ozone with oxygen as to (a) occurrence, (b) properties. (a) Ozone is only found in air under exceptional circum- stances, or in limited localities, and in very minute quantities. Oxygen occurs in all atmospheric air in the proportion of about 23 per cent, by Aveight. (b) Ozone is a very energetic oxidizing agent acting like nascent oxygen, and oxidizing substances that resist the action of ordinary oxygen, as silver. Ozone will not support respiration, acting as an irritant to respiratory membranes. Ozone supports combustion more vigorously than oxygen. State the characteristics of the following mineral waters: Chalybeate waters, bitter waters, sulfur waters, effervescent waters, cathartic waters. A chalybeate water is a mineral water containing dissolved salts of iron, usually basic carbonates. It has a slight tonic action, but may occasion intestinal and stomach derangement from its irritant action. Bitter waters may owe their bitter properties to Epsom or Glauber's salts, held in solution, when they exert a laxa- tive action ; or a natural water may be bitter from its contact CHEMISTRY. 165 with vegetable substances, acquiring thereby tonic and stom- achic properties. Sulfur waters are those usually containing dissolved alka- line sulphides, or poly-sulphides, or H 2 S, although the name sulfuretted waters is of more frequent use in such cases. Such waters exert an alterative and often slight laxative effect, and have a certain use in treating diseases of the skin. The greater value of sulfur waters is found in their use for bathing, in chronic cutaneous affections, in gout, in rheuma- tism. Effervescent waters are such as are strongly charged with C0 2 gas. It is the escape of this gas that produces the effer- vescence. Such waters are useful as sedative and slightly stimulating beverages, as the use of plain soda water in allay- ing vomiting. Cathartic waters are such as contain cathartic or laxative salts in solution, as Epsom spring water, containing MgS0 4 ; Glauber's spring water, with Na 2 SO. t ; Carlsbad waters, Hun- yadi water, Saratoga waters in general. Their effect is not only a cathartic or laxative one, but frequently they assist elimination from other channels, as kidneys, skin, etc. What is the antidote for nitric acid poisoning? Oxid of magnesium, commonly called calcined magnesia. Alkaline carbonates, soap, albumen, oils. Describe the preparation of iodid of potassium. Give the reaction. Saturate a strong solution of caustic potash in water with iodine. Evaporate to dryness, when a mixture of iodid and iodate of potassium is formed. Heat strongly, when the iodate of potassium parts with its oxygen; dissolve the re sultant mass in water, when from it will crystallize, on evap- oration, cubes of potassium iodid. ii K 1 1 ( ) -f 3I a = 5KI + KIO :t 4- :: 1 1 ,< » : Then KI<> :! d-heat=KI+ <> 166 CHEMISTRY. Describe lithium as to (a) occurrence, (b) salts com- monly used in medicine, (c) chemistry of its use in so= called rheumatic affections. (a) Lithium occurs principally in the mineral silicates or phosphates, (b) Salts used in medicine: Bromld of lithium LiBr Carbonate of lithium Li 2 C0 3 Benzoate of lithium LiC 7 H 5 2 Citrate of lithium Li 3 C 6 H 5 7 Salicylate of lithium LiC 7 H 5 3 (c) It is stated that 25 parts of carbonate of lithium will dissolve one thousand parts uric acid at 100.4° Fahr., so it is administered in gout to diminish deposits of uric acid, and to dissolve uric acid calculi. Mention the important physical, physiologic and chem- ical properties of ptomains. Ptomains are putrefactive or cadaveric alkaloids, are pro- duced during putrid decomposition of animal and vegetable matters. They are the result of the growth of bacteria that produce decomposition of dead animal and vegetable tissues. They resemble vegetable alkaloids in many important fea- tures ; thus some contain no oxygen and are like volatile alka- loids; others contain oxygen and resemble fixed alkaloids. They often give tests identical with those of the alkaloids; thus there is a ptomain that will give same color tests as strychnin; another ptomain that resembles in action and tests, atropin, etc. Ptomains may be poisonous, when they are called toxins; or they may be non-poisonous. Ptomains, acting like bases, form salts. In their poisonous action, after a period of incubation of from two to six hours, symptoms of severe gastro-intestinal irritation occur, and then other symptoms follow, dependent upon the particular ptomain. What are the chemical constituents of normal urine? Give a test for the recognition of albumin in urine. Chlorides of calcium, magnesium, sodium, potassium. Phosphates of calcium, magnesium, sodium, potassium, ammo- CHEMIST BY. 167 nium. Sulphates of sodium, potassium. Coloring matters, including urobilin, indican. Urea, uric acid (as urates), ereatinin, crcatin, hippuric acid. Boil the urine; if it becomes hazy, or a coagulum forms, add a few drops of nitric acid, when, if the urine does not become perfectly transparent, albumen is present. State the principle underlying the use of antitoxins for the prevention or cure of disease. Antitoxins are found in the blood serum of animals that have recovered from an infectious disease, and when this serum is injected into other animals, or man, it renders, on its absorption, the animal immune from that disease. How may water be decomposed? Illustrate. By passing a current of galvanic electricity through water, when the hydrogen gas collects in bubbles at the negative electrode and the oxygen gas at the positive electrode ; or by passing steam or vaporous water through an iron pipe heated to redness, when the hydrogen gas issues at the distal end of the pipe and oxygen is retained in chemical union with the iron, coating the pipe with Fe 3 4 . Define and give examples of the three varieties of attraction. Attraction of gravitation is the force tending to draw masses of all kinds of matter together, as the attractive force oxertcd between sun and earth. Heterogeneous attraction or adhesion refers to surface attraction of unlike substances for each other; thus water adheres to wood. Homogeneous attraction or cohesion is the force uniting like substances, and operates in the interior of the mass as well as at the surface; thus cohesion aggregates the minute molecules of water into visible drops. How many grams are there in a hectogram? How many scruples are contained in one pound? One hundred grams equal one hectogram. 168 CHEMISTRY. Two hundred and eighty-eight (288) scruples one pound troy. What is the test for the presence of silver, of mercury? In solution : Silver yields a white precipitate with hydrochloric acid or soluble chlorides. This precipitate is silver chloride, and it dissolves in ammonium hydrate or hyposulphite of sodium. Mercury^ as mercurosum, in solution, gives a white precipi- tate with the same reagents, of mercurous chloride, not dis- solving, but turned black on addition of ammonium hydrate. Mercury as mercuricum, gives a red precipitate with solu- tion of potassium iodid, soluble in excess of either potassium iodid or mercuric solutions. How much water vapor will be formed by the union of 500 cubic centimeters of hydrogen and 250 cubic centi» meters of oxygen? Five hundred cubic centimeters, at standard temperature and pressure. What is a graphic formula? Give five illustrations. A graphic formula endeavors to show the manner in which the atoms are joined or arranged within the molecule by a diagrammatic representation. H O I ^ Acetic acid. H— C— C— O— H I H H— O— H Water. H— S— H Hydrogen sulfid. N H -H I -H Ammonia. H C H Marsh gas. -H I H Give the atomic weight, atomic volume, molecular weight, molecular volume, and density of oxygen. Sixteen, atomic weight; 1, atomic volume: 32. molecular CHEMISTRY. 1U9 weight; 2, molecular volume; 1.1056, specific gravity com- pared with air; 15.9, specific gravity, or density, compared with hydrogen. Describe the preparation of sulfur and name the oxids of sulfur. Soil in volcanic regions saturated by sulfur is called sulfur earth. This is heaped on masonry platforms and set on fire, when burning sulfur causes unburned sulfur to melt, trick- ling down through the mass, flowing along the masonry plat- form into tubs placed to receive it; on cooling the solid resulting is called crude sulfur, and is purified by subliming and allowing the vapor to enter a brick-lined chamber, in which it condenses in small round particles, technically called flowers of sulfur. As the heat in the chamber becomes high, sulfur vapor liquefies, and is then ladled into moulds, forming, on hard- ening, the roll brimstone of commerce. Sulfur di-oxid, S0 2 , gas. Sulfur tri-oxid, S0 3 , white crystals. Sulfur sesqui-oxid, S 2 8 , green solid. Sulfur per-oxid, S 2 7 . What is Marsh's test? Describe the apparatus em- ployed, and give the conduct of the experiment. Test for detection of arsenic. May use a glass flask stoppered, and through the stopper I 1. A safety funnel, the lower end reaching to bottom of flask. 2. An outlet tube of glass; the end passing through the stopper is flush with bottom of stopper, and issuing from the stopper it is bent at a righl angle. To its far end is to be fitted (a) a tube benl a1 ;i right angle, lower pari dipping into ;i solution of A.gNO s . (b) A tube benl al ;i righl angle bo placed thai the far part of the tube, drawn out to a jet point. sh;il] point upwards. 170 CHEMISTRY. Test: Place chemically pure zinc in flask, cover with dilute sulphuric acid, C. P., in such quantity as will come above lower end of safety funnel. Hydrogen gas is evolved. Allow gas to pass from the outlet tube, to which attach tube (a), the lower end of which is immersed in nitrate of silver solution. Heat the outlet tube at a point between flask and silver solution. At expiration of half hour should there be no brown or gray-black stain found on outlet tube where heated, or no precipitate (black) found in silver solution, and should no yellow precipitate form when to a little of silver solution is added ammonium hydrate, the zinc and acid used are free from arsenic. Then pour into safety funnel the solution suspected to contain arsenic, when, should arsenic be present, a black stain forms on outlet tube, a black precipitate appears in silver solution, and this solution yields yellow precipitate of arsenite of silver when to it we add ammonium hydrate. Now remove end piece that has been used, replacing it with tube (b) ; apply light, when a whitish flame appears; if much arsenic, a garlic odor or white halo surrounds flame. Hold cold white surface, as piece of porcelain, in flame; as it issues from jet, when brown or black stain of metallic character readily dissolving in solution of chlorinated lime or chlorinated soda, indicates positively presence of arsenic. What is olefiant gas? Name some of its properties. Olcfiant gas, or ethylene, C 2 H 4 , heavy carburetted hydrogen. A colorless gas, feeble ethereal odor, density 14 compared with hydrogen. Can be liquefied, and is then used to produce low tempera- ture on its evaporation. Is inflammable, burning in air with brilliant flame. It is largely to the presence of this gas that illuminating gas yields light. Mixed with three volumes of oxygen and lit, it explodes. CHEMISTRY. 171 One volume of defiant gas with two volumes of chlorine burn with red flame. What is meant by the destructive distillation of wood, and what are some of the principal products of such a process? Heating wood in a retort until it entirely loses its charac- teristics as wood, and collecting and cooling resultant vapors. Methyl alcohol, pyroligneous acid, creosote, carbolic acid, etc. Name and differentiate the three classes of sugars. Glucose, C c II 12 G , crystallizes in white rounded masses. Its solutions polarize light to the right. Its crystals contain one molecule of water. It reduces metallic solutions, as of gold, silver, copper. Fructose or levulosc, C c H 12 O c , occurs in fruits, crystallizes without presence of water, rotates light to the left, is directly fermentable. Saccharose, C^H^On, cane sugar, obtained principally from sugar-cane, crystallizes in hard oblique rhombic prisms without water of crystallization, rotates light to left, dis- solves in one-third its weight of water, does not reduce alka- line copper solution. What is acetous fermentation? An advanced stage of the alcoholic fermentation. Brought about by presence of the mycodermic aceti, and it causes the souring of alcoholic liquors. It practically consists in the oxidation of alcohol, producing acetic acid. CJL.OII + 2 = CJI 4 2 + II 2 0. How are chlorides chemically recognized in urinalysis? By their yielding a white precipitate of chloride of silver on the addition of a solution of silver nitrate to the urine. Complete the following equation and write the name of each resulting compound under its formula: C 2 HC1 3 + NallO = CJICI3O + NaHO = CHCI3 + NaCIIO, • ihloroform sodic formate. 172 CHEMISTRY. Pb(N0 3 ) 2 + K 2 Cr0 4 = Pb(N0 3 ) 2 + K 2 Cr0 4 = PbCr0 4 + 2KN0 3 Plumbic chromate + potassic nitrate. Describe two experiments showing the difference be= tvveen chemical and mechanical action. Mix 32 grains sulfur and 5G grains iron filings ; a magnet will remove all of the iron, or bi-sulphid of carbon will dis- solve all of the sulfur. This mixing of sulfur and iron is a mechanical act, in which iron and sulfur still preserve their properties. Apply heat to such a mixture ; a temperature much higher than the degree of heat applied will appear, due to chemical union of sulfur and iron, and a magnet will no longer attract iron, nor will bi-sulphid of carbon have solvent action. This is a chemical action resulting in formation of a new substance, iron sulphid, in which properties of iron and sulfur no longer exist. Dissolve sugar in water. No heat is evolved; each drop of water shows characteristic sweetness of sugar; has been no chemical change, but a physical or mechanical one. Dissolve sugar in sulfuric acid, obtain black liquid containing no char- acteristic sweetness; sugar has entirely disappeared. This experiment is an illustration of chemical action. If potassium be thrown on water, what is the name and formula of the resulting compound? Potassium hydroxid, KOH, obtained when the water is evaporated to dryness. What are the general methods by which crystals may be obtained? Solidification by evaporation from solution. Solidification after fusion. Solidification by sublimation. Solidification by electrolysis upon a solution. Discuss arsenic and mention its properties, uses and compounds. Arsenic. As 2 3 , is the trioxid of element arsenicum. CHEMISTRY. 173 Arsenicum is found combined in many ores, particularly those of metals, zinc, iron, nickel. The arsenious anhydrid, As 2 3 , is generally obtained by sweeping the flues of smelting works, treating ores of the metals mentioned. By subliming this impure arsenious anhy- drid we obtain the pure product. In the ore the element arsenicum occurs generally as a sul- phid (orpiment or realgar). Heat oxidizes it to the oxid As 2 3 , commonly called white arsenic. This substance has slightly sweetish taste, metallic then nauseating. It is both corrosive and poisonous. Antidote is freshly prepared, hydrated, sesquioxid of iron with mag- nesia : Add MgO or aqua ammonia to ferric sulphate or ferric chlorid solutions, and collect and wash the resulting brown precipitate. Arsenic is but slightly soluble in water, soluble in most acids. It sublimes unchanged, or if a reducing agent be used, it yields on heating the brownish-black element arsenicum. Arsenic is used in shot-making, 40 pounds to a ton of lead. Enters into formation of other metallic alloys. Used medicinally as an alterative tonic, in doses not exceed- ing 1-20 of a grain. Used in treating malarial cachexia. I Ins been used as caustic in certain cancer cures. Has large use in dentistry as a devitalizing agent. Useful in chronic forms of certain skin diseases. Preparations are arsenious acid, which is chemically the arsenious anhydrid. Tri-chlorid of arsenic, AsCL. Bromides of arsenic and gold, and chlorids and iodids of these metals and of mercury. Fowler's .solution, containing arsenite of potassium. What is an anesthetic? A substance used to produce partial or complete uncoil sciousness, and thus allay pain of operative procedures and produce muscular relaxation. 174 CHEMISTRY. How much water would be required to yield ioo grams of hydrogen? Nine hundred grams of vapor of water would yield 100 grams hydrogen and 800 grams oxygen. Compare the physical properties of chlorin, bromin, iodin and fluorin. Chlorin, a heavy green gas; bromin, a heavy dark red liquid ; iodin, scale-like blue-black solid ; fluorin, a light yel- low gas. All dissolve in water in varying degrees. Bromin yields orange-colored vapor ; iodin, violet vapor. Define evaporation, filtration. Evaporation is passing of a liquid into a vapor from the surface of the liquid. This process takes place at all tem- peratures. Filtration is the act of passing a liquid through a mate- rial provided with very minute spaces or holes that allow the liquid to pass, retaining the solid suspended matters. Name the constituents of the atmosphere. Give the composition by weight and by volume. Weight. Volume. Oxygen 23 20.93 Nitrogen 77 79.07 Including about one per cent, of argon. "Water vapor, .5 to 1. Carbon dioxid, .04. Traces of ammonia and nitric acid. Several rare gases, lately separated, of which but little is known. Name bodily conditions effecting an increase in the elimination of urine and also those producing a decrease. In health urine is increased in amount where from any cause the perspiratory function or alvine discharges are less- ened, as from chill of the surface, cold bathing, etc. The ingestion of much fluid, as drink or watery foods. CHEMISTRY. 175 In health nrine is decreased from a reversal of above con- ditions. In disease urine is increased in diabetes mellitus, in chronic inflammation of kidneys, etc. Often at crisis of a. severe disease, in hysteria and in other nervous disorders. In disease urine is decreased when disease is accompanied by high fever, in acute inflammation of kidneys, in severe infectious diseases. Name three common kinds of spirituous liquors and de= scribe their manufacture. Whisky, from grain; brandy, from grape juice; rum, from molasses. In each instance fermentation is first brought about, when the results of such fermentation are distilled at certain fixed temperatures. Give the chemistry of photography. A dry plate of glass is covered with an emulsion of silver bromid in gelatine. When exposed to light the parts upon which the light strikes have their silver bromid changed to a lower salt. The plate is then subjected to the action of a developer, as solution of pyrogallic acid, when the lower salt of silver bromid is reduced to metal silver, which is left upon the plate The plate is then washed in hyposulphite of sodium solution. when all of the unchanged silver bromid is dissolved and removed, but the metal silver is not affected and still remains upon the plate; this forms a negative. From this negative, placed upon a paper prepared in much the same manner as the plate, the action of the sun prints the finished photograph. Complete the following equations and write the name of each resulting compound under its formula: Ca(HO +C0 2 = CaCO., + IT 2 ( lalcium carbonate water, NaC.JI,0 2 + NallO = CII 4 + Na 2 C< I Marsh gas sodium carbonate 176 CHEMISTRY. What is meant by atomic weight? The atomic weight of an element refers to the ratio by weight which its atom bears to the atom of hydrogen. The atomic weight of an element is that number which multiplied by its specific heat yields a product of 6.4, nearly. Explain the difference between a solid and a liquid. In a solid the attraction of aggregations binds the mole- cules so closely together that they have no readiness of move- ment, so that the substance preserves a fixed form. A solid does not unite after the passage of a cutting im- plement. A liquid has its molecules less tightly bound together, so that they may flow readily. A liquid has no fixed form, save that of the containing vessel. A liquid reunites after its separation by a cutting implement, What is a gas? An air-like body difficult to liquefy. The molecules mak- ing up a gas are self-repellent, each molecule striving to pass as far from its neighbors as possible. What is water chemically considered? Water is the monoxid of hydrogen. Its composition by weight, 18 pounds of water contains 2 pounds of hydrogen and 16 pounds of oxygen. By volume two quarts of water vapor contain two quarts of hydrogen and one quart of oxygen condensed on chemical union to measure but two quarts in all. Water may act as an electro-positive or basic "body, as in its union with S0 3 , to form H 2 S0 4 . Water may act as an electro-negative or acidulous body, as in its union with K 2 0, to form 2KHO. Water generally acts as a neutral substance. Water exists in three states, solid, liquid and gaseous. It is the greatest of solvents, and gives form and often color to crystals. How would you determine the specific gravity of a liquid? Use a hydrometer : An instrument of glass, cylindrical in CHEMISTRY. 177 shape, weighted below, and terminating above in an upright stem of glass, upon which are engraved lines indicating degrees. Place this instrument in the liquid to be examined, and note to which mark or degree the instrument sinks. This degree denotes the specific gravity of the liquid com- pared with water. Of what are the common forms of urinary calculi com= posed? Uric acid, oxalate of calcium, phosphate of calcium, phos- phate of magnesium and calcium, urate of sodium and potas- sium. What is organic chemistry? The chemistry of the hydrocarbons and their derivatives, also including cyanogen and its compounds in the study. What is the purpose of litmus paper in urinalysis? For determining if the urine be acid, alkaline or neutral in reaction, also whether the acidity be marked or slight, and whether the alkalinity be of fixed or volatile character. How is excess of uric acid shown in the urine? By a ring of whitish color forming above the point of con- tact in the urine when nitric acid has been poured below the urine in a test-tube; such ring disappears when gently heated. What effect is produced in mixing air with a blast flame as practiced with an ordinary blow=pipe? The air so dilutes the gas as to bring every particle of the gas in complete contact with the oxygen of the air, thus occa- sioning perfect and complete combustion of. the gas. The air also directs the flame to a desired point. What metallic element is constantly present in the col- oring matter of the blood? Iron. 12 178 CHEMISTRY. Explain the process of combustion. Combustion is chemical union taking place between two or more substances, accompanied by the evolution of heat and light. Name the lightest of ail known elements. Hydrogen. Etherion has been obtained recently from atmospheric air, and is estimated to be one ten- thousandth the weight of hydrogen. What is chemical affinity, and give an example? Chemical affinity expresses the desire for chemical union which substances show to certain other substances; thus it is this attractive power of chemical affinity that causes the union of chlorin with hydrogen. Give the symbols of antimony, silver, gold, iron and zinc. Antimony, Sb; silver, Ag; gold, Au; iron, Fe; zinc, Zn. How would you prepare hydrogen? Place zinc in a flask provided with a safety funnel, the lower end of which reaches to the bottom of the flask. Through a second opening in the stopper of the flask have an exit tube provided, the lower end of which enters the flask to but a short distance. Then pour into the flask through the funnel dilute sulfuric acid. Hydrogen gas is formed, and escapes through the exit tube. What acid contains chlorin as an important element? Hydrochloric acid, HO (muriatic acid). How does wine differ chemically from brandy? Wine contains from 8 per cent, to 18 per cent, of alcohol; brandy from 45 per cent, to 55 per cent. Wine is a product of fermentation of fruit juices; brandy results from distill- ing the fermented product of fruit juices. Wine contains a number of compound volatile ethers that are not present in brandy. CHEMISTRY. 179 What is the substance (or substances) from which ordi- nary alcohol is derived? Grain, as oats, rye, corn, all of which first undergo ger- mination, then fermentation, then distillation, when the ex- traneous matters may be separated by chemical means or by fractional distillation. What element constitutes four=fifths of the air? Nitrogen. Explain the principle of the Bunsen burner. The Bunsen burner is supplied near its base with aper- tures for the ready admission of air and its mixture with gas before the latter is lit. Each particle of gas is thus supplied with sufficient air to obtain perfect combustion. What is the essential element of all acids? Hydrogen. Name three elements in the potassium group. Potassium, sodium, lithium. Is sulphurous acid a solid, a liquid or a gas at ordinary temperature? It is a liquid resulting when S0 2 is dissolved in water. What is albumin? It is a protcid body composed of H, C, O, N, and S ; it is colloidal, and is changed in digestion into crystalizable pep- tone. It occurs in vegetable structures as well as in animal. Name the principal sources of bromin. Natural mineral waters containing magnesium bromid in solution. Sea waters. Give the name and formula of a compound of sulfur and hydrogen. Hydrogen sulfid. H a S (sulfuretted hydrogen). 180 CHEMISTRY. What is the meaning of the sesqui in chemical nomen- clature? It means one and a half, and refers to one and a half times the volume of one element in combination with one volume of a second element, or it refers to one and a half times the atomic weight of one element in combination with once the atomic weight of another element; but inasmuch as we can have no half atoms in formulae, it is customary to preserve the ratio between the weights of the elements while using whole numbers. Example : Fe 2 3 , sesqui-oxid of iron. Where does potassium occur? Potassium always occurs combined with other elements in nature existing in organic salts in plants, and when such plants are burned the organic salts decomposing yield, in the ash of the plant, carbonate of potassium. Define and give an example of each of the following: (a) Binary compound, (b) acid, (c) hydrate, (d) salt. (a) A compound containing two elementary forms, as AgCl. (b) An acid is a salt of hydrogen having a sour taste, bleaches vegetable colors, turns litmus red, corrosive action, when concentrated, upon tissues, unites with and neu- tralizes bases, forming salts and water, as HN0 3 . (c) A hy- drate is a member of the water type, in which one hydrogen atom in a molecule of water has been replaced by a metal or an electro-positive radical, as KOH. (d) A salt is a sub- stance formed by the replacement of all or part of the hydro- gen of an acid by a metal, as K 2 S0 4 . What are the laws governing combination of elements? 1. All chemical compounds are definite in their nature; the ratio of the elements forming them is constant. 2. If one element unites with another in more than one proportion, such proportions will be multiples or submultiples of each other. 3. The proportion by weight in which any two elements will unite with a third element represents that proportion in CHEMISTRY. 181 which they would unite with each other if they could so combine. What is a chemical reagent? A substance having an active chemical effect upon other chemical substances. A substance which by its contact with another substance creates new compounds that can be appre- ciated by us, and thus afford a test for detecting the body to which the reagent has been added. Mention a pentad element and explain the name. Nitrogen. A pentad element is one the atom of which desires five monad atoms to fully satisfy the pentad atom in its desire for chemical union. Explain the terms (a) amorphous, (b) alkali, (c) water of crystallization, (d) nascent state. (a) Amorphous means powdery, non-crystalline solid, (b) Alkali, a body possessing the strongest of basic or electro- positive properties, usually referring to oxids and hydrates of alkaline metals or metals of the alkaline earths, (c) Water of crystallization is water present in solid structures pre- serving their geometrical form and frequently the color of the crystal bodies; it may be removed by heating at temper- atures not higher than the boiling point of water, (d) Nas- cent state, or newly born, refers to matter in its atomic form, or before the individual atoms freed from a compound have united to form molecules. What are the properties and uses of glucose? A white or yellowish-while, sweetish substance, freely sol- uble in water, possessing not epiite the sweetening power of cane-sugar. It is obtained from starch and starch-like sub- stances, as cellulose. Its formula is C„TT 12 G , and it can now be obtained in crystal form. It polarizes Light towards the ri 1 / 9 grains. Xanthine, other extractives . . . . ' Give the chemistry of acetic acid and mention the most important acetates. Acetic acid, HC 2 H 3 2 , is obtained from fermentation (acetic acid fermentation) of alcoholic liquids, as cider, etc. It may be obtained through the action of sulfuric acid on alcohol. CHEMISTRY. 199 Important acetates include acetate of lead, of iron, of alum- inum, of sodium, of potassium. Mention five alkaloids. Give the derivation of each. Strychnin, from mix vomica; morphin, from opium; quinin, from cinchona bark; cocain, from erythroxylon coca; atro- pin, from belladonna. Complete the following equations: CH 3 I + HKS = CS 2 + 2H 2 + 6Cu = CH 3 I 4- HKS = CH 3 HS + KI CS 2 + 2H 2 +6Cu = 2H 2 S + C0 2 + 6Cu. State the properties of potassium. Mention ten potas- sium compounds of importance in medicine. Potassium is a soft white metal, slight bluish tint, decom- poses water at all temperatures, burning in contact with water. It is one of the strongest electro-positive elements, is of monad valency, is lighter than water, fuses below a red heat. Compounds of importance in medicine are : Potassinm iodicl Potassium chlorid " nitrate " sulphate " carbonate " hi-carbonate " bromid "' cyanide " chlorate '• hydrogen arsenide " and antimonial tartrate Give a method of determining the specific gravity of a solid substance insoluble in water. Wci^h substance in air, then suspend it in water and weigh while immersed, subtract weight in water from weight in air, divide weight in air by loss of weight shown when weighed in water, quotient will be specific gravity of sub- stance. Example: Gold weighs 10 grains in air, in water weighs 9% grains, loss equals half a grain, then 10, weight in air. divided by one-half, or the loss of weight when in water, equals 20. the specific gravity of gold. (True specific gravity of gold would be 19.3.) 200 CHEMISTRY. Give the chemical name, properties and uses of tartar emetic. Tartar emetic is potassium antimony bi-tartrate, or com- monly called bi-tartrate of potassium and antimony. For- mula: KSbOC 4 H 4 6 . It is an impalpable white soluble powder, sublimes when heated, is very poisonous. Used as an emetic and as a nau- seating and sedative expectorant. In what part of the body is sulfur found? Sulfur exists in all tissues and fluids of the body that pos- sess color. Sulfur is present in the different substances of an albuminoid nature. What kind of albumin in morbus Brightii? What prop= erty renders it readily detectable? Serum albumen. It is readily detected through its coagulability by heat or acid. How is chlorinated lime made? What is the principal use of chlorinated lime? By passing chlorin gas over slaked lime, spread upon shelves in a properly constructed room. Ca2HO + Cl 2 = CaClOCl + H 2 0. Its chief uses are as a bleaching agent and a disinfectant. In both instances its action only takes place in the presence of moisture, when the chlorin that it disengages combines chemically with the hydrogen of moisture, thus freeing the oxygen from moisture to act as the real disinfectant or bleach- ing substance. Chlorinated lime liberates chlorin when in contact with an acid. What is the difference between an alcohol and a phenol? Illustrate. Phenols differ from alcohol in : 1st. Not forming corresponding aldehydes and acids on oxidation. CHEMISTRY. 201 2d. In not dividing into water and hydrocarbons under the influence of dehydrating agents. 3d. In not reacting with acids to form ethers. Phenols form more stable compounds with metal elements that more closely resemble salts. What are carbohydrates? Into what three groups are these compounds usually divided? Carbohydrates are organic compounds, composed of C, H, 0, in which the H and exist in the relative proportions in which they are present in water. Amyloses, glucoses, saccharoses. Give the formula, uses and properties of hydrogen dioxid. H 2 2 . Used as a disinfectant, and a bleaching agent, and an oxidizing substance. Used in restoring oil paintings. It is usually sold in a watery solution containing from 10 to 12 volumes of true hydrogen dioxid, or of about 3 per cent, in weight. True peroxid of hydrogen is a thick, syrup-like liquid obtained through the evaporation of watery solutions of peroxid of hydrogen over strong sulfuric acid in a vacuum. Peroxid of hydrogen readily parts with an atom of oxygen, particularly if brought in contact with organic matter, and it is this nascent oxygen that effects the bleaching, disinfec- tant action, etc. Give the formula and properties of each of two oxids of carbon, explaining the effect of each on animal life. Carbon-monoxid, CO. This substance is a gaseous body, almost insoluble in water. no odor, burns with blue flame to form carbon dioxid. It acts as a direct poisonous agent to animals, causing de- composition of blood. Animals poisoned through the action of carbon-monoxid have the oxygen-carrying power of the red blood corpuscles destroyed. Carbon-monoxid is lighter than air. 202 CHEMISTRY. Carbon-dioxid, C0 2 , is a colorless gas, heavier than air, no odor, soluble in water, upon which it confers increased sol- vent powers. It is a normal constituent of air. It is not a direct poison when inhaled, except it be in quantities consti- tuting over 10 per cent, of the inhaled air. It is, however, not capable of supporting life. It does not burn, nor does it support combustion. It enters the air from respiration of animals, and in such respiration poisonous materials are exhaled accompanying the carbon-dioxid. It is to these poisonous matters from animal respiration, and not to the presence of carbon-dioxid, that the deleterious effect of breathing pre-breathed air is due. Describe the preparation of nitrous oxid, writing the re- action. State the properties and use of nitrous oxid. Nitrous oxid results when ammonium nitrate is heated in a retort at temperatures between 460° to 490° Fahr. NH 4 N0 3 + heat=: N 2 + 2H 2 0. It is a colorless gas, slightly sweetish taste, has no odor. It is soluble in water, heavier than air. It readily supports combustion, owing to its decomposition by the heat of the burning body introduced in it, so that it is actually the liber- ated oxygen that supports combustion. It does not burn. It is used for the production of general anesthesia of but a short duration. It is regarded as the safest of general anes- thetics, and has a large use in dentistry for operations of a short duration. A common name applied to it is "laugh- ing gas." Describe phosphorus as to (a) derivation, (b) proper- ties, (c) commercial uses, (d) medicinal uses, (e) medic= inal preparations. (a) From apatite or from bones, each of these substances containing tri-calcium phosphate. (b) In its usual form is a yellow wax-like solid, occurring also in red, black and white allotropic forms. CHEMISTRY. 203 Yellow phosphorus is spontaneously inflammable in air, especially if it be finally divided, it has an odor of garlic, is highly poisonous, is insoluble in water, but dissolves in oils, in bi-sulphid of carbon, slightly soluble in hot alcohol, etc. It glows in the dark, it melts and will take fire below the boiling-point of water. It can be burned under water in a jet of oxygen gas. Takes fire on contact with iodin, bromin. (c) Making matches, insecticides. Is used in certain metal alloys to give closer grain and prevent oxidation in the alloy, as in phosphor bronze. (d) Used medicinally in doses of l-100th of a grain as a nervous reconstructive drug. Has considerable use in treat- ing many nervous disorders. (c) Medicinal preparations — phosphorus, phosphoric acid dilute, the phosphates, as of sodium, iron, etc., the hypophos- phites of metals, and of alkaloids as well. Define reaction. "When one active chemical substance is brought in contact with another, separation of the constituents of each substance occurs, and then these constituents rearrange themselves to form new bodies; this is the reaction that follows the initial chemical action. Give the names and formulas of the various gaseous compounds capable of. producing general anesthesia. Nitrous oxid, N 2 0; chloroform, CHC1 8 ; ether, (C 2 II 5 ) 2 0. A few other substances are used for the production of anesthesia, but they have not as general a use nor as satis- factory an action as those given. Describe a method of detecting the presence of lead salts in water. Concentrate the water to small bulk, add a few drops of ammonium hydrogen sulphid, when a black precipitate or coloration appearing may indicate the presence of lead or other deleterious metallic additions to the water. 204 CHEMISTRY. This test is usually performed upon water two feet in depth in a tall glass cylinder. How may the presence and amount of urea be deter- mined? Make a fresh solution of hypo-bromite of sodium by dis- solving 100 grams of caustic soda in 250 cubic centimeters of water, and when cold adding 25 grams of bromin. Place this solution in the closed arm of a Doremus' ureo- meter. Now add one cubic centimeter of urine, so that it may mix with the hypo-bromite solution in the closed arm of the apparatus. The urea present is decomposed, its compo- nents are absorbed with the exception of nitrogen gas, which, passing to the upper portion of the tube, depresses the column of liquid downward. The space occupied by the nitrogen gas then serves to indicate the quantity of urea in the one cubic centimeter of urine operated upon. Mention a chemical antidote for sulfuric acid and ex= plain the action of this antidote. Magnesium oxid. It chemically combines with sulfuric acid to form sulphate of magnesium. This action is accompanied by the evolution of but little heat and no gas, and all corrosive properties of the acid entirely disappear in the change or neutralization that it undergoes. What is fermentation and how is it produced? What are enzymes? Fermentation is the decomposition of a non-nitrogenous body brought about through the presence of a nitrogenous body called a ferment. For its production we require a non- nitrogenous substance, a ferment, moisture, presence of air (generally), a temperature not exceeding 100° to 110° Fahr. Enzymes are soluble or unorganized ferments acting like yeast and other recognized ferments. They are of both vege- table and animal origin. Those of animal origin are found in digestive fluids, as pepsin in gastric juice, ptyalin in saliva. CHEMISTRY. 205 Differentiate chemically sucrose, glucose, lactose and maltose. Sucrose, C 12 H 22 11 , does not reduce cupric salts. Glucose, C 6 H 12 6 , reduces cupric salts. Lactose, C 12 H 22 11 II 2 0, polarizes light to the left. Maltose. C^H^OnH^O, very soluble in water. Complete the following equations: FeCl 3 + 3NH 4 OH = MgCla - XH 4 C1 + Na 3 P0 4 =. FeCl, + 3NH 4 HO = Fe3HO + 3XH 4 C1. MgCL, + NII 4 C1 + Na 3 P0 4 = NH 4 MgP0< + 3NaCl. Describe oxygen as to occurrence, preparation, physical properties, chemical properties, office in the body. Oxygen occurs mixed with nitrogen to form atmospheric air. It is found chemically combined with % of its weight of hydrogen in water. It is present in many compounds, as the oxids, oxy-acids, oxy-salts, hydrates in both mineral and organic compounds. It is the most widely distributed of elementary substances, and constitutes one-third of all matter. It is prepared by heating a mixture of potassium chlorate and manganese dioxid. Physically, oxygen is a colorless. t;i>teless. odorless gas, slightly heavier than air, its specific gravity being 1.1056. It is soluble to the extent of 3 per cent, in water. It can be liquefied, when it resembles water. and when solidified appears like ice. Chemically, oxygen supports combustion, dues qo1 burn, is ingly electro-negative, is of diad valency, combines chem- ically with all elements excepting fluoric and argon. It supports animal respiration; it is carried by the red blood corpuscles to every tissue of the body, upon which it nets destructively to allow of constant, regeneration of tissues. It is used remedially where from any cause respiration is impaired or prevented. 206 CHEMISTRY. What is chlorin? How is it prepared? How is chlorin administered medicinally through the mouth? A heavy green gas about 2% times the weight of air, freely soluble in water, generally administered in watery solutions known in pharmacy as aqua chlorini. Prepared by heating a mixture of manganese-dioxid and hydrochloric acid, and collecting the gas evolved by dis- placement. Mn0 2 + 4HC1 = MnCl 2 + 2H 2 + Cl 2 . Define alloy, amalgam. Give an example of each. An alloy is a combination of two or more metals. Example : Brass, an alloy of zinc and copper. An amalgam is an alloy in which one of the metals is mercury. Example : Tin amal- gam, composed of tin and mercury, used in making of mirrors. How is hydrogen sulfid formed in nature? How is hydrogen sulfid prepared in the laboratory? It results, in nature, from the decomposition of organic matter containing sulfur in the presence of moisture. Ex- ample: The rotting of an egg gives rise to hydrogen sulfid from the union of the sulfur in the albumen with the hydro- gen of water. Hydrogen sulfid may be prepared in the laboratory by adding dilute sulfuric acid to ferrous sulphid, as FeS + H 2 S0 4 = FeS0 4 + H 2 S. Explain the significance of the following prefixes: Hydro, sub, hyper, nitro, bi. Hydro indicates the presence of hydrogen in chemical com- bination with another element. Hydro-chloric acid, HC1, affords an example. Sub refers to a compound in which a less number of atoms so designated are present in a molecule than the number of atoms of the other body that is present. Example : Ag,0. Sub-oxid of silver takes its name from the fact that there is a less number of oxygen atoms than of silver atoms. Hyper has an opposite significance to sub, as C1 2 7 is CHEMISTRY. 207 called hyper-chloric oxid to distinguish it from C1 2 5 , called chloric oxid. Hyper here implies a greater amount or larger number, referring in this instance to the number of oxygen atoms that exist in chloric oxid. Nitro indicates the presence in a compound of the radical N0 2 , as C C H T (3N0 2 )0 5 as tri-nitro-cellulose. Bi indicates two atoms of the element so designated in chemical combination with another element, as CS 2 means bi-sulfid of carbon. Mention the metals whose salts are often taken as poisons. Silver, lead, mercury, arsenicum, antimony, copper, tin. zinc, barium. What is common salt? State where and how common salt is obtained, and give the chemistry of its use for freezing purposes. Sodium chlorid, NaCL By evaporation of sea water. By evaporation of water in which sodium chlorid is dis- solved, as in natural mineral springs, and this brought about through flooding cuttings that pass through a salt-bearim: stratum of rock, and then evaporating such water. Large quantities of sail are obtained from the vicinity of Syracuse. When salt is mixed with snow or ice it occasions the rapid liquefaction of the snow or ice, and in this act heat is ren- ed latent, and heat so rendered Latent is extracted from bodies near the Liquefying ice. Explain the formation of a vesical calculus having a uric acid nucleus. An aggregation of uric acid crystals, from their sharp angular character, produce much irritation to vesical mucous lining, so that they become Burrounded with deposits ^\' mucus, and then, from inflammation produced, we may haw 208 CHEMISTRY. decomposition of urine, which acquiring an alkaline reaction occasions formation and deposition of alkaline urates, or per- haps phosphates, around the original mass, thus forming a mixed calculus. Give two tests for morphin. Touch the suspected alkaloid with nitric acid, and if it be morphin it dissolves, yielding an orange-red liquid that soon fades to yellow. To morphin add neutral ferric chlorid solution — a blue color is produced. When are substances said to be (a) isomeric, (b) meta= meric, (c) polymeric? Bodies are truly isomeric when they are made up of the same elements in the same percentage proportion and have the same molecular formula?, containing the same elements or radicals, but such elements or radicals uniting in different groupings give rise to different bodies. Two or more bodies are metameric when composed of the same elements in the same percentage composition and have the same molecular formulas but contain different radicals. Polymeric bodies are composed of the same elements in the same percentage composition but show different molecular formulae. Write a reaction for making barium sulphate from sodium sulfate. How many grams of sodium sulfate are required to yield 2.33 grams of barium sulfate by this process? (Atomic weight of barium equals 37.) Na,S0 4 + BaCL, = BaS0 4 + 2NaCl. ]42Na 2 S0 4 make 233 of BaS0 4 . If 233 grams of barium sulfate require 142 grams of sod- ium sulfate, then 233:142: : 2.33 :X, or 1.42. Result, 1.42 grams of sodium sulfate required. Describe and illustrate (a) monobasic acid, (b) dibasic acid, (c) tribasic acid. (a) An acid containing one atom of hydrogen that is cap- CHEMISTRY. 209 able of being replaced by a metal or an electro-positive radical, as HC 2 H 3 2 , acetic acid; AgC 2 H 3 2 , argentic acetate. (b) An acid which contains two replaceable hydrogen atoms in each molecule, as H 2 S0 4 , sulfuric acid; Na 2 S0 4 , sodium sulfate. (c) An acid which contains three replaceable hydrogen atoms in each molecule, as H 3 P0 4 , phosphoric acid; Na 3 P0 4 , basic sodium phosphate. Write chemical equations showing two methods of ob= taining hydrogen. Zn 2 + 2H 2 S0 4 == 2ZnS0 4 + 2H 2 . Zn 2 + 4KOH = 2K 2 Zn0 2 + 2H 2 . What is the meaning of the words monad, tetrad and pentad? Give an example of each? Monad refers to an element or compound radical whose power of combination by volume is the same as hydrogen exhibits. That is, one quart of the substance would combine with one quart of hydrogen if such chemical union were possible and the elements were in a gaseous condition. Thus chlorin is a monad, as it combines with hydrogen in equal volumes, and theoretically it is claimed that this combination takes place with one atom of H uniting with one atom of chlorin. Tetrad is an element or compound radical exhibiting a combining power four times that possessed by hydrogen, or it is an element that would require four times its own volume of hydrogen to completely satisfy its desire for chemical union. Example : Carbon, as in marsh gas, CH 4 . A pentad exhibits in its atom a desire to combine with five hydrogen atoms, or five atoms of a monad substance. Ex- ample: Phosphorus, as in its compound phosphoric chlorid, PC1 8 . Describe cyanogen and its principal compounds. Cyanogen, C„N 6 ; symbol, Cy or CN. This body is an organic compound radical composed of 14 210 CHEMISTRY. equal volumes of carbon and nitrogen vapors. Cyanogen is studied in its molecule. It is a colorless, inflammable gas, soluble in water. It exists in a divided form in many vege- table structures, as in peach kernels. It is electro-negative or acidulous, is of monad valency, acts like chlorin in chem- ical compounds which it forms. Important compounds: Hydrocyanic acid, HCN. In one per cent, watery solution, called prussic acid. Very poison- ous, colorless, water-like liquid. KCN, potassium cyanid, used in doses of % grain for same purposes (sedative) as hydrocyanic acid. Potassium ferro-eyanid and potassium ferri-cyanid have considerable use in arts and manufactures. Nickel, silver and gold cyanids are all used for electro- plating purposes. What are the source and principal properties of vaseline? Vaseline is a fat-like mass of from white to yellow color, obtained by purifying the residue, after distilling the more volatile substances from petroleum. It is more or less fluorescent; it melts at from 104 to 125 degrees Fahr. It is almost odorless and tasteless. Give the general characteristics of the aluminum group of elements. Metals of aluminum group include aluminum, indium, gal- lium. They are tri-valent, forming compounds like MC1 3 or M 2 3 . Here M stands for the aluminum or similar metal. Their oxids are weak bases ; their sulfates of alkali metals form double salts called alums, which crystallize in the reg- ular isometric system. Oxids and hydrates are insoluble in water, as are the phos- phates and carbonates of these metals. Give a typical example of each of the following classes of mineral waters: (a) Saline cathartic, (b) alkaline, (c) sulfurous. (a) Epsom spring water (England), containing magnesium sulfate. CHEMISTRY. 211 (b) Buffalo lithia water, containing lithium carbonate. (c) Waters, natural, in vicinity of volcanoes, as in Island of Sicily, Iceland, the Yellowstone ; such water contains sul- fur dioxid gas in solution. Describe one of the processes by which HC1 and N may be prepared. HC1 is prepared by heating sulfuric acid and common salt and passing the evolved gas into water. N is prepared by passing air over copper heated to redness. The oxygen being retained by the copper allows the nitrogen to pass at the distal end of the outlet tube. Explain the difference between the Fahrenheit, centi= grade and Reaumur thermometers. The freezing-point of water in the Fahrenheit scale is marked 32 degrees, while in Centigrade and Reaumur scale this point is marked zero. The boiling-point in the Fahren- heit scale is 212 degrees, the Centigrade scale 100 degrees, Reaumur 80 degrees. It will thus be seen that between the freezing- and boiling-points of water in the F. scale we have 180 degrees, in C. scale 100, in R. 80. Hence each degree F. would correspond to ;;- of a degree C. and * of a degree R. What is litmus? Explain its uses in urinalysis. Litmus is a vegetable substance obtained from a species of lichen. It is sold in the shops in small blue cubes. It is obtained by subjecting the plant to the action of alkaline solutions, evaporating, and adding plaster of Paris. It dissolves in water; its color, owing to its formation through the use of an alkali, is blue, it gives blue solutions, it stains bibulous paper blue, it is turned red on contact with acids. Its color is due to the presence of a weak acid, while the salts formed by the union of this acid with bases are blue. In urinalysis we use it generally in the form of litmus paper to determine the reaction of urine. 212 CHEMISTRY. Give the chemical differences between chloral and chIo= roform. Chloral is aldehyde, in which three atoms of hydrogen of an "alcohol radical have been replaced by chlorin atoms, as alcohol, C 2 H 5 OH; aldehyde, C 2 H 3 OH; chloral, C 2 C1 3 0H. It is tri-chlor-aldehyde. Chloroform is tri-chlor-methane, or marsh gas, in which three hydrogen atoms in each molecule are replaced by chlorin atoms, as marsh gas, CH 4 ; chloroform, CHC1 3 . Chloral contains oxygen in its composition ; chloroform does not. Complete the following equations: CaCl 2 + (NH 4 ) 2 C0 3 = CH 4 N 2 + 2H 2 = CaCl 2 + (NH 4 ) 2 C0 3 = CaC0 3 + 2NH 4 C1. CH 4 N 2 + 2H 2 = (NH 4 ) 2 C0 3 . Define malleability, endosmosis. Malleability refers to the property possessed by metals of being hammered or rolled out into thin sheets. Endosmosis refers to the act of a liquid of a certain density passing inward through a porous partition to mix with a liquid of different density on the interior of the porous partition. Give the general characteristics of rain water, well water, river water, and lake water. In order of usable quality we would rank Rain water, pure. Well water, impure. River water, suspicious. Lake water, good. Rain water is always soft, well water and rain water gen- erally hard, lake water usually soft. In well water we are apt to find impurities deposited from the soil or carried, through the action of rain, from stable and other deposits of filth into the general well contents. CHEMISTRY. 213 This is particularly true in the case of shallow wells. River water is apt to be contaminated by sewage and waste from cities and manufacturing plants, from the facility river currents offer for the disposal of waste material. • Rain water may be very impure at first of a storm, but after a few minutes, impurities, dust and other material having been washed from the air, then should rain water be collected; it affords the purest natural supply. Lake water, unless near settled communities, contains only harmless vegetable contamination. Give the method of preparation and the special charac- teristics of ozone. It may be prepared by passing moist air or oxygen through a "Siemens" induction tube, while the tube has traversing it silent electric discharges. So prepared, ozone is a blue gas of very irritating effect upon respiratory mucous surfaces, of very active oxidizing and corroding action, acting directly to cause oxidation of substances that ordinarily resist the action of oxygen, as silver. Test for ozone : Bibulous paper is saturated with a mixture of starch mucilage and potassium iodid solution. This paper will be turned blue in contact with even minute traces of ozone. What is fluorin and where is it obtained? State the preparation and the practical uses of hydrofluoric acid. Fluorin is a yellow gas, slightly heavier than air, is electro- negative, cannot be forced to combine with oxygen, has marked affinity for hydrogen and for some of the metals. It occurs in nature in combination with metals as fluorids, as the fluorid of calcium or fluorspar, CaF 2 . Hydrofluoric acid is made by heating calcium fluorid and sulfuric acid in a leaden vessel and passing the evolved gas into water, in which it readily dissolves. This gives us a watery solution of hydrofluoric acid. Its chief use is as a solvent for glass; from this action it is known as the etching acid. 214 CHEMISTRY. It is also used in the manufacture of peroxid of hydrogen. What are the constituent parts of boroglycerid and what is its use in medicine? i Boroglycerid is an ether obtained by boiling boric acid in glycerin. U. S. P. Glyceritum boroglycerini, 31 per cent, boric acid dissolved in glycerin. It is antiseptic and detergent. What are the properties of lead? What is litharge? Give the toxicology of lead. Lead is a soft, heavy, bluish-white metal. Atomic weight, 206. Melts below a red heat, oxidizes when heated in air to form yellow oxid of lead or litharge. Lead is soluble in nitric acid, in acetic acid, in very strong hot sulfuric acid. Exposed to air a basic carbonate of lead forms upon the surface. Same occurs in water containing carbon-dioxid. Litharge is monoxid of lead, PbO. It is yellow in color; obtained by heating lead (melting) in air. Antidote for soluble lead salts is a soluble sulfate, as Epsom salt. Lead may occasion acute or chronic poisoning. In acute lead poisoning we have the action of an irritant — vomiting, purging, abdominal cramps, etc. Chronic lead poisoning, as it occurs in painters or those constantly exposed to the fumes of lead and its components, is characterized by paralysis of extensor muscles, producing "wrist-drop" in the case of painters; also many obscure nervous symptoms, paralyses, anesthesias, etc. Give the preparation, formula and characteristics of bromid of ammonium. Bromid of ammonium may be thus obtained : Place one pound of bromin in a stone jar, add to it care- fully four times its weight of water, then add half ounce at a time, very slowly, one quart of ammonia. The resulting CHEMISTRY. 215 solution from crystallization or granulation will yield am- monium bromid. 6Br + 8NH 3 = 6NH 4 Br + N 2 . Formula of ammonium bromid, NH 4 Br. It is a white cubical salt, soluble in water ; heated with caustic soda evolves odor of ammonia. Passing chlorin gas through its water solution we have bromin disengaged. Ammonium bromid acts upon the system like potassium or sodium bromid, as a depressant to the motor function of spinal cord. Its chief uses are to produce sleep and allay nervous irritability. Give a description of the preparation and mention the properties of the principal alcoholic beverages obtained from the fermentation of malted grains. The brewer "mashes" the ground malt with water, and heats at about 180 degrees F. for several hours, when such starch as has not been changed by germination of the grain in the malt now undergoes change into dextrin and sugar. The liquid resulting is "wort." Wort is now boiled with about ^ as much hops as was used of malt originally. This hopped wort is allowed to stand and the clear portion drawn off in shallow coolers, and its temperature lowered to about 60° F. Then about ,-^ of its volume of yeast is added and the liquid allowed to ferment in large vessels or tuns. As the result of fermentation glucose is changed to alcohol, with a further formation in the liquid of lactic, succinic, carbonic and acetic acids, glycerin, etc. The fermentative process is now stopped by heating the liquid sufficiently high to kill the yeast plant (pasteurizing). Ale, porter, stout, differ from beer only in the selection and proportion of the malt, hops and flavoring material. Beer. Stout. Mr. 2.78 6.66 6.26 Alcohol G.0. r ) 7.24 8.98 Solid extractive .12 .20 .11 Free acid 216 CHEMISTRY. What is the normal amount of uric acid excreted in 24 hours by an adult, and what effect has diet on the quantity so excreted? About 10 grains in 50 ounces of urine excreted in 24 hours. (Holland.) Increased during a diet rich in nitrogen, as of meats, peas, beans, eggs, etc., and alcoholic beverages. What is the fever thermometer? How is it made and graded? A small glass thermometer of a minute capillary bore, with a constriction in the lumen of the capillary tube immediately above the mercurial chamber. The mercury, in its expansion, passes through the con- stricted parts of the tube, but on cooling and contracting cannot, by its own weight, fall down the tube past the con- stricted portion. It is made like other thermometers by certain steps. 1st. Calibrating the tube. 2d. Filling the tube. 3d. Curing the tube. 4th. Graduating the thermometer. It is usually graduated from 90 degrees Fahr. to 110 de- grees Fahr. Each degree divided into five equal spaces. What is the relative importance of the element carbon in organic chemistry? All organic compounds contain carbon. It is the essential, necessary element whose presence classes the body as organic. Inorganic compounds occur in small number that contain carbon, as in the salts known as carbonates and bi-carbonates. In testing urine by heat in a case of suspected albu = minuria, what substances might be precipitated and so make the test deceptive? Phosphates. CHEMISTRY. 217 Describe the chemical process (a) when iron rusts, (b) when wood burns, (c) when silver is tarnished by coal gas. In rusting of iron the final product is Fe 2 3 , ferric oxid. Wood burns to form carbon-dioxid and water. The carbon and the hydrogen of the wood uniting with oxygen from the air and from the wood itself when influ- enced by heat. Silver, in presence of coal gas, becomes coated with a black sulfid of silver, AgS, from the presence in the coal gas of sulfur gases, as hydrogen sulfid and ammonium sulfid. How is collodion prepared and what are its uses? Collodion is a gun cotton, made, however, through the action of dilute nitric and dilute sulfuric acids upon clean raw cotton. This substance is dissolved in ether, and its etherial solu- tion when painted upon denuded surfaces deposits a coating of collodion as a protective to such surfaces when the ether evaporates. Describe the manufacture of illuminating gas. Soft coal is heated in closed retorts, and the resulting vapors from its decomposition pass into: 1st. A hydraulic "main," which is a large pipe half filled with water; the gases passing into the water emerge, and traveling along the upper portion of the main, then pass into 2d. Out-air condensers, which consist of tubes in the outer air, placed in perpendicular stacks. Then having traversed the out-air condensers the gas is conducted into the 3d. Scrubbing room, in which it comes in contact with thin films of water, and is in this manner washed and freed of certain substances, the most important being ammonia. The gas now passes into 4th. The lime chamber, where the gas is freed of sulfur compounds through the action of lime, sulfate of iron and charcoal. After all of these methods of purification, the re- sultant is then stored as illuminating gas for distribution to tin- omisumrr. 218 CHEMISTRY. In the retort is left gas-carbon and coke ; from the hydraulic main and out-air condensers coal tar is removed. From the scrubbing room ammonium hydrate is obtained. From the lime chamber calcium sulfid is obtained. Mention the antidotes applicable in cases of poisoning from (a) caustic alkalies, (b) carbolic acid. (a) Vinegar, lemon juice, oils, fats, mucilaginous drinks. (b) Soluble sulfates, as magnesium sulfate, oils, fats, albu- men, vinegar, and alcohol. Where is oxygen found in the human body and what are its important uses in the animal economy? It is present in moisture, hence in all animal tissues and fluids. It is also found in many salts and compounds, both in- organic and organic. Oxygen promotes the destruction and removal of existing tissues, with subsequent replacement by new structures. It is only through the ingestion of oxygen, in respiration, that animal life may continue. When sulfur is burned in the air, what is the product and what are its uses? Sulfur dioxid, or sulfurous anhydrid, S0 2 . It bleaches organic colors ; it is a disinfectant gas. It stops or limits fermentation; in the arts it is used for the manu- facture of sulfuric acid and other chemical bodies. It is used in organic chemical analysis and in metallurgy, as in the reduction of certain ores. Describe bromin. A heavy dark-red liquid element, vaporizing at all temper- atures as an orange-red gas. Slightly soluble in water, possessing bleaching and dis- infectant powers. It is strongly caustic, electro-negative, monad in valency. Atomic weight 80, specific gravity, 2.99; prepared by passing chlorin gas through concentrated solu- CHEMISTRY. 219 tions of bromids. Combines with metals, forms oxy-acids and oxy-salts. Write the formulas for (a) sodium sulphate, (b) potas= sium nitrate, (c) ammonium chlorid. (a) Na 2 S0 4 . (b) KN0 3 . (c) NH 4 C1. Describe the method of obtaining H and O by passing an electric current through H 2 0, and tell how to deter= mine which gas is O. Seal two platinum wires in the opposite sides of a glass flask, solder two upright strips of platinum to these entering horizontal wires. Connect one of the entering wires with the positive wire of a galvanic battery of several cells. Connect the other wire that enters the glass vessel with the negative wire from the battery. Now invert two long glass tubes that have been filled with water, in this cup or vessel, that has itself been partially filled with water. The water will be retained in the tubes through atmospheric pressure, and the tubes will be placed, mouth downward, over each of the plat- inum slips; allow the current to pass, when each tube will fill with gas, the water it contains being displaced. The tube which will contain oxygen gas fills with half the rapidity of the opposite tube, and if this tube be removed from the apparatus and held in an upright position, a fragment of wood, glowing, but not actively burning, will kindle into brilliant flame when plunged into the tube. What is effervescence and what is efflorescence? Effervescence refers to the escape of gas through a liquid, in which the gas has been held under pressure. This process produces bubbling, as we see in soda water. Efflorescence refers to the loss of water of crystallization which certain crystals undergo when exposed to air. They dry out, become powdery, losing their crystalline form, as we see in the case of alums. 220 CHEMISTRY. What changes take place in alcoholic fermentation? Glucose is converted into alcohol and carbon dioxid gas: C 6 H 12 6 = 2C 2 H 5 OH + 2C0 2 . What is understood by specific gravity, and what pre- cautions are advisable in the use of the urinometer? (a) By specific gravity of a substance we mean the ratio, or relation by weight, the substance bears to the weight of an equal volume of some substance used as a standard, when both substances have the same standard temperature and are under normal pressure. (b) Bring the temperature of the liquid to be examined (urine) to 60° Fahr. ; free the instrument, particularly its stem, of any adhering bubbles. Note on the scale of the in- strument the degree corresponding to the level of liquid in the surrounding jar, not recording the degree as shown through capillary action in the ascent, up the stem, of a thin film of liquid. Give the chemical name and formula of (a) water, (b) common salt, (c) carbonic acid, (d) nitric acid. (a) Hydrogen monoxid, H 2 0. (b) Natrium chlorid or sodic chlorid, NaCl. (c) Carbon dioxid gas, C0 2 ; true hy- drogen carbonate, H,C0 3 . (d) Hydrogen nitrate or hydric nitrate, HNO„. How does fire=damp explode in mines? When marsh gas escapes from fissures in coal formations and mixes with air, such mixtures explode with great violence when heated, as from a naked flame of a lamp, the chemical results being to form carbon dioxid and water. If the proportion of air rises to 18 times the volume of marsh gas no explosion occurs. Demonstrate the fact that air is a mixture, and not a compound. Pass air through water that has been boiled, and 3 per cent, of the oxygen of the air will be retained dissolved in CHEMISTRY. 221 the water, while less than 1 per cent, of nitrogen will be re- tained by the water. Through this method of solution of oxygen we may entirely extract the oxygen from atmospheric air. What is the chemical antidote in case of poisoning by tartar emetic? Tannic acid. What is the formula of sulphuretted hydrogen? What are some of its properties and uses? Sulphuretted hydrogen, H,S, is a colorless gas, slightly heavier than air, of a disgusting, rotten-egg-like character- istic odor. Burning with a blue flame when lit in air, it forms sulphur dioxid gas and water. It is used as a group reagent to separate metals of the so- called second analytical group from other metals when all are together in solution. Which metal is (a) the least tenacious, (b) the most infusible, (c) the best for electro=magnets, (d) the best for electro=conductors, (e) the most rare? (a) Mercury; (b) osmium; (c) iron; (d) silver; (e) ra- dium. Describe the process for the preparation of nitric acid. Sodium nitrate and sulfuric acid are strongly heated, and the resultant gas passing into water, in which it dissolves, forming dilute nitric acid, which may be concentrated by heating. Give the flame test for barium and strontium. Wet a clean platinum wire with hydrochloric acid, then place it in a little powdered barium salt; hold the wire with the adherent barium salt in the inner Bunsen flame, when the outer flame will be colored green. Strontium, under like conditions, will communicate a bril- liant red color to the outer Bunsen flame. 