COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD II! i 'ii l! ! HX00063860 i ! Ml til !!>) iiiiillllllilli'iM.^iiliiiilililili' ■n iJliililiilJiiJiiiii OBSTETBlf % SCOTT Columbia ®nibersitp m tfte Citp of ^etu gorfe COLLEGE OF PHYSICIANS AND SURGEONS 3. Reference Library Given by 9. ^7* // state 3Boar^ lexamtnation Series. QUESTIONS IN OBSTETRICS ASKED AT THE EXAMINATIONS HELD BY THE NEW YORK STATE BOARD OF MEDICAL EXAMINERS, COMPLETE, WITH REFERENCES AND ANSWERS TO EVERY QUESTION. COMPILED AND EDITED BY R. J. E. SCOTT, A.M., M.D., B.C.L., ATTENDING PHYSICIAN BELLEVDE DISPENSARY, AND ATTENDING GYNECOLOGIST DEMILT DISPENSARY, NEW YORK. / ^hj^ //-^^ LEA BROTHERS & CO., NEW YORK AND PHILADELPHIA Entered according to the Act of Congress, in the year 1903, by LEA BROTHERS & CO., In the Office of the Librarian of Congress. All rights reserved. DORNAN, PRINTER. PREFACE. This series is intended to aid medical students and practitioners in preparing to pass the State Board Examina- tions. The volumes are of the nature of neither text-books nor quiz compends. From the latter they differ materially in that they do not contain questions which might be asked, or which ought to be asked, or which, if asked, could be answered from some given text-book. They simply contain all the questions which have been asked and are being asked at the New York State Board Examinations, and they thus give an accurate idea of the scope of the examination and of the re- quirements of the examiners. Although intended primarily for use by candidates pre- paring for the examinations held by the New York State Board, this volume will also serve as a guide for correspond- ing examinations conducted elsewhere, for a careful survey of the papers set in most of the other States will show a marked similarity to and almost monotonous repetition of the questions contained in this volume. Students are advised to use this series as a companion to their text-books, to mark the questions they cannot answer and to learn the answers thereto, to write out in full all definitions, tables of composition, etc., and such other facts as they have found from experience are likely to be forgotten in the recitation room. For this purpose these volumes are iv PREFACE. arranged so as to leave right-hand pages blank and are printed on paper prepared for the use of either ink or pencil. Upon the eve of examination, students will find a review of the ques- tions in these volumes, in connection mth their personal notes, an efficient and ready means of preparation to successfully meet the test. The method adopted of supplying answers to questions by citing references to standard text-books is the outcome of <;areful thought, as furnishing the student with much fuller information than could be couched in the few lines of reply admissible in such volumes. In selecting works for refer- ence^ care has been taken to choose those in most general use and of unquestioned authority. Appended to each question is an indication of the dates upon which it has been asked, thus showing its frequency and relative importance. The remaining volumes of this series are in active prepa- ration, and will appear at an early date. R. J. E. Scott. CONTENTS. PAGE I. Female Generative Organs . . . . . .18 1. External (Q. 1 to 4). 2. Internal (Q. 5 to 16). 3. External and Internal (Q. 17 and 18). 4. Malformations of the Uterus (Q. 19). II. Menstruation and Ovulation . . . . .20 1. Puberty (Q. 20). 2. Menstruation (Q 21 to 34). 3. Ovulation (Q. 35 to 41). 4. Corpus Luteum (Q. 42). III. Fecundation; Development and Nutrition of the Ovum 22 1. Fecundation (Q. 43 to 62). 2. Development of the Owm (Q. 63 to 72). 3. Changes in the Uterine Mucosa following Impregnation (Q. 73 to 78). 4. Nutrition of the Ovum (Q. 79 to 87). 5. Embryo at Various Ages (Q. 88 to 91). 6. Changes in the Circulation at Birth (Q 92 and 93). IV. The Pelvis (Q. 94 to 108) 27 V. TheFcetalHead(Q. 109toll8) 28 VI. Changes in the Maternal Organism Caused by Pregnancy (Q. 119 to 128) 29 VII. Diagnosis of Pregnancy . . . . . .31 1. Direct Diagnosis (Q. 129 to 157). 2. Differential Diagnosis (Q. 158 to 163). 3. External Palpation (Q. 164 to 170). 4. Primipara and Multipara (Q. 171 to 175). 5. Duration of Pregnancy (Q. 176 to 181). vi CONTENTS. PAGE VIII. Hygiene, Management, and Pathology of Pregnancy 37 1. Hygiene and Pathology (Q. 182 to 189). 2. Morning Sickness and Hj'pereniesis (Q. 190 to 198). 3. Pathology of the Urinary Organs (Q. 199 to 208). 4. Pathology of the Circulatory System (Q. 209 to 211). 5. Foetal Diseases (Q. 212 to 214). 6. Hydatidiform Pregnancy (Q. 215 to 219). 7. Imra-uterine Death (Q. 220 to 226). IX. Abortion and Premature Labor (Q. 227 to 246) . . 42 X. Ectopic Gestation (Q. 247 to 264) . . . .43 XI. Labor: Its Clinical Course, Mechanism and Management 44 1. Causes (Q. 265 to 267). 2. Liquor Amnii: Its Functions, etc. (Q. 268 to 271). 3. Di\dsions. Phenomena (Q. 272 to 286). 4. General Management (Q. 287 to 298). 5. Perineal Stage (Q. 299 to 314). 6. Third Stage (Q. 315 to 337). 7. Asepsis and Antisepsis (Q. 338 to 345). 8. Anaesthetics (Q. 346 to 359). XII. Management of Mother and Child . . .54 1. Mother (Q. 360 to 377). 2. Child: (a) Asphyxia (Q. 378 to 390). (b) Eyes (Q. 391 to 399). (c) Umbihcus (Q. 400 and 401). (d) Feeding (Q. 402 and 403). (e) Caput Succedaneum (Q. 404 and 405). (f) First Twenty-four Hours (Q. 406). (g) Stillbirth (Q. 407 and 408). XIII. Mechanism in Vertex Presentations (Q. 409 to 429) . 59 XIV. Mechanism in Face Presentations (Q. 430 to 440) . 61 XV. Mechanism in Breech, Knee, and Foot Presentations (Q. 441 to 457) 62 XVI. Mechanism in Transverse Presentations (Q. 458 to 469) 64 XVII. Dystocia ......... 65 1. Definitions; Tedious Labor, and Inertia Uteri (Q. 470 to 504). CONTENTS. vii PAGE 2. Premature Rupture of the Membranes (Q. 505 to 510). 3. Obstructed Labor (Q. 511 to 518). 4. Hydrocephalus (Q. 519 to 523). 5. Short Cord (Q. 524). 6. Multiple Pregnancy (Q. 525 to 535). 7. Precipitate Labor (Q. 536 and 537). XVIII. Deformed Pelvis and Pelvimetry . , . .71 1. Deformed Pelvis (Q. 538 to 546). 2. Pelvimetry (Q. 547 and 548). XIX. Prolapse OF Funis (Q. 549 to 559) . . . .72 XX. Inversion of the Uterus (Q. 560 to 564) . . .73 XXI. Rupture of the Uterus (Q. 565 to 578) . . .74 XXII. Placenta Previa; Retained Placenta; the Hemor- rhages . . . . . . . . 75 1. Placenta Prsevia (Q. 579 to 594). 2. Retained Placenta (Q. 595 to 602). 3. Hemorrhages (Q. 603 to 629). XXIII. Eclampsia (Q. 630 to 648) 79 XXIV. Obstetric Surgery ....... 81 1. Induction of Premature Labor (Q. 649 to 667). 2. Forceps (Q. 668 to 696). 3. Version (Q. 697 to 717). 4. Cutting Operations on the Mother: (a) Cesarean Section (Q. 718 to 731). (b) Symphyseotomy (Q. 732 to 738). (c) Episiotomy (Q. 739). 5. Mutilating Operations on the Child (Q. 740 to 744) XXV. Complications of the Puerpertum . , . .92 1. Puerperal Infection: (a) Sepsis (Q. 745 to 770). (b) Phlebitis (Q. 771 to 777). (c) Phlegmasia Dolens (Q. 778 to 780). (d) Douches (Q. 781 to 786). (e) Curettage (Q. 787 to 789). 2. Puerperal Mania (Q. 790 to 793). 3. Mastitis and Mammary Abscess (Q. 794 to 801). viii CONTENTS. PAGE XXVI. Gynecology 98 1. Imperforate Hymen (Q. 802 to 805). 2. Vaginismus and Vaginitis (Q. 806 to 808). 3. Tampons (Q. 809 to 813). 4. Metritis and Endometritis (Q. 814 to 819). 5. Displacements of the Uterus (Q. 820 to 830). 6. Tumors of the Uterus (Q. 831 to 833\ 7. Menstrual Disorders (Q. 834 to 840). 8. Tubal Disease (Q. 841 to 844). 9. Ovarian Disease (Q. 845 to 847). 10. Pelvic Disease (Q. 848 to 851). 11. Sterility (Q. 852 to 859). 12. Gonorrhoea (Q. 860). XXVII. Miscellaneous . . . . . . . 105 1. Extragenital Differences between Male and Female (Q. 861 to 863). 2. Water (Q. 864). 3. Knee-chest Posture (Q. 865). 4. Medico-legal (Q. 866). 5. Cases Attended (Q. 867 to 870). Appendix 107 Questions asked Ja,nuary, 1903 (Q. 871 to 885) . . . 107 Questions asked May, 1903 (Q. 886 to 900) . . . .109 Questions asked June, 1903 (Q. 901 to 915) . . .111 OBSTETRICS. WORKS TO WHICH THE REFERENCES IN THE TEXT APPLY. KING'S MANUAL OF OBSTETRICS. Ninth edition. CROCKETT'S GYNECOLOGY. Quotations have been made from the folloiving works: JEWETT'S PRACTICE OF OBSTETRICS. Second edition DUANE'S MEDICAL DICTIONARY. Fourth edition. FINDLEY'S GYNECOLOGICAL DIAGNOSIS. The following abbreviations are used in the succeeding pages. et seg. = and following (page or pages). sub wee = under the word (or article or heading). Q= question. A = answer, (17) OBSTETRICS I. FEMALE GENERATIVE ORGANS. 1 . Give an anatomical description of the external organs of generation in the female, and mention their several functions. (June, 1897.) 2. Describe, anatomically, the external organs of generation in woman, and mention the function of each organ. {May, 1899.) 3. Describe briefly the female external organs of generation, mentioning the function of each. {May, 1900.) Jj.. Give the anatomy of the external organs of generation in the female, and mention the functions of each. {May, 1902.) 1 to 4. King's Manual of Obstetrics, pages 39 to 43. 5. Give an anatomical description of the vagina and name its functions. {September, 1895.) 6. Give an anatomical description of the vagina and describe its functions. {January, 1897.) 7. Give an anatomical description of the vagina. State the functions of the vagina. {September, 1902.) 5 to 7. King's Manual of Obstetrics, pages 43 and 44. Functions: During copulation it receives the penis; during parturition it becomes a part of the birth-canal. 8. Describe the uterus and give its relations to the other pelvic organs. {January, 1902.) 9. Describe the human uterus and give its anatomical rela- tions. {June, 1893.) (18) 19 OBSTETRICS. 8 and 9. King's Manual of Obstetrics, pages 44 to 48. 10. How is the uterus supplied with nerves? {May, 1895.) 10. King's Manual of Obstetrics, page 53. 11. Give a brief anatomical description of the uterine appendages. {September, 1896.) 11. King's Manual of Obstetrics, pages 48, 49 and 54 to 57. 12. Give a brief anato7nical description of the female internal organs of generation, and mention the function of each, {June, 1898.) 13. Give a brief anatomical description of the female internal organs of generation, mentioning the function of each. {Sep- tember, 1900.) 14. Describe, anatomically, the interned -organs of gener- ation in woman, and state the function of each organ. {Jan- uary, 1900.) 15. Describe, anatomiccdly , the internal organs of gener- ation in the female, and state the function of each. {June,. 1902.) 16. Give an anatomical description of the internal female organs of generation, and state the function of each organ, {September, 1901.) 12 to 16. King's Manual of Obstetrics, pages 43 to 49; 54 and 55 to 56. 17. Describe the female reproductive organs. {November, 1894.) 18. Give an anatomical description of the genital organs of the female, and state the functions of each organ. (JunCy. 1901.) 17 and 18. See above, Q. 1 to 4; and Q. 12 to 16. 19. Describe the mcdformations of the uterus. {January^ 1893.) 19. Crockett's Gynecology, pages 333 to 338. 20 OBSTETRICS. II. MENSTRUATION AND OVULATION. 20. What changes take 'place in the female at puberty? (June, 1901.) 21. What conditions have a hearing on the time of life in the female when menstruation first occur sf {June, 1894.) 20 and 21. King's Manual of Obstetrics, page 69. 22. What is menstruation? 22. A periodical sanguineous discharge from the uterine cavity occurring during the period of woman's sexual activity. And King's Manual of Obstetrics, page 70, last paragraph. 23. (a) Describe briefly the phenomena of menstruation. (b) State the relation of menstruation to ovulation and pregnancy. {January, 1901.) 24. (a) Give a description of the physiology of menstruation. {Jidy, 1893.) 25. (a) Give a physiological description of the phenomena of menstruation. {June, 1899.) 26. (a) Give the stages of a normal menstrual cycle. {Jan- uary, 1896.)- 27. (c) Define menstruation, and (a) describe its cliniccd course and phenomena. {June, 1895.) 28. Give the (c) definition, (d) duration, and (e) frequency of menstruation, together loith (a) the restdting changes in the uterine mucous membrane. {January, 1894.) 29. (a) Give a physiologiccd description of menstruation, noting resulting changes in the uterine mucous membrane during the molimen. {May, 1897.) 30. (a) Give a brief physiologiccd description of menstrua- tio7i, noting the changes that occur in the uterine mucosa dur- ing the molimen. {April, 1898.) 31. (f) What kind of mucous membrane lines the uterus, and (a) ivhat changes does it undergo during the catameniaf {April, 1896.) 21 OBSTETRICS, 32. (g) How soon after parturition should a woman men- struate? {January J 1895.) 33. (h) What is the menopause, and (i) in what manner woidd you explain the theory that it is a critical period in a woman's life? {September, 1894-) 34. (a) Give a physiological explanation of menstruation. (j) At what period of life does it usually appear, and (h) when does the menopause ordinarily ensue? {June, 1896.) 35. (k) Define ovulation, and (b) state its relation to men- struation. {May, 1902.) 36. Give the (k) definition, (e) physiology, and frequency of ovulation, and (b) state whether ovulation and menstruation are synchronous. {April, 1894.) 37. (1) Mention the phenomena attendant on rupture of a Graafian follicle. {September, 1902.) 38. (I) What is the mechanism of escape of the ovule and (m) its transmission to the tubes and uterus? {June, 1893.) 39. (1) What is the mechanism of the escape of the ovule and (m) its transmission to the tube and to the uterus? {Sep- tember, 1897.) 23 to 39. (a) King's Manual of Obstetrics, page 68; Crock- ett's Gynecology, page 267 ; (b) King's Manual of Obstetrics, pages 66 etseq.; (c) See Q. 22; (d) Crockett's Gynecology, page 267; (e) page 267; (f) King's Manual of Obstetrics, pages 48 and 46 ; Note : The epithelium on the free surface is ciliated columnar; (g) Generally two to three months if she is not nursing her child; and later, at about seven to eight months, if she is; (h) Crockett's Gynecology, page 269; (i) pages 269 to 271; (j) King's Manual of Obstetrics, page 69; Crockett's Gynecology, page 266; (k) King's Man- ual of Obstetrics, page 66; (1) page 59, last paragraph; pages 66 and 67; (m) During menstruation the fimbriae of the Fallopian tube are spread out over the ovary. The ciliated epithelium, which covers both aspects of the fimbriae, creates a current in the serum which tends to sweep the ovum along into the tube, thence into the uterus. Once in the tube, propulsion is further aided by peristaltic movements of the tube. 22 OBSTETRICS. 40. (a) Describe a fully developed ovum. {Xovemher, 1894.) 41. (a) Describe the human ovum; (b) where and how does it originate? (January, 1892.) 40 and 41. (a) ''It is a single cell^ more or less spherical in form, about y^ inch in diameter, and composed of yolk, a nucleus, a nucleolus, and two enveloping membranes." (Jewett's Practice of Obstetrics.) (b) King's ]\Ianual of Ob- stetrics, pages 57 et seq. 42. Define the corpus luteurn. Describe (a) the corpus luteum of menstruation, (b) the corpus luteum of pregngtncy. {June, 1902.) 42. King's Manual of Obstetrics, pages 60 to 62. III. FECUNDATION, DEVELOPMENT, AND NUTRITION OF THE OVUM. 4s. (a) What are spei^natozoa? (b) Where are they formed? (c) Describe their appearance and function. {June, 1893.) 44- (a) What are spermatozoa? (b) Where are they formed, and (c) what is their appearance and function? {November, 1893.) 45. (d) Describe the formation of a spermatozoon, and (e) state how insemination is accomplished. {April, 1898.) 46. (f) Define insemination, and (e) state the conditions necessary to its accomplishment. {April, 1897.) 47. (f) What is insemination, and (e) how is it accom- plished? {June, 1899.) 48. (f) Define insemination, and (e) give the physiology of its accomplishment. {May, 1900.) 49. (f) Define insemination, and (e) give a physiological description of its accomplishment. {June, 1900.) 50. (d) Explain the formation of a spermatozoon: (c) Describe its appearance, state its function, and (g) show how it may fertilize an ovum. {May, 1897.) 51. Give a description of (c) spermatozoa and (h) ova, and (g) a brief physiological account of impregnation. {May, 1894.) 23 OBSTETRICS. 62. (i) Describe the semen and (g) explain how fecundation is attained. {April, 1896.) 53. (c) Give the anatomical characteristics of a spermatozoon and of an (h) ovum, (g) State how the former may fertilize the latter. {January, 1900.) dJj.. (g) Give the physiology of conception or impregnation. {January, 1892.) 55. {]) What is fecundation and (g) how does it take place? {September, 1893.) 56. {]) Define fecundation, and (g) describe its physiology. {April, 1895.) 57. (g) Give a brief physiological description of the process of fecundation. {May, 1898.) 58. (g) Give a physiological description of the phenomena of fecundation. {May, 1899.) 59. (g) Describe the physiology of fecundation, (k) mention- ing essentials to the accomplishment of fecundation. {Sep- tember, 1899.) 60. (g) Give a brief description of the physiology of fecun- dation, (k) mentioning the essentials to the accomplishment of fecundation. {January, 1901.) 61 . (g) What is the physiology of impregnation? (k) What conditions are essential to impregnation? {June, 1901.) 62. (g) Describe the process of fecundation. {June, 1902.) 63. (j) Define fecundation. (1) Describe the changes in the ovum after fecundation. {May, 1902.) 61^.. (g) Stxite the physiology of fecundation, and (1) give the successive changes that take place in the ovum after fecun- dation. {September, 1897.) 65. (g) In what manner is fecundation accomplished? (1) What changes in the ovum folloio fecundation? {June, 1898.) 66. (g) Describe the fertilization of the ovum, and (1) its early development. {January, 1899.) 67. (g) Give a pyhsiological description of the fertilization of the oimm and (1) its early development thereafter. {Janu- ary, 1898.) 24 OBSTETRICS. 68. (1) Give the successive changes that take place in the ovum after fecundation. (May, 1895.) 69. (1) Describe the changes that take place in the impreg- nated ovum during its passage to the uterus. {April, 1896.) 70. (1) Describe the development of the fertilized ovum in its early stages. (November, 1891.) 71. (1) Describe the segmentation of the vitellus. (June, 1896.) 72. (1) Describe the vitellus, the (m) allantois, and (n) the amnion. (January, 1895.) 78. (o) Give an anatomical description of the internal organs of generation in the female, mentioning their functions and (p) describing the changes in the uterine mucosa that follow fecundation. (January, 1899.) 74- (p) Describe the *changes in the mucous membrane of the uterus during pregnancy. (November, 1892.) 75. (q) What kind of mucous membrane lines the uterus, and (p) what changes in it follow fecundation? (November, 1893.) 76. (p) Describe the changes in the uterine mucosa that follow fecundation. (September, 1896.) 77. (p) Describe the changes in the uterine mucosa that follow fecundation. (June, 1897.) 78. (g), (k) Describe the processes essential to conception, and (r) relate the physiological changes that follow it. (Janu- ary, 1902.) 43 to 78. (a) "The fecundating element of the semen; the male generative cells which serve to impregnate the ovum. They consist of an ovoid head to which is attached a long, vibratile tail.'^ (Duane's Medical Dictionary.) , (b) In the seminiferous tubules of the testicle; (c) King's Manual of Obstetrics, page 72; (d) ^^Spermatogenesis. The stages in the development of the spermatozoa, are as follows : The spermatogonia become enlarged to form the spermato- cytes, and each spermatocyte subdivides into two cells, and each of these again divides into two spermatids or young spermatozoa, so that the spermatocyte gives origin 25 OBSTETRICS. to four spermatozoa. The process of spermatogenesis bears a close relation to that of maturation of the ovum. The spermatocyte is equivalent to the immature ovum. It undergoes subdivision, and ultimately gives origin to four spermatozoa, each of which contains, therefore, only, one-fourth of the chromatin elements of the nucleus of, the spermatocyte. In the process of maturation of the ovum its nucleus divides, one-half being extended as the first polar body. The remaining half of the nucleus again subdivides, one-half being extended as the second polar body. The portion of the nucleus which is retained to form the female pronucleus of the now matured ovum contains, therefore, only one-fourth of the chromatin elements of the original nucleus, and thus the spermatozoon and the matured ovum, so far as their nuclear elements are concerned, may be regarded as of the same morpho- logical value. '^ (Gray's Anatomy.) (e) King's Manual of Obstetrics, pages 72 and 73; (f) Insemination is here the equivalent of fecundation. See King's Manual of Obstet- rics, page 72; (g) page 72; (h) See above, Q. 40 and 41; (i) King's Manual of Obstetrics, page 72; (j) page 72; (k) A live and healthy ovum, a live and healthy spermatozoon, the entrance of the head of the latter into the former and its union with the female pronucleus. See King's Manual of Obstetrics, pages 72 and 73; (1) pages 73 et seq.; (m) pages 86 and 87; (n) page 85; (o) See above, Q. 12 to 16; (p) King's Manual of Obstetrics, pages 91 et seq.; (q) See Q. 31 (f). (r) See Q. 119 to 128. 