Columbia ^nifaergitp intljeCitpofjaetogorfe COLLEGE OF PHYSICIANS AND SURGEONS Reference Library Given by ^ Hr;:7^n^^A state Boar& lEiamlnation Scries. QUESTIONS IN PHYSIOLOGY AND HYGIENE 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 gynecologist, demilt dispensary; instructor in gynecology at the new york school of clinical medicine; chief of the gynecological clinic at the west side german dispensary; and late attending physician, bellevue dispensary, new york. LEA BROTHERS & CO., NEW YORK A^vD PHir^ADELPHI A. ■ Entered according to the Act of Congress, in the year 1905, 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 facta 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 with 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 careful 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. A. PHYSIOLOGY. PAGE I. The Phexomexa of Life. 1. Human Physiology (Q. 1 and 2) . . . . ' 18 2. Life and Death (Q. 3) 18 3. Protoplasm (Q. 4 to 9) 18 4. Cells (Q. 10 to 23) 19 II. The Structure of the Elementary Tissues. 1. Epithelial Tissues (Q. 24 to 31) . . . . 20 2. Connectiye Tissues . . .... 22 (a) Fibrous (Q. 32 to 38). (h) Cartilage (Q. 39 to 43). (c) Bone (Q. 44 to 48). - 3. The Teeth (Q. 49 to 54) 31 4. Muscular Tissues (Q. 55 to 61) . . . . 35 5. Nervous Tissues (Q. 62 to 64) . . . . 36 III. The Chemical Composition of the Body (Q. 65) . . 36 lY. The Blood and the Circulation. 1. The Blood 36 (a) Plasma and Coagulation of the Blood (Q. 66 to 81). (6) Corpuscles (Q. 82 to 90). (c) Haemoglobin (Q. 91 and 92). (d) Stains (Q. 93). (e) Arterial and Venous Blood (Q. 94 to 97). (/) Uses of the Blood (Q. 98 to 102). 2. The Circulation of the Blood (Q. 103 to 119) . . 41 3. The Heart 45 (a) Topography and Structure (Q. 120 to 124). (b) The Sounds of the Heart (Q. 125 to 131). (c) The Impulse of the Heart (Q. 132 to 137). (d) Blood Pressure (Q. 138 to 140). (e) The Pulse (Q. 141 to 144). 4. The Bloodvessels ...... 50 (a) Structure (Q. 145 to 151). (b) Venous Flow (Q. 152 and 153). (c) Variations in the Composition of the Blood (Q. 154 and 155). (d) The Erectile Tissues (Q. 156). V. Respiration. 1. The Respiratory Apparatus (Q. 157) ... 53 2. The Respiratory Mechanism (Q. 158 to 175) . . 53 3. Respiratory Changes ...... 55 (a) In the Blood and the Circulation (Q. 176 to 183). (6) In the Air Breathed (Q. 184 to 190). vi CONTENTS. PAGE 4. Quantity of Air Required (Q. 191 to 194) . . 57 5. Asphyxia, Dyspnoea, Syncope, etc. (Q. 195 to 203) . 57 6. The Respiratory Centre (Q. 204 and 205) . . 60 7. Respiration a Proof of Live Birth (Q. 206) . . 60 VI. Digestion, Food, and Nutrition. 1. Digestion . . . ..... 61 (a) Deglutition (Q. 207 to 210). {h) The Epiglottis (Q. 211). (c) The Saliva (Q. 212 to 215). id) The Stomach (Q. 216 to 228). (e) Vomiting (Q. 229). (/) The Pancreas (Q. 230 to 240). (gr) The Liver (Q. 241 to 258). Qh) The Intestines (Q. 259 to 279). 1%) The Digestion of Food (Q. 280 to 288). 2. Absorption ....... 75 (a) Methods of Absorption (Q. 289 to 295). {h) Digestive Fluids and Ferments (Q. 296 to 300). (c) The Feces (Q. 301 to 303). Id) Rectal Feeding (Q. 304 and 305). 3. The Lymphatic System ..... 79 \a) The Lymph Flow (Q. 306 to 316). (6) The Lymph and Chyle (Q. 317 to 321). 4. Foods 81 (a) Classification of Foods (Q. 322 to 326). (6) Objects of Cooking Food (Q. 327 to 331). (c) Food Values (Q. 332 and 333). {d) Alcohol (Q. 334 to 336). (e) Influence of Food on Nutrition (Q. 337 to 339). (/) Milk, and Infant Feeding (Q. 340 to 349). ig) Diet in Old Age (Q. 350 and 351). Qi) Variations in Diet (O. 352 to 357). {%) Obesity (Q. 358 to 365). VII. Excretion. 1. The Kidnevs and the Urine . . . . . 91 (a) the Kidneys (Q. 366 to 368). (6) Excretion of the Urine (Q. 369 to 375). (c) The Urine (Q. 376 to 381). {d) Urea (Q. 382 to 384). 2. The Skin 94 (a) The Functions of the Skin (Q. 385 to 390). (6) Perspiration (Q. 391 to 393). VIII. Metabolism of the Tissues. 1. Muscular Metabolism ...... 95 (a) Muscular Contraction (Q. 394 to 404). (&) Rigor Mortis (Q. 405 to 409). 2. Glandular Metabolism (Q. 410 to 432) ... 97 3. The Ductless Glands (Q. 433 to 438) . . .100 cox TEXTS. vii PAGE IX. Animal Heat (Q. 439 to 454) 101 X. The Productiox of the Voice (Q. 455 to 464) . . 104 XI. The Nervous System. 1. The Spinal Cord and its Xerves .... 106 (a) Classification of Xerves (Q. 465 and 466). (6) Reflex Action (Q. 467 to 475). (c) The Spinal Cord and Spinal Xerves (Q. 476 to 486). (d) The Vasomotor Xerves (Q. 487 and 488). (e) The Medulla Oblongata (Q. 489). 2. The Cranial Xerves 112 (a) II. Xerve (Q. 490). (6) III. Xerve (Q. 491 and 492). (c) IV. Xerve (Q. 493). (d) V. Xerve (Q. 494). (e) VI. Xerve (Q. 495). (/) VII. Xerve (Q. 496). (g) IX. Xerve (Q. 497). (h) X. Xerve (Q. 498 to 501). (i) General (Q. 502 and 503). 3. The Cerebrum 113 (a) The Membranes (Q. 504). (6) The Cerebrospinal Fluid (Q. 505). (c) The Functions of the Cerebnmi (Q. 506 to 510). (d) The Motor Areas (Q. 511 and 512). (e) The Sensory- Centres (Q. 513 to 515). (/) The Centre^for Speech (Q. 516 and 517). 4. Sleep (Q. 518 to 524) 115 5. The Cerebellum (Q. 525 to 527) . . . .118 6. The Sympathetic System (Q. 528 to 532) . .118 XII. The Senses. 1. Common Sensations . . . . .119 (a) Pain (O. 533 and 534). (b) Hunger and Thirst (Q. 535). 2. Special Sensations . . . . . .120 (a) General (Q. 536). (6) Touch (Q. 537). (c) Smell (Q. 538 to 540). (d) Hearing (Q. 541 to 551). (e) Sight (Q. 552 to 564). XIII. The Reproductive Organs. 1. Female (Q. 565 to 577) 124 2. Male (Q. 578 to 585) 121) XIV. Miscell.\neous (Q. 586 to 604) 127 VIU CONTENTS. B. HYGIENE. I, Diseases in General (Q. 605 to 624) II. Special Diseases 1. Diphtheria (Q. 625 to 633) 2. Tuberculosis (Q. 634 to 640) 3. Tj^phoid Fever (Q. 641 to 647) 4. Scarlet Fever (Q.. 648 and 649) 5. Miscellaneous (Q. 650 to 655) 6. Scurvy (Q. 656) 7. Heat Stroke (Q. 657) 8. Yellow Fever (Q. 658) . 9. Cholera (Q. 659) . 10. Bubonic Plague (Q. 660) 11. Influenza (Q. 661) 12. Pregnancy (Q. 662 and 663) III. Food and Beverages. 1. Tea (Q. 664 to 666) 2. Coffee (Q. 667) 3. Butter (Q. 668 and 669) 4. Milk (Q. 670 to 680) 5. Meat (Q. 681) IV, Alcohol and Tobacco. 1. Alcohol (Q. 682 to 686) 2. Tobacco (Q. 687 to 690) V. Water and Ice. 1. Water (Q. 691 to 716) . 2. Ice (Q. 717 to 721) VI. Air and Ventilation (Q. 722 to 726) VII. Personal Hygiene. 1. Bathing (Q. 727 to 732) 2. Exercise (Q. 733 to 740) 3. Clothing (Q. 741 and 742) VIII. Occupation (Q. 743 to 750) IX. Habitations (Q. 751 to 769) X. Schools (Q. 770 to 787) . XI. Hospitals (Q. 788 to 794) XII. Disposal of Sewage (Q. 795 to 810) XIII. Disinfection (Q. 811 to 828) XIV. Vaccination (Q. 829 to 835) XV. Quarantine (Q. 830 to 843) XVI. Disposal of the Dead (Q. 844 to 846) XVII. Vital Statistics (Q. 847 to 851) . XVIII. Miscellaneous (Q. 852 to 870) . Appendix. Questions asked January, 1903 (Q. 871 to 885) Questions asked May, 1903 (Q. 886 to 900) . Questions asked June, 1903 (Q. 901 to 915) . Questions asked September, 1903 (Q. 916 to 930) Questions asked January, 1904 (Q. 931 to 945) Questions asked May, 1904 (Q. 946 to 960) . Questions asked June, 1904 (Q. 961 to 975) . Questions asked September, 1904 (Q. 976 to 990) PAGE 133 PHYSIOLOGY AND HYGIENE. Works to which the References in the Text Apply. COLLINS AND ROCKWELL'S PHYSIOLOGY. EGBERT'S HYGIENE AND SANITATION. Third edition. Quotations have been made from the following works: BACON'S MAxVUAL OF OTOLOGY. Third edition. CHAPMAN'S PHYSIOLOGY. Second edition. DUANE'S MEDICAL DICTIONARY. DUNGLISON'S MEDICAL DICTIONARY. Twenty-third edition GRAY'S ANATO:\IY. Fifteenth edition. GUENTHER'S EPITOME OF PHYSIOLOGY. HALL'S TEXT-BOOK OF PHYSIOLOGY. HARE'S PRACTICAL THERAPEUTICS. Tenth edition. HARRINGTON'S PRACTICAL HYGIENE. Second edition. KING'S ^L\NUAL OF OBSTETRICS. Ninth edition. SCHAFER'S ESSENTIALS OF HISTOLOGY. SIMON'S CLINICAL DIAGNOSIS. Fifth edition. THOMPSON'S PRACTICAL MEDICINE. Second edition. The following ahhreviations are used in the succeeding pages: et seq. = and following (page or pages). Q. = question. A. = answer. (17) PHYSIOLOGY AND HYGIENE. A. PHYSIOLOGY. I. THE PHENOMENA OF LIFE. 1. Define human physiology. {May, 1896.) 2. Define human physiology. (May, 1899.) 1 and 2. Human physiology is that branch of science which treats of the functions of the various tissues and organs of the human body in a state of health. 3. Define (a) life and (b) death. {May, 1894.) 3. (a) Life has been defined as the sum of the properties that enable an organism to adapt itself to surrounding conditions. In Dunglison's Medical Dictionary, Life is defined as "the state of organized beings, during which, owing to the union of an unknown force with matter, they are capable of performing functions different from those that regulate other natural bodies/' (b) Death is ^'the complete and permanent cessation of functional activity." (Duane's Medical Dictionary.) 4. (a) What is understood hy protoplasm and (b) what are its physical properties? {January, 1896.) 5. (h) What are the physical properties of protoplasm? {April, 1897.) 6. (b) What are the properties of protoplasm? {May, 1895.) 7. (b) What are the physiological characteristics of proto- plasm? {April, 1896.) 8. (b) What are the physiological characteristics of proto- plasm? {September, 1898.) (18) 19 PHYSIOLOGY AND HYGIENE. 9. (c) Of ivhat forms of activity is primary tissue capable? Illustrate. (June, 1901.) 4 to 9. (a) Collins and Rockwell's Physiology, page 22; (b) pages 22 and 23; (c) pages 22 and 23. 10. Describe an amoeba. {January, 1894.) 10. Collins and Rockwell's Physiology, pages 22 and 23. 11. (a) Define physiologically the term cell, (b) Hoiu are cells reproduced? {April, 1899.) 12. (b) How are cells reproduced? {November, 1894.) 13. (c) Illustrate by diagram or otherwise the structure of a cell. {May, 1902.) 14. (d) Describe cell growth. {September, 1896.) 15. (d) Describe cell growth. {September, 1898.) 16. Describe (c) the structure and (d) the growth of cells. {May, 1897.) 17. (d) Describe the growth and assimilation of cells. {May, 1896.) 18. (e) Mention and describe three varieties of cells according to shape. {January, 1900.) 19. (f) Mention three varieties of cells according to situation in the body. {September, 1899.) 20. (g) How are cells connected? {September, 1895.) 21. (h) Describe the decay and death of cells. {May 1895.) 11 to 21. (a) Collins and Rockwell's Physiology, page 19; (b) pages 20 and 21; (c) see Fig. 1; and Collins and Rockwell's Physiology, pages 18 to 20; (d) pages 20 and 21. (e) '^From their shape, cells are called spherical or spheroidal, which is the typical shape of the free cell; this may be altered to polyhedral when the pressure on the cells in all directions is nearly the same ; of this the primi- tive segmentation cells afford an example. The discoid form is seen in blood corpuscles, and the scale-like form in superficial epithelial cells." (Kirkes' Physiology.) (f) Collins and Rockwell's Physiology, pages 23 and 24; (g) 20 PHYSIOLOGY AND HYGIENE. cells are connected (1) by the anastomosing of their pro- toplasmic processes, and (2) by intercellular substance, which cements them together; (h) Collins and Rockwell's Physiology, page 21. Attraction sphere enclosing the centrosomea. ■ r-,^*'"--i •...-» -j^. f Plasmosome or trueJ;nucleolus. Chromatin- - network. 3 Linin-network. Karyosonie or net-knot. Plastids lying^ in the cyto- plasm. >'C 0-' >-/^ i..\uy--'y*. .Vacuole. Lifeless bodies (metaplasm) suspended in the cytoplas- mic reticulum. Fig. 1. — Diagram of a cell. (After Wilson.) ^2. Describe the development of the nuclei of cells. (June^ 1893.) 22. Collins and Rockwell's Physiology, page 20. 23. What is metaholismf {January, 1899.) 23. Collins and Rockwell's Physiology, page 18. II. THE STRUCTURE OF THE ELEMENTARY TISSUES. 1. Epithelial Tissues. 24. (a) Describe epithelium, (b) Mention varieties of epithelium, (c) State the function of epithelium. {June, 1900.) 21 . PHYSIOLOGY AND HYGIENE. 25. Describe epithelium as to (d) origin, (e) shape, (f) location, (c) function. (September, 1901.) 26. (c) What are the functions of epithelium? {January, 1898.) 24 to 26. (a) Collins and Rockwell's Physiology, page 23; (b) page 23; (c) page 24; (d) epithelium originates from the epiblast or hypoblast; endothelium from the mesoblast; (e) Collins and RockwelFs Physiology, page 23; (f) pages 23 and 24; and see Q. 886. 27. Name, locate, and give the function of each of the varieties of epithelia. {September, 1896.) 28. Give the principal location of the different varieties of epithelium. {April, 1899.) 29. Give the functions and locality of each of the different varieties of epithelia. {November, 1893.) 27 to 29. Collins and RockwelFs Physiology, pages 23 and 24. 30. (a) Describe ciliated epithelium and (b) state where it is found most abundantly, (c) What is the function of ciliated epithelium? {April, 1898.) 30. (a) Collins and Rockwell's Physiology, page 24. (b) ^'The situations in which ciliated epithelium is found in the human body are : the respiratory tract from the nose downward to the smallest ramifications of the bronchial tube (except a part of the pharynx and the surfgtce of the vocal cords), the tympanum and Eustachian tube, the Fallopian tube and upper portion of the uterus, the vasa efferentia, coni vasculosi, and the first part of the excretory duct of the testicle, and the ventricles of the brain and central canal of the spinal cord.'' (Gray's Anatomy.) (c) Motion and protection. 31. (a) Describe ciliary motion] (b) describe protoplasmic movement. {April, 1895.) 31. (a) ''When Hving ciliated epithelium is examined under the microscope, the cilia are seen to be in constant 22 PHYSIOLOGY AND HYGIENE, rapid motion, each cilium being fixed at one end, and swinging or lashing to and fro. The general impression given to the eye of the observer is very similar to that produced by waves in a field of corn, or swiftly running and rippling water, and the result of their movement is to produce a continuous current in a definite direction, and this direction is invariably the same on the same surface, being always, in the case of a cavity, toward its external orifice/' (Kirkes' Physiology.) (b) Collins and Rockwell's Physiology, page 22. 2. Connective Tissues. 32. Define connective tissue. Mention and describe the different varieties of connective tissue. (May, 1897.) 33. What is the function of connective tissue? {June, 1898.) 32 and 33. '' Connective tissues are a group of tissues forming the skeleton with its various connections — bones, cartilages, and ligaments — and affording a supporting framework and investment to the various organs com- posed of nervous, muscular, and glandular tissues. They are classified as follows (Kirkes): I. The Fibrous Connective Tissues. 1. Chief Forms. White fibrous tissue. Elastic tissue, Areolar tissue. 2. Special Varieties. Gelatinous tissue. Adenoid or retiform tissue. Neuroglia, Adipose tissue. 11. Cartilage. III. Bone. All the varieties of connective tissue are made up of two elements — cells and intercellular substance.'' (Dunglison's Medical Dictionary.) And see Collins and Rockwell's Physiology, page 24. 23 PHYSIOLOGY AND HYGIENE. 34' Differentiate white fibrous tissue and yellow elastic tissue as to (1) structure, and (2) distribution. {May, 1898.) 34. '^The white fibrous tissue is a true connecting structure, and serves three purposes in the animal economy. In the form of Hgaments it serves to bind bones together; in the form of tendons it serves to connect muscles to bones or other structures, and it forms an investing or protecting structure to various organs in the form of membranes. Examples of where it serves this latter office are to be found in the muscular fascise or sheaths, the periosteum, and perichondrium; the investments of the various glands (such as the tunica albuginea testis, the capsule of the kidney, etc.), the investing sheath of the nerves (epineurium), and of various organs, as the penis and the eye (sheath of the corpora cavernosa and •corpus spongiosum, and of the sclerotic). In white fibrous tissue, as its name implies, the white fibres predominate, the matrix being apparent only as a cement-substance, the yellow elastic fibres comparatively few, while the tissue cells are arranged in a special manner. It presents to the naked eye the appearance of silvery-white, glistening fibres, covered over with a quantity of loose, flocculent tissue which binds the fibres together and carries the bloodvessels. It is not possessed of any elasticity, and only the very slightest extensibility; it is exceedingly strong, so that upon the application of any external violence the bone with which it is connected will fracture before the fibrous tissue will give way. In ligaments and tendons the bundles run parallel with each other; in membranes they intersect one another in different places. The cells occurring in white fibrous tissue are often called Hendon cells.' They are situated on the surface of groups of bundles and are quadrangular in shape, arranged in rows in single file, each cell being separated from its neighbors by a narrow line of cement-substance. The nucleus is generally situated at one end. "Yelhw Elastic Tissue. — In certain parts of the body 24 ' PHYSIOLOGY AND HYGIENE, a tissue is found which when viewed in mass is of a yellowish color, and is possessed of great elasticity, so that it is capable of considerable extension, and when the extending force is withdrawn returns at once to its original con- dition. This is yellow elastic tissue, w^hich may be regarded as a connective tissue in which the yellow elastic fibres have developed to the practical exclusion of the other elements. It is found in the ligament a subflava, in the vocal cords, in the longitudinal coat of the trachea and bronchi, in the inner coats of the bloodvessels, especially the larger arteries, and to a very considerable extent in the thyrohyoid, cricothyroid, and stylohyoid ligaments. It is also found in the ligamentum nuchse of the lower animals. In some parts, where the fibres are broad and large and the network close, the tissue presents the appear- ance of a membrane, with gaps or perforations correspond- ing to the intervening space. This is to be found in the inner coat of the arteries, and to it the name of fenestrated membrane has been given by Henle.'' (Gray's Anatomy.) 35. (a) How is adipose tissue developed? (b) What is its use? (May, 1899.) 36. (b) Mention the chief uses of adipose tissue. (Sep- tember, 1902.) 37. (a) How are fat-cells developed? (January, 1898.) 38. (c) Where is fat stored in the body? (b) State the uses of fat. (September, 1899.) 35 to 38. (a) '^Adipose tissue consists of small vesicles, fat-cells, lodged in the meshes of areolar tissue. The fat- cells vary in size, but of about the average diameter of g-g-g- of an inch. They are formed of an exceedingly delicate protoplasmic membrane, filled with fatty matter, which is liquid during life, but becomes solidified after death. They are round or spherical where they have not been subjected to pressure; otherwise they assume a more or less angular outline. These fat-cells are contained in clusters in the areolae of fine connective tissue, and are 25 PHYSIOLOGY AND HYGIENE. held together mainly by a network of capillary blood- vessels which are distributed to them. The fat-cells are formed by the transformation of connective-tissue cor- puscles, in which small droplets of oil are formed; these coalesce to produce a larger drop, and this increases until it distends the corpuscle, the remaining protoplasm and the nucleus being crowded to the periphery of the cell.'' (Gray's Anatomy.) (b) To maintain the heat of the body by preventing its too rapid dissipation, as a packing material, as a protective, as a support for the small blood- vessels in the long bones, and to give form and roundness to the body, (c) Fat is chiefly found in the subcutaneous areolar tissue ancj under serous membranes; especially around the kidneys, in the omentum and mesentery, and around the heart. 39. (a) Give the varieties of cartilage, and (b) state their general distribution. (May, 1898.) Jfi. (a) In how many forms does cartilage exist? (c) What are the functions of cartilage? (September, 1898.) 41. (d) Describe the physical characteristics of cartilage. (e) What is temporary cartilage, permanent cartilage? Illustrate. {April, 1899.) Jj.2, How is cartilage (f) developed, (g) nourished? {June, 1897.) 43. (g) How is cartilage nourished? (c) Mention the functions of cartilage. {January, 1900.) 39 to 43. (a) The varieties of cartilage are (1) hyaline, in which the matrix is almost clear and has no fibres; (2) fibrocartilage, in which the matrix has connective-tissue fibres — and see (b) . (b) Hyaline cartilage is found covering the articular ends of the bones, where it is called articular cartilage; forming the cartilages of the ribs, where it is called costal cartilage; also in the trachea, larynx, nose, and external auditory meatus. Fibrocartilage is of two varieties: (1) the yellow or elastic, which is found in the epiglottis, the cartilages of Santorini (in the larynx), the 26 PHYSIOLOGY AND HYGIENE. external ear, the Eustachian tube; and (2) the white fibro- cartilage, which is found in the intervertebral disks, symphysis pubis, surrounding the margin of some articular cavities, as the glenoid cavity of the shoulder, and the cotyloid cavity of the hip, and occasionally in the tendons of some muscles, (c) '^ Cartilage not only represents in the foetus the bones which are to be formed (temporary cartilage), but also offers a firm, yet more or less yielding, framework for certain parts in the developed body, possess- ing at the same time strength and elasticity. It maintains the shape of tubes, as in the larynx and trachea. It affords attachment to muscles and ligaments; it binds bones together, yet allows a certain degree of movement, as between the vertebrae; it forms a firm framework and protection, yet without undue stiffness or weight, as in the pinna, larynx, and chest walls; it deepens joint cavities, as in the acetabulum, without unduly restricting the move- ments of the bones." (Kirkes' Physiology.) (d) -Hyaline cartilage is a firm, elastic, translucent substance, bluish- white in color, and consists of cells and intercellular substance; the intercellular substance may be granular or homogeneous; the cells are oval or spheroidal, with flattened sides, and are unevenly distributed in the base- ment membrane, generally lying in groups of two or four. In white fibrocartilage the intercellular substance is fibrillated. In the yellow or elastic variety the basement membrane is granular, yellowish, and opaque ; and the cells are surrounded by a capsule, consisting of a refractile substance, (e) ^^In the foetus at an early period the greater part of the skeleton is cartilaginous. As this carti- lage is afterward replaced by bone, it is called temporary, in contradistinction to that which remains unossified during the whole of life, and which is called permanent.^' (Gray's Anatomy.) (f) '^ Cartilage is developed out of an embryonal tissue, consisting of cells with a very small quantity of intercellular substance ; the cells multiply by fission within the cell-capsules, while the capsule of the parent cell 27 PHYSIOLOGY AND HYGIENE. becomes gradually fused with the surrounding intercellular substance. A repetition of this process in the young cells causes a rapid growth of the cartilage by the miitiplication of its cellular elements and corresponding increase in its matrix. Thus we see that the matrix of cartilage is chiefly derived from the cartilage cells." (Kirkes' Physiology.) (g) '' Hyaline cartilage is reckoned among the so-called non-vascular structures, no bloodvessels being supplied directly to its ow^n substance; it is nourished by those of the bone beneath. When hyaline cartilage is in thicker masses, as in the case of the cartilages of the ribs, a few bloodvessels traverse its substance." (Kirkes' Physiology.) 