222 CHEMISTRY. What is the per cent, of each constituent present in sulfuric acid, the atomic weight of sulfur being 32? Hydrogen 2.04 per cent. Oxygen 65.31 Sulphur 32.65 What are the principal constituents of milk? COWS' MILK. Water 87.41 Solids 11.59 Fat 3.66 Sugar 4.92 Casein 3.01 Albumen 75 Albuminoids 3.76 Ash 70 To what impurity is the occasional toxic effect of bis= muth salts due? Arsenic. Give the chemical reason why diabetics should abstain from starchy foods. Because of the conversion of starch into glucose through the action of ptyalin in saliva, and of a ferment in pan- creatic juice. Glucose thus formed cannot be broken up into other sub- stances because of loss of power of liver cells to perform functions, so that this glucose passes directly into the blood, from which it is eliminated after being extracted through the action of the kidneys. What chemical changes take place as a result of mus- cular activity? Rapid oxidation of tissues, particularly muscular tissues. Increased formation and elimination of urea from decom- posed nitrogenous structures. Increased rapidity of circula- CHEMISTRY. 223 tion brings formative material to quickly repair this loss or waste, so that tissues are rapidly destroyed, rapidly replaced, and the waste rapidly removed through exercise. What is the difference between fermentation and putre= faction? Fermentation is the decomposition of non-nitrogenous sub- stances due to the presence of a body called a ferment, which ferment itself contains nitrogen in its composition. Ordinary alcoholic fermentation is accompanied by the evo- lution of carbon dioxid gas. Putrefaction is the decomposition of nitrogenous bodies brought about through the presence of bacteria, and is char- acterized by the evolution of ammonia, and if putrefying substances contain sulfur, of sulfu retted hydrogen gas. Mention the antidotes applicable in a case of poisoning from iodin. Starch, mucilaginous drinks, flour, milk, white of egg. Describe chloral hydrate. Chloral hydrate, C 2 HC1 3 01I 2 0. A colorless, transparent, crystalline solid, pungent odor, acrid taste, soluble in water. Hypnotic. It liquefies if triturated with camphor, phenol, menthol, thymol. Give a chemical explanation of the souring and curdling of milk. A ferment, one of the cells of yeast, acts upon the sugar of milk, changing it to lactic acid, this lactic acid then produc ing a sour taste and coagulating the casein. Name each of the following: (a) H..SO.., (b) H ,S0 3 , (c) H 2 S0 4 , (d) H 2 S 2 3 . (a) Hyposulfurous acid; (b) sulfurous acid; (c) sulfuric acid; (d) thio-sulfuric acid (from which the class of salts known as hyposulfites are obtained). 224 CHEMISTRY. What are the chemical constituents of biliary calculi? Cholesterine pigments, biliary acids, mucus, epithelium, car- bonate of calcium, fats. Describe your mode of procedure in making a chemical examination of suspected urine. Determine the specific gravity with urinometer. The re- action with litmus paper. Note the color, the degree of clearness or presence of pre- cipitate or sediment. Now test for albumin. Fill a test-tube two-thirds full of urine and add to it suffi- cient saturated sodium chlorid solution to raise its specific gravity ten degrees. Add a few drops of acetic acid and boil the upper layer of liquid. Should it become less transparent it would indicate albumin. Then test for glucose, using Fehling's test; then deter- mine the relative quantity of indican by use of HC1 and of urophain by use of sulfuric acid. Then by centrifuge precipitate the chlorids with silver nitrate in a percentage tube, the phosphates with uranium acetate solution, the sulfates with barium chlorid solution. Then estimate urea by hypobromite of sodium solution. Describe the theory of the construction of the metric system. The metre, unit of linear measure, was supposed to be the one ten-millionth of a quadrant of a great circle of the earth. The metre is 39.37 inches in length. It is divided into ten equal parts called decimetres. Each decimetre is divided into ten equal parts called centi- metres. Each centimetre divided into ten parts called millimetres. Ten metres measure one dekametre; ten dekametres equal cue hectometre; ten hectometres equal one kilometre. A cubic centimetre of distilled water, at four degrees Cent., CHEMISTRY. 225 weighs one gram, the unit of weight equaling, in the English system, 15.432 troy grains. The gram is divided and subdivided, like the metre, into deci-, centi-, milligrams, and we also have the multiples, deka-, hecto-, kilograms, referring respectively to 10, 100 and 1000 grams. A cubical vessel with a length of side of one decimetre holds one litre of liquid, the measure of capacity. A litre contains 1000 cubic centimetres, and is nearly equal to the English quart, Wherein do wine, beer and whiskey differ? Wine containing from eight to twenty per cent, of alcohol, has present as well compound aromatic ethers and other vol- atile principles. Beer contains five to eight per cent, alcohol, and has much bitter extractive, as from hops, etc. Whiskey contains forty-five to fifty-five per cent, alcohol, possessing also aromatic substances. The skeleton of a man weighs 24 pounds and contains 58 per cent, of calcium phosphate, Ca ? (P0 4 ) 2 . Find the weight of phosphorus present. (Atomic weight of Ca, 40; of P, 31.) 100% : 58% : : 24 lbs. : X, or 13.92 lbs. of calcium phos- phate. Calcium phosphate, molecular weight 310, contains 62 of phosphorus. 310 : 62 : : 13.92 : A = 2.784 lbs. of phosphorus. Answer. Distinguish between physics and chemistry. Physics is a study treating of the changes that take place outside the molecule. The physical forces act between mole- cules. Chemistry as a science is a study of the changes occurring inside the molecule. Chemical forces act between atoms as well as between molecules. 15 226 CHEMISTRY. What is the unit of comparison in determining the spe- cific gravity of liquids? Of gases? Pure water at 4 degrees Cent., or at 60 degrees Fahr. ; barometric pressure to be such as would support a column of mercury 760 millimetres, or 30 inches, in height. This is the standard for determining specific gravity of liquids. For specific gravity of gases we use pure dry atmospheric air at zero Cent, and barometric pressure 760 millimetres, or pure dry hydrogen at the same (standard) temperature and pressure. Define qualitative analysis and give a principal method. Qualitative analysis consists of splitting apart the con- stituents of a compound, and forming with each constituent compounds of a different character that may be readily de- tected by the senses. Thus qualitative analysis performed upon silver nitrate separates the silver ions from the nitrions when to a solution of silver nitrate we add hydrochloric acid. And then instantly, when the silver ions are freed, they combine chemically with the chlorin ions of hydrochloric acid, forming the new body, silver chlorid, which from its insoluble character, its color and general appearance permit us to recognize its nature. Define (a) element, (b) compound, (c) mixture, (d) solution, (e) precipitate. (a) A substance the molecules composing it being formed of the same kind of atoms, (b) A substance the molecules forming it containing different kinds of atoms. (c) A mechanical mixture or union of two or more substances, which substances may be in any proportion and may retain their characteristic properties, (d) A solution is a liquid in which a solid substance, or a gaseous substance, has been dis- solved, (e) A solid substance insoluble in the liquid in which it forms through chemical action. CHEMISTRY. 227 Which of the elements are gases at ordinary tempera= ture and pressure? Hydrogen, oxygen, nitrogen, chlorin, fluorin, argon, and a number of lately discovered elementary substances. Where do Na, rig, Cu occur in nature? Which occur free? Copper occurs free in nature, as does also mercury, although but in limited quantity. Sodium occurs principally in union with chlorin as NaCl found in sea water, mineral springs, in natural water, in nearly all plant and animal structures. The usual form in which mercury is found in nature is in its combination with sulfur in the ore cinnabar, HgS. It is found in but few localities, as Spain, Austria, California. Copper often occurs free, called native copper. This is the case in the Lake Superior copper region. This metal is also found in a number of mineral combinations, as of sulfid, carbonate, oxid, etc. Describe hydrochloric acid as to its occurrence. We find hydrochloric acid present in certain animal fluids, as in gastric juice. It is found in a few natural mineral waters. It occurs in commerce under the name muriatic acid. How does each of the following affect litmus paper: (a) H 2 0, (b) H 2 S0 4 , (c) (NH) 4 OH? (a) No effect, (b) Turns it red. (c) Turns it blue. The quantity of urine being insufficient for the urino- meter, how would you proceed? Use a small piknometer, or specific gravity flask, some of which are of so small a size as to be completely filled when containing 25 grains of water. Weigh the flask when filled with urine and then when filled willi pure water. Deduct from each weighing the weight of the flask, then divide the weight of the urine by the weight of water the flask contains; or, dilute the urine 228 CHEMISTRY. with an exact quantity of water, as 3 parts, 4 parts, etc., then use the urinometer, and from the data calculate the true specific gravity of the urine. Distinguish between starch and sugar. By what histo= logic element is starch converted into sugar? Starch is colloidal, its formula C 6 H 10 O 5 . It is insoluble in cold water, forms a mucilage in hot water. Turns iodin blue, rotates light to the right, has no sweet taste. Sugar is crystalline, its formula C^H^On. It is soluble in cold or hot water, it rotates light to the left, it yields no color with iodin, it possesses a characteristic sweet taste. Starch is converted into sugar (glucose) by ptyalin. Complete the equation CaCl 2 -f- Na,C0 3 =. CaCL + Na 2 C0 3 = CaC0 3 + 2NaCl. Mention the antidotes applicable in cases of poisoning from (a) oxalic acid, (b) copper sulphate. (a) A salt of lime or calcium — lime water. (b) Albumin. Chemical antidote is f errocyanide of potassium. What is chemical decomposition? Chemical decomposition refers to the breaking up of a compound into simpler forms through chemical action. Give an example of a synthetic operation. The formation of cupric oxid by heating the metal copper in air or oxygen; or, mixing two parts hydrogen and one part oxygen by volume and heating, an explosion occurs and vapor of water is formed. What are the products of the combustion of ordinary coal? Principally carbon monoxid and carbon dioxid. There may also arise ammonium sulfid, ammonia, marsh gas, defiant gas and acetylene gas. CHEMISTRY. 229 In composition with what elements are the following most commonly found in nature: (a) Iron, (b) gold, (c) silver, (d) copper, (e) chlorin? (a) Oxygen or sulfur, (b) Sulfur, (c) Sulfur, tellurium and chlorin. (d) Sulfur, oxygen, carbon, (e) Sodium. Describe the production of oxygen by decomposition of potassium chlorate. Give the formula and equation. Heat potassium chlorate with or without an addition of manganese dioxid, and oxygen is liberated from the decom- position of potassium chlorate. 2KC10, + heat = 2KC1 + 30 2 . Explain an experiment to prove that chemical action may be induced by electricity. Mix equal volumes of hydrogen and chlorin gases in a flask, through the sides of which pass two platinum wires that ap- proach near each other in the center flask. Connect these wires with the wires from a battery or in- duction coil, when on sending an electric charge the hydrogen and chlorin combine with explosive violence to form hydro- chloric acid. Name and describe some of the more important potas- sium salts. Potassium nitrate, crystallizing in regular cubes, is perma- nent in air, occurring in large quantities in the soil of hot countries. Common name is saltpetre, or nitre. Has a large use in arts and industries for many purposes, as in gunpowder and pyrotechny manufacture. In chemistry it is used as an oxidizing agent. Potassium acetate : May be obtained in crystal form by chemical action resulting on the addition of acetic acid to potassium carbonate; used in medicine as febrifuge a in I diuretic. Potassium carbonate: Obtained by evaporating the water 230 CHEMISTRY. with which the ashes of plants have been washed (lixivi- ating) . It is a deliquescent salt. From it many salts of potassium may be obtained, as bi-carbonate, by passing carbon dioxid gas through a watery solution of carbonate of potassium. Potassium iodid: Made by dissolving iodin in watery solu- tion of potassium hydrate and evaporating and heating strongly, the residue dissolved in water will then yield cubical crystals of potassium iodid as the liquid evaporates. This salt is used in medicine as an alterative, to promote absorp- tion, and as an anti-syphilitic. Potassium bromid : Made by union of Br and KHO, re- sembles KI in crystal form and general appearance; used as a motor depressor to the spinal cord — a hypnotic. What is the formula for (a) chloroform, (b) sulfuric ether, (c) alcohol? (a) CHCI3. (b) (C 2 H 5 ) 2 0. (c) C 2 H 5 OH. How would you conduct an autopsy for the purpose of testing for arsenic in the stomach and tissues? The analytical chemist should be present, if possible, at the autopsy. Tie both pyloric and cardiac ends of the stomach and place this viscus, with its contents, in a glass jar that is chemically clean. Close the jar by a close-fitting glass stop- per;, seal it, if possible, hermetically, and imprint a design upon the seal in such a way that design will be broken should the jar be opened. Proceed, in the same manner, to save a portion at least of the liver, the small intestine, portion of large intestine, the spleen, one kidney, the brain. Each of these substances are preferably kept by themselves in clean, well-sealed jars, so sealed that any tampering with contents of jar would be at once evident. Complete the following equations and write the name of each resulting compound under its formula: 2NaCl + H 2 S0 4 = CaCC-3 -f 2HC1 =. CHEMISTRY. 231 2NaCl + H 2 S0 4 = Na 2 S0 4 + 2HC1. Sodic sulphate Hydric chlorid. CaC0 3 + 2HC1 = CaCl 2 + C0 2 + H 2 0. Calcium chlorid -f Carbon dioxid water. How would you determine, chemically, whether a uri- nary deposit were composed of urates or phosphates? Heat would dissolve a precipitate of urates, but would not dissolve phosphates. A drop of nitric acid would dissolve a precipitate of phos- phates, but would not dissolve urates. What is dialysis, and how would you construct a di= alyzer? Dialysis is the process of separating crystalloids from col- loids when both are in the same solution. It is performed in a • dialyzer, which consists of a glass vessel, the bottom of which is formed of parchment or parch- ment paper. We place the complex mixture in this vessel of the dialyzer and set the dialyzer in a larger vessel containing distilled water. In a short time the crystallizable substances will have passed through the animal membrane forming the bottom of the dialyzer into the distilled water, in which they may be detected, and from which they may be separated by evap- oration. The colloidal material remains in the dialyzer, not being able to pass through the membranous bottom. What is the difference between the mercurous and mer- curic chlorid? Mercurous chlorid, Hg 2 Cl a or 2IlgCl. Mercuric chlorid, IIgCl 2 . In mercurous chlorid we have chemically a molecule of mercury combining with two atoms of chlorin, a white im- palpable, insoluble powder, tasteless, odorless, turned black by alkaline hydrate solutions. Acts as a laxative. Has but Blighl poisonous action in single dose. 232 CHEMISTRY. In mercuric chloric! we have chemically an atom of mercury uniting with two chlorin atoms. It is a white, crystalline, soluble substance, of a sweetish, burning, metallic taste, turning to a white mixture when added to lime-water, giving a yellow precipitate with alka- line hydrates. Is very poisonous; used externally as antiseptic, and in concentrated solutions as disinfectant. Administered internally in doses of ^ T of a grain as a maximum, as an anti-specific, alterative, tonic. Antidote, albumin. What impurities may be present in sulfuric acid, and how would you detect them? Lead : Appearing when strong sulfuric acid is diluted with water, here giving a white precipitate or haziness to the mixture of sulfate of lead. Arsenic : Recognized by Marsh 's test, using chemically pure zinc for the work. Selenic acid: Showing its presence by communicating to the sulfuric acid a power of dissolving gold. Nitric acid, or oxid of nitrogen: Detected by testing the suspected dilute sulfuric acid by adding to it a mixture of strong sulfuric acid and carbolic acid, and evaporating these three substances in a porcelain dish to dryness, when on heat- ing slightly, should nitrates or nitric acid be present, a pink coloration is observed. Organic matter in sulfuric acid causes a darkening of tint even to the production of a black liquid. What is sulfuric ether, and what is its action upon man? It is the oxid of ethyl, (C 2 H 5 ) 2 0, receiving its name from the fact that it is obtained by distilling a mixture of alcohol and sulfuric acid. It is a colorless liquid, lighter than water, readily vaporizing at ordinary temperatures, its vapor being heavier than air and of a characteristic odor. Ether pro- duces in man, or other animals that inhale it, unconsciousness. CHEMISTRY. 233 muscular relaxation, and may occasion death, through a cen- tric paralysis of respiration. How would you detect the presence of bile in the urine? Place urine in test-tube, down which pour fuming nitric acid (a mixture of nitric and nitrous acids) so that acid collects below urine, when, at point of contact, should bile be present, a band of coagulation will appear of a greenish color; or, Add cane-sugar to urine, and to a drop or two of this mix- ture placed on white porcelain surface, add a drop of strong sulfuric acid, when, should bile be present, there will appear a play of colors forming in concentric rings, the colors par- ticularly prominent, being yellow, red and green. Give a reliable quantitative test for albumin. Weigh out 100 grains of urine, to it add acetic acid to assure its acidity, boil, cool and filter through a weighed filter paper, wash the coagulated material on filter paper with: 1st. Boiling water containing a few drops of acetic acid. 2d. With ether. 3d. With alcohol. 4th. Again with boiling acidified water. Then dry in drying oven, temperature of which is not higher than 212° F., when weigh on filter paper, and when weight remains constant between any two successive weigh- ings made at intervals of half hour; deduct from this weight, weight of filter paper, and result gives in grains weight of albumin in a hundred grains of urine. We wash coaguluin with water to remove entangled salts, with ether to remove fats or oils, witli alcohol to remove color- ing matters, resinous substances, etc. What is mucin? How would you recognize it in urine? Mucin is a compound proteid, and is composed of a proteid and a carbohydrate. It will reduce Fehling's solution. It occurs in cement substance of connective and epithelial tis- sues ; also presenl in bile and in secretions of mucous BUrffi 234 CHEMISTRY. Test : It is not precipitated from urine by boiling, but is precipitated on the addition to urine of either alcohol, dilute mineral acids, acetic, picric or citric acids. To detect it add acetic acid to form a layer below urine without heating, when at point of contact a poorly defined line of filamentous-like deposit will appear. Describe the usual method of determining chemically the presence of blood in the urine. To urine add a few drops of tr. guaiacum and then an excess of ozonized ether, shake, the ether separates and be- comes of a fine sapphire-blue should blood have been present in the urine. Give a reliable quantitative test for sugar in the urine. Select two bottles of about six ounces capacity; in each bottle place four ounces of urine, adding to one of the bottles a small fragment of yeast. Stopper the bottles loosely and place in a warm place, allowing them to remain undisturbed for from 12 to 24 hours. Then take the specific gravity of the urine in each bottle, and should the specific gravity be less in the specimen to which yeast was added it would indicate the presence of glucose, which undergoing decomposition into alcohol and carbonic acid gas, through the action of yeast, will have occasioned a lower specific gravity. Each degree of specific gravity thus lost would correspond to the presence of one grain of glucose in every ounce of urine. What is alcohol, and how is it formed? Alcohol is a hydrate of an alcohol radical ; or an alcohol is a water in which one hydrogen atom in each molecule of water has been replaced by an alcohol radical. Alcohol is formed through that variety of chemical decomposition known as fer- mentation. Alcohol is obtained by distilling the results of the fermentation of sugary liquids. How is uric acid recognized chemically? Uric acid is recognized chemically by its precipitation from CHEMISTRY. 235 urine on the addition of hydrochloric acid. Uric acid thus obtained may be washed, dried and weighed. A test for uric acid : Concentrate by evaporation a few drops of urine, add a few drops of nitric acid, heat until dry. when a pink color develops on the sides of the dish ; now add potassium hydrate, or ammonium hydrate, when a blue to purplish color is produced on further heating. This test is known as the murexid test for detecting uric acid. Name the antidotes in a case of stramonium poisoning. Tannic acid, strong infusions of coffee, morphin, physo- stigmin, pilocarpin. What is the principal pigment in normal urine? Urobilin. Give two chemical tests that you would use in water supposed to be contaminated by sewage. (a) Distil the water until free from ammonia, then add acid permanganate of potassium solution to the residue and again distil, when should ammonia appear in the distillate. as shown by the action upon it of Nessler's solution, it would indicate the presence of organic matter in the water exam- ined. (b) Estimate the chlorids in the specimen of water, using a standard solution of silver nitrate with potassium chromatc as an indicator. If it were found that the water contained an excessive quantit.y of chlorids it would point strongly to the presence of sewage in such water. Give tests for the purity of chloroform. Test for chlorin : Drop the suspected chloroform through a watery solution of potassium iodid in a test-tube. Should the chloroform, which collects at the bottom of the tube, acquire a pink color, and the supernatant liquid become yellow or brownish in tint, it indicates the presence of free chlorin. Test for IIC1: Shake the chloroform with water, ami after 236 CHEMISTRY. separating pour the water into a clean tube, and rendering it acid with a drop of nitric acid, add silver nitrate solution, when should hydrochloric acid or chlorids be present a white precipitate will form. Test for hydrocarbons : Evaporate suspected chloroform on clean porcelain surface, when no residue should be left, nor should there be any odor save that of chloroform only. Test for minute quantities of water : Add to the chloroform white anhydrous copper sulfate, when should the copper sul- fate become blue in color the presence of water would be indicated. Test for acidity: By shaking the chloroform with water, pouring off the water and testing it with a drop or two of litmus solution, when a red tint developed would indicate free acid. Explain the process of bleaching with chlorin. Chlorin only bleaches organic colors in the presence of moisture. Chlorin unites with the hydrogen of moisture, setting the oxygen free to produce the loss of color. In bleaching with chlorin we make use of a mixture of chlori- nated lime and water. The fabric to be bleached is first "soured" by passing it through a very dilute acid solution. It is then placed in the mixture of bleaching salt and water, after which it is to be thoroughly washed with proper re- agents to remove any excess of acid, chlorin or lime. State the most common and convenient antidotes for poisoning by mineral acids. State also the course to be pursued when the poison to be antidoted is unknown. Convenient antidotes for poisoning by mineral acids are: Calcined magnesia, alkaline carbonates, as baking soda, chalk, soap. Then use oils, fats, milk, flour, eggs. If poison be of unknown character administer an emetic, as mustard and water, or use stomach pump or syphon tube. If reason to suspect poison to be of alkaloidal nature give tannic acid or permanganate of potassium. CHEMISTRY. 237 Use ammonia, whiskey or strong coffee as stimulants, and meet symptoms as they arise. How would you make Fehling's solution? Dissolve 173 grams of crystallized Rochelle salts in about 500 cubic centimeters of a sodium hydroxid solution of a density of 1.14; call this solution No. 1. Dissolve 34.64 grams of crystallized copper sulfate in about 450 cubic centimeters of distilled water; call this solu- tion No. 2. Slowly add No. 2 to No. 1, stirring well and keeping the mixture in perfect solution. When mixed add sufficient dis- tilled water to make the completed Fehling's solution measure 1000 cubic centimeters. Each cubic centimeter of this solution should have its color discharged by .005 grams of glucose. If, on boiling Fehling's solution, any change in its color takes place, it has spoiled and is no longer fit for use. What element composes over half the matter of the earth? Oxygen. What is oxidation? Chemical union of elementary bodies with oxygen ; break- ing up of a compound substance, the elements of which combine with oxygen; rapid oxidation, if accompanied by heat and light, is called active combustion or burning. What is ozone? Electrified oxygen, each molecule of which consists of three atoms of oxygen ; also called allotropic oxygen. It is a blue gas of high chemical (oxidizing) powers, irrespirable excepl when extremely diluted, when it acts as a stimulant. What is Paris green? A double salt of copper arsenite and copper acetate. Cu(C 2 H 3 2 ) 2 :3Cu0 4 As 2 . Schweinfurt's green, Mitis green. 238 CHEMISTRY. An insoluble green crystallizable powder. What is the chemical name of Rochelle salts? Bi-tartrate of sodium and potassium, KNaC 4 H 4 6 . What is the chemical designation of the ordinary alcohol of commerce? Ethylic alcohol, or the hydroxid of ethyl. From what substances is ether obtained? Ether results from distilling sulfuric acid and ethylic alcohol. Name the various states in which matter may exist. Solid, liquid, gaseous, and Crookes or radiant state. What is the difference between atomic weight and spe= cific gravity? Atomic weight refers (as a rule) to the density of elemen- tary substances compared with hydrogen as a standard. Specific gravity refers (as a rule) to density of either elementary or compound bodies compared to atmospheric air, if the substance examined be gaseous. Thus density of oxy- gen is 16, while its specific gravity is 1.1056. Again, the atomic weight of an elementary substance if multiplied by its specific heat gives a product of 6.4 or nearly that; while this is not always true of the specific gravity of an elementary substance when such specific gravity is refer- able to hydrogen as a standard. Name and describe a deliquescent salt. Auric tri-chlorid. A deliquescent salt is one which when exposed to air loses its crystal character, becoming softened, and finally liquefied, through its absorbing moisture from the air. Complete the following equations: (a) 2NH 4 Cl+Ca(HO) 2 = (b) 2KN0 3 + H 2 S0 4 =. (a) 2NH 4 C1 -f Ca(HO) 2 = CaCl 2 + 2NH 3 + 2H 2 0. (b) 2KN0 3 + H,S0 4 = K 2 S0 4 + 2HN0 3 . CHEMISTRY. 2 : !9 Explain the reaction which occurs when the solution of the two parts of a seidlitz powder are mixed. Seidlitz powder consists of Rochelle salts, 120 grains; sod- ium bi-carbonate, 40 grains; these are wrapped in the blue paper. In the white paper is placed 35 grains of tartaric acid. H 2 C 4 H 4 O + 2NaHC0 5 = Na,C 4 H 4 O c +2H 2 + 2C0 2 . To what salts do most cathartic mineral waters owe their virtues? To magnesium sulfate, or to sodium sulfate. Explain the construction of the safety lamp used by miners, and state the principle involved. The flame of the lamp is surrounded by a fine wire gauze, the mesh of which is very small. Each individual mesh con- tains its film of air, and as air is a poor conductor of heat, the heat of the burning oil is not conducted through the film of air in each mesh, the wire of the mesh also assisting in cooling the heat of combustion, so that not sufficient heat passes outward through the wire mesh to inflame the sur- rounding gas. What is pepsin? A yellowish or greyish-white powder, soluble in water and glycerin, bu1 insoluble in alcohol. It gives none of the reac- tions of albumin. It is an enzyme, or unorganized ferment; it is the principal fermenl found in gastric juice. Its chiei activity is exerted upon proteid food substances, which it assists in converting into peptone- Mention the antidote applicable in case of poisoning from silver nitrate. Com mon table salt, NaCl. What is a chemical symbol? A chemical symbol is the initial Letter of the name of an elementary substance, or it may consist of the initial and one 240 CHEMISTRY. other important letter of the name of an elementary sub- stance. It is used as a short-hand designation of the element. What is the chemical composition of ordinary alum? Alum is a double sulfate of aluminum and ammonium. Its formula is 2NH 4 A12S0 4 , combining as Al 2 3SO 4- (NH 4 ) 2 S0 4 = 2NH 4 A12S0 4 . Write the formula of (a) common salt, (b) nitric acid, (c) sulfuric acid, (d) hydrochloric acid, (e) carbonic an= hydride. (a) NaCl; (b) HN0 3 ; (c) H 2 S0 4 ; (d) HC1; (e) C0 2 . What is the simplest test of the presence of (a) an acid, (b) iodin? (a) Turns litmus paper red; (b) turns starch mucilage bluish-black. Complete the following reactions: CaCl 2 + Na„C0 3 = (C 2 H 5 )HO + C 2 H 5 HS0 4 =. CaCl 2 + Na 2 C0 3 = CaC0 8 + 2NaCl. (C 2 H 5 )HO + C 2 H 5 HS0 4 =(C 2 H 5 ) 2 + H 2 S0 4 . Mention a test for ozone. Explain how ozone may be prepared in the laboratory, and compare its properties with those of oxygen. Gives a dark blue color to paper that has been wet with iodid of potassium and starch mucilage. Ozone is prepared by subjecting air or oxygen to silent electric discharges, as in the "Siemens" induction tube. Its properties are like those of oxygen, save that it acts more vigorously as an oxidizing agent. In concentrated form it is irrespirable. Name four elements that enter into the formation of organic bodies. Carbon, hydrogen, oxygen, nitrogen. CHEMISTRY. 241 What preparation of gun cotton is used in medicine, and what is its solvent? That made through the action of dilute nitric and sulfuric acids upon chemically clean cotton. Its solvent is ether. How may uric acid be obtained from urine? By adding to the urine strong hydrochloric acid, when after the mixture has stood from 12 to 24 hours uric acid will appear in minute crystals. Mention the antidotes applicable in cases of poisoning from zinc chlorid. Albumin. Use emetics or stomach-pump, cold affusions to face and neck, inhalation of ammonia; internally administer spirits of ammonia, nitro-glycerine, brandy, or inject ammonia into the veins. Mention the elements that, under ordinary circum* stances exist as (a) liquids, (b) gases. (a) Bromin and mercury, (b) Oxygen, hydrogen, nitro- gen, chlorin, fluorin, argon. Give the preparation, formula, properties and uses of potassium cyanid. Potassium cyanid, KCN or KCy. Prepared by saturating potassium hydroxid with hydrocyanic acid. A white amor- phous deliquescent salt, easily fusible, and smelling of cya- nogen. Very soluble in water, highly poisonous, used for same purpose as hydrocyanic acid, used as a cardiac sedative. as a sedative addition to cough mixtures. It is often given in conjunction with an acid to Eorm ;i freshly prepared hydro cyanic acid. Its dose does not exceed y$ of a grain. Define valence, radical. Illustrate. By valence of an clement or radical we refer to its numer- ical power by volume in which it enters into chemical onion with other elements ; thus wesa.} oxygen has a valence of two. Hi 242 CHEMISTRY. meaning by this that one quart of oxygen would require two quarts of hydrogen (our standard of unity for estimating valence) for its perfect chemical union. One quart of chlorin would require but one quart of hydro- gen for its perfect chemical union. And since this power of combination is noticed in volumes it is inferred that ultimate subdivision of the volume, or the atom of the element, will possess this power of numerical combination distinctive with the individual atom. A radical is an elementary atom ; a compound radical is an unsatisfied or unsaturated group of atoms, as S0 4 . What is the formula of carbolic acid? C 6 H 5 OH. How may phosphorus be obtained? Describe the allo= tropic forms of phosphorus. Burn bones, and to the ashes add sulfuric acid and water; after standing 24 hours decant the liquid, evaporate it to dryness and heat the residue strongly; to this result add sand and charcoal and distil, receiving the resultant vapor under water, where it solidifies to yield phosphorus. Red phosphorus is less poisonous than the ordinary form. It can be obtained by heating ordinary phosphorus in an atmosphere of carbon dioxid. It does not dissolve in disul- phid of carbon. White phosphorus is noticed coating the stick of ordinary phosphorus that is kept under water; some chemists state this to be but one of the oxids of phosphorus ; a black allotropic form is also recognized. Give the formula and chemical name of each of the following substances, indicating those soluble in water: Nitre, Epsom salts, lunar caustic, Paris green, aqua fortis, gypsum. Nitre, potassic nitrate, KN0 3 , soluble. Epsom salts, mag- nesic sulphate, MgS0 4 , soluble. Lunar caustic, argentic nitrate, AgNO,, soluble. Aqua fortis, hydric nitrate, HNO ;s , soluble. Paris green, cupric aceto-arsenite, Cu(C 2 H 3 0„) 2 : CHEMISTRY. 243 3Cu0 4 As 2 , insoluble. Gypsum, calcic sulphate. CaS0 4 2ILO, insoluble. What is the chemical designation of nitroglycerin? How is nitroglycerin manufactured? Glonoin, or tri-nitro-glycerin. A one per cent, alcoholic solution of nitroglycerin used in medicine. Nitroglycerin is made by cautiously mixing glycerin, strong nitric acid and sulfuric acid. What are amins? Give an example. They are substances which result when the hydrogen of ammonia is replaced by hydrocarbon radicals. Example : When NH 3 has one hydrogen atom replaced by C 2 H 5 it forms NH 2 C 2 H 5 , ethyl amin. Define porosity, capillary attraction. Porosity refers to that essential property of matter by virtue of which spaces called pores exist between the mole- cules of all substances, even the most dense. Capillary attrac- tion is a modification of adhesion, through which action liquids rise in small tubes, to which they adhere or wet; thus through capillary attraction oil ascends the wick of the lamp and sap travels through tree structure, etc. How do chemical antidotes and physiologic antidotes differ in action? Illustrate. A chemical antidote seeks to form an insoluble or harmless substance by combining chemically with a poisonous substance that has been taken into the body; thus magnesium sulfate is antidotal to soluble salts of lead, as it combines chemically with lead to form i lie insoluble sul fate of lead, thus to prevenl the absorption of Lead. An alkaline carbonate is antidotal to mineral acids, as it forms, in contact with the acids, harm- less -alts, and destroys the power for corrosion that the acid possesses. A physiologic antidote acts, not directly 1 1 1 > < » i * the poisonous body, but after that poisonous substance has been absorbed into the blood then the physiologic antidote pro 244 CHEMISTRY. duces symptoms opposed to those which the poison occasions; thus we use atropin as the physiologic antidote to morphine ; in its action it strongly stimulates respiration that has been depressed through the action of morphine. Mention two elements of each of the following groups: Univalent, bivalent, trivalent, quadrivalent. Univalent: Hydrogen and chlorin. Bivalent: Oxygen and magnesium. Trivalent: Arsenicum and boron. Quadrivalent: Silicon and platinum. What is the difference between analytic methods and synthetic methods in chemistry? Analytical methods seek to tear apart a compound into simpler bodies, as heating mercuric oxid, HgO, produces mer- cury and oxygen. Synthetic methods seek to build up a compound or complex body by bringing about the union of simpler bodies; thus we heat copper in air and form cupric oxid; we dissolve ammonia gas in water and thus form ammonium hydroxid, NH 4 HO. What gases are usually generated during the process of destructive distillation? If the destructive distillation be of soft coal, we find among the gases resulting hydrogen, marsh gas, olefiant gas, acety- lene gas, ammonia, sulphuretted hydrogen, carbon monoxid and carbon dioxid. Describe sulfur, and mention its important compounds. Sulfur is a lemon-yellow solid element. No taste or odor. It is strongly electro-negative, is non-metallic, resembles oxy- gen in its chemical combinations. It is insoluble in water, slightly soluble in hot alcohol, freely soluble in bi-sulnd of carbon. Its valency is 2, 4 and 6. Specific gravity compared with water is 2 ; specific heat .2. It crystallizes in octahedrons CHEMISTRY. 245 and in right rhombic prisms. It exists in several forms. Its compounds arc : Many important ores of a binary character, as zinc blend, ZnS, cinnabar, HgS, iron pyrites, FeS 2 , galena, PbS ; also in hydrogen sulfid, H 2 S. It occurs in ternary compounds, in natural substances, as Epsom salt, MgS0 4 . Glauber's salt, Na 2 S0 4 , in gypsum or calcium sulfate, in heavy spar or barium sulfate. Its important compounds are sulfuric acid, sulfurous acid, Nordhauesen, fuming sulfuric acid, carbon di-sulfid, ammonium sulfid. Many salts, as sul- fates of the metals. What is boron? Give its principal compounds. What is the chemical importance of boron in medicine? Boron is a brownish or greyish-black, solid, non-metallic element. Its principal compounds are boric acid and borax. Of boric acid, H 3 B0 3 , we have several modifications, as meta-boric acid and pyro-boric acid. An important salt of boron is sodium pyro-borate, Na 2 B 4 7 , known chemically also as sodium bi-borate, commonly called borax. Boron is only of importance in medicine from its two compounds, boric acid and borax, both of which are antiseptic, mildly astringent and detergent. Describe the incandescent electric light, and explain its use as an aid to diagnosis in medical and surgical practice. The incandescent electric light consists of a thin glass flask exhausted of air and containing a filament of carbon or platinum wire coiled in semicircle or other design, and when a current of electricity is caused to traverse this filament the resistance it offers to the passage of the current renders the filament incandescent, thus giving rise to light The incandescent electric light has a considerable use in medicine and surgery for illuminating passages which can- not be directly lighted; thus we use it in the larynx as an aid to diagnosis; in the form of the endoscope it is used in the bladder. It is used also to illuminate the interior of the Stomach, thus facilitating in the detection of hard accretions, 246 CHEMISTRY. as from tumors, which would give from the outside, under these conditions, a shadow effect. Give the composition and properties of chloroform. Chloroform, CHC1 3 , is obtained by distilling bleaching salt of lime and alcohol. It is a colorless, heavy liquid. Its specific gravity about 1.5, is of sweet taste, also hot, and has a characteristic aromatic odor. It is soluble in alcohol, but does not mix to any extent with water, although a minute quantity of water may unite with it. It burns with a green flame. Its vapor is heavier than air. It is. used for producing general anesthesia. It is a good solvent, particularly for alkaloids and rubber. Complete the following equation and give the resulting compounds: 2C 2 H 3 K0 2 + H 2 S0 4 = 2C 2 H 3 K0 2 + H 2 S0 4 = K 2 S0 4 + 2HC 2 H 3 2 . Potassic sulphate. Acetic acid. What organic acids are present in vegetables and fruits? Citric acid, malic acid, tartaric acid, oxalic acid, gallic acid, tannic acid, etc. Describe and illustrate the distinction between organic and inorganic compounds. Inorganic compounds occur in the mineral kingdom, and may contain any of the elementary forms of matter; the number of atoms in the molecule of inorganic compounds is usually small; they do not char when strongly heated, but leave a crust or residue called ash, when dried from their solutions. They are generally crystalline. Examples: Sod- ium chlorid, magnesium sulfate, etc. Organic compounds all contain carbon, and all except cya- nogen contain hydrogen. With these two elements a few other elements may be in union, among which we have, as most important, oxygen, nitrogen, sulfur, phosphorus. Often the number of atoms in each molecule of organic compound is CHEMISTRY. 247 large, though the kinds of atoms be but few; they all char when heated strongly, and burn entirely away on continued heat, unless in their composition a metal be present. Ex- amples: Alcohol, glycerin. Give the chemical composition of (a) Glauber's salt, (b) Epsom salt. (a) Sodium sulfate, Na 2 S0 4 . (b) Magnesium sulfate, MgS0 4 . Into what two principal groups are elements divided? Mention five elements that exist uncombined in nature. Into metals and metalloids or non-metals. Oxygen, nitro- gen, sulfur, gold, silver. Mention the acid constituent of bile. Taurocholic and glycocholic acids. What is hemoglobin? On what does its color depend? It is the organic coloring principle of red blood corpuscles. It forms a loose union with oxygen, whereby its formula shows 179 atoms of oxygen to the molecule instead of 177 atoms, these additional two atoms of oxygen producing a dif- ferent shape of the corpuscle and giving rise to a bright red color. Differentiate nitrates and nitrites. Mention two com= pounds of each group commonly used in medicine. Each molecule of a nitrate contains the acidulous radical N0 8 , while each molecule of a nitrite contains the acidulous radical N0 2 . Nitrates when heated with sulfuric ;icid give rise to nitric acid. Nitrites when heated with sulfuric acid yield red fumes of the <>xids of nitrogen. Nitrates when heated alone, or with other substances, pari lily with a portion of their oxygen. Examples of nitrates : 248 CHEMISTRY. Nitrate of potassium, nitrate of ammonium. Examples of nitrites : Nitrite of amyl, tri-nitrite of glycerin. What reaction takes place when chloral hydrate is mixed with an alkali? Illustrate. There results chloroform, a metallic formate and water. C 2 HCl 2 OH 2 + KOH = CHCI3 + KCH0 2 + H 2 0. What salt of mercury is soluble in water? Give the name and formula of a salt of silver used in medicine. Mercuric chlorid, HgCl 2 (bi-chlorid of mercury). Argen- tic nitrate, AgN0 3 . Describe the test for detecting the presence of strychnin. Place a crystal of the alkaloid on a watch-glass, and near it a fragment of bi-chromate of potassium. Cover each with a drop of strong sulfuric acid; after waiting a short time draw the two drops of acid together, and where they meet will appear a play of colors, in which may be clearly recog- nized yellow, red, purple and blue. What is a hydrocarbon? A hydrocarbon is an organic compound, the molecule of which consists of carbon and hydrogen atoms. What is the faradic current? How is it produced? The faradic current, called also the induced current of electricity, is developed when through an insulated wire of large sectional area a current of electricity flows that is alternately stopped and restored in its flow as it enters this coil, known as the primary coil. Surrounding the primary coil is a coil of insulated wire smaller in sectional area but much longer, and at the moment of breaking or restoring the electric flow into the primary coil currents of electricity are induced in this surrounding secondary coil. These induced currents are to-and-fro currents, that is, they are constantly changing their direction of flow; they constitute the true faradic currents. CHEMISTRY. 249 What is synthesis? Mention three coal=tar products extensively used in medicine that are prepared in the chemical laboratory by synthesis. Synthesis is the act of constructing a compound or complex substance by bringing about the union of simpler bodies. Synthetical compounds used in medicine obtained from coal- tar include salicylic acid, phenacetin, saccharin. Differentiate a mass of matter, a chemical compound and an elementary body. An elementary body is a simple substance that cannot be reduced to any simpler form, that is, it is made up of but one kind of atom. A chemical compound is the resultant of the union of two or more elementary bodies, and it may be, as the molecule, infinitely small. A mass of matter is an aggregation of either elementary or compound molecules, but of sufficient size to be acted upon by molar forces. Explain the following terms: Chemical reaction, alka= line reaction. Chemical action refers to the union of atoms or radicals to form new bodies after, through chemical action, they have been separated from their former combinations. A substance is said to have an alkaline reaction if when dissolved it changes red litmus to blue. Describe some method for (a) analysis of water, (b) the synthesis of water. (a) Pass water in the form of steam through an iron pipe heated to redness, when the oxygen of water will enter into chemical union with the iron of the pipe, coating the latter with magnetic oxid of iron, Fe 3 4 , and hydrogen gas will issue from the distal end of the pipe. (b) Pass dry hydrogen gas over copper oxid placed in a hard glass tube and heal it to redness, when the hydrogen will enter into chemical combination with the oxygen, and Tapor of water will issue from the distal end of the tube, while remaining in Hie tube will be the metal copper. 250 CHEMISTRY. State the chemical properties of carbon. Describe two allotropic forms of carbon. Carbon is an electro-negative solid element, atomic weight 12. Valency diad and tetrad. It is not a supporter of com- bustion. It combines readily with oxygen to form two oxids, carbon monoxid and carbon dioxid. Combines with hydro- gen to form many bodies known in organic chemistry as hydrocarbons. It forms binary combinations with most non- metals and with a few metal elements. It is non-poisonous. An allotropic form of carbon is graphite ; this is a greyish- black substance crystallizing in hexagonal plates. It occurs in large mineral deposits, and, when mined, has great use as a lubricant, for making crucibles and to make lead pencils. Diamond is another allotropic form of carbon, occurs in octa- hedral crystals, is colorless, of high refracting power, is hard- est substance known, occurs imbedded often in beds of blue clay, as in South African region. When burned in oxygen it gives rise to carbon dioxid gas. It is insoluble in all liquids. Mention the principal constituents of muscle. Water 80 Solids 20 Ash , 126 Albuminous 15. Etherial extractive 33 Non-nitrogenous 3.25 Glycogen 2.43 Glycosin 71 How is the air of an apartment tested to determine the presence and amount of carbon dioxid in it? Through the neutralizing effect of carbon dioxid upon the caustic strength of lime-water. We determine the caustic strength of lime-water in terms of oxalic acid solution. We next expose a measured quantity of lime-water to the action of a measured quantity of atmos- CHEMISTRY. 251 pheric air, when the carbon dioxid in the air will neutralize in part the alkalinity of the lime-water. Removing this lime- water, so changed, we again test its alkalinity by the use of oxalic acid solution, using phenolphthalein as our indicator, when the loss of alkalinity of the lime-water expresses the quantity of carbon dioxid present in the volume of air we have tested. This is, in brief, the principle upon which Pet- tenkofer's test for C0 2 depends. Give names and formulas of the salts of iron commonly used in medicine. Ferric chlorid, Fe 2 Cl e ; ferric iodid, Fe 2 I 6 ; ferric sulfate, Fe 2 3S0 4 ; ferric acetate, Fe,6C 2 H 3 2 ; ferric oxid, Fe 2 3 ;* fer- rous sulfate, FeS0 4 ; ferrous carbonate, FeC0 3 , etc. Mention two salts of mercury commonly used in medi= cine. Give their formulas. Mercuric chlorid, HgCl 2 . Mercurous chlorid, Hg 2 Cl 2 . What conditions favor putrefaction? What conditions may prevent putrefaction in dead organisms? Presence of moisture, warmth, though not a higher temper- ature than 110° F., bacteria, and a body containing nitrogen capable of undergoing putrefaction. Putrefaction may be prevented by the exclusion of bacteria or air containing the same, by exclusion of moisture, by the preservation of low temperatures at or below the freezing-point of water, and by the use of germicides. Give source, character and uses of atropin. Describe the symptoms of poisoning by atropin. Atropin is an alkaloid obtained from belladonna leaves. It is crystalli/.able and soluble in water, has ;i bitter taste, and is highly poisonous. Typical symptoms of its poisonous action are dilatation <»!' pupil of eye, dryness of throat. flushin<_ r of face, talkative delirium; lain- paralysis of centric origin, death from paralysis of respiration. Pulse ai first slow, hard; 252 CHEMISTRY. later soft and dicrotic, rapid. It is used as midriatic and as tonic to increase respiratory and cardiac efficiency. Give the properties of common alum. It is a white efflorescent crystalline body of a sweetish, somewhat metallic, styptic taste. It has heating and mildly caustic effects on mucous surfaces, particularly that variety of alum that has been heated to rapidly free it from its water of crystallization. It is used largely as an astringent and as a mechanical emetic. It is soluble in cold water, and far more soluble in hot water. It is used as a mordant in dyeing. What metallic chemical elements are found in the body in various combinations? Iron, magnesium, calcium, potassium, sodium, lithium, ammonium, hydrogen. . Differentiate hydracids and oxyacids. A hydracid or hydrogen acid is a binary compound com- posed of hydrogen and a non-metallic element, as hydrochloric acid, HC1. An oxyacid is a ternary acid containing hydro- gen, oxygen and a third element usually non-metallic (may be a metal), as sulphuric acid, H 2 S0 4 . Give the chemistry of lithium. Occurs as chlorid in the mineral lepidolite; also occurs in combination as phosphates and carbonates, frequently found in mineral waters. Separated from its compounds, the metal lithium is the lightest of metals, being little more than half the weight of water. It closely resembles potassium and sodium, with which it is grouped as an alkali metal. It de- composes water in the cold, setting hydrogen free. It is strongly electro-positive, is monad in valency, it oxidizes in air or water; it has no commercial use as a metal. What is the principal source of urea in the human economy? Urea is the result of the oxidation of nitrogenized tissues, particularly muscular tissue. Urea represents the final CHEMISTRY. 253 change of proteid foods after they have served their purpose in the economy. Give the formula of ammonium chlorid. Describe the method of preparing ammonium chlorid. Ammonium chlorid, NH 4 C1. It is prepared by saturating ammonium hydrate with hydrochloric acid, and evaporating the result and allowing crystallization to take place. Give the chemical name and properties of (a) cream of tartar, (b) plaster of Paris. (a) Sodium and potassium bi-tartrate, NaKC 4 H 4 O a . It is a crystallizable white salt, soluble in water. (b) Anhydrous calcium sulfate, 3CaS0 4 2H 2 0, or every three molecules of calcium sulfate are combined with two mole- cules of water. Plaster of Paris is a white impalpable pow- der, practically insoluble in water, but when wet it takes sufficient water to revert nearly, but not quite, to its origi- nal state of gypsum, CaS0 4 2H 2 0, and in so doing sets to a firm coherent mass, and through this action is of use for tak- ing impressions or making casts of objects. Give the physical and chemical properties of hydro- chloric acid. How is hydrochloric acid prepared? Hydrochloric acid is a colorless gas, but is best known com- mercially and chemically in the form of a solution of this gas in water. In this form, when pure, it occurs as a colorless liquid, fuming in air, with caustic and corrosive action upon organic tissues. Specific gravity is 1.2. It is a mono-basic hydrogen acid, and in union with bases forms salts called chlorids, which are all, save three, soluble in water. Hydrochloric acid may be prepared by heating m chlorid, as sodium chlorid, with sulfuric acid, and allowing the gas eous IIC1 so produced to pass into and dissolve in water. Describe Fehling's test for sugar in the urine. Fehling's test: Place one drachm of Fehling's solution in a 254 CHEMISTRY. test-tube, heat to boiling, and note that Fehling's solution does not change in color, thus proving its fitness for use ; then add from one to five drops — not more — of the suspected urine and boil, when, should Fehling's solution lose its color, or a precipitation varying in color from yelloAV to dark red appear, glucose is present in the urine. The urine must be freed from albumin, should it be present, before performing Fehling's test. Complete the following reactions: PC1 3 + 3H 2 = 2NaCl + MgS0 4 =. PCI3 + 3H 2 = H3PO3 + 3HC1. 2NaCl + MgS0 4 = MgCl 2 + Na 2 S0 4 . How are the phosphates produced in the animal body? The phosphates often exist ready formed in plant foods, as in wheat. They are also found in animal structures that afford food for the human subject. Phosphates occurring naturally in soils are absorbed by the rootlets of plants and pass at once to the fruit or grain or seed. Should phosphorus in other forms find entrance into the human subject it would quickly undergo oxidation, the newly- formed oxid would become hydrated, and a combination through chemical double decomposition would at once produce a salt or phosphate from phosphoric acid. Give the symbol, atomic weight and the occurrence in nature of bismuth. Symbol, Bi. Atomic weight, 208.9. Occurrence chiefly in the metallic state, disseminated in veins through various rocks. It also occurs in minerals as a sulfid, and it is often found in rocks which contain arsenical minerals. Give the formulas of the nitrogen acids. How is nitro= gen prepared in the labratory? Nitrous acid, HN0 2 . Nitric acid, HN0 3 . Nitrogen is prepared by burning phosphorus in a confined CHEMISTRY. 255 space of air, when the oxygen chemically combines with the phosphorus to form phosphoric and phosphorous anhydrids, both of which solidifying, fall to the bottom of the jar, and should there be water present, dissolve and enter into combination with the water, thus leaving the jar with nothing but nitrogen present. Give chemical name of (a) common table salt, (b) soot, (c) vinegar, (d) verdigris. (a) Sodium chlorid. (b) Carbon, (c) Dilute acetic acid, (d) Basic cupric acetate. What reaction of urine favors the deposition of uric acid gravel or calculi? What is the reaction of the urine during the formation of a phosphatic calculus? (a) A strongly acid reaction, (b) An alkaline reaction. What is nitroglycerin? Give the medical properties of nitroglycerin. Nitroglycerin is glycerin in which three hydrogen atoms in each molecule have been replaced by three N0 2 radicals. It is obtained through the action upon glycerin of a mix- ture of strong nitric and sulfuric acids. Its formula is C,H B (N0 2 ) 8 8 . It is used medicinally in a one per cent, alcoholic solution, acting as a strong, immediately acting cardiac stimulant. What is (a) starch, (b) dextrin? (a) Starch, C H 10 O 5 , is a white organic carbohydrate, in- soluble in cold water, forming a colloidal mucilaginous mass in hot water. Gives a blue-black color with iodin. Polar- izes light to the left. (b) Dextrin, has the same molecular formula, and may be obtained by heating the starch. It is soluble in cold water, has a somewhat sweetish taste, turns light to the right, and is a midway point, in the conversion of starch into glucose. 256 CHEMISTRY. Define proteid. Give some of the physical character- istics of proteids. A proteid is an organic food principle containing C, H, 0, N, with perhaps sulfur or phosphorus. It is found in the albuminous compounds occurring in both animals and plants. It is colloidal and insoluble. It gives an orange-red color when boiled with nitroso-nitric acid. Gives a red color on contact with sugar and sulfuric acid. Describe and state the uses of the thermometer, the barometer and the hygrometer. A thermometer is a capillary tube containing mercury, and nothing else. It is hermetically sealed ; has a bulb at the lower end and a graduated stem above. It is used to determine the degree of the intensity of heat. A barometer is a glass tube closed at the upper end, the lower end immersed in a vessel or cup of mercury. The tube above the level of the mercury has been made free of air ; the mercury extends from the cup below to a height of 30 inches up the tube. The barometer is used to indicate the condition of the air, to foretell storms; as the air becomes dry the column of mercury rises in the tube to 30 inches in height or a fraction above, while upon the occurrence of storm, water vapor in the air, prevents the air from supporting a column of mercury at this height, so the mercurial column falls. A hygrometer is an instrument used to measure indirectly the amount of moisture in the atmosphere and to determine the dew point of any specimen of air. It consists of two thermometers, the bulb of one being kept constantly wetted to promote evaporation, the thermometer so treated being known as the wet bulb thermometer, and is used to indicate the temperature of the dew point. Explain the method of producing X or Roentgen rays. The X or Roentgen rays are produced by passing a current of electricity of high potential, as from an induction coil, through a glass tube that has been, as far as possible, ex- hausted of air. CHEMISTRY. 257 (a) Express in cubic centimeters of distilled water the value of one ounce avoirdupois, (b) How many minims does a cubic centimetre contain? (a) About 30 cubic centimetres. (b) About I514 minims. What is hydrogen sulfid? Show by formulas and equa- tion how it is obtained by the action of hydrochloric acid on calcium sulfid. It is a colorless gas of highly offensive odor and poisonous effects. It burns in air with a blue flame to form sulfur dioxid and water. It is slightly heavier than air, and is solu- ble in water. CaS + 2HC1 = CaCl, + H 2 S. What salts form the tartar deposited on the teeth? From what source is the tartar derived? Calcium phosphate, calcium carbonate, bacteria, organic matter, salts of the alkalies, and silica. The tartar comes from an alkaline saliva. What are the properties of antimony? How is it found in nature? Antimony is a white, highly crystalline metal with a slight bluish tint. It volatilizes when heated, forming Sb 2 8 when burned in air. When powdered it takes fire if dropped in chlorin gas, forming a chlorid of antimony. In alloys it increases hard- . lowers fusion point, gives smoother surface, causes ex- pansion of alloy when cooled after fusion, gives rigidity to metals. It is found native; it is also found in connection with certain metallic and copper; it sometimes s as sulfid of antimony. (a) What is an amorphous substance? (b) What are isomorphous substances? (a) A dry substance, not occurring in crystalline form. 17 258 CHEMISTRY. (b) Such as although being of the same percentage compo- sition of elements yet show entirely different properties. Give uses of the urinometer. State its importance as an aid to diagnosis. It is used to determine the specific gravity of the urine. It is useful in indicating the necessity, or otherwise, for per- forming further and more exact tests upon the urine under examination. Should the urine vary in its specific gravity below 1015 or above 1025, it would at once indicate the abso- lute necessity for examining such urine to determine the presence or absence of albumin in the first place and glucose in the second place. Its record of a high specific gravity in the absence of the glucose gives many indications for the prescribing of diet and regimen in cases of disease. Describe potassium. Give the names of the principal salts of potassium used in medicine. It is a silver- white metal, nearly as soft as wax, decomposing water in the cold with liberation of hydrogen gas. It oxidizes in air and in moisture. When heated to incandescence it produces a rose-red, slightly bluish color. The color of its vapor is green; it melts below boiling point of water; it is lighter than water ; it is one of the strongest of electro-positive elements. It is a metal, and is of monad valency. It com- bines with the non-metallic elements. Its salts useful in medicine include the acetate, citrate, nitrate, chlorate, chlo- rid, bromid, iodid, hydrate, sulfate, and carbonate of potas- sium. Write a chemical equation showing a double decompo= sition. AgN0 3 + HC1 = AgCl + HN0 3 . Give the physical and chemical properties of mercury. How is mercury obtained from the native ore? Mercury is a silver-white liquid metal lSy 2 times heavier than water; it is volatile at all temperatures, opaque, insolu- ble in water, soluble in nitric acid. Chemically, it is electro- CHEMISTRY. 259 positive, and capable of forming two distinct classes of com- pounds ; in one of these classes it is thought the molecule of mercury combines with other elements or radicals in a diad capacity. Such combinations are but slightly poisonous to the human subject. Another series of compounds represent the atom of mer- cury combining as a diad with other elements or radicals and forming highly poisonous, very active and unstable com- pounds. Mercury is obtained from its principal ore, cinnabar, by heating the ore and cooling the resulting vapor of mercury and allowing of its deposition in earthenware receivers. Define decay. Decay refers, generally, to slow oxidation, causing the decomposition or organic substances. The results of de- cay favor the union of each element in the substance with oxygen. Describe distillation, filtration and precipitation as ap- plied to processes for purifying drinking water. It is impossible to distil water for very many individuals, so that this process of purifying is inadmissible for city or town. It, however, affords one of the best means at the householder's command for purifying water. After distilling the water, to fit it for use, it should be aerated by having it fall in cascade, in the air, from one vessel to a second one several feet below. In filtration the impure water passes through a collection of stone, gravel and fine sand, and not only are the suspends! matters removed from such water, but through the action of bacteria many organic substances dissolved in the water are oxidized and rendered harmless, this action occurring through the influence of bacteria settled upon and growing in the filtering medium. In precipitation, as applied to purifying water, the simplest method is to add alum in oo1 larger quan- tity than six grains to the gallon of water. The action here is a chemical one, the alum forming a bulky 260 CHEMISTRY. hydrate with organic matter present, and this hydrate en- tangling and carrying down suspended matters, so leaving the water clear. What is freezing? State the Fahrenheit freezing point of (a) water, (b) alcohol, (c) mercury. Freezing or congealing is the name given to the change of a liquid to a solid upon the lowering of temperature. In this act the molecules are packed closer together, limiting their freedom of movement. Freezing point of water, 32 degrees Fahr. Freezing point of mercury, — 39.4 degrees Fahr. Freezing point of alcohol, — 202 degrees Fahr. (absolute). Complete the following equation: C 2 H 5 OH + NaCjHjO, + H 2 S0 4 = C 2 H 5 OH + NaC 2 H 3 2 + H,S0 4 = C 2 H 5 C 2 H 3 2 + NaHSO, + H 2 Explain the difference between a sulfate and a sulfite. A sulfate is a salt, each molecule of which contains the acidulous radical S0 4 . A sulfite is a salt, each molecule of which contains the acidulous radical S0 3 . It will therefore be seen that a sulfate differs from a sulfite in containing one more atom of oxygen in each molecule. Name the elements in the potassium group, and give their physical and chemical properties. Sodium, potassium, lithium, caesium, rubidium, also the electro-positive radical ammonium. Excepting ammonium, they are all white metals, the softest being but little harder than wax. They melt below the boiling point of water, oxidize in air, decompose water, liberating hydrogen. All are strongly electro-positive, forming strong alkaline bases — oxids and hydrates. Each communicates a distinctive color to flame when incandescent. All are of monad valency, their carbonates all vaporizing unchanged when heated. Carbonates and phosphates of these metals are freely soluble in water. CHEMISTRY. 261 Describe the element silver, stating its compounds and their uses in medicine. Silver, a pure white metal, the best conductor of heat and electricity. It is the second metal in order of malleability. In tenacity it occupies fourth rank. Specific gravity 10.4. Ductility second rank. It melts at 1040 Cent., or 1904 Fahr. Its atomic weight is 107.7. It is used as pure silver wire in surgery. Silver nitrate, AgN0 3 , when pure and crystallized is used internally as an astringent and alterative. In solution it is locally applied as a stimulant or caustic. The impure silver nitrate is melted and moulded in sticks then known as lunar caustic ; has large use in surgery. Oxid of silver, Ag 2 0, is used in pill form, internally, as an alter- ative and astringent. Name five compounds of nitrogen and oxygen, and give their formulas. Nitrous oxid, N 2 ; nitric oxid, NO; nitrous anhydrid, N 2 3 ; and nitric anhydrid, N 2 5 ; nitric peroxid, N0 2 . What is the presumption as to abnormal constituents in urine having a specific gravity of 1005 or less? What tests should be applied, and how, to verify the surmise? It indicates a greatly decreased excretion of solids by the kidneys ; this may be due to lack of nervous control over excretory function of kidney, as in hysteria, chorea, at crisis of acute diseases, etc. It may be a polyuria, arising from certain nervous diseases or from large imbibition of fluids or watery foods. It may be due to such diseased conditions of kidney that have led to destructive changes in structure, rendering the kidneys un- able to properly excrete solids that should be present in urine. Such a low specific gravity always calls for a careful examination for albumin, which, if found present, would indi- B structural disease of the kidneys, if accompanied by urinary casts, as seen under the microscope. Tests for albu- min have been given. 262 CHEMISTRY. What are the differences between common alcohol and absolute alcohol? Absolute alcohol Common alcohol Not more than 1 per cent, water. About 9 per cent, water. Specific gravity .797. Specific gravity .820. Complete the following equations: C 2 H 5 C1 -f AgHO = CaC0 3 + 2HCl=. C 2 H 5 C1 + AgHO = AgCl + C 2 H 5 OH. CaC0 3 + 2HC1 = CaCl 2 + H 2 + C0 2 . What are the physical and chemical properties of SO,? It is a colorless gas, dissolving and chemically combining with water to form sulfurous acid. It has a suffocating, irrespirable odor, can be liquefied and solidified ; when lique- fied it produces on its evaporation very low temperatures in surrounding objects. S0 2 has a molecular weight of 64, and is more than twice the weight of air. It will not support combustion nor will it burn. It has a powerful affinity for moisture, to form by its union sulfurous acid, and this acid, slowly absorbing oxygen from air, changes to sulfuric acid. Sulfur dioxid is useful as a bleaching agent, as a disinfectant, and for the purpose of destroying ferments or limiting fer- mentation. It is a strongly acid anhydrid. What is reduced iron (ferrum redactum), and how is it obtained? It is a chemically pure form of iron occurring in fine pow- dery condition. It is obtained by heating ferric oxid to red- ness in a hard glass tube, and, while hot, passing through the tube dry hydrogen gas, which combines with and removes the oxygen, leaving reduced iron in the tube. Describe ethyl oxid, giving derivation, ordinary name, chemical formula and mode of production. Ethyl oxid or ordinary sulfuric ether, or ether, (C 2 H 5 ) 2 0, is obtained by the replacement of two hydrogen atoms in a CHEMISTRY. 