79. (a) Describe the development of the placenta. (July, 1893.) 80. (a) Describe the development of the placenta. (Sep- tember, 1897.) 81. (a;) Describe the formation and development of the placenta. {September, 1902.) 82. (a) Give the formation and development of the placenta. {January, 1896.) 83. (a) What is the placenta? From what is it formed, 26 OBSTETRICS. what is its structure, and (b) what are its functions? (April, 1891) 84- (a) How is the placenta jorinedf (b) What is the function of the placenta? {June, 1898.) 85. (c) What is the usual situation of the placenta? {June, 1892.) 79 to 85. (a) King's Manual of Obstetrics, pages 96 to 100; (b) page 101; (c) page 100. 86. (a) What is the umbilical cord, and (b) how is it formed, and (c) what are its anatomical characteristics? {May, 1896.) 87. (c) What structures compose the fully developed um- bilical cord? {July, 1893.) 86 and 87. (a) King's Manual of Obstetrics, page 100; (b) page 100; (c) page 100. 88. Describe the human embryo during the (a) second month, during the (b) fifth month, and during the (c) seventh month, giving size and weight. {September, 1895.) 89. Give the size of the average foetus in utero at the end of the (b) fifth, (c) sevejith, and (cl) ninth months. {May, 1895.) 90. (e) At what age does the human foetus become viable? {June, 1892.) 91. (f) What indications of ptremature birth can be deter- mined in an infant? {September, 1892.) 88 to 91. (a) King's Manual of Obstetrics, page 587; (b) page 588; (c) page 588; (d) page 588; (e) End of the twenty- eighth week, on the average ; (f ) King's Manual" of Obstetrics, page 588; see under sixth, seventh, and eighth months. 92. What changes occur in the foetal circulation at birth? {April, 1895.) 93. What changes take place in the child's circulation at the time of birth? {January, 1896.) 92 and 93. King's Manual of Obstetrics, pages 102 and 101. 27 OBSTETRICS IV. THE PELVIS. 94. (a) Describe the pelvis and its several hones, and (b) state how the female pelvis may be distinguished from the male. \Septe7nber, 1893.) 95. (a) Describe the bony pelvis, and (b) state wherein the male pelvis differs from the female pelvis. (January, 1898.) 96. (b) What are the differences between the male pelvis and the female pelvis? {June, 1899.) 97. (b) Whoi are the differences between the male and the female pelvisf {May, 1894.) 98. (b) What are the differences between the male pelvis and the female pelvis? {May, 1896.) 99. (b) Describe the anatomical differences between the bony pelvis of the male and that of the female? {May, 1901.) 94 to 99. (a) King's Manual of Obstetrics, pages 17 to 21; (b) pages 26 and 27. 100. Give the (a) bones, (b) divisions, (c) straits, and (d) symphyses of the obstetric pelvis. {January, 1894-) 101. Differentiate the (e) planes and (f) axes of the pelvis, and mention their obstetrical importance. {May, 1898.) 102. What is understood by the term (e) planes of the pelvis as ordinarily applied? {June, 1902.) 103. Give the (f) axes, (g) curves, (h) angle of inclination to the horizontcd, and (i) diameters of the obstetric pelvis. (September, 1894.) 104' (i) Name and give the length of the diameters of the inlet of the pelvis. (May, 1895.) 105. (i) Give the names and dimensions -of the diameters of the pelvic inlet. (May, 1901.) 106. (i) What are the diameters of the pelvic outlet? (j) How is the pelvic outlet bounded? (April, 1899.) 107. (i) Give the approximate lengths of the diameters of the bony pelvis. (June, 1902.) 108. (k) What structures enter into the formation of the pelvic floor? (July, 1893.) 2S OBSTETRICS. 100 to 108. (a) Innominate bones (consisting of ilium, ischimn, and pubes), sacrmii, coccyx; (b) True and false pelvis; (c) Superior and inferior; (d) Pubic, sacro-iliac, sacro-cocc3^geal ; (e) King's Manual of Obstetrics, page 24; (f) pages 24 and 25; (g) page 25; (h) page 25; (i) pages 28 and 30. Jewett's figures are easily remembered: Brim. Mid-plane. Outlet. Anteroposterior. 4 inches 5 " Oblique. Transverse. 4^ inches 5 inches 4i " 4 " (j) King's Manual of Obstetrics, page 22; (k) pages 32 and 33. V. THE FCETAL HEAD. 109. What are the (a) fontanelles of the foetal head? {June, 1892.) 110. Name the (b) sutures and (a) fontanelles of the foetal head. (November, 1893.) 111. (a) Describe the fontanelles and (c) their diagnostic relations. {November, 1892.) 112. (a) Describe the fontanelles and (c) their diagnostic value. {April, 1894.) 113. (a) Describe the fontanelles and (c) state their diagnostic value. {January, 1896.) 114. (b) Name the foetal sutures and (a) fontanelles and (c) give the diagnostic significance of the latter. {January, 1895.) 115. (d) Give the principal diameters of the foetal head at ftdl term. {June, 1896.) 116. (d) Give the prhicipal measurements of the foetal head at term. {September, 1902.) 117: (e) Give a description of the foetal head at full term. {June, 1895.) 118. (e) Give a description of the foetal head at term, and {c) show the obstetric value of the fontanelles as a means of diag- nosis. {September, 1897.) 29 OBSTETRICS, 109 to 118. (a) King's Manual of Obstetrics, pages 35 to 37; (b) page 35. (c) When diagnosis by external palpation is inconclusive, the position of the presenting vertex can be determined b}' vaginal examination, noting the relative position of the anterior (quadrilateral) and the posterior (triradiate) fontanelle, and the direction of the sagittal suture joining the two. The presence of one or both, as determined bj^ the examining finger, also serves to distin- guish vertex and brow presentations from all others, (d) King's Manual of Obstetrics, pages 37 and 38. • Note : the occipitomental is 5J inches, the occipitofrontal 4J inches, and all the others approximately 3 J inches, (e) King's Manual of Obstetrics, pages 34 to 39. VI. CHANGES IN THE MATERNAL ORGANISM CAUSED BY PREGNANCY. 119. What changes occur during pregnancy in the external genitals and vagina? (April, 1893.) 119. ^^The vagina partakes of the increased nutritive acti^dty of pregnancy. Growing vascularity causes thick- ening and softening of the mucous membrane, which furnishes a more abundant secretion. The enlarged vessels of the venous plexus impart a bluish or violet color to the vagina. The vagina is increased in length, and though it is drawn upward by the uterus during pregnancy, the columns of the anterior wall frequently protrude from the ^Tilva. The swollen papillae cause the mucous mem- brane to present a granular feel to the examining finger. '^ The external genitals share in these changes. The largely developed bloodvessels and Ijmiphatics and the increased vascular tension induce a condition of softening and infiltration which causes the ^ailva to gape and to appear particularly prominent. The venous turgescence gives to the ^ailva a dusk}^ hue. The increased vascularity results in a condition of great functional activit}' on the part of the sweat-glands and sebaceous follicles. 30 OBSTETRICS. "The pelvic floor undergoes a downward displacement during pregnancy, which by the end of gestation results in nearly doubling the skin-distance from symphysis to coccjrx." (Jewett's Practice of Obstetrics.) 120. (a) Describe the changes in position which the uterus undergoes during pregnancy. {September, 1894-) 121. (a) What changes occur in the uterus during pregnancy? {November, 1891.) 122. (a) Describe the pregnant iderus, and (b) state how it differs from a normal womb. {April, 1895.) 120 to 122. (a) King's Manual of Obstetrics, pages 119 to 123; (b) page 130. 123. When conception takes place, ichat changes occur in the generative organs of ivoman? {September, 1901.) 123. King's Manual of Obstetrics, page 130. See above^ Q. 119 to 122. 121}.. What changes occur in the blood during gestation? {April, 1896.) 124. The blood is increased in cjuantity, chiefly in serum and leucocytes; the albuminous constituents are generally diminished; fibrinogen is also increased. 125. (a) Describe the inammary glands, and (b) state the changes that occur in them during pregnancy. {September, 1902.) 126. (b) What changes occur in the breast during pregnancy? {May, 1893.) 125 and 126. (a) King's Manual of Obstetrics, pages 63 to 65; (b) pages 117 and 118. 127. What general changes occur in woman during preg- nancy? {November, 1894.) 128. Mention some of the important effects of pregnancy on the maternal organism. {June, 1901.) 127 and 128. King's Manual of Obstetrics, pages 130 to 132; and see above, Q. 119 to 126. r^' \ / ilA' / f-)-f^i 'd tv^ ^7 V <- M vv** #^ 07' ^.^-^ ■-•'■■"> -^''J'' rrrt*^ s^' 31 OBSTETRICS. VII. DIAGNOSIS OF PREGNANCY. 1^9. Define and give the signs of pregnancy. (November, 1894.) 130. How would you diagnose pregnancy? {March, 1893.) 129 and 130. King's Manual of Obstetrics, pages 103 and 104 et seq., 115 and 116 et seq. 131. Mention the signs of pregnancy, classifying them as (a) presumptive, (b) certain. {May, 1902.) 132. (b) What are the certain signs of pregnancy? {No- vember, 1891.) 133. (b) Name the four most important signs of pregnancy in the order of their value. {January, 1895.) 134. (b) Name five of the most important signs of preg- nancy, and (d) state the date when they are most available; (May, 1895.) 135. Describe the (b) certain and (a) presumptive signs of pregnancy. (April, 1894.) 136. What are the signs of pregnancy, (c) doubtfid, (a) probable, and (b) certain? (September, 1892.) 131 to 136. (a) King's Manual of Obstetrics, page 116; (b) pages 103 and 104 (relative order: 1, 2, 3, 6, 5, 4) and page 115; (c) page 116; (d) pages 104 to 115. 137. (a) What are the subjective signs of pregnancy? (May, 1893.) 138. (a) What are the subjective signs of pregnancy? (No- vember, 1892.) 139. Classify the (b) objective and (a) subjective signs of pregnancy, and state their relative value. (June, 1897.) 140. Mention the (a) subjective and (b) the objective signs of pregnancy, giving their respective values. (September, 1898.) 141. Classify the (a) subjective and the (b) objective signs of pregnancy, and state the relative value of each sign and group. (January, 1899.) 137 to 141. (a) King's Manual of Obstetrics, page 116 (1, 3, 4, 5, 10), and Quickening; (b) pages 103 and 104, 116 (2, 6, 7, 8, 9). I /^ V 32 OBSTETRICS. lJi£. Describe the foetal heart sounds, give their rate, and state when and where they are best heard. {November, 1893.) 142. King's Manual of Obstetrics, pages 104 and 105. lJf.3. Differentiate uterine bruit and umbilical souffle. . {Sep- tember, 1895.) 143. King's Manual of Obstetrics, pages 109 and 115. H4. (a) What is to be learned by abdominal auscultation in pregnancy? {November, 1891.) IJfS. (a) What may be learned by abdominal auscultation, and (b) how is it best performed in pregnancy? {September, 1897.) 144 and 145. (a) Fcetal heart sound; uterine murmur; funic souffle; active movements of foetus, (b) King's Man- ual of Obstetrics, page 105. 146. What signs of pregnancy are deterinined by the touch? {September, 1892.) 146. Presence of a uterine tumor; its size and regular growth; quickening; ballottement ; intermittent contrac- tions; Hegar's sign; softening of the os and cervix; the position of the fcetal parts. lJf7. Make a diagnosis of the early stages of pregnancy. {January, 1897.) 148. How may pregnancy be recognized in the early months? {January, 1900.) 149. How may pregnancy be recognized in the early months, and on what symptoms may the diagnosis be justified? {Jan- uary, 1902.) 150. Make a diagnosis of pregnancy at or before the end of the third month. {May, 1899.) 151. Make a diagnosis of pregnancy before the thirteenth week, stating the difficulties or uncertainties attending such a diagnosis. {April, 1897.) 152. Make a diagnosis of suspected pregnancy before the fourteenth lueek. {May, 1898.) A-^ \^,^' t*»i Vr ' ^ Ou i P 83 OBSTETRICS. 153. Mention the most reliable signs of pregnancy before the fourth month. {June, 1901.) 147 to 153. King's Manual of Obstetrics, page 125. 154. Give a differential diagnosis of pregnancy at the six- teenth week. (September, 1896.) 155. Make a differential diagnosis of pregnancy at the fifth month. {May, 1900.) 154 and 155. King's Manual of Obstetrics, pages 125 and 126 et seq. 156. (a) Describe the size, structure, and vitality of the foetus at the end of the fifth month, (b) What are the objective signs of pregnancy at this period? {April, 1899.) 157. How woidd you diagnose pregnancy at (b) five months a7id (c) at fidl term? {June, 1893.) 156 and 157. (a) King's Manual of Obstetrics, page b^^\ for vitality, see page 171; (b) page 125; fc) page 126. 158. What conditions may be mistaken for pregnancy? {March, 1893.) 159. What conditions are frequently mistaken for pregnancy? How is the differential diagnosis made ? {September, 1895.) 160. What pcdhological conditions are often mistaken for pregnancy? Hoio is a diagnosis to be established? {April, 1899.) 161. Given a distended abdomen, how woidd you differen- ticdly diagnose pregnancy, ovarian disease, ascites, and gaseous accumidcdions? {September, 1892.) 158 to 161. King's Manual of Obstetrics, pages 126 to 129. 162. Make a differential diagnosis of pregnancy at the fifth month, and pelvic tumor. {June, 1899.) 162. King's Manual of Obstetrics, pages 126, 127 and 125. 34 OBSTETRICS. 163. Make a diagnosis by exclusion of asix months' pregnant uterus. {September, 1901.) 163. King's Manual of Obstetrics, pages 126 et seq., 125. 164' (a) What may be learned by abdominal palpation of the pregnant wojnan after the eighth month? {May, 1899.) 165. (a) What may be learned by external palpation of the pregnant ivoman in the latter months, and (b) how should it be performed? {May, 1898.) 166. (b) Make by external {not bimanual) palpation a diag- nosis of the foetal position in utero. {January, 1897.) 167. (b) Make a diagnosis of the position of the foetus in utero at term by external {not bimanual) palpation. {January, 1899.) 168. (b) Alake a diagnosis of the position of the foetus in utero, as determined by abdominal palpation. {May, 1900.) 169. (h) Make a diagnosis of the position of the foetus in utero at term, as determined by external palpation. {September, 1899.) 170. (b) Differentiate the positions of the foetus at term as determined by external palpation. {January, 1896.) 164 to 170. (a) Fundus uteri; foetal parts; foetal move- ments ; intermittent contractions ; ballottement (external) ; also size; presentation; position of foetus, (b) King's Manual of Obstetrics, pages 219 to 226. Note in addition: '^Small parts few and hard to find suggest an anterior position of the 'child; small parts numerous and found near the middle section of the abdomen usually point to a dorsoposterior position of the foetus. If small parts can be felt beyond either end of the foetal ellijDsoid, that end is pretty surely the breech." Location of anterior shoidder: ^The hands are held firmly upon the abdomen over the sides of the foetal head, and without relaxing the pressure moved toward the trunk. The first obstacle encountered is the anterior shoul- 35 OBSTETRICS. der. It is more surely identified by palpating it with one hand while the other steadies the foetus by downward pressure upon the breech in the direction of the foetal axis. . . . Anterior shoulder within one or two inches of the median line indicates an anterior, several inches from the median line a posterior foetal position." (Jewett's Practice of Obstetrics.) 171. (a) How would you differentiate between first and subsequent j)regnanciesf {June, 1895.) 172. (a) Give the characteristic or distinguishing marks of a primiparous and of a multiparous woman. (June, 1897.) 173. (a) Make a differential diagnosis of a primiparous and a multiparous woman. {January, 1898.) 174. (a) How may a diagnosis be made between a first pregnancy and subsequent pregnancies? (b) How is the date of confinement calculated? {April, 1899.) 175. (a) How may a diagnosis be made between a first pregnancy and subsequent pregnancies? (b) How is the date of confinement calculated? {September, 1901.) 176. (b) HoiD is the date of confinement calculated? {Jan- uary, 1892.) 177. (c) What is the average duration of pregnancy? (b) How is it computed? {April, 1896.) 178. (c) What is the normal duration of pregnancy? (d) What are the limits of its variation, and (b) how should its duration be calculated? {June, 1895.) 179. (c) What is the normal duration of pregnancy? (d) Give the limits of the variations of pregnancy, and (b) state how its duration should be calctdated. {June, 1897.) 180. (e) Give a brief synopsis of the signs by which the period of pregnancy may be ascertained. {May, 1894.) 181. (c) Give the normal duration of pregnancy; (d) state the limits of its variations, and (f) whcd medico-legal significance attaches to them? {April, 1898.) 36 OBSTETRICS. 171 to 181. (a) Primipara. Multipara. The fourchette is present. The perineuni is tense and deep. The labia are in apposition. The vagina possesses tonicity, and is rough and rugous, with a granu- lar feel. The cervix is long, soft, and conical; the OS is un dilated. The abdomen is full, rounded, tense, and resisting to the touch. Dark, purphsh-red striae appear late in pregnancy. The breasts are full, firm, and sensi- tive to pressure. The nipples are usually small and undeveloped, or even inverted. Striae are absent from the breast. The fourchette is missing. The perineum is relaxed and prob- ably torn. The vulva is frequently patulous. The vagina is relaxed and smooth. The cervix is large, cyhndrical, short, not so soft, and probably lacer- ated; the OS is patulous. The abdominal walls are relaxed and non-resisting to the touch; the skin is loose and wrinkled. The striae may be both white and liA'id, the former being present from the beginning of pregnancy. The breasts are flabby, pendulous, and non-sensitive to pressure. The nipples are large and well devel- oped. Striae are frequently to be found. (Borland's Obstetrics.) (b) King's Manual of Obstetrics, pages 203 and 204; (c) pages 203 and 585; (d) "The French law recognizes the legitimacy of the offspring when the apparent term of gestation is within 300 days. In Austria the recognized duration of pregnancy is from 240 to 307 days. In Eng- land and the United States there are no legal limits, but the possible protraction of gestation is admitted by all legal authority .... Several cases are recorded by obstetric writers in which pregnancy was believed to have continued 319, 324, 332, and 336 days respectively after the last menstruation.'' (Jewett's Practice of Obstetrics). And see King's Manual of Obstetrics, page 585; (e) King's Manual of Obstetrics, pages 125 and 126; (f) pages 585 and 586; and 102 and 103; and see (d). 37 OBSTETRICS. VIII. HYGIENE, MANAGEMENT, AND PATHOLOGY OF PREGNANCY. 182. Give the (a) symptojns, (b) diagnosis, (c) hygiene, and (d) pathology of pregnancy. {September, 1893.) 183. What is understood by the (c) hygiene of pregnancy? (d) by the pathology? (e) In a case of pregnancy, how is the health of the patient maintained? (January, 1900.) 184- State what is meant by the (c) hygiene of pregnancy, and (e) give a brief description of the manner in which it should be put into practice. {June, 1900.) 182 to 184. (a) See above Q. 131 to 136; (b)-See above Q. 129 and 130. (c) The rules and conduct which should be observed by ever}^ pregnant woman for the preservation of health and strength both to herself and the foetus, and also as far as possible to obviate or reduce to a minimum many unpleasant or harmful concomitants incident to her condition. See King's Manual of Obstetrics, pages 132 et seq. (d) By the pathology of pregnancy is meant the discussion of the complications incident to pregnancy, and their effect on the pregnant woman, (e) King's Manual of Obstetrics, pages 132 to 134. 185. Describe the proper management of the breasts of the mother before labor. {March, 1893.) 185. King's Manual of Obstetrics, pages 158, 249 and 250. 186. Give the pathology of pregnancy. {June, 1894.) 187. Name some of the diseases of pregnancy. {January, 1893.) 188. To ivhat diseases does pregnancy predispose? {May, 1893.) 189. Name the diseases of pregnancy, and give their treat- ment. State the influence of ordinary ailments on the diseases of pregnancy. {June, 1894.) 186 to 189. King's Manual of Obstetrics, pages 135 et seq. 38 OBSTETRICS. 190. (a) Describe morning sickness, its causation and treat- ment. {April, 1893.) 191. (a) What is '^morning sickness,'^ when does it begin, how long does it usually continue, and what is its causation and treatment? {June, 1894.) 192. (b) How shoidd the vomiting of pregnancy be treated? (May, 1894.) 193. (b) Give the causes, prognosis, and treatment of hyper- emesis of pregnancy. {June, 1895.) 