44' (a) Hoio is hone nourished? (b) How is cartilage nourished? (January, 1902.) 45. (a) How are hones nourished? (September, 1893.) 46. (a) How is hone nourished? (c) Give an example of the development of hone. (April, 1898.) 47. (d) Describe the development of hone from cartilage. (September, 1900.) 48. (e) Give the process of development of the parietal bone. (January, 1895.) 4:4: to 48. (a) ^'The bloodvessels of bone are very numerous. Those of the compact tissue are derived from a close and dense network of vessels ramifying in the periosteum. From this membrane vessels pass into the minute orifices in the compact tissue, running through the canals which traverse its substance. The cancellous tissue is supplied in a similar way, but by a less mmierous set of larger vessels, which, perforating the outer compact tissue, are distributed to the cavities of the spongy portion of the bone. In the long bones numerous apertures may be seen at the ends near the articular surfaces, some of which give passage to the arteries of the larger set of vessels referred to; but the most munerous and largest apertures are for the veins of the cancellous tissue, which run separately from the arteries. The medullary canal in the shafts of 28 PHYSIOLOGY AND HYGIENE. the long bones is supplied by one large artery (or some- times more), which enters the bone at the nutrient foramen (situated in most cases near the centre of the shaft) and perforates obliquely the compact structure. The medullary or nutrient artery, usually accompanied by one or two veins, sends branches upward and downward to supply the medullary membrane, which lines the central cavity and the adjoining canals. The ramifications of this vessel anastomose with the arteries both of the cancellous and compact tissues. In most of the flat and in many of the short spongy bones one or more large apertures are observed, which transmit, to the central parts of the bone, vessels corresponding to the medullary arteries and veins. The veins emerge from the long bones in three places (Kolliker) : (1) by one or two large veins, which accompany the artery; (2) by numerous large and small veins at the articular extremities; (3) by many small veins which arise in the compact substance. In the flat cranial bones the veins are large, very numerous, and run in tortuous canals in the diploic tissue, the sides of the canals being formed by a thin lamella of bone, perforated here and there for the passage of branches from the adjacent cancelli. The same condition is also found in all cancellous tissue, the veins being enclosed and supported by osseous structure and having exceedingly thin coats. ^' (Gray\s Anatomy.) (b) See Q. 39 to 43 (g). (c) ''True bone is essentially formed in all cases by an ossification of connective tissue. Sometimes the bone is preceded by cartilage, which first becomes calcified, and this is then invaded, and for the most part removed, by an embryonic tissue which re- deposits bony matter in the interior of the cartilage, while at the same time layers of bone are being formed outside underneath the periosteum. This is intracartilaginous or endochondral ossification. Sometimes the bone is not pre- ceded by cartilage, and then the only process which occurs is one corresponding to the subperiosteal ossification of the former variety ; the ossification is then known as intramem- 29 PHYSIOLOGY AND HYGIENE. branous." (Schafer's Histology.) (d) ''Ossification of carti- lage. This may be described as occurring in three stages. In the first stage the cells in the middle of the cartilage become enlarged and arranged in rows radiating from the centre, and fine granules of calcareous matter are deposited in the matrix. Simultaneously with this the osteoblasts under- neath the periosteum deposit a layer or layers of fibrous lamellae upon the surface of the cartilage, and these lamellae also become calcified. As they are formed, some of the osteoblasts are included between them and become bone corpuscles. In the second stage some of the subperiosteal tissue eats its way through the newly formed layer of bone and into the centre of the calcified cartilage. This is freely absorbed before it, so that large spaces are produced which are filled with osteoblasts and contain numerous blood- vessels which have grown in at the same time. The spaces are termed medullary spaces, and this second stage may be termed the stage of irruption. In the third stage of endo- chondral ossification there is a gradual advance of the ossification toward the extremities of the cartilage, and at the same time a gradual deposition of fresh bony lamellae and spicules on the walls of the medullary spaces, and on the surface of the new bone under the periosteum. The advance into the cartilage always takes place by a repetition of the same changes, the cartilage cells first enlarging and becoming arranged in rows, the matrix between the rows becoming calcified, and then the calcified cartilage becom- ing excavated from behind by the osteoblastic tissue so as to form new medullary spaces. The walls of these are at first formed only by remains of the calcified cartilage matrix, but they soon become thickened by lamellae of fibrous bone which are deposited by the osteoblasts, and between which bone corpuscles become included, as in the case of the subperiosteal bone. The latter advances pari passu with the endochondral calcification, but beyond this the uncalcified cartilage grows both in length and breadth, so that the ossification is always advancing into larger 30 PHYSIOLOGY AND HYGIENE. portions of cartilage; hence the endochondral bone, as it forms, assumes the shape of an hour-glass, the cylindrical shape of the whole bone being maintained by additions of periosteal bone to the outside. The absorption of the calcified cartilage matrix appears to be effected, as is the case with absorption of bony matter wherever it occurs, by large multinucleated cells which are termed osteoclasts. They are cells of the same nature as the myeloplaxes of the marrow, and are found on surfaces where absorption of bone is taking place, whereas the osteoblasts are always foimd covering surfaces where bony deposit is proceeding. The bone which is first formed is more reticular and less regularly lamellar than that of the adult, and contains no Haversian systems. The regular lamellae are not deposited until some little time after birth, and their deposition is generally preceded by a considerable amount of absorption. It is about this time also that the medullary canal of the long bones is formed by the absorption of the bony tissue which originally occupies the centre of the shaft. After a time the cartilage in one or both ends of the long bones begins to ossify independently, and the epiphyses are formed. These are not joined to the shaft until the growth of the bone is completed. Growth takes place in length by an expansion of the cartilage (intermediate cartilage) which intervenes between the shaft and the epiphyses, and by the gradual extension of the ossification into it ; in width entirely by the deposition of fresh bony layers under the periosteum. In the terminal phalanges of the digits the ossification starts, not from the middle of the cartilage, but from its distal extremity. For the regeneration of portions of bone which have been removed by disease or operation it is important that the periosteum be left." (Schafer's Histology.) (e) ' ' Intramembranous ossification. In this variety of ossification the bone is not preceded by cartilage at all, and therefore no endochondral bone is formed, but the calcification occurs in a sort of embryonic fibrous tissue which contains numerous osteoblasts and 31 PHYSIOLOGY AND HYGIENE. bloodvessels. The fibres of this tissue (osteogenic fibres), which, like those of fibrous tissue, are collected into small bundles, become enclosed in a calcareous matrix, produced by the deposition of lime salts in the ground-substance of the connective tissue, and as the fibres grow the calcifica- tion extends further and further, so that bony spicules are formed, which, as they become thickened, rim together to form reticular layers, leaving spaces filled with osteoblasts arotmd the bloodvessels. The osteogenic fibres are covered with osteoblasts, and as the bone forms some of these be- come left as bone corpuscles within lacunae. Thus, in every particular the development of these bones resembles that of the subperiosteal layer of endochondral bone, which is also to be considered as an instance of intramembranous ossification, although taking place on the surface of cartilage. Moreover, it is the same subperiosteal tissue which, in endochondral ossification, deposits the true or * secondary bone upon those parts of the calcified cartilage matrix which have escaped absorption; and this must also, therefore, be reckoned as developed according to the same type. In fact, even in intracartilaginous ossification, very little of the calcified cartilage matrix eventually remains; this being almost wholly absorbed and either replaced by true or fibrous bone which has been formed by osteoblasts, or swept away to form the medullary and other cavities. '^ (Schafer's Histology.) 3. The Teeth. 49. (a) Give the number and arrangement of the temporary or milk teeth. {January, 1898.) 50. (a) State the approximate time of eruption of the temporary teeth. {April, 1894.) 51 . (b) Give the number and arrangement of the permanent set of teeth, (c) State the particular use of each kind of teeth. {January, 1902.) 52. (d) Describe the growth and the development of the teeth. {January, 1899.) 32 PHYSIOLOGY AND HYGIENE. "53. (e) Give the process of replacement of temporary hy permanent'lteeth. (April, 1895.) ^54. (f) Describe the temporary and the permanent teeth. (June, 1899.) 49 to 54. (a) (b) Molan Canine Fig. 2. — Temporary teeth. (Time given in months.) Molars Bicuspids Canine Fig. 3. — Permanent teeth (Time given in years.) 33 PHYSIOLOGY AND HYGIENE. (c) The incisors are to hold and divide the food as it is taken into the mouth; the canines also divide the food; the bicuspids and molars triturate the food, the molars particularly being the teeth used in mastication, (d) ''The teeth are developed in the same manner as the hairs. A continuous thickening of the epithelium occurs along the line of the gums and grows into the corium of the mucous membrane {common dental germ, or dental lamina). At regular intervals there is yet a further thick- ening and growth from the common germ into the tissue of the mucous membrane, each of these special rudiments, which are ten in number, swelling out below into a flask- shaped mass of cells, the special dental germ of a milk tooth. The intermediate parts of the dental lamina long remain, forming a common epithelial strand uniting the several special dental germs to one another and to the epithelium covering the gum. A vascular papilla is con- tinued from the corium into the bottom of each special germ ; this papilla has the shape of the crown of the future tooth. Each special dental germ, with its included papilla, presently becomes almost entirely cut off from the epithe- lium of the mouth, and surrounded by a vascular mem- brane — the dental sac. The papilla becomes transformed into the dentine and pulp of the future tooth, and the enamel is deposited upon its surface by the epithelial cells of the dental germ. The root of the tooth, with its covering of cement, is formed at a later period, when the tooth is beginning to grow up through the gum by a gradual elongation of the base of the papilla. The shaping of this into the form of the root is determined by a growth of the epithelium of the dental germ, which extends in the form of a fold (the epithelium sheath of v. Brimn) towards the future apex of each fang. Previously to the deposition of the enamel, the dental germ undergoes a peculiar trans- formation of its previously polyhedral epitheHum cells into three layers of modified cells. One of these is a layer of columnar cells (adamantohlasts, or amelohlasts) , immediately 34 PHYSIOLOGY AND HYGIENE. covering the surface of the dentine. These columnar cells form the enamel prisms by a fibrous formation, followed by a deposition of calcareous salts external to the cells (or, as some hold, by a direct calcification of their proto- plasm). The cells next to the dental sac form a single layer of cubical epithelium and nearly all the other cells of the dental germ become transformed into branching corpuscles commimicating by their processes, and thus forming a continuous network. This part of the dental germ, after it is thus modified, is known as the enamel organ. The dentine of the tooth is formed by calcification of the surface of the papilla. At this surface there is a well-marked layer of odontoblasts, and these produce a layer of dentinal matrix which forms a sort of cap to the papilla, and which soon becomes calcified by the deposition of globules of calcareous matter. Processes of the odonto- blasts remain in the dentine as it is forming, and thus the dentinal tubules are produced. Subsequently other layers of dentine are formed within the first by a repetition of the same process, and in this way the papilla gradually becomes calcified. A part, however, remains unaltered in the centre of the tooth, and with its covering of odonto- blasts forms the pulp. The ten milk-teeth are formed in each jaw in this manner. These, however, become lost within a few years after birth, and are replaced by perma- nent teeth in much the same way that a new succession of hairs occurs. A small outgrowth takes place at an early period from the dental germ of each of the milk-teeth, and this eventually becomes the germ of the corresponding permanent tooth. It gradually enlarges, acquires a papilla, forms an enamel organ; in short, passes through the same phases of development as its parent germ; and, when the milk-tooth drops out of the jaw in consequence of the absorption of its roots (by osteoclasts) the permanent tooth grows up into its place. But there are six permanent teeth in each jaw which do not succeed milk-teeth; these are the permanent molars. They are developed from an extension 35 PHYSIOLOGY AND HYGIENE. (backwards of the original epithelial thickening or common dental germ and the downgrowth from this into the corium of three successive special germs at comparatively long intervals of time. Within these the tissues of the permanent molars become formed in a manner exactly similar to that in which the milk-teeth are develoyed/' (Schafer's His- tology.) (e) '^ Previous to the permanent teeth penetrating the gum, the bony partitions which separate their sacs from the deciduous teeth are absorbed, the roots of the temporary teeth disappear by absorption through the agency of particular multinucleated cells, called odonto- blasts, which are developed at the time in the neighborhood of the root, and the permanent teeth become placed under the loose crown of the deciduous teeth; the latter finally become detached, and the permanent teeth take their place in the mouth. '^ (Gray's Anatomy.) (f) See (a) to (e). 4. Muscular Tissues. 55. Describe the structure of (a) striated muscle, (b) non- striated muscle, (c) Which of these is called voluntary, and why? (January, 1901.) 56. (d) Differentiate voluntary and involuntary muscles. Illustrate. {June, 1898.) 57. (e) What are the functions of voluntary muscles? {January, 1892.) 58. (f) What are the functions of involuntary muscles f {January, 1892.) 59. (f) Mention the uses of the involuntary muscles. {March, 1893.) 60. (g) Name some of the involuntary muscles and the functions with which each is connected. {September, 1892.) 61. (h) What are the varieties of muscular tissue? (i) What peculiarity distinguishes the muscular fibres of the heart? {September, 1901.) 55 to 61. (a) Collins and Rockwell's Physiology, page 143; (b) page 142; (c) -page 142; (d) pages 142 to 144; 36 PHYSIOLOGY AND HYGIENE. (e) motion and locomotion ; (f ) motility of the walls of the structures in which they are found, and so to influence the passage of material through these structures; (g) involim- tary muscle is found in the oesophagus, stomach, intestines^ ureters, bladder, trachea, bronchi, gall-bladder, ducts of glands, uterus, Fallopian tubes, bloodvessels, skin; (h) CoUins and Rockwell's Physiology, page 142; (i) pages 142 and 144. 5. Nervous Tissues. 62. (a) Describe nerve cells and nerve tissue. (June, 1897.) 63. (b) Describe medullated nerve fibres. (May^ 1898.) 64. (b) Describe the component parts of a medullated nerve fibre. (June, 1895.) 62 to 64. (a) Collins and Rockwell's Physiology, pages 162 and 159; (b) pages 159 and 160. III. THE CHEMICAL COMPOSITION OF THE BODY. 65. Name the inorganic proximate principles that enter into the formation of the human body. {January, 1892.) 65. Collins and Rockwell's Physiology, page 26. IV. THE BLOOD AND CIRCULATION. 1. The Blood. 66. What is the composition of the liquor sanguinis? {April, 1893.) 66. See A. 947 (a). 67. What is the specific gravity of human blood? {June, 1893.) 67. Collins and Rockwell's Physiology, page 31. 68. Name some of the bodily states which lessen the alka- linity of the blood. {June, 1894.) 37 PHYSIOLOGY AND HYGIENE. 68. ^^The alkalinity of the blood may be decreased during health by (1) great muscular exertion, and (2) by exposure of the blood to the conditions of coagulation. Pathologically, the alkalinity of the blood may be decreased by (1) anaemia, (2) uraemia, (3) rheumatism, (4) high fever, (5) diabetes, (6) cholera.'^ (HalFs Text-hook of Physiology.) 69. (a) Describe human hlood. (b) What is the weight of the hlood as compared with the weight of the whole hodyf (January, 1898.) 70. (b) What proportion of the weight of the body is hlood? (June, 1896.) 71 . (b) How does the total weight of the body compare with that of the blood in the human system? (April, 1895.) 72. (b) What proportion does the weight of the blood hear to the weight of the entire body? (c) Give the use of the blood. (September, 1900.) 69 to 72. (a) Collins and Rockwell's Physiology, pages 30 et seq.; (b) page 32; (c) page 46. 73. (a) Describe the coagulation of hlood. (January, 1892.) 7J+. (a) Describe the coagulation of the hlood. (November, 1894.) 75. (a) Give a comprehensive description of the coagu- lation of blood. (May, 1895.) 76. (a) Relate the steps in the coagulation of hlood. (Sep- tember, 1896.) 77. (b) Give the cause of coagulation of hlood. (c) How long after death does blood coagulate in the body? (Sep- tember, 1902.) 78. (d) What conditions retard, suspend, or prevent the coagidation of blood? (April, 1895.) 79. (d) What conditions hasten the coagulation of hlood, and what means may he adopted to retard or prevent it? (September, 1897.) 73 to 79. (a) Collins and Rockwell's Physiology, pages 42 et seq.; (b) pages 43 and 44 ; (c) after death, the blood 38 PHYSIOLOGY AND HYGIENE. coagulates in the body in from twelve to twenty-four hours; (d) Collins and Rockwell's Physiology, page 43. 80. Why does blood remain fluid in the body in life and coagulate when shed? {May, 1896.) 80. Collins and RockwelFs Physiology, page 45. 81. (a) Give the process of coagulation of hlood. (b) Describe a white blood corpuscle. (April, 1898.) 81. (a) Collins and Rockwell's Physiology, pages 42 et seq.; (b) page 38. 82. (a) What is the usual difference in shape between the red corpuscles of the blood in the mammalia and those in the oviparaf {April, 1896.) 83. (b) Describe the red blood corpuscles, (c) Give the best known and most important function of the red blood corpuscles. {January, 1901.) 84' (c) State the functions of the red blood corpuscles and (d) mention their nurnber as compared with the mmiber^f the white blood corpuscles. {January, 1902.) 85. (d) Name the proportions of white to red corpuscles in human blood, (e) Describe each variety. (January^ 1896.) 86. (e) Describe a white blood corpuscle, (b) a red blood corpuscle, (d) What is the relative proportion of the white to the red corpuscles in human blood f {April, 1897.) 82 to 86. (a) Collins and Rockwell's Physiology, pages 32 to 34; (b) pages 32 and 33; (c) page 35; (d) page 32; (e) pages 38 and 32. 87. (a) What are the physical properties of the white blood corpuscles? {June, 1894.) 88. (a) Describe the white blood corpuscles and (b) their function. {June, 1892.) 89. (a) Describe the white blood corpuscles, giving (c) source, (d) composition, and (a) properties. {April, 1899.) 90. What are the accepted theories as to the origin of (e) the red blood corpuscles, (c) the white blood corpuscles P (May^ 1900.) 39 PHYSIOLOGY AND HYGIENE. \ 87 to 90. (a) Collins and Rockwell's Physiology, page 38; (b) page 40; (c) page 39; (d) page 39; (e) page 34. 91. (a) Describe hcemoglohin and (b) mention its deriva- tives. (Septeinber, 1898.) 91. (a) Hsemoglobin, the most important constituent of the red blood corpuscles, is a crystalline body, whose exact percentage composition has not been determined. In addition to carbon, hydrogen, oxygen, nitrogen, and sulphur it contains iron. It constitutes over 90 per cent, of the red blood corpuscles, and it is owing to this substance that these corpuscles are capable of carrying oxygen to the tissues of the body. It readily combines with oxygen to form oxyhsemoglobin; when not thus in combination it is called reduced haemoglobin or haemoglobin, (b) The chief derivatives are: oxy haemoglobin, methsemoglobin, carbon monoxide haemoglobin, nitric oxide haemoglobin, haematin, Iiaematoidin, haemin, haemochromogen, haemotoporphyrin. Bilirubin and urobilin are also derived from haemoglobin. 92. What is blood pigment? {March, 1892.) 92. Blood pigment is the coloring matter of the blood; see A. 91. 93. How can fresh blood stains be distinguished from older blood stains? (January, 1897.) 93. Fresh blood stains are of a bright-red color, contain haemoglobin, and may show corpuscles; but after a short time of exposure (anywhere from one to five or six days) the stain becomes reddish-brown or brown, and contains haematin crystals, recognizable in solution by their spectro- scopic absorption bands. 9 J}-, (a) What causes the difference in color of the arterial and the venous blood? (April, 1893.) 95. (b) What are the differences between arterial and venous blood? (July, 1893.) 96. (b) State the difference between arterial blood and venous blood, (c) Give the characteristics of the blood in the portal vein. (May, 1902.) 40 PHYSIOLOGY AND HYGIENE. 97. (d) Describe the physical appearance and character- istics of the blood, (b) Compare arterial blood with venous blood. (May, 1899.) 94 to 97. (a) Collins and Rockwell's Physiology, page 30; (b) Arterial Blood. Color. — Bright red, monochroic ; oxy hsemoglob in . Specific Gravity. — Less. Number of Corpuscles. — Relatively- less ; blood more diluted. Temperature. — Slightly warmer in general. Coagulation. — More coagulable. Fibrinogen. — More. General Composition — More uni- form. Gas. — More O, less COj. Water. — More. Urea and Extractives. — Less. Glucose . — More . Fat. — Less. Fibrin. — More. Serum Albumin. — Less. Salts. — More. Venous Blood. Purple, dichroic ; reduced haemo- globin. More. Relatively more ; blood more con- centrated. Slightly cooler, but exceptions; warmest blood in the body found in the hepatic vein. Less coagulable. Less, except in mesenteric vein. Numerous local variations. More COj: less O, except pulmo- nary veins. Less ; transudation of water through the capillaries causes venous blood to be more con- centrated. More ; except renal vein. Less. More. Less. More. Less. (From The Reference Handbook of the Medical Sciences.) (c) The blood in the portal vein contains more water and proteids, fewer red corpuscles, and on coagulation gives a less firm clot; and see A. 114 (c); (d) Collins and Rock- well's Physiology, pages 30 to 32. 