263 molecule of water by two ethyl radicals. It is manufactured by distilling a mixture of grain alcohol and sulfuric acid. C 2 H 5 OH -f H 2 S0 4 = C 2 H 5 HS0 4 + H 2 ; Then C 2 H 5 HS0 4 + C 2 H 5 OH =(C 2 H 6 ) 2 + H 2 S0 4 . What is the presumption as to abnormal constituents in urine having a specific gravity of 1038? Such urine will probably be found to contain glucose. Give an equation showing the reaction when NH 3 comes in contact with an acid. NH 3 + HC1 = NH 4 C1. What is the chemical treatment of esophageal and stom- ach corrosion from mineral acids? Give an argument against the use of the stomach=pump in such cases. Use oxid of magnesium. Then albumin or oils. In such cases the tissues have been so thinned out through corrosion that an implement introduced, as a tube from a stomach pump, may cause perforation of the denuded tissues with fatal results. Define emulsion, soap. An emulsion is a liquid holding in suspension oil in very finely divided condition, so that the individual drops are invisible to the naked eye. There is generally present a sub- stance of mucilaginous nature to attain this result. A soap is a metallic salt of a fat acid. It is usually a potassium or sodium salt of oleic, stearic or margaric acid. Give the sources and explain the uses of benzene. C C II , benzene. It is found in the lighter oils from the distillation of coal tar. It is a solvent for fats, oils, resins, and many other organic substances. It is used as a cleansing agent and solvent. What is an alkaloid? Name three alkaloids used in medicine. An organic base which always contains nitrogen, posses- 264 CHEMISTRY. sing, of course, an alkaline reaction when in solution. It is generally of a crystallizable nature, and forms salts with, acids. The alkaloids of vegetable drugs generally possess the activity of the drug substance. Strychnin from nux vomica, quinin from cinchona bark, and morphin from opium (dried juice of the poppy) are alkaloids of frequent use in medicines. State the chemical meaning of the term incompatible. Chemically, substances are incompatible when on mixing their solutions an insoluble body results, or a new substance having markedly different properties results, or when two or more substances, in themselves harmless, form a poisonous, explosive or inflammable substance when brought in contact; or bodies are incompatible if bringing them together impairs their individual characteristic properties. State the use and the principle underlying the use of the blow=pipe. The blow-pipe serves to provide a jet of flame of extremely high temperature, and of complete combustion, through the mixing of air with gas before the latter burns. The blow-pipe serves to concentrate at a particular point very high temperature. Define electricity. Electricity is that physical force which manifests itself by producing attraction or repulsion between certain substances, and gives rise to heat, light, magnetism, chemical action and explosive or disruptive effects. (a) In what compound is sodium most abundant? (b) In what calcium? (c) In what hydrogen? (a) Sodium chlorid. (b) Calcium carbonate, (c) "Water. What is glycerin, and how is it obtained? Glycerin, C 3 H 8 3 or C 3 H 5 30H. It is a tri-atomic alcohol of the third series of hydrocarbons, of which the first member is C 3 H 8 , or propane. When three hydrogen atoms of propane are replaced by three hydroxyl radicals, glycerin results. CHEMISTRY. 265 Glycerin may be obtained by passing superheated steam through fats, which brings about a separation of the fat into glycerin and a fat acid. Glycerin also results in soap-making. Explain the difference between a galvanic and a faradic current. A galvanic current results from chemical action, and has but low potential with large quantity. Its direction of flow is always the same. A faradic current results from induction of a current into a coil of insulated wire that surrounds a shorter coil of larger wire, through which a galvanic current alternately flows, or is cut off from flowing. Such a faradic current possesses high potential, small quantity, and its direction of flow is to and fro, or alternating. What products of phenol are of interest in medicine? From phenol (carbolic acid, C G II n OH) we have coal tar creosote, the sulpho-carbolates, as of sodium, zinc, etc. Phenol-sulphonic acid, salol. Designate the following as chemical or physical changes: (a) The souring of milk. (b) Decomposition of sunlight by means of prisms. (c) Converting water into steam. (d) Dissolving salt in water. (e) Decay of wood. (a) Chemical; (b) physical; (c) physical; (d) physical; (e) chemical. Mention the chief properties of nitrogen. In its molecular form nitrogen is a very inert substance. Its properties are negative ones; thus it will not burn, will not support combustion, has no color, odor or taste. It is slightly lighter than air. Symbol, N. Atomic weight, 14. It will unite directly with heated magnesium. It may enter into chemical union under favoring conditions with hydrogen, with oxygen, and with a few otiher of the non-metals. When nitrogen is in combination with other elements its 266 CHEMISTRY. atom gives great activity to the compounds. Thus it forms with hydrogen a very strong alkaline gas ; with C, H and 0, nitrogen gives rise to extremely poisonous bodies — the alka- loids — to highly explosive bodies, as gun cotton; to food ele- ments of great nutritive value, the proteids, etc. What metal is liquid at ordinary temperature? Mercury. Mention a substance containing albumin, (a) as a liquid, (b) as a solid. (a) Milk, (b) Flour. What is the chemical cause of spontaneous combustion? May be active oxidation, as would occur were finely divided phosphorus exposed to air (oxygen). May be from direct chemical union of an intense activity, as would take place were phosphorus brought in contact with iodin or bromin. It may be due to dehydration of substances, as by the action of strong sulfuric acid on wood or paper, or through the action of quicklime combining with moisture. Describe a test for the presence of organic matter in water. Having distilled water until free from ammonia, we add to the residue in the retort an acid solution of permanganate of potassium, when if, on again distilling, ammonia appears in the distillate, it would indicate the presence of organic matter in the water that had undergone conversion into ammonia through the action of the permanganate solution. This ammonia in the distillate may be recognized by the use of Nessler 's solution. Give the names and formulas of five acids used in medi- cine. Nitric acid, HN0 3 ; sulfuric acid, H 2 S0 4 ; muriatic acid, HC1; ortho-phosphoric acid, H 3 P0 4 ; acetic acid, HC 2 H 3 2 . CHEMISTRY. 267 Mention the elements existing uncombined in nature. Hydrogen, oxygen, nitrogen, carbon, sulfur, gold, silver, platinum, copper, mercury, and a few other metals. What is carbon dioxid? Give its formula, properties, uses and mode of production. It is a gas -without color, odor or taste, being about one and a half times the weight of air. It does not support combus- tion nor animal respiration. It will not burn, it is soluble in water. It may be liquefied and solidified. The liquid allowed to evaporate occasions very low temperatures in sur- rounding objects. Its formula is C0 2 . It is often held in water under pressure, and on the pressure being relieved the carbon dioxid gas escapes through the liquid, producing bub- bling (effervescence). We find this to constitute the ordinary soda water. Dis- solved in water, carbon dioxid adds piquancy to the taste of water, and it exerts a sedative effect upon an irritated or inflamed mucous lining of the stomach. Its presence in water increases the solvent power of water. It can be prepared through the action of an acid, as sulfuric acid, upon a carbonate, as marble dust. CaC0 3 + H 2 S0 4 = CaS0 4 + H 2 + C0 2 . When and why is a flame produced by combustion? When in the gas we have present solid matter in a finely divided form. The heat of the flame rendering this solid matter incan- descent, gives rise to flame. Give the preparation of Fowler's solution, and describe the salts contained in it. Dissolve one part arsenious anhydrid and two parts potas- sium bi-carbonate in 94 parts water and add three parts compound tincture of lavender. The solution so made contains potassium met-arsenite. As 2 8 + 2KHCO, = 2KAs0 2 + H 2 + 2C0 2 . (Simon.) 268 CHEMISTRY. What is chloroform, and how is it made? It is the tri-chlorid of methane, CHC1 3 . It is a colorless liquid, specific gravity of 1.5 ; it has a char- acteristic aromatic odor and a sweet burning taste. It is capable of producing general anesthesia when inhaled. It is a valuable solvent for a number of substances, as alkaloids, rubber, etc. It is made by distilling the bleaching salt of lime with alcohol and purifying the result. Describe and illustrate alcoholic fermentation. Alcoholic fermentation is the decomposition of sugary liquids brought about through the presence of a ferment, the yeast plant, and attended by the change of glucose into alcohol and carbonic oxid gas. C 6 H 12 6 = 2C0 2 + 2C 2 H 5 OH. What is ethyl hydrate? Give its formula, and state how it is produced. Ethyl hydrate, C 2 H 5 OH, is ordinary grain alcohol. It results from fermentation of sugary liquids, and is separated from water and other matters by subsequent distillation. Complete the following equations: 2NaCl + Ag 2 S0 4 = Ba0 2 + C0 2 + H 2 = 2NaCl + Ag 2 S0 4 = 2AgCl + Na 2 S0 4 Argentic chlorid -\- Sodic sulphate. Ba0 2 + C0 2 + H 2 = BaC0 3 + H 2 2 Baric , Hydric carbonate ' peroxid. Define matter. Matter refers to anything that has weight and occupies space. Define and illustrate osmose. Osmose refers to the intermingling or mixing of liquids of different densities when separated by porous partitions; thus if a cupric sulfate solution be placed in a jar of porous CHEMISTRY. 269 earthenware, and this jar be set in a larger vessel containing distilled water, we would soon find sulfate of copper present in the outer jar that contained water, while the jar contain- ing sulfate of copper would be weakened through the passing inward from the outer vessel of distilled water. Give an illustration of decomposition by (a) heat, (b) electricity, (c) light. (a) Heat mercuric oxid, and we have it decomposed into the gas oxygen and the metal mercury. (b) Pass galvanic current through water, when it will undergo decomposition, and hydrogen and oxygen gases will be set free. (c) Expose argentic chlorid to the action of sunlight, when it undergoes decomposition, producing a sub-chlorid of silver, and changing in color from white to black. What is a compound radical? Give three examples of compound radicals, indicating the valence of each. A compound radical is a chemical combination of two or more atoms, and is capable of playing the part of an elemen- tary substance ; or a compound radical is an unsatisfied group of atoms. Examples : N0 3 , valence 1 ; S0 4 , valence 2 ; P0 4 , valence 3. Describe the medicinal uses of oxygen, stating how it is brought to the bedside and how it is applied. Oxygen gas subjected to pressure is liquefied and stored in cast steel cylinders, which though of relatively small size and easily transported will yield 40 gallons of the iras. These cylinders have adapted bo them a peculiar valve that admits id' the escape of but a minute quantity of the liquid oxygen, favoring its immediate change to the gaseous state. The •mis oxygen is conducted into a rubber bag, and from the bag through a, wash bottle containing a small quantity of water, and the putient then inhales tin 1 gas from a proper tnouth or nose piece. In the use of oxygen we secure its flow by allowing the bag to till with the gas and then compressing 270 CHEMISTRY. the bag. Oxygen is indicated wherever during disease respi- ration is embarrassed, as during the progress of pneumonia, asthma, etc. Oxygen is frequently used for its general stimulant effect. State the composition, mode of preparation and proper- ties of sal ammoniac. Sal ammoniac, ammonium chlorid, NH 4 C1, is composed of one equivalent of the radical NH 4 and one equivalent of chlorin prepared by saturating hydrochloric acid with ammo- nia. It is a white crystalline soluble substance. It has a saline, taste and neutral properties. It yields ammonia gas when heated with strong bases. It is used in medicine as an alterative and as a stimulating expectorant. What are the distinguishing characteristics of urates and of uric acid, as deposited in the urine? Uric acid and urates, as found in urine, are of yellow to red color; they form the "brick-dust" sediment. AA T e find them appearing as the urine cools, and they at once dissolve on heating the urine. Under the microscope urates are S0 2 or k_ _^ 0H (b)^ N -OHor]\J=0 H r \ n ~ 0H CHEMISTRY. 291 Describe the relations of oxygen to combustion and to life. Oxygen is the great, universal supporter of combustion, entering into chemical union with all well known elements (except fluorin) often with sufficient energy to produce heat and light, occasioning active combustion. Since life is only maintained through a constant oxidation of existing tissues, (a form of slow combustion with slight evolution of heat) and the replacement of these oxidized and decomposed structures by new materials, oxygen is absolutely necessary to life. What mineral acids are incompatible with mercurous chlorid? Give synonyms of mercurous chlorid. Mercurous chlorid, Hg 2 Cl, or 2HgCl, called calomel, mild chlorid of mercury, proto-chlorid of mercury. This substance is incompatible with sulphurous acid, hydro- chloric acid, and, in general, with* all strong mineral acids. Describe the appearance of urine containing bile. Such urine varies in color from reddish-brown to a brown- ish-black (porter-colored), its froth, yellow in tint, is not evanescent, and this urine produces yellow stains on white fabrics. Define decomposition, putrefaction. Decomposition refers to the breaking up of a complex or compound substance into simpler substances. Putrefaction is the decomposition of a nitrogenized organic substance into simpler bodies, among which ammonia, or some of its compounds, will be included. Putrefaction is occasioned through the presence of bacteria. Give the general definition of an ether. An ether is the oxide of a hydrocarbon radical. An ether is a water in which both hydrogen atoms of a water molecule have been replaced by alcohol radicals. 292 CHEMISTRY. Give a test for the detection of hydrocyanic acid in solution. Silver nitrate solution, when added to hydrocyanic acid solution, produces a curdy white precipitate of silver cyanide, soluble in ammonium hydrate, and in strong boiling nitric acid, and not turning black on exposure to light. Complete the following equations: CH 3 Cl + HCl + Zn = 2FeCl 3 + H 2 S = CH3CI + HC1 + Zn = CH 4 + ZnCl 2 . 2FeCl 3 + H 2 S = 2FeCl 2 + 2HC1 + S. Give the symbol, valence and a principal compound of each of ten elements. Hydrogen, symbol H, valence I, water, H 2 0. Oxygen, symbol 0, valence II, nitrous oxid, N 2 0. Nitrogen, symbol N, valence I, III, V, ammonia, NH 3 . Iodin, symbol I, valence I, potassium iodid, KI. Sulphur, symbol S, valence II, IV, VI, hydrogen snl- phid, H 2 S. Bromin, symbol Br, valence I, sodium bromid, NaBr. Iron, symbol Fe, valence II, IV (Fe 2 IV, VI) ferrous sul- phate, FeS0 4 . Calcium, symbol Ca, valence II, calcium hydrate, Ca2(0H). Magnesium, symbol Mg, valence II, magnesium carbon- ate, MgCOj. Silicon, symbol Si, valence IV, silicic oxid, Si0 2 . State the normal reaction of synovial fluid. Alkaline. Describe the microscopic appearance of (a) uric acid, (b) triple phosphates. (a) Yellow to orange-red in color, rhombic prisms or modi- fied forms, often grouped in star-shaped, or fan-shaped clus- ters, rough and sharply pointed at angles. (b) White, triangular prisms, coffin-shaped ; or in star- shaped, feathery crystals with points like fern leaves. CHEMISTRY. 293 Give a typical example and state the principal ingre- dients of each of the following mineral waters: Saline cathartic, alkaline, sulphurous. Saline cathartic water may be represented by Carlsbad mineral water containing sulphates of sodium and potassium, and carbonates of sodium, calcium and iron. An alkaline mineral water as Buffalo lithia water contains carbonates of lithium, calcium, sodium and potassium,- and usually an excess of C0 2 although not in sufficient amount to produce effervescence. A sulphurous water, as that of red sulphur spring of Vir- ginia, usually contains hydrogen sulphide, or an alkaline poly-sulphide. Give the characteristics of (a) nephritic urine, (b) cys- titic urine. (a) Nephritic urine is usually pale in color, clear, of low specific gravity, its froth is not evanescent, it contains a dimin- ished proportion of normal solids in solution, particularly phosphates and urea, and contains albumin, while the micro- scope shows the presence of casts of urinifcrous tubules and cells and detritis from the urinary tract; its reaction is usually faintly acid. (b) Cystitic urine is alkaline in reaction, strongly ammonia- cal in odor, or perhaps fetid, always contains pus, may be stringy or gelatinous from mucus, ammonio-magnesium phos- phate crystals are present, blood may be present, bacteria in large numbers abound, cells from bladder are found, usually exhibits considerable sediment. Express the following in apothecaries' weight and measure: Ammonii carb 5 grams Syr. aorantii fiO c. c. A.qtue distil, ad 1-0 c. c. \mmonii carb. grs. Lxxvij Syr. aurantii z, ij Aquir destil. ad .^ iv 294 CHEMISTRY. Complete the following equations: C 2 H 5 N0 3 -f KOH = CaC0 3 + 2HC1 = C 2 H 5 N0 3 + KOH = C 2 H 5 OH -f KN0 3 . CaC0 3 + 2HC1 = CaCl 2 + H 2 + C0 2 . Give the general characteristics of bismuth. Bismuth, Bi, atomic weight 207.5, valency III and V, specific gravity 9.8, melts 507° F., brittle, color white with reddish tint, crystalline, occurs native, poor (very) in con- ductivity for heat and electricity, expands on solidifying from fusion, most strongly diamagnetic, unaffected in air when cold, volatilizes, and oxidizes on heating, preferable solvent, nitric acid. Define and illustrate monatomic element, neutral salt. A monatomic element, like mercury, is one whose molecule contains but one atom, and whose molecular weight would correspond to the atomic weight. If one quart of H. and one quart of CI. unite they produce two quarts of HC1 gas because their molecules each contain two atoms (they are diatomic), but if H and CI were mona- tomic such quantities, one quart of each, combining would produce but one quart of HC1 gas. A neutral salt is one whose watery solutions do not change litmus color; usually a neutral salt is a normal salt formed through the complete replacement of all replacable hydrogen atoms of an acid by metal or basic atoms or radicals. Indicate the sources of the following acids: Lactic, butyric. Lactic acid is developed in souring milk, and decomposing meat. Butyric acid occurs in rancid butter, and cheese. Mention a diatomic element and give its chemical prop= erties. Oxygen, symbol 0, atomic weight 16, electro-negative, sup- CHEMISTRY. 295 porter of combustion, combines with all well-known elements except fluorin, diad in valency. Give an explanation of the formation of ammonia in the urine. Its presence is traceable to use of foods containing an excess of mineral, or organic, acids that are not destroyed in the body; or to conditions, as in diabetes, leading to an increased formation of acid in the body. Ammonia, in these conditions is formed in the liver to neutralize and form salts with the excess of acid, and ammoniacal salts decompose with an alkaline urine. Many morbid processes, as cystitis, occasion a decomposition of urea into ammonium carbonate and this, in an alkaline urine, frees ammonia. Complete the following equations: 2FeCl 2 + 2HC1 + = 2Na 2 H~P0 4 + 3CaCl 2 = 2FeCl 2 + 2HC1 + = Fe 2 Cl -f H 2 0. 2Na 2 IIPO, + 3CaCl 2 = Ca 3 2P0 4 + 4NaCl + 2HC1. Give the formula and properties of (a) chlorate of potas- sium, (b) ammonia gas, (c) tartaric acid. (a) Chlorate of potassium, KC10 3 , white crystalline solid, soluble in 16.7 parts of cold water and 1.7 parts boiling water. A strong oxidizing agent, decomposible by heat into oxygen and chlorid of potassium, forms explosive mixtures when in contact with strong acids or organic matter. It is a mild as- tringent and antiseptic. (b) Ammonia gas, NH 3 , is a strongly basic, diffusible, irre- spirable gas, extremely light, and very soluble in water, it is colorless, alkaline and caustic in taste and effect. (c) Tartaric acid, II 2 C 4 II 4 O c , found in vegetables and fruits : in its pure form occurs as colorless, transparent prisms, strongly acid and readily soluble in water and acids; crystals melt at 135° C. It forms salts, of which Rochelle salt, K\aC 4 II 4 O ; cream tartar, KHC 4 H 4 9 ; tartar emetic, KSbOC 4 H 4 O fl are medicinally useful. 296 CHEMISTRY. How is anilin obtained? State how anilin dyes are manufactured from anilin. Anilin, C 6 H 5 NH 2 is obtained through the action of hydrogen upon nitro-benzene. Anilin dyes are made by oxidizing mixtures of anilin and toluidin with nitric or chromic acids or other oxidizing agents. Mention two reactions by which hydrocyanic acid is formed. Give the properties of hydrocyanic acid. Add hydrochloric acid to potassium cyanid and obtain potassium chlorid and hydrocyanic acid. Add hydrochloric acid to silver cyanid and obtain silver chlorid and hydro- cyanic acid. Hydrocyanic acid is a volatile liquid, colorless, has odor of bitter almonds, very unstable, in gaseous form it burns with pink flame, it is extremely poisonous and is employed in medi- cine in a 2% water solution, the dose in this diluted form being but a drop or two. Give the symptoms and diagnostic features of oxalic acid poisoning. With what commonly used salt is oxalic acid likely to be confused? Symptoms: a hot, burning, sour taste, burning sensation extending to stomach, great burning pain in stomach and ab- domen causing drawing up of legs to obtain relief, entire pros- tration of strength, slight stupor and indifference to surround- ings, convulsions, pulse small and irregular, numbness of extremities, irregular, spasmodic breathing, death. Oxalic acid has been taken in mistake for Epsom salt. What are aldehydes? Mention the properties and prin- cipal derivatives of aldehydes. Aldehydes are alcohols which, through oxidation have lost two hydrogen atoms from each molecule. Aldehydes combine directly with ammonia, hydrocyanic acid, alkaline sulphites, etc. They are strong reducing agents, they undergo spontaneously certain modifications, their oxi- CHEMISTRY. 297 dation produces fatty acids, their reduction gives rise to alcohols. As derivatives of aldehydes we have chloral hydrate, chloroform, etc. How are soaps made? What constitutes (a) hard soap, (b) soft soap, (c) castile soap? By heating a strong base, as NaOH with fat, and then add- ing common salt to facilitate the separation of the forming soap from the liquid (glycerin). (a) A hard soap is a sodium salt of a fat acid. (b) A soft soap is a potassium salt of a fat acid. (c) Castile soap is a mixture of oleate, palmitate and stearate of sodium obtained from the employment of olive oil in its making. Complete the following equation: K 2 Cr 2 7 + 4H,S0 4 = K 2 Cr 2 7 + 4H 2 S0 4 = Cr 2 3S0 4 + K 2 S0 4 + 4H 2 + 0,. What is an ion? Give an example of ionization. The results of the decomposition of compounds, that take place in dilute physical solutions of salts, or that are brought about through electric energy are called ions. If a minute quantity of sodium chlorid be dissolved in a large quantity of water, each drop of such solution will not contain mole- cules of NaCl but separate ions of sodium and ions of chlorin. What simple tests should be employed to determine whether or not a suspected water contains albuminoid matters sufficient to make its use unhealthful? Add to the water a drop or two of dilute sulphuric acid and enough permanganate of potassium to occasion a faint pink color, cover the vessel with a glass plate and if the pink color still persists after the lapse of fifteen minutes the water is not greatly impure from organic matter. Shake a stoppered flask when half full of the suspected water; then smell; if no odor is discernible, warm flask and 298 CHEMISTRY. contents for fifteen minutes at a temperature not higher than 110° F. and again shaking vigorously unstopper the flask and smell, when should no odor be noticed the water probably is free of any material quantity of dissolved organic matter. Mention the principal uses of the following elements and their compounds: (a) Fluorin, (b) chromium, (c) sili= con, (d) selenium. (a) Fluorin forms ozone when passed into water. Hydro- fluoric acid is used as a solvent for glass; calcium fluorid is employed as a flux. (b) Chromium no use, its oxids are fused with iron oxid and carbon to form a steel : some of its salts, as lead chromate are used as pigments, dichromate of potassium, or sodium, is a constituent of electropion, the oxids and acids of chromium are oxidizing agents. (c) Silicon in the form of its oxid Si0 2 is used in making glass and glass-like substances, hydro-fluo-silicic acid is a chemical reagent, Si0 2 is also used for polishing, filtration, etc. (d) Selenium is used, from its non-conducting property, in some electrical appliances, selenic acid, H 2 Se0 4 will dissolve gold. State the atomic weight, valence and uses of sulfur. Sulfur, S, atomic weight 32, valence II, IV, VI. Is used in making gun powder, matches, as a medicine, is incorporated into rubber, is burned to form S0 2 and in this combination used for disinfection, bleaching and in making sulphuric acid. Complete the following equations: BaCl 2 + Na 2 S0 4 = 3P -f- 5HN0 3 + 2H 2 = BaCl 2 + Na 2 S0 4 = BaS0 4 + 2NaCl. 3P + 5HN0 3 + 2H 2 = 3H 3 P0 4 + 5NO. State the symptoms and diagnostic features of phos= phorus poisoning. Often find symptoms resembling those of acute yellow CHEMISTRY. 299 atrophy of the liver, jaundice, suppression of urine, delirium, uraemia and coma. The breath often has phosphorus odor, may be luminous, the urine, or vomited matter, if boiled in acidulated solution give rise to a vapor that darkens a paper wet with silver nitrate solution. Differentiate arsenic from antimony. In Marsh's test on burning the evolved gas both arsenic and antimony would produce brown-black stain on piece of cold porcelain held in the flame but the stain due to arsenic is freely soluble in chlorinated lime solution while the antimonial stain is almost insoluble in this reagent. If arseni- cal and antimonial substances be strongly heated in air, arsenic forms octahedral crystals of As 2 3 which dissolving in water produce green and yellow precipitates respectively with am- monia and copper sulphate and ammonia and silver nitrate solutions; while antimony oxidizing gives needle-like crystals not giving precipitates with the ammoniated sulphate of copper, or nitrate of silver solutions. Give two chemical tests for blood. Add a drop of suspected liquid to a freshly-made tincture of guaiacum, in a test-tube, then on the surface of this liquid an etherial solution of hydrogen di-oxid, when, if the sus- pected liquid contains blood, a blue color band forms where the tincture of guaiacum and the etherial solution of TI.,0 2 meet. The blood of man is injected repeatedly into the peritoneum of a different species of animal (as a rabbit) ; serum is then obtained from this animal, when, if to it human blood be added, a brown flocculent precipitate forms and the red blood corpuscles are disintegrated. Describe the tests for acetone, and for diacetic acid in the urine. Test for Acetone: Dissolve twenty grains of potassic iodid in a drachm of liquor potassae and boil; float the suspected urine on the surface of this solution, and at the juncture of 300 CHEMISTRY. the two liquids a layer of phosphates appear, which will be colored yellow and studded with iodoform crystals if acetone was present in the urine. Test for Di-acetic Acid : To a freshly-passed specimen of urine add a few drops of a ferric chlorid solution; if a pre- cipitate forms, filter, and to the filtrate add a few more drops of the ferric chlorid solution, when, if di-acetic acid were in the urine, a dark red color is produced, which fades on boiling. Describe a test for excess of hydrochloric acid in the gastric contents. To 100 c.c. of filtered gastric contents add a few drops of tropaeolin indicator solution, and then titrate with T ^ alkali solution until the brown color of the solution fades, when, if more than 55 c.c. of the alkali solution were required to neu- tralize the acid, hydrochloric acid existed in excess in the gastric contents. Define albumose; give a test f6r detection. Albumoses are transition compounds formed in the conver- tion of albumin into peptone. Proteo-albumose and hetero-albumose are precipitated by nitric acid when cold; deutero-albumose is precipitated by nitric acid in the cold only in the presence of an excess of salt. Define bilirubin; describe its properties; give test for its presence. Bilirubin, C 1C H 18 N 2 3 , is a reddish-yellow pigment, derived from haematin, slightly soluble in water, more soluble in hot chloroform. Test: Place a few cubic centimeters of a chloroform solu- tion of bilirubin in a test-tube and overlay it with yellow nitric acid, when at the line of union of the liquids a series of color rings form with a green ring nearest the chloroform, and above this, in order, will be found rings of blue, violet, red, and finally, near the acid, yellow color. CHEMISTRY. 301 What substances in the urine, other than glucose, may produce the reaction of the Fehling's test. Uric acid, creatinine, pyrocatechin, alkaptonic acids, allan- toin, glycuronic acid, lactose, pentose, albumin, chloroform, etc. Describe a chemical test that would suggest the pres= ence or absence of gastric carcinoma. A diminution or absence of free hydrochloric acid in the gastric contents as shown by less than 55 c.c. of a f^ alkali solution to occasion neutralization, on titration, of the II CI in 100 c.c. of gastric contents (filtered). Give chemical tests for the various forms of urinary calculi. A calculus which on heating to redness burns entirely away may be of uric acid, urate of ammonium, xanthine, cystine, cholesterine, fibrine, or bile pigment. Heat the calculus with nitric acid, then add ammonium hy- drate, when a purple color forming indicates uric acid or a urate, cystine and xanthine. Treat some of the same calculus with caustic potash, if no odor it is of uric acid, if an am- moniacal odor develops it is ammonium urate. If its solution in nitric acid gives yellow residue on evaporation, turning reddish-yellow on adding KOH and becoming violet-red on heating, it is xanthine. If the calculus leaves a residue when heated : if it gives the murexide test it is urate of soda (colors Bunsen flame yellow), potash (colors flame violet), magnesia (dissolves in dilute II 2 S0 4 and is precipitated by phosphate of soda and ammonia), calcium (after heating it gives the reactions of carbonate of calcium). Oxalate of calcium calculus is not dissolved by acetic acid, but dissolves in mineral acids and gives precipitate on add- ing ammonia. Carbonate of calcium calculus dissolves with effervescence in acids, including acetic acid. 302 CHEMISTRY. Ammonio-phosphate of magnesium calculus dissolves in acetic acid, and this solution gives crystalline precipitate on adding ammonia. Detail a test for the detection of Indoxyl=potassium sul- phate (Indican). McMunn 's method : Boil a mixture of equal parts of urine and hydrochloric acid with a few drops of nitric acid; cool and shake with chloroform — the chloroform becomes of violet color, and on spectroscopic examination shows an absorption band before D, due to indigo blue, and an absorption band after D, due to indigo red. PATHOLOGY AND BACTERIOLOGY. What are the characteristic features of diphtheritic exu- dation or infiltration of mucous membrane? The layers of mucous membrane undergo coagulation ne- crosis, and are infiltrated by a granular or fibrillar exudation of fibrin, and by leukocytes. What abnormal organic ingredients are found in the urine in chronic morbus Brightii? Tube casts — hyaline, granular or cellular ; cylindroids, epithelial cells from urinary tubules, albumin, and at times leukocytes and erythrocytes. In what general respects do " anemia and progressive pernicious anemia " differ? Anemia refers to any blood impoverishment. Pernicious anemia is a very serious type of an essential anemia in which there is a disproportionate oligocythemia. In most anemias this is proportionate to the oligochromemia. What is cretinism, and with what is it associated? A disease developing in early life characterized by disten- sion (at times myxomatous) of subcutaneous tissues and by general mental and physical ill development, that is always associated with abnormality or absence of the thyroid gland. How should sputum be examined for tubercle bacilli? A selected portion of morning expectoration is thinly spread on a cover-glass, dried, fixed by heating, stained for three minutes in hot carbol-fuchsin, washed, decolorized and coun- ter-stained for one-half minute in Gabbet's solution, washed. (303) 304 PATHOLOGY AND BACTERIOLOGY. dried, mounted in balsam, and examined under a one-twelfth oil immersion objective for minute red rods — the tubercle bacilli. What is infective inflammation? How does it differ from simple inflammation? Infective inflammation is that form due to the action of bacteria, while simple inflammation is not due to micro- organisms. Infective inflammation tends to spread, is more severe, and is often associated with marked constitutional re- action, the reverse being the case in simple inflammation. Give the morbid anatomy of acute lobar pneumonia. In engorgement (first stage) the affected lobe is deep red, boggy, slightly crepitant, and on section exudes bloody serum ; this passes into red hepatization (second stage), in which the affected lobe is dark red, solid, airless, friable, with dry, granular surface of section, while in gray hepatization (third stage) the lobe is grayish- white, solid, friable, with moister surface of section. Microscopically, in the first stage, there is intense hyperemia, with presence of serous liquid and red and white corpuscles in alveoli. In the second stage the air cells are filled by red and white corpuscles entangled in coagulated fibrin, while in the third stage the fibrin, erythro- cytes and hyperemia disappear and the alveoli are distended by leukocytes and granular detritus. Resolution (fourth stage) is characterized by liquefaction necrosis, absorption and expulsion of exudate. Give the causes and process of cerebral softening. The chief causes are the obstruction of cerebral arteries by an embolus, thrombus or arterio-sclerosis. The area thus ren- dered anemic degenerates and undergoes colliquation necrosis, and if pyogenic bacteria are present an abscess may form. Describe the rash and give the morbid anatomy of scar- latina. Scattered red points on a deep reddish base appear over PATHOLOGY AND BACTERIOLOGY. 305 neck and chest by the second day, spread over the body, and after three or four days gradually fade, to be followed by desquamation. There are no specific lesions, but usually acute catarrhal or pseudo-membranous pharyngitis, acute diffuse nephritis, and often follicular tonsillitis, lympha- denitis (at times suppurative), catarrhal gastro-enteritis, in- terstitial hepatitis, splenic enlargement, and as complications, purulent otitis media, endocarditis, pericarditis, broncho- pneumonia. What is a giant cell? Give characteristics. A very large cell with many nuclei, found in the tubercle, in gumma, in bone marrow, and in myeloid sarcoma. It is irregular, and often indefinitely outlined, with hyaline proto- plasm and from four to one or two hundred nuclei, that may be (as in tubercle) arranged peripherally, equatorially. at the poles or (as in sarcoma) near the center of the cell. Describe the formation of adipose tissue. In protoplasm of connective tissue cells, fat droplets that tend to coalesce and displace the nucleus are deposited. Finally the nucleus is displaced to extreme periphery of cell and may disappear, while the cell is transformed into a dis- tended sac filled by fat. If this take place, in many adja- cent connective tissue cells adipose tissue results. What pathological changes occur in caries? In caries (rarefying ostitis) there is a solution of bone with or without the formation of pus. A round-celled infiltration, often with the formation of granulation tissue, occurs in medulla and in Haversian canals with solution of soft and hard structure of bone, the ended pits being Howship's Lacunae. How is dental caries produced? \<'ids (especially lactic) formed by bacteria present in the saliva acting upon starchy particles, progressively dissolve the mineral structure of the tooth, whereupon saprophytic 20 306 PATHOLOGY AND BACTERIOLOGY. micro-organisms present cause solution of the organic sub- stance of the tooth. Describe catarrhal inflammation. An inflammation of a mucous surface, with the fluid exuda- tion consisting of mucus, serum, leukocytes and desquamated epithelial cells in varying proportions. The area affected is red, swollen and bathed by exuded secretion. What is the line of demarcation in gangrene? The zone of inflammatory reaction observed in the living tissue adjacent to the gangrenous area. What is the line of separation in gangrene? The narrow zone of progressive ulceration and molecular disintegration distal to the line of demarcation that tends to sever the connection between the living and dead tissues. What post=mortem changes occur in the tissues? Rigor mortis, algor mortis, livores mortis, muscular relaxa- tion, formation of adipocere, decomposition. Define atrophy. Give the varieties of atrophy. The diminution in size and functional capacity of a part. It may be simple or degenerative, passive, active, senile, pres- sure or neuropathic atrophy. Differentiate fatty infiltration and fatty degeneration. In fatty infiltration the fat is from without affected cells, and appears as fat droplets that coalesce, displace and obscure the nucleus, and distend, but do not entirely destroy, the cells. In metamorphosis the cell protoplasm is converted into fat that appears in the form of granules or minute droplets that tend to cause the breaking down and destruction of proto- plasm and nucleus. Define fibromata. Give the histology of fibromata. A tumor of the type of fibro-connective tissue, showing under the microscope whorls or curving bundles of long, nar- row fibers having occasional narrow spindle-shaped nuclei. As a rule, fibromas are encapsulated and not very vascular. PATHOLOGY AND BACTERIOLOGY. 307 What are the degenerative changes of arteries? Calcareous infiltration, hyaline, fatty and amyloid degen- eration. What pathologic changes may cicatrices undergo? Cicatricial contraction or distension, cicatricial keloid, cicatricial carcinoma, abscess and ulceration. What is ischemic paralysis? The loss of voluntary motion in a living part, the result of local anemia. Differentiate between a tubercular and typhoidal ulcer of the small intestine. The tubercular ulcer results from the action of the tubercle bacillus, is chronic, tends to have a long axis transverse (annu- lar ulcer) to bowel, to show outlying tubercles and irregularly thickened edges and base. The typhoid ulcer results from the action of the bacillus of Eberth, tends to have its long axis parallel to gut, to have undermined edges and thin floor, and often causes hemorrhage or perforation. Distinguish between burns inflicted on a body before death and those inflicted after death. Vesicles containing albuminous serum and an adjacent red zone of inflammatory reaction indicate infliction of burn dur- ing life, and are absent in case of burns produced after death. Give the causes of hemorrhage. Increased blood pressure, atheroma, aneurysm, fatty, calca- reous, inflammatory change or malignant infiltration of vessel wall, embolism, traumatism, hemophilia, scurvy, typhus fever, venoms, phosphorus poisoning, and anomalous innervation, as in hysteria. What are the causes of lymphorrhagia? Lymphatic obstruction or injury, as may result from trauma, pressure of neoplasms, aneurysms or inflammatory tissue, or obstruction by filaria or other parasites. 308 PATHOLOGY AND B ACT E BIOLOGY. How does calcareous degeneration of the arteries influ- ence the circulation? Increases arterial pressure and the work of heart, causes imperfect blood supply, at times leading to gangrene, and favors thrombosis and hemorrhage (hemiplegia). What are pyogenic bacteria? Schizomycetes capable of inaugurating suppuration. What changes take place in simple atrophy of the liver? A reduction in size, with preservation of general outlines, and without noteworthy increase of stroma, or degenerative change in the liver cells. Describe syphilitic gurhmata. Rounded, soft or firm, grayish or yellowish, circumscribed masses, from five mm. to several cm. in diameter, surrounded by an area of fibro-connective tissue, and consisting of atyp- ical granulation tissue showing mucoid degeneration or central caseous necrosis. What changes characterize inflammation of bone? An absorption of bone, with the ingrowth of new granu- lation tissue {rarefying ostitis) or possibly abscess forma- tion, or a progressive ossification with resulting thickening and condensation (condensing ostitis). Where and what are the pathologic changes in bulbar paralysis? Degenerative atrophy and sclerosis, with shrinking of motor cells and degeneration of processes, affecting the glosso- labio-laryngeal nucleus in the medulla. Give the pathologic changes in sclerosis of nerves. An overgrowth of the supporting connective tissue and neuroglia, with thickening of blood-vessel walls and atrophic, fatty or other degenerative changes in myelin sheaths and axis cylinders. PATHOLOGY AND BACTERIOLOGY. 309 Describe the protective agencies by which the body guards itself against the entrance and harmful effects of pathogenic bacteria. Phagocytosis, the ingestion and possible destruction of bacteria by certain leukocytes. Antitoxines, substances formed in the body that are antidotal to bacterial toxins. Bacteriolysins, substances resulting from the union of two bodies known as complement and addiment that produce the solution of bacteria. Antiseptic substances present in the blood serum and tissues that restrain bacterial growth. What is immunity? How is immunity produced? Immunity expresses the degree of resistance of the living organism against disease. It is produced by attacks of dis- ease, by the introduction into the body of living or dead bac- teria or their products, or of antitoxins or by heredity. Give the pathologic changes occurring in acute phlebitis. Congestion of vessels of vasa vasorum and effusion in the walls of vein of serum and leukocytes, with formation of thrombus within vessel. This may terminate in absorption and resolution, the permanent occlusion of the vein, or in suppuration. What conditions (nontraumatic) favor cerebral hemor- rhage? Mention the vessel from which cerebral hemor- rhage occurs most frequently. a. Arterio-sclerosis or aneurysm of cerebral vessels and their causes, cerebral tumor, infarction, whooping cough or convulsions, leukemia, pernicious anemia. b. The left lenticulo-striate artery. Give the histologic characteristics of amyloid degenera- tion. The amyloid substance appears in the form of irregular homogeneous, translucent, faintly granular areas of fused cells and intercellular substance affecting chiefly the con- nective tissues about the capillaries, as in the glomerules of 310 PATHOLOGY AND BACTERIOLOGY. kidney or spleen. The adjacent epithelial cells may show atrophic changes or fatty degeneration. The urinary tubules may contain amyloid casts. What are the blood changes in progressive pernicious anemia? A marked and disproportionate oligocythemia, slight leu- copenia, poikilocytosis, and the presence of nucleated red corpuscles. Give the gross and the microscopic appearance of an epithelioma of the lip. A crusted papule or warty growth, with infiltrated base, that tends to undergo crater-like ulceration. Microscopically, an invasion of the subcutaneous and deeper tissues by irreg- ular columns composed of squamous epithelial cells that often contain pearly bodies is seen. Give the functions and the products of bacteria. Functions are reproduction, motion, absorption, excretion, growth; also fermentation, decomposition, disease-production. They may produce as products ferments, toxins, phosphores- cence, pigments, acids or alkalies. Give the causes of edema. Passive hyperemia, anemia, change in vessel walls or in vascular innervation, reduction in extra-vascular pressure, lymphatic obstruction. What are cysts? How are cysts formed? Give the varieties of cysts. Abnormal, persistent, encapsulated collections of liquid formed by obstruction to outlet of glands by secretion in a cavity without outlet, extravasation of blood or other liquid, softening of tissues, tumor formation, or by the presence of a parasite or foreign body. Varieties are simple, compound, and proliferous, congenital, retention, extravasation, soften- ing, neoplastic and parasitic cysts. PATHOLOGY AND BACTERIOLOGY. 311 What varieties of degeneration may occur in lymph glands? Fatty degeneration, pigmentary infiltration, calcification, hyaline degeneration, amyloid degeneration. Mention the malignant neoplasms. The varieties of carcinoma, including epithelioma; sarcoma, endothelioma. What tissues are most frequently the seat of tubercular formation? In order of frequency — lungs, lymph glands, ileum and larynx, joints, pleura, meninges, peritoneum, hones, spleen, kidneys and genito-urinary organs. (a) On what principle are tumors classified? (b) Men- tion the important classes of tumors, giving an example under each class. a. The varieties of normal tissue that they typify. b. 1. Adult connective tissue type, as fibroma. 2. Embryonic connective tissue type, as sarcoma. 3. More highly specialized tissue type, as myoma, neuroma, lymphangioma. 4. Endothelial type, as endothelioma. 5. Epithelial type, squamous, columnar or glandular, as squamous papilloma, columnar epithelioma, adeno-carcinoma. 6. Tumors of mixed type, as teratoma. What pathologic changes may result from cerebral hemorrhage? Cerebral hematoma, softening, cyst, cicatrix, porencephalus, atrophy or sclerosis. Atrophy of voluntary muscles and cutaneous tissues, secondary descending sclerosis of motor paths. Give the process of tubercle development. (1) Lodgment of tubercle bacilli, (2) Proliferation of epi- thelioid cells and an invasion of lymphoid cells in the affected area, (3) Fusion of epithelioid cells with formation of giant 312 PATHOLOGY AND BACTERIOLOGY. cells, (4) Central coagulation necrosis, (5) Fusion of adja- cent tubercles with caseation, producing yellow tubercle. What is (a) productive inflammation? (b) Suppurative inflammation? (a) One characterized by the formation of new fibro-con- nective tissue. (b) One characterized by the formation of pus. What structures are principally involved in bubonic plague? How are these structures affected? Lymphatic glands — suppurative lymphadenitis; lungs — a form of bronchopneumonia; intestinal tract — hemorrhagic gastro-enteritis ; kidneys — an acute interstitial and parenchy- matous nephritis; spleen — hyperplastic splenitis. Mention the varieties of eczema. Squamous, papular, vesicular, pustular, impetiginous, ec- zema parasiticum, rubrum, fissum, impetiginodes, marginatum, papulosum, vesiculosum, pustulosum, squamosum, sclerosum, seborrheicum, ulcerosum. What pathologic conditions increase the elimination of urea? Acute fevers, inflammations, bacterial infections, in dia- betes, rheumatism, gout, in lithemia. Give the lesions of typhoid fever. Catarrhal entero-colitis, infiltration and hyperplasia of Peyer's patches, terminating in necrosis and ulceration, hem- orrhages, perforation or cicatrization. Mesenteric lympha- denitis. Splenic hyperplasia, parenchymatous hepatitis and nephritis. At times degeneration of cardiac or voluntary muscles, hypostatic congestion of lungs and ulceration of larynx occur. What pathologic changes take place in the blood plasma? Hypertonicity (excess of salt) ; hyperinosis (excess of fibrin factors) ; hypinosis — deficiency in fibrin factors; hy- PATHOLOGY AND BACTERIOLOGY. 313 dremia (excess of water) ; anhydremia — deficiency in water. Lipemia — contains fat droplets ; melanemia — contains mel- anin ; hemoglobinemia — contains dissolved hemoglobin. Ab- normalities in alkalinity. What conditions may cause dropsical effusion in the abdomen and in the lower extremities? Cirrhosis, or tumor of the liver, syphilitic hepatitis, valvu- lar heart disease, pulmonary disease, neoplasms, parasites or inflammatory exudates interfering with the portal circulation, tuberculous peritonitis. Give the causes and pathologic anatomy of lympha= denitis. Inflammation of lymphatic glands results from irritants, especially the pyogenic bacteria, the tubercle bacillus and the bacillus of plague. The glands are enlarged, hyperemic, soft, pulpy, and infiltrated by serum and red and white corpuscles, and may suppurate. What is calcific metamorphosis? The transformation of cells into a calcareous or mineral substance. Name some of the causes of active hyperemia and give illustrations. Paralysis of vasoconstrictor or stimulation of vaso-dilator nerves, mechanic, thermic or chemic irritation, as shown in blushing, after friction of skin, application of heat or cold. or action of bacterial or drug irritants. Illustrate and define hypostatic inflammation. When the circulation is insufficient the blood tends to settle or stagnate in dependent parts of the body (hypostatic con- gestion), and a form of inflammation may fnsuo (hypostatic inflammation), such as the hypostatic pneumonia occurring in low forms of typhoid fever. 314 PATHOLOGY AND BACTERIOLOGY. What are some of the phenomena attending pus for- mation? Heat, redness, swelling, tenderness, throbbing pain, soften- ing of tissue, fluctuation, pointing. Describe the pathologic conditions in hectic fever. Hectic fever is a persistent form characterized by high exacerbations at night, and resulting from microbic action, and, as a rule, the formation of pus within the body. What are the pathologic conditions causing favus? The proliferation in the hair follicles of a mold, achorion schoenleinii. How are secretions affected in anemia? Usually decreased, although the urine may be increased either in bulk or relative solid contents, while the free hydro- chloric acid, which may be absent from the gastric secretion in progressive anemia, may be present in increased amount in chlorosis. What organs are most subject to tuberculosis? Lungs, lymph glands, serous membranes, bones, spleen, kidneys, adrenals, genital organs, bladder, skin. Name some of the changes which occur in extravasated blood. Coagulation, solution, replacement by granulation tissue, decomposition and suppuration, desiccation and scabbing. What glands are most frequently affected by amyloid degeneration? Liver, spleen, kidneys, lymph glands. To what diseases does calcareous degeneration of the arteries predispose? Aneurysm, hemiplegia, cerebral softening, dry gangrene. Give the varieties of tubercle. Reticulated tubercle, lymphoid tubercle, epithelioid tubercle, PATHOLOGY AND BACTERIOLOGY. 315 miliary tubercle, submiliary tubercle, gray tubercle, yellow or crude tubercle of Laennec. (a) What are bacteria? (b) What conditions are favor- able to their increase, and (c) what is meant by their toxic products? (a) Fission fungi or schizoniycetes. (b) Warmth, moist- ure, albuminous media, usually best if of neutral or slightly alkaline reaction, absence of strong actinic rays, (c) Poison- ous substances, toxins, ptomaines or bacterial proteids formed by or in bacteria. Name some of the principal bacteria of the staphylo* cocci and the streptococci groups. Staphylococcus aureus, staphylococcus albus, staphylococ- cus citrous, streptococcus pyogenes, streptococcus erysipelatis. Name the important pathogenic diplococci. Diplococcus gonorrhoeae, diplococcus pneumoniae, diplo- coccus meningitidis capsulatus of Weichselbaum. What changes take place in cyanotic atrophy of the liver? Give the microscopic appearance of this diseased condition. A persistent passive congestion, with secondary hyper- plasia of the connective tissue and pigmentation of hepatic cells; microscope shows wide dilatation of capillaries and veins, with atrophy and pigmentation of hepatic cells and overgrowth of perilobular connective tissue. Define and illustrate bacilli, micrococci, spirilla. (a) Bacilli are rod-shaped; micrococci, spherical shaped; spirilla, spiral-shaped bacteria, (b) Bacillus tuberculosis, streptococcus pyogenes, spirillum cholera;. Give the pathologic features of angioleucitis (lymphan- gitis). The lymph vessels are inflamed, red, swollen and dis- tended by a cell-laden liquid. Their walls are edematous, 316 PATHOLOGY AND BACTERIOLOGY. infiltrated by leukocytes, and may be broken down if the pro- cess be suppurative. The cause is almost invariably micro- organismal, and there is usually an associated lymphadenitis. Mention the structural changes that occur in tubercular joints. Tubercles in the synovial membrane, subsynovial tissue or cancellous bone. Diffuse (tumor alb us) or nodular (synovitis tuberosa) thickening of synovial membrane, or distension of joint with inflammatory serum (hydrops) or puriform liquid (empyema); erosion of cartilage and bone; tuberculous ab- scess and sinus formation. Give the possible causes of occlusion of the bile=duct. Catarrhal swelling of mucous lining, lodgment of calculus or parasitic worm (as ascaris lumbricoides or distoma hepa- tinum), invasion by coccidia, cicatricial contraction of walls of duct, pressure from without by an adjacent tumor or floating kidney, involvement in a neighboring carcinoma, sar- coma, endothelioma or an inflammatory process, duodenal disease involving the terminal papilla. (a) What causes contribute to obesity? (b) What tis- sues are most frequently invaded in obesity? (a) Anemia, hemorrhages, use of malt liquors, lack of exer- cise, hereditary tendency, over-eating, certain dyspepsias. (b) The subcutaneous tissues and subserous tissues of abdo- men, especially about kidneys, in great omentum and appen- dices epiploicae. In what order are the organs of the thorax and abdomen best examined at a post=mortem section? Authorities differ. The following is useful : Inspection of abdominal cavity, inspection of pleura, pericardium, heart and vessels, examination of heart, lungs, organs of neck, spleen, gastro-intestinal tract, liver, pancreas, genito-urinary organs, abdominal aorta and sympathetic ganglia. PATHOLOGY AND BACTERIOLOGY. 317 What is the special cause of the croupous inflammation found in diphtheria? The toxin of the diphtheria bacillus. Describe the comma bacillus and give the manner of its introduction into the system. A spirillum, a short, curved rod .8 to 2 microns in length, motile, flagellate, readily staining but decolorized by Gram's method, usually enters through the alimentary canal with contaminated water, milk or solid food. What conditions give to the system immunity from the harmful action of bacteria? The bacteriolysins, the antitoxins, the phagocytes, the anti- septic action of tissue cells and juices, the protecting layers of epithelium. (a) Give the microscopic appearance of a melano=sar- coma and (b). state its usual sites of development. (a) Consists usually of vascularized tissue consisting of spindle cells, or at times of round cells, that have vesicular nuclei, and many of which contain dark pigment granules, (b) Skin and choroid. Describe the pathologic conditions in meningitis. An inflammation of the membranes of brain or cord char- acterized by congestion of meningeal vessels, edema of arach- noid, effusion of serum, fibrin, or pus into the cavity of arach- noid, at times petechial or larger hemorrhages within or with- out arachnoid. Adjacent degeneration of nervous substance may'occur. Give the pathology of cirrhosis of the liver. A marked hyperplasia of the interlobular connective tissue. and often of interlobular bile ducts. The new-formed con- nective tissue lends to contract, compressing the lobules and perhaps causing degeneration of the hepatic cells. The liver may become much smaller and show a rongh ("hob nail") surface. 318 PATHOLOGY AND BACTERIOLOGY. (a) How is fibrous tissue formed? (b) What tumors are composed largely of fibrous tissue, and in what part of the body do they usually occur? (a) By a proliferation of cells of the pre-existing, adjacent fibrous tissue. The young cells or fibroblasts being nourished by new capillary blood-vessels that sprout from neighboring pre-existing vessels and invade the formative area. (b) Fibromas and fibromyomas chiefly occur in the uterus. What is the significance of tube=casts in the urine? Tube-casts result from irritative and degenerative changes in the epithelium of kidney, permitting an exudation of coag- ulable substance into the tubules, and signify renal irritation or disease. They are minute cylindric bodies having a homo- genie matrix, in which there may be imbedded cellular or granular particles. Describe yellow or crude tubercle. A yellowish, rounded, firm, adherent body, one to several millimeters in diameter, showing under microscope a central caseous area, an intermediate zone of epithelioid cells and often giant cells, and a peripheral zone of lymphocytes. Give the structural differences between sarcoma and carcinoma. Sarcoma consists of connective tissue of embryonic type containing imperfectly formed blood-vessels. Tissue may consist of round, oval, spindle or, in part, of giant cells. Carcinoma is less circumscribed, consists of alveoli filled by cuboidal, columnar or squamous epithelial cells in a stroma, usually of fibro-connective tissue, that contains well-informed blood-vessels and lymphatics. Define anemia, hyperemia, leukemia. Anemia is deficiency in the quantity or quality of circulat- ing blood. Hyperemia is an excessive quantity of circulating blood in a part. PATHOLOGY AND BACTERIOLOGY. 319 Leukemia is a grave primary anemia characterized by enor- mous leucocytosis and pathologic changes in the spleen, red marrow or lymphatics. State the difference between degeneration and infiltra- tion. Illustrate. Cell degeneration is a condition in which the cell contents become abnormal. If abnormal from the deposit of substance from without it is termed cell infiltration, as in fatty infiltra- tion. If abnormal from transformation of cell contents it is termed a cell metamorphosis, as in fatty metamorphosis. Fatty infiltration and fatty metamorphosis are both examples of cell degeneration. Give the morbid anatomy of chronic bronchitis. Mucous membrane may be red and thickened and covered by thick mucus ; or pale, thinned, and showing adherent, in- spissated mucous masses. The thickening is due to leuco- cytic infiltration and overgrowth of fibrous tissue; the thin- ning to atrophy of the mucous membrane. The ciliated cells may be replaced by columnar or polygonal epithelium. What is thrombosis? Describe the manner of its for- mation. Thrombosis is the intravascular coagulation of blood during life resulting from the arrest of circulation and the formation of fibrin by the action of fibrin ferment upon the fibrinogen. a. What is mucoid degeneration? b. What is colloid degeneration? a. A conversion of cells and intercellular substance into mucin. b. A conversion of cells into colloid material, a substance resembling mucin but not giving its reaction. State the results of stenosis of the tricuspid valves of the heart. Dilatation of right auricle, cyanosis of face, passive hy- peremia of pulmonary and abdominal organs, anasarca. 320 PATHOLOGY AND BACTERIOLOGY. a. Define fatty metamorphosis, b. Give its termina- tions. a. Conversion of cells into fat. b. Destruction of cells, colliquation or caseous necrosis. What are the possible lesions in the third stage of syphilis? Gummata, syphilitic rupia, sclerotic changes in organs, especially the arteries, liver, kidneys and spinal cord. Describe the local appearances in a case of embolism of the middle meningeal artery. The affected vessel contains thrombus extending from the seat of embolism back as far as the first collateral branch. The distal branches may be shrunken, anemic, and associated with cerebral softening or distended, and in the midst of a hemorrhagic effusion (hemorrhagic infarction). What is productive inflammation? Inflammation characterized by the formation of new tissue, usually of the fibre-connective tissue type. What changes take place in hypertrophy of the heart? An increase in thickness of the muscular walls of the heart, chiefly affecting the ventricle, blunting the apex. The cavi- ties may or may not be increased in size. Give the origin and appearance of papillomata. Originate from overgrowth of the papillary body, and are wart-like, villous, dendritic or polypoid outgrowths from skin or mucous membrane covered by epithelium. Briefly describe the types of gangrene, and give the conditions determining each. Dry gangrene or putrefactive death of a part with mummi- fication is characterized by a dry, shriveled, blackish, leathery, friable area, and is caused by arterial obstruction, such as occurs in old age (senile gangrene), from arterio-sclerosis, in Raynaud's disease, from ergot poisoning and frost bite. PATHOLOGY AXD BACTEEIOLOGY. 321 Moist gangrene is characterized by swollen, greenish or blackish, cool, moist, soft, fetid area, with bleb-covered sur- face, loosened epidermis and crepitation on palpation, and is due to severe infection (pulmonary gangrene, malignant pha- gedena, hospital gangrene), trauma, venous obstruction, dia- betes (diabetic gangrene), and deficient trophic innervation (decubitus). Describe the histological elements of carcinoma. Acini containing epithelial cells. The amount of protoplasm, as in other epithelial cells, is large in proportion to the size of the nucleus. Cells may be squamous, cylindric, cuboidal or polyhedral. The nuclei are usually vesicular and atypical karyokinetic, and other cell figures may be present. The iua usually consists of well-informed fibro-connective tissue containing lymphatics and well-formed blood-vessels. Describe tuberculosis of the skin in any of its forms. Lupus vulgaris is characterized by brown nodules originat- ing in corium, and consisting of a rather vascular granula- tion tissue composed of epithelioid cells, lymphoid cells, and frequently of giant cells. The nodules may lead to extensive ulceration and cicatrization. Describe the changes in the heart due to fatty meta= morphosis. Diffuse or circumscribed, yellowish, opaque, soft, friable areas of hearl muscle, in the circumscribed form chiefly occur- ring under endocardium of papillary muscles. .Microscopic- ally, the muscle fibres lose their striation and show fatty granules, usually first aboul the nuclei; finally fibres may break down into Eatty particles and detritus. What histological changes occur in acute simple inflam- mation? Dilatation of blood-vessels, retardation and Btasis of blood current, exudation into 1 issues of modified plasma, transmi- gration of leukocytes, and often diapedesis of erythrocv L'l 322 PATHOLOGY AND BACTERIOLOGY. distension of lymphatics by exudate of cells and fluid, regen- erative or degenerative changes in the tissue cells. Give the pathology of carcinoma. Carcinoma is a malignant, uncircumscribed tumor consist- ing of acini, containing invaded epithelial cells in a vascular- ized stroma that usually consists of fibro-connective tissue. The epithelial cells tend to a progressive invasion through the lymphatic channels. What is fibrinous degeneration? A retrogressive process in which, by the action of fibrin ferment upon fibrinogen, fibrin is formed. What do you understand by the term cirrhosis of the liver? Overgrowth in the liver of connective tissue that contracts, rendering the organ smaller and firmer. Is cerebro=spinaI fever more generally sporadic or endemic? Cerebro-spinal fever generally occurs in the form of small sporadic epidemics. Give some of the lesions in chronic diffused or inter- stitial nephritis. Macroscopic. Small, granular-surfaced kidney with adhe- rent capsule and thinned cortex. Microscopic. Thickening of Bowman's capsules, hyaline degeneration of glomerules, increase of intertubular tissue, dilatation of certain tubules. What anatomic changes take place in the skin in chronic eczema? Enlargement of papillae, dilatation of blood and lymph vessels, perivascular cellular infiltration, hyperplasia of con- nective tissue and epithelium, atrophy of sebaceous and sweat glands. PATHOLOGY AND BACTERIOLOGY. 323 Give the varieties, the histology, and the physical char- acteristics of lipomata. a. Diffuse and circumscribed, sessile or pediculated. b. Resembles normal adipose tissue, consisting of fat-dis- tended cells supported in a light fibro-connective tissue frame- work. c. Greasy, lobulated, yellowish, encapsulated, soft growths. The overlying skin " dimples ". when elevated. What part of the cord is involved in locomotor ataxia? Give the pathology of locomotor ataxia. a. Posterior columns. b. In columns of Goll and Burdach areas of degeneration showing destroyed myelin sheaths and axis cylinders and a proliferation of neuroglia occur. What are the intestinal changes in chronic enteritis? The mucous membrane and muscular wall may show hyper- plastic thickenings or atrophy. Enlargement of lymph fol- licles is frequent, and polypoid masses may project from mucous membrane. Ulcers may be present. Define myomata, neuromata, angiomata. a. Myomata are tumors of the type of muscle. 1). Neuromata are tumors of the type of nerve tissue. c. Angiomata are tumors of blood or lymph vessels. Explain the development of pus corpuscles. Migrating leukocytes pass through the walls of the adja- cent capillaries, and in large numbers invade the area of sup- puration, and whether living or dead as soon as they are sur- rounded by liquor puris are termed pus corpuscles. Give the pathology of spina bifida. The spinal lamina being congenitally imperfect, the con- tents of the spinal canal tend to protrude in the form of a tumor. The mass usually contains fluid, and is covered by the attenuated cord, nerves, or bv the membranes alone. 324 PATHOLOGY AND BACTERIOLOGY. Spina bifida occulta is a form in which the vertebral cleft is unassociated with the formation of a tumor. What are the pathologic conditions in gonorrheal op= thalmia? A purulent conjunctivitis with marked chemosis, edema of eyelids, profuse purulent discharge, and as complications, ulcerative or suppurative keratitis, with or without resulting perforation, anterior synechia, leucoma, staphyloma, iritis, hypopyon. What are the pathologic appearances of anemia of the brain? The blood-vessels are empty or imperfectly distended by blood, and if the process has been long continued the brain may show atrophy or degenerative changes in the involved areas. What is embolism? Intravascular obstruction from the lodgment of a foreign body. What is an infarct? The area of degenerative and inflammatory changes pro- duced by the lodgment of an embolus in an end artery. Describe the pathologic conditions present in atheroma. A diffuse or circumscribed mesarteritis occurs with involve- ment of vasa-vasorum and the production of new sclerotic tissue that undergoes coagulation necrosis and fatty degener- ation. This softened degenerative material is termed athero- matous. It may become calcined, be discharged with the formation of an atheromatous ulcer or cause a weakening of the wall, favoring rupture or aneurysm formation. What structural changes take place in chronic gout? Polyarthritis, with deposits of urate of sodium in articular cartilages, and about joints with formation of concretions (tophi). Arterio-sclerosis, hypertrophy of left ventricle and PATHOLOGY AND BACTERIOLOGY. 