194' (b) Mention the causes and describe the management of hyperemesis of pregnancy, {January, 1897.) 196. {du), (b) Differentiate ordinary morning sickness from the hyperemesis of pregnancy, and state how the latter should he managed. {May, 1898.) 196. (a) , (b) What is the difference in significance and man- agement between the so-called morning sickness and the hyper- emesis of pregnancy? {June, 1899.) 197. (b) Define hyperemesis of pregnancy as distinguished from (a) the ordinary morning sickness, and state what should he done to relieve it. {January, 1901.) 198. (a), (b) Describe differentially the ordinary morning sickness and the hyperemesis of pregnancy, giving the treat- ment of the latter. (September, 1901.) 190 to 198. (a) King's Manual of Obstetrics, page 118; (b) pages 137 to 142. 199. To what forin of morbus Brightii are pregnant women most liable? How ivoidd you diagnose and treat it? {Jan- uary, 1892.) 200. Give a diagnosis and general management of morbus Brightii in a pregnant. {March, 1893.) 201. How ivould you measure the severity of interstitial nephritis in a pregnant woman, and how would you treat such a condition? {April, 1893.) 202. When cdbuminuria and oedema occur during preg- nancy, what is the treatment and the prognosis? {May, 1894-) 203. What are the causes of albuminuria in pregnancy? 39 OBSTETRICS. What does it indicate, and how should it he treated? {June, 1898.) 204' Describe albuminuria as met with in pregnancy. Give the causes, symptoms, and treatment. {April, 1899.) 205. Give the etiology, symptoms, and management of the albuminuria of pregnancy. {June, 1899.) 206. Give the etiology, symptoms, a7id management, as best understood and practised at present, of albuminuria of pregnancy. {June, 1900.) 207 Give the significance and treatment of albuminuria during pregnancy. {June, 1902.) 199 to 207. King's Manual of Obstetrics, pages 143 to 149. 208. What is the cause of difficult and painful urination during pregnancy? {January, 1895.) 208. King's Manual of Obstetrics, pages 149 to 151. 209. What treatment would you advise for a case of con- tinued menstruation during pregnancy? {May, 1894.) 209. If the diagnosis is correct, no treatment beyond rest in bed is required; but the condition is rare. Suspect ectopic gestation, placenta prsevia, or abortion. 210. Give the diagnosis and treatment of ancemia and chlorosis. {November, 1892.) 210. King's Manual of Obstetrics, page 159. To estab- lish the diagnosis make a blood examination, remembering that the haemoglobin will be diminished in chlorosis, and the number of the red corpuscles decreased in ansemia. Iron is indicated in chlorosis, and arsenic in ansemia. 211. What is uterine thrombosis, and how should it be treated during pregnancy? {September, 1894.) 211. Clotting of the blood in a uterine vein, usually due to pressure or marasmus. Treatment consists mainly in securing absolute rest, on account of the danger from embolism, for at least two weeks after all swelling has disappeared. If miscarriage occurs spontaneously, expe- dite labor. If the mother should die suddenly, attempts 40 OBSTETRICS. should be made to save the child, if viable. (Reynolds and Newell.) 21£. What diseases of the mother are liable to injure the foetus in utero? {November, 1894-) 212. Nephritis (eclampsia), diabetes, syphilis, chorea, valvular heart disease, and all the acute infectious fevers. 213. How does constitutional syphilis in the parents affect the infant, and how can you detect its presence in the infant? (May, 1893.) 213. ^'The disease may be acquired from father or mother, or from both parents, the poison being conveyed by the spermatozoa of the male or the ovum of the female. Without antisyphilitic treatment the spermatozoa can usually convey the syphilitic poison during the first year after primary infection, and there is great danger to the foetus from syphilitic contagion up to the fourth year. ^Tien the virus of the disease is concentrated, as in cases where both parents are syphilitic, the foetus will be at- tacked by the disease in the uterus, and as a result abor- tion will occur more or less early in the pregnancy. "Very early syphilis is usually accompanied by emacia- tion, eruptions of bullae, particularly upon the palms of the hands and the soles of the feet, and an extreme degree of coryza, cracked and ulcerated lips, and evidences of visceral and bone disease. In the older cases there may be no interference with nutrition, and one or two mucous patches may be the only active evidence of infection." (Jewett's Practice of Obstetrics.) 2H. Name the diseases of 'the foetus and its membranes in utero. (January, 189 4.) 214. Inflammation of the decidual tissues: — acute de- cidual endometritis; chronic decidual endometritis: — (a) chronic diffuse; ib) chronic polypoid; (c) catarrhal. Hy- drorrhoea gravidarum. Atrophy of decidua; deficiency of amniotic fluid; hydramnios; hydatid mole; infarcts of 41 OBSTETRICS. placenta; calcareous degeneration of placenta; fatty degen- eration of placenta; tumors of placenta; cysts of placenta; placentitis; syphilis of placenta; malnutrition; errors of development. (From Jewett's Practice of Obstetrics.) 215. What is meant by the term hydatid pregnancy? {January, 1895.) 216. What are uterine hydatids? What are their source and treatment? {May, 1893.) 217. What are uterine hydatids? Give their source and treatment. {June, 1894.) 218. Give a -pathological description of so-called hydatidi- form pregnancy with its diagnosis and treatment. {April, 1898.) 219. Give the pathology, diagnosis, and treatment of so- called hydatidiform pregnancy. {September, 1897.) 215 to 219. King's Manual of Obstetrics, pages 196 to 199. 220. (a) Mention the signs of probable fcetal death in utero. {June, 1902.) 221. (a) Give the symptoms which indicate the probable death of the foetus in utero. {April, 1899.) 222. (a) What symptoms would indicate the probable death of the foetus in utero? {June, 1896.) 223. (a) Hoio ivoidd yon diagnose the death of the foetus in utero? {May, 1893.) 224 (a) What signs would indicate death of the foetus prior to labor, and (b) what should be done in such a condition. {November, 1891.) 225 (a) Hoio may death of the foetus be recognized in utero after the period of viability? (b) What should be done in such cases? {September, 1897.) 226. (a) State diagnostic symptoms of a dead foetus in utero and (b) give the mangement of such a condition. {June, 1898.) 220 to 226. (a) King's Manual of Obstetrics, page 175; and 427 and 428; (b) pages 176 and 428. nr^ ly^, jL^'w 42 OBSTETRICS. IX. ABORTION AND PREMATURE LABOR. 227. Differentiate the terms abortion, miscarriage, and pre- mature labor, applying them to the three trimesters of preg- nancy. {September, 1898.) 227. King's Manual of Obstetrics, page 171. 228 (a) State the principal causes of abortion due to general maternal conditions. {June, 1898.) 229. (a) What are the causes of premature labor and (b) what symptoms presage itf {November, 1892.) 230. (a) What are the causes of premature labor? (b) What symptoms presage it? {November, 189 4.) 231. (b) What are the premonitory symptoms of abortion? {January, 1892.) 232. (c) What are the symptoms of an inevitable abortion? {April, 1896.) 233. (b) How may threatened abortion be recognized, and (d) lohat should be done toward its prevention? {May, 1902.) 234-. (a) State the principal causes of premature labor {after the thirtieth loeek) . (b) What symptoms presage it, and (d) , (e) how should it be managed? {April, 1897.) 235. (d) What means should be employed to prevent threat- ened abortion during the first three months of pregnancy? {January, 1897.) 236. (d) How may threatened abortion {foetus non-viable) be prevented? (e) How should inevitable abortion be man- aged? {January, 1901.) 237. (e) What is the proper management of inevitable abor- tion? {September, 1896.) 238. (e) What is the proper management of non-preventable abortion? {January, 1900.) 239. (e) State the proper management of so-called non- preventable abortion. {June, 1900.) 2Ifi. (f) What is abortion and what is its managernent, both (d) preventive and (e) curative? {July, 1893.) 241. Give the (f) definition, (a) causes, (b) diagnosis, and r> r / / - • / / .^.^ U/J V 43 OBSTETRICS. (d), (e) indications for treatment of abortion. (September, 1893.) 2Jf2. (e) How would you manage a case of premature labor? {January, 1894.) 243. (e) How would you treat a case of premature labor? {September, 1892.) 244- (g) Describe the symptoms and (h) gvoe the management of an incomplete abortion. {June, 1896.) 245. (h) Give the treatment of retained placenta after abor- tion. {April, 1898.) 228 to 245. (a) King's Manual of Obstetrics, page 172; (b) page 173; (c) page 174; (d) page 176; (e) page 177, also page 182; (f) page 171; (g) page 174; (h) page 180. 246. What are the immediate dangers of abortion? {March, 1892.) 246. Hemorrhage, sepsis or sapr^emia, and subinvolution. X. ECTOPIC GESTATION. 247. (a) Give the causes and (b) classification of ectopic pregnancy. (May, 1895.) 248. (b) What are the varieties of extra-uterine pregnancy? (January, 1892.) 249. (h) What are the varieties of extra-uterine pregnancy? (April, 1893.) 250. (b) What are the varieties of extra-uterine pregnancy? (May, 1898.) 251 . (c) Define ectopic gestation, (b) Mention the varieties and (e), (h) give the management of ectopic gestation. (Sep- tember, 1902.) 252. (c) Define ectopic gestation, giving its fd) symptoms and (e), (h) management. (September, 1898.) 253. (c) Define ectopic pregnancy, (d) JVhat are its symp- to7ns and (a) how does it occur? (June, 1898.) 254. (d) What are the symptoms of extra-uterine gestation? (March, 1892.) 44 OBSTETRICS. 255. (c) De-fine and (h), classify ectopic pregnancy, (e), (h) Give its treatment. (June, 1896.) 256. How icould you (d) diagnose and (e), (h) treat a case of extra-uterine pregnancy? {June, 1893.) 257. Give the (d) symptoms, diagnosis, and (e), (h) treat- ment, according to coriditions, of ectopic pregnancy. (Sep- tember, 1893.) 258. (c) What is ectopic pregnancy? (f) Mention the dangers of ectopic pregnancy, and {e), (h) state how it should he treated. {June, 1901.) 259. (c) Define ectopic pregnancy, (g) Give symptoms of rupture at or before the fourteenth week, and (h) state management in case of such an accident. {April, 1897.) 260. (c) Define ectopic pregnancy, (g) Give the symp- toms of rupture at or before the fourteenth week, and (h) state the proper mcmagement of such a condition. {May, 1899.) 261. (c) Define ectopic pregnancy, (g) give the symptoms of rupture, and (h) describe the proper procedure when this condition exists. {September, 1900.) 262. (g) What are the symptoms of rupture in ectopic pregnancy? (h) What shoidd be done when such rupture occurs? {January, 1897.) 263. State the (d) diagnosis, symptoms, and (e), (h) treat- ment of tubal pregnancy. {January, 1895.) 264. (f) What are some of the possible terminations of a tubal pregnancy? {January, 1893.) 247 to 264. (a) King's Manual of Obstetrics, page 183; (b) page 182; (c) page 182; (d) pages 184, 189 and 193; (e) page 186; (f) pages 183 and 184; (g) page 185; (h) pages 186 and 187. XI. LABOR: CLINICAL COUBSE, MECHANISM, AND MANAGEMENT. .265. Describe the causes of normal labor. {January, 1893.) 265. King'sManualof Obstetrics, page 205; add : "Loosen- ing attachment of the ovum. The decidua vera is divided 45 OBSTETRICS. into two parts. One part consists of an outer, dense, mem- branous layer of large cells resembling pavement epithe- lium; the other part, of a layer of much looser texture in which are found the large decidual glands. It is in this spongy layer that the separation of the decidua takes place. In this layer the trabecule enclosing the spaces of the network have been observed to decrease in size from 5^ inch to YoVo hich. The layer seems to shrivel and thus to permit easj^ separation. The occurrence of hemor- rhage . . . also tends to detach the ovum from the walls of the uterus and may act to intensify the pains already established. This separation of the decidua from the uterine wall makes the ovum in part a foreign body, and this explains the continuance of the expulsive efforts/^ Also excess of carbon dioxide in the blood, distention of the uterus hy the growing ovum, and mental impressions. (Jewett's Practice of Obstetrics.) 266. Describe the propelling forces in labor. {June, 1896.) 267. Describe the jnechanism of expulsion in natural labor. {January, 1896.) 266 and 267. King's Manual of Obstetrics, page 205. 268. What are the uses of the liquor amnii? {January, 1892.) 269. What is the character of the liquor amnii, and what are its uses? {November, 1894-.) 270. Name the functions, character, and relative quantity and sources of the liquor amnii. {April, 1894.) 271. What is the liquor amnii? Give its functions in pregnancy and during labor. {April, 1899.) 268 to 271. King's Manual of Obstetrics, page 206. 'The liquor amnii is a clear, serous fluid, secreted within the amniotic membrane, specific gravit}^ 1007 to 1028, an alkahne reaction, and a composition including fixed solids, epithelial scales, lanugo, and other matters derived from the foetus, besides water. It amounts to about onejor two 46 OBSTETRICS. pints at term^ and is probably largely derived by trans- udation from the maternal structures." (Jewett's Practice of Obstetrics.) 272. What are the precursory symptoms of labor? (March, 1892.) 273. What symptoms precede the beginning of labor? {April, 1895.) 272 and 273. King's Manual of Obstetrics, pages 207 and 208. 27 Jf.. How can you distinguish false from true labor pains? {January, 1893.) 275. What is the diagnosis of false from true labor pains? {July, 1893.) 274 and 275. King's Manual of Obstetrics, pages 228 and 206. 276. (a) Into how many stages is labor divided? {March, 1893.) 277. (a) Into what stages is labor divided, and where do these stages begin and end? {April, 1893.) 278. (a) Mention the several stages of labor, and give the phenomenon marking the end of each. {June, 1902.) 279. (a) Into how many stages is labor divided? (b) What are the phenomena of each stage? {September, 1894.) 280. (c) Define and describe the management of the first stage of labor. {April, 1895.) 281 . (b) Give a brief description of the three stages of labor. {June, 1893.) 282. (b) Mention in consecutive order the essential phe- nomena of normal labor. {September, 1899.) 283. (b) Mention in order the essential phenomena of normcd labor. (June, 1900.) 284. State the (e) divisions, (d) prodromata, (a) stages, and (f) periods of labor. {September, 1893.) 276 to 284. (a) King's Manual of Obstetrics, page 207; (b) pages 210, 211, and 212; fc) pages 215 to 230; (d) pages 207 and 208; (e) True and false, (f) First stage: ten to 47 OBSTETRICS. fourteen hours in primiparse; six to eight hours in multiparse. Second stage: two hours in priniipar^e; one hour in mul- tiparse. Third stage : twent}^ minutes (average) . (Jewett's Practice of Obstetrics.) 285. State the causes of the dilatation of the os and cervix uteri as related to labor. (January, 1894.) 285. King's Manual of Obstetrics, page 206. "In the dilatation of the cervix three agencies are concerned: (1) Softening of the cervical tissues; (2) the hydrostatic press- ure of the bag of waters; (3) the contraction of the longi- tudinal fibres of the upper uterine segment." (Jewett's Practice of Obstetrics.) 286. Give the character, situation, and cause of the pains during the first and second stages of labor. {May, 1893.) 286. Kmg's Manual of Obstetrics, pages 210, 21 1 and 212. 287. (a) What ^preliminary preparations would you suggest for a case of labor? {November, 1894.) 288. (a) Give briefly some essential general preparations for labor at term. {May, 1902.) 289. (b) Give full details of how a labor should be inanaged antiseptically . {May, 1901.) 290. (b) What antiseptic precautions should be employed in the conduct of labor, and liow should they be applied? {January, 1902.) 291. Describe the preparation of (c) the bed, (d) the ivoman, (e) the physician, and (f ) the nurse for a case of labor. {April, 1896.) . 292. (i) Describe the duties of the accoucheur during normal labor. {September, 1892.) 293. (g) Describe the course of a normal labor and (i) the duties of the accoucheur during such a labor. {April, 189^.) 29 Jf.. (h) How should the first examination be made at the bedside of a woman in labor? {April, 1895.) 295. (i) Describe the conduct of a normal labor in its several stages. {June, 1895.) 48 OBSTETRICS. 287 to 295. (a) King's Manual of Obstetrics, pages 214 to 218; (b) pages 215 to 217, and 539 and 540; (c) page 217; (d) page 216; (e) page 216; (f) '^The nurse must be no less careful in all particulars than the doctor is required to be in the observance of antiseptic details. Her clothing must be scrupulously clean, and she should wear wash- dresses. As an extra precaution she must refrain from attendance on obstetric patients for a week or more after a septic exposure. During that time her hands and fore- arms are to be sterilized repeatedly, and she should take two or three full baths, with special pains to cleanse the hair. In all cases the nurse makes an entire change on taking charge of a patient in labor.'' (Jewett's Practice of Obstetrics.) And see (e). (g) King's Manual of Obstetrics, pages 207 to 213; (h) pages 218 to 227; (i) pages 214 to 242. 296. Give the managertient of the second stage of labor. (April, 1896.) 297. State how the second stage of labor should be managed. (January, 1895.) 298. Define and describe the management of the second stage of labor. (September, 1896.) 296 to 298. King's Manual of Obstetrics, pages 230 (last line) to 235. 299. (a) What is the perineum? (b) How is it endangered in labor, and (c) how should it be protected? (November, 1894). 300. (b) How is the perineum endangered in labor? (N'o- vemher, 1891.) 301. (c) Describe the management of the perineum after the head has descended on it. (May, 1896.) 302. (b) How is the perineum endangered in labor? (c) How should it be guarded? (May, 1897.) 303. (c) HoiD is the perineum best j^rotected during labor? (September, 1892.) 49 OBSTETRICS. 304. (c) Give the 'prevention and (d) treatment of rupture of the perineum. {January, 1902.) 305. (c) Give directions for the protection of the perineum during labor, (d) State what shoidd he done in case of laceration of the perineum. {June, 1897.) 306. (b) Hoio may the perineum become jeopardized in labor f (c) How shoidd it be guarded to prevent rupture? (d) What should be done in case it is torn? {June, 1899.) 307. (b) What conditions serve to jeopardize the perineum in labor? (c) Stcde how the perineum should be guarded, and (d) hoio it should be treated if lacerated? {September, 1898.) 308. (c) What precautions shoidd be observed to prevent laceration of the perineum? (d) If the latter he torn, when and how should it be trecded? {September, 1896.) 309. (c) How shoidd the perineum he guarded in labor, and (d) if lacerated how should it he trecded? {July, 1893.) 310. (d) When and how is the perineum best restored when injured during labor? {June, 1892.) 311. (d) Describe the proper management of a torn peri- neum. . {April, 1896.) 312. (d) Describe the operation for immediate repair of a lacerated perineum. {September, 1896.) 313. (c) How should the second stage of labor he conducted in view of preventing rupture of the perineum? (d) What should he done in case of such a rupture? {January, 1901.) 314. How should lacerations of the (e) uterus and (d) perineum occurring during labor he treated? {April, 1894.) 299 to 314. (a) King's Manual of Obstetrics, pages 32 to 34. Obstetrically speaking, it is the structure situated between the vagina and the rectum; (b) King's Manual of Obstetrics, page 230, last line; (c) pages 230 to 235; (d) pages 475 and 476; (e) pages 470, 472 and 473. 31-5. (a) What is the management of the third stage of labor? {May, 1893.) 316. (a) . Describe the proper management of the third stage of labor. {January, 1899.) 50 OBSTETRICS, 317. (a) Describe the proper management of the third stage of labor. (January, 1900.) 318. (a) Describe the delivery of the placenta after the method of Crede. (January, 1897.) 319. (b) Define the third stage of labor, and (a) state how it should be managed. (May,- 1896.) 320. (a) Describe the proper method of delivering 'the placenta after labor at term. (September, 1899.) 321. (a) Describe in detail the Crede method of delivering the placenta. (January, 1902.) 322. (a) Relate the details of Crede' s method of expression of the placenta. (January, 1896.) 323. (c) Give the causes of separation of the placenta, (d) State how the placenta normally presents at the os uteri, (a) Describe the treatment. (June, 1894.) 324. (a), (e) Describe the methods of removing the placenta and ivhen they are appropriate. (November, 1891.) 325. (a), (e) Describe the methods of removing the placenta and state when each method is appropriate. (June, 1893.) 326. What are the dangers of traction (f) on the child, and (g) on the placenta? (January, 1895.) 