98. Give (a) the composition, (b) reaction, and (c) uses of blood. (June, 1901.) 99. Describe briefly (a) the composition and (c) functions of the blood. (June, 1892.) 41 PHYSIOLOGY AND HYGIENE, 100. (c) What are the uses of the hlood? (April, 1894.) 101. (c) Name four uses of the hlood. {June, 1895.) 102. (d) What are the uses of the hlood serum? {June, 1892.) 98 to 102. (a) See A. to 947 (a) ; (b) Collins and Rock- well's Physiology, page 31; (c) page 46; (d) page 46. 2. The Circulation of the Blood. 103. Give (a) the uses of the hlood, (b) the normal circu- latory velocity of the hlood. {January, 1900.) 10 4 . (b) Compare arteries, veins, and capillaries in respect to rapidity of the hlood stream. {May, 1901.) 103 and 104. (a) See Q. 99 to 102 (c); (b) Collins and Rockwell's Physiology, page 57. 105. (a) Name the apparatus concerned in the main- tenance of the normal flow of hlood in the circulation. {No- vemher, 1893.) 106. (b) Descrihe the circulation of the hlood. {Novemher, 1892.) 107. (b) State the manner in which hlood circulates through the heart and the lungs, heginning at the right auricle. {May, 1901.) 108. (b) Descrihe the circulation of the hlood, commencing with the right auricle. {May, 1893.) 109. (b) Descrihe the circulation of the hlood, heginning at the left ventricle. {April, 1897.) 110. (c) Give the shortest course a drop of hlood can take in passing from the left to the right ventricle of the heart in normal circulation. {April, 1893.) 111. What causes (d) the circulation of the hlood, (e) the heating of the pxdsef {May, 1897.) 105 to 111. (a) Collins and Rockwell's Physiology, page 48; (b) pages 49 to 51. (c) The shortest course a drop of blood can take in passing from the left to the right ventricle of the heart is to leave the left ventricle, enter the aorta, 42 PHYSIOLOGY AND HYGIENE. then one of the coronary arteries, and, leaving it by one of its early branches, return to the right auricle by the coronary vein, then pass through the tricuspid valve into the right ventricle, (d) Collins and RockwelPs Physiology, page 56. (e) The beating of the pulse is caused by the contractions of the heart, the resistance produced by the friction of the blood in the vessels, and the elasticity of the walls of the bloodvessels. J 12. (a) Describe the circulation of the blood in the liver. {September, 1900.) 113. Describe (a) the portal circulation, (b) the pulmonary circulation. (May, 1900.) 114' Describe (b) the pulmonary blood circulation, (a) the portal blood circulation, (c) What changes take place in the character of the blood in each? (June, 1902.) 115. (a) Describe the portal circulation. {June, 1897.) 116. Describe (a) the portal circulation, (d) the renal circulation. {May, 1895.) 117. (e) Describe the foetal circulation. {June, 1892.) 118. (e) Describe the facial circulation. (June, 1898.) 119. (f) Give the physiological course of the blood through the heart, (e) Describe the foetal circulation. (January, 1901.) 112 to 119. (a) '^To understand the distribution of the bloodvessels in the liver, it will be well to trace, first, the two bloodvessels and the duct which enter the organ on the under surface at the transverse fissure, viz., the portal vein, hepatic artery, and hepatic duct. Running together through the substance of the liver, they are contained in small channels called portal canals, their immediate invest- ment being a sheath of areolar tissue continuous with Glisson's capsule. To take the distribution of the portal vein first : In its course through the liver this vessel gives off small branches which divide and subdivide between the lobules surrounding them and limiting them, and from this circumstance called mier-lobular veins. From these small vessels a dense capillary network is prolonged into the 43 PHYSIOLOGY AND HYGIENE. substance of the lobule, and this network gradually gather- ing itself up, so to speak, into larger vessels, converges finally to a single small vein, occupying the centre of the lobule, and hence called m^ra-lobular. The small intra- lobular veins discharge their contents into veins called suh-lohulai, while these again, by their union, form the main branches of the hepatic veins, which leave the pos- terior border of the liver to end by two or three principal trunks in the inferior vena cava, just before its passage through the diaphragm. The st^6-lobular and hepatic veins, unlike the portal vein and its companions, have little or no areolar tissue around them, and their coats being very thin, they form little more than mere channels in the liver substance which closely surrounds them. The hepatic artery, the chief function of which is to distribute blood for nutrition to Glisson's capsule, the walls of the ducts, and bloodvessels, and other parts of the liver, is dis- tributed in a very similar manner to the portal vein, its blood being returned by small branches either into the ramifications of the portal vein, or into the capillary plexus of the lobules which connect the inter- and intra- lobular veins. The hepatic duct divides and subdivides in a manner very like that of the portal vein and hepatic artery, the larger branches being lined by cylindrical, and the smaller by small polygonal epitheliimi. The bile- capillaries commence between the hepatic cells, and are boimded by a delicate membranous wall of their own. They appear to be always boimded by hepatic cells on all sides, and are thus separated from the nearest blood capillary by at least the breadth of one cell.^' (Kirkes' Physiology.) (b) ''While the lungs are nourished by the bronchial arteries, it is by the means of the pulmonary arteries that the venous blood is carried to them from the right side of the heart and aerated. The pulmonary artery, arising from the right ventricle of the heart, soon divides into a right and left branch for either lung. Following the bronchus and bronchial tubes, the artery divides and sub- 44 PHYSIOLOGY AND HYGIENE, divides, the branches becoming smaller and smaller as they approach the primary lobules, imtil finally they terminate as the pulmonary capillaries. The terminal arterial capil- laries surround each alveolus or air cell as a vascular circle, which anastomoses with those of the adjacent alveoli. From these vessels arise a capillary network, so closely set that the meshes are even smaller than the diameter of the vessels themselves, the latter having usually a diameter of from -^ to 2-^ of a mm. 2000 to ^of an inch) . This network supports the bottom of each air cell, and the blood that it carries is separated from the air of the cells only by its wall and the extremely delicate epithelial lining of it. The carbon dioxide of the venous blood conveyed to the lungs by the pulmonary artery is thus separated from the oxygen of the air within the air cells brought by the trachea by nothing but the wall of the capillary and epithelium of the air cell. . . . From the capillary network surrounding the air cells the pulmonary veins arise, which, uniting with each other, gradually form four larger trunks, which finally terminate in the left auricle of the heart and convey to it the aerated oxygenated blood to be distributed by the arterial system to all parts of the body." (Chapman's Physiology.) (c) For the changes occurring in the blood during the pulmonary circulation, see A. 95 to 98 (b). In the portal circulation the following changes have been observed: Portal Vein. More plasma. Fewer corpuscles. More fat. More sugar during digestion, and less afterwards. Hepatic Vein. Less plasma. More corpuscles. Less fat. Less sugar during digestion, and more afterwards. (d) CoUins and Rockwell's Physiology, page 128; (e) page 293: (f) page 49. 45 PHYSIOLOGY AND HYGIENE. 3. The Heart. 120. Describe systole and diastole and their causes. (Sep- tember, 1895.) 120. Collins and Rockwell's Physiology, page 61. 121. Describe the topography of the normal heart in an adult male. {January, 1897.) 121. ^'In order to show the extent of the heart in relation to the front of the chest, draw a line from the lower border of the second left costal cartilage, one inch from the sternum, to the upper border of the third right costal cartilage, half an inch from the sternum. This represents the base line or upper limit of the organ. Take a point an inch and a half below and three-quarters of an inch internal to the left nipple — that is, about three and a half inches to the left of the median line of the body. This represents the apex of the heart. Draw a line from this apex point, with a slight convexity downward, to the junction of the seventh right costal cartilage to the sternum. This represents the lower limit of the heart. Join the right extremity of the first line — that is, the base line — with the right extremity of this line — that is, to the seventh right chondrosternal joint — with a slight curve outward, so that it projects about an inch and a half from the middle line of the sternum. Lastly, join the left extremity of the base line and the apex point by a line curved slightly to the left." (Gray's Anatomy, page 470.) 122. What is the office of the columnce carnecef (May, 1894-) 122. To prevent too great dilatation of the ventricles; to regulate their contraction; and to prevent the auriculo- ventricular valves from being turned into the auricles. 123. Describe the mechanism of the mitral valve. (March, 1892.) 124. Describe the mechanism in the opening and closing of the aortic valves. (March, 1893.) 123 and 124. Collins and Rockwell's Physiology, page 53. 46 PHYSIOLOGY AND HYGIENE. 125. (a) Define heart sounds. (June, 1898.) 126. (a) Describe normal heart sounds. (April, 1899.) 127. (a) What are the normal heart sounds? (b) Where, topographically, are the heart sounds most audible? (June, 1900.) 128. (a) Describe the normal heart sounds, (b) How and where should the stethoscope or the ear be placed to hear these sounds to best advantage? (June, 1901.) 129. (c) What causes the first sound of the heart? (April, 1894.) ISO. (d) What causes the second sound of the heart? (September, 1898.) 131. (c), (d) Describe the factors ivhich cause the heart sounds. (September, 1896.) 125 to 131. (a) Collins and Rockwell's Physiology, page 62; (b) Fig. 4. — From above downward, showing the anatomical positions of the puhnonic, aortic, mitral, and tricuspid valves. The arrow-heads show their respective sites of audibility. Shaded portion shows part of left heart projecting beyond the right heart. 47 PHYSIOLOGY AND HYGIENE. (c) Collins and RockwelFs Physiology, page 63; (d) page 63. ISS. What are the causes of the apex heat of the heart? {May, 1900.) 132. Collins and Rockwell's Physiology, page 61. 133. What are the causes within physiological limits of the increase of the pulse rate? {June, 1892.) 133. Collins and Rockwell's Physiology, page 61. 13Ji.. (a) What effect is produced on the hearths action by stimulation of the cardio-inhihitory centre? {May, 1896.) 135. (b) In what manner is the heart heat influenced by the pneumogastric nerve? What is the average number of heart beats per minute in (c) a child aged one year, (d) an adult aged seventy? {September, 1900.) 136. (e) What is the average rate of heart beat in the infant; the adult; and old age? {September, 1893.) 137. (f) Give the extremes of slowness and rapidity of the hearths action which are consistent with physical vigor, and with ability to perform manual labor. {January, 1895.) 134 to 137. (a) Collins and Rockwell's Physiology, page 65; (b) page 65; (c) 108 to 130 beats; (d) 60 to 65 beats; (e) Collins and Rockwell's Physiology, page 61; (f) ordi- narily these limits are placed at about 60 and 90 beats per minute, but occasionally these extremes may be ex- ceeded. ^ 138. What do you understand by blood pressure? {Sep- tember, 1892.) 139. Describe the conditions loithin nor7nal physiological limits which increase arterial blood pressure. {January, 1892.) Ufi. State three ways in which a decrease of blood pressure in the arteries may be produced. {June, 1902.) 48 PHYSIOLOGY AND HYGIENE. 138 to 140. ''Blood pressure is the force exercised by the blood against the walls of the bloodvessels. This is modi- fied, of course, by the condition of the heart, the elasticity of^,the vessels, etc. The causes of alteration in the blood- pressure may be tabulated as follows (Brunton) : May be raised — 1. By the heart beating more quickly. 2. By the heart beating more vigorously and more com- pletely, and sending more blood into the aorta at each beat. 3. By contraction of the arterioles, retaining the blood in the arterial system. May be lowered — By the heart beating more slowly. By the heart beating less vigor- ously and completely, and send- ing less blood into the aorta at each beat. By dilatation of the arterioles, allowing the blood to flow more quickly into the veins. By deficient supply of blood to the left ventricle, as from con- traction of the pulmonary ves- sels or obstruction to the pass- age of blood through them, or from stagnation of blood in the large veins — e. g., in shock. (Dunglison's Medical Dictionary.) HI. (a) Describe the sphygmograph and state its use. (b) Draw a normal pulse tracing. {September^ 1900.) 142. Make a sphygmographic drawing (b) of a normal pulse; (c) of a dicrotic pulse. (April, 1897.) 143. (d) Explain by drawing or otherwise the sphygmo- graphic tracing in mitral insufficiency. {January, 1896.) Uf-Jf.. (e) Give in language or by drawing the sphygmo- graphic tracing in aortic insufficiency. {June, 1895.) 141 to 144. (a) '' Instruments for recording the pulsations of an artery are called sphygmographs. There are several forms. The one in most common use by clinicians is the Dudgeon sphygmograph. An essential feature of this 49 PHYSIOLOGY AND HYGIENE. instrument is a system of compound levers which transmits the movement of the arterial wall from the foot or pad which rests upon the skin over the artery to a tracing point connected with the last lever. This system of levers multiplies the motion of the foot about fifty times. A second feature of the instrument is a recording apparatus consisting of a clockwork which turns a pair of small cylinders, between which runs a shp of blackened paper. The tracing point rests upon this paper and records there the magnified movements of the foot or pad. The sphygmo- graph has the great advantage that it makes a record of the variation of pressure, and when properly used may reveal many facts about the general condition of the circulatory system." (Hall's Text-hook of Physiology, page 172.) (b) Fig. 5. — Sphygmographic tracing of normal pulse. a, h, percussion up-stroke; a, h, c, percussion wave; c, d, e, tidal wave; «, /, g, dicrotic wave; d, e, f, aortic notch; /, g, diastolic period. (c) Fig. 6.- (d) -Low-tension dicrotic pulse (pneumonia eight hours before death). Fig. 7. — Mitral regurgitation. so PHYSIOLOGY AND HYGIENE. (e) Fig. 8. — Aortic regurgitation. 4. The Bloodvessels. 145. (a) Describe the structure of arteries, (b) How do arteries exercise their function? (January, 1901.) llfi. (a) (Jme the structural differences between arteries, veins, and capillaries. (September, 1896.) H7. How do veins, arteries, and capillaries differ as to (a) structure, (b) function? (September, 1901.) 148. How do arteries and veins differ in (a) structure, (h) function? (September, 1901.) 145 to 148. (a) Collins and RockwelPs Physiology, pages 54 and 55; (b) pages 54 to 60, and 66 to 68. 149. (a) What is the relation of the capillaries to the circulatory system? (September, 189 4-) 150. (b) What physiological process takes place in the capillaries? (September, 1892.) 151. (c) Describe the movements of the blood corpuscles in the capillaries and explain the phenomena of diapedesis. (September, 1899.) 149 to 151. (a) Collins and Rockwell's Physiology, pages 54 and 49. (b) Chiefly nutrition, oxidation, and excretion; it is in the capillary circulation that all the changes between the blood and the tissues take place, (c) Collins and Rock- well's Physiology, pages 59 and 60. 152. (a) Give the causes of the flow of the blood in the veins. (May, 1893.) 153. (a) How is the venous blood current maintainedf (b) What arteries carry venous blood? (May, 1898.) 51 PHYSIOLOGY AND HYGIENE. 152 and 153. (a) ''(1) Residuum of heart pressure exerted through the capillaries. (2) Action of diaphragm and intercostals in causing negative intrathoracic pressure during inspiration, actually lifting the column of blood in the ascending vena cava. (3) Ventricular systole causing negative intrathoracic pressure at end of systole and beginning of diastole, through the sudden decrease in volume of heart. (4) Action of muscles pressing upon the veins. (5) The force of gravitation, which materially assists in filling the ventricles and the left auricle, as well as in assisting the flow in the jugulars and descending or anterior vena cava, while it retards the flow in the veins below the heart. (6) Contraction of the mouths of the veins. (7) Under certain circumstances, positive intra- abdominal pressure, during inspiration and expiration (forced). (8) Negative intrathoracic pressure through pushing out of the anterior thoracic wall by the apex beat of the heart. '^Of these forces the first three are the efficient forces of venous circulation; the remaining forces are either so small in relation to the first three that they may be ignored or they act only under special conditions. The force of gravitation, though it assists the downward flow in all veins and retards the upward flow, may rather be recorded among the factors which modify venous circulation. Any action of the walls of the abdominal cavity (descent of diaphragm in inspiration or contraction of the lateral walls in expiration) will force toward the thoracic cavity any blood in the abdominal veins, but it will, to the same degree, keep out of the abdominal veins any blood in the legs.'' (Hall's Text-hook of Physiology, page 178.) (b) The pulmonary artery and its two branches, the right and left pulmonary arteries. 154- What are the variations in the composition of the hlood in the different parts of the body? (September, 1898.) 154. See Q. 96 and 97; in addition to the variations there given, the chief are as follows: 52 PHYSIOLOGY AND HYGIENE. ''1. The Blood of the Capillaries. — Virchow has noted that the blood from the capillaries does not coagulate after death even when exposed to the air, which apparently indicates some modification of the fibrin or fibrin ferment. "2. The Blood of the Mesenteric Vein. — More fibrinogen is found in this vein than in arterial blood. "3. The Blood of the Portal and Hepatic Veins. — Drosdoff has observed in dogs fed with meat, bread, and milk that the portal vein contains fewer corpuscles and more plasma than that of the hepatic. There is also more fatty material present in the portal, which may apparently be stored up in the liver. During digestion the portal vein contains more sugar than the hepatic, but later the reverse is the case, although it is not likely that the portal vein is at any time entirely destitute of it. "4:. The Blood of the Splenic Vein. — The evidence is con- flicting here. Some have claimed that a larger number of corpuscles are present in this blood, while others hold that they are fewer and are destroyed in the spleen as well as in the liver. "5. The Blood of the Renal Vessels. — The differences are best shown in the following table: Renal Artery. Renal Vein Water .... Solids .... . 790 . 210 778 222 1000 1000 Albuminoids Mineral salts Urea Uric acid and kreatin Oxygen .... Carbon dioxide . . less. , more. it tt tt tt more. less. tt tt if tt '^Very briefly, there is loss of water, salts, urea, CO2, and extractive materials. ''6. The Blood of the Glands. — The blood which leaves a resting gland is dark and possesses the ordinary characters of venous blood; that leaving an active gland is brighter 53 PHYSIOLOGY AND HYGIENE. (Bernard) and contains less COj than common venous blood, because a certain amount of the COj is given off in the fluid secreted by the glands, especially the salivary.'' (Reference Handbook of the Medical Sciences.) 155. Through what mediums is the hlood (a) relieved of effete matter, and (b) provided with new material? {June, 1899.) ■ 155. (a) The blood is relieved of effete matter through the lungs, liver, kidneys, and skin; (b) it is provided with new material through the alimentary canal, skin (absorp- tion), lungs, lymphatics, liver, and spleen. 156. (a) Mention the erectile tissues of the body, and (b) explain their characteristic functions. {January, 1901.) 156. (a) The corpora cavernosa and corpus spongiosum of the penis, the clitoris, the bulbi vestibuli, the tissue covering the turbinated bones of the nose, and, to a slight extent, the nipple, (b) ^'Erectile tissues are tissues suscep- tible of turgescence and increase of size, and formed of a collection of arteries and veins intermixed with nervous filaments; the veins are varicose and contained in spaces formed by trabeculse of fibrous tissue, being prolongations from the fibrous envelope." (Dunglison's Medical Dic- tionary.) V. RESPIRATION. 157. Define the function of the mucous membrane of the respiratory tract? {June, 1893.) 157. The functions of the mucous membrane of the respiratory tract are: To warm and moisten the inspired air, and to keep foreign matter (such as dust, germs, and noxious gases) out of the respiratory tract. That of the alveoli permits osmotic interchange of gases between the blood of the capillary network and the air in the alveoli. The mucous membrane of the nose also contains the peripheral organs of the sense of smell, 158. (a) What is the purpose of respiration? (b) Give the mechanism of respiration. {January, 1898.) 54 PHYSIOLOGY AND HYGIENE. 159. (b) Describe the mechanism of respiration. (March^ 1892.) 160. Explain (b) the mechanical action and (c) the physi- ology of respiration. {May, 1894.) 161. (c) Give the physiology and (b) the mechanism of respiration. (September, 1896.) 162. (d) Describe in full a normal respiration. (No- vember, 1892.) 163. (c) Give the physiology of respiration, (e) What is reserve air? (September, 1901.) WJf.. (b) Give the mechanism of respiration. Define (f) tidal air, (g) complemental air, (e) reserve air, (h) residual air. (June, 1898.) 165. Define (e) reserve air, (h) residual air, (g) comple- mental air, (f) tidal air. (June, 1896.) 166. (h) What is meant by the residual air? (March^ 1893.) 167. (i) Explain the process of expiration. (June, 1894.) 158 to 167. (a) The purpose of respiration is to introduce oxygen into the system, and to excrete carbon dioxide; (b) Collins and Rockwell's Physiology, pages 75, and 78 to 81; (c) pages 84 and 85; (d) page 75; (e) page 82; (f) page 82; (g) page 83; (h) page 83; (i) page 81. 168. (a) State the changes in the diameter of the chest in inspiration and in expiration. (April, 1896.) 169. (b) What muscles are engaged in ordinary inspira- tion? (c) What muscles are involved in extraordinary or forced inspiration? (September, 1895.) 170. (d) What muscles are brought into action during respiration? (January, 1893.) 