325 sclerotic changes in liver and kidneys are common, and there is a tendency to inflammation of the larger serous sacs. What are the four cardinal indications of inflammation? Heat, swelling, redness and pain, to which may be added altered function. Define ascites. An abnormal collection of serous fluid in the peritoneal cavity. What condition of the blood is generally prominent in all forms of gout? Excess of sodium urate. Give some of the causes (pathologic) of paresis. A chronic, progressive meningoencephalitis characterized by a productive arteritis involving especially the adventitia, with degenerative atrophy and sclerosis of cortex and sub- cortical portions of brain. Degenerative changes in spinal cord are associated. What is the pathology of aneurysm? A localized enlargement of an artery containing blood or clot, due to a circumscribed stretching of one or all the coats of a vessel. It occurs in vessels weakened by trauma, arterio- sclerosis, mycotic inflammation, or by ulceration, or proximal to areas of thrombosis or embolism. The vessel walls forming the aneurysm are thinned, often calcified, with impaired elas- ticity, and usually having thicker or thinner lining of adhe- rent, laminated fibrin. Describe the pathological conditions in icterus. The skin, conjunctivae, urine, blood and the various organs are tinged a yellow color by the biliary pigment. The \'rrr<. are usually clay-colored. The pulse is slow; there is a ten- dency to hemorrhage. Define the term malignant as applied to new formations. New growths having an inherenl tendency to a fatal issue. 326 PATHOLOGY AND BACTERIOLOGY. Give the pathology of peritonitis. The peritoneum is red from vascular injection, the surface is dull, and may be covered by adherent fibrinous or puriform exudate. The cavity of the peritoneum contains serum, in which there may be fibrin or pus. There is a tendency for adjacent peritoneal surfaces to adhere, localizing the process. What is understood by the phrase " new formation?" A multiplication of certain cells of the body producing a mass of tissue that has no place in the normal organism, such, for example, as a tumor. By examining the fluid removed by lumbar puncture, how may we distinguish between tubercular and other forms of meningitis? In tuberculous meningitis the fluid contains chiefly lympho- cytes, and by staining, or inoculation into animals, the pres- ence of the tubercle bacillus may be demonstrated. In other forms of meningitis the cerebro-spinal fluid, as a rule, is more turbid, contains chiefly polymorpho-nuclear leukocytes, and the causal organisms, as the pneumococcus, the diplococcus intracellulars meningitidis or other bacterium, but not the tubercle bacillus. Differentiate a tuberculous joint from one enlarged by chronic rheumatism. Tuberculous joint-disease occurs chiefly in children, affects usually but a single joint, has insidious onset, with slight and often characteristically reflected pain, and muscular rigidity; is persistent, and tends to cause flexion and pale, doughy thickening of joint, with later the formation of cold abscess and sinuses. Rheumatism usually involves several joints, has acute onset, is transient, with marked localized tender- ness, and if severe, redness and swelling. What part of the spinal cord is involved in progressive muscular atrophy? The anterior horns of the gray matter. PATHOLOGY AND BACTERIOLOGY. 327 a. What features render a tumor malignant? b. Men- tion some of the growths considered malignant. a. Invasion of adjacent tissue, recidivity, metastasis, the production of cachexia. b. Carcinoma, sarcoma, endothelioma. What is lardaceous (amyloid, waxy, bacony) degener- ation? The transformation of tissue into a homogeneous, wax-like albuminous material, giving a mahogany-brown color with dilute Lugol's solution. What is the pathology of plastic inflammation? A modified serum, leukocytes and at times erythrocytes escape from the vessels. The fibrin factors in this exudate unite, producing fibrin that may cause adhesion between con- tiguous viscera. Later this plastic exudate may break down, or. if it be replaced by new fibro-connective tissue, more or less permanent adhesions may result. What are some of the results of lymphorrhagia? Chylous extravasation, lymph fistulas, chyluria, chylothorax, chylous ascites, malnutrition, death. What conditions may result from enlargement of lymph spaces or lymph vessels? Capillary, cavernous or cystic lymphangioma, cystic hy- groma ("hydrocele of the neck"), macroglossia (of tongue), macrocheilia (of lip), elephantiasis, lymph scrotum. What inflammatory conditions may result in enlarge- ment of the lymphatic glands? Infection by pyogenic bacteria, plague, syphilis, tubercu- losis. What noninflammatory condition may produce enlarge- ment of lymph gland? Eodgkin's disease (pseudoleukemia), leukemia (especially lymphatic types), lymphadenoma, secondary tumors (carci- noma, sarcoma) ill lymph '.'lands. 328 PATHOLOGY AND BACTERIOLOGY. Give the pathologic features of mechanical hyperemia of the liver (nutmeg liver). A chronic, passive hyperemic condition resulting from val- vular heart disease, emphysema, pleuritic exudations, aneu- rysm, or other obstructions to venous return. The liver is more or less enlarged and is deeply mottled, this being due to the distension of the capillaries near the center of the lobules by blood, often with atrophy of the adjacent hepatic cells, while the liver cells at the periphery of the lobules may show fatty or other degenerative changes. Describe the formation of an acute abscess. By stages : 1. Local tissue irritation, usually from the pres- ence of pyogenic bacteria. 2. Exudation of modified serum and many leucocytes. 3. Colliquation necrosis in affected area, resulting in the formation of cavity (abscess) filled with a liquid (pus), consisting of fluid part (liquor puris) and many dead and living leucocytes (pus cells). Describe symbiosis with special reference to patho= genesis and cite an example. Symbiosis refers to the modifications in the activities of different species of bacteria resulting from their association as compared with their activities when in pure culture. Thus, the injurious affects of the tubercle bacilli upon the tissues are greatly increased when the bacilli are in association with streptococci or staphylococci. Upon the other hand, anthrax bacilli become less virulent when mixed with cultures of Bacillus prodigiosus. Give a general description of the action of agglutinins. Agglutinins are substances observed chiefly in the blood serum of infected animals, which when brought in contact with living or dead bacteria of the same species as those having pro- duced the infection, cause the bacteria to become immotile, and to agglutinate or collect in clumps. The action is usually specific; that is, it occurs only against bacteria of the same species as that causing the infection. It is not necessarily PATHOLOGY AND BACTERIOLOGY. 329 associated with the death of the bacteria, and as agglutinins may be produced by the action of bacteria upon culture media, the animal body is not essential to their formation. Describe the process of ulceration. Ulceration or the production of an ulcer is an inflammatory process in which a definite loss of substance from a surface of the body is produced. The area may be destroyed by the injurious action of physical or animate agents, by interfer- ences with the circulation, or as a result of the progress of tumors. The tissue of the involved area is first removed by processes of necrosis, or mechanically. The area left has borders of more or less healthy tissue which become the seat of extension or of healing of the ulcer; and a floor or base, which usually becomes occupied by granulations, or, if the ulcer be progressive, by necrotic and sloughing tissues. Ulceration may be a chronic, indolent process, may be progres- sive, leading to extension of the ulcer, or as usually occurs. it becomes arrested and cicatrization, or healing of the ar< a, occurs. Describe the changes that occur in cartilage in arthritis deformans. Tin- cartilage becomes softened, fissured, and develops sur- face excavations which may extend deeply into the bone. Simultaneously, other cartilage cells may proliferate and pro- duce nodular, cartilaginous projections. Medullary spaces invade 1li< j degenerating and proliferating cartilage, and it is transformed in part into osteoid tissue. Villous or nodular, fatty, calcareous or bony outgrowths may spring from the Bynovial membrane, and it' they become detached, form free joinl bodies. The bones making up the .joint become d flattened, more porous, excavated, or the sent of new l><>ny pro- :mil fibrous ankylosis, subluxation or luxation fre- quently follow. Enumerate the most Ordinary senile changes that occur in the various tissues of the body. hi organs, atrophy and increase of fibro-connectivr 330 PATHOLOGY AND BACTERIOLOGY. elements. In bones, absorption of osseous tissue, and cer- tain changes in form, especially noted in the edentulous man- dible, and in the neck of the femur. In walls of arteries and veins, arteriosclerotic changes, with tendency to calcification. In joints, degenerative changes, resembling rheumatoid arthri- tis of a mild type. In skin and adipose tissue, wasting and atrophy. Describe how mitral stenosis and aortic regurgitation respectively affect the cavities and musculature of the heart. In mitral stenosis, as the left ventricle receives insufficient blood, it may atrophy. As the left auricle insufficiently empties, it hypertrophies and dilates. Secondarily, the back pressure through the lungs increases the work of the right ventricle, which hypertrophies. The cavities of the right ventricle and left auricle are increased and their walls are thickened. The cavity of the left ventricle decreases in size, and has unaltered or thinned walls. In aortic regurgitation, much of the blood which has left the left ventricle is per- mitted to return, so that the ventricle receives not only the normal blood from the left auricle, but also the return leak from the aorta. This results in distension of the cavity and compensatory hypertrophy. This may cause an enormous in- crease in the thickness and size of the ventricle. Eventually the ventricle becomes incompetent, or in its distension pro- duces mitral insufficiency, and there ensues an auricular hypertrophy, and dilatation, pulmonary congestion, and finally distension and hypertrophy of the right heart. An enormous heart (cor-bovinum) may thus be produced. Describe the bacillus tuberculosis, its habitat, mode of growth and method of detection. The tubercle bacillus has the form of a minute, slightly curved rod, with rounded ends, and an average measurement of 2 x .35 microns. It occurs singly and in small groups. Its hibitat is the tissues of vertebrates. Precise knowledge of its natural growth outside of the body is wanting. Its growth PATHOLOGY AND BACTERIOLOGY. 331 under artificial cultivation is slow, requiring several weeks for colonies to develop, and necessitates special media, such as glycerine agar, or special blood serum. Pale gray or yel- lowish, dry. wrinkled, rather firm, crustlike, surface masses are formed by the growth of the bacteria. Growth usually occurs only at a temperature about that of the body, in the absence of strong light, and in the presence of free oxygen. It is detected — (a) by inoculating guinea-pigs with some of the suspected material, and six weeks later killing them and searching for the characteristic lesions of tuberculosis. Or — (b) by staining spread smears of suspected material thre<- minutes with hot carbol-fuchsin and decolorizing for five min- utes with a three per cent, solution of HC1. in absolute al- cohol. Tubercle bacilli retain the red fuchsin color after this treatment, while nearly all other bacteria are decolorized. Describe the microscopic appearances of acute paren= chymatous nephritis and explain the origin of blood in the hemorrhagic form. The microscopic changes may be chiefly of the glomerules — glomerulonephritis, or in convoluted tubules — tubulo-ne- phritis, or may affect all the parenchyma. In the capsular spaces are glomerular or desquamated epithelial cells, leuko- cytes, erythrocytes and plastic or granular exudate. The epithelial cells may show cloudy swelling, fatty metamor- phosis, or karyokinetic changes indicating regenerative ef- forts. Where the walls of the vascular tuft in the glomerulus give way, a hemorrhage occurs, distends the capsules, flows per cent, of all cases of labor. It results from anything which will prevent thorough flexion of the head, such as an enlarged thyroid or thymus gland or a prominent thorax, or anything that will disturb tie- relationship existing between the Long axes of the body and head of the fetus, as dolichocephalus. The mech- anism consists in full extension Mini moulding, descent of the chin to the pelvic floor, anterior rotation to the symphysis under which it lodges, and birth of the head by a process of flexion; the shoulder and hip then rotate from the opposite side, and the rest of the mechanism is the same as in vertex presentations. If the chin be anterior the labor will prob- ably be easy, since small diameters present. If the head sticks, forceps may be applied and the ehin drawn down, after which labor will proceed. Give the diagnosis of face presentation before and after rupture of the membranes. Before rupture of the membranes the presentation will be noted ms high; there is an absence of the dome-like projection of other head presentations; the features of the face may be 482 OBSTETRICS AND GYNECOLOGY. detected. After rupture of the membranes the examining finger can be introduced into the mouth, when, if the child be living, reflex closure of the gums will be noted. How may a face presentation be converted into a vertex presentation? If labor have not yet begun, Schatz's method of cephalic version, performed by external manipulation alone, may be attempted. With one hand firm pressure is exerted against the anterior portion of the fetal neck, while counter-pressure is made with the opposite hand upon the occiput; at the same time an assistant pushes the breech in the direction in which the face is looking; the head is thus flexed upon the body and the vertex caused to present. If labor has already begun, and the os is dilating, Baudelocque's method of cephalic ver- sion, the "ratchet method," may be attempted under anes- thesia. One hand is placed against the face, and while the thumb pushes the chin upward the fingers hook over the occi- put and drag it down ; an assistant at the same time carries the breech over to the side toward which the face is directed. What is the mechanism of a mento=posterior position, and what the complications? A persistent mento-posterior position is an absolutely im- possible labor, and therefore there is no mechanism. For labor to advance the chin must strike the pelvic floor. The lateral height of the pelvis is 3% inches (9 cm.), while the length of the fetal neck is only iy 2 inches. The posterior height of the pelvis is 5 inches (12% cm.). In order for the chin to reach the floor in these cases it would be necessary for the thorax and occiput (I8V2 cm. or 7 inches) to enter the superior strait simultaneously. No diameter of this strait could accommodate such a bulk. The uterus becomes tetanic in action, the head and shoulders become impacted, the child perishes, and the mother is exposed to the danger of uterine rupture. OBSTETRICS AND GYNECOLOGY. 483 How should forceps be applied in a case of face presen= tation? In the mento-occipital diameter, the chin being in apposition with the heel of the bladder; the forceps should be used only as rotators in mento-posterior positions. How would you manage a brow presentation? A brow presentation is an absolutely impossible case of labor. The occipito-mental diameter of the fetal head, 13 1^ cm., attempts to engage, but can find no accommodation in the superior strait. The treatment consists in the perform- ance of cephalic version, bringing down the occiput and apply- ing forceps. If this be not possible, podalic version should be tried. In impacted cases with the child dead, craniotomy. with perforation through the bregma, becomes necessary. How would you treat a case of lateral presentation? Lateral presentations of the head, including the parietal eminence or the ear, should be treated by manual replace- ment, converting the presentation into a true vertex presen- tation. If this be impossible forceps may be applied or podalic version performed. Make a diagnosis of transverse presentation, and state how it should be managed. Give the frequency, causes, mechanism and management of such a case. A transverse, shoulder or trunk presentation occurs in about !/2 per cent, of all cases of labor. The causes are oversize of the fetal head, overgrowth of the entire fetus, fetal mon- strosities, mobility of the fetus, hydramnios, multiple preg- nancy, uterine deformities, undue obliquity of the uterus, uterine and pelvic tumors, placenta praevia. and traumatism, such as falls or jars. There is no mechanism for such a case, the labor being absolutely impossible. The condition may be recognized readily by external palpation, the child lying at right angles to the long axis of the maternal body. Vaginal examination reveals a high position of the presentation, and the shoulder or elbow may be palpated through the mom- 484 OBSTETRICS AND GYNECOLOGY. branes. There is but one thing to do in all transverse pre- sentations, namely, podalic version under full anesthesia. How should a hand presentation be managed? What course would you pursue if you found an arm projecting from the vulvar orifice? This would indicate a cross-birth. The arm should be left alone, and podalic version performed. A tape .may be tied around the wrist in order to prevent extension of the extremity during the process of turning; if the tape be held taut the arm is carried in front of the face and descends with the shoulders. What are the causes of precipitate labor, what are its dangers, and what is the treatment? Precipitate labor may be caused by an excess in the expul- sive power of labor or a deficiency in the resistant powers. The dangers to the fetus are asphyxiation from rupture of the cord or premature detachment of the placenta and injury from a fall upon the floor or into a commode. The maternal dangers are hemorrhage, fatal syncope from sudden evacua- tion of the uterine contents, inversion of the uterus, laceration of the cervix or perineum, and post-partum hemorrhage. The treatment of precipitate labor consists in a retardation of the advancing presentation in order to avoid the foregoing acci- dents. When the head is on the floor short forceps may be applied and the progress of the head arrested. What are the causes of delay in labor (a) on the part of the mother; (b) on the part of the child? The maternal causes of delayed labor are uterine inertia and obstruction in the birth-canal from any cause. The fetal causes are malposition and malpresentation, oversize, hydro- cephalus, fetal syphilis, fetal ascites, and other diseases caus- ing overgrowth of organs or distension of cavities. State the dangers and symptoms of a prolonged labor. The symptoms of prolonged labor are those of uterine iner- OBSTETRICS AND GYNECOLOGY. 485 tia (see below). The dangers are, for the fetus, fatal com- pression of the brain-centers and intra-uterine respiration, with inspiration of liquor amnii or other substances. The maternal dangers are pressure-necrosis, the development of sepsis, exhaustion and death, and postpartum hemorrhage. Give the causes, diagnosis and management of uterine inertia. Uteri a i m< rtia is that condition in which the uterine con- tractions are irregular, weak and ineffectual, not sufficing to induce dilatation of the os or expulsion of the fetus. The causes are idiosyncrasy, advanced age of the woman, multi- parity, emotion, temporary paralysis of the uterine muscles, as from over-distension, weakness of the muscle, and any cause preventing the hydraulic action of the liquor amnii. The symptoms are weak, infrequent and irregular contractions, slight suffering, and slow or no advance of the fetal presen- tation. In the first stage of labor quinin may be adminis- tered in large doses and a firm abdominal binder applied ; strychnin during the last weeks of pregnancy has a tendency to increase the efficiency of the uterine contraction. In the second stage of labor forceps should be applied, and ergot must be used after the delivery of the child in large doses to prevent post-partum hemorrhage. What is the proper management of rigidity of the os uteri in labor? Rigidity of the cervix is common in elderly primipane and in those suffering from uterine inertia; it may result from cicatrices and from cancerous involvement of the cervix. The treatment consists in the administration of large doses of chloral, hot vaginal douches, anesthesia, cocain to the cervix, digital divnlsion. or incision. Give the diagnosis and treatment of hour=glass contrac- tion of the uterus. Hour-glass contraction of the uterus is an irregular con- traction of the uterus, usually occurring before the escape of 486 OBSTETRICS AND GYNECOLOGY. the placenta, which is retained above the ring of Bandl. The latter appears to be in an abnormal state of contraction. Digital exploration traces the cord up to the contracted ring. Treatment consists in digital divulsion of the contracted por- tion, followed by removal of the placenta and antisepsis of the cavity. Give the causes, symptoms, diagnosis and prognosis of rupture of the uterus during labor, and state how such an accident should be managed. The exciting causes of uterine rupture during labor are some insuperable, obstruction to the delivery of the child, misdirected or injudicious efforts at version, and tetanic ac- tion of the muscle of the upper uterine segment from the administration of ergot. The predisposing causes are dimin- ished tonicity of the uterine walls, undue prolongation of labor, fatty degeneration of the uterine muscle, or a previous operation upon the uterus. The site of the rupture is usually in the lower uterine segment. The symptoms are sudden acute lancinating pain, immediate collapse, signs of internal hemorrhage, an anxious expression, pallor, rapid running pulse, recession of the presenting part, the presence of two distinct tumors, and the ability to detect the rent by the examining finger. The prognosis is grave; the maternal mortality is 55 to 60 per cent. The treatment consists in immediate evacuation of the uterine contents, and if the tear has not completely perforated the uterus the patient may be watched carefully for the development of sepsis. In com- plete laceration an abdominal section must be performed and the tear sutured aseptically. Make a differential diagnosis of intrauterine and extra= uterine hemorrhage. In the former there will be noted either a free escape of blood per vaginam or a rapidly distending uterine body, asso- ciated with the symptoms of hemorrhage. In the latter the signs of concealed hemorrhage will be present, and vaginal OBSTETRICS AND GYNECOLOGY. 487 examination will reveal the presence of a boggy mass in the abdominal cavity and in Douglass' cul-de-sac. Give the diagnosis, causes and treatment of pelvic hematocele. Pelvic hematocele results generally from rupture of an extra-uterine pregnancy. It may result from rupture of varicose veins in the broad ligament. It is recognized by the signs of concealed hemorrhage and a rapidly increasing boggy- mass in Douglas' cul-de-sac. The only treatment is abdom- inal section and ligation of the bleeding point. Name three important forms of hemorrhage occurring in obstetric practice. Antepartum hemorrhage, or that occurring in the last tri- mester of pregnancy. This may be due to placenta praevia or premature separation of the placenta. Intrapartum hem- orrhage is that occurring during the progress of labor, as in the case of uterine rupture or inversion of the uterus. Post- partum hemorrhage is that form occurring immediately after labor. What is placenta praevia? Name its causes, varieties, symptoms, dangers and management. Placenta previa is that condition in which the placenta is attached to the lower uterine segment, and presents in front of the fetus. It may be complete or central {placenta cen- tralis), lateral, marginal and parietal. The cause of placenta praevia is unknown. It has been said to be due to uterine subinvolution, low fixation of the ovum, and downward growth of the decidua reflexa. There is but one symptom, namely, free and painless hemorrhage, occurring at decreas- ing intervals and in increasing quantity. The dangers are fetal and maternal death from asphyxia, hemorrhage, air- embolism, and septic infection. The treatment consists in rapid dilatation of the os and delivery of the fetus by version, or in the marginal form the application of the forceps and 488 OBSTETRICS AND GYNECOLOGY. rapid engagement of the head. In the central variety the hand must be carried directly through the placenta. Mention two distinct methods of dilatation of the cervix uteri in obstetric practice. Edgar's method consists in bimanual stretching and par- alyzing of the cervical muscle. The index and middle fingers of both hands are introduced into the cervix, which is gradu- ally but forcibly stretched in various directions. Another method is the use of bags, such as Barnes' or those of Cham- petier de Ribes and Voorhees. What are the dangers of traction on the child and on the placenta? Traction on the cord may cause premature separation of the placenta. It may cause rupture of the cord or avulsion of the cord from the placenta, or it may result in inversion of the uterus. What is inversion of the uterus, what its causes and symptoms, and how is it recognized? By this term is meant a turning of the uterus inside out, either completely or in part. It may occur spontaneously, the uterine fundus or placental site being temporarily par- alyzed and sinking in ; it may result from traction on the cord, the placenta not yet having separated ; or it may follow suction from close fitting of the detached placenta in the lower uterine segment and traction being made upon the cord. Other causes are vigorous Crede manipulations and violent bearing down on the part of the woman. The symptoms are acute pain, hemorrhage, shock, bearing down, and the appear- ance of a tumor in the vagina. This may be mistaken for a uterine polyp, but the surface of the latter will be covered with the normal uterine mucosa, while the inverted uterus will show decidual tissue and the site of the placental attach- ment ; the orifices of the Fallopian tubes may also be detected. The treatment of acute inversion consists in immediate re- OBSTETRICS AXD GYNECOLOGY. 489 placement, followed by the introduction of a strip of gauze to prevent recurrence. Give the causes, pathology, symptoms and prognosis of eclampsia gravidarum, and state the relative frequency in primiparae and multiparae. What is the treatment? Puerperal eclampsia or puerperal convulsion is a convul- sive or epileptiform seizure appearing suddenly in a woman prior to, during or shortly after labor, and characterized by tonic and then clonic convulsions of the muscles, with albu- minuria, coma and death. The great majority of cases occur in primiparae — about 75 per cent. Other causes are heredity, climatic influence, multiple pregnancy, extreme anemia, and nervous excitability, all acting as predisposing influences. The true cause is the presence in the blood of toxins, probably of hepatic origin, which cause a general arteriole contraction ; as a consequence there follows an anemia of the base of the brain and a corresponding cortical congestion. The symp- toms are fixing of the eyes, tonic contraction of the facial muscles {sardonic grin), lividity, rapid involvement of all the trunk muscles, distension of the superficial veins, and frothing at the mouth. The paroxysm lasts from y 2 to 2 minutes. It is followed by increasing coma and a rise of temperature. The urine becomes loaded with albumin. The prognosis is grave ; 30 per cent, of the women and 50 to 74 per cent, of the children perish. The causes of maternal death are asphyxia, cerebral apoplexy, syncope, pulmonary edema, and exhaustion. The fetus dies of asphyxia. The prophylactic treatmenl is the treatment of the kidney of preg- nancy. During the attack chloroform must be administered. A rim- the spasm, if the patient be plethoric, venesection to the amount of 20-25 ounces may be performed, followed by the introduction of normal saline solution into the tissues. Croton oil 1 to 3 drops, chloral hydrate 30 grains by the rec- tum, ami veratrum vir'nlc 1 5 drops of the fluid extract hypo- dermieally may be administered. A hoi pack aids in the elimination of the poison. The nterus should be emptied as soon as possible in order to still further relieve the system. 490 OBSTETRICS AND GYNECOLOGY. Give the danger signals of impending eclampsia. Rapidly lessening amount of urates in the urine; lessened urinary toxicity, the development of eye-symptoms, including musca? volitantes, scintillations and blindness, and neuralgic pains over the eyes, under the clavicles and in the epigastrium. In case eclampsia gravidarum appears before the end of the eighth month how should it be managed? By dilatation of the os and removal of the child by forceps or version. The course of treatment already indicated should be adopted. What are the varieties of puerperal convulsions, and how are they differentially diagnosed? A puerperal woman may suffer from various convulsive seizures, including the true puerperal eclampsia. She may have an anemia or an hysteric convulsion, or one due to ner- vous irritability. A true epileptic convulsion may occur, but this is not accompanied by albuminuria, has not the same prodromata nor the rise of temperature, and there is, as a rule, a definite history of previous attacks. Meningitis is accom- panied by vomiting, optic neuritis, opisthotonos, and a rise of temperature before the onset of the convulsions. When is curettage of the uterus justifiable in obstetric practice, and how should it be performed? Curettage is required whenever there has occurred a reten- tion of some of the products of conception either after abor- tion or labor. The best curet is the finger of the obstetrician, but if this will not answer the dull curet may be employed or the placental forceps, under thorough asepsis and anti- sepsis. In curetting the uterine cavity the walls should be scraped systematically and without great pressure. The dangers are hemorrhage and perforation. Define puerperal mania. Give its etiology, symptoms and treatment. Puerperal mania is the most common form of puerperal OBSTETBICS AND GYNECOLOGY. 491 insanity, or insanity occurring during the lying-in period. It may result from heredity, primiparity. anxiety, dystocia, and septic infection. Some authorities attribute all the cases to septic infection. The disease appears with alarming ab- ruptness. Without warning the patient becomes maniacal or wildly delirious, and suffers from the most peculiar hallu- cinations. A homicidal or suicidal tendency is common. 25 to 35 per cent, of the cases die from exhaustion or from septi- cemia, or remain permanently insane. The patient should be confined in a hospital and given nerve-sedatives, bromids. hyoscin, trional, sulfonal and tonics. Rest and mental diver- sion are essential. What hygienic precautions are necessary for a nursing child if the mother has sore nipples? If the nipples are fissured the child may suck in blood and suffer from hematemesis. It should temporarily be fed on the bottle or from a spoon, but returned to the breast as soon as the nipple will permit. An artificial nipple may also be used. Give the management in a case of (a) flat or inverted nipples, and (b) cracked nipples. A flat or inverted nipple requires gentle traction and manip- ulation during the last weeks of pregnancy, or more powerful suction through a breast-pump. If this does not succeed an artificial nipple must be employed. Fissured nipples should be kept clean and dry, and anointed between the nursins with sweet oil. In worse cases healing applications are neces- sary, as ichthyol in lanolin or glycerin, or I dram each of bismuth subnitrate and castor oil, compound tincture of ben- zoin, or a 4 to 8 per cent, solution of silver nitrate after cocainization. The child should not nurse from these nipples. Give the varieties, pathology, symptoms and treatment of puerperal mastitis. Mastitis or inflammation of the mammary gland may be suppurative or non-suppurative. It is almost always due to 492 OBSTETRICS AND GYXECOLOGY. septic infection occurring through a fissured nipple. Occa- sionally it may result from caking of the breasts or milk- stasis. The pathology consists essentially in an acute inflam- mation of the cellular tissue of the gland. The symptoms are acute pain, inflammation, reddening of the surface, indu- ration, malaise, elevation of temperature and headache. The treatment consists in hot compresses of lead-water and laud- anum, the ice-bag, the application of a mammary binder, and ichthyol or belladonna locally; the child should not nurse. The bowels should be opened. Give the symptoms and treatment of mammary abscess. If mastitis advances to suppuration the symptoms will change. This is most common in the third or fourth week of the puerperium. The pain becomes dull and throbbing; rigor or chills are noted ; the fever becomes hectic in type ; the indurated portion of the breast becomes softer at a certain point, and fluctuation may be noted ; the surface of the gland becomes edematous, livid and glazed. AVhen the abscess is situated deeply in the areolar tissue just above the pectoral muscles a postmammary or submammary abscess results. In this case the pus is very apt to burrow, and the gland is raised from the chest and becomes protuberant. The treatment of abscess is early incision, the line of incision radiating from the nipple ; the wound should be bathed in mercuric chlorid (1:4000) and packed with sterile gauze. What is the treatment of galactorrhea? Galactorrhea is an excessive flow of milk from the engorged breasts. It may be corrected by feeding the infant at regular intervals, and between the feedings the breast-pump may be employed to remove the excessive flow. Ergot may be admin- istered in small amounts, potassium iodid given in doses of 10 grains three times daily, and belladonna ointment applied locally, or a 5 per cent, solution of cocain in equal parts of glycerin and water. OBSTETRICS AND GYNECOLOGY. 493 To what dangers in pregnancy and labor does gonorrhea of the mother expose her and her offspring? During pregnancy a gonorrheal woman may develop a pus- tube, which may rupture or cause an abortion and expose her to the development of septic infection. A gonorrheal woman is always in imminent danger of puerperal sepsis after the delivery of her child. The child is exposed to the danger of ophthalmia neonatorum. Give the symptoms, treatment and prognosis of oph= thalmia neonatorum. State its causes and the means of prevention. Ophthalmia neonatorum is a purulent inflammation of the conjunctiva of the infant due to infection at birth by gonor- rheal virus contained in the uterine and vaginal discharges. It is very virulent, and frequently results in total loss of sight from perforation of the cornea and destruction of the super- ficial tissues. The symptoms are reddening and edema of the palpebral, agglutination of the lids, profuse purulent dis- charge, a bright-red appearance of the conjunctiva?, and later ulceration and perforation of the cornea. The prognosis is good unless corneal ulceration occurs. The treat un ni is mainly prophylactic and this consists in frequent vaginal douching during labor, and. immediately after the birth of the head, cleansing of the eyes with warm sterilized water. followed by the instillation of a few drops of a L' per cent, solution of silver nitrate. After the disease has appeared the cleaning must be done hourly | Creole's nn thod < with warm water, followed in alternate hours by mercuric chlorid 1 to 5000 to 8000, and a saturated solution of boric arid. Twic< daily an application of silver nitrate 4 per cent, solution maj be used. The well eye should be protected with a collodion dressing. Give the pathology of hydrocephalus. State how hydro- cephalus may be recognized before delivery, and how such a complication should be dealt with. Hydrocephalus is a collection of serous fluid at some pojnl 494 OBSTETRICS AND GYNECOLOGY. within the cerebral substance (internal hydrocephalus) or outside the brain-substance (external hydrocephalus), pre- venting closure of the fontanels and causing enlargement of the skull. It is probably a sequel of some obscure form of inflammation of the cerebral meninges. The vaginal finger detects bulging fontanels and widely separated sutures, both yielding the sensation of fluctuation. Occasionally crepita- tion may be noted. Abdominal palpation reveals an unusual size of the head. The treatment consists in aseptic puncture through a fontanel or suture; if this fails craniotomy is indi- cated. How may multiple (twin) pregnancy be recognized? State how it may complicate labor, and show how labor should be managed when this condition exists. A twin pregnancy may be recognized by the unusual size of the abdomen, by the presence of two distinct fetal heart- beats, heard best at different points of the abdominal surface ; there may be two distinct placental souffles, irregularity in the outline of the uterus, the presence of a number of fetal extremities or parts, and the ability to outline two fetuses. The dangers are uterine inertia, abnormal presentations, im- perfect development of the fetuses, the formation of mon- strosities, and locking of the babies. The first child present- ing normally, labor should proceed normally; after its birth the second child should be made to present in a proper man- ner, and then 1 dram of the fluid extract of ergot should be administered. Not infrequently a forceps-delivery is re- quired. What complications may arise in a twin labor, and how may they be overcome? Malpreseritation and malposition are frequent and must be corrected. Locking of the heads requires separation of the chins, the application of forceps or decapitation. What is superfetation, and how does it take place? Superf etation is the supposed fertilization of an ovum when OBSTETRICS AND GYNECOLOGY. 495 there is another from a previous ovulation in uterogestation. There is considerable doubt as to the possibility of such an occurrence. If it does occur it will probably take place within the first few days after the primary conception, i. e., before the formation of the decidua. The occurrence of superfeta- tion at a more advanced stage in the development of the pri- marily fertilized ovum seems, however, to have been proved by remarkable cases reported by eminent men. What is meant by prolapse of the funis? When does it occur? What are its dangers? How would you manage such a case? Prolapse of the cord consists in the descent of a loop of the umbilical cord in advance of the presenting fetal portion. It occurs in certain malpositions and malpresentations of the fetus, in multiple pregnancy, in hydramnios with sudden escape of the liquor amnii, and in contracted pelvis when the fetal head does not properly fit into the superior strait. The danger is fetal death from asphyxiation due to pressure on the cord. The treatment consists in replacement of the cord, the woman resting in the knee-chest or Trendelenburg post- ure. This may be accomplished by gravity, aided by the hand or by a repositor. If this fails, podalic version may be per- formed or the child hastily delivered by forceps. What is premature respiration? The establishment of the function of respiration before delivery of the child has been accomplished. This is due to the entrance of air into the birth-canal, and occurs in cases of dystocia or during the performance of version. The dan- ger is insufflation of liquor amnii or clots, with the develop- ment of fetal pneumonia. How does constitutional syphilis in the parents affect the infant, and how can you detect its presence in the infant? The offspring of syphilitic parents is generally infected by the disease. Congenital syphilis will be shown by the follow- 496 OBSTETRICS AND GYNECOLOGY. ing symptoms: Undersize of the fetus, delivery at term of a still-born baby, syphilitic pemphigus on the palms and soles, enlargement of the liver and glands of the body, catarrhal or white pneumonia, and a line of fatty tissue between the epi- physis and diaphysis of the long bones. If the child be born alive and apparently healthy it will develop a coryza or "snuffles" at the expiration of four or five weeks, followed by the appearance of eruptions over the body and the devel- opment of marasmus. Give the causes and treatment of umbilical hemorrhage of the new=born child. Primary omphalorrhagia results from loose ligature or laceration of the cord, and occurs immediately after birth. Secondary hemorrhage occurs at the time of separation of the cord, and is due to a dislodgement of the clots or to the hem- orrhagic diathesis. The treatment consists in religation of the cord, the application of a firm compress with an astringent solution, the application of a firm plaster of Paris dressing, or of a figure-of-eight ligature applied over hare-lip pins. How would you decide whether a dead infant had been born alive? By the presence of air in the lungs (hypostatic test). What are the causes of stilUbirth, and how should a stilUborn child be treated? The causes of still-birth are various intra-uterine diseases, asphyxia from pressure on the cord or interference with the fetoplacental circulation, as in eclampsia or premature sepa- ration of the placenta, and traumatism during some obstetric operation. Such a child should be handled tenderly and be given a decent burial. The term "still-birth" should not be confounded with asphyxia neonatorum. Give the etymology and uses of the forceps, and name the conditions for their application, together with the rules therefor and precautions to be observed in the same. The obstetric forceps (a Latin word) is an instrument with OBSTETRICS AXD GYNECOLOGY. 497 two blades and handles for pulling, grasping or compressing the fetus. Its use is indicated by the presence of uterine inertia, minor degrees of pelvic contraction, threatened fetal or maternal life, and to correct malpositions of the fetal head. In order that the instrument may be applied the os must be dilated, the membranes ruptured, there must not be too great disproportion between the head and the birth-canal, the part should be engaged, and the labor must be possible. The left blade is always introduced first, and must be grasped in the left hand and carried to the left side of the patient. It must not be forcibly thrust in, but must be slightly rotated in order to accommodate it to the pelvic and fetal curves. The blade that corresponds in name to the pelvic diameter in which the fetal presentation is lying must be pried forward in order to grasp the fetal head on the sides. Describe the common varieties of obstetric forceps. A short forceps is one in which the blades are attached directly to the handles without the intervention of a shank: il has the cephalic curve only, and is used only when the head is on the pelvic floor (low forceps operation). The long for- ceps is one in which a shank is placed between the handles and the blades; it has a pelvic curve, as well as the cephalic. It may be used at the superior strait, but usually applied to the head in the pelvic cavity (median forceps operation) . The axis-traction forceps is a long forceps, in which, by an appliance or supplementary handle attached to the under surface of the blades, the traction force is constantly exerted in the line of the axis of the parturient canal. It is used at the superior strait [high forceps operation . Describe the position of patient and physician for the readiest means of applying the forceps. The patient in this country lies upon her back in the litho- tomy position, with the limbs flexed and the buttocks over the Bide of the bed. The physician sits on a chair between the thi<_ r hs. which are separated and held by assistant 498 OBSTETRICS AND GYNECOLOGY. In what direction should traction be made when the fetal head is in the cavity of the pelvis? At first downward and outward, then upward and backward. What powers may be exerted by the forceps? The forceps are generally used as tractors. They may be employed as levers, rotators and compressors. What are the dangers in the use of forceps, and how are such dangers to be avoided? The dangers are slipping of the instrument, septic infec- tion, laceration of the cervix and soft tissues, and fatal com- pression of the fetal head. If applied gently, without force, and in the proper (less) diameters of the fetal skull, and if thorough asepsis be employed, these dangers may be obviated. Describe the technic of the high forceps operation. The instrument (axis-traction forceps) must be introduced through the cervix, and applied to the head in the best diam- eter possible. The grip is a vicious one, because a large diam- eter must be seized and there is danger of slipping. Traction is made well down at first, and as the head descends and the upper handles of the instrument rise the extra handles must be raised in order to keep the two handles together. When the head is low enough the instrument should be withdrawn and reapplied in a better position, or a simple instrument used. Describe the occasion for the application of the forceps in the inferior strait. This is a low operation. The blades are introduced in the manner already described, and traction made outward and downward until the floor is reached. The head is then pulled upward and outward and then upward and backward until it emerges through the vulvar orifice. The instrument in the last stage of delivery is grasped in the right hand only, as a dagger would be held, and the left hand spans the perineum in order to regulate the degree of distension. OBSTETRICS AND GYNECOLOGY. 499 Describe the use of the forceps in the occipito=posterior position. This is a double forceps-operation. The occiput generally lies in the right oblique diameter (R. 0. P.). After applying the forceps in the manner already described traction is made downward and outward until the head impinges upon the pelvic floor. In the intervals of relaxation a certain amount of anterior rotation will take place. This will carry the occi- put through the transverse and into the left oblique diameter. The forceps must then be removed and reapplied in the new diameter to prevent inversion of the instrument. The final traction and delivery are as in the ordinary anterior forceps- delivery. What indications would lead you to insert a hand into the uterus, and what precautions should you observe? Failure of the placenta to descend, active post-part urn hemorrhage, and the necessity for the performance of version are the indications for the introduction of the hand into the uterus. Thorough asepsis and antisepsis must be observed, and the hand must be anointed with an antiseptic ointment. Define version. Give the varieties, indications and dangers of version, together with the preliminaries and the method of operating. Version or turning is an obstetric operation whereby by manual efforts the position of the fetus in utero is altered bo that one extremity of the fetal ellipse is made to take the place occupied by the other extremity or by some portion of the trunk. The varieties of version are: 1. Cephalic, in which the head is made to present: '_'. Pelvic, in which the breech is caused to present at the superior strait; and 3. Podalic, in which one or both feet are grasped and drawn down into tho parturient canal. The indications for version are malposi- tion of the head and malpresentations, minor degrees of pelvic contraction, placenta praevia, anything Indicating speedy delivery of the child. ;is threatened Petal or maternal life, and 500 OBSTETRICS AND GYNECOLOGY. sudden death of the mother. The dangers of the operation are the introduction of septic matter or of air, with the pro- duction of air-embolism, rupture of the uterus, laceration of the cervix, and serious fetal injury. The patient should be anesthetized, and every antiseptic precaution observed. The membranes should not be ruptured until the hand is ready to be introduced. One foot should be grasped with the heel in the palmar surface and the child gently turned to avoid undue distension of the lower uterine segment. After the body is turned the case is treated as a breech presentation. Compare version with the employment of forceps, and state when each is preferable. Version is a shorter operation, and one that is to be pre- ferred when haste is required. The dangers of sepsis are greater than in the use of forceps, and also the danger of uterine rupture. Version should be used when the forceps fail to engage the head in minor degrees of pelvic contraction. Version cannot be employed when engagement has occurred or when there is a high position of Bandl's ring. Describe symphyseotomy, and give the indications for its performance. Symphyseotomy or division of the pubic symphysis is an extremely limited operation. It should be done, if done at all, only in those cases of pelvic contraction in which the con- jugate diameter of the superior strait measures from 7 to 8 cm. The operation of choice is the indirect method, in Which an incision iy 2 to 2 inches long is made above the symphysis in the median line, and after separation of the muscles the Galbiati knife is passed down beneath the symphysis and the bone divided from below upward and from within outward. As the symphysis separates gauze is packed in to arrest hem- orrhage. The forceps is then applied and the child extracted. After delivery the wound is closed and the bones held in appo- sition by means of a firm pelvic binder. OBSTETRICS AXD GYNECOLOGY. 501 Define embryotomy and craniotomy, and give the indi= cations for and method of operating in each. Embryotomy is any mutilating operation upon the fetus. It includes decapitation or beheading of the fetus, amputa- tions of the fetal extremities, evisceration, or removal of the viscera piecemeal, and craniotomy, or opening of the fetal skull, with evacuation of the brain. The technic of crani- otomy is as follows : Vaginal asepsis, fixation of the head and scalp with volsella-forceps, perforation through a suture or fontanel, enlargement of the perforation, disorganization of the brain-mass, decerebration by intra-cranial injections of warm carbolized water, crushing of the skull, and extraction of the head by the craniotractor. Give the various steps in embryotomy in the transverse presentation. If the fetus presents by the back, the operation of spon- dylotomy or division of the vertebrae is indicated, followed by evisceration or by delivery of the fetal body doubled upon itself. Spondylotomy or rachiotomy is performed by means of scissors, as is also evisceration. Occasionally in impacted shoulder presentations the operation of decapitation will be indicated. This can be accomplished by means of the blunt or the sharp hook or by scissors. The body is readily re- moved, and the head must then be grasped by forceps, crushed and extracted. Give the condition requiring Cesarean section or hys- terectomy, and describe a modified form of the operation. Cesarean section or delivery of the child through an abdom- inal and uterine incision is indicated in grave degrees of pel- vic contraction, in labor obstructed by tumors of the uterus and pelvis, in irreducible vagina] tumors, in rupture of the uterus, and in sudden maternal death. The original Cesa- rean section, in which an incision was made into the uterine wall and the child extracted, has been modified by Sanger as follows: The alnlomen is opened m the median line, the uterus 502 OBSTETRICS AND GYNECOLOGY. delivered and towels packed around it. Then while the uter- ine arteries are controlled by an assistant an incision is made into the uterus and the child and placenta extracted. The uterine cavity is cleaned out and sutures introduced to close the uterine incision, after which the abdominal wound is closed. Define Porro's operation, state when it is applicable, and describe the method of its performance. The Porro operation or celiohyst erect omy consists in the extirpation of the uterus and its appendages after the extrac- tion of the fetus, as in the simple Cesarean section. The indi- cations for this operation are extreme degrees of pelvic con- traction, marked atresia of the cervix, vagina or vulva, the presence of large bony growths in the plevic canal, large fibrous or myomatous tumors of the uterus, extensive rupture of the uterus, with involvement of adjacent structures, a relaxed and flabby condition of the uterus after the section, and a septic condition of the uterus, with threatened general septic infection. The operation is the same up to extraction of the child. The ovarian and uterine arteries are then ligated and the uterus amputated at the cervical junction. The case is then treated as an ordinary abdominal section. What complications in labor justify abdominal section? Give the technic of the operation. The conditions that indicate Cesarean section, rupture of the uterus, retrodisplacement of the' uterus with incarceration, extra-uterine pregnancy, labor complicated with tumors, grave septic infection of the uterus, appendages or broad ligament, all indicate abdominal section. The technic is that of Cesa- rean section with or without the removal of the uterus. Describe the malformations of the uterus. Owing to failure of development of the ducts of Miiller we have varying degrees of doable uterus. The slightest degrees are known as uterus incudif ormis and uterus cordiformis. From these minor degrees the uterine deformity may advance OBSTETRICS AXD GYNECOLOGY. 503 through the stages of uterus septus, subseptus, partitus, bi- partitus, bilocularis and semipartitus. In the uterus bicornis the two tubes unite below, but are separated above. The uterus unicornis results from a lack of development of one of the Miillerian ducts, its fellow undergoing the normal process of evolution. Describe and differentiate anteversion, retroversion and prolapsus of the uterus. State the obstetric significance of each. Anteversion of the uterus is a bending of that organ for- ward; retroversion is a bending backward; prolapsus is a falling down or descent of the organ. Anteversion may prevent a rising of the uterus if the organ be fixed, and so interfere with pregnancy. Retroversion of a pregnant womb may result in incarceration with serious results. Prolapse does not as a rule interfere with gestation ; the uterus returns to its normal position as gestation advances. Mention the symptoms and give the management of long=retained excretions due to imperforate hymen. In addition to menstrual suppression there will be noted cramp-like pains and a steadily growing cystic tumor in the median line of the abdomen. Palpation will elicit pain. Va- ginal examination will show the imperforate condition of the hymen. The treatment consists of thorough asepsis, followed by cervical incision into the hymen. As the tarry fluid es- capes a two-way catheter should be introduced and an anti- septic solution allowed to flow into the uterus in order to prevent shock from sudden evacuation and to prevent septic infection. What is vaginismus? How may it be recognized and treated? Vaginismus is painful spasm of the vagina and vulva. It results from rigid hymen, fissure and other local conditions. ami appeals at the time of coitus or digital exploration. It is best treated l>v dilatation under anesthi 504 OBSTETRICS AND GYNECOLOGY. • What methods should be employed to dilate the non= pregnant uterus, and under what circumstances is the operation justifiable? The best method of dilating the uterus is the use of the dilator of Goodell or Wathens, the glove-stretching apparatus. This is required whenever there is stenosis of the cervical canal, or as a preliminary step to the operation of curettage. Is, ventrofixation of the uterus justifiable? If so, state under what circumstances, and describe the operation. It is a safe and proper operation for the correction of retrodisplacement of the uterus in women past the child- bearing period. An abdominal opening is made, the uterus is brought forward, and a stitch is passed through the peri- toneal and subperitoneal tissues on one side of the incision, then through the fundus of the uterus on a line with the Fallopian tubes and through the corresponding tissues on the other side. A second suture must be passed a little back of this and firmly secured. The abdominal wound is then closed. Under what conditions may shortening of the round ligament become justifiable, and how should the operation be performed? Shortening of the round ligament may be performed when there is a retrodisplacement of the uterus. It is best per- formed by Wylie's method or some other of the intraperitoneal methods, the ligaments being folded upon themselves or im- planted further back upon the uterus. Alexander's opera- tion is shortening of these ligaments in the inguinal canals. Define salpingitis, state its causes and pathology, and give its management. Salpingitis is inflammation of the Fallopian tubes. It may be septic, gonorrheal or tuberculous in origin, or merely a catarrhal condition. The mucosa swells, secretes a fluid, and if the edges of the fimbria? adhere a retension-cyst is formed. The treatment may be derivative, and consist in purgation, with local applications to the cervix and vaginal vault, or • OBSTETRICS AND GYNECOLOGY. 505 abdominal section may be performed and the appendages removed. Give the pathology of (a) hydrosalpinx, (b) hematosaU pinx. Give the diagnosis and treatment of each. Hydrosalpinx, or a watery collection in the tube, results from an old pyosalpinx or purulent collection. The pyogenic membrane has become destroyed, and the fluid slowly assumes the watery nature. II on otosalpinx, or blood in the tube, results almost invariably from an extra-uterine pregnancy. The treatment of each is excision. The diagnosis is made by the presence of a sensitive tumor in the situation of the tube, with pain on the affected side. Define endometritis, and give its causes, varieties and treatment. Endometritis, or inflammation of the lining membrane of the uterus, may be septic, gonorrheal, traumatic, catarrhal or tuberculous in origin, and occur as a glandular or as an interstitial affection, or as both combined. It may be treated by local applications, depletion, curettement, intra-uterine applications, or by excision of the uterus. Give the causes of pelvic inflammation, and state its relation to involvement of the ovary. Pelvic inflammation is generally septic or gonorrheal in origin. It may result from exposure to cold or wet or from abrupt stopping of the menstrual discharge. If active and virulent or long continued there follows a thickening and chronic inflammation of the ovarian capsule, which will result in follicular cysts forming in the ovarian stroma from in- ability of the Graafian follicles to rupture. Give a differential diagnosis between ovaritis and ovaralgia. Ovaritis, or inflammation cst antidote if 536 THERAPEUTICS AND MATERIA MEDIC A. the morphine is in the stomach ; black coffee is also of value. (c) Chloral hydrate has caused death in several instances by a 30-grain dose. Atropine and morphine are its antidotes. Write a prescription containing the tincture of the chlor= ide of iron and the chlorate of potash, with the proper dose for a child four years old. Jan. 1, 1903. John Smith. R . Potassii chloratis gr. xvi. Tincture ferri chloridi f 3 iss Ext. gl vcerrkizte 3 i Aqua?, q. s. ad f 5 iv Sig. — A teaspoonful in water every three hours. John Jones, M. D. Criticize the following prescription: Tr. guaiac f 3 i Aq. cinnamon. f ^ ii Sig. — A teaspoonful every four hours. 5,12/99. Ds. J. This is an example of pharmaceutical incompatibility. An alcoholic tincture should not be prescribed with aqueous solu- tions, nor should resinous tinctures be combined with aqueous solutions. What is the source of carbo ligni? What are the thera= peutic uses of carbo ligni? Carbo ligni is charcoal derived from soft wood. It is em- ployed as an absorbent of foul gases and as a deodorant and disinfectant. Internally it is useful in affections of the gastro-intestinal tract associated with hyperacidity and flatu- lent distension. Give the dose of (a) caffein, (b) wine of ipecac. (a) 1 to 5 grains; (b) y 2 to 6 fluid drams. What are the therapeutic uses of convallaria majalis? Lily of the valley possesses actions analogous to digitalis, strengthening the heart and increasing the flow of urine; it does not disturb the stomach and is not cumulative in its effects. THERAPEUTICS AXD MATERIA MEDIC A. 537 Define a general anesthetic. Mention three general anesthetics in common use. A general anesthetic is a drug which when inhaled suffi- ciently produces complete unconsciousness and loss of sensa- tion, also lessened motor power. The general anesthetics mostly belong to the alcohols and ethers. Ether, chloroform and nitrous oxide are three examples of such drugs. Mention three principal salts of potassium used in medi= cine and give the dose of each. Potassium bromide, dose y 2 to 2 drams; potassium acetate, dose y 2 to 1 dram ; potassium bicarbonate, dose y 2 to 1 dram. Of what is duboisin an alkaloid? What are the physio= logic effects of duboisin? Duboisin is the alkaloid of duboisia ; it is believed to be identical with hyoscyamine, and strongly resembles atropine. It is a prompt mydriatic. In moderate doses it induces quiet and refreshing sleep, and is not dangerous. When given in large doses it may produce vertigo, nausea or syncope. It is less irritating to mucous membranes than atropine. What are the therapeutic uses of nitro=glycerine? By what other names is nitroglycerine known? Xitro-glycerine is also known as glonoin and trinitrin. It is valuable in certain forms of cardiac disease, especially in sudden heart failure, angina pectoris and fatty degeneration of the heart. It relieves the high arterial tension and the dyspnea of chronic nephritis. Define materia medica, therapeutics. Materia medica treats of the substances used as medicines and describes their origin, composition, chemical properties, modes of preparation and administration, also their physio- logic and toxicologic actions. Therapeutics comprises all the science and art of healing, including the use of medicines and all other agents given with the object of curing dis< 538 THERAPEUTICS AND M ATE EI A MEDIC A. What are the therapeutic uses of sulphur? Externally it is of value as a stimulant and parasiticide in diseases of the skin of chronic type. Internally it is a mild laxative. It is of use both internally and externally in chronic articular rheumatism. Outline the general treatment of acute articular rheu= matism. Write a prescription containing at least two ingredients for an adult to relieve pain in acute articular rheumatism. Rest in bed is essential. The joints should be wrapped in cotton-wool. The nourishment should consist of milk, beef tea, broths and gruel. The free use of lemonade or mineral waters is advisable. The best remedies are the salicylates and the alkaline salts of potassium. The following is a useful combination : R . Sodii salicylat 3 ii Potass, citrat. 3 iii Glycerin i. Tinct. cardamom, comp aa f 3 ss Aqua 3 , q. s. ad f % v. M. Sig. — A tablespoonful every two hours. What are the therapeutic uses of strophanthus? Men= tion the dose of the tincture of strophanthus. Strophanthus is a valuable cardiac tonic, and may be em- ployed in the class of cases in which digitalis is indicated. The dose of the tincture is 3 to 10 minims. Define official preparations as applied to preparations of medicinal agents. All of those drugs which have gained entrance to the Phar- macopoeia are termed official preparations. What are the therapeutic uses of cardamom? It is used as an agreeable aromatic for disguising the taste of other drugs and as a carminative. THERAPEUTICS AND MATERIA MEDIC A. 539 What is the common name of staphisagria? What are the therapeutic uses of staphisagria? Staphisagria, stavesacre, is an unofficial drug. It is a vio- lent emetic, cathartic and parasiticide. Mention the preparations of ammonia. What effect has ammonia on the heart? The official preparations are aqua amnioniae, aqua ammoniae fortior, linimentum ammonias, spiritus ammonias, spiritus ammoniae aromaticus. Moderate doses of ammonia increase the strength and rapidity of the heart, and this effect is pro- duced by a direct stimulation of the heart and its accelerator nerves. Write a compound prescription for an adult containing iron, quinine and opium in pill form for neuralgia. Jan. J, 1903. John Smith. H . Pulveris opii • gr. i Ferri sulphatis exsiccate, Quinine sulphatis. aa gr. x.\. M. et fiant in pilulse No. 20. Sig. — One every four hours. John Jones, M. D. Define tincture and spirits. Tinctures are alcoholic solutions of medicinal substances. Spirits are alcoholic solutions of volatile substances, which may be solids, liquids or gases. Tinctures, with the exception of the tincture of iodine, are made from non-volatile bodies. Mention three drugs used to accelerate the action of the heart and give the dose of some preparation of each. Atropine, dose of atropine sulphate 1-150 to 1-75 grain. Nitro-glycerine, close 1-100 grain. Ammonia, dose of the aromatic spirits 20 to 60 minims. Give the treatment of obstinate hiccough. Rhythmic traction of the tongue will often arresl obstinate hiccough. -Ether as a spray to the epigastrium for ten min- utes, then to the site of the phrenic in the neck, is also ad- 540 THERAPEUTICS AND MATERIA MEDICA. vised. Morphine hypoderniically, either alone or in combi- nation with atropine, has sometimes proven effective. What is the physiologic effect of cocaine on the ocular conjunctiva, the pupil of the eye and the salivary and sweat glands. Cocaine dropped upon the conjunctiva causes dilatation of the pupil and profound anesthesia of that membrane; it also produces partial paralysis of accommodation, slight lachry- mation and sometimes temporary ptosis. It lessens the secretion of the salivary glands and the sweat glands. Write a prescription for a syphilitic adult containing cor= rosive sublimate and iodide of potassium in solution. January 1, 1903. For John Jones. B; . Hydrargyri chloridi corrosivi gr. i Potassii iodidi 3 ii Tincturse gentianse comp. f "% iii. M. et Sig. — A teaspoonful thrice daily after meals. John Smith, M. D. What are the therapeutic uses of tar? Tar is used as a stimulating expectorant and as a stimulant to the skin in certain chronic inflammatory diseases. What are the physiologic effects and therapeutic uses of chromic acid? Chromic acid exerts a powerful caustic effect upon all ani- mal tissue. It has a destructive action upon micro-organisms, and from the readiness with which it parts with its oxygen it rapidly decomposes organic matter, and so serves as a disin- fectant. It is not employed internally. It is a useful escha- rotic for destroying corns, warts, syphilitic vegetations and the like. Give the source and state the uses of thymol. Thymol is a phenol obtained from the volatile oil of thyme and certain other volatile oils. Thymol is used as a disin- fectant in the form of a wash, as an ointment in chronic skin diseases, and internally as an efficient antiseptic. THERAPEUTICS AND MATERIA MEDIC A. 541 What is the dose of croton oil as a cathartic? What are the contraindications to its use? The dose is y 2 to 2 drops, given in glycerine or olive oil. It is contra-indicated when either debility, organic obstruc- tion or inflammatory conditions of the stomach or bowels exist. What are the physiologic effects and therapeutic uses of cubebs? Ciibebs is an aromatic stomachic and a stimulant diuretic in small or medium dose, but large amounts derange digestion and may act as a gastro-intestinal irritant. Its constituents are eliminated by the bronchial mucous membranes, the skin and the kidneys, stimulating and disinfecting the genito- urinary passages, increasing the bronchial mucus, sweat and urine, and frequently causing an urticarial or vesicular erup- tion. It increases the action of the heart and the vascular system and promotes the menstrual discharge. Cubebs is used in the acute stage of gonorrhea, in chronic cystitis and chronic bronchitis. It is applied in powder form in hay fever, chronic nasal catarrh and follicular pharyngitis. Mention the therapeutic uses of carbolic acid except as an antiseptic. It is used as a caustic, local anesthetic, as an antiemetic and carminative What is the treatment of scabies? Sulphur, styrax and aaphthol are efficient local applications as ointments. An excellent formula is the following: Sulphur Bnblimat. 