315 to 326. (a) King's Manual of Obstetrics, pages 237 (last line) et seq.; (b) page 207; (c) "After expulsion of the child the uterus grows smaller by retraction and closes about the placenta. TMien active contractions are again resumed the placenta is gradually detached. As the seat of placental attachment shrinks during a uterine contrac- tion, the placenta not being sufhciently retractile to accom- modate itself fully to the diminished area of the placental site, it is partially torn from the uterine wall with each pain. Rarely it may happen that the placenta is wholly separated by the first strong contraction. The placenta will then probably be forced out, folded on itself from side to side, presenting by its edge. If the placenta is not wholh^ detached at first expulsive efforts a different mechanism may obtain. Detachment sometimes takes place first 51 OBSTETRICS. over the central portion of the placental seat. Then, as the uterus. relaxes, a retroplacental blood clot is formed. With each succeeding contraction the area of detachment is increased, and the clot grows accordingly. The liberated portion of the placenta is thus thrust downward toward the cervical opening and the after-birth is expelled flatwise by its amniotic surface. When it is extruded, with its edge presenting, the grasp of the uterus acts directly upon the placenta. When it is dissected off by the blood clot its expulsion is partly due to the extruding force propagated through the retroplacental blood clot during the uterine contractions. The membranes are last to be detached. In either method of expulsion the placenta is thrust downward through the rent in the memibranes and the latter are peeled off by traction of the placenta." (Jewett^s Practice of Obstetrics.) See also above, under A. 265. (cl) King's Manual of Obstetrics, page 240; (e) pages 460 to 462; (f) page 343; (g) page 240, last two lines. 327. (a) When and how should the cord be tied? {Jan- uary, 1894.) 328. What is the ^proper management of the (a) cord and (b) umbilicus in the newborn? {January, 1896.) 329. (c) How is the umbilical cord formed? (d) Mention its anatomical characteristics, and (a) state how it should be ligated. {May, 1899.) 330. (c) Describe the formation of the umbilical cord, (d) state its co7istituents at term, and (a) describe its proper ligation. {September, 1901.) 331. Give the (c) formation and (d) anatomical character- istics of the umbilical cord, and (a) describe its proper ligation. {September, 1900.) 332. (a) What general rule should denote when the umbilical cord should be tied? Describe the method of ligation. {Jan- uary, 1895.) 333. (a) How soon after the birth of the child shoidd the umbilical cord be ligated? Describe your method of procedure. {January, 1892.) 52 OBSTETRICS. 334. Describe the (e) early important attention to the new- horn, (a) including the ligation of the cord. {May, 1900.) 335. (a) Describe the "proper ligature of the umbilical cord, and in this connection (e) state what important attention should he given to the newborn. (September, 1899.) 336. Describe the (a) ligation of the umbilical cord and (e) the first attention to the neioborn. (May, 1898.) 337. Describe (e) the early important attention to the new- born, (a) including the ligation of the cord. (June, 1902.) 327 to 337. (a) King's Manual of Obstetrics, page 236; (b) pages 244 and 237; (c) page 100, also 85 et seq.; (d) page 100; (e) pages 235 to 237. 338. Asepsis and antisepsis, how applied in midwifery? (a) as regards the accoucheur; (b) as regards the parturient; (c) as regards the child. (June, 1892.) 339. (a), (b), (c) Give a resume of obstetrical asepsis and antisepsis, (d) differentiating the terms. (June, 1895.) 340. (d) Define the terms asepsis, antisepsis, (a), (b), (c) Give their proper application in the lying-in chamber. (May, 1896.) 341 ' (a), (b), (c) How shoidd asepsis and antisepsis he applied in obstetrical practice? (September, 1898.) 342. (d) Define the terms asepsis, antisepsis, (b) State the application of each to the parturient. (April, 1897.) 343. (d) Define the terms asepsis and antisepsis, and differentiate the terms, (a), (b), (c) State the obstetrical appli- cation of each. (January, 1899.) 344- (a), (b) State how the conditions of asepsis and anti- sepsis should be maintained during labor. (June, 1902.) 345. (a), (b) Give a summary of antiseptic measures to be employed in the care of a case of labor. (June, 189 4-) 338 to 345. (a) King's Manual of Obstetrics, pages 215 and 216; (b) pages 215 and 216; (c) pages 235 and 256, last three lines of chapter, (d) Asepsis: Absence of patho- genic micro-organisms. Antisepsis: Destruction of patho- genic micro-organisms. As usuall}^ applied, the term 53 OBSTETRICS. means the use of vigorous measures for destroying micro- organisms or inhibiting their growth after they have secured lodgement. 346. (a) Discuss the obstetrical use of ancesthetics . (April, 1895.) 347. (a) What are the indications for ancesthesia in labor? (January, 1892.) 348. (a) State the principles that should govern the employ- ment of ancesthetics during labor. (January, 1898.) 349. (a) Under lohat conditions is obstetrical ancesthesia to be employed? (b) How should ancesthetics be adminis- tered? (May, 1900.) 360. Describe (a) the important obstetrical uses of ances- thetics, (b) methods of administering them. (January, 1897.) 351. (a) Under what conditions, and (b) in lohat manner may ancesthetics be employed in labor? (September, 1899.) 352. Give (a) indications, (c) contraindications, and (b) essential methods for the employment of ancesthetics in labor. (May, 1897.) 353. (a), (b), (c) Give rules for administering ancesthetics in labor, stating when they are indicated. (May, 1896.) 354. (a) Give the indications for the use of ancesthetics in labor; (d) name their effects on uterine contraction, and (e) on the duration of labor. (June, 1894.) 355. (a) Whe7i and (b) hoio should chloroform be adminis- tered during labor? (September, 1894.) 356. (a) When and (b) how should chloroform be given during labor? (April, 1896.) 357. State the effects of ancesthetics on the (f) os uteri, (f) cervix uteri, (g) abdominal muscles, (h) perineum, and (i) child. (November, 1894.) 358. (c) What conditions may arise during labor that would contraindicate the administration of a general ances- thetic? (May, 1901.) 359. (c) What would contraindicate the use of ancesthetics inlabor? (May, 1893.) 54 OBSTETRICS. 346 to 359. (a) King's Manual of Obstetrics, pages 521 to 525; (b) page 523. (c) ''In the presence of bronchitis, ether is unsuitable, owing to its irritant effect on the respiratory mucous membranes. In atheromatous disease it is dangerous, since it increases the vascular tension. Chloroform is to be preferred in eclampsia and in tetanic contraction of the uterus. . . . The presence of cardiac disease does not necessarily forbid the use of anaesthetics, . . . yet a weak heart calls for special caution in the use of these agents." (Jewett's Practice of Obstetrics.) King's Manual of Obstetrics, pages 522 and 523. (d) ' ' When pushed beyond the stage of mere analgesia, they lessen the strength and frequency of the uterine contrac- tions." (Jew^ett's Practice of Obstetrics.) (e) Generally their employment lengthens the duration of labor; but in nervous and apprehensive patients, when used in moder- ation, they often shorten labor by blunting the acuteness of the suffering, removing its inhibitory action on the accessory forces exerted by the diaphragm and abdominal muscles, (f) Promotes relaxation and dilatation, (g) If carried to surgical degree, anaesthetics abolish their func- tions; in minor degrees, see (e) above, (h) Same as (f), (i) Predisposes to asphyxia neonatorum. XII. MANAGEMENT OF MOTHER AND CHILD. 360. Give some general directions for the care of the patient at the close of labor. {September, 1902.) 360. King's Manual of Obstetrics, pages 244 et seq. 361. What 'principal dangers may arise after complete delivery, and hoio should they be guarded against? {May, 1898.) 361. Hemorrhage and sepsis. King's Manual of Ob- stetrics, pages 241 to 243 and 450 to 460; and see Q. 338 to 345. 55 OBSTETRICS. 362. What attention to the bladder of the mother is re- quired (a) during and (b) after labor? {January, 1892.) 363. (b) What general directions shoidd be observed in passing the catheter on a "patient during the puerperal state? {May, 1895.) 362 and 363. (a) King's Manual of Obstetrics, page 230; (b) page 248. 36Jf.. What are the after-pains? State their cause, and give the treatment. {March, 1893.) 365. What are the ^^ after-pains,^^ and how should they he treated? {May, 1894.) 364 and 365. King's Manual of Obstetrics, page 247. 366. (a) What is the puerperal state? (b) Describe the changes of the uterus during it. {May, 1894.) 367. (b) What changes occur in the uterine organs of a healthy woman after parturition? {June, 1896.) 368. (b) What is involution? (c) Hoio long a time is usually required for this process, and (d) ivhat causes may operate to delay or prevent it? {July, 1893.) 369. Define (b) involution, (e) subinvolution, (f) Hoiv may involution be promoted? {January, 1897.) 370. (e) What is meant by subinvolution of the uterus? (d) What are its causes? (f) Give the treatment for it. {March, 1893.) 371. (e) Define subinvolution of the uterus, and state its (g) effects, (g) results, and (f) treatment. {May, 1901.) 366 to 371. (a) King's Manual of Obstetrics, page 244; (b) page 53; (c) page 53. (d) 1. Absence of normal con- tractions; 2. mild infection of endometrium, (e) Subinvolu- tion = tardy or imperfect involution, (f) 1. Hot vaginal douches; 2. massage and friction of fmidus; 3. small doses of ergot, (g) Chronic parenchymatous metritis; chronic endometritis; displacements and flexions of uterus; pro- lapse of uterus; sterilit}^ 372. What instructions shoidd be given a primipara in regard to lactation? {January, 1895.) 56 OBSTETRICS, 372. King's Manual of Obstetrics, page 252. 373. What is the treatment of galactorrhoeaf {September, 1896.) 373. King's Manual of Obstetrics, page 251. 37 Jf.. Give the management in a case of (a) fiat or inverted nipples, (b) cracked nipples. (May, 1901.) 375. (b) What hygienic precautions are necessary for a nursing child if the mother has sore nipples? {November, 1894.) 374 and 375. (a) King's Manual of Obstetrics, page 250; (b);page 249. 376. (a) Describe the mammary glands and (b) the changes they undergo in pregnancy, (c) When the child is stillborn what care shotdd be taken of the mother^ s breasts? {April, 1898.) 376. (a) King's Manual of Obstetrics, pages 63 to65; (b) page 117; (c) page 251. 377. What care does the mother require after labor? {No- vember, 1891.) 377. King's Manual of Obstetrics, pages 246 to 249. 378. Give (a) the hygiene and (b) the pathology of preg- nancy, and (c) the first care of the newborn. (September, 1897.) 379. (c) Give details of the first care of the infant. (Sep- Umber, 1893.) 378 and 379. (a) See above, Q. 182 to 184, (c); (b) See above, Q. 182 to 184, (d) ; (c) King's Manual of Obstetrics, pages 236, 243 and 252. 380. What is premature respiration? (September, 1895.) 380. Attempts on the part of the child at respiration before the mouth and nose have passed the vaginal outlet. 381. (a) What are the causes of stillbirth, and (b) hoiu should a stillborn child be treated? (November, 1894.) 57 OBSTETRICS. 382. Give the (a) cause mid (b) treatment of foetal asphyxia. (April, 1894.) 383. Give the (a) causes, (c) symjptovis, and (b) treatment of asphyxia of the newborn. {November, 1891.) 384' (b) Give the methods of treatment for the resuscitation of an asphyxiated newborn infant. {January, 1902.) 385. (b) Describe a method of resuscitation of the new- born. {November, 1893.) 386. (b) Describe the methods of performing artificial respiration in the newborn. {July, 1893.) 387. (b) Hoiv would you attempt to resuscitate a stillborn child? {January, 1893.) 388. (b) What methods of resuscitation are available in the apparently stillborn? {September, 1895.) 389. (b) Describe the methods of resuscitation in the appar- ently stillborn. {January, 1898.) 390. (b) State hoiv the apparently stillborn should be managed with reference to resuscitation. {June, 1897.) 381 to 390. (a) King's Manual of Obstetrics, page 577; (b) pages 579 to 584; (c) page 578. 391. (a) To what diseases are the eyes of the newborn most liable? What are the (b) causes and (c) treatment of these diseases? {May, 1893.) 392. (b) What causes disease of the eyes of the newborn, and (c) what is the proper treatment? {May, 1894.) 393. State the (b) causes, (cl) prognosis, (e) prevejition, and (c) treatment of ophthalmia neonatorum. {April, 1898.) 394. How may ophthalmia neonatorum be (f) recognized, (e) prevented, (c) treated? {May, 1899.) 395. (e) What measures should be employed to prevent ophthalmia neonatorum? {May, 1896.) 396. State the (f) symptoms and (c) management of ophthcdmia neonatorum. {June, 1900.) 397. (e) Whcd means shoidd be taken to jDrevent ophthcdmia neonatorum? (c) Give the treatment of ophthalmia neona- torum. {January, 1902.) 58 OBSTETRICS, 398. Give the (f) symptoins, (c) treatment, and (d) j)rog- nosis of ojjhthahnia neonatorum. {May, 1895.) 399. Give the (f) symptoms, (c) treatment, and (d) prog- nosis of ophthalmia neonatorum. State its (b) causes and (e) the means of prevention. {April, 1897.) 391 to 399. (a) 1. Catarrhal conjunctivitis; 2. ophthalmia neonatorum; 3. dacryocystitis, (b) King's Manual of Ob- stetrics, page 255; (c) page 255. (d) 'T'nless the inflam- mation quickly subsides, the eye is irreparably damaged by ulceration and partial destruction of the cornea." (Jewett's Practice of Obstetrics.) King's Manual of Ob- stetrics, page 255; (e) page 256, last three lines of chapter; (f) page 255. 4-00. Discuss umbilical hemorrhage. {May, 1895.) Jfll. How would you treat hemorrhage of the umbilical cord? {May, 1893.) 400 and 401. King's Manual of Obstetrics, page 255. If end of cord is bleeding, simply re-tie with aseptic ligature. 4-02. Describe your method of artificial feeding when the mother cannot nurse the newly-born child. {January, 1894.) 403. Describe the immediate care of the newborn child when for any reason the mother cannot nurse it. Give rules for artificial feeding. {June, 1897.) 402 and 403. King's Manual of Obstetrics, pages 251 and 252. 404. (a) Define caput succedaneum. (b) Staie how it is produced and give its significance. {April, 1898.) 405. (b) Give the formation of the caput succedaneum. (c) Where does the caput succedaneum appear in the third position? {April, 1899.) 404 and 405. (a) ''An ceclematous swelling which is developed on the presenting part in the course of birth." (Jewett's Practice of Obstetrics.) (b) ''Dm'uig a uterine contraction all parts of the foetal mass are rmder pressure except that which offers to the examining finger "uithin 59 OBSTETRICS. the girdle of resistance. The vessels of the presenting part become engorged during the pains and a serous exudate takes place into the cellular tissues of that portion of the foetal surface." ''The location of the caput succe- daneum is of interest in the examination of the head after delivery as indicating the position in which the head had descended. In anterior positions it is situated at the pos- terior, and in posterior positions on the anterior aspect of the summit of the head. In left positions it occurs to the right, and in right positions to the left of the median line." (Jewett's Practice of Obstetrics.) (c) King gives the third position as R. 0. A., in which case the caput succedaneum will be found on the posterior part of the left parietal region. Jewett gives the third position as R. 0. P., in which case it will be found on the anterior part of the left parietal region. 406. Describe the care of an infant during the first twenty- four hours after birth. {September, 1895.) 406. King's Manual of Obstetrics, pages 243 and 252 et seq. 407. How would you decide whether a dead infant had been born alive? {March, 1893.) 408. If called to a dead and newly-born infant, how could you prove that it was living when born? {June, 1893.) 407 and 408. King's Manual of Obstetrics, pages 599 to 601. XIII. MECHANISM IN VERTEX PRESENTATIONS. 409. Define and differentiate (a) position, (b) presenta- tion, (c) rotation. {September, 1898.) 410. Differentiate the following: (a) position, (b) presen- tation, (c) rotation. {September, 1897.) 411. Differentiate the terms (a) position, (b) presentation, and (c) rotation. {September, 1896.) 412. Define the folloioing terms: (a) position, (b) presen- tation, (d) version, (c) rotation. {April, 1896.) 4 I l^ 'S d^ >■; ■^T J^ h.."^"' frt' ^■t.^ i^t'-* t /.*•' %!«''**^ /i 60 OBSTETRICS. 409 to 412. (a) King's Manual of Obstetrics, pages 258 and 609; (b) page 608; Jewett defines presentation ''as the relation of the long axis of the foetal ovoid to the uterine axis ;'' or ''the part of the foetus which presents at the pelvic brim.'' (c) King's Manual of Obstetrics, page 262; (d) page 347. Jf-lS. How many ^presentations of the foetus are given? {March, 1892.) 41 Jj.. How many different presentations are liable to he met with in obstetrical practice? What are they? (Sep- tember, 1895.) 413 and 414. King's Manual of Obstetrics, page 256. 415. What are (a) the positions and (b) attitudes of the foetus in utero, and what are their causes? (April, 1893.) 415. (a) King's Manual of Obstetrics, pages 257, 274, 286 and 311; (b) pages 256 and 258. ''The foetal posture is the result partly of the primitive form of the embryo, mainly of the uterine pressure forces." (Jewett's Practice of Obstetrics). 416. How many positions of the vertex are there? Name and describe each. (September, 1894.) 416. King's Manual of Obstetrics, pages 258 and 259. 417. Give the usual (a) vertex, (h) face, and (c) breech presentations. (May, 1895.) 418. (a) Give the normal vertex presentations in the order of their frequency. (September, 1896.) 419. (a) Describe the varieties of vertex presentation. (June, 1896.) 420. (d) How is a vertex presentation recognized by pcdpa- tion? (September, 1895.) 421 (d) Labor having begun, how by abdominal palpation could a vertex presentation be recognized? (April, 1899.) 422. (a), (b) Name and describe the various forms of head presentation with (e) the management appropriate to each. (June, 1894.) 61 OBSTETRICS. 423. (f) Give the causes of cephalic j/resentation, and state why favorable. {January, 1894.) 4^4- (g) Name the fundamental presentations in labor, and (h) give the methods of their diagnosis. (November, 1893.) 425. (i) Describe the mechanism of labor in the first, or left occipito-anterior presentation. (January, 1898.) 426. (j) On ivhat signs may a diagnosis of occipito^ posterior position be based? {June, 1901.) 427 . (h) Row would you know a head presentation? How a breech presentation? How a transverse presentation? (April, 1894.) 428. (i) Give the mechanism of labor in the first position (L. 0. A.). (January, 1899.) 429. {']) How woidd you diagnose, arid (e) manage a case of occipito-posterior presentation? (September, 1892.) 417 to 429. (a) King's Manual of Obstetrics, pages 257 to 259; (b) pages 273 to 275; (c) pages 287 and 288; (d) pages 219, 269 and 270; (e) pages 270 to 272 and 282 et seq. (f) ^'The preponderance of vertex presentations is clue mainly to adaptation of the foetal ovoid to the shape of the uterus, and in some degree to gravity, the cephalic being the heavier extremity of the foetus.'' (Jewett's Prac- tice of Obstetrics.) (g), (h) Head, see (d) above. Breech, King's Manual of Obstetrics, page 295. Transverse, page 317. (i) pages 259 et seq. (j) page 269. XIV. MECHANISM IN FACE PRESENTATIONS. 430. Give the (a) frequency, (b) causes, (c), (d) diagnosis, (e) mechanism, and (f) treatment of face presentation. (No- vember, 1894') 43 L (g) Mention the varieties of face presentation. State the (h) prognosis and (f) treatment of each variety. (Jan- uary, 1902.) 432. Give the diagnosis of face presentation fc) before rupture, fd) after rupture of the membranes. (April, 1899.) f si^A^^"^' A |/>|/ / 0> r-! P M/ \A> 62 OBSTETRICS. 433. (e) Give the mechanism of a face ^presentation. (May^ 1894.) 434. Give the (c), (d) diagnosis and (f) management of a face presentation. (November, 1891.) 435. (g) Describe face presentation, its (c), (cl) diagnosis and (f) management. {January, 189 4-) 436. State how a face presentation may be (c), (d) recog- nized and (f) rectified. (September, 1898.) 437. State hoiv a face presentation may be (c), (d) recog- nized and (f) managed. [January, 1900.) 438. (f) How may face presentation be converted into vertex presentation? (January, 1896.) 439. (f) Hoio shoidd labor be conducted in a face presen- tation? {January, 1901.) 430 to 439. (a) King's Manual of Obstetrics, page 276; (b) page 273; (c), (d) page 281; (e) pages 276 to 279; (f) pages 282 and 283; (g) page 273; (h) page 282. 440. Describe the difficulties which arise during labor from mcdposition of the foetal head. 440. King's Manual of Obstetrics, page 271, under prog- nosis of occipito-posterior positions) also pages 280 and 282. XV. MECHANISM IN BREECH, KNEE, AND FOOT PRESENTATIONS. 