171. (e) How is the diaphragm affected in expiration? State cause. (May, 1900.) 172. (e) Describe the mechanism of the diaphragm in respiration. (May, 1893.) 173. Give the mechanism of the diaphragm in (e) respira- tion, (f) hiccough. (September, 1897.) 55 PHYSIOLOGY AND HYGIENE. 174' (g) Describe the action of the muscles and the move- ments of the ribs in the complete act of inspiration and expiration. (June, 1901.) 175. Describe (h) the nervous and (d) muscular mechanism of the respiratory act. {June, 1900.) 168 to 175. (a) Collins and Rockwell's Physiology, pages 78 to 81; (b) pages 78 to 80; (c) page 81: (d) pages 78 to 82; (e) pages 78 to 81 and 86; (f) page 89; (g) pages 79 to 81; (h) pages 85 to 87. 176. (a) How do the movements of the chest in respiration influence the circulation? (March, 1893.) 177. (b) Do variations in the rate and force of respiration affect the heart, and, if so, in what manner? (May, 1893.) 178. (b) What effect on the heart, if any, has a variation of the rate and force of respiration? (September, 1897.) 179. (b) Explain how variation in the rate and force of respiration affects the heart. (September, 1898.) 176 to 179. (a) Collins and Rockwell's Physiology, page 88; (b) page 88. 180. (a) What is the average number of respirations per minute in a healthy person? (b) Give in cubic inches of air the average respiratory capacity of a healthy adult. (April, 1898.) 181. (a) What is the normal rate of respiration per minute in (1) a child, (2) an adult? (c) What influences regulate the rate of respiration? (January, 1902.) 182. (d) What is the normal ratio of respiration to heart pidsations? (June, 1897.) 180 to 182. (a) "Frequency of respiration in various ages CQuetelet): newborn, 44; 5th year, 26; 15th to 20th years,^ 20; 20th to 25th years, 18.7; 25th to 30th years, 16; 30th to 50th years, 18.1." (Dunglison's Medical Dictionary.) (b) 225 cubic inches, (c) "The chief ways in which the respirations may be rendered quicker or slower are the following, according to Brunton: 56 PHYSIOLOGY AND HYGIENE. The respira- tory move- ments may -{ be quick- ened by The respira- tory move- ments may \ be render- ed slow by Excitement f Stimulation of the vagus. ^f ^^^.r^r, ^ stimulation of optic nerve, or nerves, i - . . - - ^ 1 Stimulation of acoustic nerve. Greater ex- citement of respira- tory centre Diminished excitement of respira- | tory centre J r Action of brain (voluntary). J Increased temperature of blood. j Increased venosity of blood. i_ Action of drugs. 1 Diminished venosity of blood. }- Action of drugs. Action of brain (voluntary). Nervous in- fluences. f Paralysis of vagi. I Stimulation of superior laryngeal nerves. J Stimulation of inferior laryngeal nerves. Stimulation of nasal nerves. Stimulation of cutaneous nerves. Stimulation of splanchnic nerves. ''Other influences exerted on the frequency of respiration may be stated, according to Guy : while standing the respira- tions are 22 to the minute; while sitting, 19; while lying down, 13. The newborn child breathes, when the body is in a vertical position, one-third more frequently. Inges- tion of food increases the frequency of respiration; during digestion the frequency is 1.72 respirations per minute higher (if no nourishment had been taken seven hours previously) ; eating with or without wine increases frequency 1.22 (Vierordt) Greater muscular exercise increases the frequency of respiration. In the sleeping adult the decrease in frequency of respiration amoimts to about one-quarter (Quetelet).'' (Dimglison's Medical Dic- tionary.) (d) Collins and Rockwell's Physiology, page 82. 183. (a) How does respiration affect the hloodf (No- vemher, 1891.) 184. Give (b) the mechanism of respiration', (c) the chem- istry of respiration. {September, 1899.) 185. (d) What changes are produced in the air by respira- tion? {June, 1892.) 57 PHYSIOLOGY AND HYGIENE. 186. (e) How does the air of crowded rooms become joul? {November, 1891.) 187. (a) What effect on the blood has respirationf (d) What changes take place in air that has been respired? {May, 1898.) 188. What changes are produced (d) in the air and (a) in the blood by respirationf {April, 1899.) 189. (e) Mention some of the sources of impure atmosphere. {June, 1892.) 183 to 189. (a) Collins and Rockwell's Physiology, pages 84, 85 and 88; and see table in A. 95 to 98 (b) ; (b) Collins and Rockwell's Physiology, pages 75 and 78 to 81; (c) pages 84 and 85; (d) pages 83 and 84; (e) page 88, and Egbert's Hygiene and Sanitation, pages 72 to 75. 190. Define and describe respiratory rhythm, respiratory sounds. {June, 1899.) 190. Collins and Rockwell's Physiology, page 82. 191. (a) How tnuch air is required jor normal respiration during twenty-four hours? {April, 1893.) 192. (a) How many cubic feet of fresh air per hour are required by an adult f {September, 1897.) 19S. (b) How much space is required for a single indi- vidual in a sleeping apartment to ensure health? {November ^ 1891.) 19 Jf.. (c) Hov: should a sleeping-room be ventilated and (d) what should be its temperature? {September, 1892.) 191 to 194. (a) Egbert's Hygiene and Sanitation, pages 104 and 106; (b) page 106; (c) pages 113 and 114; (d) page 123. 195. (a) Describe the effect upon man of inhaling carbon dioxide gas. {January, 1892.) 196. (b) What is asphyxia? {March, 1892.) 197. (b) What is asphyxia? (c) How is asphyxia pro- duced? (d) What are the causes of death from asphyxia? {April, 1898.) 58 PHYSIOLOGY AND HYGIENE. 198. Describe the phenomena of (b) asphyxia, (e) syncope, (f) sleep. (September, 1896.) 199. Give the causes of perverted function producing (g) dyspnoea and (b) asphyxia. (September, 189Jf.) 200. Define and give the physiological significance of (g) dyspnoea, (h) dysphagia, (i) apnoea. (April, 1897.) 201. (e) Describe the phenomena of syncope. (January, 1895.) 202. (e) Define and describe syncope. (September, 1896.) 208. (e) Describe the phenomena of syncope. (September, 1893.) 195 to 203. (a) Egbert's Hygiene and Sanitation, pages 75 to 78 and 95, and Collins and Rockwell's Physiology, page 87 ; (b) page 87. (c) Asphyxia is produced by prevent- ing oxygen from reaching the blood, by obstruction of the respiratory passages ; or by inhaling a gas without oyxgen, or one which strongly tends to displace oxygen from haemo- globin, as CO; or by interfering with the interchange of gases which should take place between the air and the blood, (d) Death is caused by paralysis of the respiratory centres in the medulla, due to the action of the, venous blood and lack of arterial blood, (e) '^Syncope is the complete and, commonly, sudden loss of sensation and motion, with considerable diminution or entire suspension of the pulsations of the heart and the respiratory move- ments. Syncope is commonly an affection of no conse- quence; sometimes it is an index of diseased heart.'' (D^^R^\^on!^ Medical Dictionary.) (f) '^ Sleep. This phe- nomenon is one of many instances of the rhythmic activities of the central nervous system. From time to time all animals with a well-developed nervous system go to sleep, during which psychical activity is at its lowest point. To reach this condition, the most important favoring factor is an exclusion of all or most of the impulses from the central nervous system. In a well-known case of Striimpell, in which, from a complicated anaesthesia, all sensory impulses were limited in their entrance to a single eye and a single 59 PHYSIOLOGY AND HYGIENE. ear, the patient could be put to sleep at will by closing the eye and stopping the ear. In addition, sleep has been attributed to the following influences: (1) chemical influ- ences; (2) circulatory influences; (3) histological influences. Those who hold to chemical influences in the production of sleep maintain that during normal activity of the body various substances are formed which are circulated in the blood, and directly lessen the activity of the nerve cells or indirectly diminish the supply of blood to the brain. In the theories of circulatory influences sl fatigue of the vaso- motor centre is looked upon as the cause of the anaemia of the brain, resulting in sleep. In the third set of theories sleep is supposed to be due to a separation of the dendrites of the brain cells, due to a shrinkage of the nerve-cell bodies or to an intrusion of neuroglia cells between them. During sleep the capability of the nervous system to transmit impulses is not entirely lost. The cerebral cortex is most affected, the spinal cord least. The close relation between dreams and external stimuli is well known, and it has been proved experimentally that vasomotor changes, induced by external stimuli, may take place without awakening the sleeper. The period of deep sleep is short and falls within the first two hours after its onset. During this time the pulse and breathing are slower, the intestines and bladder are at rest, the output of carbon dioxide is lessened, and the consumption of oxygen still more so; metabolism is less vigorous and the temperature falls. The respiration is said to become thoracic in type and to take on a more or less pronounced Cheyne-Stokes rhythm. The visual axes are probably parallel and directed to a distance, but the pupils are contracted. The latter is peculiar, since an absence of light should bring about dilatation. This is connected perhaps with important actions taking place in lower levels of the brain.'' (Guenther's Physiology, page 197.) (g) Collins and Rockwell's Physiology, page 87. (h) Dysphagia means ^'difficulty of deglutition. It is almost always symptomatic either of inflammation or of other disease of 60 PHYSIOLOGY AND HYGIENE. the organs of deglutition, or of incomplete obstruction of the oesophagus, by some obstacle within it, or by a neigh- boring tumor. At times it is produced by spasms or paralysis of the oesophagus/' (Dunglison's Medical Dic- tionary.) (i) Collins and Rockwell's Physiology, page 87. W4. (a) Where is the respiratory centre located in man? (November, 1894.) 205. (a) Where is the respiratory centre? (b) Where is the centre of defecation? (May, 1896.) 204 and 205. (a) Collins and Rockwell's Physiology, page 86; (b) page 110. 206. What post-mortem tests should he applied to prove that air has entered the lungs of a supposedly stillborn child? (June, 1895.) 206. '' The Hydrostatic Test (specific gravitj^ of lungs). — Its general principle is, that before respiration the limgs sink rapidly when placed in water; after respiration they float high in that fluid. They may, however, float from other causes, viz., from gases developed in them during putrefaction, from artificial inflation, and from emphysema. In these cases the contained air (or gas) can be forced out of the lungs by compression (to be applied as described below), so that they afterward sink; this cannot be done after perfect respiration. Artificial inflation does not increase w^eight of lungs. After imperfect respiration (as in feeble children, or those who take only a few gasps) the air can be expelled by compression, so that this is not to be distinguished from artificial inflation. '^Exceptionally, the lungs may sink after respiration, from congestion, inflammation, and other diseases having increased their weight. Incising the lung and squeezing out its extra blood, or cutting it up and compressing each piece, will generally cause the organ, or some pieces of it, to float, if the child has breathed. "Application of Hydrostatic Test. — Having opened chest, note position of lungs (before respiration they occupy a 61 PHYSIOLOGY AND HYGIENE. small space at upper and posterior parts of thorax) ; their volume (of course increased after breathing); their shape (before respiration, borders sharp or pointed; after it, rounded); their color (before breathing, brownish-red; after it, pale red or pink); their appearance as regards disease and putrefaction; and whether they crepitate on pressure (as they will after respiration). '^Take out lungs, with heart attached, and place them in pure water having temperature of surrounding air. Note whether they float (high or low), or sink (slowly or rapidly). Separate them from the heart; weigh them accurately, and then place them in water again, and note sinking or floating as before. Subject each lung to pressure with the hand, and note sinking or floating again. Cut each limg in pieces and test floating again. Take out each piece, wrap it in a cloth, and compress with fingers as hard as possible, and test floating, etc., as before. The crucial test of perfect respiration is each piece floating after the most vigorous compression.'' (King's Manual of Obstetrics j page 600.) VI. DIGESTION, FOOD, AND NUTRITION. 1. Digestion. 207. (a) What is meant hy digestion? {November, 1892.) 208. (a) What is digestion? (b) Describe the stages of deglutition. {April, 1896.) 209. (b) How is deglutition accomplished? {June, 1902.) 210. (b) Give a description of the act of deglutition and (c) mention the muscles brought into action in swallowing. {April, 1898.) 207 to 210. (a) Collins and Rockwell's Physiology, page 90; (b) page 94; (c) the hyoglossi, styloglossi, palatoglossi, palatopharyngei, azygos uvulae, tensores palati, levatores palati, stylopharyngei, stylohyoids, geniohyoids, mylo- hyoids, thyrohyoids, digastrics, constrictors of the pharynx and the muscles of the tongue. 62 PHYSIOLOGY AND HYGIENE. 211. Give the function of the epiglottis. {January, 1894.) 211. The function of the epiglottis is to cover the larynx during deglutition, and thus prevent food or drink entering the respiratory tract. 212. (a) Describe gland secretion as illustrated hy the action of the parotid gland. (March, 1892.) 213. State (b) the composition and (c) function of saliva, {November, 189 4.) 214-. (d) What influence has the saliva on digestion^ {September, 1893.) 215. (e) What would be the effect on the saliva and on digestion if Stenson^s duct should be divided? {January, 1895.) 212 to 215. (a) ^ ' During and after secretion very remark- able changes take place in the cells lining the acini, which are in some way connected with the production of the essential constituents of the salivary fluids. In the case of the parotid gland, which may be regarded as the type of a serous or albuminous gland, the following changes have been observed by Langley. During the period of rest and just previous to secretory activity, the epithelial cells are enlarged and swollen, and encroach on the lumen of the acinus. The protoplasm of the cells is so completely filled with dark, fine granules as not only to obscure the nucleus, but to almost obliterate the line of union of the cells. As soon as secretion becomes active, however, the granules begin to disappear from the outer region of the cell and move toward the inner border and into the lumen of the acinus. From these observations it might be inferred that during rest the protoplasm of the cells gives rise to granular material, and that during and after secretory activity there is an absorption of new material from the lymph and a reconstruction of the granular material.'' (Brubaker's Text-book of Physiology.) And see Q. 428 to 431. (b) Collins and Rockwell's Physiology, page 92; (c) page 92; (d) page 93; (e) the saliva might be less watery and the digestion 63 PHYSIOLOGY AND HYGIENE. of starches a little hindered, but the effects would be very- slight indeed. 216. Describe, by drawing or otherwise, a peptic gland. {April, 1895.) 216. Collins and Rockwell's Physiology, page 96. 217. Describe (a) the functions and (b) secretions of the stomach. {June, 1899.) 217. (a) The functions of the stomach are: (1) the recep- tion of the food; (2) the secretion of the gastric juice; (3) the thorough mixing of the gastric juice with the food; (4) the digestion of proteids; and (5) the absorption of such part of the food as is ready for absorption, (b) Collins and Rockwell's Physiology, pages 97 and 98. 218. State (a) the specific gravity and (b) reaction of gastric juice, and (c) describe its action. {January, 1894.) 219. (d) Give the principal characteristics of gastric juice in man. {January, 1897.) 220. (e) What circumstances and conditions favor gastric digestion? {May, 1895.) 221. (f) What are the ferments of gastric juice and what is the action of each ferment? {September, 1897.) 222. (g) Discuss the action of gastric juice on carbo- hydrates and fats. {June, 1901.) 223. (h) What are the products of gastric digestion? (i) What disposition is made of these products? {September, 1901.) 224. (h) What are the products of gastric digestion? {Sep- tember, 1898.) 225. (c), (d) What is the physiological action of gastric juice on food? (j) State the average time occupied in gastric digestion. {June, 1902.) 226. (k) What are peptones? How are they formed? {May, 1899.) 227. (1) How does the nervous system influence gastric digestion? {September, 1897.) 64 PHYSIOLOGY AND HYGIENE. 228. (m) What 'prevents digestion of the stomach hy its own juice f {April, 1897.) 218 to 228. (a) Collins and Rockwell's Physiology, page 97; (b) page 97; (c) pages 98 and 99; (d) pages 98 and 99; (e) page 100; (f) see below Table in A. 231 to 239 (e); (g) Collins and Rockwell's Physiology, page 99 ; (h) pages 98 and 99; (i) pages 98 and 99; (j) page 100; (k) pages 98 and 99; (1) page 100. (m) '^ Why the stomach or any other portion of the intestinal tract brought into contact with digestive juices is not destroyed has given rise to much discussion. Normally, self-digestion does not occur, but if an animal is killed while in full digestion and the body is kept warm, the stomach will be destroyed. This has been found to take place in human bodies. If a portion of the stomach is deprived of its blood supply, that portion will be attacked and a perforation of the stomach may result. The immunity of the stomach to the gastric juice has been explained in a number of ways, but not satisfactorily. It has been said that the epithelial lining of the stomach prevents the absorption of the gastric juice, but this explanation raises the question why the living epithelial cells are immune. The secretion of mucus forming a protective coating for the stomach is an inadequate explanation, owing to the diffi- culty of conceiving such a means of protection to be as perfect as it is. Another theory, which holds the alkaline blood to neutralize the acid of the stomach as it is formed, cannot be applied in the case of the intestine, where the digestive juice is alkaline. An explanation is at present impossible. All that can be said is that the immunity of the intestinal tract is due to the fact that it is alive. Bernard introduced the hind-leg of a living frog into a dog's stomach through a fistula. It was digested. But in this case the cells of the frog's limb were first destroyed by the acid. It has been shown by Neumeister that a living frog's leg is not digested by a strong pancreatic digestive mixture of weak alkaline reaction, because in this case the cells are not killed." (Guenther's Physiology, page 67.) 65 PHYSIOLOGY AND HYGIENE. 229. Describe the ^physiology of vomiting. (May, 1896.) 229. Collins and RockwelPs Physiology, page 101. 230. What is the reaction of (a) saliva, (b) pancreatic juice, (c) blood? {January, 1902.) 230. (a) Alkaline; (b) alkaline; (c) alkaline. 231. (a) What are the functions of the pancreas? {May, 1897.) 232. Describe (b) the properties and (c) functions of pancreatic juice. {April, 1894.) 233. Give (d) the composition and (c) the function of pancreatic juice. {June, 1898.) 234. (b) Describe the pancreatic juice, (e) mentioning its ferments and stating their specific actions. {April, 1899.) 235. (e) Name and give the action of each of the ferments in pancreatic juice. {May, 1896.) 236. (e) State the action of the pancreatic secretion in the digestion of food. {January, 1896.) 237. (e) What are the uses of saliva, trypsin, amylopsin? {May, 1901.) 238. (e) State the function of ptyalin, amylopsin, pepsin, trypsin, invertin, steapsin. {September, 1899.) 239. (f) What would be the effect on digestion if the pancreatic duct were obstructed? {May, 1895.) 231 to 239. (a) Collins and Rockwell's Physiology, pages 104 to 106; (b) pages 104 and 105; (c) pages 106 and 105; (d) page 105; (e) page 105. The following table from Dunglison's Medical Dictionary will be of use: m PHYSIOLOGY AND HYGIENE. Table op Ferments Contained in the Digestive Juices. Digestive Juices. Saliva. Gastric juice. Pancreatic juice. Bile. Intestinal juice. Ferments contained in them. Salivary diastase or ptyalin. {Pepsin. Curdling ferment. Trypsin. Curdling ferment. Pancreatic diastase. Emulsive ferment. f Invertin. L Curdling ferment. Action as Food Materials. Changes starch into dextrin and sugar. Changes proteids into pep- tones in an acid medium. Curdles the casein of milk. Changes proteids into pep- tones in alkaline and neu- tral media. Curdles the casein of milk. Changes starch into dextrin and sugar. Emulsifies and partially saponifies fats. Assists in emulsifying fats. Changes cane-sugar into in- vert sugar. Curdles the casein of milk. (f) Collins and Rockwell's Physiology, page 106; there would be a decided diminution in the activity of the digestion of all kinds of foods — particularly of proteids and fats; there would be noticeable carbohydrate indigestion, and starch would be abundant in the stools. 240. Define emulsification, saponification. Illustrate. (June, 190 L) 240. Collins and Rockwell's Physiology, page 105. 241 . What changes occur in the hlood in its passage through the liver? (March, 1892.) 241. See Q. 114. 242. What are the functions of the liver? [April, 1897.) 24s. Describe the functions of the liver. (November, 1891.) 67 PHYSIOLOGY AND HYGIENE. 2J^Jj.. What is the physiological function of the liver? {May^ 1899.) 242 to 244. Collins and Rockwell's Physiology, pages 106 to 110. 245. (a) Mention and describe in detail an important function of the liver other than the secretion of bile. (January, 1902.) 24.6. Describe (b) the bile producing and (a) the glycogenic function of the liver. {January, 1898.) 2^7. State (c) the origin, (d) nature, and (e) destination of the glycogen of the liver. {June, 1900.) 248. (f) What experiments have been made to prove the glycogenic function of the liver f {June, 1897.) 