3j Balsam Peravianae sjse Adipia 3j. M. et Big. — Rob in thoroughly twice a day. How does an antagonist differ from an antidote? Antagonists arc agents which oppose each "tier in their 542 THERAPEUTICS AND MATERIA MEDICA. physiologic action, and may be employed against each other as counter poisons to neutralize their effects upon the organ- ism. They do their work in the blood and tissues after ab- sorption, and are especially available against poisons admin- istered hypodemiically, in which case antidotes are useless. Antidotes affect a poison so as to remove it from the body or alter its character before absorption, and thereby prevent its toxic action on the organism. They do their work in the alimentary canal or in the respiratory passages. (Potter.) Name and describe the methods of introducing medicines into the circulation. Medicines may be introduced into the circulation by various routes, including the mouth, the stomach, the rectum, the res- piratory tract, the veins and arteries, the subcutaneous cel- lular tissues and the skin. Intravenous medication is only used in emergencies where immediate action is desired. Saline solution is the usual remedy introduced by this route. The rectum will absorb any substances applied in the form of enemata or suppositories. The hypodermic method is the introduction of medicines into the organism by injecting them into the subcutaneous tissue, from which they are quickly absorbed by the lymphatic and capillary vessels. The respi- ratory tract admits of the rapid absorption of medicinal sub- stances through its extensive blood supply, especially by inhalation. The stomach is the most convenient organ for the absorption of medicine. The remedies find their way into the current of the circulation through the walls of the gastro- intestinal blood vessels and the lacteals. How do strophanthus and digitalis differ in physiologic action? Compared with digitalis, strophanthus is a powerful cardiac stimulant, differing from digitalis in not producing vaso- motor constriction of the arterioles. It reduces the pulse, lowers body temperature somewhat, is not cumulative in action, and does not cause any gastro-intestinal disturbance. It is a diuretic by direct stimulation of the renal circulation, THERAPEUTICS AND MATERIA MEDICA. 543 and has power over rigors by its rapid cardiac action, stop- ping them and preventing their recurrence. Mention the official turpentines. State from whence they are obtained. There are two official turpentines, terebinthina, a concrete oleoresin from Pinus palustris, the yellow pine, and other species of Pinus, natural order Conifers; Terebinthina canadensis, a liquid oleoresin obtained from Abies balsa)n L-20 in l-"> grain. Describe the therapeutic uses of hydrochloric acid. It is employed internally in the treatment •>!' dysp associated with subacidity. Tt is useful as a refrigeranl ami digestanl in the continued fevers. In conjunction with 35 546 THERAPEUTICS AND MATERIA MEDIC A. strychnia it is of value in intestinal indigestion. The strong acid is also an escharotic. What are the principal uses of chloride of lime? To which ingredient does it owe its energy? Calcium chloride is of value as an internal remedy in the various manifestations of the strumous diathesis. It often causes the resolution of glandular enlargement, and is of value in chorea, lupus and eczema. It owes its energy to the cal- cium contained. What are the symptoms of opium poisoning? Unless the dose has been very large there is at first a stage of excitement, in which the imagination is stimulated and the feelings exalted. This stage is soon followed by depression; the patient becomes stupid and drowsy, and finally falls asleep. The sleep deepens into coma, the pulse becomes slow and full, the pupils contracted, the respiration slow and heavy and the face suffused. At this time it is still possible to arouse the patient by a loud noise, flagellation or shaking. In the third stage the coma becomes absolute, the pulse rapid and feeble, the breathing shallow and irregular, the skin moist, the muscles relaxed, the pupils dilated, and finally death results from paralysis of the respiration. Mention the remedy which will arrest the secretion of milk and state how it should be employed. Camphor used locally by inunction in saturated solution of olive oil is efficient in checking the secretion of milk, as is belladonna. Give the methods and the therapy of cold water treat= ment applied externally. Cold water may be applied in the form of cloths saturated with it, by sponging, bathing or packing with ice. The cold bath is the most frequently employed. A bath-tub half full of water at 70° F. is kept in readiness at the bedside of the patient, and whenever the temperature rises above 102.4° F. THERAPEUTICS AND MATERIA MEDICA. 547 the patient is wrapped in a sheet and carefully lifted into the tub. While in the bath cold affusions should be applied to the head, and the body should be constantly subjected to gen- tle friction and massage, so as to bring new relays of blood to the surface. A stimulant is often necessary to counteract the shock. After remaining in the water 15 to 20 minutes he is placed in a dry sheet and covered with a light blanket. What are the therapeutic uses of alcohol? The question of the advisability of employing alcohol in medicine has given rise to never-ending controversy. Many give it a high place, while others do not employ it at all. The external and local use of alcohol includes many applications of its antiseptic, refrigerant and rubefacient qualities. In the form of champagne it is especially valuable in controlling- vomiting. A single dose of whiskey or brandy is an efficient- combatant of fainting or of collapse. In fevers it acts as an antipyretic, a food, and promotes sleep. It is well to with- hold it until the first sound of the heart becomes feeble and dull, and then to use it boldly. It is of especial value in the treatment of pneumonia, typhoid fever and snake-bite. Mention the physiologic effects of bryonia. What is the dose of the tincture of bryonia? Bryonia is a pure irritant, setting up local inflammation wherever it is applied. It has a vesicant action on the skin, and is violently irritant to the serous and mucous membranes. It produces cerebral congestion, with frontal headache and vertigo. It is a drastic purgative and a powerful diuretic. It causes in full dose hepatic and renal congestion, vesical tenesmus and depression of the heart's action. The dose of the tincture is 5 drops to % ounce. State the dose of aconitin. too to ,,',, of a grain. Give the composition and state the uses of lotio hydrar- JO ri flava. ?"ellow wash is a favorite application for syphilitic suns. 548 THERAPEUTICS AND MATERIA MEDIC A. It is prepared by adding 18 grains of corrosive sublimate to 10 ounces of lime water, producing the yellow oxide. Give indications for the internal use of bichloride of mercury. State the dose of bichloride of mercury for in= ternal use. It is of value in anemia, as an absorbent in diphtheria, as a general alterative, and is highly prized as an anti-syphilitic remedy in the secondary and tertiary stages. The dose is 1-100 to 1-12 grain. What are the principal therapeutic uses of the salt of lead? Lead salts are chiefly used as astringents and hemostatics. The acetate is an efficient internal styptic. The nitrate is of value locally in epithelioma and unhealthy granulations. The iodide is employed locally to enlarged lymphatic glands and in chronic skin affections. The carbonate is only used exter- nally to protect irritated surfaces, such as intertrigo, etc. Explain the constipating action of opium. Opium arrests all the secretions except the milk and the sweat, and retards the digestive juices. The biliary and glycogenic functions of the liver are affected and metabolism greatly reduced. Its constipating action is produced chiefly by stimulation of the inhibitory nerves of the intestines through the splanchnics. Mention the symptoms of poisoning by phosphorus. Toxic doses of phosphorus produce, after the lapse of a few hours, a garlicky taste in the mouth, thirst, intense abdominal pain, obstinate vomiting, restlessness and prostration. The ejected materials contain mucus, bile, and occasionally dis- integrated blood, and are luminous in the dark. At the end of 24 or 36 hours the symptoms gradually subside and the patient feels comparatively comfortable, but soon jaundice develops, the vomiting and pain return, the liver becomes enlarged and painful, the urine contains albumin, bile, hypo- THERAPEUTICS AND MATERIA MEDICA. 549 phosphoric acid and crystals of leucin and tyrosin. The tongue is coated, the breath offensive, the belly distended, the bowels either constipated or loose and the stools clay- colored and sometimes phosphorescent. Death is generally preceded by grave nervous symptoms, such as headache, de- lirium, convulsions, stupor and coma. "When recovery follows convalescence is protracted and tedious. Write a prescription containing a sedative and an ex- pectorant for a bronchial cough in a three=year=old child. Jaxcaky 1. 1903. Fob Walter Smith. B . Tinqtura opii camphorata> gtt. lxiv Potassii citratis Jjii Syrupi pruni virginiana 1 , q. ^. ad f 3 iv. M. Sig. — Teaspoonful every four bonis. Wis.. Jones. M. D. In what pathologic condition is jaborandi useful? It is of use in dropsy, especially of renal origin, in uremia, inflammation of the serous membranes, in diabetes insipidus, but is contra-indicated when the heart's action is weak. It is useful in the form of a lotion for alopecia. What is the dose of carbolic acid for internal adminis- tration? Dose 14 to 2 grains well diluted. What is the common name of lactucarium? State the physiologic action of lactucarium. Lettuce. Lactucarium is feebly hynotic and somewhat sedative and diuretic. It acts feebly. The syrup is a good vehicle for expectorants and anti-spasmodics. What is the physiologic action of colchicum? Emetic, diuretic, diaphoretic, a drastic purgative and car- diac depressant, gastro-intestinal irritant. In small doses it is an emeto-cathartic. What serious results may ensue from indiscriminate use of acetanilid? A toxic dose destroys the ozonizing function of the blood 550 THERAPEUTICS AND MATERIA MEDIC A. and forms methyl-hemoglobin, causes fatty degeneration of the heart, liver and kidneys in animals poisoned by it. When administered continuously or in too great dose it is apt to cause subnormal temperature, cyanosis and collapse. What is cascara sagrada? State the dose of the fluid extract of cascara sagrada. It is the bark of Rhamnus purshiana, California buckthorn. The dose of the fluid extract is y 2 to iy 2 drams. What are the therapeutic uses of tincture of capsicum internally administered? State the dose of the tincture of capsicum. It is employed chiefly as a stomachic and carminative. A weak solution of the tincture is also a much used gargle in sore throat with relaxed uvula. The drug is especially valu- able in alcoholic gastritis and obstinate constipation. The dose of the tincture is 5 to 10 minims. What part of aconite is used in medicine? What is the alkaloid of aconite? Aconite is derived from the root of the aconitum napellus. Its most important alkaloid is aconitine. Write a prescription for corrosive sublimate to be used as a parasiticide. January 1. 1903. Fob John Jone6. Hydrargyri bichloridi gr. ii Unguenti petrolati f ^ i. M. et Sig. — Use locally. John Smith, M. D. How is liquor ammonii acetatis prepared? In what conditions is this preparation useful? Spirit of Mindererus is prepared by neutralizing dilute acetic acid with ammonium carbonate ; it should be freshly made, as it soon deteriorates. It is an active diuretic if the body be cool, and a diaphoretic if the body be warm. In wineglassful doses it will counteract many of the immediate effects of alcohol. THERAPEUTICS AXD MATERIA MEDICA. 551 Give the therapeutic uses of sodium phosphate. In doses of % ounce it is a mild purgative. It has been recommended in catarrhal jaundice and cholelithiasis. State the ingredients and uses of sulphur ointment. Sulphur ointment is made up of 30 parts of sublimed sul- phur and 70 parts of benzoinated lard thoroughly mixed. Sulphur ointment is used in certain forms of skin diseases and as a means of administering sulphur when it is not well borne by the stomach. Give the composition and the chief use of lotio hydrar= gyri nigra. Black-wash is prepared by adding' 30 grains of calomel to 10 ounces of lime water, producing the black oxide, and is used as an application to syphilitic sores. What are the therapeutic uses of Pulsatilla? Some therapeutists regard the drug as of no value whatever ; others claim good effects from its employment as an emmena- gogue, a diuretic and diaphoretic; it is also a cardiac and vascular sedative, and possesses some antipyretic action. Where is quassia indigenous? What part of the plant is used in medicine? The West Indies. The wood is used. What is the common name of ferrous sulphate? Give the chief uses of ferrous sulphate. Copperas: it is impure ferrous sulphate. It is chiefly used to make the dry sulphate and other preparations. It is some- times employed as a tonic astringent. Describe the physiologic action and the therapeutic use of guarana. Guarana has similar actions to those of coffee, the active principle of both plants being perhaps identical. It may be used in migraine, in convalescence in acute diseases, in diar- rhea of phthisis, etc. 552 THERAPEUTICS AND MATERIA MEDIC A. Give the composition of Vienna paste (pasta caustica Viennensis). It is a grayish-white deliquescent powder consisting of equal parts of potassa and lime rubbed together. Explain the distinction between physiologic action and the therapeutic use of medicinal agents. The physiologic action of a drug is its effect upon the economy in health, and includes its action upon the nervous centers, respiration, circulation and metabolism. From its physiologic action is deduced its therapeutic indication or employment in certain diseased states. Define a mydriatic. Give three examples, with the dose for the local application in each case. Mydriatics are agents which produce dilatation of the pupils! Atropine is used locally in solutions of 8 grains to the ounce. Homatropine, in strength of 4 grains to the ounce. Cocaine locally in a 5 per cent, solution. Define germicides, parasiticides. Germicides are agents that destroy germs, as solutions of bichloride of mercury, permanganate of potash, carbolic acid, etc. Parasiticides are agents which are destructive to para- sites; the principal parasiticides are mercurial ointment, sul- phur and acetic acid. What results from combining silver nitrate and creo= sote? An explosive compound, which is white in color, without odor, and has the appearance of an emulsion. What symptoms are produced by toxic doses of tartar emetic? Pain, vomiting, diarrhea, with watery stools and collapse, motor and sensory paralysis and suppression of the urine. Mention two remedies commonly used to increase in= testinal peristalsis. Senna and rhubarb. THERAPEUTICS AND MATERIA MEDICA. 553 What are the therapeutic uses of buchu? Chronic affections of the genito-urinary mucous membranes, lithiasis, prostatic affections, atonic dyspepsia and chronic rheumatism. What is the ultimate effect on the heart's action of medicinal doses of belladonna? Following the ingestion of belladonna the heart rate is at first slowed, but soon becomes rapid and vigorous, and the arterial tension is increased; this is accomplished by stimula- tion of the cardiac sympathetic and paralysis of the pneumo- gastric, thus stimulating the accelerator apparatus while lessening the inhibitory. Compare the strength of dilute hydrochloric acid with that of the absolute acid. What is the dose of the former? Dilute hydrochloric acid is a 10 per cent, solution of the absolute acid in water. Its dose is 3 to 10 minims. How do styptics and hemostatics differ? Give an ex= ample of each. These are agents which arrest bleeding, styptics being those which are applied locally, as alum, and hemostatics those which are administered internally, as gallic acid. What part of zingiber is used in medicine? What are its therapeutic uses? The rhizome. The official preparations are fluid extract, tincture, syrup, troches and the oleoresin. It is employed as a carminative and as an adjunct to purgative medicine to pre- vent griping; the syrup is commonly employed as a flavoring adjuvant. Define pharmacy. Pharmacy is the art of selecting and preserving medicines and preparing them for administration. How do therapeutic agents act to promote waste? Destructive metamorphosis of the tissues is promoted by 554 THERAPEUTICS AND MATERIA MEDIC A. alteratives and astringents. The manner in which alteratives act has never been determined. We know that of such drugs as mercury and iodine, the former being endowed with the power of breaking up newly deposited fibrin and disorganizing syphilitic deposits, and the latter acts ener- getically upon the lymphatic system and promotes absorption. Mention the principal therapeutic application of anti= pyrin. Antipyretic, analgesic, antiseptic, as a local anesthetic and to diminish secretion, as an anti-galactagogue. What is the dose of curare for hypodermic use? What are the antagonists of curare? 1-20 to y G grain. Strychnine, atropine, and more effective still, artificial respiration. What is codein? State the dose of codein. What are the advantages of codein over opium? Codein is an alkaloid of opium, differing from morphine in having the radical CH 3 replacing an atom of hydrogen. It is less irritating to the digestive tract than opium. Its dose is % to 14 of a grain. Mention the therapeutic uses of creosote. Locally as an anesthetic and antiseptic. Internally as an antiseptic, in chronic gastric catarrh, in diarrhea, dysentery and phthisis. What is the common name of hamamelis? State the dose of the fluid extract of hamamelis. Witch-hazel. The dose of the fluid extract is 1 minim to 1 dram. What part of buchu is used in medicine? State the dose of the fluid extract of buchu. The leaves. Dose of the fluid extract 10 minims to 1 dram. What is the official name of tartar emetic? State the dose of tartar emetic. Antimonii et potassii tartras. Dose y 1 ^ to ^ of a grain. THERAPEUTICS AXD MATERIA MEDICA. odd What are the uses of cantharis (a) externally applied, (b) internally administered? Externally it is employed as a vesicant and internally as a stimulant to the genito-urinary tract. What is pepo? State its therapeutic use. Pumpkin-seed. It is used as an anthelmintic against tape- worms. Describe the physiologic action and the therapeutic uses of scammonium. Scammony is a powerful irritating hydragogue cathartic. It may be used in combination with other cathartics in obsti- nate constipation. Mention the preparations of ergot and give the dose of each preparation. The extract of ergot, dose 5 to 20 grains ; the fluid extract, dose 1 to 2 drams ; the wine, dose 2 to 4 drams. Define hematics. Mention two principal hematics. These are medicines which increase the quantity of hematin in the blood. They consist chiefly of iron and manganese and their compounds. What are the physiologic effects of iodoform internally administered? State the therapeutic uses of iodoform when externally applied. In small doses internally iodoform is considered to be a tonic and alterative. If taken over a protracted period it may cause profuse salivation. In toxic doses it causes pyrexia, then headache, quick and feeble pulse, marked anxiety and restless- ness; collapse and death may suddenly supervene. Locally its action is anesthetic and powerfully antiseptic. It is one of the best agents to prevent decomposition, and it destroys the germs of putrefaction and of disease, but must In- carefully employed. 556 THERAPEUTICS AND MATERIA MEDICA. Give the dose of (a) liquor potassii arsenitis, (b) liquor sodii arsenitis. (a) 2 to 8 minims freely diluted, (b) 2 to 8 minims freely diluted. Define emulsion. Emulsions are liquid preparations containing an insoluble medicinal substance, as an oil or a resin, in a state of minute subdivision, and suspended by the aid of some viscid excipi- ent, as gum, which may be contained in the medicinal ingre- dient itself or be added by the pharmaceutist. Where is the habitat and what are the physiologic effects of digitalis? It grows wild in Europe and is cultivated in this country. The dominant action of digitalis is on the circulation. In therapeutic doses it slows the pulse and raises the blood pres- sure. The slowing of the pulse results from a prolongation of the diastole, and this in turn is due to stimulation of the vagi or inhibitory nerves. The increased blood pressure is due to a powerful stimulant effect on the heart and to a con- traction of the arterioles resulting indirectly from stimulation of the vasomotor center and directly from the action of the drug on the vessel wall. Toxic doses quicken the pulse by paralyzing the vagi and lower the arterial pressure by causing a powerful systolic contraction so that the diastole becomes too imperfect to permit the ventricles to be completely filled. Therapeutic doses have no effect on the nervous system, but toxic doses lessen the reflexes, first by stimulating Setsche- now's inhibitory centers and later by depressing the spinal cord. It requires toxic doses to influence the respiration, and then slowing occurs. Large doses occasionally produce nausea, vomiting and diarrhea. In health digitalis has little or no diuretic action. When the urine is diminished from embarrassment of the circulation it produces free diuresis, which is attributed to its effect on the heart and vessels, and not to a direct influence on the secreting structure of the kidney. THERAPEUTICS AND MATERIA MEDICA. 557 What parts of gossypium are used in medicine? The bark of the root is official, as gossypii radicis and the hairs of the seed, as gossypium purificatum. What is the important alkaloid of erythroxylon and what is its principal therapeutic use? Its alkaloid, cocain, is allied to caffein, but is more power- ful, and its proportion in the leaves of the plant varies greatly in the different samples which occur in commerce. Its chief use is that of a local anesthetic. Name the official preparations of bismuth and give the dose of each. Bismuth citrate, used only for pharmaceutical purposes; bismuth and ammonium citrate, dose 1 to 5 grains ; bismuth subcarbonate, dose 5 to 30 grains; bismuth subnitrate, dose 5 to 30 grains. What is the physiologic action of iris? Iris when fresh is actively purgative, emetic and diuretic, producing severe nausea and prostration. What is the dose of (a) potassium iodide, (b) ammo= nium iodide, (c) sodium iodide? (a) Potassium iodide, 5 to 60 grains; (b) 2 to 10 grains; (c) 5 to 60 grains. From what is koumiss made and what are its thera- peutic uses? Koumiss is an effervescing fermented liquor originally pre- pared by the Tartars from marcs* milk, hut now imitated with cows' milk by adding sugar of milk, fermenting in an open tank, skimming off the casein ami butter, then bottling during active fer atation. Koumiss is an invaluable article of dirt in many wasting diseases, especially tuberculosis. It is of ureal benefit in dyspepsia, the diarrheas of children, con- valescence Erom acute maladies, chronic affections of the kid- neys, chronic bronchitis ami other cachexia?. 558 THERAPEUTICS AND MATERIA MEDIC A. What is the proportion of mercury in hydrargyrum cum creta? What is the dose? Thirty-eight per cent, mercury. Dose, i/> to 10 grains. Compare the therapeutic uses of pepsin and pancreatin. How are these remedies prepared? Pepsin is the name for the hypothetical digestive principle of gastric juice. Pancreatin is a mixture of the enzymes naturally existing in the pancreas of warm-blooded animals. Pepsin is usually obtained from a solution prepared by di- gesting the mucus scraped from the rennet-bags of sheep or the stomach of the pig in acidulated water for several days. It is then precipitated by sodium chloride, lead acetate or alcohol. Pancreatin is usually obtained from the fresh pan- creas of the hog. Pepsin is employed in cases of gastric indi- gestion; while pancreatin is indicated in intestinal indigestion. Describe the therapeutic action of spigelia. What are its therapeutic uses? Spigelia, pink root, is anthelmintic against the round-worm and is usually administered with senna. In large doses it is an uncertain cathartic, and may produce serious symptoms, including vertigo, dimness of vision, dilated pupils and con- vulsions. What are the therapeutic uses of cannabis and what is the dose of the tincture of cannabis indica? It is used as a sedative and soporific as a substitute for opium in such conditions as chronic bronchitis, phthisis, in the dyspnea of asthma, and in the restlessness of chronic neph- ritis. As an analgesic it is useful in neuralgia and migraine. It is also employed in mania, delirium tremens, and in some forms of dysmenorrhea and menorrhagia. The dose of the tincture is 10 to 60 minims. What is the composition of hydrargyri iodidum rubrum? It is a red crystalline powder prepared by the double de- composition between potassium iodide, 5 parts, and mercuric chloride, 4 parts. THERAPEUTICS AXD MATERIA MEDIC A. 559 Where is the cinchona tree indigenous? What part of the tree is used in medicine? It is a native of the eastern slope of the Andes. The bark. Name three drugs used to retard the heart's action and state the dose of some preparation of each. Aconite, dose of the tincture, 1 to 3 minims; antimony, dose of tartar emetic 1-16 to 1 grain; veratrum viride, dose of the tincture 3 to 6 drops. Describe the symptoms of hydrargyrism. The first symptoms of chronic mercurial poisoning are fetid breath, swollen and spongy gums having a bluish line along their margin, stomatitis, sore and loosened teeth, sali- vation. Anorexia, diarrhea and fever follow, also ulceration, and in some cases even gangrene of the lips and tongue. There is destruction of tissue and various nervous disturb- ances. The patient becomes emaciated, suffers from head- ache, insomnia, neuralgia and tremor, a vesicular or pustular eruption appeals, and finally there follow coma and con- vulsion.^. Give the common name and state the physiologic effects of mentha piperita. Peppermint. It is an aromatic stimulant, also carmina- tive and anti-spasmodic. It is used in the form of menthol, as an antiseptic and loc;il anesthetic. Peppermint is cm- ployed internally for the relief of nausea and colic and as a carminative. Ii is an agreeable corrigenl for combination with purgatives to prevent griping. Of what is iodoform a preparation and what is the dose for internal administration? Iodoform contains from H4 to 97 per cent, of iodine. Dosi . 1 to 5 grains. What are the sources of salicylic acid? Salicylic acid is an organic acid existing naturally in com 560 THERAPEUTICS AND MATERIA MEDICA. bination in various plants, but is generally prepared synthet- ically from carbolic acid. Give the source and describe the uses of lanolin. Lanolin is the purified fat of the wool of sheep mixed with not more than 30 per cent, of water. It is useful in chronic skin diseases where there is infiltration and where a pene- trative action is required for medicaments locally applied. How do oleates and ointments differ? Oleates are liquid solutions of metallic salts, or alkaloids in oleic acid intended for external administration. Oint- ments are soft, fatty mixtures of medicinal agents with a basis of lard, petrolatum, etc. They are intended for appli- cation to the skin by inunction, and have a melting point which is below the ordinary temperature of the human body. What are the therapeutic uses of acetanilid adminis= tered internally? Has it any uses when locally applied? If so, what are they? It is used internally as an antipyretic and an analgesic and anti-spasmodic. It is extensively employed in surgical prac- tice as a dry dressing for wounds, etc. Describe linum and give its medical preparations and uses. Flaxseed is the seed of Union usitatissimum. It contains 15 per cent, of mucilage in the epithelium, also 30 to 40 per cent, of fixed oil in the embryo. Linseed oil is official. Lin- seed tea is in common use, but is not official. Carron oil, a favorite application for burns, consists of equal parts of lin- seed oil and lime water. Linseed is demulcent, emollient, expectorant and diuretic. The oil is laxative in doses of 1 ounce. The ground seed is used in making the linseed poultice. What are the symptoms of iodism? How may it be prevented while the use of the iodide is continued? The symptoms of iodism are anemia, emaciation and mental THERAPEUTICS AST) MATERIA MEDICA. 561 depression. There is frontal headache, ptyalism, a saline taste in the mouth, dysphagia, temporary impotence and an eruption of acne on the face and limbs. The iodide of potash may be prescribed in combination with tincture of cinchona or with Fowler's solution, which prevents the iodic eruption to some extent. If the iodides are given freely diluted in water the toxic effects are less likely to be produced. Give the common name of Hydrastis and describe its therapeutic uses. The common name is goldenseal. It is used chiefly as a stomachic tonic and antiperiodic, a mild laxative and an antiseptic. It is of value in catarrhal inflammation of the gastro-intestinal and genito-urinary tract and as a local alter- ative and antiseptic application. Write the following prescription by the metric system: Potassii bicarb. 3j dr. Acidi acetici 7 H. dr. Aquae 3 fl . oz. Potassii bicarb grammes 1 :!.<>os Acidi acetici cubic c. c. 26. Aqua' cubic c. c. 89. What are the possible dangers from the use of salol in large doses? Salol breaks up in the body into salicylic acid and carbolic acid. It is apt to produce the symptoms of carbolic acid poisoning. Give the medical name and the official preparation of lignum vitae. Guaiacum. The official preparations are the tincture of guiac and the ammoniated tincture What are the therapeutic uses of manganese? The salts of manganese, especially the permanganate of potash, are used in anemia, in irregularities of menstruation, as an antidote againsl opium or morphine in the stomach and 36 562 THERAPEUTICS AND MATERIA MEDICA. locally, as an antiseptic and oxidizing agent. The dioxide is a good remedy in amenorrhea, gastrodynia and pyrosis, and in the form of an ointment for many skin diseases. How is the peroxide of hydrogen prepared? What are its therapeutic uses? The peroxide of hydrogen of commerce is the solution of hydrogen dioxide. It consists of water to which nascent oxygen has been presented, whereby an additional atom of the oxygen has entered into combination with the hydrogen, producing H 2 C\. This solution contains, when freshly pre- pared, 3 per cent, of the pure dioxide, corresponding to about 10 volumes of available oxygen. This preparation is a non- toxic antiseptic. It is employed as a gargle or spray in quinsy, croup, diphtheria, scarlet fever, ozena, and for the purpose of cleansing wounds. It may possess some value as an intestinal antiseptic on account of the fact that it is a valuable oxidizing agent. What are the therapeutic uses of uva ursae? What part of this plant is used in medicine? Bearberry is an astringent tonic, and is feebly diuretic. The leaves are employed. What is the common name of oleum morrhuae? On what physiologic effect does its therapeutic use depend? Cod-liver oil. The action of cod-liver oil is like that of any other fat except that it is more easily assimilated than any member of the class. Its beneficial effects, therefore, are derived solely from its food value. What is the composition of linimentum calcis? For what is it principally used? Carron oil consists of equal parts of lime water and linseed oil, and is employed chiefly in burns. What action on the heart has valerian in full doses? State the therapeutic uses of valerian. In full doses it increases the action of the heart and raises THERAPEUTICS AND MATERIA MEDICA. 563 the temperature. The oil in large doses lowers the blood pressure and slows the pulse. Valerian is used in hysteria, for the flatulence of infants and nervous subjects, also for coughs of nervous type, in whooping cough, diabetes insipi- dus and in delirium with vital depression. Where is jalap indigenous? What part of it is used in medicine? Jalap is a Mexican plant. The root is used. Mention the salts of silver used in medicine and give the dose of each. Silver nitrate, dose y G to y 2 grain. Silver cyanide; this is not used in medicine except in the preparation of hydro- cyanic acid. Silver iodide, dose ^4 to 1 grain. Silver oxide, dose y% to 2 grains. Describe the therapeutic uses of (a) water and (b) min- eral water. Cold water or ice has many external applications of value in the treatment of disease. As a wet pack it is used in ton- sillitis and diphtheria. The ccld baths and the cold wet pack are the best methods of obtaining an antipyretic effect in fevers. Cold or ice water is applied to the head in acute cerebral congestion. Locally in orchitis, the uterus in post- partum hemorrhage. Hot water externally is most effective in reducing local congestion and setting up resolu- tion of local inflammation. The hot wet pack is highly es- teemed in inflammations of the chest. The vaginal hot-water douche is serviceable in catarrhal conditions of the vaginal and cervical mucous membrane and congestive, swollen or neuralgic conditions of the ovaries, tubes and adjacent tis- sues. Vapor and Turkish baths are used in chronic kidney ase ;md as diaphoretics generally wherever a diuretic effect is desired. Internally, water is of value as diuretic. and if hot as a diaphoretic. Mineral waters are esteemed must highly when they are of the class possessing aperienl and purgative properties. Depending upon the composition 564 THERAPEUTICS AND MATERIA MEDICA. of these waters, they may be of value in chronic rheumatism, diabetes, obesity, syphilis, metallic poisoning, constipation, etc. Where is the cinnamon tree indigenous? Mention the active principle of cinnamon and give its dose. Ceylon. The active principle is a volatile oil, the dose of which is 10 to 20 grains. What therapeutic uses has chloroform other than an anesthetic? It is used in intestinal colic and serous diarrhea, as a car- minative and as a sedative in cases of obstinate cough. What is the dose of tincture of belladonna and what indications show that its physiologic effect has been ob= tained? Five to thirty minims. Medicinal doses quicken the pulse and large doses stimulate respiration. Dryness of the mucous membrane and skin and dilatation of the pupil will indicate the physiologic effect has been reached. For what purposes and effects is strychnia frequently used in formulae for cathartics? Strychnia stimulates the muscular coat of the intestine, increasing peristalsis, and thus acts as a purgative, but it restrains the frequent discharges due to atony of the bowels. What effect has pilocarpus on (a) the heart, (b) the skin, (c) the salivary glands? (a) Pilocarpus is a cardiac depressant by stimulation of the vagus ends; (b) it causes prompt and profuse perspira- tion, and (c) salivation. What is the source from which eserin is obtained? How and for what purpose is eserin principally used? Eserin is one of the two alkaloids of physostigma. It is used locally in solution of 2 grains to the ounce in the eye to contract the pupil and reduce intra-ocular tension. Inter- THERAPEUTICS AND MATERIA MED1CA. 565 nally it is efficient in constipation due to torpor of the bowel, in which condition it is usually combined with belladonna and nux vomica. Describe the therapeutic uses and the dangers of chloral hydrate. How does a toxic dose of chloral hydrate affect body temperature? Chloral is chiefly used to promote sleep and to check spasms. It must be administered with care on account of the danger of the patient becoming addicted to the chloral habit. It is a distinctly dangerous drug, as it lowers the blood pressure and body temperature. Cardiac and respiratory weakness are contra-indications to its use. Toxic doses lower body tem- perature. What is the common name of guaiacum? What are the therapeutic uses of guaiacum? Its common name is lignum vita. Guaiacum is diaphoretic, expectorant and alterative, also laxative and purgative, ac- cording to the dose administered. What are the therapeutic uses of limonis succus? Lemon juice is used as a refrigerant and diuretic mixture in fever. For acidity of the stomach and as a common remedy in obesity. Locally it is used as an antipyretic, anti- pruritic and as a gargle. It is also used for flavoring pur- poses. Define anthelmintic and name the remedies of this class. Anthelmintics are agents which destroy or expel worms inhabiting the intestinal canal. They are classed according to the worm against which they are each most efficient. For thread worms the principal remedies are quassia, alum, sodium chloride, lime water and the vegetable astringents. For round worm, santonin, spigelia, chenopodium. For tape worm, filix mas, kamala, kousso, pepo and granatum. The principal vermifuges are the purgatives, castor oil. jalap and Bcammony. 566 THERAPEUTICS AND MATERIA MEDIC A. What are the therapeutic uses of resorcin? Resorcin is employed as an antipyretic and antiseptic. A 3 per cent, solution gives good results in ulcer of the stomach, cancer and other morbid conditions. It is also used locally as a remedy in skin diseases. Name the official preparation and state the therapeutic uses of santalum album. Oil of sandal wood is official. It is extensively used in chronic bronchitis and catarrhal conditions of the genito- urinary tract. How is collodium made? What are the preparations of collodium? Collodium is made by dissolving 3 parts of pyroxylin in 75 parts of ether and 25 parts of alcohol. There are flexible collodium, styptic collodium and canthariclal collodium. Collodium is used as a protective covering for superficial burns, ulcers, wounds and slight cuts. Styptic collodium has many uses as a hemostatic and protective, while the cantharidal form is a convenient epispastic. Give the common name and the therapeutic uses of hematoxylon. Log-wood. Log-wood is mildly astringent, its properties depending upon the tannin contained in it. It is not irritat- ing, and is useful in diarrhea and hemorrhages in young children. It has been employed as a hemostatic in bleeding of the lungs and hemorrhages from the uterus and intestines, also as an astringent injection. On what physiologic action does the therapeutic use of elaterin depend? Elaterin is the most powerful of the hydragogue cathar- tics, causing profuse watery stools, and when given in large doses great prostration and gastro-intestinal irritation, nau- sea and vomiting. THERAPEUTICS AND MATERIA MEDIC A. 567 State the source of ichthyol and give its uses in medi= cine. Ichthyol is prepared from the product of the distillation of bituminous rocks from the Tyrol, which contain fossil fishes. It is useful in certain chronic skin diseases, particu- larly eczema and psoriasis. It is extensively used externally for its antiseptic and alterative properties in rheumatism, erysipelas and lymphatic enlargements. Combined with gly- cerin, it is valuable, locally applied, in the various inflamma- tory affections of the female genital organs. What are the therapeutic uses of aconite? Give the dose of the fluid extract of this drug. Aconite is used locally in neuralgia; internally in hyper- emesis, in acute inflammation, such as tonsillitis, bronchitis and pneumonia, in excessive hypertrophy of the heart, in nervous palpation, in the tachycardia of exophthalmic goiter and in active cerebral congestion with high arterial tension. What part of scoparius is used in medicine? What alkaloid is derived from scoparius? The tops of cytisus scoparius. Its alkaloid is sparteine. Give the common name of taraxacum and state what part of this plant is used in medicine. Dandelion. The root is used in medicine. What is the physiologic action of tincture of the chlor= ide of iron upon the kidneys? The tincture of the chloride is considered diuretic. (iive the chief source and the dose of gallic acid. It is prepared from a paste of powdered galls by ferment- in.:' for six weeks, boiling and retailing in water, filtering and itallizing. Dose, 5 to 15 grains. Give the dose of hyoscin for hypodermic use. For what purpose is hyoscin used? The dose of hyoscin hydrobromate hypodermically is 1-200 568 THERAPEUTICS AND MATERIA MEDIC A: to 1-50 grain. Hyoscin is a cerebral and spinal sedative, a powerful hypnotic. It is employed as anodyne when opium is contra-indicated. What is an excipient? Give examples. Excipients are substances which give form and consistence to prescriptions, and serve as vehicles for the exhibition of the other ingredients. Examples are syrups, acacia and the various flavoring agents, such as syrup of lemon. Describe the technique of venesection. The patient having been placed in a semi-recumbent posi- tion, the arm should be constricted three or four inches above the elbow by a few turns of a roller or a twisted hankerchief ; if this is not sufficient to render the veins prominent, the arm may be rubbed for a few minutes from below upwards. A large vein having been selected, it should be incised by a thumb-lancet or a spring-lancet in a direction oblique to the long axis of the vessel. The amount of blood abstracted will depend entirely upon the pulse, which should be carefully observed during the operation, and when it lessens in force and becomes more compressible the bleeding must be sus- pended. Define glucosides and give two examples. Glucosides form a group of organic principles existing in plants, and are generally neutral in character. Examples are salicin, obtained from willow and other barks, and glycyr- rhizin, from liquorice root. What is the most active laxative ingredient in pulvis glycyrrhizae compositus? Senna. By what methods do antipyretics act? Give an example of one that acts by each method. Antipyretics reduce the body temperature in fever: (a) by lessening the production of heat; (1) by diminishing tis- sue change; (2) reducing the circulation, or (b) promoting THEE APED 'TICS AND MATE EI A MEDIC A. 569 the loss of heat; by (3) dilating the cutaneous vessels; 4 producing perspiration and (5) abstracting heat from the body. Examples of antipyretics acting in the order named are as follows: Quinine (1), digitalis (2), carbolic acid (1 and 3), antipyrin (1 and 4), cold sponging (5). Indicate the common name and give the preparations of serpentaria. Virginia snake-root. The preparations are the fluid ex- tract and the tincture. It also is one of the components of compound tincture of cinchona. What are the therapeutic uses and the official prepara= tions of oleic acid? Oleic acid is used only in making the oleates. Three preparations are official, the oleate of mercury, the oleate of veratrine and the oleate of zinc. What is the antidote for strychnine? Chloral hydrate. Describe the manner of making barley water as food for the patient. It may be made as follows: Grind % ounce of pearl barley in a coffee mill, add 6 ounces of water, boil 20 minutes, add salt and strain. What are the therapeutic uses of the preparations of silver? The nitrate is the most soluble of the silver salts; it is antiseptic, astringent, hemostatic, irritant, and a limited charotic, also anti-phlogistic, anti-spasmodic and tonic. The oxide is the least irritant, and does not discolor the skill quickly. Internally it has been used in gastric neuralgia, irritable dyspepsia, pyrosis, gastric and pulmonary hemor- rhages, dysmenorrhea, monorrhagia, to check profuse Mveat- ing, to control vomiting, and in diarrhea depending on reflex nervous irritation. Tho iodide is similarly employed 570 THERAPEUTICS AND MATERIA MEDICA. How would you distinguish chemically between ether and chloroform? Ether is ethyl oxide (C 2 H 5 ) 2 0. In its absolute form it is not official, the strongest preparation containing 4 per cent, of alcohol and some water. Chloroform is the true chloride of methyl, CHC1. Name four drugs used in the treatment of chronic inter= stitial nephritis. Nitroglycerin, Basham's mixture, caffein and magnesium sulphate. Give the therapeutic uses of caffein. Cardiac stimulant in cardiac and renal dropsy, and alone or in combination with antipyrin or the bromides in nervous headache and migraine. Describe the physiologic action of aconite. It is a powerful depressant of the sensory nerve ends, the nervous and muscular apparatus of the heart and respiration, and the spinal nervous system. It is also antipyretic, dia- phoretic and diuretic. Name the official preparations and doses of digitalis, cascara sagrada and ipecacuanha. Digitalis, the extract, dose y± to y 2 grain, the fluid extract 1 to 2 drops, the infusion 1 to 4 drams, the tincture 5 to 20 drops. Cascara sagrada, the fluid extract, dose y 2 to 1 dram. Ipecacuanha, the fluid extract, emetic dose 20 minims, Dover's powder 5 to 10 grains, the syrup emetic dose 4 to 6 drams, troches, each contain % grain, troches of morphine and ipecac, contain 1-36 grain morphia, 1-12 grain ipecac, wine of ipecac, emetic dose 4 to 6 drams. Name four efficient hypnotics and give the source and dose of each. Sulphate of morphine derived from opium, dose % to ^4 grain; hyoscine, the alkaloid of hyoscyamus, dose of the ex- tract y 2 to 2 grains ; chloral hydrate obtained from the union THERAPEUTICS AND MATERIA MEDIC A. 571 of water with trichlor-aldehyde, dose 10 to 20 grains; sul- phonal, a synthetic product obtained by the oxidation of a mixture of ethyl-mercaptan and acetone, dose 15 to 30 grains. Write a prescription for (a) a collyrium, (b) a supposi= tory, and (c) a mouth=wash. ( a ) B . Acidi borici gr. x Aquae camphors Aquae destillatae fifi q. b. ad f t ?j Sig. — Fifteen drops in both eyes thrice daily. ( b ) R . Pulveria opii gr. i todoformi -'•. j Olei theobrom. q. s. Fr. in suppositoria No. 1 . Sig. — Use on retiring. ( c ) R . Potassii chloratis. gr. lxxx Aquae laurocerasi f'3 viij M. S. — Use as mouth-wash. Name five antiseptics and tell in what proportions each should be diluted for surgical purposes. Bichloride of mercury, 1 to 1000. Permanganate of pot- ash, 25 grains to the pint. Boric acid, 15 grains to the ounce. Carbolic acid, 5 per cent, solution in glycerine and water. Peroxide of hydrogen, the full strength of the official prepa- ration is 3 per cent. Describe the physiologic action of hyoscin and name a physiologic antidote. It is a cerebral and spinal sedative and powerful hypnotic, directly depressing the higher function of the brain and affecting the heart but feebly. Tannin and morphine. Give the composition of the official compound cathartic pill. Compound extract of colocynth, L30 grains; extract of jalap, 100 grains; mild chloride of mercury, 100 grains; gamboge, 25 grains. These quantities properly prepared make 1(H) pills. 572 THERAPEUTICS AND MATERIA MED1CA. Describe two escharotics and tell how you would apply them. Nitrate of silver applied in the form of lunar caustic is an efficient superficial escharotic ; carbolic acid is escharotic, and should be used in strong solution, 1 to 10. Write a correct prescription containing nitrate of silver. Argenti nitratis gr. iij Gum Tragacanth, q. s. Ft. — In pil. no. xii. Sig. — One before meals. John Jones, M. D. State the direct and indirect effect of pilocarpine in dropsical effusion. It causes prompt and profuse perspiration and salivation, increases the bronchial and lachrymal secretion, and some- times causes serous diarrhea. Full doses cause a decrease in arterial tension. The elimination of urea is greatly in- creased, but not the quantity of the urine. What are the physiological effects of nux vomica on the nerves and circulatory system? It is a powerful stimulant of the spinal cord, especially the motor columns. In toxic doses it produces spinal convulsions. Small amounts stimulate the brain and increase the mental powers. In moderate doses the heart is stimulated and the arterial pressure raised by stimulation of the vasomotor cen- ter in the medulla. What is wrong with the following prescription? R . Argentse nitratis . drams, one. Sodi chloridum drams, four. Syrupus lemonis, q. s. ounces, four. Sig. — Take a tablespoonful after meals in water. Argents should read argenti; sodi chloridum should read sodii chloridi; syrupus lemonis should read syrupus limonis. This prescription affords the example of a pharmaceutical incompatibility. Nitrate of silver should not be compounded THERAPEUTICS AND MATERIA MEDIC A. 573 with sodium chloride, for there results the insoluble chloride of silver. Write for an adult a complete prescription for a diarrhea mixture containing three remedies and the excipient. & Cretan preparatse 3 ii Tincturae catechu 3 ss Tinctura? opii rr^lxxx Aqua cinnamomi ad f J viii M. Sig. — Two teaspoonfuls every four hours. Name the official preparations of belladonna and the dose of those used internally. Extractum belladonna faliorum alcoholicum. Dose 1-12 to 14 grain; tinctura belladonna foliorum, dose 5 to 30 min. : extractum belladonna radicis fluid am, 1 to - min.; emplas- trum belladonna ; unguentum belladonna:. Write a prescription containing oil of sandal wood and at least one other constituent for chronic cystitis. January 1, L903. Foe William Smith. K . Olei santali f 5 i Salol 5 i Ft. in < lapsules no. xii. Big.— One after meals. Wm. Jones, M. I>. Define narcotics, anesthetics and sedatives, and give an example of each. Narcotics are agents which Lessen pain and produee sleep or stupor; example, opium. Anesthetics are agents which temporarily destroy sensation; they arc both general and local; example, ether as a general anesthetic and chloride of ethyl as a local anesthetic. Sedatives are agents which exerl B soothing influence on the system by lessening functional activity, depressing motility and diminishing pain; example 1 he bromides. Treat a case of opium poisoning; also give the thera= peutic uses of opium. The stomach should be emptied by the stomach pump or a 574 THERAPEUTICS AND MATERIA MEDIC A. stimulating emetic, like sulphate of zinc or mustard. Pre- vious to this, however, if the opium is in the stomach, solution of permanganate of potash should be administered freely ; as a chemical antidote strong coffee should be given, and the patient should be aroused by flagellation, douching, or forced walking. Atropine and strychnine should be given hypoder- mically. The temperature should be maintained by the ex- ternal application of heat. In therapeutics opium is used internally to produce sleep, to relieve pain, to lessen nervous excitement, to promote diaphoresis, to check hemorrhage and to support the system. Externally it is used as a sedative. Name five emetics and give the dose of each. Alum, dose, 1 to 4 drams; mustard, dose, 1 to 4 drams; ipecac, dose, of the fluid extract, 15 to 30 minims; apomor- phine, dose, 1-10 to 1-5 grain ; sulphate of zinc, dose, 10 to 30 grains. What are the advantages and disadvantages in the use of chloroform as an anesthetic and what are the signs in= dicative of danger in the patient? Inhalations of chloroform produce sensations which are rather agreeable than otherwise, while the first stage of ether anesthesia is decidedly unpleasant. Chloroform produces anesthesia more quickly than ether, and in certain cases this is an advantage. It is, however, much more dangerous than ether. Its dangerous symptoms are: (1) respiration becomes stertorous or* shallow, (2) sudden dilatation of the pupils, (3) signs of cardiac failure. Chloroform produces much less subsequent vomiting. Define briefly but clearly serum therapy. Serum therapy properly means the prophylactic and cura- tive treatment of certain acute infectious diseases by the sub- cutaneous injection of a blood serum containing an antitoxin specific to the particular disease. As generally used., how- ever, this term includes the treatment of the same disorders by the toxins produced by attenuated cultures of their re- THERAPEUTICS AND MATERIA MEDIC A. 575 speetive microbes; but these toxins, though sometimes grown on blood serum, may be cultivated on other media, and are never administered in a serum, as the antitoxins invariably are. The antitoxins at present employed in serum therapy are those of diphtheria, tetanus, tuberculosis, erysipelas, pneu- monia, cholera, syphilis, plague and typhoid fever, but only the first three have come into anything like general use. (Potter.) What official preparations are derived from the willow? Salicin is a glucoside obtained from several species of the willow. The various salicylates are prepared from salicin as well as salicylic acid. The salix nigra is the source of the fluid extract of this willow which is on the market. What active principles are found in digitalis? What are the official preparations of petroleum? Digitalin, digitoxin, digitalein, digitonin and digitin. Pe- trolatum is a mixture of the hydrocarbons obtained from petroleum. The official preparations are -petrolatum li- quidum, petrolatum molle and petrolatum spissum. Give the physiologic action and therapy of saline pur= gatives. This group includes the neutral salts of metals of the alka- line or alkaline earths. They stimulate the intestinal glands to increased secretion, and by their low diffusibility impede re-absorption, causing an accumulation of fluid in the intes- tinal tract. This, partly from the effect of gravity and part 1 v by gentle stimulation of peristalsis excited by distension, reaches the rectum and produces a copious evacuation. Mag nesium sulphate and sodium sulphate are the typical salines. They should be given in plenty of water and during active movement (as in walking) in order to produce their besl effects. Name three drugs used in the treatment of intermittent fever. State how each controls this disease. Quinine exerts a B] ific influence in all malarial infections 576 THERAPEUTICS AND MATERIA MEDIC A. by reason of its power to prevent the development of the Plasmodium to which malaria is due. A 10-grain dose of the sulphate should be given in the sweating stage, and again five hours before the expected time of the next paroxysm. In the intervals arsenic is of more value ; its therapeutic action is due to the fact that it is a valuable anti-periodic, as well as tonic and alterative. Mercury is also of value for its hema- tinic and alterative properties. Describe the treatment of intestinal indigestion. Under this term a variety of conditions have been described dependent upon various causes, but it is usually restricted to acute or chronic intestinal catarrh. When this is dependent upon causes residing in the stomach the existing gastritis must be first treated. A course of calomel and soda is of value ; this may be followed by the administration of pancreatin, which will aid digestion. Proper measures of diet and exer- cise are important. Charcoal in 10-20-grain doses is useful. Name four drugs incompatible with tannic acid. Name two incompatible with hyoscyamus. Tartar emetic, lead acetate, silver nitrate and hydrochloric acid are incompatible. The hydroxid of potassium with tan- nin and sodium with hyoscyamus. What doses of antitoxin are used for a child five years old ill with diphtheria? What would be the prophylactic dose for the same child? 1500 units. 500 units. Correct the following prescription: R . Atropiae Sulphati. grs. iss Potas. Iodidi joz. Jnfusae Digitalis i fl. oz. Elix. Simpl. q. s. ad 2 fl. oz. M. S. — Teaspoonful in water four times a day. Potassium iodide is best given alone. The dose of atropine is much too great. It should be about 1-100 grain to each dram. Atropice sulphati should read Atrophia: sulphatis. In the last drug Infuscc should read Infusi. THERAPEUTICS AS D MATERIA ME Die A. 577 Name three drugs incompatible with belladonna and two incompatible with pilocarpine. The hydroxids of potassium, sodium and lithium are in- compatible with belladonna, and these are also incompatible with pilocarpine, as are the salts of the metals generally. Give the usual dose of creosote and tell how it is best administered. It is prescribed in 1 to 5 minim doses, well diluted in wine or whiskey. Name four official pills and give the principal ingre= dients of each. Pills with aloes contain purified aloe3 and powdered soap; pills of asafetida contain asafetida and powdered soap; com- pound pills of iron contain myrrh, carbonate of sodium, sul- phate of iron and syrup; compound rhubarb pills contain rhubarb, aloes, myrrh and oil of peppermint. Define tinctures, extracts and ointments and tell as a rule how many drops of a tincture are in a fluid dram. Tinctures are alcoholic solutions of medicinal substances, and with the exception of tincture of iodine are made from non-volatile bodies. Extracts are solid or semi-solid prepa- rations obtained by evaporating solutions of vegetable prin- ciples. Ointments are soft, fatty mixtures of drugs with a basis of lard, petroleum or fixed oils. The number of drops to a fluid dram of tinctures varies widely; lli» may he con- sidered an average. Write a complete prescription containing at least three drugs for acute bronchitis in an adult. Use no abbrevia= tions. Jantary 1, 1903. Fob Mks. \V i li . Tincture opii camphorata fj|v Tincture nucis vomicae 1*3 ii M isture glycyrrhizae composite ffliv M. 8 —Teaspbonful every four hours. John Joins, M. I' 37 578 THERAPEUTICS AND MATERIA MED1CA. In the treatment of syphilitic node or gumma state which should be used, a mercurial or an iodide, and give the reason therefor. In the treatment of the tertiary lesions of syphilis the iodides and mercury, the so-called mixed treatment, is often employed, the object being to get the greatest possible alter- ative effect. The appearance of a gumma, especially of the nervous system, demands energetic drug treatment. Iodides should be given in the largest possible doses, and mercury should be administered by inunction. Give the reason which would determine the employment of a vegetable or a mineral astringent in acute inflam= matory conditions. Vegetable astringents check secretion and hemorrhages and cut short local inflammation. They are practically non-toxic. Differentiate the conditions in which opium and hyoscine should be used to promote sleep. Hyoscine is useful as a hypnotic in children, and in general in conditions in which opium is contra-indicated. Children are particularly susceptible to opium, and an opium habitue would require a different hypnotic. State when calomel or podophyllum should be given and give the reason for the selection. Calomel is unirritating, and has also a diuretic effect. Podophyllum is more irritating and causes more griping, and is to be selected in cases of habitual constipation. Name the coahtar products used to reduce temperature. Their name is legion. Those in general use are antipyrin, phenacetin, acetanilid. Describe the alkaloid, strychnia, and give a test for de= termining its presence. Strychnia is an alkaloid derived from the seed of strychnos nux vomica, a tree of the natural order Loganiacese, growing in India and China. Strychnia and its salts dissolve without THERAPEUTICS AND MATERIA MEDIC A. 579 color in concentrated sulphuric acid, but on adding to the solution lead peroxide a beautiful blue color results, passing into violet, then red, and finally yellow. What are the derivatives of cinchona and their doses? Cinchona bark contains 21 natural alkaloids, of> which 4 are official, quinine, quinidine, cinchonine and cinchonidine. The sulphates of these alkaloids may be administered in the following doses : 2 to 20 grains, 1 to 30 grains, 5 to 30 grains, 1 to 20 grains. Describe four diuretics and give the dose of each. Potassium citrate occurs in transparent crystals, is odor- less, of cooling saline taste and a neutral reaction, dose 5 to 30 grains. Spartein sulphate, the alkaloid of seoparius, oc- curs in white prismatic crystals of slightly saline and bitter taste, dose Vn to 2 grains. Digitalis (elsewhere described), dose of the tincture 10 minims. Calomel, the mild chloride of mercury, is efficient as a diuretic in y G grain doses every hour. How does a lethal dose of gelsemium affect the system? In toxic doses it produces vertigo, diplopia, drooped eye- lids, dilated pupils, labored respiration, slow and feeble heart, dropped jaw, staggering gait, extreme muscle weak- ness, almost complete anesthesia, and death by asphyxia. Name three indications for the use of opium. To relieve pain, to produce sleep, to check excessive secre- tion, as in dysentery. How does opium act when used as in the last question? The principal action of opium is on the nervous system, first affecting the cerebral convolutions, which are brii stimulated and soon depressed; next the perceptive and sen- sory centers in the higher brain are blunted and the con ductivity of the afferent nerves is impaired. The hypnotic action of opium is believed to be due to the Lessened activity produced by the drug on the nerve cells and the consequently 580 THERAPEUTICS AND MATERIA MEDICA. lessened demand for blood. Its constipating action is pro- duced by stimulation of the inhibitory nerves of the intestine through the splanchnic. What are the therapeutic uses of the preparations of bismuth? Locally the insoluble bismuth salts are used in acne rosa- cea, stomatitis, coryza, gonorrhea and leucorrhea. The sub- nitrate is regarded as of great value in diarrhea and dysen- tery, in disordered digestion, vomiting, gastralgia and gastric ulcer. The bismuth nitrate is soluble and toxic, and is not generally used. The subcarbonate and the subgallate are used in the same class of cases as the subnitrate. How would you distinguish quinine from the other cin= chona alkaloids? The slight solubility of the sulphate of quinine in water distinguishes this alkaloid from other cinchona alkaloids. Give the adult dose of phosphorus, arsenious acid and tincture of aconite. 1-100 grain ; 1-50 grain ; 1 to 3 minims. What condition of the eye contra=indicates the use of mydriatics? All diseases increasing intra-ocular tension. Describe the physiologic action of arsenic and name three indications for its use. In therapeutic dose, with the exception of a slight increase in the pulse, arsenic exerts very little influence on the circu- lation. In toxic dose it causes the fall of blood-pressure. In medicinal dose it is a cerebro-spinal stimulant, but in toxic doses it paralyzes the spinal cord, especially the sensory side. Small doses increase the appetite and stimulate digestion. Toxic doses produce violent gastro-intestinal inflammation. In small doses it diminishes and in large doses increases tissue waste. In concentrated form it is a powerful irritant and escharotic. It is indicated in anemia, malaria and diabetes. THERAPEUTICS AND MATERIA MEDICA. 581 Describe and give the indications for the uses of cardiac sedatives, with an example. Cardiac sedatives are drugs which are used to decrease the activity of the circulation. The indications for their use are increased arterial excitement, splenic fevers and severe local inflammation. Aconite is an example of such a drug. It reduces very markedly the rate of the pulse and the arterial pressure. Describe the physiologic action of antipyrin in medicinal doses on the circulation and temperature. After the ingestion of a full medicinal dose there is a stim- ulant stage, in which the heart's activity is increased; this is soon followed by profuse sweating, coolness of the surface, slowed pulse, considerable depression, and if fever be present by lowered temperature. In health it has very slight anti- pyretic effect. It raises the arterial tension and blood pres- sure. How do digitalis and belladonna act in increasing blood pressure? Digitalis increases blood pressure by its powerful stimu- lating effect on the heart by contraction of the arterioles, resulting indirectly from stimulation of the vasomotor center, and directly from the action of the drug on the vessel wall. The increased blood-pressure produced by belladonna is due to stimulation of the vasomotor centers and the heart itself. Name a vasomotor stimulant, a vasomotor depressant and describe the physiologic action of each. Belladonna is a vasomotor stimulant: it quickens the pulse and raises arterial pressure. The increased blood-pressure is due to stimulation of the vasomotor center and the heart itself. Toxic doses paralyze the heart ; Large doses stimulate the respiratory center; toxic doses paralyze it; Large doses stimulate the brain and spinal cord and act as a depressant to the motor and sensory iidvrs; il Lessens nearly all of the secretions except that of tile kidney; it dilates the pupil by 582 THERAPEUTICS AND MATERIA MEDICA. paralyzing the peripheral ends of the oculo-motor nerves and by stimulating the ends of the sympathetic. Veratrum viride is a vasomotor depressant; it lessens in a marked de- gree the force and rate of the cardiac pulsation; the lowered arterial tension results from depression of the vasomotor cen- ter and of the heart itself; the slowing of the pulse from stimulation of the inhibitory nerves of the heart and from weakening of the cardiac muscles. Large doses depress the respiratory center, the spinal cord and peripheral nerves and muscles. Give the theory of the alkaline treatment of rheuma= tism. The alkaline treatment of rheumatism by the administra- tion of potassium acetate, citrate, etc., was in general use before the introduction of the salicylates. "Wood states that the alkalies do good in rheumatism by lowering arterial ac- tion, by favoring oxidation and elimination of partially effete products, and by neutralizing excessive acidity. What is incompatibility in medicine, and what are the different kinds of incompatibles? Give an example of each. Incompatibility in medicine signifies that a combination is not suitable for administration. Incompatibility may be chemical, pharmaceutical and therapeutic, according as the prescribed combination results in chemical decomposition, physical disassociation or antagonistic action. An example of chemical incompatibility is seen in the prescribing of qui- nine sulphate with potassium acetate, resulting in a volu- minous precipitate of quinine acetate. An instance of phar- maceutical incompatibility is the addition of an acid to a quinine and liquorice mixture, resulting in precipitation of the glycyrrhizin, relied on to cover the taste of the quinine by the acid. Therapeutic incompatibility rises when two agents are mixed together when they oppose each other in their ac- tion, for instance belladonna and physostigma. THERAPEUTICS AXD MATERIA MEDIC A. 583 Describe the physiologic action of salicylic acid. Salicylic acid is a powerful antipyretic and antiseptic. In small doses it stimulates the stomach, heart and respiration, but moderate quantities derange the stomach, causing nausea and vomiting, while large doses depress the heart's action and the respiration, lower the arterial tension, relax the ves- sels and produce free perspiration. Name the therapeutic uses of apomorphia and state how codeia differs in its physiologic action from morphia. Apomorphia is a valuable emetic and a useful expectorant in the dry stage of acute bronchitis, and in chronic bronchitis when the expectoration is viscid and scanty. "While codeia possesses but feeble hypnotic powers, it exerts a sedative influ- ence similar to morphine ; it is at times much better borne by patients than morphine, but is regarded as less reliable. Enumerate the symptoms arising from a toxic dose of digitalis. Digitalis poisoning is characterized by obstinate vomiting. diarrhea, headache, severe pain in the back and limbs and a very slow, full pulse, which, when the patient sits up, may become rapid and feeble. Later, even in recumbency, the pulse becomes rapid, thready and irregular, the surface cold, the urine suppressed and the mind stuporous. Intelligence, however, is not lost until shortly before death. Occasionally convulsions develop during the last stage. What are the therapeutic uses of tartar emetic? It is employed as an emetic, diaphoretic, sedative, expecto- rant, cardiac depressant and counter-irritant. Describe cantharis and name four official preparations. Cantharis is the dried body of the beetle. Cantharia vesica- toria. found chiefly in the south of Europe. The active prin- ciple is cantharidin. Ceratrum cantharidis, collodium ean- tharidatum, emplastrum picis cantharidatum, tinctura cantharidis. 