441. (a) Describe briefly the usual mechanism of a breech presentation, and (b) state how its dangers are to be avoided. {June, 1902.) 442. (c) Make a diagnosis of breech presentation, and (b) state the principles that shoidd govern its management. {June, 1901.) 443. Give the (d) frequency, (e) causes, (c) diagnosis, (f) prognosis, (b) treatment, and (f ) dangers to the foetus in pelvic presentations. (N'^v^mber, 1893.) 444. How would you (c) diagnose and (b) manage a case of breech presentation? {May, 1893.) /^y^ V ?U«-^. ^v^ ri: ii^ 1 =4-^'" nu-^ s trv-Y'^Ji.- 63 OBSTETRICS. 44^. (a) Describe a case of breech presentation and (b) state how to manage it. {January, 1895.) 446. (c) Diagnose breech presentation, and (b) state how it should be managed. {May, 1896.) 44"^' Give the (c) diagnosis and (b) mano.gement of a case of breech presentation. {May, 1897.) 448- (c) Diagnose and (b) stnte how to conduct a head- last labor. {May, 1896.) 449. (c) Make a diagnosis of an after-coming head, (b) giving in detail its proper management. {September, 1899.) 450. In the case of an after-coming head, ivhat are the (c) symptoms and the (b) 7nanagementf {June, 1898.) 4.51. Describe the (a) mechanism and the (b) management vf the after-coming head. {January, 1897.) 452. (a) Describe the mechanism and (b) give the manage- ment of the after-coming head. {September, 1896.) 453. (a) How may the after-coming head be diagnosed? (b) How should such a condition be managed? {September, 1900.) 454. (g) Describe the managemeftit of an impacted breech presentation. {September, 1895.) 455. (h) How may the knee be distinguished from the elbow when presenting? {June, 1898.) 441 to 455. (a) King's Manual of Obstetrics^ pages 288 et seq.; (b) page 298; (c) page 295; (d) 2 to 4 per cent, of all cases; (e) King's Manual of Obstetrics, page 295; (f) page 298; (g) pages 306 to 309; (h) page 297. 456. (a) What is meconium and (b) what are its diagnostic relations? {November, 1893.) 457. (a) What is meconium and (b) ivhat are its diagnostic relations? {September, 1892.) 456 and 457. (a) ''The. stools of the newborn infant are greenish-black in color, and are termed meconium. Meconium is composed of intestinal mucus, bile, vernix caseosa, epithehal cells, hair, fat, cholesterin crystals, and calcium and magnesium phosphates." (Jewett's Practice 64 OBSTETRICS. of Obstetrics.) (b) Its continuous passage from the vagina of the parturient woman during labor indicates breech presentation. Its discharge in undoubted head or trans- verse presentations is indicative of impending or actual death of the foetus. XVI. MEOHANISM IN TRANSVERSE PRESENTATIONS. 438. (a) How may trunk presentation he recognized and (b) managed? (June, 1899.) 459. (b) State what must he done to accomiplish delivery in a transverse or trunk presentation. {May, 1900.) 460. (a) Make a diagnosis of trunk presentation hefore rupture of the membranes and (b) indicate its management. (April, 1897.) 461 . (a) Diagnose trunk presentation before the jnembranes have ruptured. (May, 1896.) 462. Give the (c) frequency, (d) causes, (e) mechanism, and (b) mayiagement of trunk presentations. (April, 1894.) 463. (b) Hoio is delivery accomplished when the foetus presents transversely? (May, 1898.) 464' (b) How should a hand presentation be managed? (January, 1896.) 465. (a) Make a diagnosis of shoulder presentation, and (b) state how it should be managed. (June, 1897.) 466. (b) Give the management of shoulder presentation after labor has begun. (June, 1896.) 467. How would you (a) diagnose and (b) inanage a case of shoulder presentation? (January, 1893.) 468. How would you (a) diagnose and (b) manage a case of shoulder presentation? (September, 1893.) 469. (f) How should a neglected shoulder presentation be maiiaged? (January, 1902.) 458 to 469. (a) King's Manual of Obstetrics, page 317; (b) pages 320, 312 and 347 et seq.; (c) Once in 250 cases; (d) King's Manual of Obstetrics, page 317; (e) pages 312 et seq., including spontaneous version and evolution; (f) King's Manual of Obstetrics, page 400. 65 OBSTETRICS. XVII. DYSTOCIA. 470. Define (a) eutocia, (b) dystocia, (c), (d) Give an example of each. (September, 1900.) 471. Define (a) eutocia and (b) dystocia, (c), (d) giving examples of each. (September, 1899.) 472. Define the terms (a) eutocia, and (b) dystocia, (d) giving instances of the latter. (September, 1898.) 473. Differentiate (a) eutocia from (b) dystocia, (d) Mention important varieties of the latter and (e) give their management. (January, 1899.) 474' Differentiate (a) eutocia and (b) dystocia^ (d) Mention the important varieties of dystocia. (June, 1897.) 476. (b) Define dystocia and (d) name its more important varieties. {May, 1896.) 476. (b) Define dystocia and (d) name its several forms. (July, 1893.) 477. Give the (b) definition and (cl) principal causes of dystocia. (March, 1892.) 478. (b) Define dystocia and (e) give the management of some of its most important varieties. (September, 1896.) 479. (cl) Give the causes of dystocia in the uterus, vagina, pelvis, and vuha. (November, 1893.) 480. (d) Mention the causes of tedious labor and (e) state the proper methods of correcting it. (May, 1901.) 481. (d) What are the causes of delay in labor on the part of the mother, on the part of the child? (March, 1893.) 482. Stctte the (f) dangers and the (g) symptoms of pro- longed labor. (April, 1895.) 483. (g) What symptoms presage tedious labor, and (e) whcd can be done to accelerate itf (November, 1892.) 484' (d) State the essential causes of delayed labor and (e) show hoiv to overcome them. (May, 1898.) 485. State the (h) causes and (e) management of delayed labor in the first stage. (June, 1899.) 470 to 485. (a) ''The term eutocia is applied to labors which terminate without artificial aid and without injury 66 OBSTETRICS. to mother or child." (Jewett's Practice of Obstetrics.) (b) ^^ Dystocia is the term apphecl to labor which, without artificial assistance, would be difficult or impossible, or would be attended with danger to mother or child." (Jewett's Practice of Obstetrics.) (c) e. g., L. 0. A. position, small or medium-sized child, roomy pelvis, good pains. (d) '^1. Anomalies of the expellent forces: (a) excess; (b) deficiency; (c) spasm and irregularity. 2. Anomalies of the passages: (a) hard parts, pelvic deformities; (b) soft parts: — uterus: developmental anomalies; atresia of cervix; rigidity of cervix; impaction of cervix; malposition; saccu- lation; new-growths; stenosis and rigidity of vulva and vagina; hsematoma vulvae; oedema vulvae; labial abscess and cysts; conditions of intestines; conditions of bladder; tumors and swellings of various tissues. 3. Anomalies of the foetus: malposition of head; occipito-posterior cases; malpresentations, face, brow, pelvic, transverse; prolapse of the limbs; anomalies of foetal development — shortness of cord, unduly ossified skull, large size of foetus, death of foetus, enlargement of head or body by disease; plural births; monstrosities." (Jewett's Practice of Obstetrics.) See also King's Manual of Obstetrics, pages 489 et seq.; (e) pages 495 et seq.; (f) pages 492 and 493; (g) pages 493 and 494; (h) pages 490 and 491; and add premature rupture of membranes. 486. (a) Give the treatment of dystocia from defect of expellent force and (b) name the causes of inefficient pains. {June, 1893.) 487. (a) What medicines can be given a woman in labor to cause contractions of the uterus? {January, 1895.) 488. (a) What tneans are employed to stiniidate iveak and ineffective uterine contractions? {July, 1893.) 489. (c) The uterine contractions being irregular during labor, and the os only slightly dilated, ivhat treatment should be adopted? (May, 1894.) 67 OBSTETRICS. 490. (a) In ante-partum uterine inertia state what should he done to stimulate uterine contractions. {April, 1898.) 491. Give the (cl) diagnosis and (a) treatment of uterine inertia. (September, 1894.) 492. (d) Diagnose uterine inertia and (a) give its treat- ment. {June, 1896.) 493. (b) What are the principal causes of uterine inertia and (a) how should it he treated? {May, 1897.) 494. (b) What are the causes of uterine inertia and (a) how shoidd it he treated? {June, 1895.) 495. (e) What is meant hy inertia of the uterus during lahorf (f) How does it complicate lahor and (a) how should it he treated? {November, 1891.) 496. Mention the (b) causes and (d) symptoms of uterine inertia, and (a) give the details of management in such cases. {January, 1899.) 497. (g) Give the causes of uterine inertia in the second stage. How should such a condition he managed? {Sep- temher, 1900.) 498. (g) Give the causes of delayed lahor in the second stage and state how they shoidd he overcome. {Septemher, 1902.) 499. (h) In a lahor otherwise normal, hut tedious, how soon is it proper to interfere and lohat symptoms woidd prompt such a course? (March, 1892.) 486 to 499. (a) King's Manual of Obstetrics, pages 495 et seq., 525 and 526; (b) pages 490 e^ seq.; (c) page 495; (d) pages 493 and 494. (e) '^ When the uterine action is insuf- ficient to overcome the resistance of the parturient canal the pains are said to be lueak.^' (Jewett's Practice of Ob- stetrics.) This condition is inertia uteri, (f) King's Manual of Obstetrics, page 492; (g) pages 490, 491, and 495 et seq.; (h) pages 493 to 495. 500. Give the diagnosis and treatment of hour-glass con- tractions of the uterus. (January, 1895.) 500. King's Manual of Obstetrics, pages 491, 496 and 460. 68 OBSTETRICS. 501. (a) What is meant by rigidity of the as uteri in labor and (b) what is its management? { September, 1892.) 502. (c) How may a rigid os ideri delaying labor be recog- nized, and (b) icha.t shoidd be done in such a case? (Jan- uary, 1898.) 503. (b) Whcd is the proper management of rigidity of the OS uteri in labor? (April, 1894.) 504. (h) In a case of tedious labor due to undilcded cervix, iQhat shoidd be done? (April, 1896.) 501 to 504. (a), (b) King's Manual of Obstetrics, pages 498 and 499; (c) '^Os is sensitive to the touch and feels to the examining finger like a tensely stretched ring; it may remain for hours michanged, in spite of strong uterine action.'"' (Jewett's Practice of Obstetrics.) 505. ■^( a) Whcd would be the effect of premature rupture of the membranes? {May, 1894.) 506. (a) What is the significance of a premature escape of amniotic fluid? , (b) Stcde the causes. (January, 1897.) 507. (b) What are the causes of premature rupture of the me?nbranes during labor, and fa) how does the accident influence labor? (January, 1893.) 508. (h) What may cause premcdure rupture of the mem- branes? How may this rupture influence (a) the progress and (q) conduct of labor? (June, 1899.) 509. (h) What are the causes of premature rupture of the membranes in labor, and how does this accident influence the (a) course and (o) conduct of labor? (January, 1894.) 510. (b) Mention the causes of premature rupture of the membranes in Ictbor, and .state how this accident may influence the fa) course and (o) conduct of labor. (June, 1897.) 505 to 510. (a) By robbing the uterus of its dilating wedge, it minimizes the effect of the contractions, retard- ing cervical dilatation, predisposing to spasm of the os with secondary uterine inertia and its sequels, or, on the other hand, tojiic contraction of the uterus. Also, by permitting the premature escape of the liciuor amnii, it 69 OBSTETRICS. removes the hydrostatic element from the mechanism of expulsion, and nullifies the action of all but the longi- tudinal muscular fibres of the uterus, (b) 1. Abnoniial thinness. 2. Irregular adhesions to uterine mucosa. 3. Separation of the two laj^ers of membrane, with distention by fluid of the space between. 4. Smallness, irregular shape, or hindered descent of the presentmg part. 5. Excessively strong contractions at the onset of labor. 6. Rough vaginal examinations, (c) King's Manual of Obstetrics, page 499. 511. (a) What obstructions of the soft parts prevent an otherwise normal delivery? {March, 1892.) 512. (b) What forms of tumors may complicate labor, and how? {March, 1892.) 511 and 512. (a) King's Manual of Obstetrics, pages 503 et seq.; (b) pages 507 et seq. 513. What obstructions in the ^yiaternal parts may retard the progress of labor, and what treatment is indicated to over- come each? {May, 1895.) 514. Mention some of the anomalies of the maternal soft structures that may serve to obstruct labor, and state what should be done in each condition inentioned. {September, 1902.) 513 and 514. Kmg's Manual of Obstetrics, page 498 et seq. 515. What are rectocele and cystocele and how do they complicate labor? {January, 1893.) 516. Give a description of cystocele and rectocele. State how each may complicate labor, and what should be done in the arising contingency. {May, 1899.) 517. Give a brief pathological definition of rectocele and cystocele. State Jww they may complicate labor, and lohat shoidd be done in su^h cases. {April, 1898.) 515 to 517. King's Manual of Obstetrics, page 505. 618. What can be done to modify the dangers of labor 70 OBSTETRICS. when complicated by the presence of an ovarian, fibroid^ or polypoid tumor? (jtrne, 1892.) 518. King's Manual of Obstetrics, pages 507 to 511. 519. (a) Give a pathological definition of hydrocephalus. (b) State how it may he diagnosed, and (c) give the com- plications it may cause in the management of labor. {May, 1897.) 520. (a) Define hydrocephalus, (d) State hoiv hydro- cephalus may complicate labor, and (c) lohat should be done in such a case. (January, 1898.) 521. (a) What is hydrocephalus? (b) How ivoidd you diagnose its presence in the foetus, and (c) hoiv does its ex- istence complicate the management of labor? {April, 1893.) 522. (a) What is the pathology of hydrocephalus? How may hydrocephalus be (b) recognized and (c) treated? {June, 1899.) 523. (a) Give the pathology of hydrocephalus. State (b) hoio hydrocephalus may be recognized before delivery, and (c) hoiv such a comjMcation should be dealt with. {Sep- tember, 1900.) 519 to 523. (a) King's Manual of Obstetrics, page 484. Note : The fluid collects principally in the lateral ventricles, (b) Kmg's Manual of Obstetrics, page 485; (c) page 486; (d) page 486 (Prognosis). 524. How may a short funis complicate labor? State how such a condition shoidd be managed. {September, 1902.) 524. King's Manual of Obstetrics, pages 520 and 521. 525. (a) Define multiple pregnancy, (b) Make a diag- nosis of this condition. {May, 1901.) 526. (b) How can the presence of more than one foetus in utero be ascertained before labor has commenced? {April, 1895.) 527. (b) Make a diagnosis of multiple pregnancy at or about the thirty-fifth week as determined by external {non- bimanual) palpation. {April, 1897.) 71 OBSTETRICS. 528. (b) Make a diagnosis of multij)le pregnancy after the thirty-fifth lueek, and (d) state how delivery may he com- plicated thereby. (January, 1898.) 529. (d) What is the ordinary course of twin labor, and what are the difficulties likely to occur? (July, 1893.) 530. (b) Diagnose a twin labor, (d) State what com- plications may arise in it, and (c) show how they may be overcome. {May, 1897.) 531. (b) How may midtiple pregnancy be recognized? (d) State how it may complicate labor, and (c) show how labor should be managed when this condition exists. {Jan- uary, 1900.) 632. (b) How may a twin labor be recognized? (d) What complications may arise during its course, and (c) how should such complications be managed? {May, 1899.) 533. (d) What complications may arise in a tvnn labor, and (c) how may they be overcome? {September, 1896.) 534. (c) What peculiar management is required in twin pregnancy? {March, 1892.) 525 to 534. (a) King's Manual of Obstetrics, page 477; (b) page 479; (c) page 481; (d) page 480. 535. What is super fcetation, and how does it take place? {September, 1896.) 535. King's Manual of Obstetrics, page 589, ^' Third." 536. What are the dangers of precipitate labor, and how may they be averted? {September, 1898.) 537. What are the dangers of too rapid labor, and how can such dangers be modified? {June, 1892.) 536 and 537. King's Manual of Obstetrics, pages 497 and 498. XVIII. DEFORMED PELVIS AND PELVIMETRY. 538. What are the varieties of deformed pelvis? {April, 1895.) 539. Name the deformities of the female pelvis and their causes. {November, 1892.) 72 OBSTETRICS. 540. What varieties of the deformed pelvis are liable to interfere with obstetrical procedure? How? {June, 1894.) 54I' What difficulties arise during labor from malfor- mations of the maternal pelvis? (November, 1892.) 538 to 541. King's Manual of Obstetrics, pages 402 to 414. 542. Describe (a) justo-minor pelvis and (b) justo-major pelvis, (c), (d) Rtate how each may influence or complicate labor. {April, 1897.) 64s. Describe (a) justo-minor pelvis and (b) justo-major pelvis, (c); (d) State how each may influence the course of labor. {April, 1898.) 544' Describe and differentiate (a) justo-minor and (b) justo-major, pelvis and (c), (d) state how each may complicate labor. {January, 1900.) 545. Describe and differentiate (a) justo-minor pelvis and (b) justo-major pelvis, (c), (d) State how each may complicate labor. {September, 1900.) 646. Describe the (b) justo-major and the (a) justo-minor pelvis, and (c), (d) state how each may influence labor and delivery. {May, 1901.) 542 to 546. (a) King's Manual of Obstetrics, page 404; (b) page 403; (c) pages 404 and 424; (d) page 404. 547. (a) Describe pelvimetry and (b) state its obstetrical uses and value. {September, 1901.) 548. (c) Define pelvimetry and (b) state its object, (a) Show how pelvimetry is accomplished. {May, 1902.) 547 and 548. (a) King's Manual of Obstetrics, pages 417 et seq.; (b) pages 402 to 431 ; (c) Measurement of the pelvic dimensions. XIX. PROLAPSE OF FUNIS. 549. (a) What is meant by prolapse of the funis? (b) When does it occur? (c) What are its dangers? (d) How would you manage such a case? {September, 1893.) 74 OBSTETRICS. 564. (c) Give the treatment of recent inversion of the uterus. {November, 1892.) 560 to 564. (a) King's Manual of Obstetrics, page 463; (b) page 464; (c) page 465. XXI. RUPTURE OF THE UTERUS. 565. (a) How may rupture of the uterus during labor be recognized? (b) What shoidd be done in case of such a rupture? {January, 1901.) 566. (a) Describe the symptoms of rupture of the uterus during labor. {September, 1892.) 567. (a) Describe the symptoms and (b) give the treatment of rupture of the uterus. {April, 1895.) 568. What are the (c) causes, (a) symptoms, and (b) treatment of rupture of the uterus? {June, 1896.) 569. What are the (c) causes, (a) symptoms, and (b) treatment of rupture of the uterus? {January, 1898.) 570. Give the (c) causes, (a) symptoms, diagnosis, (d) prognosis, and (b) treatment of rupture of the uterus. {April, 1899.) 571. Describe the (a) symptoms of rupture of the uterus during labor. {September, 1893.) 572. Give the (c) causes, (a) symptoms, and (b) manage- ment of rupture of the uterus during labor. {September, 1901.) 573. Give the (a) symptoms of rupture of the uterus during labor and (b) state how such an accident should be managed. {May, 1897.) 574. (a) What symptoms lead to the suspicion of rupture of the uterus during labor? (b) State how such a compli- cation should be managed. {May, 1898.) 575. (a) How may rupture of the uterus during labor be recognized? (b) How should it be managed? {June, 1899.) 576. (b) HoiD would you manage a case of rupture of the uterus during labor? {January, 1893.) 75 OBSTETRICS. 577. (b) HoiD should a case of rupture of the uterus during labor be managed? {June, 189 4-) 565 to 577. (a) King's Manual of Obstetrics, page 467; (b) pages 470 et seq.; (c) page 466; (d) page 470. 578. Give the causes and treatment of laceration of the cervix uteri. {June, 1896.) 578. King's Manual of Obstetrics, page 473. XXII. PLACENTA PR-ffiVIA; RETAINED PLACENTA; THE HEMORRHAGES. 579. Give the (a) definition and pathology of placenta prcEvia. (b) State how placenta prcevia should be managed. {January, 1900.) 580. (a) Describe the varieties of placenta prcevia. {Aprilj 1896.) 581. (a) Mention the varieties of placenta prcevia and make a differential diagnosis of the varieties. {September j 1898.) 582. (c) Make a diagnosis of placenta prcevia and (b) state hoio such a condition should be managed. {May, 1900.) 583. Give the (d) causes, (a) varieties, (c) symptoms, and (b) management of placenta prcevia. {September, 1896.) 584. Give the (d) causes, (c) symptoms, and (b) manage- ment of placenta prcevia. {September, 1902.) 585. (a) Mention the varieties of placenta prcevia, and (b) state how each should be managed. {April, 1897.) 586. (a) Name the varieties of placenta prcevia, and (b) give the management of each. {September, 1896.) 587. (a) Describe the varieties of placenta prcevia, and (b) give the treatment of each variety. {September, 1901.) 588. (a) Define and classify placenta prcevia, and (b) state how it shoidd be dealt with. {June, 1898.) 