245 to 248. (a) Collins and Rockwell's Physiology, page 109; (b) pages 106 and 109; (c) page 110; (d) pages 110 and 109. (e) Its destination is the other tissues of the body^ chiefly the muscles, where it is a factor in the generating of muscular activity and body heat, (f) Claude Bernard ''fed a dog for seven days with food containing a large quantity of sugar and starch; and, as might be expected,, found sugar in both the portal and hepatic blood. But when this dog was fed with meat only, sugar was still found in the blood of the hepatic veins. No sugar was found under a meat diet, in the portal vein, if care were taken, by applying a ligature on it at the transverse fissure^ to prevent reflux of blood from the hepatic venous system. Bernard found sugar also in the substance of the liver. He also found that a liver, removed from the body, and from which all sugar had been completely washed away by injecting a stream of w^ater through its blood-vessels, after the lapse of a few hours contained sugar in abundance." (Kirkes' Physiology.) ' ' The chief experimental evidences in favor of the glyco- genic function of the liver may be enumerated as follows: ''1. The glycogen is most abundantly formed in the liver cells when carbohydrate food is given, it is formed 68 PHYSIOLOGY AND HYGIENE. in only small quantity on a liberal proteid diet, and is probably never produced from fat; also the amount of glycogen in the cells increases with the time which has elapsed after a meal rich in carbohydrates. "2. The glycogen contained in the liver cells is after death converted rapidly into dextrose, and such an action is probably due to the exaggerated activity of the asphyx- iated and dying liver cells. '^3. A similar disappearance of glycogen occurs during a period of inanition, the amount which has disappeared being proportional to the time which has elapsed, and during this period the amount of circulating dextrose is kept up close to the normal value. Hence the most probable explanation is that the blood is being contin- uously supplied with dextrose from the stored-up glycogen of the liver. '^4. The kidneys tolerate only a certain percentage of dextrose in the circulating blood and commence to secrete urine containing dextrose when this low level of about two parts per thousand is exceeded. Hence, did the liver not store up the dextrose in some form, it would reach the systemic circulation, and so the kidneys, and be nearly all excreted in the urine and lost to the body. That this is the true explanation of the prevention of glycosuria after a carbohydrate meal is perhaps most clearly demonstrated by slowly injecting a strong solution of glucose in whipped blood, under like conditions, in one case into the central end of a mesenteric vein and in the other into the central end of a systemic vein, such as the jugular. In the former case, no glycosuria occurs because the liver cells store up the sugar; but, in the latter case, glycosuria follows immediately, obviously because the sugar in excessive amount reaches the general circulation, and so the kidneys, before it can be taken up by the liver cells. ^'5. Direct analysis of the blood of the portal and hepatic veins, (a) during carbohydrate absorption, and (5) during 69 PHYSIOLOGY AND HYGIENE. inanition, have demonstrated that in the former case the blood passing to the Hver contains more carbohydrate than that leaving the organ, while in the latter case the reverse condition is observed. Here it must be remarked, however, that the blood supply to the liver is so copious as to render the difference in percentage small even when a large trans- ference of material may be taking place. Further, the rate of removal of carbohydrate from the liver is never so great as the rate of its storage during the assimilation of a heavy carbohydrate meal, and hence, although the differences in percentages of portal and hepatic blood are sufficient to demonstrate storage in the liver, they are quite insufficient according to many observers to prove that this stored carbohydrate is again set free as dextrose. '^ (Reference Handbook of the Medical Sciences). .249. (a) Where is bile first formed? (b) Trace its course to the intestines. (April, 1895.) 250. (c) Describe the process of bile secretion, (d) Mention the functions of the bile. (January, 1900.) 251. (d) Name the functions of bile in the intestines. (November, 1893.) 252. What is the function in digestion of (e) saliva, (d) bile? (September, 1896.) 253. (f ) Describe cholesterin, giving its origin and function. (September, 1899.) 25 Jj.. (g) Name the bile salts and (d) state the physiological function of bile. (June, 189^.) 255. (d) What are the uses of bile? (November, 1892.) 256. (h) Describe bile and (d) its uses, (i) Give a test for bile. (June, 1902.) 249 to 256. (a) Bile is first formed in the cells of the liver, (b) From the liver cells the bile passes into the bile capillaries, then into one of the two main trunks which form the hepatic duct, then through the hepatic and cystic ducts into the gall-bladder; it may here be stored up for a time, but eventually passes through the cystic and 70 PHYSIOLOGY AND HYGIENE. common bile ducts to enter the duodenum at the same place as the pancreatic juice flows in from the pancreatic duct. Sometimes (during digestion) the bile passes at once from the hepatic duct to the duodenum, (c) Collins and Rockwell's Physiology, pages 106 and 109; (d) page 109; (e) pages 92 and 93; (f) page 109. '^The mode of origin of cholesterin in the body has not been clearly made out. Whether it is formed in the tissues generally, in the blood, or in the liver, is not known; nor has it been determined conclusively that it is derived from albuminous or nervous matter. It is also doubtful if we are to regard it as a waste substance of no use to the body, as its presence in the blood corpuscles, in jiervous matter, in the egg, and in vegetable grains points to a possible function of a histo- genetic or tissue-forming character." (McKendrick.) (g) Collins and Rockwell's Physiology, page 107 ; (h) page 107 ; (i) page 108. 257. (a) What causes an increased flow of hile into the duodenum? (b) What pathological effects may^ensue because of occlusion of the ductus communis choledochus? (June^ 1900.) 258, (c) How would digestion he affected were the ductus communis choledochus obstructed? {September, 1896.) 257 and 258. (a) An increased supply of water; the ingestion of food, particularly during the time of its absorption; the absorption of bile or bile salts; certain drugs, called cholagogues, such as sodium salicylate and benzoate, colchicum, aloes, jalap, podophyllin, rhubarb, colocynth, etc. (b) Jaundice, gastrointestinal indigestion, hepatic colic, pruritus, enlargement of gall-bladder, hyper- trophy of liver with possible subsequent atrophy, hemor- rhage, bodily weakness and loss of weight, and finally death, (c) Owing to the consequent loss of bile to the intestinal contents, fermentation and putrefaction are much increased ; emulsification of fats is considerably impaired. From irritation set up by excessive putrefaction, peristalsis may become much accelerated, causing diarrhoea 71 PHYSIOLOGY AND HYGIENE. 259. What substances are absorbed principally in (a) the stomach, (b) the duodenum? (May, 1897.) 259. (a) Alcohol chiefly; peptones, sugars, and salts to a limited extent; water very slightly, and fats not at all. Absorption in the stomach is aided by alcoholics and condiments, (b) Nearly all products of digestion; water, proteoses, peptones, sugars, soaps, salts. 260. Describe the vermicular movement of (a) the stomach and (b) intestines, (c) What purpose does this movement serve? {May, 1900.) 261. Describe the peristaltic action of (a) the stomach and of (b) the intestines. {June, 1894.) 262. (b) Describe the peristaltic movement of the intestines. (April, 1897.) 263. (a), (b) Describe peristalsis and state where it occurs. {April, 1893.) 264' (a), (b) Describe peristaltic movement. {November, 1892.) 265. (b) Describe the physiological operation of peristalsis in the small intestine. {November, 1894.) 266. (d) Define peristalsis, (e) In what conditions is peristaltic action reversed? {September, 1901.) 260 to 266. (a) Collins and Rockwell's Physiology, pages 99 and 100, and see (d) ; (b) Collins and Rockwell's Physi- ology, pages 101 and 102, and see (d) ; (c) Collins and Rock- well's Physiology, pages 100 and 102. (d) Peristalsis is ' ' a kind of undulation or vermicular movement, induced by contraction of the circular muscular fibres of the intestine from above downward. The purpose of this successive contraction of the circular fibres is to propel the intestinal contents. When the fibres contract inversely they occasion an antiperistaltic action. Peristaltic action is involuntary, and is not under the immediate influence of either brain or spinal marrow. It continues for some time after death." (Dunglison's Medical Dictionary.) (e) Peristaltic action is reversed in vomiting, in cases of hernia, and intestinal 72 PHYSIOLOGY AND HYGIENE. obstruction; also when the rectum is not emptied its contents are carried upward into the sigmoid flexure. 267. Where are the valvulce conniventesf State how they are formed and give their function. (January, 1902.) 267. Collins and Rockwell's Physiology, pages 102, 111 and 112. 268. (a) What digestive changes take place in the small intestine? (September, 1902.) 269. (a) Mention the digestive changes that take place in the small intestine, (b) Give the physiology of rectal feeding, (May, 1898.) 268 and 269. (a) Collins and Rockwell's Physiology, pages 104, 105, 106 and 109; (b) page 110; and see Q. 304 and 305. 270. (a) Describe the structure of an intestinal villus and show how it is adapted for absorption. (April, 1893.) 271. Describe (b) the glands and (a) the villi of the intes- tines. (June, 1898.) 270 and 271. (a) Collins and Rockwell's Physiology, page 112; (b) pages 102 to 104 and 112. 272. Describe the ileoccecal function. (January, 1894.) 272. The function of the ileocsecal valve is to prevent the contents of the large intestine from passing back again into the small intestine; it is also a barrier against the passage upward of the bacteria which are normally found in the large intestine. 273. State the physiological uses of the large intestine. (April, 1899.) 273. The physiological uses of the large intestine are (1) for absorption; (2) formation of fecal matter from the residue of its contents after the absorption of the nutritious parts; and see Collins and Rockwell's Physiology, pages 110 and 111. 271}.. What digestive changes take place in (a) the small intestines, (b) the large intestine? (January, 1901.) 73 PHYSIOLOGY AND HYGIENE. 275. (b) Give a summary of the digestive changes in the large intestine. (April, 1895.) 276. (b) What digestive changes occur in the large intestine? {September, 1896.) 274 to 276. (a) Collins and Rockwell's Physiology, pages 101 to 110; (b) page 110. 277. Give the junction of (a) gastric juice, (b) synovial fluid, (c) succus entericus. (January, 1899.) 277. (a) Collins and Rockwell's Physiology, page 98. (b) To lubricate the joints and also to prevent friction between the tendons and their sheaths, (c) "It has no influence on proteids and fats, but may convert starches to maltose and dextrin, invert cane-sugar to dextrose and levulose, and change maltose to dextrose." (Guenther's Physiology.) 278. Oj ivhat are the common and expected contents oj the appendix vermijormis composed, whether jound on the dissect- ing table, or in surgical operations involving that structure? (January, 1895.) 278. The ordinary contents of the appendix are: mucus, fecal matter, or concretions, lymphoid tissue, pus, and rarely a foreign body. 279. Discuss bacteria in the intestines. (May, 1895.) 279. "Certain changes take place in the intestinal con- tents independent of, or at any rate supplemental to, the action of the digestive ferments. These changes are brought about by the action of micro-organisms or bacteria . . . . Many forms of bacteria have been isolated from the mouth, a few varieties from the stomach, and a very large number from the intestines. It is only in the last- named locality that their multiplication has much effect from a physiological point of view. In the intestinal canal it appears that certain changes occur which are distinctly due to micro-organisms; these changes are possibly kept within limits by the presence of bile in the intestine. The 74 PHYSIOLOGY AND HYGIENE. changes said to be due under ordinary circumstances are as follows: (1) The formation of indol, skatol, cresol and phenol, chiefly from peptone (? antipeptone) in the small intestine, and possibly in the large intestine also. These substances are absorbed and excreted in the urine as combined sulphates. In addition to these, as results of decomposition of albuminous substances, there are many other products — e. g., gases, such as ammonia, sulphuretted hydrogen, volatile and fatty acids, leucin and tyrosin, phenylacetic, phenylpropionic, and other acids. (2) The formation of lactic acid and butyric acid from carbohydrates. This occurs in two stages, and chiefly results from decom- position of sugars. (3) The decomposition of cellulose (CeHipOs-l-HaO^SCO^+SCHJ.'' (Kirkes' Handbook of Physiology.) 280. (a) In a healthy man, what time is consumed in the digestion of an ordinary meal of meat, vegetables, and bread? (b) Describe the digestion of meat. (June, 1896.) 280. (a) Coflins and Rockwell's Physiology, page 100; (b) pages 98, 99, 105, and Egbert's Hygiene and Sanitation, pages 221 to 226. 281. Give the successive steps in the digestion of a meal of roast beef and potatoes. (January, 1898.) 282. Describe the digestion of a meal of beefsteak and potatoes. (May, 1894.) 283. Describe the digestion of a meal consisting of roast beef (with an excess of fat) and potatoes. (April, 1897.) 284' Gi'^''^ the process of the digestion of milk. (January, 1894.) 285. Describe the digestion in the stomach of a meal of bread and milk. (March, 1893.) 286. Describe in detail the digestion of a meal consisting of bacon, eggs, and toasted bread. (May, 1901.) 287. Mention three examples of amyloid food. Describe in detail the changes that amyloid food undergoes in the process of digestion, (September, 1902.) 75 PHYSIOLOGY AND HYGIENE. 288. Describe the digestion and absorption of a meal of eggs and beef. (November, 1894.) 281 to 288. Collins and Rockwell's Physiology, pages 28, 29, and 98 to 110; and Egbert's Hygiene and Sanitation, pages 217 to 225. 2. Absorption. 289. (a) What do you understand by absorption? (July, 1893.) 290. (b) What are the channels of absorption? {Aprily 1894.) 291. Describe the process of absorption by (c) the blood- vessels, (d) the lymphatics. (June, 1901.) 292. (e) How do the products of digestion find their way into the blood? (January, 1901.) 293. (e) How do the products of digestion enter the circu- lation? (July, 1893.) 294' (g) How does the digested food enter the circulation of the blood? (November, 1891.) 295. (f) Describe the relative activity of absorption in the alimentary canal, the skin, and the lungs. (May, 1895.) 289 to 295. (a) Collins and Rockwell's Physiology, page 111; (b) page 111; (c) page 114; (d) page 113; (e) pages 113 and 114. ''Physiological experiments have demon- strated that the agents concerned in the removal of the products of digestion after their absorption from the interior of the villus are: (1) The bloodvessels of the gastrointestinal tract, which unite to form the portal vein. (2) The lymph vessels of the small intestine, which con- verge to empty into the thoracic duct. The products of digestion find their way into the general circulation by these two routes, as follows: The water, inorganic salts, proteids, and sugar after entering the blood-vessels of the villus are carried by the blood directly into the liver by the portal vein; after circulating through the capillaries of the liver and being influenced by the liver cells, they are 76 PHYSIOLOGY AND HYGIENE. discharged by the hepatic veins into the ascending vena cava. The fats after entering the lymph radicle of the villus are carried by the lymph stream into the thoracic duct, by which they are poured into the blood at the junction of the left subclavian and internal jugular veins.'' (Brubaker's Text-hook of Physiology.) (f) (1) ''The greatest activity of absorption occurs in the alimentary canal. In it the materials of the duly digested food find their way by means of this process on the one hand into the blood- vessels of the portal circulation, and on the other into the lacteal vessels, which are the commencements of the lymphatic vessels of the intestines. (2) When simply left" in contact with the skin, substances, unless in a fluid state, are seldom absorbed. Metallic preparations and vegetable matters, if soluble or already in solution, are absorbed if rubbed into the skin. The effect of the rubbing is probably to convey the particles of the matter into the orifices of the glands, whence they are more readily absorbed than they would be^ through the epidermis. (3) It is a remark- able fact that not only is the epithelium of the pulmonary air vesicles able to allow the passage through it of gases and volatile substances, but that also under certain con- ditions fluids such as water may also be absorbed, and besides this, the presence of carbon particles in the bron- chial glands and elsewhere in connection with the lungs must point to the pulmonary epithelium as the only possible channel of their absorption." (Kirkes' Handbook of Physi- ology.) 296. (a) Mention the different digestive fluids and state the function of each. {June, 1897.) 297. (a) Name the digestive fluids with which the food is brought in contact in its passage through the alimentary canal. (June, 1893.) 298. (b) Mention the enzymes of the digestive system and state the peculiar function of each. {June, 1902.) 299. (a) Name the severed digestive ferments and give the action of each. {November, 1891.) 77 PHYSIOLOGY AND HYGIENE. 300. (a) Name the ferments that are the essential con- stituents of each digestive fluid. (June, 1895.) 296 to 300. (a) See Table in A. 231 to 239 (e); (b) Table of Enzymes. DiASTATIC OR AMYLOLYTI C FERMENTS. Invbrsivb ferments. ' Which convert starch and ^ amyloids into maltose. ' Which convert maltose into glucose. ' Which convert cane-sugar into dextrose and leva- - lose. Which decompose gluco- sides. Decomposing sugar. Decomposing fats. Proteolytic f Which decompose proteids FERMENTS. \ and form peptones. Diastase from malt. Ptyalin from saliva. Amylopsin from pan- creas. Other ferments having a similar action from other parts of the body. From small intestine. Invertin from the intes- tinal juice. Invertin from the mucus of the mouth. Invertin from the tissue of the testis. Emulsin from bitter al- monds. Myrosin from mustard. Rennet. From stomach. From pancreas (Sfcea- topsin). Pepsin from stomach. Trypsin from pancreas. Others from saliva. Histozvme. (From Dunglison's Medical Dictionary.) 301. (a) Give the composition of normal feces. (November, 1893.) 302. (b) State the average weight of feces in twenty-four hours in a normal man. (c) What proportion is made up of -fluid and what of solid contents? (November, 1894.) 78 PHYSIOLOGY AND HYGIENE. 303. (d) Give the muscular and nervous mechanism of defecation. (September, 1895.) 301 to 303. (a) Composition of Feces. Gases. Liquids. Solids: Undigested Food. Indigestible Matter. Bacteria and the Resins. Bile Residues. Excretin. Inorganic Salts. N, H, COj, H^S, CH4. HjO (68 % to 82 % normally). Fats, fragments of meat, starch. Cellulose, ligaments from meat, keratin, mucin, gums. Products of their decomposition of foods: lower fatty acids, lactic acid, tyrosin and its decomposition products, phenol, hsematin, insoluble soaps of Ca and Mg. Mucus, cholesterin, biliary acids, stercobilin. CtsHissSO^ Soluble salts of Na, K, Mg, etc. Insoluble salts of Ca, Mg, Fe, etc. (From Hall's Text-hook of Physiology, p. 340.) (b) About eight ounces; (c) fluid about 75 per cent., solid about 25 per cent. ; (d) Collins and Rockwell's Physiology^ page 110. 304. Describe the physiology of rectal feeding. (May^ 1894.) 305. What physiological laws are the basis of rectal feeding in disease? (September, 1893.) 304 and 305. ''That all mucous membranes are capable of absorbing certain materials from their surfaces and passing them into the bloodvessels or lymphatics has long been recognized; but it is only of comparatively recent years that this knowledge has been applied extensively to the purpose of nourishing patients by means of the rectum^ and the fact is now established that sufficient aliment may 79 PHYSIOLOGY AND HYGIENE. be absorbed from the mucous membrane of the rectum or sigmoid flexure alone to sustain Ufe for a considerable period, amounting in some cases from four to seven weeks. Moreover, the rectum may be utilized for accessory feeding for manj^ cases in which the stomach is able to digest some food, but not in sufficient quantity to prevent emaciation. Whenever rectal food enemata are employed certain prin- ciples should be observed: (1) The rectal surface must be cleansed from all mucus and feces. (2) The irritation of the rectum should be allayed as far as possible. (3) The quantity and quality of food thus administered should be so regulated as to avoid exciting peristalsis, and yet allow of the complete absorption of one injection before another is given.'' (Thompson's Practical Dietetics.) 3. The Lymphatic System. 306. (a) Describe the lymphatic system. (May, 1898.) 307. (a) Describe the lymphatic system. {September , 1896.) 308. (a) Describe the lymphatic circulation and (b) name the forces by which the current of lymph is kept up. (January ^ 1896.) 309. (b) What agencies induce the flow of lymph to the point of discharge in the veins? (April, 1895.) 310. (b) What agencies cause the lymph to flow toward the point of its discharge in the body? (September, 1898.) 311. (c) Describe the flow of lymph. (June, 1898.) 312. (c) Give the course of a lymph corpuscle to its deposit in the circulation. (June, 1895.) 306 to 312. (a) Collins and Rockwell's Physiology, pages 70 to 75; (b) page 73; (c) pages 72 and 73. 313. (a) Describe lymph and (b) state its uses. (May, 1899.) 314. Give (c) the origin and (b) uses of lymph. (June^ 1896.) 80 PHYSIOLOGY AND HYGIENE. 315. State (c) the source and (b) the uses of lymph. (Janu- ary, 1897.) 313 to 315. (a) Collins and Rockwell's Physiology, page 46; (b) page 47; (c) page 47. 316. State the origin and the uses of (a) the lymph, (b) the hile. (September, 1900.) 316. (a) See Q. 314; (b) Collins and Rockwell's Physi- ology, pages 106 and 109. 317. Give (a) the properties and (b) composition of lymph and of chyle. (April, 1896.) 318. (a), (b) State the difference between chyle and lymph. (September, 1892.) 319. (a) Describe the physical properties of lymph and chyle. (May, 1901.) 317 to 319. (a) Collins and Rockwell's Physiology, pages 46 and 47; (b) Lymph. Chyle. Water 95.0 90.5 Solids 5.0 9.5 Fibrin 0.1 0.1 Proteids 4.1 7.0 Fat, etc. . . . . traces 1.0 Extractives 0.3 } 1.4 Salts 0.5 (Compiled from Chapman's Human Physiology.) 320. Describe (a) chyme, (b) chyle. (April, 1898.) 320. (a) ''Chyme is the grayish, thick, acid liquid, into which the food is transformed by gastric digestion. It consists of a solution of proteids and salts containing liquefied fat and suspended particles and lumps of undi- gested matter." (Duane's Medical Dictionary.) (b) See Q. 317 to 319. 81 PHYSIOLOGY AND HYGIENE. 321. What are the junctions of the lymphatic vessels and glands? (November, 1892.) 321. Collins and Rockwell's Physiology, pages 70 and 73. 4. Foods. 322. (a) Into what general classes are foods divided, and (b) give examples of each class f (November, 1891.) 323. (a) Make a division, arbitrary or otherwise, of food- stuffs, (b) giving an example of each variety. (April, 1898.) 324. (c) Name eight principal carbohydrates used for food. (November, 1894.) 325. What are (d) amyloid foods, (e) proteid foods? Give three examples of each. (June, 1895.) 322 to 325. (a) Foods may be classified as follows: T T . r Salts. I. Inorganic I ^^^^^ f Proteids. II. Organic i Carbohydrates. I Fats. See also Egbert's Hygiene and Sanitation, pages 215 to 217. (b) Examples of: Salts: Sodium chloride and carbo- nate. Proteids: Flesh of animals, milk, peas, beans. Fats: Fat of meat, nuts, grains. Carbohydrates: Sugar, fruits, milk, cereals, malt, bread, green vegetables, sweets, (c) See (b). (d) Amyloid foods are foods containing amyloses or starches; examples : cereals, pototoes, bread, (e) Egbert's Hygiene and Sanitation, page 217; for examples see (b). 326. Mention four alimentary principles essential to health. (September, 1902.) 326. Collins and Rockwell's Physiology, pages 28 and 29; and Egbert's Hygiene and Sanitation, page 217. 327. What are the objects of cooking food? (November, 1891.) 328. What changes in food are effected by cooking? (May, 1900.) 82 PHYSIOLOGY AND HYGIENE. 