584 THERAPEUTICS AND MATERIA MEDIC A. By what rule would you determine the dose of any medi= cine for a child? Young's rule will be found the most convenient. Add 12 to the age and divide by the age, to get the denominator of a fraction, the numerator of which is 1 ; thus, for a child 2 years old, 2 plus 12 divided by 2 equals 7, and the dose is 1-7 of that for an adult. Name ten official preparations of mercury. Name four alkaloids of opium. Hydrargyrum cum creta, massa hydrargyri, unguentum hydrargyri, emplastrum hydrargyri, hydrargyri chloridum mite, hydrargyrum ammoniatum, unguentum hydrargyri ammoniati, hydrargyri oxidum flavum, unguentum hydrar- gyri oxidi flavi, hydrargyri oxidum rubrum. The four alka- loids of opium are morphine, codeine, thebaine and narcotine. Give the source and dose of picrotoxin, creosote and pix Iiquida. Picrotoxin is a neutral principle derived from cocculus indicus, dose 1-100 to 1-20 grain. Creosote is a product ob- tained from distillation of wood-tar, dose 1 to 5 minims. Pix Iiquida, tar, is an oleoresin obtained from the destructive distillation of certain species of Pinus: the dose is 5 to 10 grains. What are the principal therapeutic uses of the prepara= tions of mercury? The plaster of mercury is used as an absorbent and counter- irritant over chronic inflammatory swelling, glandular en- largements, syphilitic nodes, etc. Mercurial ointment and the oleate of mercury are used for the same purposes as the plaster; they are also extensively employed in the treatment of syphilis by inunction. Blue mass is used as a cholagogue, laxative and diuretic. Ammoniated mercury is used exter- nally as a stimulant or parasiticide. The chloride of mer- cury is an antiseptic, anti-parasitic, anti-syphilitic and ab- sorbent, and a tonic. The mild chloride, calomel, is used THERAPEUTICS AND MATERIA MEDICA. 585 internally as an anti-syphilitic, as a laxative, as a gastric sedative, a cholagogue and a diuretic, and externally as a stimulant and desiccant. Mercury and chalk is used in the same class of cases as calomel. The yellow iodide is fre- quently used as a substitute for the chloride, as is the red iodide. The nitrate is used externally as a powerful caustic. The oxide is used externally for its stimulant and alterative effect. The yellow sulphate, turpeth mineral, is sometimes employed as a stimulating emetic for children, but it is dis- tinctly poisonous. State the contraindications to the use of quinine. It is contra-indicated in acute inflammatory affections of the brain, eyes and ears. In what form would you prescribe eucalyptus and in what doses? Whence is eucalyptus obtained? Eucalyptus is derived from the leaves of the tree Euca- lyptus globulus, a native of Australia. It may be prescribed in 10 drops to 1 dram doses of the fluid extract or in 5 to 30 minim doses of the oil in elastic capsules or emulsion. In what strength would you use solutions of nitrate of silver, borax, permanganate of potash, bichloride of mer= cury and creolin for injection into the bladder? Silver nitrate, 1 grain in 4 ounces of water; borax, 10 grains to the ounce ; permanganate of potassium, 20 grains to the pint; bichloride of mercury, 1 to 3000; creolin, y 2 to 1 per- cent. Name six drugs containing large quantities of tannic acid. Galla, catechu, hamamelis, kino, granatum, hematoxylon. Name four drugs incompatible with iodide of potassium, two with atropine and one with antipyrin. Potassium iodide decomposes most of the metallic salts. The following four drugs are examples of this incompati- bility: Sulphate of quinine, sulphate of iron, acetate of lead, 586 THERAPEUTICS AND MATERIA MEDICA. oxide of zinc. Physostigmine and aconite are incompatible with atropine. Tannic acid is incompatible with antipyrin. Give the physiologic action of ergot and mention its therapeutic uses. Ergot is a motor excitant and a vascular contractor. It is also hemostatic and anhydrotic, emmenagogue and oxytocic. It increases the functional activity of the spinal cord, it stim- ulates the vasomotor center, raises the blood-pressure, pro- duces contraction of unstriped muscle fiber, reduces the cali- bre of the arterioles, depresses the motor ganglia of the heart and causes a slower and weaker pulsation. Ergot is used to promote uterine contractions in labor, in amenorrhea due to plethora and in the atonic form of sper- matorrhea. It is useful in catarrhal inflammations of the mucous, membranes generally. It is an excellent remedy in chronic diarrhea and dysentery, in hemorrhages of arterial type, in headache and migraine of congestive form, in mye- litis and tabes and chronic nervous diseases. It is also used locally in hemorrhages. Name four drugs used in the treatment of bronchorrhea and explain their action. Eucalyptus for its expectorant effect. Lead acetate for its astringent effect to restrict secretions. Quinine and arsenic as valuable tonics and restoratives. What is the physiologic action of rhubarb in dose of i to 5 grains? In dose of 30 to 60 grains? In small doses its action is that of a gastric tonic and an intestinal astringent. In larger doses its cathartic action prevails, producing in 6 to 8 hours copious yellow stools with some griping and considerable hepatic stimulation. For what purposes is diaphoresis produced? Name three diaphoretics. Diaphoretics are employed in medicine to fulfil the follow- ing indications: (1) to arrest forming diseases of not very THERAPEUTICS AND MATERIA MEDIC A. 587 severe type, as in general cold and suppressed menstruation; (2) to favor absorption, as in dropsy, (3) to aid in the sub- sidence of diseases which naturally pass off in a sweat, as malaria; (4) to eliminate noxious materials from the blood. Three excellent diaphoretics are pilocarpus, spirit of nitrous ether and Dover's powder. What is the source and what are the therapeutic uses of picrotoxin? Picrotoxin is a poisonous neutral principle obtained from the seeds of cocculus indicus, used in the night sweats of phthisis and in the form of an ointment as an anti-parasitic. Give the chemical name and the dose of (a) Epsom salts, (b) Rochelle salts, (c) Glauber's salts. (a) Magnesium sulphate, dose 1 dram to 1 ounce; (b) potassium and sodium tartrate, dose y 2 to 2 ounces; (c) so- dium sulphate, dose 1 dram to V2 ounce. Describe hypodermoclysis and state the circumstances under which it is practiced as a therapeutic measure. Hypodermoclysis is the introduction into the subcutaneous tissue of fluids in large quantity. It is indicated to replace the fluid lost through excessive purging or hemorrhage. It may also be used to wash from the body certain impurities circulating in the blood and lymph; in other instances it may be used to supply the body with liquid when the stomach will not permit drinks to be swallowed, as in gastric ulcer or abdominal operations. Normal saline solution is used for such injections. The sterilized liquid is placed in a proper '•1 which is absolutely aseptic, and to which air gains ac- cess only by means of a glass tube filled with sterilized cotton; from the lower part of the vessel a rubber tube leads, to which is attached a camila carefully sterilized. The skin over the place where the liquid is to enter is to be rend' sterile. The trocar is then inserted into the subcutaneous I issue of the abdomen or thigh a ml tin.' solution allowed to flow at the rate of 1 dram to each pound of body weighl in 15 588 THERAPEUTICS AND MATERIA MEDIC A. minutes. The pressure is obtained by raising the container a few feet. Define galactagogue and sialagogue and give an example of each. A galactagogue is an agent which increases the secretion of milk, example pilocarpus. A sialagogue increases the secre- tion and flow of saliva and buccal mucus, example mercury. By what process and from what source is sugar of milk principally obtained? It is a peculiar crystalline sugar obtained from the whey of cows ' milk by evaporation and purified by recrystallization. State the source and give the uses of saccharin. It is a sweet amide derived from a coal-tar product, toluene. It is about 500 times sweeter than sugar; it is used as a sub- stitute for sugar in the food of diabetics and subjects of liver disease and corpulence. Describe the preparation of lime water. Give the offi= cial name and the adult dose. Liquor calcis may be given to an adult in doses of % to 4 ounces. It may be prepared by pouring 2 quarts of hot water over fresh unslaked lime the size of a walnut; stir till slaked, let it stand until clear and bottle. Give the source, the physiologic action and the thera- peutic uses of oleum ricini. Castor oil is a fixed oil expressed from the seeds of ricinus communis. It acts as a mild, but rather slow purgative, pro- ducing without irritation copious semi-liquid stools. It does not increase the flow of bile nor to a great extent the secre- tions of the intestinal canal, but excites catharsis by stimu- lating the muscular coat of the bowel. It is useful in acute inflammatory affection of the bowel and as a laxative in preg- uancy, anal fissure and painful hemorrhoids. What are the medicinal uses of potassium chlorate? It is an excellent local application in inflammatory condi- THERAPEUTICS AM) MATERIA MEDIC A. 589 tions of the mouth and throat, being valuable in the various forms of stomatitis, in acute pharyngitis, in diphtheria and scarlet fever. How should poisoning by coal gas be treated? Antidotes, chlorine water as a spray, inhaled. Antago- nists, oxygen by inhalation 4 or 5 quarts. Ammonia vapor inhaled. Galvanism, by interrupted current to extremities. Artificial respiration, to be maintained steadily for hours. Rhythmic traction of the tongue. Fresh air in plenty; open all doors and windows. Coffee, black, a pint as enema. Venesection may be of service. Douche, alternately cold and warm, to head and chest. Horizontal position, clothing re- moved. Alcohol moderately by mouth or rectum. Catheter may be required in prolonged cases. Subsequently a warm bed, heat applied to the body and limbs, open windows, perfect quiet, Condy's fluid about the room, stimulants sparingly, cold acid drinks freely. Write a prescription for a cough mixture containing muriate of ammonia and an opiate, giving adult dose. January 1, 1903. For Joseph Wilson. li . Ammonii chloridi ~ } v Tr. opii camph t 3 v Svr. pruni virg 1 'J iv M. S. — f 3 i every four hours. Joseph Jones, M. D. What are the therapeutic uses of podophyllin? It is an excellent laxative in constipation associated with hepatic congestion. It tends to produce griping, and is usu- ally given with small doses of belladonna or byoscyamus. What is the dose of Fowler's solution and what precau = tions should be observed in its administration? The dose is 1 to 5 minims. Potter advises thai full doses of the solution should 1"' taken ,-it first, and always immedi ately after fund: the dose should then be gradually reduced. Susceptible persons often tolerate it better it' a few drops of 590 THERAPEUTICS AND MATERIA MEDICA. laudanum are administered with each dose. Swelling beneath the eyes is an indication of the physiologic limit for the em- ployment of the drug. From what part of the colchicum plant is the active principle obtained? From the corm and seed. What injurious effect is liable to follow the prolonged internal use of the preparations of silver? Argyria. The first sign of this condition is a slate-colored line along the margin of the gum with some inflammatory swelling. Subsequently grayish patches appear on various parts of the skin and mucous membrane and gradually extend over the whole body. As a rule, argyria does not produce serious effects on the health of the subject. The pigmenta- tion is due to a deposit of silver in the connective tissues. In the skin it is found in the corium. The discoloration is per- manent. Name a vesicant derived from (a) the animal kingdom, (b) the vegetable kingdom, (c) the mineral kingdom. (a) Cantharides, (b) mustard, (c) iodine. Write a prescription for diarrhea containing an alkali and an astringent suitable for a child of ten years. January 1, 1903. Walter. R . Sodii bicarbonatis ^ii Bismuthis subcarbonatis 3 ii Tragacanthte 3 i Spts. cbloroformi f 3 i Aquae cinnamorm f J iv M. S. — Teaspoonful every four hours. Joseph Jones, M. D. What is the vulgar name for veratrum viride? What is its active principle and the dose of the principle? American hellebore. It contains several active principles, of which the most important is veratrine. The dose of the tincture is 3 to 6 drops. THERAPEUTICS AND MATERIA MEDICA. 591 For what medicinal purposes is senna used? It is used as a laxative in habitual constipation, and in larger doses as a cathartic. Write a prescription for an ointment containing a rube= facient and at least one other constituent. January 1, 1903. Foil John Smith. K • Unguenti hydrargyri nitratis 3 iv Sulphuris gii < Ireosoti gtt. z Adipis. 1'3 i Fr. unguentum f 3 i s. Kuh in well. James Jones, M. !». What is the usual physiologic action of an astringent administered internally? Astringents are agents which produce contraction of muscle fiber and condensation of other tissues. They lessen secre- tions from mucous membranes. What are the medical uses of ammonia? Ammonia is employed in medicine when a quickly-acting heart and respiratory stimulant is required. It is also used as an antacid and a counter-irritant. What are the therapeutic uses of lime (calcium)? Lime in its unslaked form has a great affinity for water, and readily combines with sulphur, 1 hereby decomposing and destroying organic matter. Upon the skin its action is irri- tant and superficially caustic, but more severe on the mucous membrane, and if inhaled or swallowed it may produce dan- gerous inflammation, followed by ulceration. In weal, solu- tion it has a sedative and an astringenl effect, both locally and internally, and acts as an absorbent and antacid. For what pathologic conditions may capsicum be used? h is an excellent stomachic tonic in atonic dyspepsia and in that of chronic alcoholism with tremor and insomnia. In acute dipsomania iarge doses are effective in producing sleep 592 THERAPEUTICS AND MATERIA MEDICA. and promoting appetite. Locally, capsicum plaster is a mild counter-irritant. What is the ordinary relative strength of a tincture to a fluid extract of the same drug? In strength the fluid extracts, a cubic centimeter in each case, represent the medicinal powers of 1 dram of the drug. Tinctures are very much weaker, 5 centimeters of the tincture representing various quantities in drams of the drug, from 5 to 50. Name three agents which are used to promote menstru= ation. Potassium permanganate, purgatives, as castor oil, and ergot. How do the preparations of gentian affect the human system and in what conditions are they indicated? Gentian is used exclusively as a bitter tonic. In atonic dyspepsia it increases the appetite and stimulates digestion. The dose of a medicine given by the mouth being i grain, what would be the equivalent dose for hypodermic use and what for administration by the rectum? For hypodermic injection the dose should be % or % of that used by the mouth. By the rectum | of the same. How should a case of poisoning with chloral hydrate be treated? The patient should be aroused by friction, douches, etc., but must not be made to walk, as in opium poisoning, on ac- count of heart failure. Cardiac and respiratory stimulants should be given freely, as ammonia, atropine and strychnine. Artificial respiration should be resorted to early, before the development of asphyxia. In what conditions may cathartics be useful in the treat= ment of diarrhea or dysentery? Cathartics are useful in the treatment of diarrhea and dys- THERAPEUTICS AND MATERIA MED1CA. 593 entery, especially early in the course of this condition, in the case of diarrhea for the purpose of removing offending mate- rial, as indigestible food, discharges, bacteria, etc. Define a laxative, a saline purgative, a drastic purgative, a hydragogue purgative and a cholagogue purgative, with an example of each- Laxatives are drugs which excite moderate peristalsis and produce soft stools without irritation, as sulphur. Saline purgatives include the neutral salts of metals, of the alkalies or alkaline earths; they stimulate the intestinal glands to increased secretions and produce a copious evacuation, as Epsom salts. A drastic purgative produces violent peri- stalsis and watery stools, with much griping pain and tenes- mus ; in large doses irritant poisoning results, as jalap. Hy- dragogue purgatives are those which remove a large quantity of water from the vessels, as elaterium. Cholagogue purga- tives stimulate the discharge of bile and produce free purga- tion, as podophyllin. Would you administer charcoal internally, and if so in what dose and for what purpose? It may be given with advantage in chronic gastric catarrh, cancer, intestinal dyspepsia and diarrhea when flatulence is a prominent symptom. Dose is 10 to 20 grains. What are the physiologic effects of gelsemium? Medicinal doses do not affect the circulation. Toxic doses depress the heart. It is a marked depressant to the spinal cord, and in toxic doses produces paralysis. The drug kills by paralyzing the respiratory center. Locally the drug causes dilatation of the pupil, probably from paralysis of the oculo-motor nerve. Describe the therapeutic uses of jalap and state how it differs in effect from aloes. In moderate dose jalap acts as a hydragogue cathartic, pro- ducing copious watery discharges. It is best given in th<' form of compound jalap powder in conditions of genera] 38 594 THERAPEUTICS AND MATERIA MEDICA. dropsy, and should never be employed in simple constipation. Aloes is a cholagogue cathartic, stimulating the discharge of bile. Name two remedies which are commonly used to pro= mote intestinal peristalsis. Belladonna and nux vomica. What are the therapeutic uses of guaiac? Used locally and internally in acute bronchitis ; often pre- scribed in chronic rheumatism, gout, sciatica and lumbago. Name the official bromides. The bromides of potassium, sodium, lithium, ammonium, strontium and zinc. Describe the therapeutic uses of ox=gaIl. It is a tonic, antiseptic and purgative, stimulating the ab- sorption powers of the mucous membrane. It is frequently used as a laxative in constipation. Where does buckthorn grow? Give the official prepara= tion and dose. In Europe. Fluid extract of frangula. Dose y 2 to 2 drachms. What are the therapeutic uses of gelsemium? It is indicated in all conditions of exalted nerve function, and contra-indicated whenever the heart is weak. It is espe- cially useful in cerebro-spinal meningitis, mania, persistent insomnia, neuralgia, dysmenorrhea, incontinence of urine, irritation of the bladder, spasmodic coughs and remittent or typho-malarial fevers. What is the purgative dose of acetate of potassium? Two to four drachms. What is the common name and therapeutic use of plumbi acetatis? Sugar of lead. It is a component of the mixture of lead THERAPEUTICS AND MATERIA MEDICA. 595 water and laudanum, which is employed in bruises and in- flammatory swellings where the skin is not broken. It is used in solution as a lotion in skin diseases and pruritus, and is employed as an astringent in diarrhea. How do official waters, e. g. aqua camphorae, differ from solutions, e. g. liquor calcis? Waters are aqueous solutions of volatile substances; liquors are all aqueous solutions of non-volatile substances. How do potassium acetate and potassium bitartrate compare as diuretics and purgatives? The acetate is the most certain diuretic; the bitartrate is the most active cathartic. Give the common name and the official preparations of prunus Virginiana. Wild cherry. The official preparations are the fluid ex- tract, infusion and syrup. On what chemical change in the intestinal tract does the purgative action of castor oil depend? The oil is decomposed by the pancreatic juice setting free ricinoteric acid, which produces purgation by a mildly irritant action on the bowels, stimulating the glands and muscular coat, but not the liver. What are the therapeutic uses of acetic acid? Used internally as a mild refrigerant and antiscorbutic, and a.s an antidote in poisoning by alkalies, such as ammonia. Locally it is used to check hemorrhages and as an escharotic. • What is the proportion of mercury in blue pill? What is the dose of blue pill? It contains 33 per cent, of mercury. Dose 1 to 20 grains. What effect has benzoin on the urine? Name the prep- arations of benzoin. . It renders the urine acid and increases its quantity. The preparations of benzoin are adeps benzoin, tinctura benzoini, 596 THERAPEUTICS AND MATERIA MEDICA. tinct. benzoini composita, acidum benzoicum, amrnonii ben- zoas, lithii benzoas, iodi benzoas. What are the alkaloids of pilocarpus and how do they compare in physiologic effect? The alkalies of pilocarpus are pilocarpine, jaborine, antag- onistic to pilocarpine in action; pilocarpidine, analogous to pilocarpine, and jaboridine, which is analogous to jaborine. What is the source of camphor and what is the dose of spiritus camphorae? Camphor is a stearopten obtained from the Connamonium camphorae, a tree of the natural order Laurinece (indigenous to China and Japan), purified by sublimation. Dose of the spirit 5 to 20 minims. Give the common name and the therapeutic uses of potassium bitartrate. Cream of tartar. It is an agreeable laxative, and also is used as a diuretic in infusion of juniper in general cardiac dropsy. Give the source and preparations of gum arabic. Acacia, gum arabic, is a gummy exudation of Acacia Sen- egal, a small tree native to Africa. Its preparations are the syrups and mucilage. It enters also into the composition of official troches, etc. Mention the therapeutic uses of nitric acid. It is locally a powerful escharotic, and internally in dilute form in bilious affections. It lessens phosphatic deposits and acts as an astringent to the system, diminishing the profuse expectoration in bronchorrhea and phthisis. Give the physiologic action and the therapeutic uses of sarsaparilla. It is doubtful if it possesses any physiologic action. Some, however, claim it to be diuretic, diaphoretic, tonic and alter- ative. Its chief value is as an excipient for administering, potassium iodide and mercuric chloride in syphilis. THEEAPEUTICS AND MATERIA MED1CA. 597 Name three drugs which are administered internally to arrest bleeding. Ergot, gallic acid and hematoxylon. What are the therapeutic uses of magnesia? Magnesia is the oxide of magnesium. It is used as an ant- acid and laxative in acidity, sick headache, colic, etc., and as an antidote in poisoning by acids, arsenic, phosphorus and the mercuric and copper salts. Mention the medical uses of the oil of turpentine. The oil of turpentine is employed externally as a rubefa- cient and counter-irritant in many conditions causing pain and inflammation. The liniment is in constant use for sprain, neuralgia and other slight local affections. Internally it is best employed in ulceration and hemorrhage of the intestines, and in passive hemorrhage from other organs. It is also used as an anthelmintic against tape-worm, and is of value in flatu- lent colic. It is employed in chronic bronchitis and chronic inflammations of the mucous membranes generally. For what are the preparations of juniper used in medi- cines? Juniper is a stomachic tonic, diaphoretic, diuretic and aphrodisiac. The oil acts therapeutically like the oil of tur- pentine, and may be used in chronic cystitis, etc., but is contra-indicated where acute inflammations of the kidney exist. How should a case of poisoning with atropine be treated? Tannic acid should be given freely and the stomach emptied by an emetic or the stomach-pump. Collapse must be met by the use of heart stimulants, such as ammonia, alcohol and nitroglycerin. What is the vulgar name of physostigma? ( lalabar bean. 598 THERAPEUTICS AND MATERIA MEDICA. What are the therapeutic uses of the preparations of zinc? The acetate is used as an astringent application in conjunc- tivitis and subacute gonorrhea. The precipitated zinc car- bonate is used as a sedative astringent in acute inflammatory affections of the skin, such as erythema and eczema. The chloride is used as an astringent antiseptic and caustic. It is also used in chronic inflammation of the mucous mem- branes. The oxide is employed in the form of an ointment or powder externally as a mild astringent and sedative in burns, acute ulcers, etc. Internally it is of doubtful value as an anti-spasmodic and anti-hydrotic. The phosphide of zinc is employed in the same class of cases in which phos- phorus is indicated. The sulphate of zinc is employed locally as an astringent, and internally is used in chronic dysentery and diarrhea, as well as an emetic in large doses in cases of narcotic poison. Name three official preparations of camphor. Aqua camphora?, linimentum camphorce and spiritus cam- phor a. Write a prescription containing some preparation of iron in a delectable form. January 1, 1903. For Wm. Jones. li . Tincturse ferri chloridi f 3 ii Acidi phosphorici diluti f giii Spiritus limonis fgi Syrupi f J iiss Aquam ad f 3 vi M. S. — Tablespoonful after meals. John Smith, M. D. What preparations of copper are used in medicine and for what purposes? The only official salt of copper is the sulphate; it is useful in phosphorus poisoning both as an emetic and a chemical antidote. The application of the solid crystal is often useful for its astringent and stimulating qualities. It is also useful THERAPEUTICS AND MATERIA ME Die A. 599 in gonorrhea in the subacute stage. Internally it is some- times employed in chronic diarrhea. What are the therapeutic uses and the preparations of borax? Borax is sodium borate, which is a powerful antiseptic and disinfectant. It has been used internally in amenorrhea, dysmenorrhea and puerperal convulsions and epilepsy. In the form of a wash it is of value as an anti-pruritic. Boric acid is prepared largely from borax by the action of sulphuric acid. It is an efficient antiseptic, disinfectant and deodorant. With what remedies should spasmodic croup be treated? Name three suitable ones. With emetics, as ipecac, and with anti-spasmodics, such as the bromides. Lobelia is a useful remedy. Describe the medicinal uses of hydrocyanic acid. Hydrocyanic acid is used solely to allay irritation of the peripheral nerves. Thus it is employed internally for the cough of phthisis and chronic bronchitis, for gastralgia in obstinate vomiting, and externally to subdue the itching in pruritis, eczema and urticaria. Mention the conditions which affect the dosage of medi= cines. The age of the patient, the personal idiosyncrasy, the con- dition of the heart, kidneys, nervous and respiratory system. What class of acids would you use to acidify alkaline urine? Benzoic acid and its derivatives, as benzoate of sodium and ammonium. What is the dose of phenacetin as an antipyretic? Dose 8 to 10 grains every 4 to 6 hours. . What is the composition of the so=called green soap? Green soap is prepared from potassa and linseed oil. 600 THERAPEUTICS AND MATERIA MEDIC A. Where does arnica grow most abundantly? What part of the plant is used in medicine? In the mountains of northern Europe and Siberia. Both the flowers and the roots are official. What is glycerine and what are its therapeutic uses? Glycerin is obtained by the decomposition of vegetable or animal fats or fixed oils. It is a trihydric alcohol, existing in fats and fixed oils in combination with the fatty acids. Externally it is used in various forms as an emollient. In the various acute inflammations of the fauces, it makes an excellent vehicle for carrying other drugs. Being hygro- scopic, it not only depletes the turgid vessels, but it spreads the medicant over the entire surface. It is especially useful in tampons in such conditions as uterine congestion. It may be employed in suppository in obstinate constipation. It is sometimes used as a substitute for sugar in diabetes. How many grains of the hydrochlorate of cocaine are contained in one ounce of a ten per cent, solution? Forty-eight grains. What is the dose of the fluid extract of senna? Two to four drams. What injury may result from large doses or long con= tinued use of potassium chlorate? The chlorate is distinctly irritant to the kidneys. An in- flammation of these organs may follow its use. Give the habitat of squills and state which of its prep= arations are used in medicine. It is native to southern Europe. The preparations are vinegar of squills, fluid extract, syrup ? compound syrup and tincture. Describe the therapeutic uses of olive oil and state where it is principally produced. It is produced principally in southern Europe, California THERAPEUTICS AND MATERIA MEDICA. 601 and Australia. Externally used it is a good protective from the air, and if rubbed into the skin is absorbed by the lym- phatics and is directly nutritive. Internally it is a food and a mild laxative, and in quantity protects the mucous mem- branes against the action of poisonous substances. How should phosphorus poisoning be treated? Immediate full dose of sulphate of copper, which is an emetic as well as a chemical antidote. Potassium perman- ganate and French oil of turpentine are also of value. What is the dose of oleum erigerontis? The oil of fleabane is not official. It has the same action as oil of turpentine in a milder way. Dose 10 to 30 minims. Write the following prescription in the metric system: R. Ammonii bromidi 2 drams Sp. ammonite aromat 1 dram Aquae 4 ounces Misce. R . Ammonii bromidi grams 7.78 Sp. ammonite aromat grams 3.89 Aqiue cubic c. c. 118. Misce. What is the dose of oleum sabinae? One to five drops. What medicine would you give to promote bone growth? Some of the preparations of lime, as lime water, or the carbonate or phosphate. What is the alkaloid of pomegranate and for what is it used? Pellatierine ; it is a teniafuge. By what other names is saltpetre known? Potassium nitrate and nitre. In what dose may sulphonal be administered to an adult to produce a soporific effect? It may be given in 10 to 20 grain doses in hot milk about 2 hours before retiring. 602 THERAPEUTICS AND MATERIA MEDICA. To what chemical change does sulphur ointment owe its efficiency as a parasiticide? Sulphur ointment contains an alkaline ingredient and de- velops sulphides which are powerful anti-parasitics. What are the uses of lactic acid in medical practice and what pathologic conditions may its administration pro= duce? It is employed as a mild caustic, a digestant and intestinal antiseptic. It is a valuable local remedy in laryngeal tuber- culosis, and internally in cholera, typhoid fever, simple diar- rhea and the diarrhea of infants. It is supposed to cause acute rheumatism when in excess and free in the blood. Write the following prescription in the metric system: & . Morphinse sulphatis grains 6 Sodii boratis drams 4 Aqure camphone fl. ounces 6 R . Morphine sulphatis 387 milligrams Sodii boratis 15 .5 grams Aquae camphone. 177. cubic c. c. What is the effect of full doses of opium on respiration and to what extent may this effect be safely carried in treatment? In full dose there is irregular and slow respiration. It should not be used when there is profuse expectoration, as the lowering of excitability of the respiratory center which it produces would be dangerous in such a case. Morphine is combined with atropine to overcome the effect of the former on the circulation. It should be avoided in all organic dis- eases of the lungs associated with weak respiration. Where is colocynth obtained and for what is it used? Colocynth is the fruit of citrullus colocynthis deprived of its rind. The plant is a native of Spain and Asiatic Turkey. It is classed among the tonic, astringent and resin- bearing purgatives. In moderate doses it increases peristal- THERAPEUTICS AND MATERIA MEDIC A. 603 sis and the intestinal glandular secretion; watery evacuations with griping pain. What is the comparative action of strychnine and a!co= hoi on the arterioles? Strychnine raises the arterial pressure by stimulating the vasomotor center in the medulla. Alcohol inhibits the vaso- motor system, causing dilatation of all the vessels of the body, especially those of the periphery. The blood pressure is raised, however, owing to the great increase of cardiac action, which overcomes the results of the arteriole dilatation. How may carbolic acid poisoning be produced and how treated? Carbolic acid poisoning may be induced by the local use, especially of weak solutions, of the acid, as well as by the internal ingestion of carbolic acid or its derivatives. The treatment of the poisoning consists of the administration of the antidote, which is a soluble sulphate, as sulphate of mag- nesium ; this unites with the acid, forming an insoluble sulpho- carbolate. Evacuation of the stomach, the application of external heat and stimulants and the use of mucilaginous drinks are indicated. Would you write for potassium chlorate and tannin in the same prescription? Give reason for your answer. No. Tannin precipitates potassium chlorate. Mention the therapeutic uses of gamboge. Gamboge is an irritant purgative, decidedly diaphoretic; its catharsis is accompanied by vomiting and colic. It has do eholagogue action. Its use, for the most part, is limited to the compound cathartic pill, of which it is a constituent. Where is kousso obtained? What preparation is used and for what purpose? Kousso is a native of Abyssinia; it is used in the form of the fluid extract as an anthelmintic againsl tape-worm. 604 THERAPEUTICS AND MATERIA MEDIC A. What remedies should be used for hemorrhages from mucous surfaces? The astringents and vaso-contractors ; the extract of supra- renal gland is probably of greatest value ; ergot, gallic acid and opium are employed internally. On what theory can the use of salol in diarrheal diseases be advocated? In the intestine it is separated into carbolic and salicylic acids and acts as an antiseptic. It is free from irritating properties. For what is copaiba used in medical practice? Copaiba is used in subacute or chronic inflammations of the genito-urinary tract. Name a drug commonly used which affects the color of the stools without altering the constituency, and explain the cause. The organic salts of iron blacken the feces by conversion into a sulphide. Describe the three stages of chloroform narcosis. 1st stage: This stage is very short and the symptoms are very similar to those of alcoholic intoxication. Consciousness is not lost but the sensibility is generally dulled, but rarely altogether abolished. 2d stage : This is the stage of anesthesia, consciousness and sensibility are abolished, the muscles are relaxed and the pa- tient is quiet. The pulse is generally normal in frequency, but somewhat weakened. 3d stage : This stage is one of profound narcosis with ster- torous breathing, intense muscular relaxation, abolition of the ordinary reflexes and fall of bodily temperature. Pulse is weak and rapid. Describe the three stages of anesthesia under ether. 1st stage : Burning in the fauces, feeling of strangulation, sense of exhilaration, lightness in the head with a buzzing or THERAPEUTICS AND MATERIA MEDIC A. 605 roaring in the ears. These symptoms are soon followed by a feeling that the surroundings of the patient are at a distance, which fades into semi-unconsciousness with visions and illu- sions. Patients may laugh, shout, weep, fight or pray. 2d stage : This stage begins with a complete loss of con- sciousness. Muscular rigidity soon passes off and the patient is quiet. Respiration is slow and regular. 3d stage : Same as the third stage under chloroform narcosis. Give the contraindications to the use of anesthetics. Organic brain disease, including tumors, atheromatous con- ditions of the blood vessels, organic affections of the heart, lungs and kidneys (AYood). Some authorities add diabetes mellitus, chronic alcoholism and enlarged tonsils. Why is the use of ether as an anesthetic contra=indicated in diseases of the lungs and kidneys? Because it is eliminated by the lungs and kidneys, and on account of its irritating qualities it would aggravate the diseased condition. What is meant by cataphoric application of a remedy? By cataphoric application of a remedy is meant the in- filtrating of the tissue with some drug by electrical osmosis. Give the indications for the use in producing sleep of (a) morphine, (b) chloral, (c) potassium bromide. (a) Morphine is used when sleeplessness is due to pain. (b) Chloral is indicated when sleeplessness is due to mental overwork and where a more powerful hypnotic than potassium bromide is required. If the heart or stomach are in bad con- dition it should not be given, (c) Potassium bromide is given when insomnia is caused by cerebral excitement, nervous ex- citement(especially when connected with the genital function) and motor activity. According to Wood it is contra-indicated by an excessive irritability of the gastro-intestinal mucous membrane and great exhaustion. 606 THERAPEUTICS AND MATERIA MEDICA. (a) What systemic conditions contra=indicate the use of nitrous oxide gas? (b) State why. (a) Atheromatous vessels, fatty heart and pulmonary em- physema. (Burchard). (b) Nitrous oxide gas increases blood pressure and in atheromatous degeneration of the arteries this may result in rupture of these vessels and if in the brain, apoplexy or early death may ensue. In fatty heart the muscles are weakened, and on account of the increased resistance in the blood-vessels there may be sudden dilatation of this organ. In pulmonary emphysema the danger is in the engorgement of the blood vessels of the lungs which causes an increased re- sistance to the right heart, which may result in the sudden dilatation of this organ, or there may be pulmonary edema or hemorrhage. (a) What are topical remedies? (b) Mention two classes, (c) Give two examples of each. (a) Topical remedies are those which are applied locally. (b) Plasters and liniments, (c) Belladonna plaster and cap- sicum plaster — turpentine liniment and chloroform liniment. Give the signs of danger in chloroform anesthesia and tell what should be done. Lividity of the face, irregular or stertorous breathing or feebleness of the pulse. Withdraw the anesthetic, lower the head, use artificial respiration and give a hypodermic injection of strychnine, digitalis, or ammonia. When is chloroform preferred to ether as an anesthetic? In acute inflammation of the bronchi or lungs, aneurism, atheroma and nephritis. Name the accidents that may happen during the admin- istration of ether, and give the treatment in each case. In the early part of the administration of ether we may have failure of respiration, which is due to reflex spasm of the laryngeal muscles excited by the ether. By giving more air with the ether we can correct this trouble. THERAPEUTICS AND MATERIA MEDICA. 607 Embarrassed respiration may be due to the accumulation of mucus in the upper air passages. In this condition we sim- ply turn the head to one side. Kespiratory failure may be caused by the action of the either on the respiratory centre. In this case we withdraw the ether; push the jaw forward by pressing on its angles, draw the tongue forward by means of a tenaculum or for- ceps and make rhythmic traction of the tongue. Pour ether on the abdomen or chest in order to stimulate inspiration by reflex action, give strychnine and atropin hypodermically. Practice artificial respiration. Name the most common aftereffects of the administra= tion of ether. Nausea and vomiting. Under what conditions is ether contra=indicated as an anesthetic? In acute inflammatory infections of the respiratory tract, advanced arteriosclerosis, severe nephritis, especially when associated with cardiovascular lesions and anemia when the hemoglobin is less than 30%. Diabetes mellitus, especially when well established and associated with acetonuria (Stevens). PRACTICE OF MEDICINE. What is dysphagia, and with what pathological condition is it associated? Dysphagia is difficulty or pain in swallowing. It may be clue to causes in the mouth and fauces, such as glossitis, cancer of the tongue, to various forms of stomatitis, tonsillitis and pharyngitis. Some of the exanthemata, such as scarlet fever and variola, give rise to lesions of the throat, diphtheria, spasm or paralysis of the pharynx, disease of the larynx, dis- ease of the esophagus, such as stricture, cancer, etc. Finally, from pressure from the outside, such as from an enlarged thyroid gland, thoracic aneurysm, mediastinal tumor, etc.. and from pleural and pericardial effusion. How would aneurysm of the abdominal aorta affect the dorsalis pedis artery pulse as compared with the radial pulse? The pulse of the dorsalis pedis artery compared with the radial pulse would be small and delayed. What conditions predispose to cerebral hemorrhage? Heredity is important ; many individuals inherit the apo- plectic constitution. It is a disease of middle life, and more common in the male sex. Diseases of the blood vessels are important factors. It may follow the infectious fevers and diseases producing disturbances of the # blood. Embolism is an important factor. Hypertrophy of the heart, exertion or excitement frequently cause rupture of the diseased blood vessels. 39 (609) 610 PRACTICE OF MEDICINE. What are the causes of endocarditis? The greatest number of cases are the result of rheumatic fever. Chorea is also a cause. The acute exanthemata also give rise to it, also pneumonia, erysipelas, sepsis, puer- peral diseases, and sometimes gonorrhea. Tuberculosis, gout, renal disease and diabetes are etiological factors. Trauma has also been given as a cause. It occurs in fetal life. It may sometimes be secondary, from extension of the disease from the myocardium or aorta. Differentiate between cerebral vomiting and gastric vomiting. Cerebral vomiting occurs without nausea, often with a clean tongue, and is not related to the taking of food. In gastric vomiting there is the history of some gastro-intestinal affec- tion. The tongue is coated, and there is always considerable nausea and much retching. Give the characteristic differences between diabetes insipidus and diabetes mellitus. In diabetes insipidus the urine is of low specific gravity, never over 1010 ; there is no sugar present, no itching of the skin and genitalia, no hunger, no tendency to the formation of carbuncles or boils. In diabetes mellitus the urine is of high specific gravity, 1030 and over, sugar is present in the urine, there is itching of the skin, great hunger, tendency to formation of boils, loss of weight, and frequently an etherial odf r of the breath. Give the cause of vertigo. Vertigo occurs in the course of neurasthenia and lithemia, from gastric disorders, from arteriosclerosis, valvular disease of the heart and aneurysm, from Meniere's disease, from reflex causes, such as disease of the eye, nose and larynx. It also occurs in many nervous diseases, such as epilepsy, etc. Describe pyuria and state its import. Pyuria is pus in the urine, and is an important symptom PRACTICE OF MEDICINE. 611 in many diseases of the urinary tract, from the kidney to the end of the urethra. It is present in urethritis, cystitis, ure- teritis, pyelitis and pyelonephritis. Pus may be caused by rupture of an abscess in the urinary tract (especially the bladder) ; this may occur in salpingitis, abscess of the ovary, extra-uterine pregnancy, cysts of various kinds, psoas and other forms of abscess, etc. Describe leukemia and mention the pathological changes occurring in this disease. Leukemia is a disease in which the white blood corpuscles are greatly increased in number; the percentage of the various forms also differ greatly from the normal. It is character- ized anatomically by changes in the spleen, lymphatic glands or bone marrow, singly or combined. In the splenomedullary form the spleen is greatly enlarged, and it may weigh ten pounds or more. The capsule is thickened, and the surface of the organ somewhat irregular. On section it is quite firm. The color of the pulp is reddish-brown. Infarcts are common. The gross appearance of the blood is altered, occasionally being milky in character, the specific gravity is decreased, the alkalinity is somewhat diminished, and coagulation is Blightly retarded. The leukocytes show a great increase in number, from 250,000-500,000 or more per cinin. In the lymphatic variety groups of lymph glands .ire enlarged, owing to hyper- plasia of the lymphoid cells, and the spleen is slightly increased in size. The uross appearance of the blood may show very slight change or resemble the variety just described. The Leu- kocytes are also greatly increased in number, bul not \<> the extent thai they are in the splenomedullary form. Exami- nation of the stained films shows an enormous increase in the Lymphocytes. Give the symptoms indicative of impacted gallstone. When the gallstone has become impacted there is an arrest of the pain. Jaundice is marked, the urine shows bile incuts, and the stools are clay-colored. There is hepatic inter- 612 PRACTICE OF MEDICINE. mittent fever, sometimes called Charcot's fever. This con- sists of high temperature, chills and sweating. While this fever is paroxysmal, it does not show the regularity of a malarial attack. Give the treatment of yellow fever. Disinfection of the person and all effects. Strict quaran- tine. A mild cathartic may be given at the onset with advan- tage. Vomiting and gastric irritability may be treated by the administration of carbolic acid, cocaine or broken doses of calomel. The fever should be treated by cold applications to the head and cold sponging. For the pain opium in some form is useful. Strychnine is valuable as a cardiac tonic. For the hemorrhage, opium, ergot and suprarenal extract may be administered. Outline appropriate treatment for Asiatic cholera. Complete isolation of the sick and thorough disinfection of all discharges and all articles of clothing are absolutely necessary. Efficient quarantine must be established. All milk and water should be boiled, and no raw fruit or vege- table should be eaten. In the stage of premonitory diarrhea it is considered good practice to administer a prompt laxative. If there be great pain opium may be given hypodermically. Salol and guaiacol carbonate may be given from time to time as intestinal antiseptics. In the stage of serous diarrhea the patient should be wrapped in flannels and external heat ap- plied to the body. If there be cramp, friction of the muscles is useful. Fluids should only be allowed in very small quan- tities. Enteroclysis should be used in this stage. When col- lapse sets in, hypodermoclysis of a normal salt solution should be given. Strychnine may be given by the skin, but it must be remembered that as absorption is slow, accumulation may occur. What are the causes and treatment of palpitation of the heart? This may be due to reflex causes, such as disease of the PRACTICE OF MEDICINE. 613 stomach, disease of the genito-urinary apparatus, and sexual excesses. Toxic causes may give rise to it, such as the abuse of alcohol, tobacco, tea and coffee. Gout and anemia are productive features, and the condition occurs in inanition and marasmus. Finally, it is due to disease of the heart itself, such as organic disease, and it is an important symptom of exophthalmic goitre. The treatment consists in removing the cause, if possible, and is then symptomatic. Rest in the re- cumbent posture and an icebag over the heart are useful. What are the causes and symptoms of dilatation of the stomach? The dilatation may be acute or chronic. It may be due to obstruction of the pyloric end of the stomach, such as con- genital stenosis, the cicatrices resulting from gastric ulcer, and from tumors, the most common being malignant. Motor insufficiency of the stomach may give rise to dilatation; this may result from overeating or drinking, and frequently occurs in beer drinkers. The symptoms are general feebleness, ane- mia, emaciation, thirst, scanty urine, sallow and hollowed face, flabby coated tongue, pyrosis, chilliness, cyanosis, subnormal temperature and nervous symptoms. Pain and vomiting are always present. The outline of the stomach may be demon- strated by means of the X-ray. What is scurvy, how should it be prevented and treated? Scurvy is an affection characterized by anemia, by swollen, tender and bleeding gums, by manifestations of purpura and by great prostration due to improper food. The prevention of the condition is due to the use of anti-scorbutic food on shipboard or among the army supplies. In the treatment, antiseptic mouth washes are of use. Fresh vegetables should be administered. Lemon-juice is very valuable, as are also bitter ionics. Give in detail the treatment of diphtheria. The prophylaxis is highly important, the disease being very contagious and easily transmitted. The patient should 614 PBACTICE OF MEDICINE. strictly isolated. Efficient disinfection is also necessary. The food must be nutritious and easily digested. If the patient cannot swallow, rectal alimentation must be resorted to. Alcohol is necessary, and must be given freely, even in mild cases. The membrane must not be removed. Antiseptic and soothing applications are employed ; inhalations of quick- lime and steam in all cases in which there is danger of invasion of the larynx are useful. Hydrogen dioxide in solution is serviceable as a mouth wash. Internally, the tincture of chloride of iron may be given in medium doses. Calomel or corrosive sublimate in appropriate doses are useful. The antitoxin treatment, however, is the most important. The dose in individual cases varies; from 3,000 antitoxin unite may be given at a dose, but this may be increased in severe cases and repeated. In laryngeal cases intubation and tra- cheotomy may have to be resorted to. What is the prognosis of suppurative nephritis secondary to cystitis? Outline the treatment of the condition. The prognosis is unfavorable, and the treatment is surgical. Give the etiology of tubercular peritonitis and the treat= ment. The disease appears at all ages, but it is more common in childhood. Males are more frequently attacked than females, and it is more often met with in the negro than in the white race. It is also found associated with intestinal or mesenteric tuberculosis. The condition may be primary in the perito- neum, and may be confined solely to this membrane. A com- mon mode of infection is through the intestines ; this may also occur through the lymphatics or by extension from the pleura or the pericardium. It is often of the miliary variety, but also of the chronic ulcerative and chronic fibroid forms. The modern treatment of this condition is surgical, the best results having been obtained by opening the abdomen and producing adhesions. PRACTICE OF MEDICINE. 615 Give the prophylactic treatment of gout. As nearly as possible a vegetable diet should be adhered to, as animal food gives rise to uric acid. Water should be par- taken of plentifully. Alcoholic and malt liquors, especially the rich, sweet wines, such as port, sherry, champagne, should be particularly prohibited. Systematic bathing, regular ex- ercise in the open air, avoidance of exposure to cold and damp- ness are important. At what age is spasmodic croup most common? Give the symptoms and treatment of spasmodic croup. The disease is most common in children before the age of puberty. The attack begins suddenly, most often at night. The first indication is usually a hoarse metallic cough, fol- lowed by dyspnea. In severe cases the dyspnea is so extreme that cj'anosis of the face and extremities occurs. There is some elevation of temperature. The cough is unproductive at first, but. at the close of the attack free expectoration may occur. The child should at once be immersed in a warm bath, and an emetic promptly given. Inhalations of steam are also useful. Between the attacks the child should have tonic treatment. Give the etiology, duration and prognosis of pertussis. It is an infectious disease of early childhood, and common between the second and seventh year. The disease usually lasts from four to six weeks. The pen. is a rule is favorable, the danger being due to complications. Describe the treatment of biliary Iithiasis. The prophylaxis consists in appropriate diet, exercise and general favorable hygiene. In women tight lacing should be avoided. Warm baths, regular exercise in the fresh air, etc., should be recommended. The patient should avoid indul- gence in sweet and starchy foods. Constipation should be corrected. Massage has been Btrongly advised. For the treatment of the attack hot fomentations should be applied over the liver. For the pain hypodermic injections of mor- 616 PRACTICE OF MEDICINE. phine give relief. If the condition is not relieved by medical means, if the jaundice persist, and especially if symptoms of Charcot's fever appear, surgical interference should be re- sorted to. Give the etiology and treatment of St. Vitus' dance. Chorea is a disease of childhood, although it may occur at any age. Females are most often attacked, and the disease is more common in the temperate climate. It is most prevalent in the spring months. Acute rheumatic fever has been noted as an exciting cause in a large number of cases. Fright, shock and worry are predisposing causes. It may be due to reflex causes, such as intestinal worms, eye-strain, nasal dis- ease and sexual disorders. The treatment consists in long hours of rest, especially in bed. If the child be attending school it had better discontinue and remain at home. The diet should be simple, meats and highly-seasoned foods should be excluded. Arsenic, antipyrine, bromide of zinc and qui- nine are the most useful drugs. Give the etiology, symptoms and treatment of cirrhosis of the liver. The disease occurs most often in the male sex, and is very frequently due to alcohol. In the newborn the affection is due to hereditary syphilis. The next most important causes are acquired syphilis, malaria and other infectious diseases, such as cholera, enteric fever and scarlet- fever. Gout and rickets also give rise to it. The disease may begin without prodromes, except in the case of topers who present a long history of gastro-intestinal catarrh. Early in the course of the affection there may be some slight enlargement of the liver. In the fully established disease the organ is dimin- ished in size. Of decided diagnostic import is an early atro- phic change in the right lobe of the liver, which in some cases can scarcely be felt in the abdomen. Jaundice is absent as a rule. The most characteristic symptoms relate to the disturb- ance of the circulation in the portal vein, or to the diminished PRACTICE OF MEDICINE. 617 function in the atrophied cells of the liver, or they depend upon a combination of these two conditions. One of the most prominent signs is ascites. Even before this the effect of congestion of the mucous membranes of the stomach and bowels may be noted by hematemesis and enterorrhagia, which occur in the course of this affection. Hemorrhoids occur. The spleen is enlarged. The cutaneous veins of the abdomen are often greatly enlarged. The urine is diminished in amount and is of low specific gravity, frequently reddish in color. The temperature is normal or subnormal. The gen- eral nutrition suffers greatly, and the patient loses flesh. The treatment consists in abstaining from alcohol. Potassium iodide and mercury are of use in the syphilitic form. The bowels should be carefully regulated, and when ascites be- comes prominent, paracentesis abdominis becomes necessary. Give the etiology of tetanus. The disease occurs in either sex and at any age. It may result from a wound in any part of the body, and sometimes without apparent trauma. It occurs most often from wounds that are exposed to dirt and filth. The exciting cause is the bacillus of tetanus described by Kitasato. Give the treatment of sciatica. Rest by means of splinting the limb is important. Atten- tion must be directed to the cause of the disease. If of rheu- matic origin the salicylates are of value. Phenacetine, anti- pyrine and other members of the coal-tar group are of value ; in severe cases, however, morphine is necessary. Surgical measures should only be resorted to after all forms of medical relief have failed. State the varieties, causes and prognosis of angina pec- toris. True angina pectoris and pseudo angina pectoris. Occlu- sion of the coronary arteries and sclerosis are important fac- tors. The true form occurs after middle life, and in the male sex; the pseudo form occurs most freqiifiitly in young women, 618 PRACTICE OF MEDICINE. in connection with hysteria and neurasthenia. The prog- nosis in the true form is very unfavorable ; in the pseudo form it is favorable. How should insolation (sunstroke) be treated? The treatment of thermic fever consists in the application of cold to the surface of the body, preferably in the form of an ice bath or dee rubbing. The cold pack is sometimes sub- stituted. The bath is commonly continued until the temper- ature reaches the normal point. Ice water enemata may also be employed. Measures should also be taken to guard the heart. For this purpose strychnine, digitalis and alcohol are useful. Give the treatment and prognosis of erysipelas. Cold water should be liberally administered to the patient, and cold sponging, especially if the temperature is high, is of distinct advantage. Ice cloths are also the best treatment for the eruption. They should be frequently renewed. An ointment of ichthyol and lanolin is also used for this purpose. The administration of tincture of the chloride of iron in full doses is the general method of treating erysipelas. When the nervous symptoms become prominent, or if in the aged or cachectic, bold stimulation is necessary, alcohol is best for this purpose. If the pain be severe morphine should be re- sorted to. Anti-streptococcic serum may be beneficial, and should always be resorted to in malignant cases. In simple, uncomplicated cases occurring in those in pre- vious good health the prognosis is favorable. The prognosis should be regarded as serious when erysipelas occurs as a complication of any other malady, or when it results from surgical accidents or occurs in the puerperal state. It is always serious in alcoholics and cachectics. State the etiology and prophylaxis of biliary calculi. In a majority of cases they are found in persons of thirty and over, and they occur more frequently in the female than in the male sex. Catarrh of the bile-ducts and gall-bladder PRACTICE OF MEDICINE. 619 may lead to stagnation of bile and to an increase in the amount of cholesterine. Farinaceous foods may give rise to the for- mation of gall-stones; in diseases in which nitrogenous food is largely partaken of, as in diabetes, gall-stones are rarely found. They are formed most frequently in the gall-bladder. They may occur in the larger gall-ducts, and, rarely, even in the smaller biliary passages of the liver. The prophylaxis consists in appropriate diet, exercise and general favorable hygiene. In women tight lacing should be avoided. Warm baths, regular exercise in the fresh air, etc., should be recom- mended. The patient should avoid indulgence in sweets and starchy foods. Constipation should be corrected. This may best be done by the use of waters, such as Carlsbad. Massage has been strongly advised. What is chronic hydrocephalus? As a rule the child's head begins to increase in size soon after birth, or it may even be greatly enlarged at birth. There is irritability and restlessness, and much impairment of the general nutrition; the child does not grow as is usual with normal children, even though the appetite be good. Mental development is tardy, and as a rule the child does not learn to walk. Ocular phenomena are present, such as strabismus. and occasionally optic atrophy. Within a few yens vomiting, coma and convulsions appear. Death usually takes place from exhaustion. Give the etiology and treatment of anthrax. This is a widespread disease in animals, occurring all over the world. The affection is conveyed to man as the result of the handling of wool or bides, rarely by direel inoculation from the bites of insects that have fed on animals that have died of the disease. It is a very rare affection in man. Cer- tain occupations predispose to it, such as those of stablemen, tanners, butchers, shepherds and wool-sorters. The exciting cause is the bacillus of anthrax. It is important that the pustules should be treated surgically, the site of inoculation 620 PRACTICE OF MEDICINE. being destroyed by bichloride of mercury, carbolic acid or the actual cautery. Constitutional treatment consists in the use of quinine, iron, strychnine and alcohol. Give the treatment of catarrhal pneumonitis. "When the temperature becomes high, cyanosis shows itself and somnolence is threatened, and a warm bath with cold effu- sion to the head is useful. Alcohol is valuable as a circulatory stimulant. Inhalations of steam are of value. In strong children in whom there is great secretion in the bronchial tubes which is brought up with difficulty, emetics may be used from time to time, but these should not be continued through- out the course of the disease. It is dangerous to administer narcotics to young children. Stimulating expectorants, such as the salts of ammonia, are often useful. Minute doses of strychnine and inhalations of oxygen are of benefit. A mild purge at the onset frequently gives great relief. The diet should be a light and nutritious one. What is the prognosis as to the cure of epilepsy? Give the treatment of epilepsy. True epilepsy is an incurable affection. Much may be done to diminish the number and severity of the attacks, but a true cure is rarely met with. In the treatment it is important to relieve the cause if possible. It is best to endeavor to treat the epileptic in a colony, in which he may have an out-door occupation. The bowels should be regulated, the diet should consist of meat sparingly, fruit, cereals and vegetables. The best results have been obtained from the use of the bromides. What cutaneous diseases may occur as complications of saccharine diabetes? Boils, carbuncles, erythema, eczema, especially of the geni- tals, purpura, cellulitis and gangrene. What is hemophilia? How should it be treated? This is a disease characterized by a tendency to hemorrhage, which is often uncontrollable, and it is due to a deficiency in PRACTICE OF MEDICINE. 621 the coagulability of the blood. The coagulation is retarded, and frequently in this condition the blood does not coagulate in less than from thirty to fifty minutes. The prophylaxis is important ; wounds and operations should be avoided in a per- son suspected to be a bleeder. "When the bleeding is from a free surface and easy of access, compression and rest should be tried. Ice. locally, is of value. Calcium chloride and per- chloride of iron are recommended by many. Gelatine, collo- dion and extract of the suprarenal capsule may be found useful when applied to the bleeding surface. Freshly drawn blood from a healthy person may be employed as an appli- cation. Describe the treatment of purulent pleurisy. The aspirator should be used, and drainage should be as free as possible. If the pus does not flow through the needle a surgical operation is necessary. Describe the treatment and prophylaxis of nephroliths iasis. The treatment consists in relieving the pain during an attack of renal colic, which is best accomplished by a hypo- dermic of morphine or by the inhalation of chloroform. Hot baths and hot fomentations to the loins are useful. Fluids should be freely partaken of. For uric acid calculi, piper- azin, urotropin, and the salts of lithia are of value. The waters of various mineral springs are valuable, such as Carls- bad, Ems, Kissingen. Surgical interference is sometimes necessary. How should cholera morbus be treated? Absolute rest in bed is necessary. Food should be given sparingly, and it had better be withheld for some time if vomiting be frequent. Sterilized milk and animal broths may be administered sparingly. Local sinapisms and hot turpen- tine stupes are of benefit to allay vomiting. At the onset of the disease it is good practice to give a purge. The remedy for the condition is opium in some form. Later in the coins.' 622 PRACTICE OF MEDICINE. of the affection bismuth and antiseptics which act on the intestinal tract are of value. What is the treatment of spasmodic stricture of the esophagus? Dilatation with the esophageal bougie is of value. Remedies to act upon the nervous system and tonics are of use. The general hygiene of the patient should be carefuly looked after. Give the treatment of hematemesis. Absolute rest in bed. Food and drink should be stopped. For the thirst small pellets of ice may be taken in the mouth. Opium and ergot hypodermically are the best remedies. Describe the treatment of rachitis. The child should have the best of food, and if the mother cannot nurse it a wet-nurse should be procured. Abundance of fresh air and sunshine are essential. Daily warm bathing is necessary. The child should not be encouraged to walk. The remedies that have proven most effective are phosphorus, cod-liver oil and the syrup of the iodide of iron. Give the treatment of ulcer of the stomach. Rest in bed is most important, even in the mildest cases. Food should be withheld from the stomach for some time, rec- tal alimentation being resorted to. Milk is the best food, and may be given either hot or cold. External applications over the stomach, such as hot poultices frequently renewed, are of value. Among the most useful of the many drugs that have been recommended is bismuth; this remedy should be em- ployed in large doses. Salol, oxide of silver, carbonate of soda, carbolic acid and cocaine are also highly recommended. If there be great pain opium, and sometimes cannabis indica are useful. Give the symptoms of (a) acute lead poisoning, (b) chronic lead poisoning. In acute lead poisoning the symptoms may come on in a few PRACTICE OF MEDICINE. 