589. (a) Name the varieties of placenta prcevia, and (b) state hoio they should be managed. {June, 1895.) 76 OBSTETRICS. 590. (a) What is placenta prceviaf Name its (d) causes, (c) symptoms, and (b) management. {November, 1894.) 591. (c) What is the characteristic symptom of placenta prceviaf {April, 1893.) 592. (b) How should a case of placenta prcevia centralis be treated? (January, 1894.) 593. (b) What is the treatment of placenta prceviaf {Jan- uary, 1893.) 594' (b) How would you manage a case of placenta prceviaf {January, 1892.) 579 to 594. (a) King's Manual of Obstetrics, page 443; (b) page 445; (c) page 444; (cl) page 443. 595. (a) State the causes and (b) give the proper manage- ment of retained placenta after normcd labor. (June, 1900.) 596. Describe the (a) causes of retained placenta and the (b) proper management of its varieties. {April, 1894.) 597. (a) What are the causes of retained placenta? (b) Give the treatment for each variety. (September, 1896.) 598. (c) Hoiu should the placenta be delivered at term? (b) What is the managemeiit of retained placenta? {May, 1895.) 599. (b) Give the technique of manual removal of the placenta. (May, 1901.) 600. (b) Describe the proper method of delivering an adherent placenta at term. {September, 1900.) 601. (b) Hoio should adherent placenta be treated? {No- vember, 1893.) 602. (b) Describe the management in detail in case of adherent placenta after delivery of the fcetus at term. {June, 1899.) 595 to 602. fa) King's Manual of Obstetrics, page 460; (b) page 460; (c) See above, Q. 315 to 326, (a). 603. Mention the varieties of hemorrhage that mciy affect the pregnant woman, the parturient woman, and the puerperal woynan.- Explain the causes and describe the treatment of each variety. {January, 1902.) 77 OBSTETRICS. 603. King's Manual of Obstetrics, pages 443, 449, 450 and 459. 604. Describe three important forms of hemorrhage occur- ring in obstetrical practice. (September, 1895.) 604. King's Manual of Obstetrics, pages 443, 449 and 450. 605. (a) How would you manage a case of uterine hemor- rhage prior to labor? {June, 1892.) 606. Give the (b) causes, (c) import, and (a) management of ante-partum hemorrhage. {September, 1897.) 607. What are the (b) causes and (c) import of hemor- rhage before labor, and (a) how would you manage such a case? {January, 1894-.) 608. What are the (b) causes and (c) import of hemor- rhage before labor? {January, 1893.) 609. State (b) the causes of ante-partum hemorrhage, and (a) mention the measures that should be taken to restrain it. {May, 1901.) 605 to 609. (a) First diagnose between accidental hemor- rhage and that due to placenta prsevia. For treatment appropriate to each, see King's Manual of Obstetrics, pages 445 and 450. (b) Placenta prsevia; partial separa- tion of normally implanted placenta. See King's Manual of Obstetrics, pages 443 and 449; (c) pages 443, third paragraph; 449, last paragraph. 610. What is meant by concealed hemorrhage? State its cause and management. {June, 1892.) 610. Hemorrhage from the placental site, which, failing to find an outlet, accumulates within the uterine cavity. See King's Manual of Obstetrics, pages 449 and 450. 611. Make a differential diagnosis of intra-uterine hemor- rhage and extra-uterine hemorrhage. {April, 1899.) 611. King's Manual of Obstetrics, page 185, '^symp- toms of rupture," and page 449, third paragraph. 9- 78 OBSTETRICS. 612. (a), (c) What conditions and sy7nptoms, both during and after labor, would lead you to apprehend post-partum hemorrhage? (March, 1893.) 613. (a) Mention the principal causes of post-partum hemorrhage, and (b) state the details of prevention and of management. {January, 1899.) 614' G'^^^^ ihe (a) causes, (c) symptoms, and (b) treatment of hemorrhage occurring during the third stage of labor. {September, 1896.) 615. (a) Name the causes of post-partum hemorrhage, and (b) give the details of its management. {September, 1896.) 616. (a) Give the usual causes of post-partum hemorrhage, and (b) state the principles of its management. (May, 1897.) 617. (a) State the principcd causes of post-partum hemor- rhage, and (b) give its management. {January, 1897.) 618. (c) What are the usual symptoms of post-partum hemorrhage? (b) How should post-partum hemorrhage be treated? {September, 1898.) 619. Describe post-partum hemorrhage, naming its (c) symptoms and (a) causes. {June, 1896.) 620. (a) Name the causes of post-partum hemorrhage ante- cedent to labor and subsequent to labor. {November, 1893.) 621. (b) How ivould you treat a case of post-partum hemorrhage? (April, 1893.) 622. Give the (a) chief cause and (b) management of post-partum hemorrhage? (January, 1892.) 623. (a) What are the causes of hemorrhage after labor, and (b) what is the treatment? (November, 1891.) 624-. (a) State the causes and ((b) give the treatment of post-partum hemorrhage. (September, 1894.) 625. Name the causes of post-partum hemorrhage, and (b) give the details of its management. (June, 1895.) 626. (b) What is the treatment of post-partum hemorrhage, preventive and curative? (April, 1895.) 627. (d) What are after-pains? (a) Give the causes of post-partum hemorrhage. (April, 1899.) 79 OBSTETRICS. 612 to 627. (a) King's Manual of Obstetrics^ page 451; (b) pages 452 et seq.; (c) page 452; (d) page 247. 628. (a) What is ergot, (b) what are its most reliable forms; (c) when and in what dose is it properly and im- properly employed? 629. (c) Mention the indications for the use of ergot in labor, fb), (c) How shoidd ergot be employed? (September, 1902.) 628 and 629. (a) The sclerotium of Glaviceps purpurea, a fungus growing on rye. (b) Fluid extract, J to 2 drachms; ergotole (half the dose of fluid extract); ergotin f to 5 grains. The two latter only should be used hypodermic- ally, as the fluid extract irritates, (c) King's Manual of Obstetrics, page 525. XXIII. ECLAMPSIA. 630. (e) Define puerperal eclampsia. Give the (a) causes, (f) pathology, and (d) treatment of puerperal eclampsia. (January, 1901.) 631. (e) Define puerperal eclampsia. Give the (a) causes and (d) treatment of puerperal eclampsia. (September, 1902.) 632. (e) Define puerperal eclampsia, and give its (a) etiology, (g) prognosis, and (d) treatment. (May, 1897.) 633. (e) Define puerperal eclampsia and give its (a) etiology, (g) prognosis, and (cl) treatment. (January, 1899.) 634. Describe the (f) nature, (a) causes, and (d) treatment of puerperal eclampsia. (June, 1901.) 635. Give the (h) danger signals of impending eclampsia. (May, 1901.) 636. (d) In case eclampsia gravidarum appears before the end of the eighth month, how should it be managed? (May, 1899.) 637. State the (a) causes, (b) symptoms, and (d) treat- ment of eclampsia gravidarum. (January, 1898.) 80 OBSTETRICS. 638. Give the (a) theory of causation, (d) treatment, mid (g) prognosis of eclampsia gravidarum. (November, 1893.) 639. Give the (f ) pathology and (h) prodromata of eclampsia gravidarum, and (i) state the relative frequency in primiparce and jnultiparcB. {November, 189 4.) 6Jf.O. (d) Describe the treatment of eclampsia. {July, 1893.) 6Jf.t. Give the (b) symptoms and (d) treatment of puerperal convulsions. {June, 1892.) 642. (a) State the causes of the different varieties of puer- peral convulsions. {March, 1892.) 643. (j) What are the varieties of puerperal convulsions, and how are they differentially diagnosed? {January, 1892.) 6Jf4' Puerperal eclampsia, give (a) causes; (b) symptoms; (c) preventive management; (d) treatment. {March, 1893.) 645. (e) Define puerperal eclampsia and give its (a) etiology, (g) prognosis, and (d) treatment. {September, 1896.) 64.6. (b) Diagnose urcemic eclampsia, and (d) give the treatment. (April, 1896.) 647. (b) Diagnose an eclamptic seizure, and (g) give the prognosis of the disease. (June, 1895.) 648. (b) Describe an eclamptic seizure in the puerperal condition, and (d) outline the treatinent. (September, 1896.) 630 to 648. (a) King's Manual of Obstetrics, page 526. Predisposing causes: 1. All chronic and acute forms of kidney disease. 2. Long-continued and marked retention of urine, particularly that produced by pressure on the ureters by (a) abnormally enlarged uterus, twin preg- nancy, hydramnios; (b) small pelvis; (c) large foetus or foetal head. 3. Very young or very old primiparse, on account of rigidit}^ and lack of room in their pelvic and abdominal cavities. Exciting causes: 1. Sudden, partial or complete, suppression of urine. 2. Constipation. 3. Painful uterine contractions. 4. Prolonged and exhausting efforts at expulsion. 5. Profound emotion." (Jewett's Practice of Obstetrics.) (b) King's Manual of Obstetrics, page 527; (c) pages 146 (last hne) to 149; (d) page 528. (( 81 OBSTETRICS. (e) ''An acute morbid condition^ making its advent dm^ing pregnancy, labor, or the puerperal state, which is charac- terized by a series of tonic and clonic convulsions, affecting first the voluntary and then the involuntary muscles, accom- panied by complete loss of consciousness and ending in coma or sleep/^ (Jewett's Practice of Obstetrics.) (f) ^'Post-mortem changes: an anaemia of the organs generally, a congestion of the cerebral cortex, occasional slight hepatic apoplexies, and a fluid condition of the blood. The chief changes, diminished urinary toxicity and corresponding in- crease in amount of circulatory poisons, are rather to be found intra vitam than after cleath/' (Jewett's Practice of Obstetrics.) (g) King's Manual of Obstetrics, page 528; (h) pages 528 and 146. (i) ''The proportion of eclamptic primiparse to multiparse is three to one." (Jewett's Practice of Obstetrics.) (j) King's Manual of Obstetrics, page 527. XXIV. OBSTETRIC SURGERY. 1. Induction of Premature Labor. 649. (a) Classify abortion, miscarriage, and premature labor; state (b) when their induction is justifiable, and (c) how they are performed. {May, 1894.) 650. (a) What is abortion? (b) When and (c) how shoidd it be induced? {April, 1895.) 651. (b) When is it justifiable to produce an abortion? {May, 1893.) 652. (b) What conditions justify the induction of abortion? (c) Mention the methods that may be employed. {June, 1901.) 653. (c) Hdio can premature labor be most safely induced, and how would you conduct a case of that kind? {November, 1892.) 654. (b) Is the induction of premature labor ever justifiable, and, if so, when? {April, 1893.) 655. (b) Is the production of premature labor ever justifi- 82 OBSTETRICS. able? If so, when and (c) how would you accomplish that object? {November, 1893.) 656. (b) When is the induction of premature labor justi- fiable, and (c) how inay premature labor be induced? {Jan- uary, 1896.) 657. (b) Under ivhat conditions should a premature labor be induced? {June, 1894.) 658. (b) Under what circumstances is premature delivery demanded? (c) How should premature delivery be induced? {June, 1902.) 659. (b) Under what conditions is the induction of pre- mature labor justifiable, and (c) how should it be perforined? {May, 1898.) 660. (b) What conditions justify the induction of prema- ture loJjor during viability of the foetus? (January, 1897.) 661. (b) What are the indications for the induction of premature labor after the beginning of the eighth month? {June, 1898.) 662. (b) Under what conditions may the ^induction of premature labor {child viable) become justifiable, and (c) how should it be performed? {May, 1900.) 663. (a) What is premature labor, and (b) when and (c) how should it be induced, the foetus being viable? {June, 1896.) 66Jf.. (b) Under what conditions may the induction of premature labor {child viable) become justifiable, and (c) how should it be performed? {May, 1899.) 665. (b) Give the indications for the induction of premature labor {child viable), and (c) state how it shoidd be performed. {September, 1901.) 666. (b) What circumstances justify the induction of premature labor (foetus viable), and (c) lohat means are best to promote it? {September, 1897.) 667. Give the (a) definition, (d) causes, (e) diagnosis, and (f) treatment of premature labor; and also (b) indi- cations for its induction. (June, 1893.) 83 OBSTETRICS. 649 to 667. (a) King's Manual of Obstetrics, page 171; (b) page 432; (c) pages 435 et seq. and 434; (d) page 172; (e) page 173; (f) page 182, see also pages 176 et seq. 2. Forceps. 668. (a) Describe the common varieties of obstetric forceps and their adaptations. (November, 1894.) 669. Describe (a) the common varieties of obstetric forceps and (b) their application. {November, 1891.) 670. (c) What powers may be exerted by the forceps? (b) Describe its application. {April, 1895.) 671. (d) What are the indications for the use of forceps? {March, 1892.) 672. (b) Describe the position of patient and physician for the readiest and safest means of applying the forceps. {May, 1894.) 673. (d) What conditions justify the use of forceps, and (b) what preliminaries are necessary to its application? {September, 1895.) 674' (d) State the important indications for using the forceps, (b) Explain the amplication of the forceps, giving necessary preparations. {May, 1898.) 675. (d) Give indications for the employment of forceps, and (b) state rules and precautions to be observed. {June, 1897.) 676. (d) When may . the forceps become advisable? (b) How should they be applied and what cautions should be observed in their application? {May, 1899.) 677. (b) What general rides should be observed in using the forceps? {June, 1895.) 678. (d) Under what conditions should the forceps be employed? (b) How should the instrument be used? {Jan- uary, 1901.) 679. (e) Describe the use of the forceps in the occipito- posterior position. {January, 1896.) 84 OBSTETRICS. 680. (f) Make a diagnosis of face presentation.' .^ (g) How should forceps he applied in a case of face presentation? {January, 1898.) 681. (d) Describe the occasion for the application of the forceps in the inferior strait. {November, 1893.) 682. Give the (h) etymology and (c) uses of the forceps, and (h), (cl) ncmie the conditions for its application, together with the rides therefor and precautions to be observed in the same. {June, 1893.) ■ 668 to 682. (a) ^^The modern obstetric forceps consists of two interlocking arms or branches. Each has fom* parts — handle^ lock, shank, and blade. The handles when the arms are locked fall together so as to be both conveniently grasped by one hand of the operator. For a more secure hold they are generally roughened or corrugated on their outer margins. There is usualty a transverse projection at the upper end of each handle over which a finger may be hooked when making traction. The blades in the prevailing patterns of forceps have a double curve — a cephalic and a pelvic. The former adapts them to the shape of the foetal head, the latter to that of the birth- canal. The cephalic curve is elliptical rather then circular, since the former better adapts itself to heads of different sizes. In the usual pattern the cephalic and the pelvic curves are nearly ec{ual. The shanks connect the blades and the handles. The lock is based either on the Smellie or on the Levret model. The former is constructed on the prin- ciple of a mortise and tenon; in the latter there is on the lower half a thumbscrew, or a pin surmounted by a button, and in the edge of the other half a notch into which the pin or screw fits. The lock is usually placed one-third way from the proximal to the distal end of the instrument.''' (Abridged from Jewett's Practice of Obstetrics.) And see King's Manual of Obstetrics, pages 324, 322, 323, 336, 337, 339, 340 and 341. (b) pages 325 et seq.; (c) pages 324, ''action of forceps;" and 332. (d) ''1. Forces at faidt: 85 OBSTETRICS. Inertia uteri in the presence of conditions likely to jeopar- dize the interests of mother or child, (a) Impending ex- haustion; (b) arrest of head, from feeble pains. 2. Passages at fault: Moderate narrowing 3^- to 3| inches, true conju- gate; moderate obstruction in the soft parts. 3. Passenger at fault: A. Dystocia due to (a) occipito-posterior ; (6) mento-anterior face; (c) breech arrested in cavity. B. Evidence of foetal exhaustion (pulse above 160 or below 100 per minute). 4. Accidental complications: Hemor- rhage; prolapsus funis; eclampsia. AH acute or chronic diseases or complications in which immediate delivery is required in the interest of mother or child or both." (Abridged from Jewett's Practice of Obstetrics.) (e) King's Manual of Obstetrics, page 332, last paragraph; (f) page 281; (g) page 344; (h) the Latin word forceps = Si pair of tongs. 683. Describe the (a) high and (b) loiu forceps operations respectively, mentioning the instruments appropriate to each. (January, 1900.) 684' (^) Descride the application of the forceps in the supe- rior strait, naming the preliminary steps, the position of the ivoman, and the direction of the traction. {July, 1893.) 685. (a) Describe the application of the forceps in the superior strait, giving precautions to be observed in the delivery of the foetus in such a case. (January, 1899.) 686. (a) Describe the use of the forceps in the superior strait. (June, 1894.) 687. (c) Describe the obstetric forceps, and (a) state the method of its application to the foetal head in the superior strait. (September, 1896.) 688. (a) Describe the technique of the so-called high forceps operation. (September, 1896.) 689. (a) Describe the high forceps operation. (September, 1891) 690. (a) Describe the application of the axis-traction forceps. (June, 1900.) 10 86 OBSTETRICS. 691. (a) Describe the applicatioii of axis-traction forceps in the superior strait, giving preliminaries and details. {April, 1897.) 692. (d) Mention the indications for the axis-traction forceps and (a) describe their application. {May, 1899.) 693. (d) Mention the indications for the axis-traction forceps and (a) describe their application at the brim. {Sep- tember, 1901.) 694. {^) Describe the application of the forceps to the foetal head, movable above the inlet. {June, 1898.) 683 to 694. (a) Preliminaries, King's Manual of Obstet- rics, pages 325; operation, page 336; position, page 339. Note. As a guide, introduce the half -hand into vagina, with two fingers into the cervix, before introducing the blades, (b) King's Manual of Obstetrics, pages 325, 326 et seq. (c) See above, Q. 668 to 682, (a) ; (d) See above, Q. 668 to 682, (d) ; 1, 2, 3 (evidence of foetal exhaustion), 4. 695. (a) State the dangers accompanying the use of forceps. {September, 1893.) 696. (a) What are the dangers in the use of forceps, and (b) how are such dangers to be avoided? {April] 1893.) 695 and 696. (a) King's Manual of Obstetrics, page 342; (b) page 325 ('Conditions Essential to Safety," etc.); page 325, last paragraph. See also description of proper method of operating, pages 326 to 332. 3. Version. 697. (a) Define version, (b) name its varieties, and (c) state how it should be performed. {May, 1896.) 698. (a) Define version, (b) name its varieties, and (c) state how it should be performed. {September, 1896.) 699. (a) Define version, (b) mention its varieties, and (c) state how to. per form it. {May, 1897.) 700. (a) Define version, (b) mention its varieties, and (c) describe its performance. {June, 1901.) 87 OBSTETRICS. 701. (b) Mention the different varieties of version, and (c) state how each is performed. (June, 1898.) 702. (b) What are the several varieties of version, and (d) when do they become perfectly available in labor? {Sep- tember, 1898.) 70S. (a) Define version, (d) state the conditions under which it shoidd be employed, and (c) show how it should be performed. {January, 1899.) 701^.. (a) Define version, (b) mention its varieties, and (d) state conditions under which it should be employed as ■an alternative. {May, 1900.) 705. (a), (c) Describe version, (b) mention its varieties, and (d) state ivhen it is applicable as an alternative. (Jan- uary, 1900.) 706. (b) How many hinds of version are there, arid (d) what are the indications for this procedure? {May, 1895.) 707. (b) Mention the varieties of version, and (d) state the indications for their employment. {April, 1898.) 708. (d) When is version appropriate, and (c) how is it performed? {May, 1893.) 709. (a) What is the operation of version? (b) Describe its varieties, and (d) state when each is appropriate. {Jan- uary, 1894-) 710. (a) Define version. Give (b) varieties, (d) indica- tions, and (e) dangers of version, together ivith (c) prelimi- naries and operation. {June, 189 4-) 711. What are (b) the varieties, and (f) methods of version? {January, 1892.) 697 to 711. (a) King's Manual of Obstetrics, page 347; (b) Cephalic and podalic; (c) King's Manual of Obstetrics, pages 348 et seq. Note : Catheterize as a preliminary, (d) King's Manual of Obstetrics, pages 347 and 348. (e) Rup- ture of vagina, cervix, or uterus. Shock. Foetal death, due to delay in extraction, from extended arms, dorsally displaced arms, extended head,- obstruction in maternal hard or soft parts. Sepsis, (f) Internal, external, com- bined; and see King's Manual of Obstetrics, page 348. 88 OBSTETRICS 712. For what conditions loould you advise podalic version? (April, 1896.) 