329. Discuss the effect of the cooking of food as a means of rendering it more digestible. (April, 1895.) 330. What purpose is served in boiling starchy food-stuffs? Explain. (May, 1901.) 327 to 330. Egbert's Hygiene and Sanitation, page 226. 331. What precautions should be taken in the ingestion of vegetable foods? Give reasons for taking these precautions. (September, 1894.) 331. Egbert's Hygiene and Sanitation, page 255; vege- tables eaten raw should be very thoroughly washed, and care taken to prevent the possibility of ingesting parasites (or their ova) or typhoid germs. 332. Give (a) the relative food value and (b) ease of diges- tion of meat, milk, eggs, leguminous fruits. (September, 1895.) 332. (a) Leguminous fruits, eggs, meat, milk; (b) milk, eggs, meat, leguminous fruits. 333. What fruits are preferable in cases of habitual consti- pation? (January, 1899.) 333. Figs, prunes, fresh apples, berries, plums, shaddock, oranges. 334. (a) Discuss the dietetic value of alcohol. (June, 1901.) 335. (a) Does alcohol possess a food action? On what do you base your ansiver? (June, 1894.) 336. (b) Describe the physiological action of alcohol. (May, 1894.) 334 to 336. (a) Egbert's Hygiene and Sanitation, pages 262 to 265. (b) Nervous system: Alcohol is first a powerful excitant, afterward a depressant; it increases the reflex activity of spinal cord, muscles, and nerves; in large doses it produces lack of co-ordination. Circulatory system: It stimulates the heart muscle and increases the rapidity and force of the heart beat; there is a rise of arterial pressure. Respiration is stimulated by small doses, and decreased by 83 PHYSIOLOGY AND HYGIENE, large ones. Temperature: Alcohol produces a sensation of warmth, and warms the extremities by causing the heart to pump hot blood from the centre of the body to the cold parts. If used in excess the temperature rapidly falls owing to increase of heat radiation and to depression of vital power. Bodily metabolism: Elimination of CO2 is generally increased; the effect on absorption of is not known. It adds force but not tissue to the body. Elimination: It is largely burnt up in the body; but in excessive doses it is eliminated by the breath, skin, kidneys and intestines. Digestion is aided by moderate doses, but is disordered by large amounts. (From Hare's Therapeutics.) 337. What special use does each of the following serve in the body after ingestion: (a) proteids, (a) fats, (a) carbo- hydrates, (b) alcohol, (c) tea and (c) coffee? {May, 1900.) 338. (a) What is the function of each class of foods in the nutritive process? (September, 1900.) 337 and 338. (a) Egbert's Hygiene and Sanitation, page 217; (b) pages 262 to 265; (c) pages 260 and 261. 339. What is the influence of diet on nutrition? (June^ 1894.) 339. Collins and Rockwell's Physiology, pages 136 to 140. 340. What is the composition of human milk? {July, 1893.) 340. Collins and Rockwell's Physiology, page 120. 341 . What precautions are necessary in the artificial feeding of infants? {January, 1892.) 341. Milk should be of good quality, preferably ''cer- tified." It should be' used raw ; neither boiled nor, if possible to avoid, Pasteurized. It should be so manipulated, by creaming and dilution with boiled water, with the addition of milk-sugar, as to resemble as nearly as may be himaan milk. It is well, as a preliminary, to start with percentages well within the digestive capacity of the child and gradually to increase them, keeping watch on the stools for evidence of overfeeding, and upon the weight for signs of under- jeeding. 84 PHYSIOLOGY AND HYGIENE. 342. What is milk sterilization and how is it performed? (September, 1898.) 342. '^Sterilization of milk requires continuous heating under pressure for about two hours at 248° F., at which temperature not alone the bacteria and their spores are destroyed, but the normal appearance and taste of the milk as well. Part of the sugar is converted to caramel, part of the casein is precipitated, and the milk will no longer form a cohesive coagulum with rennet. '^ (Harring- ton's Practical Hygiene.) 343. Give the comparative nutritive value of sterilized and of unsterilized cows^ milk. {January, 1897.) 343. Unsterilized milk has a greater nutritive value than sterilized milk. 344' What in your judgment is the best method of prep- aration of artificial food for infants? Why? {November, 1893.) 344. Authorities are generally agreed that some modi- fication of cows' milk is the most practical, useful, and reliable. The following "low average" is suggested for a healthy infant : Fat, 3 per cent. ; sugar, 6 per cent. ; pro- teid, 1 per cent. It can be approximated by taking — Top milk (after six hours) from a quart bottle . 10 ozs. Boiled water . 30 " Milk-sugar, by weight (about 8 teaspoonfuls) . . 2 " Salt a pinch. Two to 4 ounces of the water may at times, with advan- tage, be replaced by an equal quantity of lime-water or strained barley-water. 345. How would you prepare an artificial food for a newborn infant? {March, 1893.) 345. For the first twenty-four hours give simply 5 per cent, solution of lactose. Thereafter a formula of 85 PHYSIOLOGY AND HYGIENE. Fats 2 per ct. Sugar 4.5 '' Proteid 0.5 " might be tried, compounded as follows : Let bottle stand six hours. Take top milk (of quart bottle) 1 pint. Boiled water 3 pints. To every 10 ounces of this dilution add 2 teaspoonfuls of lactose, warm, and feed 1 ounce every two hours. Pre- pare fresh every day. Keep on ice. 346. Prescribe the diet of a child about ceasing to nurse at the mother's breast. (September, 1896.) 346. Starr gives the following: Cream 1 tablespoonful (f^ss). Milk 11 tablespoonfuls (f^vss). Milk-sugar 1 teaspoonful (5J)- Salt a pinch. Water 4 tablespoonfuls (f^ij). 3Jf.7. What class of foods should be given to children between the first and second year of age? {November, 1892.) 348. How should an infant be fed between the ninth and twenty-fourth month? (April, 1893.) 349. What should be the diet of a child over two years of age? (January, 1893.) 347 to 349. ''The following is a sample diet given by Holt for a child eighteen months old: First Meal. — A tablespoonful of some cereal with salt and one table- spoonful of cream, one-half pint of milk. Second Meal. — One-half pint of milk. Third Meal. — One tablespoonful of scraped meat, two small pieces of dried bread, half a pint of milk. Fourth MeaL— Milk. Fifth Meal.—W\\k. with farina or arrowroot. Instead of scraped meat, beef-juice or a soft-cooked egg may be substituted occasionally. Of 10 86 PHYSIOLOGY AND HYGIENE. the beef -juice from one to three tablespoonfuls may be given at a time. ''The quantity of milk allowed at a single feeding for a child during the second year should be from eight to ten ounces during the first half and from ten to twelve ounces during the latter half of the year" (Holt). "Diet from the Eighteenth to the Thirtieth Month (Starr), 7 A.M., new milk, eight ounces; the yolk of an egg lightly boiled; two thin slices of bread and butter, or else milk^ and two tablespoonfuls of well-cooked oatmeal or wheaten grits, with sugar and cream. 11 a.m., milk, six ounces^ with a soda biscuit or bread and butter. 2 p.m., one table- spoonful of rare mutton pounded to a paste, bread and butter, or mashed potatoes moistened with good dish gravy, a saucer of junket; or else a breakf astcupful of beef- tea or mutton or chicken broth, a thin slice of stale bread, a saucer of rice and milk pudding. 6.30 p.m., a breakfast- cupful of milk with bread and butter, or soft milk toast.'' ' ' Diet from Two and a Half to Three and a Half Years of Age — i. e., for Children who have Cut their Milk Teeth (Starr). 7 a.m., one or two tumblers of milk, a saucer of thoroughly cooked oatmeal or wheaten grits, a slice of bread and butter. 11 a.m. (if hungry), a tumbler of milk or a teacupful of beef-tea with a biscuit. 2 p.m., a slice of underdone roast beef or mutton, or a bit of roast chicken or turkey, minced as fine as possible; a mashed baked potato moistened with dish gravy, a slice of bread and butter, a saucer of junket or rice and milk pudding. 7 p.m., a tumblerful of milk and a slice or two of soft milk toast.'' (Thompson's Practical Dietetics.) 350. What class of foods should predominate for persons over sixty years of age? (May, 1893.) 351. Give a dietary for people beyond the age of sixty years, {January, 1898.) 350 and 351. The following, from Yeo, is taken from Thompson's Practical Dietetics: " Oi animal foods best suited for this time of life the following may be mentioned. 87 PHYSIOLOGY AND HYGIENE. When the organs of mastication are altogether inefficient these foods should be minced or pounded into a paste or otherwise finely divided. Young and tender chicken and game and other tender meats. . . . White fish, best when boiled. Bacon, grilled; eggs lightly cooked or beaten up with milk. Nutritious soups, such as chicken or fish, beef-tea, mutton and chicken broths. Milk in all forms when easily digested. . . . Bread and milk made with the crumb of stale bread. Porridge and oatmeal gruel. Puddings of ground rice, tapioca, arrowroot, sago, macaroni with milk or eggs. . . . Artificial foods, consisting of predigested starches. Vegetable purees of all kinds in moderation, stewed celery. Stewed or baked fruits and fruit jellies.'' 352, What is the daily quantity of food required to nourish the human system? (January, 1895.) 352. Egbert's Hygiene and Sanitation, page 228; and Collins and Rockwell's Physiology, page 137. 853. Mention a daily ration containing the proper relative proportion of proteids, fats, and carbohydrates. (May, 1902.) 353. The following is quoted as an '4deal ration" in Thompson's Practical Dietetics: Material. Amount. Proteid Fats Carbohydrates (ounces) . (ounces) . (ounces). (ounces). Bread . . 16 1.12 0.08 9.04 Meat 8 1.20 0.40 ■ Oysters 8 0.44 0.07 • • • • Breakfast cocoa 1 0.23 0.26 0.34 MHk . . . 4 0.13 0.16 0.17 Broth . . . 16 0.64 0.64 3.20 Sugar 1 • . . > .... 0.96 Butter . h . . , . .... .... 354' Describe the effects of a cereal diet. [September, 1897.) 88 PHYSIOLOGY AND HYGIENE, 354. From a cereal diet alone, the maximum of work and energy, either mental or physical, cannot be obtained. *'It is claimed that a vegetable diet favors the deposition of mineral salts in different parts of the body, as phosphatic stone, gravel, the tartar on the teeth, and that living upon coarse cereals alone makes the skin rough and the indi- vidual dull, heavy, and ill-tempered." (Thompson's Prac- tical Dietetics); and see Egbert's Hygiene and Sanitation, page 252. 355. What is the effect of an excessive meat diet? {Septem- ber, 1896.) 355. See Q. 357 (b). 356. What effect does an excessive starchy diet produce? {September, 1892.) 356. It may produce dyspepsia, flatulence, diarrhoea, glycosuria, or obesity. 357. (a) Give a fattening diet, (b) What are the effects of too much food on the human system? {June, 1897.) 357. (a) ''When the digestive organs admit, the follow- ing articles may be prescribed in the diet: Abimdant fat meats, butter, cream, milk, cocoa, and chocolate. Bread, potatoes, legumes, well-cooked cereals, especially oatmeal and cornmeal, farinaceous puddings with sugar and cream cake, sweets, syrup, honey, sweet wines, port, porter, stout, ales, and beer. Malt preparations of all sorts are also useful. Sweet fruits may be eaten. To be avoided are: pickles, acids, condiments, much bulk of green vegetables, and strong liquors." (Thompson's Practical Dietetics.) (b) '' Overeating not only taxes the digestive system, but, what is often more serious, it throws too great a strain upon the glandular and excretory organs, especially the liver and kidneys, and if the habit is long continued disease inevi- tably results Chronic overeating may cause such diseases or diatheses as obesity, gout, lithsemia, oxaluria, and the formation of renal, vesical, and hepatic 89 PHYSIOLOGY AND HYGIENE. calculi. It is certain to cause congestion of the liver and the condition known as 'biliousness/ in which the stomach and intestines are engorged, constipation results, the tongue is heavily coated, the bodily secretions are altered in com- position, the urine especially becoming overloaded with salts, the liver becomes congested, and finally the nervous and muscular systems are affected, with the results of the production of headache and feelings of fatigue, lassitude, drowsiness, and mental stupor/' (Thompson's Practical Dietetics.) 358. (a) Describe the 'physiological causes of obesity. {May, 1894.) 359. (a) What physiological causes tend to produce obesity? {September, 1896.) 360. (b) What kinds of food would you recommend in cases of obesity f {January, 1893.) 361. (b) What diet should be advised to reduce obesity? {September, 1895.) 362. (b) Indicate hygienic treatment to reduce excess of fat in an unmarried woman whose organs are normal. {January, 1902.) 358 to 362. (a) Heredity, age, overeating, ingestion of too much carbohydrate food, idiosyncrasy, lack of exercise, (b) Diminish the carbohydrates, give saline laxatives, , massage, gradual exercise; and see A. to 365 (b). 363. How should diet in Cuba differ from diet in Gree7i- landf {January, 1901.) 363. Diet in Cuba should consist of more fruit and vegetables, less meat and fat, and the total quantity should be diminished somewhat. In Greenland a larger quantity would be required, and a considerable amount of fatty food would be consumed; this latter would, on being oxidized in the body, furnish a large supply of heat. 364- What precautions as to food and drink should be observed by those forced to work under the direct rays of the sun in summer weather? {May, 1896.) 90 PHYSIOLOGY AND HYGIENE. 364. ^'Moderation of diet is especially to be enjoined. Very little animal food should be taken; the food, while sufficiently nutritious, should be light and unstimulating. Iced water should be drunk freely and frequently, and the greatest moderation in the use of stimulants should be observed. Excesses in eating and drinking are to be deprecated.'^ (AUbutt's System of Medicine.) 365. Indicate a proper diet in a case of (a) diabetes ' mellitus, (b) obesity, and (c) early convalescence from typhoid fever. {January, 1899.) 365. (a) " During' s diet for Diabetes is as follows: Early Breakfast. — Milk, with a little coffee but no sugar (lime- water, to prevent milk from souring in the stomach) ; stale white bread ad libitum, or, if it is not well borne, oatmeal, barley, or rice gruel made with water, a little salt, but no butter. Second Breakfast. — White bread, stale and well baked; an egg, lightly boiled; rice or oatmeal gruel, with or without milk, a breakf astcupf ul ; or half a glass of good red wine (with water in certain cases). Dinner (taken between two and three o'clock). — Soup, with rice, barley, or oatmeal; meat, roasted, two hundred and fifty grammes (game, ham, and smoked meats, as free from fat as possible, are permissible); no condiments, no fatty sauces; compote of dried apples, plums, cherries; dried peas or white beans in some cases; green vegetables, asparagus, French beans, carrots, cauliflower, cabbage (boiled in water with salt, not with fat or stock) ; dessert of a little raw fruit, apples, cherries, and one small glass of red wine diluted with water. Supper (about 7 p.m.). — Gruel of barley, oatmeal, or rice, with salt (but no butter), and strained, which in some cases may be made with milk. Ice or iced water, to relieve thirst between meals." (Thompson's Practical Dietetics.) (b) "Ebstein's diet for Obesity is as follows: Breakfast con- sists of a cup of black tea without sugar or milk and two o\mces of buttered toast. Dinner, which is given at noon, comprises a meat soup or broth; four to six ounces of 91 PHYSIOLOGY AND HYGIENE. boiled or roasted fat beef with meat gravy, not thickened; one or two fresh vegetables, in moderation; and for dessert salads and fresh or dried fruits. He allows a little light wine and black tea without milk or sugar. Supper includes tea as before, a soft-cooked egg, and a moderate allowance of fish, ham, or cold fat meat, an ounce of thin buttered bread or toast, and fresh fruit." (Thompson's Practical Dietetics.) (c) ^'The following is a list of foods suitable for the different days of convalescence (from typhoid fever) ^ commencing a day or two after disappearance of all fever. Milk should still be given until gradually wholly replaced by solid food. First Day. — Chicken broth thickened with thoroughly boiled rice. Milk toast or cream| toast once only during the day. Beef-juice. Second Day. — Junket, mutton broth, and bread crimibs. Cocoa; milk toast. A piece of tender steak may be chewed, but not swallowed. One of the prepared farinaceous foods, such as Mellin's or Horlick's, may be given with a cup of hot milk. Third Day. — A small scraped-beef sandwich at noon. A soft- cooked egg or baked custard for supper. Boiled rice or potato puree strained. Arrowroot gruel.'' (Thompson's Practical Dietetics.) VII. EXCRETION. 1. The Kidneys and the Urine. 366. What changes take place in the composition of blood as it passes through the kidneys? {January, 1895.) 366. See A. 154 (5). 367. Describe the function of the kidneys. {September^ 1901.) 368. Describe the physiological action of the kidneys. {November, 1894.) 367 and 368. The function of the kidneys is to secrete urine. (See Collins and Rockwell's Physiology, page 131.) 92 PHYSIOLOGY AND HYGIENE. 369. Give the ^physiology of urine excretion. {June, 1897.) 370. Describe the excretion of urine hy the kidneys. (Sep- tember, 1898.) 371. Describe the excretion of urine. {May, 1901.) 372. What is the mechanism of urinary excretion? {March^ 1893.) 369 to 372. Collins and RockwelFs Physiology, page 131. 373. Describe the mechanism (a) of defecation, (b) of micturition. {September, 1896.) 374- (b) Describe the mechanism of micturition. {JunCy 1895.) 375. (c) Give the nervous mechanism of urination. {May, 1896.) 373 to 375. (a) Collins and RockwelFs Physiology, page 110; (b) page 133; (c) pages 133 and 182. 376. (a) Describe the physical properties of healthy urine. {April, 1896.) 377. (b) What is the composition of urine? (c) Give the normal reaction and (d) the specific gravity of urine. {June, 1899.) 378. (e) Give the variations within the limits of health in the specific gravity of urine. {June, 1893.) 379. (b) In one thousand parts of normal urine what pro- portion is water? (b) Mention the substances that make up the solids in normal urine. {September, 1899.) 380. (b) Name the solids of the urine and (f) state the approximate amount of each voided daily by an adult. {January, 1897.) 381. (g) What conditions increase the amount of solids in the urine? {July, 1893.) 376 to 381. (a) Collins and RockwelFs Physiology, page 129 ; (b) page 130 ; and see (f ) ; (c) Collins and Rockwell's Physiology, page 130; (d) page 129; (e) page 129. (f) "The following table shows the average composition of urine and amount of each constituent voided daily: 93 PHYSIOLOGY AND HYGIENE. Voided per Day. Water . . . . 950 Urea .... 28 1 Uric acid 0.60 Hippuric acid . 0.35 - Creatinine . 0.65 Extractives . 8.00 Sodium chloride 8.00 1 Phosphoric acid 2.00 Sulphuric acid . 1.25 Lime (CaO) . . 0.25 I Magnesia (MgO) 0.30 1 Potash (KjO) and^sc )da (N( ifi) 0.60 J Grains. Organic 520.80 matter, 37.60 11.16 6.51 12.09 148.80 148.80 T . 37.20 Inorganic go 45 matter, ^^g 5.58 11.16 12.40 Total . Water Organic matter . Inorganic matter 1000.00 950.00 37.60 12.40 930.20 699.36 230.64 Grams. 35.00 0.75 0.44 0.81 10.00 10.00 2.50 1.56 0.31 0.37 0.75 62.49 47.00 15.49 The average quantity of urine voided in twenty-four hours is from forty to sixty fiuidounces.'' (DungUson's Medical Dictionary.) (g) Meat diet, muscular exertion, mental effort, worry, hysteria, fevers, diabetes, nephritis, dyspepsia, and many other diseases. S82. Describe urea, (a) its occurrence, (b) variations in the quantity excreted, and (c) recognition in the voided urine. {September, 1894.) 383. (b) What conditions within normal limits will modify the quantity of urea in the urine? {November, 1891.) 384. State what you know about urea. {April, 1893.) 382 to 384. Collins and Rockwell's Physiology, page 134. (a) Urea is the chief solid constituent of the urine; it is also found in blood, lymph, chyle, muscle tissue, bile, perspiration, saliva, milk, liver, lungs, spleen, and brain. (b) The amount of urea eliminated varies with age, sex, and diet. In infancy there is little or no urea eliminated; growing children void relatively more urea than adults; in old age the quantity is diminished. Males excrete more urea than females ; during pregnancy females excrete more 11 94 PHYSIOLOGY AND HYGIENE. urea than males. A heavy meat diet and large quantities of water increase the output of urea. It is also believed that exercise increases the amount of urea excreted, (c) ''There are no very characteristic reactions by which urea can be well recognized. From organic mixtures it is sepa- rated by digesting them with from 3 to 4 volimies of alcohol in the cold ; the filtered liquid is evaporated to dryness and extracted with alcohol, which again is evaporated. The dry residue may be tested for urea as follows : (1) Dissolved in a few drops of water, the addition of an equal quantity of colorless nitric acid causes the formation of white, shining, crystalline plates or prisms of urea nitrate. (2) If a strong solution of oxalic acid is added instead of nitric acid, rhombic plates of urea oxalate form. (3) The residue (or urea) heated in a test-tube to about 160° C. (320° F.), until no more vapors of ammonia are evolved, leaves a substance termed biuret, Cfl^fi^, which upon the addition of a few drops of potassium hydroxide solution and a drop of cupric sulphate solution causes the solution of the cupric hydroxide with a reddish-violet color." (Dunglison's Med- ical Dictionary.) 2. The Skin. 885. What are the functions of the skin? {January, 1892.) 386. What are the functions of the skin? {June, 1893.) 387. What are the functions of the skin and its appendages? {May, 1899.) 385 to 387. The functions of the skin and its appendages are: protection, excretion, heat regulation, absorption, sensation, respiration. 388. (a) What matters are excreted by the skin? (b) How may the function of the skin be affected as to amount of excretion? {January, 1900.) 388. (a) Sebum and sweat, (b) Collins and Rockwell's Physiology, page 125. 389. What is the function of (a) the sudoriferous glands; (b) the sebaceous glands? {April, 1894-) 95 PHYSIOLOGY AND HYGIENE. 390. (a), (b) Mention the glands of the skin and give their function. (May, 1897.) 389 and 390. (a) Collins and Rockwell's Physiology, pages 122 and 124; (b) pages 122 and 125. 391. What is the composition of the sweat? {January, 1894,) 391. Water 98.88 SoUds 1.12 ( Fats and fatty acids . . . . . . 0.41 6^ ] Epithelium 0.17 ^ Urea and other nitrogenous compounds 0.08 Inorganic J Sodium chloride 0.28 0.46 I Other salts 0.18 (From Hall's Physiology.) 392. What are the uses of the perspiration? {July, 1893.) 392. Collins and Rockwell's Physiology, page 125. 393, What relation does the nervous system hear to the excretion of perspiration? {January, 1896.) 393. Collins and Rockwell's Physiology, page 125. VIII. METABOLISM OF TISSUES. 1. Muscular Metabolism. 394- (a) What stimuli produce muscular contraction? (b) What is the nervous mechanism of muscular contraction? Illustrate. {June, 1899.) 395. (b) Describe the mechanism of muscular contraction. {January, 1893.) 396. (c) Differentiate tonic muscular contraction and clonic muscular contraction. {May, 1902.) 397. (c) Define tonic muscular contraction, clonic muscu- lar contraction. Give an example of each. {April, 1899.) 