623 weeks. Rapid and marked anemia is usually the earliest symptom. Constipation, which is followed by excessive diar- rhea, vomiting, abdominal tenderness and distension are pres- ent. The abdomen, as a rule, is hard and distended. There is colic of the severest type over the entire abdomen. The paroxysms are of gradual onset and increase in severity. The pain is relieved by deep pressure. The temperature, as a rule, is subnormal. The symptoms of chronic lead poisoning are due to the prolonged absorption of lead in small quantities. The anemia may be profound, showing a marked decrease in the red blood-cells, with a corresponding decrease in the hem- oglobin. There is wasting of the muscles and a peculiar yel- low complexion, which, however, is not due to the deposit of bile pigment. Along the border of the gums, usually most marked under the incisor teeth, is a bluish-black line. Tre- mors occur from time to time. There is a metallic taste in the mouth, coated tongue, fetid breath, marked dyspepsia and obstinate constipation. Lead colic is particularly marked. The pain, as a rule, is more severe in the afternoon and at night. Occasionally paroxysmal pains occur in the joints without swelling, redness or fever. An important symptom is lead paralysis. This most frequently occurs as wrist-drop, the extensors being particularly affected. Occasionally cere- bral symptoms develop, this condition being known as lead encephalopathy. Give the treatment of suppurative hepatitis. The treatment consists in the early evacuation of the ab- scess in suitable cases. Purging with calomel or salts is recommended. Opium is best to relieve pain. When the septic phenomena are marked, free stimulation should be re- sorted to, whiskey and strychnine giving good results. Qui- nine is often of nve. For the anemia, iron and arsenic should be administered. The diet should be ligb.1 and nutritious. What is uremia and how should it be treated? Uremia is a clinical condition due to acute or chronic .lis- 624 PRACTICE OF MEDICINE. ease of the kidney or of its conducting apparatus. Depend- ing upon whether the symptoms arise rapidly or suddenly or whether they are more insidious, the condition is known as acute or chronic uremia. In the treatment it is important to withdraw the urine. In young subjects with slow pulse and high arterial tension bleeding is indicated, and should be fol- lowed by hypodermoclysis of a normal salt solution. Intra- venous injections of a normal salt solution are often indicated. Purging by croton oil and broken doses of calomel is useful. For the convulsions, chloral and morphine hypodermically are the most reliable agents. Sweating should be induced by a hot pack or by some similar method. The administration of pilocarpine is accompanied with danger on account of its depressing effect upon the heart. How should acute nephritis accompanying or following scarlet fever be treated? Absolute rest in bed is important. It is well to put the patient on an absolute milk diet. Some of the alkaline min- eral waters, such as Seltzers and Vichy, may be mixed with the milk. Daily sponging with warm water and gentle fric- tion of the skin are of use. Calomel in fractional doses is useful, which may be followed by a saline, even if there be no tendency to constipation. Some of the diuretics may be used, such as citrate of potash or benzoate of soda. Iron in some form is useful, and Basham's mixture is often administered. How should edema of the glottis be treated? The treatment is that of dropsy occurring in other parts of the body. Surgical treatment, such as scarification, intuba- tion, tracheotomy, etc., is often necessary. Name one important complication and one important sequel of typhoid fever. An important complication of typhoid fever is hemorrhage from the bowels. An important sequel is phlebitis, which most frequently occurs in the left leg. PRACTICE OF MEDICINE. 625 Outline a plan of treatment of typhus fever. The prophylaxis is of the greatest importance. An abund- ant supply of good food, fresh air and free ventilation are important. Stimulation is necessary on account of the severe prostration. If hyperpyrexia occur the cold bath should be resorted to. Strychnine may be necessary as a respiratory and cardiac stimulant. Complications are treated as they arise. The constipation must be relieved by enemata, and in convalescence tonics should be administered. Give the treatment of pyelitis. The patient must be kept in bed and protected against cold. A bland diet should be given and the alkaline mineral waters freely used. Application of heat to the renal region should be resorted to. Warm baths are grateful to the patient. Opium in some form to relieve the pain is necessary. In chronic pyelitis astringents are indicated, such as acetate of lead. Salol and methylene blue are sometimes found of ben- efit. Surgical interference is necessary if hydronephrosis or pyelonephrosis is present. Mention the most reliable remedy for pulmonary hem= orrhage. Rest in bed, abstaining from food and drink, an ice-bag applied to the chest, and opium and ergot. What remedies should be used in hemorrhage from mucous surfaces? Opium, ergot and suprarenal capsule. What are the complications and sequelae of whooping cough? I It'inorrhages occur, such as petechia?, about the face and neck; episi;i.\:is and hemoptysis may occur ; broncho-pneumonia is a complication which adds greatly to the gravity of the case. Pulmonary tuberculosis is comparatively frequent in a considerable proportion of tin- c.-iscs. especially in ad< cents. 40 626 PRACTICE OF MEDICINE. Describe the treatment of paralysis agitans. The treatment is purely symptomatic. Occasionally hyos- cyamin or hyoscin control the tremor. The general hygiene of the patient is to be looked after ; tonics, such as arsenic and strychnia, are of use. What are the causes of peritonitis? The most frequent mode of infection is through the intes- tines and from the female generative organs. Various forms of ulcer may produce peritonitis, such as the typhoid or tuber- cular ulcer. Malignant disease of the intestine may give rise to it. It also arises from forms of intestinal obstruction, such as volvulus and stricture. The gall-bladder and liver may be the sources of infection, and particularly abscesses, and syphilitic disease may give rise to it. Obstruction of the biliary passages by gall-stones may produce it. The affection may arise from the spleen, through an infected embolus. It may occur from infective disease of the kidney, from disease of the bladder wall, from the prostate and from the urethra. Peritonitis occasionally occurs in the course of some of the acute infectious diseases, such as erysipelas, acute rheumatic fever and septicemia. Name the places where yellow fever is endemic. The disease is endemic in the "West Indies, parts of the Mediterranean coast, South America and Africa. What treatment would you recommend for diphtheritic paralysis? What is the prognosis? Rest, tonics, strychnia, and later, electricity are useful. The prognosis in all forms of diphtheritic paralysis is favor- able as a rule, except in paralysis of the heart. What are the causes and treatment of acute myelitis? Exposure to variations of temperature, especially to cold, is important. Thus certain occupations predispose, such as engi- neers, cabmen, drivers, etc. Gout, rheumatism and certain metallic poisons, such as lead, mercury and arsenic, have been PRACTICE OF MEDIC IS E. 627 recognized as etiologic factors. Alcohol may also be a cause. Syphilis usually gives rise to the chronic form. Occasionally acute myelitis may be secondary, resulting from extension, as in abscess, caries or cancer of the spine. Traumatism is per- haps the most common cause. The puerperal period and the existence of septic conditions have also been noted as causes of the disease. In the treatment, counter-irritation by blisters or the application of cold are of use in the acute stage, but they are contra-indicated after this stage. Precaution should be token not to interfere with the nutrition of the skin on account of the great liability to trophic changes. Absolute rest is important. Great care must be taken of the bladder. The catheter should be carefully sterilized. Electricity is benefi- cial late in the course of the disease, and at this time massage is also valuable. A warm climate favors improvement. Hy- drotherapy has been highly recommended. General tonics are of use; the bowels may be moved by enema ta. In syphi- litic cases anti-syphilitic treatment is indicated. What are the complications and sequelae of scarlet fever? Diphtheria and nephritis are the most important complica- tions, and occur in nearly all severe cases. Endocarditis occurs; less commonly pericarditis. Meningitis, peritonitis, pleurisy, with and without effusion, also occur. Among the most common sequels are enlarged lymphatic glands, chronic joint affection, the hemorrhagic diathesis, monoplegia, hemi- plegia, peripheral neuritis, hysteria and anemia. On what symptoms would you base a diagnosis of ty- phoid fever? Upon the slow onset, with a gradual rise id temperature, nose-bleed, headache, diarrhea, the occurrence on or about the seventh day of the typical eruption, enlargement of the Bpleen, dilated pupils, the Widal reaction, and the dicrotic pulse How should scarlatina be treated? Strict isolation is important. The scales during the p 628 PRACTICE OF MEDICINE. of desquamation should be carefully collected and burned. The diet should be nutritious and easily assimilated. Pure drinking water or the alkaline mineral waters may be freely administered. Milk is a necessary article of diet. There is no specific treatment. A mild laxative should be given at the onset. Tepid sponging, at least twice daily, is necessary in severe cases. "Warm bathing is' usually very grateful to the patient. During the period of eruption an animal fat, used as an inunction to the skin, prevents itching and hastens des- quamation. A mild diuretic may be used, and it is important to keep the kidneys active. Complications must be treated upon general principles. What should be done for a patient during the passage of a biliary calculus? Hot fomentations should be applied over the lower part of the liver. If the pain is severe, whiffs of chloroform may be inhaled. However, in the majority of the cases relief of the pain only follows the hypodermic use of morphine. If the condition is not relieved by medical means surgical interfer- ence must be resorted to. How should small=pox be treated? Vaccination should be practiced as a prophylaxis. Com- plete isolation and disinfection are absolutely necessary. There is no specific treatment. Food is not well borne at first, and there may be much vomiting and diarrhea. Usually acid drinks or small particles of ice are grateful to the patient. From the onset of the disease detergent washes containing antiseptic solutions should be used for the mouth. The room should be darkened; the solar light being rigidly excluded. This prevents pitting. Warm baths two or three times daily are of decided benefit to the patient. During the time of secondary fever bold stimulation is necessary. At the onset a laxative is useful. Pain should be overcome by small doses of opium, but great care must be exercised with this drug, as it tends to lock up the secretions. Restlessness PRACTICE OF MEDICINE. 629 and insomnia should be treated by trional and sulphonal. In convalescence tonics are useful. What is the treatment for angina pectoris? For the attack, hypodermics of morphia are necessary. In- halations of amyl nitrite or nitroglycerin in full doses may prove beneficial. In the interval between the attacks the patient must lead a quiet life. The functions of the body should be well looked after, and the administration of the nitrite of sodium with strychnine is of use. What should be done to give relief in intestinal obstruc= tion? The treatment is largely surgical. Opium should be given to relieve the pain. If vomiting be persistent the stomaeh tube may be used. Purgatives should be avoided. Hot tur- pentine stupes may be applied to the abdomen. Rectal feed- ing may be resorted to, but surgical interference sooner or later becomes imperative. Atropine in large doses hypoder- mically has been lately advised. What causes cerebro=spinal meningitis, and how should it be treated? The exciting cause is the diplococcus intracellularis menin- gitidis, described by Weichselbaum in 1887. The treatment is purely symptomatic. Cold applications to the head and to the spinal cord are useful. On the other hand, heat to the head and spine may be preferred by some patients. A laxa- tive dose of calomel early in the course of the disea.se and mercury throughout the entire affection has many advocates. Opium perhaps offers the best mode of treatment, and there is a remarkable tolerance for this drug even in the very young. If vomiting be a prominent symptom morphine should he given hypodermically. Chloral, the bromides and cannabis indica have been used, but in effect cannot, be com- pared with the systematic use of opium. Alcohol is necessary when depression shows itself ami asthenia is marked. 630 PRACTICE OF MEDICINE. Describe the treatment of pericarditis. In the first stage ice-bags applied over the precordium are of use in relieving pain and quieting the cardiac action. Small blisters at some distance from the precordium are of benefit, especially when there is an effusion. If pain be severe opium in some form is necessary. In very large effu- sion paracentesis is necessary, especially so if the effusion be purulent, in which condition surgical interference is impera- tive. Gentle purges from time to time are useful. A mild, non-stimulating diet is indicated. How should apoplexy due to cerebral hemorrhage be treated? The patient must be placed in bed with the head elevated. If arterial tension be high venesection should be performed immediately. Ice-bags are applied to the head. Croton oil or calomel is of great value in inducing free purgation. If the patient be unconscious for a considerable length of time the bladder must be evacuated with a catheter. What is the treatment of diarrhea occurring in typhoid fever? Large doses of bismuth, salol and some of the intestinal antiseptics are of value in this condition. Opium must be administered with great caution. Give the treatment of whooping=cough. Food should be abundant and nutritious, and if the child vomits during a paroxysm nourishment should be immediately readministered. Antipyrine in doses proportionate to the age of the patient has some influence on the paroxysms. Bromoform is of use. but is very likely to give rise to nausea. Good hygiene is essential in the treatment of the case. What measures should be adopted in the treatment of pulmonary edema? The treatment is largely that of the primary disease which causes the edema. There should be active purging, especially PRACTICE OF MEDICINE. 631 if cyanosis be absent. Hypodermics of atropia in large doses frequently repeated have been found of use in some cases. How should endocarditis be treated? The treatment consists in absolute rest in the recumbent posture. Digitalis should only be given for definite and fixed indications, and is not required unless the pulse becomes quick and small or irregular, or the signs of failing compensation occur. Strychnia is of benefit in this condition. If anemia persists, iron with quinine and arsenic will be found valuable. What measures should be employed to rid the system of tape=worm? The most reliable anthelmintics are the male fern, the pome- granate root, bark and its alkaloid pelletierin. kousso. pump- kin seed, turpentine and chloroform. Thymol is also highly recommended by some authorities. Before the administration of any of these drugs the patient should be put upon a milk diet for at least twenty-four hours. It is then desirable the night before the vermifuge is administered to give a brisk cathartic, preferably calomel. Early the following morning the anthelmintic is administered, and a few hours afterward another purgative. What are the ordinary age limits of typhoid fever, and what conditions are essential to its production? The age at which enteric fever most frequently occurs is from 15 to 30. The predisposing causes are temperate cli- mate, autumn months, unfavorable hygienic surroundings, such as infected drinking water, food, sewage and poor drain- age. The exciting cause is the bacillus of Eberth or the ba- cillus typhosus. How does the cause of typhoid fever principally ^ain entrance to the human body? Outline the prophylaxis. Most frequently through the digestive tracl in the foi infected drinking water or milk. The prophylaxis in the absolute destruction of the discharges and disinfection G32 PRACTICE OF MEDICINE. of the soiled linen. The drinking water should be boiled, and suspected milk should also be boiled. Describe the treatment of cancer of the stomach. The most important point in the treatment relates to the early diagnosis, with the hope of operative interference. [Medical methods are only palliative. They consist in allevi- ation of the dyspeptic conditions and the pain. To accom- plish these ends systematic lavage and the use of opium are the most satisfactory agents. Strength may be maintained by rectal alimentation. Give the period of incubation and the treatment of mumps. The period of incubation is about two weeks. It may be as long as three weeks. In the treatment the patient should be isolated, and a mild laxative given at the onset. Rest in bed is important. Attention should be given to the alleviation of pain. Describe herpes zoster and its treatment. One or more groups of small vesicles seated upon a plane base and attended by neuralgic, burning pain, occuring along the course of one or more branches of a nerve, is known as herpes zoster. The process is acute and self-limited. Mild cases rarely require any constitutional treatment. In the more severe cases remedies which invigorate the nervous sys- tem are of value. Zinc phosphid every three or four hours seems to be of service, and in some cases quinin and strychnin are useful, also arsenic. If the pain be very severe opium in some form is useful. Antipyrin. phenacetin and salicylate of sodium have been highly recommended. A dusting powder consisting of oxid of zinc, boric acid and talc should be ap- plied over the vesicles. This may be changed daily or every few days. Give the symptoms and treatment of exophthalmic goitre. The four cardinal symptoms of exophthalmic goitre are PRACTICE OF MEDICINE. 633 enlargement of the thyriod gland, protrusion of the eyeball, tachycardia and tremor. Hydrotherapy is often valuable ; rest in bed and ice-bags applied to the precordium give much relief to the patient. Digitalis, aconite, veratrum viride, tincture of strophanthus and potassium bromid have been employed in this disease. Thyroid extract has also been lately recommended. Removal of the thyroid gland has been prac- ticed with but little benefit. Name five diseases caused by a known germ. Tuberculosis, enteric fever, cholera, plague and diphtheria. Describe the treatment of neurasthenia. The study of the individual case is important. The rest cure is applicable in many cases, while in others a change of climate is of great benefit. Hydrotherapy, electricity, mas- sage and hypnotism have all been of value in the treatment. The diet must be easy of digestion. In the cerebral variety the bromids are valuable. In the gastric variety arsenic in the form of Fowler's solution is of service. Syrup of the hypophosphites and valerian, caffeine, hyoscin and phenacetin are of benefit in suitable cases. Opium and other hypnotics must be used with great caution. Iron and cod-liver oil are useful. Systematic exercise is of great benefit. Give the morbid anatomy and physical signs of acute endocarditis. The lesions are usually situated in the left side of the heart. Tin- endocardium lining the valves is mosl frequently affected. The Lesions are small vegetations varying in size from one to four millimeters in diameter. Usually micro-organisms are Kjiated with simple endocarditis, Microscopically the first fliange noted in the endocardium is the granular degeneration of the epithelial cells. In the Bub-endothelial tissues hlood- "I changes thai accompany inflammation are noted, agnlation necrosis and the proliferation of the lix-'il cells are found. The inflammatory exudate, the Bnb-endothelial tissues and the fibrin upon the free surface cause the bulging 634 PRACTICE OF MEDICINE. or warty excrescences. Upon this projection, fibrin from the blood stream is also deposited. Intermingled with the exu- date the various micro-organisms may be present. Early on inspection no change is usually noted, and the important physical signs can only be discovered upon auscultation. As the mitral valve is most frequently involved, a systolic mur- mur, which has its maximum intensity at or near the apex, and is transmitted to the left axilla, and often to the angle of the scapula, shows that mitral regurgitation has taken place. The murmur is at first soft and blowing in character. When other valves are implicated murmurs related to them occur. Mention the causes and symptoms of gastralgia. The condition consists in severe boring, rumbling, painful contractions in the epigastric region extending from the xiphoid cartilage and radiating to the back, accompanied by syncope and signs of collapse. The condition may appear suddenly without apparent cause, or may be due to slight pressure in the epigastrium. It may be accompanied by the sensation of the globus hystericus, bulimia, frequent micturi- tion and vomiting. It disappears after having lasted a few moments. The attacks occur with marked irregularity, occa- sionally several taking place in one day, upon alternate days, or not recurring for months. It is a neurosis of the stomach. Describe the treatment of leukemia. Rest in bed is desirable, and a nutritious diet should be given. Arsenic should be administered early, and the dose increased to the point of tolerance. This drug seems to have a marked beneficial effect. Ergot has been recommended; bone marrow and iron are also found to be useful, especially when arsenic is not well borne. Oxygen inhalations may be beneficial. Describe the symptoms and treatment of multiple sclerosis. The first symptoms may appear after some mental or phys- PRACTICE OF MEDICINE. 635 ical strain, the patient behaving as if affected by hysteria. There may be temporary aphonia, from which there may be speedy recovery, or numbness may occur in some part of the body. These symptoms may disappear for a time and re- appear with increased severity. Charcot has given the fol- lowing description: The patient develops spastic paraplegia with exaggerated reflexes, with ankle clonus and limited movements. An irregular jerky tension tremor occurs, nys- tagmus being a prominent symptom. Diplopia and paralysis of the ocular muscles are common. Scanning speech is prom- inent, There are parasthesia, tinnitus aurium and vertigo. The mental faculties are blunted, and in some few cases apo- plectiform and epileptiform convulsions occur. Trophic changes arise late in the disease, the sphincters, however, remaining normal. The treatment is the same as in other forms of sclerosis. The salts of gold, silver and arsenic have been recommended. Describe the eruptions in the eruptive fevers. State where they first appear and the time of their appearance. In scarlet fever the eruption occurs at the end of the first day or beginning of the second day. It consists of pin-head points appearing first upon the neck and chest and spreading rapidly all over the body, except certain parts of the face, the mouth and chin. These red points, which are close together, soon coalesce, giving a diffuse pinkish or reddish appearance to the entire skin, which presents a boiled lobster color. Some slight edema may also be noted. Throughout the entire erup- tion raised papules are found. The eruption lasts about four or five days, and disappears by desquamation. The eruption in measles occurs upon the fourth day. It appears firsl I the face and neck, and spreads rapidly over the entire body The eruption consists of rose-red or brownish maculo-papular points raised above the skin, with intervening healthy skin, often arranged in a crescentic shape, especially upon t ; head and wrists. The eruption remains at its heighl for about four days. The eruption in rubella appears upon the 636 PRACTICE OF MEDICINE. day, and occurs irregularly over the face, neck, chest, body and limbs, varying in individual cases and in different epi- demics. The multiform eruption may resemble erythema, urticaria, and in some cases that of true measles or scarlet fever. It may be confluent or diffuse, lasting from two to four days. The eruption in small-pox occurs upon the third day. The temperature falls as the eruption occurs. The eruption may be discrete or confluent. At first the rash is about the size of a pin-head, and soon becomes hard, feeling like a shot under the skin. The macular eruption is rapidly converted into a papule of a reddish color. There may be itching and burning attending these early eruptive symptoms. In from twenty-four to forty-eight hours the rash has invaded the entire body. The earlier papules soon become vesicular, this change taking place about the sixth or seventh day from the onset of the attack. In a day or so the fluid becomes turbid and purulent, the top being held down (primary um- bilication). In from twenty-four to forty-eight hours this umbilication has disappeared, the top now being conic in shape. About this time an intense red inflammatory areola is noticed about the base of the pock, and the eruption is now exceedingly painful. On or about the ninth day from the beginning of the disease suppuration begins in the pock, last- ing about three days, when the apex of the cone drops in, due to the absorption of the contents of the pock (secondary um- bilication). "When absorption has been completed a crust forms that may remain for some days, these crusts falling off on or about the sixteenth day from the beginning of the dis- ease, leaving depressed striated scars. The eruption in vari- cella occurs upon the first day, and marks the beginning of the disease. The exanthem shows itself as a small reddish point or papule, which in a very few hours becomes a vesicle. It is slightly elevated above the skin rather than having the appearance of being under the skin ; the vesicles are thin and transparent, and from one-eighth to one-quarter of an inch in diameter. There is usually no areola. In the course of a few hours the vesicle becomes milky and begins to shrivel, PRACTICE OF MEDICINE. 637 with depression at the top from absorption of its contents. This results as a yellowish-brown orust that in about ten days from the beginning of the attack, and even before this, sepa- rates, leaving a more or less well-defined scar, which in some cases, especially upon the face, remains permanently. The pocks may appear upon the face, neck, scalp, wrist and some parts of the body. Give the symptoms of acute pericarditis. • It is impossible to diagnosticate a true pericarditis by symptoms without a careful physical examination. The dis- ease commonly begins with severe pain in the region of the precordium. The pulse rate increases, and may be from 90 to 160 per minute. In some cases it may be normal, or when effusion occurs the pulsus paradoxus occurs. Fever of some degree is usually present. The most important sign is a fric- tion sound, which varies greatly in intensity. It is limited to the precordial area, and is heard most frequently at the base of the heart. It is increased by pressure with the stetho- scope. If an effusion develops the friction sound disappears, and returns again as absorption takes place. What are the complications and sequelae of cerebro= spinal fever? The important complications are broncho-pneumonia, bron- chitis, croupous pneumonia, endocarditis and pericarditis. The sequels are exceedingly common. They consist in affec- tions of the special senses. There may be loss of sight, per- manent deafness, loss of smell, loss of taste, various forms paralysis and neuralgia. Describe the eruption of typhus fever. The characteristic eruption of typhus appears upon the fifth day of the disease, and in its early stages closely resem- bles measles. Macular spots of irregular size and outline, and of a dirty pinkish or reddish color, characterize the ex- anthem. It appears first upon the ehesl and abdomen, and extends to the extremities, the face being rarely affected. ft 638 PRACTICE OF MEDICINE. is particularly copious upon the extremities, where later in the disease it becomes darker or petechial. Another erup- tion is also characteristic, and consists of marbling or mottling of the skin. This rash lasts throughout the disease, and does not disappear in death. Describe the treatment of measles. There is not specific treatment, and in uncomplicated cases medicines are unnecessary. A mild laxative at the onset is useful. The entire treatment should be directed to the pre- vention of complications, especially broncho-pneumonia. When complications occur they must be treated upon general prin- ciples. Give the physical signs of a cavity of the lung in pul= rnonary tuberculosis. If the cavity be large and superficially situated there will be depression upon inspection. Upon palpation, if the cavity be empty, there will be increased vocal fremitus. Upon per- cussion, if the cavity is empty, a tympanitic note may be elic- ited. If the cavity communicate with the bronchus a cracked- pot sound may occur. If the cavity be filled dulness will be noted upon percussion. On auscultation, if the cavity be empty, increased vocal resonance and cavernous breathing will be heard. If fluid be present in the cavity bubbling rales are heard. Around the cavity a friction sound is frequently noted. Give the etiology and treatment of hemothorax. Hemothorax may result from traumatism, caused by frac- ture of a rib or wounding of a lung. It may also result from rupture of an aneurysm, from malignant disease of the lung, and in the hemorrhagic diathesis. If the hemothorax be mod- erate in size it should not be interfered with, as subsequent absorption and clotting will take place. Rest and the free administration of opium are necessary. Avoid stimulation, for it will interfere with the formation of a clot. PRACTICE OF MEDICINE. 639 Describe the Brand method of treatment in typhoid fever. When the temperature in the axilla reaches 102.6° F. a cold bath is given, and repeated every three hours, the water being at a temperature of about 70° F. The patient should be immersed in the tub, the water covering all but the head ; then water of a lower temperature should be poured upon the patient's head or a wet ice pack used. Gentle friction should be applied constantly by the attendants, and the patient should be encouraged to do likewise. The abdomen should not be rubbed. The duration of the bath is 15 minutes. Some alcoholic stimulant should be administered to the pa- tient before and after the bath. When the bath is finished the patient should be lifted back to his bed and covered with woolen blankets. The temperature should be taken one-half hour afterward to note the fall produced by the bath. Give the symptoms and treatment of myocarditis. The symptoms may be entirely latent, and the condition in mild grades is not likely to be recognized. In the advanced stages pain in the preoordium, especially upon slight exertion, becomes prominent. It radiates and shoots down the left arm, and tingling may occur in the fingers. Shortness of breath is a prominent symptom. The apex beat is weak and diffused, the pulse is feeble, and often intermittent. Marked arrhythmia occurs. Constipation and gastric disturbances are common. In advanced stages edema of the skin may occur. The treatment consists in careful regulation of the diet, attention to the functions of the body, ami the systemic use of such drugs as alcohol, strychnia, iodide of potassium and arsenic. What is the practical import of hematuria, and how can its source be diagnosed? Blood in the urine is caused by the presence of red blood corpuscles, the color being of a reddish hue. When hlo.nl is derived from the bladder the first that is passed will contain 640 PRACTICE OF MEDICINE. a smaller amount of blood than the last. Blood from the bladder may be copious in amount, and this urine in contrast to that containing blood from the kidney, upon standing, will show fibrin. Blood from the kidney is more likely to be inti- mately mixed with the urine, and if coagula be present they are apt to be washed out. From the urethra only the last drops are likely to be bloody. Give the etiology of scarlet fever. Age is an important predisposing cause. It rarely occurs after the tenth year of life. Neither sex nor occupation pre- dispose to it. The disease is more common in cold and tem- perate regions. Epidemics are more prevalent in the winter. In this disease there is a marked personal predisposition. One attack confers immunity as a rule. The exciting cause is not known. Give the treatment of tic douloureux. It is especially important to treat the underlying condition. If the disease be reflex it is important to give attention to the affection giving rise to it. Hygienic treatment is of import- ance. Change of scene and residence, with good, nourishing diet, are necessary. Many drugs have been recommended for the treatment of the paroxysm, such as quinine, the coal-tar analgesics, the salicylates, caffeine, aconite, gelsemium and belladonna. Morphine should be avoided if possible, as there is great danger of the patient acquiring the opium habit. Local treatment is sometimes of use, thus hot and cold appli- cations, liniments containing menthol, and occasionally elec- tricity may be tried. In protracted oases surgical interfer- ence should be thought of. Give the symptoms of appendicitis. The onset is sudden ; there is pain in the abdomen, which at first may be general or centered around the umbilicus, and occasionally in the epigastrium and in the left or right iliac fossa. In many cases the pain is confined to the right iliac fossa, and directly in the region of the appendix (McBurney's PRACTICE OF MEDICINE. 641 point). If the pain is general it soon localizes itself to the right iliac fossa, usually within the course of twenty-four lion re. It is paroxysmal or intermittent, and colic-like. This pain may be preceded by chilliness. Frequently nausea and vomiting mark the beginning of the attack. Fever rapidly follows the onset of the disease, which is usually moderate, from 100°-103° F. Occasionally it may be absent. The fre- quency of the pulse generally corresponds to the degree of the fever. Constipation is commonly present. The tongue is coated posteriorly. The facial expression of the patient shows anxiety and suffering. The position of the patient is often characteristic. The righl thigh is most frequently par- tially flexed upon the abdomen, while the left leg is extended. Examination of the abdomen shows slight distension. On palpating ihe abdomen the right rectus muscle will be found rigid. Tenderness is as constant as pain. Pressure upon the opposite side produces pain in the region of the appendix. In some instances the appendix may be clearly made out. and occasionally a tumor is palpable. Define aphasia and give its etiology. Aphasia embraces a variety of defects in the use or the comprehension of language, either spoken or written. In the majority of cases aphasia is one of the symptoms of organic local cerebral disease, occurring in the left hemisphere in the right-handed, and vice versa. It occurs in cerebral hemor- rhage, thrombosis, embolism, abscess, tumor, and depressed fracture of the skull. Rarely it has been noted in hysteria and neurasthenia. Give the diagnosis and treatment of acute follicular tonsillitis. The diagnosis depends upon greal pain in swallowing. This may be preceded by Lassitude, malaise, headache, pain in the bones, vomiting, and marked fever. Examination of the throafl shows redness and swelling of one or both tonsils, with yellowish-white patches upon them, varying in sdze from a 41 642 PRACTICE OF MEDICINE. pin-head to a split pea. These may be stripped off: without leaving a bleeding surface, leaving an intact mucous mem- brane beneath. The breath is usually fetid. The patient should be put to bed and a laxative administered. The coal- tar products, especially phenacetin, in small doses, guardedly given, promptly relieve the pain. Ice bandages and small particles of ice in the mouth are useful. If pain and sleep- lessness persists, opium, especially Dover's powder, may be administered. Give the treatment of intestinal hemorrhage in typhoid fever. Food and drink should be withdrawn ; one or more ice-bags applied to the right iliac fossa, and opium given for effect. The head of the bed may be lowered and the foot of the bed elevated. The opium should be pushed so as to produce mild somnolence. If thirst becomes excessive, small pellets of ice may be placed in the mouth from time to time. Give the treatment of delirium tremens. One of the most important features in the treatment is care- ful feeding. Little food should be given a/t a time, but it should be frequently administered. If vomiting is persistent, rectal alimentation may be resorted to. If there are signs of heart failure stimulants must be administered. Strychnin hypodermically is of great value. Every effort should be made to induce sleep. The most useful agents are morphin, hypoderonically, or hyoscin. Chloral is also useful, but it has a depressing effect upon the heart. Give the treatment and prognosis of progressive perni= cious anemia. Rest in bed is essential, and easily digested, nutritious foods should be given. Arsenic has been found of most value, given in the form of Fowler's solution in ascending doses. If this drug is not well borne iron may be substituted. Bone marrow is also useful. Stimulants, such as strychnin and alcohol, and inhalations of oxygen, are of advantage. The prognosis PRACTICE OF MEDICINE. 643 is always grave. Death results in from a few months to a few years. Apparent recovery followed by relapse is common. Give the symptoms of acute exudative nephritis. The disease may begin suddenly or gradually. Edema develops rapidly. The urine becomes scanty and high col- ored, and uremic symptoms, such as vomiting and convulsions. occur. The edema at first is most marked in the face, partic- ularly about the eyelids. There is dull headache, with pain in the back and loins, dryness of the skin and dyspnea. The temperature is sub-febrile. The urine upon examination shows that it is decreased in amount, the color is dark red and is turbid, blood being present. The specific gravity is from 1020 to 1030, and upon testing the urine large quantities of serum albumin are found. The quantity of urea is usually less than normal. Under the microscope hyaline, granular and epithelial casts are noted, with renal epithelium, red blood cells and granular matter. Define and describe bronchorrhea. This is a rare form of bronchitis, characterized by an exces- sive amount of secretion, which is very foul. It is sometimes called purulent bronchorrhea. The quantity of expectoration varies from one to three pints. The character may be either thin or watery or it may be transparent or ropy. Dyspnea and cough are always present, often being persistent, and paroxysmal. Define hydronephrosis. State its causes and describe its treatment. Obstruction to some part of the ureter, bladder or urethra may give pise to dilatation of the pelvis and tubules of the kidney from accumulation of urine. It ma\ be due to the twisting of the ureter, it may result from congenita] narrow- ing of the ureter or urethra, from pressure. The treatment is Largely surgical. Massage may be practiced with favorable results. However, it' the condition persists, aspiration and drainage are necessary. 644 PRACTICE OF MEDICINE. Give the symptoms and treatment of migraine. The principal symptom is the headache, which shows greater or lesser periodicity. This symptom is followed by pallor and some vasomotor spasm. As a rule the disease is unilateral, the left side being oftener affected than the right. The pupil upon the affected side is often smaller, and the eye may be retracted. Often there is disturbance of vision, the duration, however, being temporary. Occasionally, tinnitus aurium occurs, which may be associated with vertigo. These symp- toms are accompanied in the majority of cases by marked gastric disturbances, such as nausea, with frequent vomiting. The treatment consists in relieving the pain and the preven- tion of its recurrence. The following drugs have been recom- mended : Ergot, the coal-tar products, salicylate of sodium, the bromids, caffein and gelsemium. As a prophylactic, nitro- glycerin taken after meals with bismuth and pepsin has been said to be of value. Mild purging with calomel from time to time often prevents attacks. Mention a disease of the nervous system in which the patella reflex usually disappears; one in which it is usually exaggerated. In locomotor ataxia the knee-jerk usually disappears; in spastic paraplegia, as a rule, the knee-jerk is exaggerated. Define myxedema and give its treatment. This is a disease characterized by a myxomatous change in the subcutaneous tissues due to pathologic lesions in the thy- roid gland causing diminished or absent secretion. Thyroid extract should be administered as early as possible, and should be continued until all the symptoms disappear, and then a prophylactic dose must be given regularly. General tonics, such as iron, quinin and strychnia, are of value. Define simple acute stomatitis; at what age is it most common and what is its treatment? This is an inflammation of -the mucous membrane of the mouth. The disease is most frequent in children, but may PRACTICE OF MEDICINE. 645 also occur in adults. The treatment consists in cleanliness, careful feeding, and the use of a mild alkaline mouth wash. A mild purge is often advantageous. Give the causes and treatment of bronchial asthma. The disease is sometimes hereditary. It is more common in males than in females. It may follow an attack of bron- chitis, and ds commonly associated with chronic bronchitis and emphysema. The inhalation of dust, the pollen of certain plants, fog, fumes, vapors, odors that emanate from certain animals may produce an attack of asthma. Reflex causes, as irritation from nasal polypi, causes relating to the gastro-intestinal tract, skin or genito-urinary center may act in a like manner. For the treatment of the paroxysm nar- cotics and anti-spasmodics are usually employed. Chloral, whiffs of chloroform or ether, amyl nitrite by inhalation, or morphia and atropia hypodennically are useful drugs. Re- lief sometimes follows the inhalation of nitre paper cigarettes, which also contain lobelia and stramonium. Sinapisms and turpentine stupes to the chest may be of value. Give the treatment of an acute attack of gout. A mild laxative at the onset is useful. The affected joint .should be kept at rest, and a diet of milk and farinaceous articles, with plenty of water, should be insisted upon. If the pain become severe opium in some form must be adminis- tered. For the attack itself colchicum is the remedy. Iodid and bromid of potassium are also useful, as are also the sali- cylates and the salts of lithia. State the prognosis in aneurysm of the thoracic aorta. Tin' prognosis is always grave, death invariably resulting. Differentiate broncho=pneumonia and incipient phthisis. This is very frequently difficult, incipient phthisis often occurring as a localized broncho-pneumonia. Broncho-pneu- monia follows ;m acute bronchitis, making itself known by a rise in temperature over 103 F., by ;m increase in the respi- 646 PRACTICE OF MEDICINE. ratory and pulse rate, the pulse commonly running from 120- 160 per minute, while the respiratory rate may be from 40-80 per minute. Broncho-pneumonia occurs at the extremes of age. The physical signs of well-developed broncho-pneumonia are, upon inspection, an increased respiratory rate; on palpa- tion, increased vocal fremitus in areas over both lungs; upon percussion, localized areas of dulness over both lungs (more marked posteriorly) surrounded by a tympanitic area; on auscultation, broncho-vesicular breathing suberepitant rales mixed with large and small mucous rales. The physical signs are all more marked posteriorly, and are usually well marked at the bases. Incipient phthisis has a gradual onset with loss of appetite, gastric disturbance, slight evening rise of temperature (100° or thereabouts), anemia and general malaise. There is, as a rule, slight cough with scanty expectoration (the tubercle bacillus may be found in the expectorated material). Occa- sionally there is slight hemoptysis or the sputum may be blood- tinged; there is a progressive loss of weight. The physical sdgns relate principally to the apices. There is a slight im- pairment of resonance at one or both apices on percussion, and upon auscultation there may be heard slight friction sounds, harsh breathing and some fine moist rales. What are the diagnostic signs of retro=pharyngeaI abscess? This may follow the infectious fevers, such as scarlet fever or diphtheria, usually in young children, occasionally due to caries of bone. There is pain on swallowing (dysphagia), difficulty in breathing, occasionally hoarseness, cough and stiffness of the neck. Upon examination of the throat by inspection and palpation there is discovered a fluctuating tumor which projects from the posterior wall of the pharynx. Differentiate tonic and clonic spasms. A tonic sp'asm is a continuous spasm ; a clonic spasm is an interrupted one, as contraction and relaxation. PRACTICE OF MEDICINE. 647 Describe the characteristics and significance of the several kinds of arterial pulse. The normal radial pulse is characterized by regularity, fair volume, and, in the healthy adult, is from 70 to 80 per minute in the erect posture. The pulse of aortic regurgitation is known as the water-hammer or Corrigan pulse. It makes itself known by an apparent fulness, which, however, soon passes, and it recedes from the finger, hence it is also known as the receding pulse. The pulse of mitral stenosis is a small, irregular, rapid pulse. The dicrotic pulse conveys to the finger a double beat. Diagnosticate diabetes mellitus. The diagnosis of diabetes mellitus consists in the continuous presence of glucose in the urine. The amount of urine passed by the patient may be from 3 to 5 quarts in the 24 hours ; its specific gravity is high, 1030 or over. The color is usually straw-colored, and the urine is clear. The patient has great thirst, large appetite, as a rule loses weight, and an etherial odor may often be detected in the breath; there is pruritus, especially of the genitals, and boils and carbuncles are apt to form. Differentiate gastric cancer from gastric ulcer. G-astric cancer occurs after the age of 40, most frequently in the male sex; gastric ulcer is a disease most frequently occurring in young females in whom chlorosis is often present. Gastric cancer is characterized by loss of weight, marked cachexia, and often by the presence of a tumor in the region of the pylorus. There is pain which, as a rule, is dull in char- acter and not particularly aggravated by food. Vomiting occurs after a longer period, 24 hours or more, of food which is but partially digested. The Opp' bacillus ma; present in the vomited material, and there may also be ti: of blood. In ulcer there is pain and marked tenderness in the region of the ensiform cartilage. This pain is greatly prorated by the taking of food; vomiting occurs soon after 648 PRACTICE OF MEDICINE. a meal ; there is frequently hematemesis. In the examination of the gastric contents it will be found that in cancer there is an absence of free HC1 and the presence of lactic acid, while in ulcer there is an excess of free HC1. Differentiate scarlatina, measles and roseola. In scarlatina the eruption appears late on the first day or early on the second day of the disease, while in measles it appears on the fourth day, and in roseola the eruption is the first symptom of the disease. The onset in scarlet fever is abrupt, with a chill or convulsion, high temperature, rapid pulse, 140-160 per minute or more, sore throat, etc. In measles the onset is characterized by marked catarrhal symptoms, such as sneezing, coughing, lachrymation, etc. ; the temperature moderate, there is slight sore throat and mild gastric dis- turbance. How would you diagnose pneumonia? The direct diagnosis of pneumonia depends upon the sudden onset with chill, temperature which, as a rule, is high, severe pain in the side, cough, at first with scanty expectoration, later the expectoration becoming very tenacious and containing blood (rusty sputum), and upon the physical signs. These consist of the crepitant rale in the first stage, dulness on per- cussion in the second stage with bronchial breathing, and the occurrence of the crepitus redux in the third stage. Differentiate peritonitis and enteritis. In peritonitis there are present marked abdominal pain, tenderness on pressure, abdominal distension, after which effusion is apt to occur, vomiting, which becomes persistent, fever and perhaps the occurrence of collapse ; marked consti- pation is an important symptom. In enteritis there is diar- rhoea, there is rarely marked distension, no abdominal rigidity ; as a rule, there is the history of some dietary error. Differentiate organic and functional heart murmur. Organic murmurs may be systolic, presystolic or diastolic in PRACTICE OF MEDICINE. 649 time. There is evidence of cardiac hypertrophy, dilatation, or both. The murmur is conducted in certain definite direc- tions (except the presystolic murmur). A thrill is sometimes present. A functional murmur is always systolic in time: it is heard at the base, particularly at the left base (whereas the organic murmur is heard at the punctum maximum), it is not transmitted, there is no evidence of hypertrophy or dila- tation, and it is present in anemic conditions. Describe three pathological pulmonary sounds heard on auscultation, and give their significance in diagnosis. The friction sound which may be heard in inspiration, expi- ration or both, which indicates a fibrinous pleurisy. A crep- itant rale, which indicates usually fluid in the vesicular struc- ture of the lung. Amphoric breathing, showing a cavity. Differentiate aortic stenosis and aortic insufficiency. In aortic stenosis the murmur is systolic in time, transmit! ed to the arteries of the neck; a systolic thrill is also often p ent, there is some evidence of hypertrophy of the left ventri- cle, the pulse is full and, as a rule, not rapid. In aortic regurgitation the murmur is diastolic in time, heard at the left base, conducted down the sternum. The water-hammer or Corrigan pulse is present. There is marked evidence of hypertrophy of the left ventricle. Occasionally the "FLinl murmur" may be heard. Differentiate typhoid fever and remittent fever. In typhoid fever prodromes are present, such as loss of appetite, headache, diarrhea, evening fever, becoming more marked each succeeding night. < )n or aboul the 7th day the characteristic eruption appears, the typical tongue makes appearance, the spleen is enlarged, and the dicrotic puis found during the second week. The Widal and diazo reac- I inns are present. Remittent fever may be present in many of these cases; there is, however, no Widal or dia • tion, no dicrotic pulse, and the presence in the blood of Plasmodium malaria' will in all cases lead to a correct d nosis. 650 PRACTICE OF MEDICINE. Describe four peculiar appearances of the tongue and give their significance in diagnosis. A flabby, indented, swollen tongue, covered with a yellowish fur, shows catarrhal gastritis. This tongue is also seen in smokers and drinkers, and occurs often in moderate fevers. A tongue which is red at the edges and tips and is coated pos- teriorly occurs in enteric fever. The "strawberry" or cat tongue, in which the papillae are elevated and a slight grayish fur is seen, occurs in scarlet fever. Furrings which are small and limited indicate irritation from a rough tooth or inflam- mation of a tonsil. Differentiate acute rheumatism and periostitis. Acute rheumatism is characterized by redness, swelling and pain in the joints, by fever of a moderate range, by acid sweats and a constant tendency to inflammation of the serous membranes of the heart. Periostitis, as a rule, follows an injury; the pain is more localized and does not refer to the joints ; there are no acid sweats, and pus formation may occur, which is exceedingly rare in acute rheumatism. Differentiate neuritis from myalgia. In neuritis the pain is, as a rule, along the nerve trunks; trophic changes may occur. In myalgia pain is over the mus- cles; there is no constitutional disturbance; fever is entirely absent; pressure upon the affected area in myalgia gives re- lief ; in neuralgia the pain is aggravated by pressure. Describe the symptoms of yellow fever. For convenience of description the disease is divided into three stages: The stage of onset, which generally lasts three days ; the period of calm, which lasts from 12 to 24 hours ; and the period of collapse, the duration of which is indefinite. In the first stage there is headache, pain in the bones, nausea and vomiting, moderate fever, the pulse may be 80 to 100 in a min- ute, and becomes progressively slower as the disease advances, the urine is albuminous ; there may be even in this stage slight jaundice. These symptoms disappear more or less abruptly PRACTICE OF MEDICINE. 651 and give place to the stage of calm, in which all the previous symptoms disappear; and recovery from this stage may be uninterrupted. If this favorable event should not occur, the third stage is ushered in. with the appearance of marked jaun- dice, from which the disease receives its name. There may be hemorrhage from any of the internal organs, most frequently, however, from the stomach, the characteristic black vomit. The symptoms of the first stage are added to this. Give the diagnosis of gastric ulcer. The disease is most frequent in young anemic females. There is pain and tenderness on pressure in the region of the ensiform cartilage; there is hematemesis and obstinate con- stipation. Examination of the gastric contents shows an excess of HC1. Give the symptoms resulting from paralysis of the phrenic nerve. This is a paralysis of the diaphragm, if the condition is bi- lateral ; no movement is noted on the abdomen and epigas- trium; the hypochondrium is drawn in; marked dyspnea occurs upon the slightest exertion. There may be enlarge- ment of the chest. What is the significance of the patellar reflex as a sign of disease? Absence of the knee-jerk is caused by a lesion affecting any region of the reflex are; it is. therefore, lost in disease affect- ing either motor or sensory fibers or both, as in neuritis, in disease of the posterior roots or columns, as in Friedreich's ataxia. It may be absent in apoplexy, epilepsy, injury to the cord and in meningitis; it is sometimes absent in diabi diphtheria and chorea. It is exaggerated in hemiplegia fol- lowing apoplexy, in the cerebral palsies of children, in general paralysis of the insane, also in hysteria, neurasthenia and strychnine poisoning. Differentiate epilepsy from hysteria. Kpilepsy is often preceded by an aura, followed by complete 652 PRACTICE OF MEDICINE. loss of consciousness. These are at first tonic, followed by clonic, convulsions ; during the attack the pupils are dilated ; the patients often bite their tong'ue. In hysteria there is never complete loss of consciousness; there is no regularity with regard to the convulsion ; it is most common in females be- tween the ages of 15 and 25 ; the pupils are irregular, hystero- genic zones are present, the patient never falls so that she may be injured. Differentiate neuritis and rheumatism. In neuritis the pain is commonly along the nerve trunks; trophic changes occur ; there may be foot-drop or wrist-drop ; fever is slight. In rheumatism there is redness, swelling and pain in the joints, acid sweats, frequent implication of the membranes of the heart, marked deposits of urates in the urine. Differentiate acute phthisis and capillary bronchitis. There is a form of acute pulmonary phthisis which is known as the broncho-pneumonic form, which can with the greatest difficulty only be differentiated from so-called capillary bron- chitis. The main points of difference would consist in the progressive emaciation, a family history of tuberculosis, the finding of tubercle bacilli in the sputum, and the appearance of the physical signs in the lungs. What are the clinical manifestations of biliary calculi? As long as the calculi remain quiescent in the gall-bladder no symptoms arise. It is only upon the passage of the gall- stones into the duct that the symptoms of hepatic colic arise, which consist in great pain in the region of the liver, radiating toward the umbilicus and right shoulder-blade, nausea and vomiting «and, after the passage of stones, jaundice, clay- colored stools and the appearance of biliary pigments in the urine. Differentiate empyema from pulmonary abscess. In pulmonary abscess there is a fever of a septic type, the PRACTICE OF MEDICINE. 653 physical signs of a cavity are commonly present, frequently expectoration of foul-smelling pus. which under the micro- scope shows elastic fibers. In such cases leukocytosis is pres- ent. In empyema there are the usual signs of pleural effusion, the temperature may range from 102° to 105 °, displacement of the heart and the adjacent organs is common, local edema and redness of the skin are often present. Describe the diagnostic characteristics of the eruption of typhoid fever, smallpox and chicken=pox. The eruption of typhoid fever appears about the seventh day, consisting of slightly elevated, rose-colored spots, which disappear on pressure and appear again after the pressure is removed; they occur in crops, having a duration of from two to three days ; they appear commonly on the abdomen, chest, between the shoulder-blades, extremely rarely upon the face. The eruption of smallpox appears on the third day in the form of a macula, passing through the successive stages of vesicle, pustule, crust and scar. The pustule is umbilicated and has an inflammatory areola: the eruption appears all over the body, especially on the exposed parts. The eruption of chicken-pox appears on the firel day; it appears as a small reddish papule, which in a very few hours becomes a vesicle: the vesicle is thin and transparent. Differentiate diphtheria from follicular tonsillitis. In diphtheria the exudate is found upon all parts of the posterior pharynx, uvula and tonsils. Around the exudate there is an inflamed areola. The exudate is removed with grea/l difficulty, leaving a bleeding surface, the false mem- brane rapidly reforming. In follicular tonsillitis the exudate is strictly Limited to the crypts of the tonsils; it is wiped away with isi.se, without leaving a bleeding surface, and it does nol reform. The Klebs-Loffler bacillus is found only in tin- diph- theritic exudate. Differentiate acute enteritis from acute dysentery. In dysentery the important symptoms to be considered are 654 PRACTICE OF MEDICINE. tormina, tenesmus and stools composed of mucus and blood. These symptoms in acute enteritis do not occur in anything like the severity and constancy that they do in dysentery. Differentiate appendicitis from enteric fever. As a rule, appendicitis begins abruptly, with marked pain in the right iliac fossa over McBurney's point. There is con- stipation, tenderness, board-like rigidity, all this occurring, as a rule, within a few days. The onset of enteric fever is gradual, with prodromes of diarrhea, headache, characteristic tongue, appearance of the eruption about the seventh day, enlargement of the spleen, dicrotic pulse, Widal reaction. Differentiate acute pericarditis from acute endocarditis. In pericarditis there is pain in the pericardium. This, as a rule, is absent in endocarditis. In pericarditis there is a friction sound, which may be either systolic or diastolic, but as a rule, is not related to either. In endocarditis there is a murmur, which is either systolic, diastolic or presystolic; the murmur is transmitted, the friction sound is localized. The murmur is heard at the punctum maximum ; the friction sound is heard over the body of the heart and is nearer the ear. How would you diagnose a case of rickets? Sometime between the seventh month and second year of life the patient shows irritability, restlessness and some fever toward evening, dentition is delayed and gastro-intestinal disturbances follow; there is profuse sweating. The shape of the head is characteristic ; it is rectangular, the face ap- pearing small in proportion to the skull, bone changes are noted, and the rachitic rosary appears. Differentiate variola and varicella. In variola the eruption appears on the third day, preceded by marked constitutional symptoms. The eruption goes through the successive stages of macule, papule, vesicle, pus- tule, which is umbilicated and surrounded by an inflammatory areola, crust and scar. The eruption in varicella appears on PRACTICE OF MEDICINE. the first day and is vesicular almost from the beginning. There are rarely marked CQnstitutional phenomena, and the disease is essentially one of childhood. Differentiate apoplexy from uremic coma. This is often very difficult ; however, the following points favor apoplexy: Profound coma, the face may be pale and cyanotic or flushed; respiration is stertorous and slow and may be of the Cheyne-Stokes type; hard arteries, with a slow. hard, irregular, full pulse; the pupils are dilated or unequal and do not react to light ; conjugate deviation of the head may be present; there is evidence of paralysis; the skin is hot and dry; the coma in uremia may be preceded by, or accompanied with, convulsions; the face may be pale and edematous; the pulse is slow and of high tension, showing either hypertrophy of the heart or sclerosis of the vessels; there may be a urinous odor exhaling from the patient; frequently there is edema of the feet; albumin and casts a.re found in the urine; albumi- nuric retinitis may be present. Differentiate unconsciousness from apoplexy, syncope and alcoholic intoxication. (Apoplexy see above.) In syncope the face is very pallid, the pulse is very weak, and the pupils are markedly dilated. In alcoholic coma the unconsciousness is rarely complete. The alcoholic odor of the breath is not diagnostic, as apoplexy and uremia may occur in persons that have been drinking. The pulse Ls at first rapid and full, later becoming small and fee- ble. The pupils ar [iial and often dilated. The skin is cool and moist and the temperature subnormal. Differentiate cardiac hypertrophy from cardiac dilata= tion. In cardiac hypertrophy the apex-beat is displaced down- ward and to the Left. The first sound of the heart is Btrong and booming. The piil.se Ls slow and strong. In cardiac dila- tation the apex-beal is displaced to the right, ft is diffused 656 PRACTICE OF MEDICINE. and feeble, the first sound being weak. The pulse is often rapid, irregular and weak. Differentiate Asiatic cholera from cholera morbus. This often presents great difficulties, especially in times of an epidemic of cholera; however, the finding of the comma bacillus will in all cases clear up the diagnosis. Rice water discharges are much more common in true cholera. In cholera morbus there is usually the history of an indiscretion in diet. Differentiate heat exhaustion from sunstroke. In heat exhaustion premonitory symptoms occur, such as dizziness, headache, nausea and vomiting. The respirations are increased in number, and the pulse is very rapid, 130-140 per minute. Unconsciousness is not profound. The temper- ature may be normal or subnormal, or slight fever may be pres- ent. In sunstroke there may or may not be prodromes. The temperature is very high, from 106°-115°, or even higher. Dyspnea is marked, and the skin of the body is red and some- times even livid. The pupils are contracted and the pulse is very rapid. There is complete unconsciousness in which con- vulsions may occur. Cheyne-Stokes breathing may be present. Diagnosticate parenchymatous nephritis. The face is pale and edematous. The pulse is full and strong, showing some hypertrophy of the heart at first, al- though this is not nearly as common as in the interstitial varietj'. The urine is decreased in amount, of high specifie gravity, high-colored, and contains large amounts of albumin and oasts. Often there is also edema of the lower extremity. Differentiate aortic and mitral valvular diseases. In aortic disease the murmur is heard with the greatest in- tensity at the aortic cartilage (second right costal cartilage) ; it is either transmitted to the neck, if it be systolic, or it is transmitted down the sternum, if the murmur be diastolic in time. In aortic valvular disease there is always hypertrophy of the left ventricle. In mitral disease the murmur is heard PRACTICE OF MEDICINE. 657 at the apex. It is transmitted to the axilla and the angle of the scapula if the murmur be systolic in time. The presys- tolic murmur is not transmitted and is accompanied with a presystolic thrill. When is perforation in typhoid fever most likely to occur? Sometime in the course of the third week. Describe the essentially different sounds given by the thorax on percussion. Tympany is elicited over the trachea, resonance over the lungs, dulness over the heart. In what cases would the ophthalmoscope aid in diag= nosis? In disease of the arteries (retinal hemorrhages). In dis- ease of the kidney, in disease of the nervous system, syphilis, tobacco-poisoning, lead-poisoning, tubercular meningitis, dia- betes, etc. Differentiate in a general way between cerebrospinal fever and tubercular meningitis. The onset of tuberculosis is not as sudden as in cerebro- spinal meningitis; the pains, hyperesthesia and retraction are less, and there are no eruptions. Retraction of the abdomen, irregular pulse and Cheyne-Stokes respiration are much more frequent. A pre-existing tuberculous lesion may be found, and the ophthalmoscope may reveal tubercles in the choroid. What does bronchial breathing indicate? This is heard normally when Listening over the trachea. Il is encountered over airless spaces in the lung tissue and over cavities. In what diseases can we employ the microscope to ad- vantage as an aid in diagnosis? Principally in diseases of the blond and kidney. It is also necessary in the examination of all secretions and excretions for pathogenic organisms and parasites. 42 658 PRACTICE OF MEDICINE. Describe the physical signs of simple ascites and those of ovarian dropsy. In ascites, if the patient be lying upon the back, the center of the abdomen is flat (provided the amount of fluid is not excessive), the lateral and dependent portions bulge. There will be tympany over the region of the umbilicus and flatness in the flanks. Fluctuation will be obtained. In dropsy due to ovarian disease the accumulation of the fluid is local (in the region of the ovary) ; it does not change with the position of the patient. If the accumulation be great, the differential diagnosis is very difficult ; vaginal examination must be made, and sometimes the character of the dropsy can only be deter- mined from the fluid withdrawn. Differentiate the early eruption of syphilis and measles. In syphilis there is the history of the chancre, and quite a period (six weeks) before the eruption appears. Coincident with the eruption there is inflammation of the throat (mucous patches). There is rarely any fever. The eruption is copper- colored, and is not particularly prominent on the face. In measles there is marked fever from the onset, with severe catarrhal symptoms. The eruption does not appear before the fourth day, it occurs prominently on the face and rapidly spreads all over the body, the catarrhal symptoms continuing. What are the methods of physical diagnosis or explora= tion? Inspection, palpation, mensuration, percussion, auscultation and succussion. Describe the symptoms of acute inflammatory arti= cular rheumatism. The disease, as a rule, begins with pain, swelling and red- ness of one or more of the large joints. The joints implicated are symmetrical. There is moderate fever, 102°-103°, acid sweats and marked urates in the urine. There is a tendency to implication of the serous membranes of the heart. PRACTICE OF MEDICINE. 659 Describe the symptoms of a case of apoplexy due to cerebral hemorrhage. Prodromes may precede the attack, such as nausea, vomit- ing, vertigo. As a rule, the attack comes on suddenly, the patient becoming comatose. The faoe is flushed or pale. There is stertorous breathing, occasionally of the Cheyne-Stokes type. There is conjugate deviation of the head and eyes; the pupils are irregular, and there is evidence of hemiplegia. Differentiate acute bronchitis from lobar pneumonia. In acute bronchitis there is cough, at first without, later with mucopurulent expectoration; subfebrile temperature, and slight pain under the sternum. There are no changes from the normal on percussion, but upon auscultation there are at first dry rales, followed by moist rales. Lobar pneu- monia is characterized by sudden onset, with marked chill, high temperature, "stitches in the side," cough, a sputum which is very tenacious and often rusty; full pulse at first, later becoming rapid. The physical signs are quite characteristic. There is, in the first stage, the crepitant rale, in the second stage dulness on percussion with bronchial breathing and. in the last stage, "crepitus redux." Differentiate hemoptysis and hematemesis. //. moptytis. Henuitemesis. Blood is bright red and frothy; often Blood is dark, clotted and often coughed up. mixed with food; is vomited. Stools may In- tarry. Alkaline in reaction. V < - 1 . 