712. King's Manual of Obstetrics, page 347, last para- graph; page 348, first paragraph. 718. Describe the operation of version by the internal method. (January, 1898.) 713. King's Manual of Obstetrics, page 353 et seq. 714' (a) Under what conditions should a head presentation be converted into a foot presentation? (b) How should this he accomplished? (May, 1902.) 714. (a) See Q. 712; (b) King's Manual of Obstetrics, pages 350 et seq. 715. Describe in detail the proper procedure when the head is movable above the brim, but does not engage. (June, 1900.) 716. Describe in detail the proper procedure when the head is movable above the brim of the pelvis, but does not engage. (September, 1899.) 715 and 716. 1. Empty bladder and rectum. 2. Ascer- tain by palpation whether there is serious disproportion between head and pelvis. Press the head do^niward into pelvis; this manoeuvre may be aided by Walcher's position. If there is marked disproportion, Csesarean section and craniotomy must be considered. (See these operations, Q. 718 to 728; and 740 to 743.) If disproportion is apparently not insuperable, rupture the membranes just after the acme of a pain, when the cervix is fully dilated. If the head thereupon engages during the next few pains, allow to deliver spontaneously or aid mth forceps if necessar}^ (See high forceps indica- tions and operation, Q. 683 to 694.) If it still refuses to engage, apply axis-traction forceps in Walcher's position tentatively; if unsuccessful, perform podalic version by combined or internal method. (See King's Manual of Obstetrics, pages 350 et seq.) 89 OBSTETRICS, If membranes have already ruptured, note whether there is marked retraction-ring. If not, podalic version is proper, subject to hmitation of shght disproportion; but if the uterus has retracted markedly, forceps, and, that failing, C^esarean section, symphyseotomy or craniotomy are alone admissible. 717. Compare version with the eviployment of forceps and state when each is preferable. {January, 1893.) 717. ^'In flat pelves of moderate contraction version has an advantage over forceps, as the long occipitomental diameter of the foetal head can be brought into the trans- verse of the inlet and the occiput guided through the roomiest part of the brim. On the other hand, in slight general contraction forceps used in conjunction with the tValcher position offers the best prognosis for mother and child. . . The dexterity and practice of the operator must also be taken into consideration in determining the relative value of forceps and version. . . '^ The general rule for emergencies still holds good — i e., that where rapid delivery is demanded and the head has not engaged at the pelvic inlet, version is the operation of choice, while forceps is to be chosen when the head is in the brim.'' (Jewett's Practice of Obstetrics.) 4. Cutting Operations on the Mother. 718. (a) Under what conditions does delivery by abdominal section become jiistificible, and (b), (c) luhat is the technique of the operation? (January, 1902.) 719. (a) Mention complications of labor that may justify ahdomincd section, (b), (c) Give an illustration, describing the technique of the operation. {September, 1900.) 720. (a) State the indications for C cesarean section, and (b), (c) describe the operation. {September, 1896.) 721. (b), (c) Describe C cesarean section, and differentiate its important modifications. {September, 1897.) 90 OBSTETRICS. 722. (b), (c) Describe the classic Ccesarean section and give its modifications as it is practised at present. (April, 1898.) ■■ 723. (a) Give the conditions requiring Ccesarean section, and (b) describe a modified form of the operation. {April, 1894.) 724. (b) , (c) Describe the classic Ccesarean section and the Sanger and Porro modifications of this section. {May, 1899.) 725. (d) Define Porro^s operation, (e) state when it is applicable, and (c) describe the method of its performance. {June, 1900.) 726. (a) What complications in labor justify abdominal section? (b) Give the technique of the operation. {May, 1897.) 727. (a) Mention the complications of labor that may justify abdominal section, and (b) describe the technique of the operation. {May, 1899.) 728. (a) When is abdominal section indicated in com- plicated labor? {November, 1892.) 729. (g) What is hysterotomy, and (a) when does that operation become necessary? {March, 1893.) 730. (f) What is hysterectomy? (e) Give its proper sphere in obstetrics. {September, 1899.) 731. (f) Define hysterectomy and (e) state when it is applicable in obstetric complications. {June, 1897.) 718 to 731. (a) King's Manual of Obstetrics, page 373; (b) pages 376 et seq. Sanger's modification was tlie intro- duction of the method of suturing the uterine wound. It is the operation now generally performed, (c) King's Manual of Obstetrics, pages 381 et seq.; (d) pages 381 et seq.; (e) page 382; (f) ^^Hysterectomy is excision of the uterus; it may be performed by laparotomy or through the vagina" (Dusme^s Medical Dictionary); (g) ^^Hysterotomy is the act of incising the uterus, either through the abdo- men {laparo-hysterotomy) or the vagina {vaginal hyster- otomyY' {DnB.n.e's Medical Dictionary). -^ ' ^'J ' ' ' - ■ 732. (a) Describe symphyseotomy, and (b) give indications for its performance. {November, 1893.) 91 OBSTETRICS. 733. (c) Define symphyseotomy, (b) state when it is ad- missible, and (a) describe its technique. {September, 1901.) 734. (b) Give the indications for the operation of syinphys- eotomy. (a) Describe this operation. {May, 1898.) 736. (b) When is symphyseotomy indicated? (a) Describe the operation. {April, 1895.) 736. (c) What is symphyseotomy? (a) How and (b) for ivhat reason is this operation performed? {September^ 1894.) 737. (b) What are the indications for symphyseotomy, and (a) hoio shoidd the operation be performed? {Sep- tember, 1895.) 738. (b) When may symphyseotomy become an appro- priate alternative as an obstetric operation, and (a) how should this operation be performed? {June, 1899.) 732 to 738. (a) King's Manual of Obstetrics, pages 367 et seq.; (b) page 365 ; (c) page 364. 739. What is episiotomy, and when is such interference indicated? {May, 1896.) 739. Lateral incision of the vulva. ^'When extensive laceration at the vaginal outlet is otherwise inevitable, incisions may be made on either side. Episiotomy substitutes for a posterior laceration, which is often difficult of complete repair, incisions through less important structures, which can easily and perfectly be closed by suture." (Jewett's Practice of Obstetrics.) 5. Mutilating Operations on the Child. 740. (a) Under what conditions should craniotomy be performed? (b) Describe the operation. {April, 1899.) 741 ' (a) What are the indications for craniotomy, and (c) what are its alternatives? {January, 1892.) 742. (a) When does it become proper to perform crani- otomy, and (b) how is that operation performed? {April, 1893.) 92 OBSTETRICS. 743. (d) Define embryotomy and craniotomy, and give (a), (e) the indications for and (b), (f) method of operating in each. {June, 1893.) 744. (f) Give the various steps in embryotomy on the transverse presentation. (May, 1895.) 740 to 744. (a) King's Manual of Obstetrics, page 386; (b) pages 387 et seq. (c) Induction of premature labor; symphyseotomy; Csesarean section, (d) King's Manual of Obstetrics, page 386; (e) page 400; (f) page 400. XXV. COMPLICATIONS OF THE PUERPERIUM. 745. Mention the pathogenic bacteria that invade the vagina, and state how the vagina is normally protected from them. (May, 1901.) 745. Streptococcus, staphylococcus, gonococcus, bacillus coli commmiis, bacillus diphtherise, bacillus aerogenes cap- sulatus, pneumococcus, bacillus typhosus, and bacteria of putrefaction. The vaginal mucus is antiseptic, and is secreted in large quantities before and during labor. 746. What is meant by autoinfection during or after labor, and how does it originate? {June, 1892.) 746. ^'Many believe that in a certain number of cases [of puerperal infection] the infection is not due to the introduction of organisms from without, but owes its origin to micro-organisms which were within the woman before the onset of labor. To infections arising in this way the term ' autoinfection' is applied. The conception was intro- duced by Kaltenbach that in a considerable number of cases pathogenic organisms are normally found in the vaginae of pregnant women, which may be introduced into the uterus by the introduction of a perfectily sterile finger within the vagina." (Jewett's Practice of Obstet- rics.) 747. (a) What is puerperal fever, and (b) what are its causes? {November, 1892.) 93 OBSTETRICS. 748. (b) Name the favorable conditions for sepsis in the puerperium. {April, 1894.) 749. (b) What are the principal causes of puerperal infection? (c) How may puerperal infection he prevented? (September, 1899.) 750. (a) What do you understand by the term puerperal sepsis, and (c) hoiv would you attempt to prevent it? {June, 1893.) 751. (a) Define puerperal sepsis, and (c) state what should he done to prevent it. {January, 1897.) 752. (a) Define puerperal sepsis, and state both (c) how to prevent it and (d) how to overcome it. {June, 1897.) 753. (c) What means should be employed to avoid sepsis in the puerperal state? {March, 1892.) 754. (c) What precautions shoidd be taken against in- fection during labor and in the puerperal state? {June, 1898.) 755. (c) Hoiv should a case of labor be conducted to avoid puerperal infection? (d) What would he the proper manage- ment if infection should occur? {January, 1901.) 756. How should puerperal infection be (c) guarded against and (d) managed when present? {May, 1900.) 757. How may puerperal sepsis be (b) engendered, (c) prevented, (d) managed? (January, 1900.) 758. (b) Mention the principal sources of puerperal sepsis, and give details of (c) prevention and (d) of treatment. (Jan- uary, 1899.) 759. (a) What is puerperal septiccemia? (c) How is it prevented, and (d) hoio treated when it does occur? (April, 1893.) 760. Give the (e) symptoms and (d) treatment of sepsis or autoinfection in the puerperal state. (March, 1893.) 761. (a) Define and (b) 7iame the predisposing causes of puerperal infection; also give the (c) prophylaxis, (e) symptoms, and (d) treatment of puerperal sepsis. (Sep- tember, 1893.) 11 94 . OBSTETRICS. 762. (a) What is puerperal sepsis? How may it he (c) prevented and (d) cured? (September, 189 Jj..) 763. Give the (e) symptoms and (d) treatment of puerperal sepsis. {January, 1896.) 764. (a) Define puerperal sepsis, and state its (b) causes, (c) prophylaxis, and (d) treatment. (September, 1898.) 765. (a) Define puerperal infection, and state its (b) essential causes. Give the (e) symptoms, (c) prophylaxis, and (d) treatment of puerperal sepsis. (September, 1897.) 766. (a) Define puerperal septicaemia. State its (b) causes and (c), (d) its management. (April, 1897.) 767. Describe the (c) prophylactic and (d) curative treat- ment of septiccemia. (July, 1893.) 768. Give the (e) symptoms and (d) treatment of puerperal fever. (March, 1892.) 769. Give (e) diagnosis and (d) treatment of puerperal fever. (January, 189 Jf..) 747 to 769. (a) King's Manual of Obstetrics, page 533; (b) pages 534 et seq.; (c) pages 546 and 215; (d) pages 547 et seq.; (e) pages 540 et seq. 770. What is milk fever? Describe its occurrence and treatment. [June, 1892.) 770. King's Manual of Obstetrics, page 249. 771. (a) Define puerperal phlebitis, and (b), (c) give its pathology, (d), (e) symptoms, and (f), (g) treatment. (Mo.y, 1901.) ' 772. State the (h) causes, (h), (c) pathology, (d), (e) symptoms, and (f), (g) treatment of puerperal phlebitis. (May, 1900.) 773. Give the (b), (c) pathology, (d), (e) symptoms, and (f), (g) management of puerperal phlebitis. (June, 1899.) 77 Jj.. State the (h) causes, (d), (e) symptoms, and (f), (g) management of puerperal phlebitis. (April, 1898.) 775. (f), (g) How would you treat puerperal phlebitis? (June, 1893^ 95 OBSTETRICS. 776. Give the (h) causes, (cl), (e) symptoms, (f), (g) treat- ment, and (i) sequelce of puerperal phlebitis. (May, 1895.) 777. (h) Give the causes and (f), (g) treatment of puerperal phlebitis. (September, 1902.) 771 to 777. (a) King's Manual of Obstetrics, page 543; (b) page 543; (c) page 555; (d) page 543; (e) page 555; (f) pages 539 and 546; (g) pages 539 and 555; (h) pages 539; 547 et seq., and 555: (i) Uterine phlebitis, thrombosis, pyaemia, and septicaemia. Crural swelling, impairment of motion, liability to relapse. 778. (a) What is phlegmasia alba dolens? (b) Give treatment. (April, 1899.) 779. (a) Describe phlegmasia alba dolens (milk leg), its (c) causes, (d) nature, and (b) treatment. (June, 1892.) 780. Give the varieties, (e) symptoms, and (b) treatment of phlegmasia dolens. (April, 1894-.) 778 to 780. (a) King's Manual of Obstetrics, page 562; (b) pages 563 and 564; (c) page 562; (d) page 562; (e) page 562. 781. (a) What are the uses of the vaginal douche during and after labor? (November, 1892.) 782. (a) Mention the indications for the obstetric employ- ment of the vaginal douche, and (b) state the technique of its application. (April, 1898.) 783. (a) State under what circumstances the vaginal douche may be employed before, during, and after labor, (b) Give the technique. (May, 1897.) 78Ij.. (a) When should the ante-partum antiseptic douche be employed? (b) Give the details of its use. (January, 1896.) 781 to 784. (a) Before labor: 1. To induce premature labor; 2. As prophylactic in cases of suspicious or un- doubtedly infective vaginal discharge. During labor: As preliminary to version, forceps, or embryotomy. After labor: 1. Many obstetricians give routine douche for the 96 OBSTETRICS, sake of cleanliness; 2. In case of foul lochia; 3. After repair of perineal lacerations; 4. As an element of treatment of puerperal sepsis, (b) Apparatus: Fountain syringe, hold- ing from two to four quarts ; sterilized glass douche-nozzle ; Kelly pad. Hot 2 per cent, creolin mixture in boiled water (110° to 120° F.). Position: Dorsal, crosswise of bed, knees drawn up, on inflated Kelly pad, apron of which dips into empty pail at bedside. Preliminaries: Disinfect hands; clean external genitals with bichloride solution (1 to 2000) ; allow all air to escape from tube and nozzle ; separate labia with one hand, while the other introduces douche-nozzle to posterior fornix; move nozzle about, to reach every portion of the vagina, but do not obstruct the free outflow by compression of the introitus. 755.2(a) What are the indications for intra-uterine irri- gation after labor, and (b) how shoidd it he performed? {June, 1892.) 786. (b) Describe the technique of intra-uterine irrigation, and (a) state when its employment is justifiable. {May, 1896.) 785 and 786. (a) After all intra-uterine manipulations: Version, high forceps, embryotomy, manual extraction of placenta; post-partum hemorrhage ; uterine infection, (b) Apparatus: Fountain syringe; Kehy pad; long, curved, sterile douche-nozzle; hot, sterile, saline solution. Pre- liminaries as above, Q. 781 to 784. (b) Introduce two fui- gers of left hand into vagina, to the posterior lip of cervix. Avoid carrying m infective material from the external genitals. With these fingers as guide, introduce douche- nozzle (having first expelled all air) into cervix. Transfer hand from vagina to abdomen and continue introduction of tube gently up to fundus uteri. (King's Manual of Ob- stetrics,|pages 547 et seq. - . . - ^ - 181 . (a) When is curettage of the uterus justifiable in obstetric practice, and (b) how should it be performed? {June, 1900.) 97 OBSTETRICS. 788. (c) Define uterine curettage, (a) Give the indications for curettage, and (b) describe its technique. (May, 1902.) 789. (a) Under ivhat circumstances may the curette become necessary, and (b) what precautions should be taken in its use? (d) State the dangers attending the use of the curette. (January, 1902.) 787 to 789. (a) 1. Incomplete abortion; 2. Sepsis caused by retained placenta, blood clot, membranes, (b) Crockett's Gynecology, pages 51 to 53. (c) Scraping the uterine mu- cous membrane, (d) 1. Laceration of cervix; 2. Perforation of uterine wall; 3. Sepsis. 790. (a) What is puerperal mcinia? When does it occur, and (b) whcd are its causes? {March, 1893.) 791. What are the (c) symptoms and (d) treatment of p^ierpercd mania? {April, 1893.) 792. Give the (b) causes and (c) describe the clinical phenomena of puerperal mania. {September, 1896.) 793. (a) Define puerperal mania. Give its (b) etiology, (c) symptoms, and (d) treatment. {September, 1897.) 790 to 793. (a) King's Manual of Obstetrics, pages 566 and 565; (b) pa2:e 566; (c) page 567; (d) pages 568 and 569. 794. (a) Define mastitis. State its (b) etiology, and give its treatment, (d) preventive and (e) curative. {September, 1897.) ■ 795. (a) Define mastitis, and give its (b) causes, (d) prevention, and (e) treatment. {September, 1896.) 796. Give the (f) varieties, (b) etiology, (c) symptoms, and (e) treatment of mastitis. {November, 1894.) 797. Give the (b) etiology, (e) treatment, and (g) com- plications of mastitis. {May, 1896.) 798. (a) What is inastitis, and (e) how should it he treated? {September, 1893.) 799. What is the (h) pathology of puerperal mastitis? (e) Stcde how puerperal mastitis shoidd be treated. {June, 1901.) 98 OBSTETRICS. 800. Give the (b) causes, (c) symptoms, and (i) treatment of mammary abscess in the puerperal state. (November, 1891.) 801. State the (b) causes of mammary abscess in the puerperal state, and give its (c) symptoms and (i) treatment. (April, 1897.) 794 to 801. (a) King's Manual of Obstetrics, page 571; (b) page 572; (c) pages 572 et seq.; (d) page 249 C^sore nipples''); (e) pages 574 et seq.; (I) page 571; (g) Abscess, general septic infection; (h) King's Manual of Obstetrics, page 571; (i) page 575. XXVI. GYNECOLOGY. 80S. Give the (a) causes and (b) treatment of imperforate hymen. [June, 1895.) 803. How may imperforate hymen with long-retained menstrual fluid be (c) recognized and (b) treated? (Sep- tember, 1898.) 804. (c) Make a diagnosis of imperforate hymen, and (b) state its treatment in a case of long-retained menstrual fluid. (April, 1897.) 805. (c) Mention the symptoms, and (b) gi've the manage- ment of long-retained excretions due to imperforate hymen. (September, 1899.) 802 to 805. (a) Crockett's Gynecology, page 340; (b) page 342; (c) page 341. 806. (a) What is vaginismus? How may vaginismus be (b) recognized and fc) treated? (September, 1900.) 807. (a) What is vaginisinus? Give the (d) causes and (c) treatment of vaginismus. (January, 1902.) 808. (a) Define vaginismus, (e) vaginitis. Give the (c), (f) treatment of each condition. (September, 1902.) ' 806 to 808. (a) Crockett's Gynecology, page 90; (b) page 90; (c) page 90; (d) page 90; (e) Inflammation of 99 OBSTETRICS. the mucous membrane of the vagina; (f) Crockett's Gyne- cology, page 87. 809. What is a taviponf How is it made, and when is it properly used? {November, 1892.) 810. What is a tampon? How is it made, and what are its proper uses? (September, 18 93.) 811. What precautions are to be observed in the use of the tampon? {January, 1895.) 809 to 811. Crockett's Gynecology, pages 38 to 41. 812. Describe the uterine tampon, its uses, its dangers, and state what precautions should be observed when employ- ing it. {September, 1896.) 813. Describe a uterine tampon. State its uses and dangers and indicate the precautions that shoidd be observed in its employment. {May, 1902.) 812 and 813. Crockett's Gynecology, pages 43 and 42. Dangers: Perforation in introducing; sepsis; shock. 814. Name the diseases of the endometrium, and state their effects in pregnancy. {September, 1894.) 814. Acute endometritis; chronic endometritis: — (a) Chronic diffuse; (b) Chronic polypoid; (c) Catarrhal; {d) Hydrorrhcea gravidarum. (Jewett's Practice of Obstetrics.) They are very apt to cause abortion or adherent placenta at term. 815. (a) Define endometritis, and give its (b) causes, (c) varieties, and (d) treatment. (January, 1901.) 816. (a) Define endometritis, and give its (d) treatment. (May, 1902.) 817. (a) Define endometritis, and fd) state hoio it should he treated. (Septeynber, 1900.) 818. Give the (h) causes, (e) pathology, (f) symptoms, and (d) treatment of endometritis. (September, 1901.) 815 to 818. (a) Inflammation of the uterus, manifested most prominently in its mucous membrane; (b) Crockett's Gynecology, pages 95 and 99; (c) pages 95 and 99; (d) 100 OBSTETRICS. pages 97 and 106; (e) pages 95 and 100; (f) pages 96 and 102. 819. Describe the various forms of inflammation of the uterus. (November, 1892.) 819. Crockett^s Gynecology, pages 95 and 100. 820. (a) HoiD do uterine displacements originate, and how do they influence (b) conception and (c) pregnancy? {June, 1894.) 821. What influence upon (b) conception and (c) preg- nancy have uterine displacements? (September, 1892.) 822. Mention the uterine displacements that are liable to influence (b) conception, (c) pregnancy, and (d) labor, and state the manner of such influence. (June, 1901.) 