394 to 397. (a) Collins and Rockwell's Physiology, page 150; (b) pages 148 and 149. (c) In tonic muscular con- 96 PHYSIOLOGY AND HYGIENE. traction the muscle remains for some time in a state of rigid contraction; in clonic contraction, the muscle alter- nately contracts and relaxes. Tonic muscular contraction occurs in tetanus; clonic in an ordinary convulsion. 398. What changes take place in a muscle during con- traction? (June, 1893.) 399. Describe the changes in form and volume, and in physical and chemical properties, occurring in the contraction of a muscle. (April, 1896.) 398 and 399. During contraction the following changes take place in a muscle: 1. It becomes shorter and thicker, but 2. There is no change in volume or bulk. 3. There is an increased consumption of oxygen. 4. More carbon dioxide is set free. 5. The muscle becomes acid in reaction, due to 6. Formation of sarcolactic acid. 7. Its extensibility is increased. 8. Its elasticity is diminished. 9. There is an increase in heat production, and conse- quently a rise of temperature. 10. The electric reaction becomes relatively negative. 11. A sound is produced. JflO. What is meant hy the condition of tetanus in a muscle f (March, 1893.) 400. Collins and Rockwell's Physiology, page 153. 401. How do the striped and the unstriped muscular fibres differ in response to stimuli? (January, 1896.) 401. Collins and Rockwell's Physiology, page 151. If.02. Give the causes of muscular fatigue. (May, 1896.) 402. Collins and Rockwell's Physiology, page 147. Jf.03. Describe the metabolism of muscle during activity. {January, 1902.) JfiJ^. What is the effect of suspended functional activity on muscles? (November, 1893.) 97 PHYSIOLOGY AND HYGIENE. 403 and 404. Collins and Rockwell's Physiology, page 145; and see Q. 398 and 399. 406. (a) What is rigor mortis f (b) What is tetanus? (March, 1893.) 406. (a) Describe the rigor mortis. (March, 1893.) 407. (c) What is the order of occurrence of rigor mortis in the different parts of the body? (January, 1893.) 408. (a) Define rigor mortis, (d) What regulates its onset and duration? (March, 1892.) 409. Give (e) the cause and (c) the order of occurrence of rigor mortis. (May, 1893.) 405 to 409. (a) Collins and Rockwell's Physiology, page 158; (b) see Q. 400; (c) Collins and Rockwell's Physiology, page 159; (d) page 158; (e) page 159. 2. Glandular Metabolism. 410. Describe an epithelial secreting surface. (January, 1892.) 410. Collins and Rockwell's Physiology, page 116. 411. Explain the anatomical and physiological differences between mucous, serous, and synovial membranes. (Novem- ber, 1892.) 412. What is the function of the serous and of the synovial membranes? (November, 1892.) 411 and 412. ^^ Mucous membrane, so called on account of the mucous fluid by which it is constantly lubricated. Mucous membranes line the canals, cavities, and hollow organs which communicate externally by different aper- tures on the skin. Bichat refers them to two great divisions — the gastropidmonary and the genito-urinary . Mucous membranes have a striking analogy with the cutaneous tissue in organization, functions, and diseases. They are composed of corium, papillae, and epidermis, and are furnished with a multitude of follicles which secrete a viscid humor — mucus. They receive a number of arterial 98 PHYSIOLOGY AND HYGIENE. vessels, veins, lymphatics, and nerves. The serous mem- branes are transparent and thin. One surface adheres to other textures ; the other is smooth, polished, and moistened by a serous fluid. Serous membranes resemble the areolar membrane in structure and diseases. They facilitate the motion on each other of the organs which they envelop. They may be divided into (a) Serous membranes, properly so called, as the arachnoid, pleura, peritoneum, and tunica vaginalis; (b) Synovial membranes or capsules, which belong to joints, tendons aponeuroses, etc. These mem- branes — mucous and serous — are constituted of similar layers — epithelial, basement membrane, condensed areolar tissue — and a looser form of areolar tissue, termed sub- mucous in one case, subserous in the other.'' (Dunglison's Medical Dictionary.) And see Collins and Rockwell's Physiology, page 118. 4-13. What office is performed by (a) synovial membrane; (b) joint ligaments? (November, 1892.) 413. (a) ^'To diminish friction between the articular ends of the bones forming a movable joint; between a tendon and a bone, where the former glides over the latter; and between the skin and various subcutaneous bony prominences." (Gray's Anatomy.) (b) Ligaments connect bones in the formation of a joint, bones with soft parts, cartilages, soft parts with soft parts. 41Ji.. Define and illustrate simple tubular glands, compound tubular glands, racemose glands. {April, 1893.) 4-15. Give a general description of secreting glands. {Sep- tember, 1892.) 414 and 415. Collins and Rockwell's Physiology, page 116. 416. Define (a) metabolism, (b) assimilation, (c) secretion, and (d) excretion. {November, 1891.) 417. Define (c) secretion, (d) excretion, (e) protoplasm j (b) assimilation. Give an example of each. {March, 1892.) 99 PHYSIOLOGY AND HYGIENE. Jf.18. Define (c) secretion and (d) excretion, and give an example of each. (September, 1892.) 419. What is the difference between (c) secretion and (d) excretion in glandular function? Give an illustration of each. (March, 1892.) 420. Define (c) secretion; (d) excretion. Give two examples of each. (November, 1891.) 421. Define (c) secretion; (d) excretion, (f) Give the function of three secretions in the human economy. (January, 1893.) 422. (c) What do you understand by secretion? (No- vember, 1891.) 423. (g) Name seven secretions and give the functions of each. (June, 1892.) 4^4' (g) Name the secretions of the body. (June, 1892.) 4^5. (g) Name the secretions and give the functions of each. (November, 1892.) 426. (h) Name the excretory glands of the body and the function of each. (March, 1892.) 427. (h) Name the excretions of the body. (April, 1893.) 416 to 427. (a) Collins and Rockwell's Physiology, page 18; (b) page 140; (c) page 115; (d) page 115; (e) pages 19 and 22; (f) page 136; (g) pages 136 and 115; (h) pages 136 and 115; the excretions proper are sweat, urine, and bile. 4^8. (a) Name two circumstances influencing secretion. (November, 1892.) 429. (b) What is the influence of the nervous system on glandular secretion? (November, 1892.) 430. (b) What influence has the nervous system on the process of secretion? (November, 1891.) 428 to 430. (a) Colhns and Rockwell's Physiology, page 117; (b) page 117. 431. Describe the process of secretion from a typical gland such as the submaxillary. (June, 1892.) 100 PHYSIOLOGY AND HYGIENE. 431. ''In the submaxillary gland, a portion of which may be taken as a type of a mucous gland, changes have been observed similar to those described in the case of the parotid gland. (See answer to Q. 212.) During rest the epithelial cells are large, clear in appearance, highly re- fractive, and loaded with small globules resembling mucin. The nucleus, surrounded by a small quantity of proto- plasm, lies near the margin of the cell. That the granules are not protoplasmic in character is shown by the fact that they do not stain on the addition of carmine. When treated with water or .dilute acids the globules swell up, coalesce, and form a uniform mass. The chemical relations of this substance indicate that it is the precursor of mucin, namely, mucigen. During secretory activity the cells dis- charge these mucigen granules into the lumen of the acinus, where they are transformed into mucin. Though the appearance of the gland cell appears to indicate it, there is no evidence for the view that the cell itself undergoes disintegration in the process." (Brubaker's Text-hook of Physiology.) 482. Mention the secreting membranes of the body and state the function or functions of each. (June, 1892.) 432. ColUns and Rockwell's Physiology, pages 118, 115, and 136. 3. The Ductless Glands. J^33. (a) Mention the ductless glands and (b) give the theory as to the functions of any one of them. (September, 1892.) 434. (b) State the theories held regarding the function of the spleen. (November, 1892.) 435. (c) What explanation may be given for enlargement of the spleen in leukocythcemiaf (November, 1892.) 433 to 435. (a) The ductless glands are: the spleen, thyroid, thymus, suprarenal capsules, parathyroids, carotid and coccygeal glands, and the pituitary body, (b) The 101 PHYSIOLOGY AND HYGIENE. following theories have been held regarding the functions of the spleen: (1) it is a source of production of white blood corpuscles; (2) it is a source of production of red blood corpuscles during foetal life; (3) it is a place where the red blood corpuscles are destroyed; (4) uric acid is produced in the spleen; (5) an enzyme is produced in the spleen, this enzyme is carried by the blood to the pancreas, and there converts the trypsinogen found in that gland into trypsin, (c) In leukocythsemia the spleen is enlarged owing to the great increase in the number of white blood cor- puscles found in this condition ; these white blood corpuscles are supposed to be manufactured in the spleen. See (b). 436. What effects are produced in the system by the removal of the thyroid gland f (March, 1892.) 436. The face becomes white, puffy, and loses all expres- sion; the mental and intellectual faculties become dulled, and may terminate in idiocy; the heart becomes slowed, blood pressure lowered; temperature may be subnormal; albuminuria and dyspnoea may be present; the pufhness of the face extends to the neck and supraclavicular fossse; the tongue is enlarged and speech is slow and measured; the extremities become enlarged and movements are slow, labored, and clumsy. 4S7. In what glands of the body is function undetermined? {September, 1892.) 438. Name structures in the body whose functions are doubtful or unknown. (March, 1893.) 437 and 438. See A. 433 (a), omitting suprarenal cap- sules. IX. ANIMAL HEAT. 439. (a) What is animal heat, and (b) how is it produced? (November, 1892.) 440. (b) What is the mode of production of heat in the body? (June, 1892.) 441 ' (c) How is the heat of the body maintained? (Sep- tember, 1892.) 12 102 PHYSIOLOGY AND HYGIENE. 442. (d) What is the normal body temperature? (c) How is it regulated and sustained? (November, 1892.) 44$. (c) How is the temperature of the body regulated? {January, 1893.) 444. (c) By what means is the body temperature regulated and kept uniform? {March, 1892.) 445. (c) What conditions tend to keep the body temperature uniform? {May, 1893.) 439 to 445. (a) ''By animal heat is understood the heat that is constantly being formed by the body of a living animal, by which it preserves nearly same temperature whatever may be that of the medium in which it is placed. It takes place over the whole body, in production of carbonic acid, and in other oxidizing processes, and in changes in nutrition/' (From Dunglison's Medical Dic- tionary.) (b) ColUns and Rockwell's Physiology, page 14.0; (c) page 141; (d) page 140. 44^' {^) What variations of temperature are found in different parts of the body? (b) Mention the reasons for such variations. {July, 1893.) 44"^' (b) What conditions produce variations in the normal temperature of the body? {April, 1893.) 448. (b) What conditions influence the temperature of the body? {March, 1893.) 44^' (b) Mention the conditions that cause variation in the amount of animal heat produced in the body. {January, 1892.) 450. (b) Give the causes of variation in the heat of the body. (March, 1892.) 446 to 450. (a) Collins and Rockwell's Physiology, page 140. Hall, in his Text-book of Physiology, gives the follow- ing temperatures: Bend of knee, 35° C.; inguinal fold, 35.8° C; closed axilla, 36.5° C; mouth (under tongue), 37.2° C; rectum, 38° C; vagina, 38.3° C. (b) Age, sex, climate and season, bodily and mental activity, bathing, food, sleep, drugs, and diseases. 1Q3 PHYSIOLOGY AND HYGIENE. 451. (a) How is the average temperature of the body main- tained? (b) Give the normal temperature of the body as shown by (1) the mouth, (2) the rectum. {June, 1892.) 451. (a) See Q. 439 to 445 (c); (b) see Q. 446 (a). Jj.52. Wherein does the temperature of the body in advanced age differ from its temperature in middle life? What is the temperature of the newborn child? {April, 18 98.) 452. "The average temperature of the newborn child is only about half a degree C. (1° F.) above that of the adult ; and the difference becomes still more trifling during infancy and early childhood. The temperature falls to the extent of about 0.2° C. (0.5° F.) from early infancy to puberty, and by about the same amoimt from puberty to fifty or sixty years of age. In old age the temperature again rises, and approaches that of infancy.'' (Kirkes' Fhysiology.) 4.53. Give the difference (a) between the temperature of a newborn child and that of an adult; (b) between the temper- ature of a person intoxicated by alcoholic drink and his temperature after the first stimulating drink of liquor. {Janu- ary, 1893.) 453. (a) See Q. 452. (b) In a person intoxicated by alcoholic drink, the body temperature will be lowered; whereas, after the first stimulating drink it may be tempo- rarily raised a little. 454. (a) State the conditions that affect bodily temperature. (b) What mechanism is concerned in therinogenesis? (c) Explain occasional post-mortem rise of temperature. {Janu- ary, 1893.) 454. (a) See Q. 446 to 450 (b). (b) The mechanism con- cerned in thermogenesis consists of: (1) thermogenetic tissues, such as voluntary muscles, glands, the heart; (2) thermogenetic nerves; and (3) thermogenetic centres in the cortex and base of the brain, pons, medulla, and spinal cord; these centres are of two kinds, thermo-accelerator and 104 PHYSIOLOGY AND HYGIENE. thermo-inhihitory . (c) '^The most important factors are these : When the circulation and respiration cease at death, the normal loss of heat from these causes and from sweating also comes to an end, but the tissues live for a short time and produce heat even after the death of the organism as a, whole. If this production of heat is greater than the loss of heat from the corpse, the temperature rises; if, on the other hand, it is less, then the effect is only to delay the fall of temperature. The next source of heat is in the muscles on the onset of rigidity ; and, finally, when decom- position sets in, and this may after some diseases occur exceedingly rapidly, there is a further production of heat due to putrefaction. In some cases the temperature of a corpse does not fall to that of the atmosphere even in four or five days." (Schafer's Text-hook of Physiology.) X. THE PRODUCTION OF THE VOICE. 455. Give the physiology of the human voice. (September, 1892.) Jf.56. Give the physiology of the human voice, mentioning the organs and forces concerned in the production. (Sep- tember, 1892.) 451 . How are the vocal sounds produced? (January, 1895.) 455 to 457. Collins and Rockwell's Physiology, page 241. Jf.58. Describe the action of the vocal cords. (March, 1892,) 459. Give the movements of the vocal cords in vocalization. (March, 1892.) 458 and 459. Collins and Rockwell's Physiology, page 241. 460. What organs constitute the vocal apparatus? Explain in detail how they operate to produce and modulate the voice. (May, 1893.) 460. See Q. 455 to 459. 461. (a) What constitutes the usual difference between male and female voices? (January, 1892.) 105 PHYSIOLOGY AND HYGIENE. 4.62. (a) What causes the difference in pitch between male and female voices? (b) What causes the voice of the youth at the period of puberty to " crack f (April, 1893.) 461 and 462. (a) ^'The difference in the pitch of the male and female voices depends on the different length of the vocal cords in the two sexes; their relative length in men and women being as three to two. The difference of the two voices in tone or timbre is owing to the different nature and form of the resounding walls, which in the male larynx are much more extensive, and form a more acute angle anteriorly. The different qualities of the tenor and bass, and of the alto and soprano voices, probably depend on some peculiarities of the ligaments and the membranous and cartilaginous parietes of the laryngeal cavity, which are not at present understood, but of which we may form some idea by recollecting that musical instruments made of different materials — e. g., metallic and gut strings — may be tuned to the same note, but that each will give it with a peculiar tone or timbre." (Kirkes' Physiology.) (b) ''The boy's larynx resembles the female larynx; their vocal cords before puberty are not two-thirds the length of the adult cords; and the angle of their thyroid cartilage is as little prominent as in the female larynx. Boys' voices are alto and soprano, resembling in pitch those of women, but louder, and differing somewhat from them in tone. But, after the larynx has undergone the change produced during the period of development at puberty, the boy's voice becomes bass or tenor. T\niile the change of form is taking place the voice is said to crack; it becomes imperfect, frequently hoarse and crowing, and is unfitted for singing until the new tones are brought under command by practice." (Kirkes' Physiology.) 463. How are the phenomena of ventriloquism produced? (January, 1892.) 463. ''It seems that the essential mechanical parts of the process of ventriloquism consist in taking a full inspi- 106 PHYSIOLOGY AND HYGIENE. ration, then keeping the muscles of the chest and neck fixed, and speaking with the mouth almost closed, and the lips and lower jaw as motionless as possible, while the air is very slowly expired through a very narrow glottis; care being taken also that none of the expired air passes through the nose. But, much of the ventriloquist's skill in imitating the voices coming from particular directions consists in deceiving other senses than hearing.'' (Kirkes' Physiology.) 464- (a) Define stammering, and (b) state what causes it. (April, 1893.) 464. (a) Stammering is defined as ''faltering and inter- rupted speech; especially, hesitancy and interruption in speech from difficulty in enunciating certain letters prop- erly." (Duane's Medical Dictionary.) (b) ''Stammering depends on a want of harmony between the action of the muscles (chiefly abdominal) which expel air through the larynx, and that of the muscles which guard the orifice (rima glottidis) by which it escapes, and of those (of tongue, palate, etc.) which modulate the sound to the form of speech. Over either of these groups of muscles, by itself, a stammerer may have as much power as other people; but he cannot harmoniously arrange their conjoint actions." (Kirkes' Physiology.) XI. THE NERVOUS SYSTEM. 1. The Spinal Cord and its Nerves. Jf.65. What is (1) an efferent nerve; (2) an afferent nerve? Illustrate each. {June, 1898.) Jf.66. How are the motor and sensory nerve impulses trans- mitted? {June, 1892.) 465 and 466. Collins and Rockwell's Physiology, page 162. 4-67. Give the mechanism of nerve reflex and an example of its action. {November, 1891.) 107 PHYSIOLOGY AND HYGIENE. J^68. Give two examples of reflex nerve action. (Aprils 1893.) 469. Define and describe reflex action. Give four examples of reflex action. {January, 1902.) 470. Deflne reflex nervous action. Give examples. (Janu- ary, 1901.) 467 to 470. Collins and Rockwell's Physiology, pages 181 to 183. 4-71. Give the physiology of (a) blushing, (b) pallor, (c) tear shedding. (May, 1897.) 472. (c) Describe the origin of a tear as the result of pain. (May, 1894.) 471 and 472. (a) and (b) ''Throughout the system of bloodvessels of the body we find an accompanying intricate nerve supply, through which medium the muscular walls of the bloodvessels are influenced to contract or to relax, and so control the volume of blood in a given part. In the heart there are met everywhere in its muscular walls nerve fibres originating in the cardiac ganglia, in those of the sympathetic system elsewhere, and in the medulla oblongata. None of these is subject to volimtary control, and stimuli arriving through them originate by irritation of the centres directly or by sensory impressions received by these centres. In the latter case it will be seen that a true reflex mechanism is called into play. Dilatation and contraction of the smaller, peripheral bloodvessels, giving rise to the phenomena of blushing and pallor, respectively, are often due to sensory stimulation. This may result as a simple reflex act or with the interposition of an emotional (psychic) state. It may not be unjustifiable to consider the latter as a complex reflex action, as when the sight of an accident happening to another produces pallor, for example.'' (KsiW, Text-book of Physiology.) (c) An afferent nerve conveys the sensation of pain, and an efferent impulse is sent reflexly to the lacrymal gland, causing an increased secretion of tears. 108 PHYSIOLOGY AND HYGIENE. Jf.73. Explain the action of the ano-spinal centre in defeca- tion. (June, 1898.) 473. Collins and RockwelFs Physiology, pages 183, 182 and 110. 474' What tests should he applied to ascertain the integrity of (a) the superficial reflexes, (b) the deep reflexes? (May, 1901.) 474. (a) *' Superficial Reflexes. (1) Plantar; elicited by stroking or scratching the sole of the foot, which causes attempts to withdraw the foot from the source of irritation. (2) Gluteal; a contraction of the gluteal muscles en masse when the buttock is gently pricked or scratched. (3) Cremasteric; when the thigh is irritated on its inner surface by grasping, stroking, scratching, etc., the homolateral testicle is distinctly retracted. (4) Erectile reflex of penis; produced by gentle friction of the glans penis, especially of the frsenum, resulting in turgidity of the organ and erection. Its analogue in the female pertains to the erection of the clitoris. (5) Abdominal; consists of a retraction of the anterior abdominal walls when the skin is slightly irritated. (6) Mammary; in women a retraction of the epigastrium when the mammary region is tickled.' (7) Palmar; corresponding to the plantar, usually less developed than the latter, (b) Deep Reflexes. (1) Tendo Achillis reflex; when the extended leg is supported at the knee, the hand pressing firmly against the ball of the foot, a tap on the tendo Achillis causes contraction of the gastrocnemius and soleus, and the heel is jerked up. (2) Ankle clonus; if the half -extended leg be supported at the knee, and the ball of the foot be suddenly pressed up, putting the tendo Achillis on a stretch, in certain instances there results a series of clonic contractions of the calf- muscles with consequent alternate extension and flexion of the foot, which continues as long as the pressure is maintained on the ball of the foot and ceases as soon as the foot is released from pressure. (3) Patellar Reflex 109 PHYSIOLOGY AND HYGIENE. (knee-jerk); when the thigh is supported by the hand or by being crossed over the other thigh, and the leg is flexed at the knee, thus securing relaxation of the quadriceps extensor, a tap on the tendon just below the patella causes the leg to be suddenly extended. (4) Triceps Reflex (elbow- jerk); this is analogous to the knee-jerk and is elicited by supporting the arm in the hand, on the examiner's knee, or by leaning on a table, the forearm being somewhat flexed, and then tapping the triceps tendon just above the olecranon." (Hall's Text-hook of Physiology.) 4.7s. Give illustrations of morbid reflex action. (April , 1898.) 