1 in reaction. Containing air bubbles. Air bobbles absent. Tubercle bacilli may be presenf in the No tubercle bacilli in the blood. blood. Differentiate rheumatism from gout. Gout occurs suddenly and shows a special preference for the smaller joints, especially the great toe. Rheumatism comes on more gradually ami attacks principally the large joints. The appearance of the joint in goul is swollen, glee tense and bluish. There is less sweating ami Less fever than 660 PRACTICE OF MEDICINE. in rheumatism ; gastric and nervous symptoms are never prominent. Implication of the membranes of the heart in gout is decidedly less frequent than in rheumatism. Differentiate intestinal colic, uterine colic and renal colic. Intestinal Colic. — Diffuse pain, which may be localized, very severe in character ; usually of sudden onset, relieved by pressure ; lasting, as a rule, a few hours. A free discharge of flatus relieves the attack. Uterine Colic. — The pain is in the pelvis, there is some his- tory of uterine discharge and disease. Renal Colic. — The pain starts from the region of the kidney, shooting down the ureter. There is retraction of the testicle ; often nausea and sometimes vomiting. Give the physical signs of the most usual valvular lesions of the heart. Mitral insufficiency is the most common valvular lesion of the heart. The physical sign is a murmur at the apex, systolic in time and transmitted to the left axilla and the angle of the scapula. Differentiate pleurisy and pneumonia. In pleurisy there is a friction sound heard commonly both in inspiration and expiration ; fever is slight, there is marked pain in breathing. There may be slight cough. In the first stage of pneumonia there is a pleurisy, especially when the inflammatory exudate reaches the periphery of the lung. There is high fever, which is preceded by a marked chill, cough, rusty sputum and the physical signs (crepitant rale, dulness on percussion, bronchial breathing and crepitus redux) . What conditions might cause alvine discharges contain^ ing fat? In obstructive jaundice fatty stools are sometimes noted ; they occur occasionally in overfed infants. Fatty stools are PRACTICE OF MEDICINE. 661 often indicative of disease of the pancreas, such as cancer or pancreatic calculi. Give the characteristic symptoms of purpura hemor= rhagica. Hemorrhages from the mucous membranes and extravasa- tion in the cutaneous surfaces; great weakness, anemia due to loss of blood. Fever is present, as a rule. What conditions increase the amount of uric acid voided with the urine? Increased by diet (fat and sugar), muscular exercise. In the acute fevers (pneumonia and rheumatic fever), in leuke- mia and in disease of the spleen generally ; in diabetes and in lithemia. It is decreased in amount under strict milk diet, in anemia, chronic lead-poisoning and chronic interstitial neph- ritis. Differentiate thrombosis and embolism. Thrombosis. — Prodromes are common, drowsiness and head- ache, the onset of the attack is insidious. Hemiplegia gradual in onset. Ocular and other nerve palsies. Emboli$)>i. — Loss of consciousness rapid, hemiplegia and disturbances of the pulse and respiration. Embolism is more frequent in the left side of the brain, hence valvular disease favors embolism. What diseases are liable to occur in the right inguinal region? Appendicitis, floating kidney, disease of the liver and of the bladder. Distinguish between the terms illusion, delusion and hallucination as used in diagnosis. An illusion is a wrong conception of an objecl which really exists. A delusion is an absurd and unfounded belief. A hallucination is ;i Bense perception without a physical !•. 662 PRACTICE OF MEDICINE. Give the physical and rational signs of pericarditis be= fore and after effusion. There is slight fever, marked pain in the precordial region, dyspnea and irregular, usually quickened, pulse. There is pericardial friction on auscultation. "When effusion occurs the friction disappears; there is dulness in the precordial area, the base of dulness being at the apex of the heart, quite the reverse from the usual condition. Define vocal fremitus and state its significance in pul= monary disease. Vocal fremitus means the vibrations of the voice which are transmitted to the chest wall. These are conducted from the larynx by the trachea and bronchi to the smaller tubes within the lungs, and thence through the lung tissue to the surface. V ( ocal fremitus is increased by consolidated lung tissue ; it is increased from an empty pulmonary cavity super- ficially situated, and is diminished or lost on accumulation of fluid in the pleural cavity. Differentiate between sunstroke (coup de soleil) and apoplexy. In sunstroke there is the history of exposure to the sun. The temperature is very high, 105°-115° or over, but no evi- dence of hemiplegia. In apoplexy there is conjugate devia- tion of the head and eyes, hemiplegia, irregular pupils, never so high a temperature, and full, bounding pulse. What casts are frequently found in albuminous urine and what do they denote? Hyaline, granular, epithelial and blood casts. Hyaline casts probably result from the exudation or secretion of a material from the epithelial cells lining the tubules. They are sometimes found in healthy individuals. Granular casts indicate nephritis. Epithelial casts are always indicative of a renal lesion. Blood casts are found in acute parenchyma- tous nephritis or in a condition in which the renal tubules become filled with red blood corpuscles. PRACTICE OF MEDICINE. 663 Of what import is the spleen in the diagnosis of febrile conditions? Give the topography of the spleen. As a rule, the spleen is enlarged in all febrile conditions. The spleen extends from the ninth rib to the margin of the twelfth rib in the midaxillary line of the left side. Differentiate the crepitant rales and the subcrepitant rales and give the clinical significance of each. The crepitant rale is a fine moist rale and is heard only at the end of inspiration. It is found in the vesicular structure of the lung. The subcrepitant rale is also a fine moist rale, somewhat coarser than the crepitant rale, found in the finer bronchi and heard both in inspiration and in expiration. The crepitant rale is heard in croupous pneumonia, broncho- pneumonia, hemorrhage, pulmonary infarcts, edema of the lung and sometimes in tuberculosis. The subcrepitant rale is heard in congestion and edema of the lungs, in hemorrhage or in any condition in which fluid is present in the finer bron- chi ; in pulmonary tuberculosis, in the third stage of croupous pneumonia and in broncho-pneumonia. What are the manifestations of hereditary syphilis? The child at birth is very feeble, and the eruption may be present; the child snuffles, the mouth is fissured, and the lips are ulcerated. Liver and spleen are enlarged, and bone symp- toms are prominent. If the symptoms do not appear at birth, they will appear at or about the third month. There is then nasal catarrh, with a seropurulent discharge. Necrosis of bone is rapid, and the nose undergoes a characteristic de- formity. Lesions of the skin also appear. When the teeth appear they are notched (Hutchinson's teeth). Make a diagnosis of aneurysm of the descending aorta. There is marked pain, especially in the back, and a large tumor may appear posteriorly in the scapular region. P plegia may oeeui- from pressure <>n the cord, dysphagia from Mure on the esophagus, and pulmonary symptoms from 664 PRACTICE OF MEDICINE. pressure on the left bronchus. There are, besides, all the physical signs of aneurysm in any other locality, such as ex- pansible pulsation, tumor, bruit and thrill. Make a differential diagnosis of pleuritic and pericardial effusion. If the pericardial effusion be very great, it may much resemble a left-sided pleural effusion. In pericardial effusion, however, there is pulmonary resonance at the base, Skodaic resonance in the axilla, and the heart is not displaced to the right of the sternum. The dyspnea is greater in pericarditis with effusion, and the paradoxical pulse may be present. An antecedent history of rheumatic fever may help the diagnosis and favor pericarditis. Describe the treatment of hay fever. A change of residence before the annual attack is the only prophylaxis ; a correction of the neurotic and gouty tendency of the individual should be attempted. A spray to keep the nasal passages clean is important. A weak solution of cocaine for this purpose is valuable. Suprarenal extract appears to give the best results both locally and internally. Define epidemic parotitis. What complications may arise in the course of this disease? There is abrupt development of fever and an enlarged par- otid gland on one side. Inflammatory edema of the surround- ing tissue is common, the ear may be pushed upward. The mouth is displaced and the face disfigured. The fever is usually about 102°. In some cases the opposite gland becomes affected after a few days. Suppuration does not occur. Occasionally other glands, such as the testicles, ovaries and mammary glands, are affected. Define chlorosis. Chlorosis is a form of primary anemia, affecting chiefly females at the time of puberty, and characterized by marked diminution of the hemoglobin. PRACTICE OF MEDICINE. 665 Give the etiology and describe the symptoms of idio= pathic erysipelas. It occurs at all seasons of the year and in all climates. It is most liable to occur in debilitated and cachectic persons and in the course of chronic pulmonary tuberculosis. The disease may occur in the puerperal state. The exciting cause is the streptococcus erysipelatis of Fehleisen. The dis- ease begins with a chill or chilliness, and is followed by the development of the eruption. There are gastro-intestinal symptoms or fever. The skin becomes irritated, itchy and swollen. There is heat, tension and burning in the pari. The eruption shows decided elevation with a distinct, promi- nent margin, it is red or puffy in the center and glossy in appearance. Uncomplicated cases last from two to three weeks. Mention the causes and describe the treatment of pri= mary lobar pneumonia. The exciting cause is the diplococcus or pneumococcus of Frankel. Exposure to cold and wet, alcohol, are said to be predisposing causes. The treatment of the disease consists in giving the preliminary purge, preferably calomel. Dover's powder or a hypodermic injection of morphine to relieve the pleural pain, remedies to sustain the heart and respiration, such as alcohol and strychnine, are useful. Ammonium car- bonate and ammonium chloride are also of value. Describe the treatment of hydrothorax. Purges, diaphoretics and diuretics are of value. It' these remedies do not relieve the condition the aspirator must be resorted to. State your treatment, including diet, of typhoid fever. If the patient be seen before the tenth 'lay of the disease, a calomel purge should he administered. The systematic cold hath of Brand is a favorite method of treatment. Alcohol ami strychnine are valuable adjuncts to sustain the circula- tion. The diet should he absolutely Liquid. Water pleiiti- 666 PRACTICE OF MEDICINE. fully, milk, liquid peptonoids are commonly employed. No solid nor semi-solid food should be administered before the evening temperature has been normal for at least one week. Describe the treatment of diabetes mellitus. Diet is most important. No starches or sugars should be given. The diet should consist in the fresh green vegetables, meat, fish. No alcoholic or malt liquors had better be em- ployed. The generally accepted treatment is by some form of opium, codeine being most often employed. Give the symptoms and treatment of tetanus. The prominent symptoms are the occurrence and recurrence, at varying intervals, of tonic spasm of greater or lesser inten- sity in the voluntary muscles. The spasm is usually first noticed in the neck, which is soon followed by spasm of the muscles of the jaw, with inability to open the mouth. There is pain, which, however, is not severe. Occasionally the body arches backward, a condition known as opisthotonos. There is usually fever of about 101°, but after prolonged spasm hyperpyrexia may occur. The urine is scanty, extremely toxic and often contains albumin. Profuse sweating is a prominent symptom. The treatment consists in the endeavor to administer nutriment, and rectal injections should be re- sorted to. Chloral is of value because it produces sleep and sometimes relaxes spasm. Antitetanic serum is of value in some cases. The wound should be thoroughly cleansed and treated antiseptically. What is the most common cause of tabes dorsalis? Syphilis. How should acute coryza be treated? Acute coryza should be treated by cleansing the nose with a mild antiseptic solution ; a weak solution of cocaine is also of value. Dover's powder is also recommended internally. Describe the treatment of pleurisy with effusion. The common measures administered to absorb fluid, such as PRACTICE OF MEDICINE. 667 purges, diaphoretics and diuretics, should be resorted to. If these fail the aspirator may be used. What is the period of incubation in variola and vaccinia? The period of incubation of variola is from ten to thirteen days. The period of incubation in vaccinia varies from three to seven days, depending upon whether humanized or bovine virus is used. What are the symptoms of hepatic abscess? In what climates is hepatic abscess most likely to occur? The symptoms of hepatic abscess are an enlarged and tender liver, with jaundice, anemia and wasting. The clinical mani- festations vary, and large abscesses may be present without marked disturbance. Occasionally fluctuation may be de- tected in the liver. There may be pain of a throbbing char- acter. Occasionally all the phenomena of sepsis are present, chills, fever and sweating. The disease is most common in hot climates. How may pleuritis in its early stages be differentiated from intercostal neuralgia? In pleuritis there is pain, which is especially aggravated by breathing. In intercostal neuralgia the pain is over the exit of the intercostal nerves. It is increased by pressure. In pleuritis the pain is diminished by pressure. The pain is not aggravated in intercostal neuralgia by deep breathing. In pleurisy there is a friction sound, which does not occur in intercostal neuralgia. Frequently intercostal neuralgia is accompanied by the development of herpes zoster. How many and what are the stages of malarial inter- mittent fever? There are three stages : The stage of chill, the stage of fever, ;iinl the sweating stage. Mention the eruptive fevers. Scarlet fever, measles, German or French measles or rubella. variola, varicella ami erysipelas. 668 PRACTICE OF MEDICINE. Describe the treatment of intermittent fever. The treatment of intermittent fever consists in the admin- istration of quinine in sufficient doses to destroy the Plasmo- dium of malaria. From 10 to 20 grains a day for an adult is sufficient for this purpose. Give the etiology and outline the treatment for acute gastritis. In the majority of instances the condition is due to irritants, either thermic or chemical, that come in contact with the mucous membrane of the stomach, producing an acute inflam- mation. Food either too hot or too cold, spices, drugs and poisons may have this influence on the mucous membrane. The treatment consists in the administration of a purge, such as calomel or castor oil. The diet should be restricted for a while. In severe cases it is necessary to produce vomiting. Lavage is useful. Drugs are scarcely ever necessary. Describe the symptoms and treatment of chronic hydro= cephalus in children. The symptoms of congenital hydrocephalus are difficulty in the movements of the child on account of the weight of the head. As a rule there is impairment of intellect. The head is often enormous in size. There may be headache and dim- ness of vision, and the gait may become irregular. The pulse is usually slow. Medical treatment is of no avail in this con- dition. Operative methods are advised by some authorities. Define rubeola and describe its symptoms. Rubeola is an acute, infectious, contagious disease charac- terized by marked catarrhal symptoms, especially of the res- piratory tract, with a characteristic eruption occurring on the fourth day. The disease may begin with a chill, followed by fever that may reach 103° F. or higher, with marked catarrhal symptoms from the onset. There is injected conjunctiva, lachrymation, photophobia, coryza, and some cough. Rales are heard in the chest. Koplik's sign may appear about this time. On the fourth day the eruption appears, which consists PRACTICE OF MEDICINE. 669 of rose-red or brownish maculo-papular points raised above the skin, with intervening healthy skin, often arranged in creseentic shape. The eruption remains at its height for about four days. The catarrhal symptoms continue. About the eighth day of the disease the eruption begins to fade. A fine desquamation occurs. In the absence of complications the disease lasts about twelve days. Describe the symptoms and treatment of gangrene of the lung. Cough accompanied by expectoration, which is abundant, thin and foul-smelling, should call attention to gangrene of the lung. Fever is always present. There is often hemop- tysis. Microscopically the sputum contains leukocytes, shreds of lung tissue, especially elastic fibers, fat crystals and bac- teria. Upon percussion over the affected area dulness is pres- ent. Upon auscultation, bronchial breathing and, if excava- tion occurs, signs of a cavity are present. The treatment is supportive. Describe the symptoms of tubercular meningitis. The course of the disease is usually divided into a pro- dromal stage, a period of excitement and a period of paral In the prodromal stage the child becomes irritable and rest- less, there is anorexia, headache, pain in the Limbs, accom- panied by nausea and obstinate vomiting. Tin- second stage is marked by an aggravation of the symptoms just • 'numerated, with fever. The headache becomes intense, and is usually general. The hydrocephalic cry is usually present. Obstinate constipation is characteristic. There is a rapid pulse, which may be from 120 to 160 per minute; the abdomen is prominent ; nervous symptoms are present, most frequently delirium. The pupils are contracted, and strabismus may occur. There is marked cutaneous hyperesthesia. Convul- sive movements are common. This period lasts for a week or ten days and is followed by the stage of paralysis. The p I mes higher, often reaching 105 or 106 . Spasmodic 670 PRACTICE OF MEDICINE. contractions, with tremor and twitching of the tendons and muscles, with local paralysis occur. The third nerve is most frequently involved, causing ptosis. The duration of the dis- ease is variable, lasting about three weeks. When the disease occurs in adults it may be prolonged to three or four months. Leukocytosis is present throughout the course of the disease. What should be done for hemoptysis occurring in the course of phthisis? Absolute quiet is essential ; food and drink should be stopped for a while ; ice-bags may be applied over the chest ; the ad- ministration of opium in some form is generally advised. Give the symptoms of epidemic influenza. The disease occurs suddenly, usually with a chill and marked fever, 103°-105°, with catarrhal symptoms, such as sneezing, coughing, etc. There is headache, usually frontal or behind the eyes, or at the root of the nose, pain in the limbs and in the bones. There is marked prostration, out of proportion to all the other phenomena. There is a constant tendency to complications resulting from inflammation of the respiratory or gastro-intestinal mucous membrane. There may be nau- sea and diarrhea. Uncomplicated cases last from a week to ten days. What is hemoptysis? Bleeding from the lungs. Give the physical signs of pleuritic effusion. On inspection there may be slight bulging. The apex-beat of the heart is seen to be displaced. Upon palpation there is decreased vocal fremitus. Upon percussion there is flatness over the affected area. Upon auscultation the breath-sounds are absent, and vocal resonance cannot be obtained over the affected area. Describe the natural heart sounds. Two distinct sounds are encountered: The systolic or first sound, and the diastolic or second sound. They are separated PRACTICE OF MEDICINE. 67] from each other by a short pause, a long pause occurring between the second and first sound. The first sound is due to the contraction of the ventricle, the rush of blood and the closure of the auriculo-ventricular valve. It is long, low and booming in character. The second sound is due to the closure of the semilunar valve, and is short and valvular. The first sound is best heard at the apex, the second sound at the I of the heart. On what day does the rash usually appear in scarlatina? At the end of the first or beginning of the second day. What are the symptoms of delirium tremens? The prodromes consist of nervousness, restlessness and ano- rexia. As a rule there is insomnia. A tremor occurs which affects the lips, tongue and limbs. Delirium soon develops, which is active and constantly changing. The skin is moist and the expression is anxious. The pupils are dilated. The temperature is subfebrile, the pulse soft and rapid. The tongue is covered with a thick fur, and there is sometimes nausea and vomiting. What are the clinical features of cerebrospinal fever? The onset is sudden, beginning with intense headache, stiff- ness in the muscles of the back of the neck, nausea and vomit- ing. The attack may begin with a chill. Delirium and stupor commonly occur. There is marked alteration of sensation. The fever varies from 101°-105° or more Kernig's sign is present. Herpes is very common. Other eruptions also occur, such as erythema, urticaria and petechia'. Arthritis may be present. The urine is scanty ami may contain albumin. Diagnose varioloid. The disease begins with a chill, followed by fever of aboul 103°. There is nausea and vomiting, pain in the hea46 vulvovaginal, 379 Absorption, by blood vessels. 93 in duodenum, 124 in stomach, 124 relative activity of, 109 Acacia, 596 Accommodation. 68 Acetabulum, description of, 6 Acetanilid, 549, 560 Acetone, tests. 299 Acetous fermentation, 171 Acid, acetic. 187, 198, 595 boric, 517 carbolic, 218, 287, 525. 54'.». 603 carbonic, formula, 240 citric 278, 288 definition of, 180 essential element of, 179 gallic, 526, 567 hydiioilic. 289 bydrobromic, 289 hydrochloric, 240, 263, 546, 553 hydrocyanic, 279, 296, hydrofluoric, 218 lactic, 602 nitric. 165, 240, 596 Acid, nitric, preparation, 221 oleic. 569 oxalic, antidotes for, 228, 296 salicylic, 524, 559, 583 sulfuric. 222, 232, 277 tartaric. 272 test for, 240 uric. 216, 234 Acids. 266 mineral antidotes, 236 nitrogen, 254 organic, 246 Aconite. 524, 550, 567, 570, 680 Aconitin, dose of, 517 Acromegaly. 412 Adenoma. 341 Adipose tissue, 305 Afferent nerve. 101 Affinity, chemical examples, 178 Affixes, 164 Agglutinins, Air.- ■■•Lin changes in by respiration, 81 elements in four-fifths of, 179 ground, effect on health. 137 how differs from nitric oxide. 182 test for CO,, 250 Albumin, 286 description of. I7'.t urine, teats for. . Albumins, differentiate, 189 Albuminoids, 192 Albumose, test. 300 Alcohol, 200, 230, 238,262 a- ;i food. 1 15 chemical process. 188 effects Of, 134, 531 how derived, 179 methylic, 288 physiological action. 1 15 therapy of, 647 Alcoholic beverages, 215 intoxication. -'I 44 (689) 690 INDEX. Alcoholism, 332, 682 prescription for, 531 Aldehydes, 296 Alimentary canal, 56, 70 Alkali, 181 Alkalies, antidotes for, 218 Alkaloid, 263, 518 Allantois, 434 Allotropism, definition of, 198 Alloy, definition of, 206 Aloes, source and how eliminated, 544 Alum, 544 composition of, 240 properties of, 252 test for, in baking powder, 290 Aluminum, 210 properties of, 185 Alvine discharges, 660 Amalgam, definition of, 206 Amenorrhea, .507 Amines, 243 Ammonia, 295, 539 equation for produc- tion of, 182 gas, 295 source and use, 281 uses of , 591 Ammonium, 274 bromide, 214 carbonate, uses of ,543 chloride, 219 Amnion, 434 Amorphous, 181, 257 Amputations, 344, 362, 409 Amyl-nitrite, 529 Amyloid foods, 73 Analysis, 244 qualitative, 188 quantitative, 188 Anemia, 314. 318, 507, 688 pernicious, 310, 642, 679 remedies for, 522 Anesthesia, compoundsproducing, 203 local, 339 Anesthetics, 173, 537, 573 contra indications,605 Aneurysm, 609, 645, 663 arterio-venous, 412 pathology of, 325 sacculated, 380 Angina pectoris, 617, 629 Angioleucitis, 315 Angiomata, 323, 340 Anhydrid, definition of, 189 Anhydrous, 288 Anilin, 296 Animals, diseases in, 156 Ankle-joint, internal malleolus, 18 synovitis in, 342 Ankylosis, varieties, 356 Ano-spinal center, in defecation, 100 Anodynes, 523 Antagonist, 541 Anthelmintics, 565 Anthrax, 619 Antidote, 541 Antimony, 178, 257, 299 Antipyretics, 568 Antipyrin, 554, 581 Antiseptics, 467, 571, 585 Antitoxin, 148, 167,576 Antrum of Highmore, 366 Aorta, abdominal, 19, 47 description of, 54 Aortic insufficiency, 73 valve, mechanism, 114 Aphasia. 81, 641 Aphonia, 81 Apnoea, 122 Apomorphia, 529, 583 Aponeurosis, 5 Apoplexy, 394, 535, 630, 655 symptoms of, 659, 662 Apothecaries' weight, 293 Appendicitis, 22, 640, 654, 672 McBurney's inci- sion, 408 Appendix vermiformis, 10, 34 Aqua ammonia, 275 fortis, 242, 275 regia, 275 Arnica, 600 Arsenic, 172, 299, 580 in wall paper, 279 preparations of, 556 test for in food, 198 uses of, 534 Arsenious acid, dose, 580 Arteries, abdominal aorta, its branches, 19, 47 carrying venous blood, 100 degenerative changes in, 307 intercostal, 24 palmar arterial arches, 22 INDEX. 691 Arteries, structure and function, 93,94 Artery, axillary branches and re- lations, 8 basilar, 32 brachial, 23, 402 ligation of, 1 coronary, 333 external carotid, 3 femoral, 10, 338 femoral obstruction of, 62, 63 internal carotid, divisions of, 30 internal iliac, branches of, 44 left common carotid, 33 ligation of, 344, 376 lingual, 336 middle meningeal, 29,:!20, 400 popliteal, branches of, 51 posterior tibial, 40 pulmonary, 46 subclavian, 356 subclavian, 1 tranches of, 14 ulnar, 44 Articulation, temporo-maxillary, describe, 54 Arthritis deformans, 329 Artisans, 150 Asafetida, 530 Ascites, definition of, 325 physical signs of, 658 removal or fluid, 397 Asepsis, definition of, 467 Asiatic cholera, epidemic of, 129, 130 Assimilation, definition of, 99 Asphyxia, 77 how causes death, 86 how produced, 86 in new-born, 173 Asthma, 645, 878 treatment of, 534 Astigmatism, define, 90 Astringent, 59 1 Atavism, 121 Atheroma, pal oology of, 824 Atmosphere, 174 percentage of < '< > s in, 195 Atom, 168 Atomic theory, define, 197 Atomic weight, 176, 238 weights, description of 190 Atrophy, 306 causes of, S55 of liver, 308 progressive muscular, 682 Atropin, 251 use of, 527 Atropine combined with mor- phine, 544 dose of, 517 treatment of poisoning, 597 Attraction, 167 Auditory apparatus, describe, 18 vertigo, 105 Aural labyrinth, describe, 51 Autoinfection, 475 Autopsy, 230 Axillary artery, describe, 8 Axilla, boundaries and contents of, 19 Bacilli, 315 Bacillus, comma, 317 tuberculosis, 330 Back, muscles of, 47 Bacteria, 308, 315 in intestines, 109 in vagina, 475 Baking powders, 277 Ballottement, 442 Balsam of Peru, 519 Barium, flame tesl Cor, 221 Bailey water. 569 Barometer. 256 Base, definition of, 187 Basic radical, definition of, 187 Bassini's operal ion, 414 Hath, cold, dangers of, 137 Bathing, 139 Baths, hot, 142 public, 155 Battery currents, effect of, on nerves, 126 Beer, 225 Belladonna. 518, r.:;:;, .V,:;, 564, 573 alkaloids of, 582 drugs incompatible With, 577 Benzene, 263 Benzoin, 595 Bile, 247 causes "i increased iiow, ;»7 692 INDEX. Bile, chemicalicomposition of, 186 -duct, occlusion of, 316 function of, 116 reaction of, 276 salts, 116 Bilirubin, 300 Binary compounds, 180, 189, Bismuth, 254, 294 preparations of, 557 salts, 222 therapy of, 580 subnitrate, therapeutic class of, 532 Bladder, anatomy of, 38. 64 arterial supply of, in male, 15 atony of, 361 blood and nerve supply ,64 male and female, struct- ures, 63 stone in, 337 Bleaching, 236 Bleeding, drugs to arrest, 597 Blisters, 526 Blue vitriol, chemical name of, 183 Blushing, physiology of, 123 Blood , alkalinity of , how decreased, 115 changes in kidneys, 121 by respiration, 81 circulation, causes of, 123 coagulation of, 86 composition and uses, 92 conditions retarding coag- ulation of, 110 corpuscles, difference in shape, 104 current, venous, 100 difference in life and death, 83 expectoration of, 685 extra vasa ted, 314 heart and lung circulation, 90 how cleansed, 88 in gout, 325 metallic element in, 177 movement of in capillaries, 102 plasma, 312 pressure, 111, 124,581 proportion of in body, 126 reaction of, 112 red corpuscles. 65, 98 renewed after loss, 126 Blood stains, 76 stream, comparison of, 90 test, 299 vessels, arteries and nerves supplying, 52 functions of, 68 white corpuscles, 80, 98 Blow-pipe, 264 effect on air with Maine, 177 Body, changes in, following death, 187 post mortem of, 316 protective agencies of, 309 senile changes in, 329 temperature, regulation of, 88 variations of temperature in, 114 Bone, how nourished, 87 hyoid, 39 inflammatory diseases of, 308, 335 parietal. 120 ramus of jaw, 43 superior maxillary, 39 Bones, clavical, articulation of, 23 forming ossa innominata, 37 frontal, articulation of, 22 malar, articulation of, 15 nasal. 401 radius, articulation of, 19 sternum, 38 Wormian, 42 Borax, 183,517,599 Boroglycerid, uses of, 214 Boron, 245 Brachial artery, ligation of, 1, 4u2 Brain, anemia of, 324 center for articulate speech , 112 description of convolu- tions, 58 4th ventricle of, 16 function of white and gray matter, 117 gray matter of, 116 hemispheres of, 34 lobes and fissures of, 11 membranes of, 12, 76 motor area, 66, 106 seat of special senses, 105 tumor, 359 ventricles of, 31 INDEX. 693 Brandy, chemically different from wine. 178 Breast, puerperal, diseases of, 512 Breasts, management of, before labor, 449 Breathing, bronchial, 657, 681 Bright ii morbus, albumin in, 200 Bromides. 278, 521, 530, 594 Bromid of ammonium, iil 4 Bromine, 174. 179, 197, 218 Bromism, 545 Bronchi, respiratory sounds of, 68 Bronchial tubes, describe, 14 Bronchitis. 659 capillary, 652 chronic, 319, 681 prescription for, 577 Broncho-pneumonia, 645 Bronchorrhea, 586, 643 Bryonia. -547 Bubo, treatment of, 384 Bubonic plague. 157. 312 Buchu, 553, 554 Buckthorn, 594 Buildings, height of. 135 Bunion, 410 Bunsen burner, principle of, 171 use in body, 99 Carbolic acid. 242, 2s7. 603 Carboligni, 536 Carbon, 216, 250 allotropic forms of, 250 dioxide, 267, :!74 Carbuncle, 341 Carcinoma, 318, 337 dissemination of. 341 histological elements of, 321 pathology of, Cardamom, uses of, 538 Caries, dental, 305 Carron oil, 562 Cartilage, 73, 80 Cartilages, arytenoid. 4:; Cascara sagrada, 550, 570 Castor oil, Castration, indications for, 349 Cecum, description of, 30 Celiohysterectomy. 502 Cell, according to shape. 103 giant. 305 iwth, 77 Cells, how connected, 118 varieties of. 102 Cemeteries, 138 Centigrade, 163 Cerebellum, its function Cerebral hemorrhage, 31 1 softening, 304 Cerebro-spinal fever, 322 brum, removal of, llii Cerumen, impacted, 385 Cervical caries, 350 ( Vivi\ uteri, dilatat ion of, 488 laceration of, 166 < iesarean section, 501 . 502 Chancre, 367 Chancroid. 363, 367 ( 'harcoal, 593 Chemical action, 172, 178, 274, 281 antidote-. 243 changes, 197, 222, 279 compound, 249 decomposition, 228 694 INDEX. Chemical symbol, 239 Chemistry, 196, 225 Chest, respiratory action of, 104 Chicken-pox, eruption of, 653 Chloral, 212, 535 hydrate, 223, 248, 565 poisoning by ,523. 592 Chloride of lime, 546 Chlorides, 278 Chlorinated lime, how made, 200 Chlorine, 174, 206 bleaching process, 236 element of acid, 178 occurrence in nature, 1 83 Chloroform, 212, 230, 246, 268, 564, 574 narcosis, 604, 606 tests for purity, 235 Chlorosis, 507. 664, 673 Cholagogue, 529 Cholera, 129, 153, 612, 679 Asiatic, epidemic of, 129, 130 morbus, 621, 656 Cholesterin, description of, 102 Chondrin, where found, 88 Chorda tympani, 125 Chorea, 678 Chromium, 298 Chyle, 86, 91 Chyme, 86 Cicatrices, 307 Cinchona, derivatives of, 579 effects of, 523 tree, 559 Cinnamon tree, 564 Circle of Willis, 31 Circulation, fetal, 470 of blood, causes, 123 portal, 108 renal, 2, 108 Circumcision, 381 Cisterns, 150 Cities, death rate, 156 Citric acid, 288 Clavicle, fracture of, 354 Climate, hot, effects of, 149 Clubfoot, varieties of, 381 Coal, 228 oil, 285 -tar, products of, 249 Cocaine, 600 antagonist of, 526 effect of, 540 Codeia compared with morphia, 583 Codein, 554 Coeliac axis, branches of, 51 Coffee, adulterations of, 133 use in body, 99 Coin, 284 Colchicum plant, 590 tincture, close, 517 uses of, 549 Cold, how to avoid, 129 Colic, hepatic, 685 intestinal, 660 renal, 660, 68^ uterine, 660 Colocynth, 602 extract, dose of, 528 Collodion, 217 Collodium, 566 Collyrium, prescription for, 571 Color blindness, 76 sensations of, 107 Colostomy, 410 Columna? carnese, 115 Coma, from injury, 394 Combustion, 178,' 266. 267, 271 Common carotid artery, ligation of, 353 Complemental air. 82 Compounds, 226. 287 Congestion, 408 active and passive, 378 Conium, extract, dose of, 533 uses of, 530 Connective tissue, 35, 101 Consumptives, resorts for, 133 Convallaria, 536 Copaiba, 604 Copper, 227, 598 preparations of, 521 sulphate, antidote, 228 uses of, 528 Copperas, 551 Cord, spermatic, 24 Coronary arteries, 333 Corpus callosum, 48 luteum, 75 Corpuscles, red, 93 white, 80 Corrosive sublimate, 196, 521 Coryza, 666 Cotton, merits of, 141 Cough, prescription for, 533, 549, INDEX. 695 Craniotomy, 501 Cream of tartar, 253 Cremation, 141 Creosote, 577 source and dose, 584 therapy of, 554 with silver nitrate. 552 Cretinism, 303 Croup, spasmodic, 615 treatment of, 599 Crystalline lens, description of, 12 Crystallization, 163 Crystals, source of, 172 Cubebs, effects and uses, 541 Cupric nitrate, formula, 276 sulphate, formula, 278 Curare, 554 Cyanogen, description of, 209 Cyanosis, 687 Cyst, ovarian, 506, 511 Cysts, 310 dermoid, 396 Cystitis, prescription for, 573 urine in, 680 Cystocele, 506 Death, definition of. 114 rate, 134 Decantation, 288 Decay, 259, 271 Decomposition, 269, 29] Degeneration, 306, 319 amyloid, 309, 327 calcareous, 308 colloid, 319 fibrinous, 322 mucoid, 319 renal, 333 Deglutition, muscles assisting in, 26 Delayed union. 364 Deliquescent, 288 salt, 238 Delirium tremens, symptoms of, 670 Delusion, 661 Depressant, vasomotor, 581 Dermoid cysts, 396 Destructive distillation, 171, 244 Dextrin. 266 Diabetes, 620 insipidus, mo mellitus, Ms. 610 diagnosis, 647 treatment of, 666 Diabetes, mellitus, urine in, 672 Diabetics, 222 Diacetic acid, 299 Dialysis, definition of, 231 Dialyzer, 231 Diapedesis, explanation of, 102 Diaphoresis, 531 , 586 Diaphoretics, 516, 531, 586 Diaphragm, 11, 98 in respiration, hic- cough, 119 Diarrhea, prescription for, 573, 590 treatment of, 592, 630 Diet, cereal, effects of, 159 effect of starchy, 111 for children. 132 influence of, on nutrition, 115 meat, effect of. 77 Dietary, for aged, 85 Digestion, gastric, 108, 113 definition of, 111 time consumed in, 83 Digestive fluids, ferments of, 72 secretions, 66 Digitalis. ~rl\ active principles, 575 habitat and effecl of, 556 infusion, dose, 534 preparations. .57(1 symptoms of poisoning. 583 Diphtheria, 147. Mo. :;i7, 613, 653, 678 sources of infection. 127 Diplococci, 315 Disease, germ theory of, 152 sacro-iliac, 352, •"-77 Diseases, 314 caused by water. 160 endemic, nil epidemic, ltd filth. 168 germ, 683 infect LOUS, 162 of microbic origin, 152 Of SChool life, 15.". preventable, 156 prevenl ion of, 158 pulmonary, causes, 146 skin lesions of. ti7i' Disinfectants, 127, 188 Disinfection. 195 bj formalin. 129 Dislocation. 848, 865 696 INDEX. Dislocation of shoulder-joint, 348 Dislocations, reduction of, 350 Distillation, 194. 259 destructive, 171 Diuretics, 515, 579 Drink, precautions observed, 135 for summer, 135 Dropsy, 680, 688 causes of, 313 ovarian, physical signs of, 658 Drugs, increasing peristalsis, 552 physiological action of, 552 " Dry earth system," explanation of, 131 Duboisin, 537 Duct, lachrymal, 357 pancreatic, obstruction of, 109 Stenson's, division of, 121 thoracic, 24 Ductless glands, 103 Ducts, salivary openings of, 36 Ductus choledochus, 35, 97, 119 Dura mater, description of, 27 Dwelling, site fur, 157 Dwellings, dangers of shade, 143 Dysentery, acute, 653 Dysphagia, 122,411,609 Dyspnoea, 122, 677 Dystocia, 478, 479 Ear, abscesses of middle, 339 inflammatory conditions of, 687 suppuration in, 350 Ecbolics, 516 Eclampsia, 489, 400 Ectopic pregnancy, 455, 456 Eczema, varieties"of. 312, 322 Edema, causes of, 310 pulmonary, 630, 681 Efferent nerve, definition of, 101 Effervescence, definition of , 219 Efflorescence, definition of, 219 Effusion, pericardial, 664, 666, 670 Elaterin, 566 Elbow, triangle of, 63 joint, describe, 53 luxation of, 420 resection of, 359 Electric battery, 280 current, define chemi- cally, 190 light, 245 Electricity, 264 Electrolysis, 288 Element, diatomic, 294 mo n atomic, 294 negative, definition of, 184 positive, definition of, 184 Elementary body. 249 Elements, 226, 227, 229, 243, 274, 292 as gases, 241 as liquids, 241 division of, 147 lightest of, 178 laws governing, 180 potassium group, 260 uncombined, 247 Embolism, 324. 661 Embryo, 439 Embryotomy, 501 Emetics, 555. 574 Emmenagogues, 533 Empiric formula, 192 Empyema, 652 Emulsion, 263, 556 Emulsitication, 97 Endemic diseases, 161 Endocarditis, 610, 631, 633, 654 Endocardium. 14 Endometritis, 505 Endometrium, diseases of, 451 Endosmosis, 212 Endothelium, 3 Energy, muscles source of, 125 Enteric fever. 654 Enteritis, 323, 648, 653 Enzymes, definition of, 2C4 Epidemic diseases, 161 Epidemics, how prevented, 134 Epiglottis, function of, 117 Epilepsy, 620. 651, 686 Episiotomy, 465 Epispadias, 351 Epistaxis, 391 Epsom salts, 242 Epithelia, function of, 78 Epithelium, varieties of, 52 ciliated, 85 Equation, complete, 212 Equations, 171, 175, 193, 228,230. 246, 254, 258, 260, 273 Ergot, 555, 586 poisoning by, 520 Erigerontis oleum, 601 INDEX. 697 Erysipelas, 387, 618, 665 Erythroxylon, 557 Escharotics, 572 Eserin, 564 Esophagus, 16, 263 stricture of, 340. 622 Ether, 230, 232, 291, 606, 607 chemistry of, 282 compared with chloroform, 570 compound, 186 how applied, 522 how obtained, 238 narcosis, stages, 604 Ethvl hydrate, 268 ox i.l. 262 Eucalyptus, 5S5 Eustachian tube, 11, 75 Eutocia, 478 Evaporation, 174 Exanthemata, 684,685 Excavation of streets, 146 Excipient, 568 Excretion, definition of, 99 Excretory glands. 115 Exhumations, 138 Exophthalmos, 350 Expectation of life, 152 Extracts, 577 Exudation, diphtheritic. 303 Eye, 580 abnormal condil ions, 152 accommodation of, 96 blood supply of, 31 ciliary process in, 48 refracting media of, 112 tunics of. jo Eyeball, description of. 30 enucleation of. :;si,390 humors of. 43 in myopia, so muscles of, 98 nerves of. ."ii Facial oerve, division of. 355 fund ion of. 122 Btretching of, 401 Factories, hygiene of. 156 Fahrenheil . 163 Fallopian tubes, 27 Faraaic current . 248 Fascia, palmar, 59 Fat , origin of. t',7 Fats, use iii body, 99 Favus. :;l I Eeces. 151. 686 composition of, 118 Fecundation. 4::; Feeding, artificial, 471, 510 Fehling's solution, 237 test. 253 Female, changes at puberty, 435 Eemoral artery, 10, 339 Femur, dislocation of head of, 118 fracture of, 398, 418, 426 muscles attached, 2 Fermentation. 204, 220, 268, 271 acetous, 171 Ferments, of digestive fluid, 72 Ferric chlorid, 197 Ferrous sulphate, 551 Fetal head, 441 circulation, 94 Fetus, deatli of, 440 diseases of, 44o positions of, 448 Fever, cerebrospinal, 322 669, c,7 1 enteric. 654 eruptive. 635,667 exanthematous, 678 heel ic, -"-I t inflammatory, 418 intermittent, 575, 667, 668, remittent, 649 scarlet. 304, 627, 640 septic, surgical, 374 typhoid, 312, 624, 627, 631, 657, 665, 67 [ typhoid, treatment . 639 typhus, 625, 637, 677 yellow. 612, 626, 650 Fibrin, where found, 88 Fibromata. 306 Fifth nerve, neuralgia of, 354 Filtration, 174, 259 Fire-damp, 220 Fissure of Sj h ins. l"> Rolando, 15 Fistula. 34!) in ano. •"./.' varieties of, 381 Fluorin, 174, 213, i Food, carbohydrates, I'd cooking of, 1 10 for child, 161 for different climates, 187 for Bummer, 185 meat and milk, 1 19 precaut ions in, 185 698 INDEX. Food, quantity for daily use, 128 Foods, amyloid, 73 for aged, 133 nutritive function, 96 proteid, 73 vegetable, 70 Foot, bones of, 18 muscle moving it inward, 48 Foramen ovale, 47 Forceps, 496, 497, 498, 499, 509 Forces, changing solid or gas, 277 Forearm, amputation of, 15 dislocation of, 368 flexor muscles of, 5 fracture of, 409 Forests, 151 Formaldehyde, 129 Formula, empiric, 192 graphic, 168 rational, 192 Formulas, 271 Fossa, ischio-rectal, 36 Fossae, nasal, 60 Fowler's solution, 267 Fracture, compound, 387 displacement in, 375 Potts', 358 reduction of, 348 varieties of, 398 with deformity, 361 Fractures, 347, 366, 383 Freezing, 260 Fruits, in constipation, 148 Fuel, 161 Funis, prolapse of, 495 Furuncle, 341 Galactagogue, 588 Galactorrhea, 492 Gall-bladder, 6 stone, impacted, 611 Galvanic cell, 193 current, 265 Gamboge, 603 Ganglia, of fifth nerve, 14 Gangrene, 306, 320 Garbage, 132 Gas, 176 coal, treatment of poisoning, 589 illuminating, 194, 276 nitrous oxide, 606 olefiant, 170 sewer, prevention of, 133 Gastralgia, 634 Gastric cancer, 301 contents, 300 digestion. 108 juice, 76, 92, 112 Gastritis, 668 Gastro- duodenitis, 532 Gastrostomy, 352 Gelsemium, 527, 593 poisoning by, 579 therapy, 594 Genitalia, female, 379 Gentian, 592 Genu valgum, 351 Germicides, 552 Gestation, 439 Giant cell, 305 Gland, prostate, 23 thymus, 49 thyroid, 4, 76 Glands, 314 ductless, 103 excretory, 115 lachrymal, 50 lymphatic, 36 mammary, 39 meibomian, 2 of unknown function, 75 Peyers, 46 sebaceous, 118 salivary, 1 sudoriferous, 118 Glauber's salt, 247 Glaucoma, 360 Gliomata, 350 Globulins, 189 Glottis, edema of, 624 Glucose, 181, 188, 205 Glucosides, 568 Glycerin, 186, 264, 600 Glycogen, how derived, 192 Goitre, 632 Gold, symbol of, 178 official preparations of, 517 Gonorrhea during pregnancy, 493 Gossypium, 557 Gout, 645, 659 blood in, 325 pathology of, 324 treatment of, 615 Gravitation, 189 Groin, diseases of, 338 Guaiac, therapy, 594 Guaiacum, 565 Guarana, 551 Gum arabic, 596 INDEX. 699 G-ummata, 308 Gun cotton, 241 Gypsum, 242 Hallucination, 661 Halogens, 184 Haloid salt, 272 Hamamelis, 554 Hammer-toe, 396 Ham-strings, internal, 24 Hand, arterial supply, 58 bones of, 32 Hair follicle, 42 Hare-lip, 392 Haversian system, 52 Hay fever, treatment of, 664 Head, muscle moving forward, 48 bones of. 6 Health, nuisances dangerous to, 133 Hearing, 77. Ill Heart. 21 action of, 83, 121 aortic diseases of, 649 regurgitation of. 679 apex beat. 99 blood supply of. 24 -beat, 97 columnar carneae, 115 dilatation of, 655 diseases of, 330 drugs to increase action of, 539 retarding action, 559 exercises affecting it, 104 fatty degeneration of, 321 foramen ovale, 47 hypertrophy of, 320,655 left ventricle, 18 mitral disease of, 672 murmurs of, 6 18 palpitation of, 612 revolut ion of, 67 right ventricle, 3 sounds, 76, 670, 676 fetal, H2 stenosis of valves, 319 valvular diseases, 656, 660, 683 weak, training for, 158 Heat exhaustion, 666 how produced in body, 102 latent, 189 unconscious by, 154 Hectic fever, 81 1 Hectogram, 167 Heel, bone forming it, 24 Hematemesis, 622. 659 Hematocele, pelvic, 487 Hematosalpinx. 505 Hematoxylin, 566 Hematuria, 639 Hemic murmurs. 677 Hemoglobin, 122. 247 Hemophilia, 620 Hemoptvsis, 659, 670 Hemorrhage, 303, 363, 416 cerebral. 311, 609, 675, 678 drugs to arrest, 597, 604 forms of, in obstet- rics, 487 from mucous sur- faces. 625 intestinal. 642 postpartum, 477 pulmonary, 625 secondary, 339 umbilical, 496 uterine. 486 Hemothorax, 638 Hepatitis, suppurative, 623 Hernia, abdominal, 340, 399 congenital inguinal, 422 femoral. 34, 342 oblique inguinal, 362, 414 scrotal. 380 umbilical. 421 Herpes progenitalis, 367 zoster. 632 II LCCOUgh, treatment of, 539 High altitudes, 142 Hip-joint, dislocation. 345, 393 Hippuric acid. 88 Hospitals. 168, 156 | Houses, foundations. 15s heating of, 160 Human blood, describe, 84 Humerus, 2, 1,11, 378, 391 H timidity, 144 Hunger, physiology of, 120 Hydracids. 252 Hydragogue, 529 Hydrargyri iodidum rubrum Hydrargyrism, 559 I tydrargyrum, cum creta, 558 Hydrastis, 180, 561 Hydrid. 272 Hydriodic acid. 289 700 INDEX. Hydrobromic acid, 289 Hydrocarbon. 248 Hydrocele, 342 Hydrocephalus, 493, 619, 668 Hydrochloric acid, 278, 300 Hydrocyanic acid, 279, 292 Hydrogen, 219, 275 peroxide, 275, 562 sultid, 206, 257 with oxygen, 168 Hydronephrosis. 643 Hydrophobia, 373 Hydrosalpinx, 505 Hydrothorax, treatment of, 665 Hydroxid, 287 Hygiene, 12!) Hygrometer, 256 Hymen, imperforate, 503 Hyoscin, 531, 567, 571 Hyoscyamus, 531, 576 Hyperemia, 313, 318 Hypermetropia, 'hi Hypertrophy, 364 Hypodermic method, precautions Of, .523 Hypodermoclysis, 587 Hypostatic test, 496 Hypnotics, 570 Hysterectomy, 476, 501 Hysteria, 651 Ice, 135, 152 artificial, versus natural. 135 Ichthyol. source and uses, 567 Icterus, 677 pathology of, 325" Iliocecal valve, function of, 117 Illusion, 661 Immigrants, 142 Immunity, 149, 161, 309, 317 Incompatible, 264 Incompatibilities, 585, 603 Incompatibility, 582 chemical, 525, 533 therapeutic, 533 Incubative stages of fevers, 131 Indican, test. 302 Indigestion, cause, tea drinking, 134 treatment of, 576 Infant feeding, 137 Infarct, definition of, 324 Infection, sources, 349 Infectious diseases, 162 Inferior maxillary bone, disloca- tion, 348 fracture of ,389 Infiltration, 306, 319 diphtheritic, 303 Inflammation, 335, 391, 408 catarrhal , 306 croupous, 317 etiology of, 392 hist ological changes in, 321 hypostatic, 313 infective, 304 of bone, 308 pelvic, 505 plastic, 327 productive, 312, 320 signs of, 325 suppurative, 312 treatment of, 366 Infainmatory conditions, treat- ment, 578 fever, 418 Influenza, symptoms of, 670 Inguinal canal, describe, 14 structures in, 24 region, diseases of, 661 Inorganic compounds, 246 proximate principles, 124 Insemination, 432 Insolation, 618 Insomnia, prescription for, 529 Intermittent fever, treatment, 575 Internal abdominal ring, 45 Intervertebral substance, 48 Intestinal obstruction, 337, 427, 629 Intestine, large, uses of, 81 small, glands in, 21 Intestines, bacteria in, 109 glands and villi of, 101 large and small, 94, 95 vermicular movement , of, 100 Intussusception, 342 Intoxication, 655 Involution. 469 lodidS, 278, 287, 557 Iodin, 174 antidotes, 223, 531 test for, 240 uses of, 527 Iodisin. 560 Iodoform, 196, 555, 55!) INDEX. 701 Ion, 297 Ionization, 297 Ipecac, 534, 536, 570 Iris, action of, 557 description, of, 62 Iron, 178,217,262,270 formulas of salts of, 251 prescription for, 598 Ischemic paralysis, 307 Ischio-rectal abscess, 357, 423 Isomeric, define. 208 Isomorphous, 187, 188, 257 Jaborandi, 525, 549 Jalap, 563 compared with aloes, 593 compound powder, 534 pulvis compositus, 519 Jaw, ankylosis of, 358 lower, excision of, 345 Joint, ankle. 15, 28 ankylosis of, 372 elbow, 53,359 scapulo-humeral, muscles of, 59 wrist, description of, 26 Joints, classification of, 7 shoulder. 7, 378 tubercular, 316, 326 Juniper, 597 Kidney, relations of right, 3 Kidneys, action of, 68 act ion of tr. chloride of iron upon. 567 arteries and veins of, 63 descript ion of, 27 impaired function, 91 location and description of, 20 Knee-joint . 50, 31 1, 127 Koumiss, 557 Konsso, 603 Labor, 157, 158 after-pains, 170 anesthel ics in, 166, 167 ant isepl ic measures in. 167 bag of waters during, Ml care of infant alter. 171 mother after, 169 causes of delaj in, i s i complicated bj uterine fibroid, 51 l conduction of. 472 Labor, dangers to mother in. 407 definition of. 456 delay in second stage, 512 dilatation of cervix in. 462 duties of accoucheur dur- ing. 168 examination of woman in. 465 injuries during, ~>n s ligation of cord, 47u malposition of fetal head in. 47U mechanism of. 45'.». 460, 461 precipitate, 484 preliminary preparations, 456 premature, 452, 455, 47n premature rupture of membrane, 462 preparation of bed. woman. etc., 4H4 preparations for. 467 prolonged, 1st retention of urine in. 474 stages of. 162, 163 uses of ergot in. 468 vaginal douche in. 168 Lachrymal duct, stenosis of. 357 Lactation in primipara. 472 Lact ic acid, source of. 294 Lactose, chemical differentiation. 205 Lactucarium, 549 Lanolin. 560 Laryngismus stridulus, 677 Larynx, anatomj of. 13 stenosis of. ■ ventricles of. (i:; Laughing gas, 27:; Law for erect ion of buildings, 135 of Gaj - Lussac, 284 Laxal ive, 593 Lead acetate, poisoning from. 192 poisoning, symptoms, <;22 properties of, 21 1 salts, detection of in water. 203 2ul soluble salt ol . therapy of salts oi. 548 toxicology of. :ji i i mi nit at l "" of| 3 L> nuisides forming calf. 1 of back of. 30 Lens, crystalline, desci ibe, 12 Leontiasis oss< a, 112 702 INDEX. Leucin, where found, 88 Leucocytheniia, 82 Leucomain, 75 Leukemia, 318, 611, 634 Life, definition of, 114 Ligament, Poupart's, describe, 10 round, 504 Lignum vitae, 561 Limonis succus, 565 Linea alba, 41 Lingual artery, ligation of, 336 Linimentum calcis, 562 Linum, 560 Lip, epithelioma of, 310 Lipoma, 323 Liquid, 176 specific gravity of, 176 Liquor ammonii acetatis, 550 amnii, 434 calcis, 588 Liquors, 175 Litharge, definition of, 214 Lithemia, 677 Lithiasis, biliary, 615 Lithium, 166, 252, 521 Litholapaxy. 346 Lithotomy, 34H. 427 Litmus, 211, 227 Liver, amyloid, 331 atrophy of, 308, 315 blood supply of, 22 cirrhosis of, 317, 322, 616 function of, 74, 85, 90 hemorrhage from, 358 hyperemia of, 328 ligaments.fissures and lobes, 35 nutmeg, 328 outlines of, 676 Lobelia, 521 Locomotor ataxia, 323, 676 Lotio hydrargyri flava, 547 nigra, 551 Lung, congestion of, 672 gangrene of, 669 signs of cavity, 638 solidification of, 674 Lungs, description of, 27, 50 impaired function, 91 respiratory sounds of, 68 Lunar caustic, 242 Lupus, 381 Lymph, best for vaccination, 133 flow of, how induced, 110 in vaccination, 133 Lymph, properties of, 91 vessels, 327 Lymphadenitis, 313 Lymphangitis, 315 Lymphatic glands, 47, 311, 327 system, 78 Lymphatics, how absorb, 93 Lymphorrhagia, 307, 327 Magnesia, therapy, 597 Malarial districts', 161 Malignant, definition of, 325 Malleability, definition of, 212 Malleolus, external, 22 internal, 18 Malt, 274 Maltose, differentiation chemic- ally, 205 Mammary carcinoma, 413 glands, 39, 371, 447, 449 description of, 39 Man, height and weight of, 138 Manganese, therapy of, 561 Manure, 139 Marble, chemical name of, 183 Marsh's test, 169 Mastication, muscles assisting in, 26 Mastitis, puerperal, 491 Materia medica. definition, 537 Matter, 238, 249, 268, 283 Measles, 131. 155, 638, 648, 658, 679 Meat inspection. 144 Mechanical action, 172 Meconium. 442 Median nerve, division of, 369 Mediastinum, 37, 45 anterior, 48 Medicine to promote bone growth, 601 Medicines, dose of, 584, 592, 599 methods of introduc- tion, 542 Medulla oblongata, 49, 118 Melano-sarcoma, 317 Membrana tympani, 372 Meniere's disease, 105 Meningitis, 317 cerebrospinal, 629, 674 spinal, 676 tubercular, 657 Menopause, 507 Menstruation, 430, 431, 472, 592 Mentha piperita, 559 INDEX. 703 Mercuric chlorid, 231, 276 iodid, 289 Mercurous chlorid, 231, 2S2, 291 iodid, 289 Mercury, 227, 248. 258, 260, 286 bichloride, 534, 548 formulas of salts of, 251 poisoning by, 286 preparations of, 584 test for, 168 therapy of, 584 Mesentery, description of, 20 Metabolism, description of, 125 Metals, 190, 221, 266, 284, 285 poisonous ones, 207 Metameric, define, 208 Metamorphosis, 313, 320 Methane, formula and properties, 186 Metric system, 167, 224, 257 Metritis, puerperal, 476 Micrococci, 315 Microscope, 657 Micturition, 7^ Middle meningeal artery, 320, 400 Migraine. 644 Milium, 384 Milk, 147. 154,273, 287 adulterations of, 140 constituents of, --- diseases communicated through, 134 human, composition of, 107 remedy arresting secretion of, 546 source of disease, 134 souring of, 223 sugar of, 588 Mineral waters, 164, 210, 239. 278, 293 Miscarriage, V>- Mixture, definition of, 226 Kolecule, 163 Monad. 209 Morbus Brightii, 150 coxae, '■>'- coxarius, 352 Morning sickness. 1 15 Morphine, poisoning dose. 535 tests for, 208 Moitilieat ion. II I Mouth, anesl hel ic tor operation, 341 hygiene of, 128 ■wash, prescription for, 57] Mucous membrane, 104 Mumps, 632 Murmur, puerile, 680 Muscle, action of when stimulated. 105 biceps describe, 33 changes in during con- traction, 105 compressor urethral, 6 condition of, in tetanus, 113 constituents of, 250 deltoid describe. 32 flexor profundis digi- toriun. 5 glutens maximus, 29, 48 internal oblique, 36 masseter, action of. 4s rectus abdominis, 37 sphincter ani, 41 structure. 95 trapezius. 7 tibialis ant icus. 42. 48 Muscles, abdominal, •';•"> affect ions of. 353 attached to femur. 2 description of. I forming calf of leg, 4 quadriceps ex- tensor crureus, 15 triangle of neck anterior. :,~ how divided. 4 involuntary, function of, Ho keeping body erect . 2s mo\ ing humerus, l of orbit, 6 Muscular contraction, 82, 88, B9 energy, source of, 125 fatigue, causes for. 83 Myalgia, 650 Mydriatics, 552 Myelitis, 626, 672 Myocarditis, 639 Myoma, definition of. 323 Myopia. 90, 132 Myot Lcs, ■'<■'•] M\ icedema, 64 1 NTaevus, 860 \ai cut ics, 516, ">t:: Nasal bones, i rad ure of, lul Nasal fossa, descripl ion of. I Nascent state, explain term, i v i 704 INDEX. Necrosis, 42S Negroes, diseases of, 141 Nephrectomy, 344 Nephritis, 656 acute, 624 exudative, 643 in pregnancy, 450 interstitial, 322, 679 parenchymatous, 331 suppurative, 614 treatment of, 570 Nephrolithiasis, 621 Nephrorrhaphy, 344 Nephrotomy, 344 Nerve, abducens, function of, 65 afferent, definition, 101 cells, 74 chorda tympani, 125 efferent, 'definition, 101 facial. 53, 122, 355, 401 fiber, describe, 27 fibers, 74 fifth, 99, 354 fourth cranial, 120 function of 3rd cranial, 43 glosso-pharyngeal, 29 great sciatic, describe, 8 median, 23, 369 nervus opticus, function of, 125 oculomotor, 75 olfactory, 39 optic, 6 pathetic, 120 phrenic, 44, 651 pneumogastric, 37, 41, 57, 107 radial, 41, 347 roots, spinal, 87 sixth cranial, 3 spinal accessory, 390 superior laryngeal, func- tion of, 110 sympathetic, 31, 71 third cranial, 98 ulnar, 351 vasoconstrictor, division of, 99 vasodilator, division of, 99 Nerves, cranial, name, 11 ninth pair of cranial, 41 palm of hand, 62 pharyngeal plexus, 44 sclerosis of, 308 sensory, division of fifth pair, 43 Nerves, spinal, functions of, 113 third division of fifth, de- scribe, 19 Nervous system, influence on di- gestion, 120 influence on se- cretion, 111 relation to per- spiration, 106 Neoplasms, malignant, 311 Neuralgia, intercostal, 667 prescription for, 539 Neurasthenia, 633 Neuritis, 650, 652 Neuroma, definition of, 323 New-born, food for, 162 hygiene of, 136 resuscitation of, 474 formation, definition of, 326 Night sweats, treatment of, 520 Nipple, Paget's disease of, 371 Nipples, sore, 491 Nitrates, 247 Nitre, 242 Nitric acid, 165, 195, 281, 596 graphic formula, 290 oxid, how differs from air, 182 Nitrite of amyl, 518 Nitrites, 247 Nitrogen, 211, 254, 261, 265 Nitroglycerin, 243, 255, 528, 537 Nitrous oxide, preparation of, 202 Non-metals, 190 Nuisance, 138 Nuisances, dangerous to health, 133 Nursing woman, 127 Nutrition, 115, 124 Nux vomica, 524, 572 Obesity, 316 causes of, 115 food in, 112, 148 Occipital bone, articulation of, 18 Occupations, a menace to health, 150 Oil of vitriol, 275 Ointments, 560, 577, 591 Oleates, 560 Olefiant gas, 170 Oleomargarine, 162 Oleum gaultheriae, dose of, 518 HHirrhuae, 562 ricini, 588 theobromae, 515 tiglii, 521, 541 Olfactory apparatus, 79 INDEX. 705 Olive oil, 600 Omentum, great, describe, 9 Operations, plastic, 387 Ophthalmia gonorrheal, :;24 neonatorum, 493 Ophthalmoscope, 657 Opium, 573, 579, 584 compared with bella- donna, 543 compared with hvoscine, 578 constipating action of, 548 effect of, on respiration, 602 preparations of, 533 poisoning, 394, 546 Optic commissure, describe, 8 nerves, describe, 6 Orbit, muscles of, 6 Organic acids, 246 bodies, 240 chemistry, description of, 177 compounds, 246 Organs of special sense, 113 reproductive, 429 subject to tuberculosis, 314 Osmose, 268 Osmosis. To Ostitis deformans. 412 Os uteri, rigidity of, 485 Ovaralgia, 505 Ovaries, cystic degeneration of, 506 location and description of, 68 Ovaritis, 505 Over-exertion, 142 -strain, 1 12 -training, 142 Ovulation. 433 Ovule, 433 ovum. f,;i. 183, 434 Oxalic acid, 296 Ox gall. .V.i I Oxidation, definition of, 231 Oxid of carbon, descripl Ion of, 201 < ).\vacids, 252 Oxygen, 164, 218, 269, 284, 291 compounds of, 281 general description of, 205 preparation of, 219, 229 Ozone, 164, 287 45 Ozone, preparation and character- istics of, 213 test, preparation of. 240 Pain, how produced, Hi' Pallor, physiology of, 123 Pancreas, 9, 123 Pancreatic duct, obstruction of, 109 juice, reaction of, 112 Pancreatin, 558 Fapillomata. 320 Paracentesis thoracis. 340 Paralvsis agitans, 626 bulbar. 308 diphtheritic, 626 infantile spinal, 687 ischemic, 307 ocular. 683 Paraphimosis. 351, 376 Parasiticide, prescription as a, 550 Parasiticiaes, 552 Paresis, cau.^es of. 325 Paris green, 237, l'42 Paronychia, 355, 4lu Parotitis, 147, 664 Parturition, premature. 508 Patella, attachments of, 26 fractures of. 425 reflex, 644, 651 Pelvic floor, 138 Pel vi mi try. 512 Pelvis, anatomy of. 25 deformed, 437, 438 male and female, 435 obstetric. 436 Pentad, 209 element, description of, 18] People, old, food for, 133 Pepo, therapj of. 555 Pepsin, 2: in. 558 Peptones, how produced, 189 Peri< arditis, 680, 637, 654, 662, 678 Pericardium, describe. ;• Perineum, how protected in labor. 165 laceration of. 466, 509 male, muscles of. :;. P, 509 transverse, 483 Presentations. 448, 449, 458, 459 vertex, 159 Privy, 140 Progressive muscular atrophy, 326 Prolonged expiration, 678 Prostatectomy, 121 Prostatitis. 105 Proteids. 73, 99, 256 Protoplasm, 99, l<>4 Primus Virginiana, 595 Ptomaine-, 146, 166 Ptosis. 365 Puerperal mania, 490 sepsis, 175 Puerpeiiiim. complications of, 172 ilcliiiition of, 472 passing catheter, 470 sources of infection in. 17- Pulmonarv artery, description of, 46" diseases, causes of. 146 sounds, 649 Pulsatilla. 551 Pulse. 65, 123, 647 Pulvis glycyrrhizae compositus, 525, 568 Pnpil, contraction and dilatation of, 118 Pupils, hours in school, 151 Purgative-. 575, 593 Purpura hemorrhagica, 661 simplex, 683 Pus cocci, 159 corpuscles, formation of. 314 Pustule, malignant, 386 Putrefaction, 223, 251, 271. 291 Pyelitis, treatment Pyemia, H4 Pyuria. 610 Quadriceps extensor lemons. 375 Qualitative analysis. 226 Quarantine. 152 Quassia, 551 Quickening, 444 Quinine. Rachitis. Radial nerve, division of. 347 Radical. 241. 269 Rales. 663, 680, 683,687 Rational formula, explanation of. 192 Rattlesnake bite. 361 Reaction, alkaline. 249 chemical, 249 definition of, 203 . •mi. chemical, describe, 1 81 g, physiology of, ll l Rectum, descripl ion of, 16, 17 nerve and blood supply of, 26 stricture of, -"'It ii. left hypochondriac, con- tents of, 28 right hypochondriac, 17 Reflex action, 65, 87, 95 deep, integritj of, 91 superficial, integrity of, 91 Remedj . cataphoric application of, 605 Remedies, topical, • 708 INDEX. Eemittent fever, 649 Eespiration. 67, 75, 112, 159 Oheyne-Stokes, 683 description of, 84 premature, 495 quantity of air for, 139 Respirations, number per minute, 117 Respiratory capacity. 117 sounds, define, 89 tract, function of mu- cous membrane, 106 Reserve air, 82 Residual air, 82 Resorcin, 566 Rest cure, 79 Retina, function of, 104 rods and cones of, 95-96 Rheumatic patients, hygiene of, 128 Rheumatism, 652, 658, 659, 680 acute articular, 538 articular, 673 blood in, 675 cardiac lesions in, 680 chronic, 326 treatment of, 582 urine in, 680 Rhubarb, 586 Rhythm, define, 89 Ribs, fracture of, 393 Ricini oleum, 595 Rickets, 654 Rigor mortis, 71, 106 Rochelle salts, chemical name of, 238 Roentgen rays, 256 Roll sulphur, description of, 194, 195 Room, temperature for, 132 Rooms, gases in, 136 Roseola, 648 Rotation, 458 Rotheln, incubation of, 147 Rubeola, 668 Rural districts, death rate, 156 Sabinae oleum, dose, 601 Saccharin, source and uses of, 588 Sacro-iliac disease, 352, 377 Safety lamp, 239 Saliva, reaction of, 276 Sal ammoniac, 270 Salicylic acid, 182 Salol, 561, 604 Salpingitis. 504 Salt, 180, 220, 255 common, its source, etc., 207 formula. 240 neutral, 294 solution, 348 Saltpetre. 601 Salts, Epsom, 587 Glauber's, 587 Rochelle, 587 Santalum album, 566 Saponification, 97, 282 Sarcoma. 317, 318 Sarsaparilla, 596 Saturation, 276 Scabies, treatment of, 541 Scalp wound, 372 Scammonium, 555 Scarlatina, 131, 640,648, 671, 673, 676 lymphatic glands in, 675 rash of, 304 treatment of, 627 Scarpa's triangle, boundaries and contents. 19 Scholars, sight of, 130 School-room, dimensions of, 140 School-rooms, precautions neces- sary, 130, 131 Sciatica, treatment of, 617 Sclerosis, multiple, 634 Scoparius, 567 Scrotum, diseases of, 337 Scurvy, 613 Sebaceous glands, fun'ction of, 118 Secreting surface, epithelial, 92 Secretion, 99, 117 Secretions of alimentary canal, 70 Sedatives, 573, 581 Seidlitz powder, 239 Selenium, 298 Semen, 432 Seminal fluid, 77 Senna. 545, 591 , 600 Sense of smell, 119 Septicemia, 352 Serous membrane, 104 Serpentaria, 569 Serum therapy, 574 Sesqui, meaning of, 180 Sewage, 159 Sewer gas, 133, 155 INDEX. 709 Shock, 388, 397 Shoulder, muscles of, 33 joint, describe, 7 dislocations, 348, 378, 422 Sialagogue, 528, 588 Sigmoid flexure, locate, 34 Silicon, 298 Silk, merits of, 141 Silver, 261 nitrate, 239, 289, 572 preparations of, 569 salt of, 248, 563, 590 symbol of, 178 tarnished, 217 test for, 178 Sinapis, 515 Sinus, 349 lateral, describe. 57 maxillary, describe. -54 Sinuses, accessory of face, de- scribe, 61 Skeleton, quantity of phosphorus in, 225 Skin, 89,91, 103 eruptions, drugs causing, 531 hygiene of, 128 matters excreted by, 103 minute anatomy of, 56 tuberculosis of, 321 Skull, foramina at base of, 17 fractures of, 371, 375, 377, 386, 424 sutures of, 1 Sleep, 77. 116, 136 drags to promote, 578, 605 Small-pox, 140, 628, 653 Smell, 119 Snake bite. 116 Soap, 263. 297, 599 Sodium, 227, 264 chloride, 519 nitrate 286 phosphate, therapy of, -,.-,i salicylate, 545 sulphate. 219, 27(1.519 Solid, 176 Solution, definition of, 226 I ►onovan's, 528 Fowler's, 528, 589 Solutions compared with waters, 595 Solvent, 543 Soot, chemical name of, Sound conveyed to brain, 103 Space, popliteal, boundaries and contents. 51 Sparteine, 519 Spasms, 646 Special senses, organs of, 113 Specific gravity, 199, 221, 226, 238 heat, 272 Spermatic cord, parts of, :!4 Spermatozoa. 432 Sphygmograph, description of, 96 Spigelia, Spina bifida. 323 Spinal accessory nerve, resection of. 390 canal, puncture of, 326 column, 28, 55 cord, 38, 72, 82, 113 nerves, 91, 113 Spirilla. 315 Spirits, definition, 539 Spleen. 25, 663 Sprain, 389 Sputum, 152, 303 Stammering, define, 89 Staphisagria, 539 Starch, 228, 255 Steuson's duct, division of, 121 Sterility, causes of, 452 Sterilization. 143, 286 Still-born child, 7:;. 496 Stimulant, vasomotor, 581 Stomach. 122 cancer of, 364, 632, 647 corrosion of, digestion in, 1 13 digestion of, 123 dilatation of, 613 foreign body in. 405 lesions oi p\ loric orifice of, 22 ulcer of, 622, hit. 851 vermicular movemenl of, 100 Stomal it is, 64 1 Stools, drug affecl ing color, ' ; "i Strabismus, operat ion for, 848 Stramonium, antidotes. 235 Stricture, esophageal, 840 Stronl iuin. flame test for. 221 Stropbanthua compared with digi- talis. 642 t r. dose of, Strychnia, 272, 710 INDEX. Strychnia, effects of, in cathartics, 564 Strychnin, test for, 248 Strychnine and alcohol compared, 603 antidote for, 569 poisoning dose, 535 source of, 517 Subclavian artery, 14, 356 vein, describe, 5 Subinvolution, 469 Sublimation, define an example of, 194 Substances fusible by heat, 270 volatilized by heat, 270 Sucrose, differentiate chemically, 205 Sudoriferous glands, function of 118 Sugar, 171, 195, 196, 228 of milk, 588 Sulf., see also Sulph. Sulfate, 260 Sulfite, 260 Sulfur, 169, 200, 276, 298,518 dioxid, 262 precipitated, 194, 195 flowers of, 194 uses of, 218, 538 Sulfuric acid, graphic formula, 290 antidote for, 204 Sulf urous acid, 179, 278 Sulphur ointment, 551, 602 Sulphuric acid, 277, 279 manufacture of, 191 Sulphuretted hydrogen, 179, 221, 283 Sulphonal, 601 Sunstroke, 618, 656, 662 Superfetation, 494 Suppository, prescription for, 571 Suprarenal capsules, relations, 49 Surgical fever, 374 Survivorship, 106 Sutures, varieties, 361 Sympathetic nerve, 71 Symphyseotomy, 500 Symbiosis, 328 Symbols, 271 Syncope, 77, 655 Synovial bursae, 348 fluid, 292 membrane, 104 Synthesis, 244, 249 Synthetic operation, 228 Syphilis, 663 constitutional, 495 eruption of, 658 lesions in, 320 prescription for, 540 symptoms of, 366 treatment of, 578 Tabes dorsalis, 666 Talipes calcaneus, 376 equino-varus, 385, 403, 404 Tampon, 478 Tannic acid, drugs incompatible with, 576 source of, 585 Tannin, 288 Tape worm, 631 Tar, uses of, 540 Taraxacum, 567 Tartar emetic, 200, 221, 552, 554, 583 on teeth. 257 Tartaric acid, 272, 295 double salts of, 280 Tea, 99. 134 Tear, origin of, 115 Tears, physiology of, 123 Teeth, formation of, 53 growth of, 79 hygiene of, 128 permanent and temporary, 87, 88 replacement of temporary, 109 tartar on, 257 temporary, time of erup- tion, 117 Temperature, drugs for reduction of, 578 grades of, 673 proper for rooms, 132 subnormal, 68 variations during life, 73, 82, 83, 114, 117 Temporal bone, mastoid portion of, 57 Tendo Achillis, muscles forming, 17 Tendons, compare, 5 Tenia, 688 Testes, descent of, 37 description of, 64 INDEX. 711 Testicle, descent of, 79 Tetanus 71, 617, 666 Tetrad, 209 Therapeutics, definition of, 537 Thermometer, 211, 216, 256 Thigh, amputation of, 4U» Thirst, physiology of, 120 Thorax, 45,657 Thrombosis, 319, 362, 661 Thumb, muscle moving it out- ward. 48 Thymol, source and uses, 540 Thyroid gland, 4. 76 Thyroidectomy, 378 Tic douloureux. 640 Tidal air, 82 Tincture and tt. ext., relative strength, 592 definition, 539 Tinctures, 577 Tinnitus aurium, causes of, 368 Tissue, adipose, 305 connective, function of, 101 fibrous, 100, 318 muscular, describe, 52 yellow elastic 100 Tissues, erectile, their function, 94 post-mortem changes, 306 seal of t uberculosis, 31 1 separation of, 404 Tobacco, effects of use of, 132, 154 Tongue, appearances of, 650 carcinoma of, 357, 364 Tonsillitis, 641,653 Tonsils, description of, 32, 46 Torticollis. 350 Towns, death rate, 156 Toxins for prevention of disease. 1 13 Trachea, describe, 55 foreign bodies in. 402 Tracheotome , 1 1. 374 Treat men! by cold water. 546 Trephining, indications for, 375 Triangle of elbow, structures of, 63 Scarpa's, hound, i ( .» Trichinosis, 518 Triple phosphates, 292 Tubercle, 311, 31 1, 318 Tnbercula quadrigemina, 2 Tuberculosis, 145, 161, 681 Tuberculous joint, 826 Tubes, Eustachian, describe, 11 Tumor, benign, 336 cartilaginous, 335 cerebral, 684 definition of, 360 diagnosis of, 375 heterologous, 383 homologous, 383 malignant . 311, 336, 356 of brain. 359 Tumors, classes of, :;i 1 of fibrous tissue. 318 Turkish bath, 138 Turpentine. 277, ~>\-\. 597 Typhoid fever, 160, 312, 624, 631, (i4!l diagnosis, 627 diet in, 148 eruption of, 653 hemorrhage in. 642 treatment of. 639 Tympanum, methods of inflating, '845 Tyrotoxicon. 1 hi Ulcer, typhoid, 307 tubercular, 307 Ulceration, 329, m Ulnar nerves, division of, 351 Umbilical cord, 434, 4:;5 souffle, 447 Urates, 231, 270, 272 Urea, 71 effect of diet, 277 how determined, ~^\ so nice of, 252 Uremia. 394, 534 623 l remic coma. 655 I "let er, description of, 35 Ureters, female, course of, 44 Urethra, female, description of. 17 male, description of, 16 Urethritis, gonorrheal, 871 Uric acid, 177. 241, _'•'_. 661 Urinalysis, purpose of litmus paper, l tt Urinarj calculi, 177. 301 Urination, nervous mechanism, s i Urine, 188, 256, 261, 263, 288, 801 act ion of drugs on. 679 albumin. quant native test . ammonia in. 295 bile in. ij.".:; blood in. 28 I This book is due on the date indicated below, or at the I expiration of a definite period after the date of borrowing, as >d provided by the rules of the Library or by special arrange- f > : ment with the Librarian in charge DATE BORROWED DATE DUE fc* C2a(l14l)MIOO DATE BORROWED DATE DUE rv #"v M^^^I ^K'vJ ,v a? #g wcm P, m rt&b m Answers to questions prescribed _ I f *> r A