820 to 822. (a) Crockett's Gynecology, pages 284, 244 and 259; (b) page 288, third paragraph; (c) King's Manual of Obstetrics, pages 151 to 156; (d) pages 154 and 156. 823. What uterine displacement is liable to interrupt pregnancy, and what should be done to prevent it? (Jan- uary, 1898.) 824. How would you diagnose and treat retroversion of the gravid uterus? (March, 1892.) 823 and 824. King's Manual of Obstetrics, pages 152 to 155. 826. Differentiate (a) anteversion and (b) retroversion, (c), (d) stating the obstetric significance of each. (September, 1899.) 826. Describe and differentiate (a) anteversion, (b) retro- version, and (e) prolapsus of the uterus. (June, 1900.) 827. Define and differentioAe (a) anteversion and (b) retroversion of the uterus, (f), (g) State what should be done for the relief of each. (January, 1901.) 828. (a), (b) Give a differential diagnosis of anteversion of the uterus and retroversion of the uterus, (f), (g) State what may be done to correct each. (June, 1902.) 825 to 828. (a) Crockett's Gynecology, pages 260 and 101 OBSTETRICS. 261; (b) pages 244 to 247; (c) King's Manual of Ob- stetrics, page 155; (d) page 152; (e) Crockett's Gynecology, pages 234 to 239; (f) page 261; (g) pages 248 to 259. 829. Under what conditions may shortening of the round ligaments become justifiable, and hoio should the operation he performed? (May. 1900.) 829. Crockett's Gynecology, page 254. 830. Is ventrofixation of the uterus justifiable? If so, state under what circumstances, and describe the operation. {June, 1900.) 830. Crockett's Gynecology, page 257. 831. How shoidd a case of .fibroid tumor complicating pregnancy be treated? {June, 1902.) 831. King's Manual of Obstetrics, page 509. 832. (a) What symptoms lead to the suspicion of malignant disease of the uterus? {May, 1902.) 833. Give the (b) early diagnosis and the (c) treatment of cancer of the uterus. {May, 1898.) 832 and 833. (a) Crockett's Gynecology, page 178; (b) pages 179 and 180; (c) pages 180 to 189. 83Jf.. (a) Define menstruation, its clinical course, and (b) abnormalities. {September, 1893.) 835. (b) Describe the abnormalities of menstruation, and give their (c) etiology and (d) treatment. {September, 1895.) 834 and 835. (a) See Q. 22, and Crockett's Gynecology, page 267; (b) Amenorrhoea; d3^smenorrhoea ; menorrhagia ; metrorrhagia; vicarious menstruation, (c), (d) Crockett's Gynecology, pages 272 to 286 and 269, third paragraph. 836. What are the symptoms and treatment of amenorrhoea? {April, 1893.) 836. Crockett's Gynecology, pages 272 et seq. 837. Define dysmenorrhcea and give its varieties, causes, and treatment. {January, 1902.) 837. Crockett's Gynecology, pages 279 et seq. 12 102 OBSTETRICS. 838. What is vicarious menstruationf {June, 1893.) 838. Crockett's Gynecology, page 269. 839. What methods should he employed to dilate the non- pregnant uterus, and under ivhat circumstances is the oper- ation justifiable? {June, 1901.) 839. Crockett's Gynecology, pages 51, 97 and 285. 840. Mention two distinct methods of dilatation of the cervix uteri iri obstetric practice, and describe in detail one of the operations. {June, 1898.) 840. King's Manual of Obstetrics, page 434; Crockett's Gynecology, page 51. 841' (a) Define salpingitis, (b) state its causes, and (c) give its management. {September, 1900.) 842. (a) Define salpingitis, and give its (cl) pathology and (c) treatment. {January, 1901.) 843. Give the (b) causes, (cl) pathology, and (c) treatment of salpingitis. (June, 1902.) 844- Gi^^^ the pathology of (e) hydrosalpinx ,{i) hcemato- salpinx. (g) Give the diagnosis and (h) treatment of each, {May, 1901.) 841 to 844. (a) Crockett's Gynecology, page 110; (b) page 110; (c) pages 127 to 139; (cl) page 111; (e) page 115; (f) page 114; (g) pages 121, second paragraph; 124, para- graphs four and five. Note: If blood has coagulated, in hsematosalpinx, the tube will have a firmer, non-fluctuat- ing feel, (h) Crockett's Gynecology, pages 127 et seq. Note page 133. 84s. Give a differential diagnosis between ovaritis and ovaralgia. {January, 1893.) 845. Pain and tenderness are fairly constant in ovaritis; in ovaralgia there may be spontaneous pain, relieved or increased by pressure. Pressure on neuralgic ovary is often productive of hysterical symptoms, palpitation, globus hystericus, convulsions. Bimanual examination is negative in ovaralgia ; in ovaritis the ovary is usually enlarged, often uneven in contour, and bound down by adhesions. 103 OBSTETRICS. 8Jj6. How would you diagnose cystic degeneration of the ovaries from other forms of disease which simulate it? {Sep- tember, 1892.) 846. Crockett's Gynecology, pages 210 and 215. 847. Give the pathology and treatment of an ovarian cyst. {June, 1901.) 847. Crockett's Gynecology, pages 196 et seq., and 215. 848. Describe and differentiate pelvic celliditis and pelvic peritonitis. {March, 1892.) 848. Crockett's Gynecology, pages 117, 118, 121 and 122. The following table is from Findley's Gynecological Diag- nosis: Pelvic Cellulitis. Pelvic Peritonitis. 1. Exudate lies low in the pelvis. 1. Lies high in the pehds. 2. Pain may not be great, and is 2. Pain usually more intense, sharp, dull and continuous. lancinating, and parox^'smal. 3. Exudate commonly at the side 3. Exudate commonly behind the of the uterus, never extending uterus, often extending to the to the fundus. fundus. 4. Exudate of firm consistency; 4. Commonly less firm; no great tendency to suppuration. tendency to suppuration. 5. Uterus partially fixed. 5. Uterus may be firmly fixed. 6. Tympanites usually absent. 6. Tj-mpanites usually present. 7. Facial expression may be natural. 7. Facial expression anxious. 8. Nausea and vomiting not com- 8. Nausea and vomiting common. 9. mon. One leg flexed. 9. Both legs flexed. 8Jfi. State the (a) causes, (b) symptoms, and (c) treatment of pus in the pelvis. {September, 1901.) 860. Give the (a) causes of pelvic inflammation, and (d) state its relation to involvement of the ovary. {Sep- tember, 1896.) 849 and 850. (a) Crockett's Gynecology, page 110; (b) pages 122 (cellulitis) and 124; (c) page 137; (d) page 116, second paragraph. 851. Give the diagnosis, causes, and treatment of pelvic hoematocele. {May, 1893.) 104 . OBSTETRICS. 851. Causes: Extra-uterine pregnancy; rupture; torn peritoneal adhesions. Systemic diseases : smallpox; scarla- tina; jaundice. Diagnosis: Crockett's Gynecology, page 125; King's Manual of Obstetrics, page 185. Treatment: Crockett's Gynecology, page 129. 8S^. (a) State some of the most common causes of sterility. {June, 1895.) 853. (a) Mention some of the essential causes of sterility in women, (b) State how fertility may he developed in the sterile. {April, 1897.) 854. (a) Mention some of the usual causes of sterility in women, and (b) state how they may he overcome. {June, 1897.) 855. (a) What are some of the essential causes of sterility in woman, and (b) what can he done to remove them? {Sep- tember, 1898.) 856. (a) Mention the most essential causes of sterility in woman, and (b) state how fertility may he promoted. {Jan- uary, 1899.) 857. (a) What are some of the principal causes of sterility in woman? (b) How may fertility in woman he jjromotedf (Jauary, 1900.) 858. (a) Mention some of the principal causes of sterility in ivoman, arid (b) state how fertility may he promoted. {Septemher, 1900.) 859. (a) Mention the principal causes of sterility in woman, arid (b) describe methods hy which fertility may he promoted. {January, 1901.) 852 to 859. (a) Crockett's Gynecology, pages 287 to 289; (b) page 290. 860. To what dangers from pregnancy and lahor does gonorrhoea of the mother expose her and her offspring. 860. Mother: Abortion; puerperal sepsis. Child: oph- thalmia neonatorum with consequent blindness. 105 OBSTETRICS. XXVII. MISCELLANEOUS. 861. Describe the anatomical cliff erences, not includiiig the sexual organs, between the male and the female figure. {June, 1901.) 862. Give a non-sexual anatomical description of the mcde and female figures in outline, differentiating them. {June, 1900.) 863. Give a non-sexual anatomiccd differ efritiation of the male and femcde figures. {September, 1899.) 861 to 863. In the female the bones are hghter, less prominent, and less strong; the lines and prommences less pronounced. The sternum is shorter; the pelvis has well- marked and characteristic differences, for which see King's Manual of Obstetrics, pages 26 and 27. The female has more subcutaneous fat; hence the more rounded appear- ance of the body. There is less hair on the female body, particularly on the face, chest, abdomen, and limbs; the pubic hair does not grow upward toward the mnbilicus as in the male. The larynx is smaller in the female, the hips are wider, and the waist smaller as compared with the chest; the breasts are larger. 864. Describe the obstetric uses of water. {September, 1892.) 864. 1. Cleansing; 2. vehicle for antiseptics; 3. as enema, cathartic; 4. as saline enema or hypoclermoclysis, diluent of body toxins in eclampsia and sepsis; 5. applied cold externally, stmiulant to uterine contraction, and to inspi- ration in the newborn; 6. hot, as adjuvant in asphyxia neonatorum; 7. in douche, as an agent for inducing abortion. 865. (a) Describe the knee-chest posture, and (b) state its obstetric applications. (September, 1901.) 865. (a) King's Manual of Obstetrics, page 515; (b) King's Manual of Obstetrics, page 152; Retroversion, prolapsus funis, page 515; precipitate labor. 106 OBSTETRICS^ 866. State the medico-legal complications that may arise from an erroneous diagnosis of pregnancy. (September, 1899.) 866. King's Manual of Obstetrics, pages 102, 103, 589 and 593. In addition the paternity of the child is involved, as also the mother's right to demand from the father sup- port for the child. 867. How many cases of labor have you attended, assisted at, or witnessed? Describe the most complicated case that you have delivered. {May, 1900.) 868. State hoiv mayiy cases of labor you have attended without professional assistance. Describe the most., com- plicated case that you have delivered. (June, 1900.) 869. How many cases of labor have you attended, assisted at, or witnessed? Describe the most complicated case that you have delivered. (September, 1900.) 870. How many cases of labor have you conducted inde- pendently? Give a brief description of the most complicated case. (January, 1901.) APPENDIX. Questions asked January, 1903. 871 . Give in consecutive detail the jjhysiological phenomena pertaining to reproduction of the species. 871. See Q. 43 to 78, (e), (g), and (1). 872. Give (a) the prohahle symptoms of pregnancy before quick&iiing, (b) the positive symptoms of jwegnancy after four and one-half months. 872. (a) King's Manual of Obstetrics, page 116, ^' first five,'' and Hegar's sign; (b) pages 103 and 104, omitting Hegar's sign. 873. (a) Mention the symptoms of approaching labor and (b) state the preparations that should be made when they occur. 873. (a) See Q. 272 and 273; (b) See Q. 287 and 288. 87 J},. Describe the management of three important abnormal presentations. 874. See Q. 430 to 469. 875. Mention the principal causes of sterility in woman, and state whoi may be done to promote fertility. 875. See Q. 852 to 859. 876. Define puerperal eclampsia. State the probable causes, the symptoms, and the management of puerperal eclampsia. 876. See Q. 630 to 648. 877. What is cystitis? State the causes of cystitis in the female and give its treatment. 877. Crockett's Gynecology, pages 146 to 150. (107) 108 APPENDIX. 878. State the principal causes of puerperal infection. What means should he taken to prevent puerj)eral infection? 878. See Q. 749 to 770. 879. Give the symptoms, diagnosis, and treatment of inversion of the uterus. 879. See Q. 560 to 564. 880. (a) Enumerate some of the most frequent causes of dystocia, and (b) differentiate uterine inertia and obstructed labor. 880. fa) See A. 470 to 486 (d) ; (b) See Q. 486 to 496, and Q. 511 to 514. 881. (a) Mention the important diameters of the foital head at term and give their measurements, (b) State similar diameters, with measurements, of the bony pelvis. 881. (a) See A. 109 to 118 fd) ; (b) See A. 100 to 108 (i). 882. Describe in detail the liquor amnii and give its functions. 882. See Q. 268 to 271. 883. Describe a condition requiring the use of an anaes- thetic during labor. State the kind of ancesthetic preferred and give the method of administering it. 883. See Q. 346 to 359. 884. Mention the forms of asphyxia neonatorum and give methods of resuscitation. 884. See Q. 382 to 390. 885. (a) How may the date of labor be estimated? (b) What medico-legal complications may result from an erroneous diagnosis of pregnancy? 885. (a) See Q. 174 to 176 fb) ; (b) See Q. 866. 109 APPENDIX. Questions asked May, 1903. 886. (a) Give an anatomical description of the uterus, (b) including the arrangement of its muscular fibres. 886. (a) See Q. 8 and 9; (b) ^'The uterus is essentially a muscular organ. It is lined with mucous membrane and partially invested with peritoneum. Its walls are of an average thickness of three-eighths of an inch. Though the fibres interlace in such a manner as to be inseparable except in the gravid uterus, anatomists are almost univer- sally agreed that they are arranged m three distinct layers. They are of the unstriated or involuntary variety, and have interpose'd between them connective-tissue cells. The external muscular layer or stratum is exceedingly thin, and can be demonstrated upon such parts of the uterus onty as are covered by the peritoneum, and with this it is intimately connected. The fibres of this layer pass from the anterior and the posterior surfaces and from the fundus upon the Fallopian tubes, the round and the ovarian ligaments, and accompany such parts of the peritoneum as form the broad and the utero-sacral ligaments. The internal muscular layer is so intimately connected with the mucous membrane as to be, by some, described with it, for, except in the cervix, there exists in the uterus no submucosa. The fibres of this layer have a chcular arrangement. They are augmented at the orifices of the Fallopian tubes, at the os externum, and at the os internum. Those at the os internum are considered as forming a s])hincter muscle. The middle muscular layer constitutes much the greatest part of the structm^e of the uterus, and is continuous with the muscular coat of the vagina. It is of an average thickness of one-quarter of an inch. The fibres have no definite arrangement, but interlace in every direction. They develop in size enormoush^ during gesta- tion. This stratum is exceeclingty vascular." (Jewett's Practice of Obstetrics.) 13 110 APPENDIX, 887. Describe physiologically the impregnation of the ovum. 887. See Q. 43 to 62 (e), and (g). 888. Mention the average duration of 'pregnancy and state the methods by which the date of labor may be prognosticated. S^^. See Q. 174 to 179 (b), and (c), 889. Give the causes, symptoms, and treatment of asphyxia neonatorum. 889. See Q. 383. 890. Give the treatment of the pernicious vomiting of preg- nancy. 890. See Q. 192 to 198 (b). 891. Under what conditions is version indicated? What methods are used in the operation? 891. See Q. 697 to 711. 892. Describe the knee-chest posture and merdion some of the reasons for its employment. 892. See Q. 865. 893. How should a woman in the puerperal state be catheterized? 893. See Q. 363. 894. Describe in detail the delivery of the placetita accord- ing to the method of Crede. 894. See Q. 318, 321 and 322. 895. Describe and differentiate hydrosalpinx, pyosalpinx, hcemato salpinx. 895. Crockett's Gynecology, pages 112 to 116, and table on page 111. » 896. Give the approximate length of the foetus at the sixth, the seventh, the eighth, and the ninth calendar months of ges- tation. 896. King's Manual of Obstetrics, page bS^. Ill APPENDIX. 897. Give the management of a case of rigidity of the os uteri during labor. 897. See Q. 501 to 504 (b). 898. State when obstetric ancesthesia is admissible. How should the ancesthetic be administered? 898. See Q. 346 to 349. 899. How may laceration of the cervix be recognized and how shoidd it be treated? 899. See Q. 578; and King's Manual of Obstetrics, page 473. 900. Mention the dangers of puerperal sepsis and give its prophylactic treatment. 900. See Q. 749 to 770. Questions asked June, 1903. 901. Give the anatomy of the female reproductive organs. 901. See Q. 17 and 18. 90S. (a) Mention the several processes relating to fecun- dation, (b) including the changes in the ovum following fertilization. 902. (a) See Q. 43 to 78 (g) ; (b) See Q. 43 to 78 (1). 903. Describe the foetal circulation. 903. King's Manual of Obstetrics, page 101. 904. Describe the changes that occur in the genital organs after pregnancy. 904. See Q. 123. 905. (a) Define multiple pregnancy, (b) State the causes and signs of multiple pregnancy and show how it may compli- cate labor. 905. (a) See Q. 525 (a); (b) See Q. 528 to 534 (b), and (d); for the ''causes" see King's Manual of Obstetrics, page 478. 112 APPENDIX. 906. Describe the mechanical and the surgical treatment of retrodisplacement of the uterus. 906. Crockett's Gynecology, pages 248 to 259. 907. Give (c) the symq)toms, (a) varieties, and dangers of -placenta prcevia. (b) State the methods of dealing with placenta prcevia. 907. See Q. 579 to 594; for ^'dangers" see King's Manual of Obstetrics, page 443. 908. Give the causes, pathology, symptoms, diagnosis, and treatment of vaginitis. 908. Crockett's Gynecology, pages ^^ to SS. 909. Give the causes, pathology, symptoms, diagnosis, and treatment of chronic simple endometritis. 909. Crockett's Gynecology, pages 98 to 110. 910. Define vaginismus and give its causes, pathology, and treatment. 910. See Q. 806 to 808. 911. Describe the classic Ccesarean section, give its modifica- tions and state the indications for the application of each. 911. See Q. 720 to 725. 91S. How may it be ascertained that a fibroid tumor complicates labor? Give the management of this condition. 912. King's Manual of Obstetrics, pages 508 and 509. 913. Under what conditions is version to be performed? Give the technique of version. 913. See Q. 697 to 711. 914. Define pelvimetry and state its purpose. Describe the technique of pelvimetry. 914. See Q. 547 and 548. 915. Give the symptoms, diagnosis, and treatment of rupture of the uterus complicating labor. 915. See Q. 565 to 577. SECOND EDITION. THOROUGHLY REVISED JEWETT'S OBSTETRICS The Pkinciples and Pbactice of Obstetrics. By Eminent American Authors. Edited by Charles Jettett, M.D., Professor of Obstetrics in the Long Island College Hospital, Brooklyn, X. Y, In one handsome octavo volume of 775 pages, with 44-5 engravings in black and colors and 36 full- page colored plates. Cloth, SS.OO, net; Leather, $6.00, net ; Half moroeeo, $6.50, net Dr. Jewett, the editor, has long been recognized as a keen and scientific observer, an accurate, forcible and concise writer, as well as a most successful teacher of obstetrics. It is pre-eminently a practical treatise, suited to the needs of medical classes, while, at the same time, it furnishes a concise, ccmprehensive and trustworthy guide to the practi- tioner. We regard this as being one of the most scientific and thoroughly modem treatises upon this important subject in use to-day. — American Gynecological and Obstetrical Journal. KING'S MANUAL OF OBSTETRICS NINTH EDITION A Maxuai, of Obstetrics By A. F. A. King, M.D., Professor of Obstetrics and Diseases of Women in the Medical Department of the Colum- bian University, Washington, D.C., and in the University of Vermont, etc. Eighth and revised edition 12mo. , 622 pages, with 275 illustrations. Cloth, $2. SO, net From first to finish it is thoroughly practical, concise in expression, well illustrated, and includes a statement of nearly every fact of importance discussed in obstetric treatises. The well-arranged index renders the book useful to the practitioner who is in haste to refresh his memory or learn a fact. — Georgia Journal of Medicine and Surgery. It is the best of its kind, an eminently practical handbook on midwifery, and fully up to date. — The Chicago Medical Recorder. FINDLEY'S GYNECOLOGICAL DIAGNOSIS A Text-Book of Gynecological Diagnosis, for the Use of Prac- titioners AND Students. By Palmer Findley, M.D., Associate in Obstetrics and Gynecology in Rush Medical College, Chicago. Octavo, 493 pages, with 210 engravings and 45 plates, in black and colors. Cloth, $4. SO, net; Leather, $S SO, net CROCKETT'S GYNECOLOGY A Pocket Text- Book of Diseases of Women. By Montgomery A. Crockett, A.B., M.D. , Adjunct Professor of Obstetrics and Clinical Gyne- cology, Medical Department, University of Buffalo, N. Y. In one 12mo. volume of 368 pages, with 107 illustrations. Cloth, $l.SO, net; Flexible Leather, $2.00, net LecCs Series of Pocket Text-Books, edited by Bern B. Gallaudet, M.D. For sale by all dealers in Medical Books or sent carriage paid to any address on receipt of price. LEA BROTHERS & CO. PUBLISHERS 706-8-10 SANSOM STREET 111 FIFTH AVENUE PHILADELPHIA NEW YORK Annex