475. The ankle clonus [see A. 474 (b)] is probably never present in health. Other instances of morbid reflex action can be seen in tetanus, when a slight touch, or even a breath of air, on the skin, may cause convulsions of the whole body; also in the vomiting of pregnancy. 476. What are the functions of the spinal cord? (No- vember, 1892.) 477. What are the functions of the spinal cord? (Sep- tember, 1899.) 478. What are the functions of the spinal cord? (Sep- tember, 1900.) 479. What are the functions of the spinal cord? (June, 1895.) 476 to 479. Collins and Rockwell's Physiology, page 178. 480. Describe the functions of spinal nerves. (March, 1893.) 481. What are the respective functions of the anterior and of the posterior cornua of the spinal cord? (June, 1896.) 482. State the function of the anterior spinal nerve roots. How is this function proved? (April, 1898.) 480 to 482. Collins and Rockwell's Physiology, pages 176 to 178. 483. To what extent is the spinal cord an independent nerve centre? (June, 1892.) 13 110 PHYSIOLOGY AND HYGIENE. 483. ^'The efferent cells of the spinal segments are the immediate sources of the nerve energy which excites activity in muscles, bloodvessels, glands. The discharge of their energy may be caused: (1) By variations in the composition of the blood or lymph by which they are surrounded. The activity of the cell thus occasioned is termed automatic or autochthonic. (2) By the arrival of nerve energy coming through afferent nerves from the general sentient periphery, skin, mucous membrane, etc. (3) By the arrival of nerve energy descending the spinal cord from the cerebrum or subordinate structures. The peripheral activity in the former instance is said to be reflex or peripheral in origin; in the latter instance, direct or cerebral in origin. In this latter instance, also, the muscle movements are due to volitional, the vascular variations and glandular discharges to emotional, forms of cerebral activity. Each segment of the spinal cord may be regarded, therefore, because of its contained nerve-cells : (1) As a centre for automatic activity. (2) As a centre for the reception of excitations arising either at the periphery or in the cerebrum, and for their subsequent transmission through efferent nerves to various peripheral organs.'' (Brubaker's Text-hook of Physiology.) 484- Describe the effect of a transverse section of the spinal cord in the mid-dorsal region. (March, 1893.) 484. ''A total transverse lesion, destroying absolutely one segment of the cord, will result in the following symp- toms: (1) Paralysis of the muscular area supplied by the destroyed segment, followed by rapid atrophy, reaction of degeneration, and loss of reflexes in this particular group of muscles. (2) Paralysis of all the muscles supplied by the segments below that which has been destroyed. The trophic conditiofi remains normal, at any rate, for a time; but when secondary descending degeneration in the antero- lateral columns has occurred, the muscles become con- tracted, tense, and rigid (late rigidity). The condition of Ill PHYSIOLOGY AND HYGIENE. the reflexes after a total transverse lesion has been a fertile source of discussion, but it is now maintained that the deep reflexes are entirely and permanently lost, whilst the superficial reflexes, though absent for a time, may reappear. (3) Complete anaesthesia of the sensitive area supplied by the destroyed segment, and of all the sensitive areas below. (4) A narrow zone of hypersesthesia is found at the upper level of the anaesthetic area, due to irritation of the nerve roots at the site of injury. (5) Vasomotor paralysis com- bined with trophic disturbances in the parts which are paralyzed. (6) Visceral changes, especially in the bladder and rectum." (Incontinence of urine, following over- distention of the bladder; and either constipation or incontinence of feces.) (Rose and Carless, Manual of Surgery.) 485. What would he the effect of a transverse section of (a) the anterior root of a spinal nerve, (b) the posterior root of a spinal nerve f (May, 1901.) 486. What would he the effect of dividing the posterior root of a spinal nerve external to the ganglion? (Novemher, 1892.) 485 and 486. Collins and Rockwell's Physiology, pages 177 and 178. 487. (a) Descrihe the action of the vasomotor nerves. (No- vember, 1893.) 488. What effects, if any, result from the division of (b) a vasoconstrictor nerve, (c) a vasodilator nerve? (May, 1900.) 487 and 488. (a) Collins and Rockwell's Physiology, pages 66 to 68. (b) In division of a vasoconstrictor nerve the vasoconstrictor influence is interrupted and, therefore, there will be dilatation of the bloodvessels supplied by the vasoconstrictor nerve, with rise of temperature in the parts nourished by those bloodvessels, (c) In division of a vaso- dilator nerve the effects produced are neither definite nor constant. 489. Name the principal centres of organic function in the medulla oblongata (April, 1894-) 112 PHYSIOLOGY AND HYGIENE, 489. Collins and RockwelFs Physiology, pages 188 and 189. 2. The Cranial Nerves. 490. What is the function of (a) the optic nerve, (b) the trochlear nerve f (May, 1901.) 490. (a) The optic nerve is the special nerve of the sense of sight, (b) The trochlear nerve is the motor nerve of the superior oblique muscle of the eye. 491. Give (a) the foramen of exit, (b) the distribution, and (c) function of the oculomotor nerve. (June, 1897.) 492. (c) State the function of the third cranial nerve, (d) What is the effect of division of the third cranial nerve? {June, 1900.) 491 and 492. (a) The sphenoidal fissure; (b) Collins and Rockwell's Physiology, page 207; (c) page 207; (d) page 207. 493. Give (a) the foramen of exit, (b) the distribution, and (c) the function of the pathetic {fourth cranial) nerve. {Sep- tember, 1897.) 493. (a) The sphenoidal fissure; (b) Collins and Rock- well's Physiology, page 208; (c) page 208, and see Q. 490 (b). 494. State the functions of the fifth cranial nerve. {May, 1900.) 494. Collins and Rockwell's Physiology, page 208. 495. Give the origin and function of the sixth {abducens) nerve. {May, 1895.) 495. Collins and Rockwell's Physiology, page 211. 496. What would be the effect of paralysis of the seventh cranial nerve {portio dura) on the right side? {January^ 1902.) 496. Collins and Rockwell's Physiology, page 213. 497. What is the function of the glossopharyngeal nerve f {January, 1895.) 113 PHYSIOLOGY AND HYGIENE. 497. Collins and RockwelFs Physiology, page 215. 498. What is the function of the par vagum? (April ^ 1897.) 499. What are the functions of the pneumogastric nerve? (March, 1892.) 500. What are the functions of the pneumogastric nerves? (July, 1893.) 498 to 500. Collins and Rockwell's Physiology, pages 216 to 219. 601. What is the function of the superior laryngeal nerves? (April, 1895.) 501. The superior laryngeal nerve is the nerve of sensa- tion to the upper part of the larynx, also the motor nerve to the cricothyroid. Hence, with loss of sensation in the larynx there is also loss of voice production. This nerve also protects the larynx from the entrance of foreign bodies. 502. Which of the cranial nerves are nerves of special sense? Give the origin and function of each nerve mentioned. (June, 1902.) 502. Collins and Rockwell's Physiology, pages 206, 230, 253, 238, 208 and 215. See also Q. 490, 494 and 497. 503. (a) What is the cerebrospinal system of nerves and (b) to what parts of the body are its fibres chiefly distributed? (September, 1901.) 503. (a) Collins and Rockwell's Physiology, page 169; (b) To the voluntary muscles, the organs of sense, skin, and other parts endowed with sensibility. 3. The Cerebrum. 504. What are the functions of the brain membranes? (January, 1897.) 504. ''The dura mater, by its outer layer, acts as a periosteum; by its inner layer as a lymph sac. It is also, 114 PHYSIOLOGY AND HYGIENE. by virtue of its sensitiveness, a protection against injury and disease. The arachnoid forms the inner wall of the lymph sac. The pi a mater is a vascular and nutritive organ. It is, however, also closely connected with the lymphatic system of the arachnoid. '' (Dana's Text-hook of Nervous Diseases.) 505. Give (a) the composition and (b) uses of cerebrospinal fluid. (January, 1896.) 505. (a) "Water 987.00 Albumin 1.10 Fat 0.09 Cholesterin 0.21 Alcoholic and aqueous extract, minus salts') ^ jk Sodium lactate f Chlorides 6.14 Earthy phosphates 0.10 Sulphates 0.20 '^In addition urea is at times found, as also a substance which reduces Fehling's solution and gives rise to a brown color when boiled with caustic potash, but which neither imdergoes fermentation nor forms an osazone when treated with phenylhydrazin. The substance in question is gener- ally regarded as pyrocatechin." (Simon's Clinical Diag- nosis.) (b) '^The cerebrospinal fluid forms a water bed on which rests the base of the middle and posterior parts of the encephalon. It performs an important function in protecting the brain from injury and the circle of Willis from compression. It also helps to dissipate the force of a blow, so that less injury is done at the point of its recep- tion." (Reference Handbook of the Medical Sciences.) 506. What are the effects of removal of the cerebrum in the lower animals? (September, 1895.) 506. Collins and Rockwell's Physiology, page 206. 115 PHYSIOLOGY AND HYGIENE. 507. (a) What is the function of the gray matter of the brain f (September, 1896.) 608. Describe (a) the offices and (b) the characteristics of the gray matter of the brain. {June, 1894.) 509. What differences of function exist between the (c) white and (a) gray matter of the encephalonf {January,. 1894.) 510. What are the functions of the (c) white and (a) gray matter of the brain f {January, 1892.) 507 to 510. (a) Collins and Rockwell's Physiology, page 198; (b) pages 195 and 196; (c) pages 193 and 197. 511. What portion of the cerebrum comprises the motor area? {January, 1896.) 512. Describe the motor area of the human brain. {April, 1893.) 511 and 512. Collins and RockwelFs Physiology, pages 199 and 200. 513. (a) Where is the visual centre located? {March, 1893.) 514. Locate in the brain the seat of (a) sight, (b) hearing. {June, 1893.) 515. Locate in the brain the seat of the special sense (a) of sight, (b) of hearing, (c) of smell. {April, 1896.) 513 to 515. (a) Collins and RockwelFs Physiology, page 199 ; (b) page 199 ; (c) in the uncinate gyrus, and the fornicate gyrus. 516. (a) What is the location of the centre for articulate speech? {January, 1893.) 517. Where is the centre of (a) speech, (b) respirationf {May, 1897.) 516 and 517. (a) Collins and Rockwell's Physiology,, page 199; (b) page 86. 4. Sleep. 518. (a) Give a physiological explanation of sleep. What is the condition of the brain during sleep? {June, 1896.) 116 PHYSIOLOGY AND HYGIENE. 519. (a) Describe the 'phenomena of sleep. {November^ 1893.) 520. (b) Enumerate the physiological advantages of natural sleep; and (c) state at what period of life the least sleep is required? (June, 189 4.) 518 to 520. (a) See A. 195 to 203 (f); (b) (1) entire rest to the whole body; (2) restitution of the energy that has been expended during the time of work and wakefulness; (3) removal of waste products of muscular metabohsm. (c) The least sleep is required in adult life, from about twenty-five years of age to fifty; at this period seven hours in the twenty-four are all that is generally requisite, and many people require only five. 521. What are the physiological causes of (a) sleep, (b) dreams? {June, 1901.) 521. (a) See A. 195 to 203 (f). (b) ''After sleep has supervened there are many gradations in its depth and character. In some cases it may be so light that the individual is partly conscious of external impressions and of the disordered trains of thought and feeling that pass through his mind, constituting dreams, and these may be more or less vivid according to the degree of consciousness remaining. On the other hand, the sleep may be so profound as to abolish all psychical phenomena; there are no dreams, and when the sleeper awakes the time passed in this unconscious state is a blank. The first period of sleep is the most profound. After a variable period^ usually from five to six hours of deep sleep, the faculties awaken, not simultaneously, but often fitfully, so that there are transient periods of consciousness. This is the time of dreaming. As the period of waking approaches the sensibility becomes more acute, so that external impressions are faintly perceived. These impressions may influence and mould the flow of images in the mind of the sleeper, frequently altering the nature of his dreams or making them more vivid Dreams only occur 117 PHYSIOLOGY AND HYGIENE. when sleep is light, and they indicate that consciousness is still continued. The characteristic feature of dreaming is that the mind has no control over the groups of images that crowd upon it. These images are either revivals of old sensory impressions that have been stored up in the brain or they are the result of an untrammelled imagina- tion. The will has lost the power of direction and control; ideas, often grotesque, always confused, rise apparently spontaneously, are vivid for an instant, and then disappear. Dreaming may be described as a kind of physiological delirium." (Encyclopcedia Britannica, vol. xxii.) 622. Define somnambulism, from a physiological point of view. {J line, 1900.) 522. '^ 1. The condition of half -sleep, in which the senses are but partially suspended; also sleep-walking, a condition in which the individual walks during sleep. 2. The type of hypnotic sleep, in which the subject is possessed of all his senses, often having the appearance of one awake, but whose will and consciousness are under the control of the hypnotizer." (Gould's Medical Dictionary.) 523. What is hypnotism? What constitutes susceptibility in an hypnotic subject? (January, 1899.) 523. '^A state of artificial somnambulism or trance, induced in certain persons by concentrating the gaze on a small object, or on a revolving mirror, or by complete subjection of their will to that of another, at whose com- mand the hypnotic stage develops. Three stages are described — the cataleptic, the lethargic, and the somnam- bulistic." (Gould's Medical Dictionary.) '^Hypnosis is nothing more than the intentional artificial production of a hysterical attack, or a hysterical psychosis by suggestion — that is, by the action of definite ideas on the person to be hypnotized. Therefore, only those persons can be hypnotized in whom these ideas have a strong-enough influence. No man can be hypnotized to whom the nature 14 118 PHYSIOLOGY AND HYGIENE. of hypnosis is clear. The essential feature of all hypnotic procedures is merely to produce in the most lively way possible the idea, 'It will happen as the hypnotizer says/ All other things — the fixation of the eyes on bright objects, the vibrations of a tuning-fork, etc. — are side issues, and are merely to support the suggestion." (Striimpell, Practice of Medicine.) 524. What is unconscious cerebration? {March, 1892.) 524. By unconscious cerebration is meant an unconscious exercise of the mind during sleep or mental occupation. (Dunglison's Medical Dictionary.) 5. The Cerebellum. 525. Describe the junctions of the cerebellum. {June,. 1892.) 526. What are the functions of the cerebellum? {May, 1893.) 527. What is the function of the cerebellum? {January,. 1898.) 525 to 527. Collins and Rockwell's Physiology, page 203. 6. The Sympathetic System. 528. What are the functions of the main sympathetic ganglia? {November, 1894.) 529. Give the varied functions of the sympathetic nerve. {September, 189 Jf.) 530. What is the function of the great sympathetic nerve? {January, 1898.) 531. State the functions of the sympathetic nerves. {Sep- tember, 1902.) 532. What are the functions of the great sympathetic nerve? {May, 1893.) 528 to 532. Collins and Rockwell's Physiology, page 173- 119 PHYSIOLOGY AND HYGIENE. XII. THE SENSES. 1. Common Sensations. 5S3. Describe the physiology of pain. (September, 1893.) 634. How is the sensation of pain produced? (January, 1893.) 533 and 534. ^' As regards painful sensations, three views can be taken: (1) that it is a special sensation provided with a special conducting apparatus in each part of the body; (2) that it is produced by an overstimulation of the special nerves concerned with touch or temperature, or of the other nerves of special sense; or (3) that it is an over- stimulation of the nerves of common sensation, which tell us of the condition of our own bodies, both of the surface a,nd of the internal organs. There seems to be much in favor of all these views. The weight of evidence is, however, rather against there being any special pain sense with a special end-organ and fibres. It is, however, certain that, even if any variety of pain be a special sensation, some kind of pain may be produced by stimulation of the bare sensory nerves apart from any special form of nerve termination." (Kirkes' Handbook of Physiology.) And see Collins and Rockwell's Physiology, page 221. 535. Give the physiology of (1) hunger, (2) thirst. (Sep- tember, 1897.) 535. '^Himger and thirst are peculiar sensations which depend partly on local and partly on general causes. Diminution in the bulk of water and of circulating aliment in the body no doubt causes excitement of sensory nerves on which depend the feelings of thirst and hunger, but in ordinary life these feelings are dependent on the physical condition of certain mucous surfaces. Any circumstance which causes drying of the lining membrane of the mouth provokes thirst, and some condition of the empty stomach arouses hunger. Thirst may be assuaged by introducing water directly into the stomach through a gastric fistula, 120 PHYSIOLOGY AND HYGIENE. though to effect the purpose a larger quantity must be employed in this way than by the mouth. Hunger in a somewhat similar manner may be appeased by rectal alimentation. It seems probable, however, that these sensations as usually felt are the result of a sort of habit, depending on the physiological condition of the secreting and absorbing mechanisms of the alimentary canal." (American Text-hook of Physiology.) 2. Special Sensations. S36. Name the organs of the special senses. (May, 1893.) 536. Collins and Rockwell's Physiology, pages 222, 225, 229, 232 and 243. 537. Describe the sense of feeling and explain how it is produced. (March, 1892.) 537. Collins and Rockwell's Physiology, page 222. 538. (a) What conditions are necessary for properly exercising the sense of smell? (September, 1895.) 539. (b) Describe the olfactory apparatus, (c) What part of the olfactory apparatus is the seat of smell? (January, 1899.) 540. (d) What is the function of the Schneiderian (pitui- tary) membrane? (May, 1894.) 538 to 540. (a) Collins and Rockwell's Physiology, page 229; (b) page 230; (c) the Schneiderian membrane; (d) it is the seat of the sense of smell. 541 ' (a) Describe the mechanism of hearing. (March, 1893.) 542. (a) Give the mechanism of the organs of hearing. (November, 1892.) 543. (a) How are auditory sensations produced? (No- vember, 1894') 544' (^ How is the sensation of sound conveyed to the brain? (January, 1900.) 121 PHYSIOLOGY AND HYGIENE. 54s. (b) Explain in detail how the functions of the auditory organs are performed. {June, 1902.) 541 to 545. (a) Collins and Rockwell's Physiology, page 239; (b) pages 233 to 240. 546. (a) What office does the Eustachian tube perform? {June, 1897.) 5Jf.7. (a) State the physiological purpose of the Eustachian tube. {September, 1899.) 548. (b) What effect on hearing has the closing of the Eustachian tube? {January, 1894.) 546 to 548. (a) Collins and RockwelFs Physiology, page 235. (b) ' ' When constriction of the tube takes place, so that the air does not enter the tympanum except with difficulty, the result is that the drumhead and ossicles are forced inward and congestion of the middle ear occurs, followed by adhesions and deafness, if not relieved." (Bacon's Manual of Otology.) 549. How and why is hearing affected by rupture of the membrana tympani? {September, 1896.) 6 SO. What effect on hearing has the perforation of the membrana tympani, and how is it explained? {January, 1893.) 549 and 550. The acuteness of hearing is considerably diminished; this is due to the lessened capacity for vibra- tion produced by the rupture of the membrana tympani. It has been asserted, however, that ''an opening in it, or even its total loss, may hardly impair the hearing to a perceptible degree." (Randall.) 551. Explain the phenomena and causation of auditory vertigo or Meniere's disease. {April, 1896.) 551. ''Under the term Meniere's disease is grouped a class of cases in which vertigo is caused by perversion or abeyance of the labyrinthine function. The labyrinthine disturbance may be caused either (1) directly by an affection of the labyrinth, such as (a) hemorrhage, (b) congestion and inflammation; or (2) indirectly, by {a) disease of the middle 122 PHYSIOLOGY AND HYGIENE. ear (otitis media), (h) obstruction of the Eustachian tube, (c) spasm of the tensor tympani, or paralysis of the stape- dius, or (d) irritation or obstruction of the external auditory meatus, and pressure on the membrana tympani, as by cerumen, foreign bodies, or by syringing the ears, especially when the membrana tympani is perforated. In Meniere's disease, strictly speaking, there is always coincident affec- tion of the semicircular canals and cochlea, as indicated by the three most important associated symptoms : vertigo, tinnitus, and deafness. Accompanying these cardinal symptoms there are accessory phenomena, due to secondary visceral disturbance, namely, pallor, faintness, and nausea or vomiting — a condition of syncope." (Quain's Dictionary of Medicine.) 552. What are the movements of the eyeball? Mention the muscles concerned in each of these movements. {June, 1900.) 552. Action of ocular muscles: Number of Muscles Acting. One Two Three, Direction- Inward Outward Upward Downward Inward and upward Inward and downward Outward and upward Outward and downward Muscles Acting. Internal External f Superior \ Inferior f Inferior \ Superior {Internal Superior Inferior Internal Inferior Superior {External Superior Inferior External Inferior Superior pectus. rectus. rectus. oblique. rectus. oblique. rectus. rectus. oblique. rectus. rectus. oblique. rectus. rectus. oblique. rectus. rectus. oblique. (Chapman's Human Physiology.) 123 PHYSIOLOGY AND HYGIENE. 553. (a) Name the refracting media of the eye and the effect that each has on the rays of light. (January, 1893.) 554. (b) State the function of the aqueous humor of the eye. (September, 1902.) 553 and 554. (a) Collins and Rockwell's Physiology, pages 245 to 249; (b) page 247. 555. Give the nervous and muscular mechanism of the dilation and contraction of the pupil of the eye. (May, 1902.) 556. Account for the contraction and dilatation of the pupil. (April, 189Jf..) 557. Explain the contraction of the pupil of the eye, (May, 1897.) 555 to 557. Collins and Rockwell's Physiology, page 248. 558. (a) How is accommodation in the eye accomplished? (b) What is color-blindness? (September, 1900.) 559. (c) How are the sensations of color produced? (July, 1893.) 560. (b) Describe color-blindness and name the colors which the subject commonly fails to distinguish. (January, 1897.) 558 to 560. (a) Collins and Rockwell's Physiology, page 250; (b) pages 262 and 264; (c) page 262. 561. (a) Describe the rods and cones of the retina. (Janu- ary, 1901.) 562. (b) State the function of the retina. (January, 1900.) 561 and 562. (a) Collins • and Rockwell's Physiology, page 251; (b) pages 250 and 251. 563. (a) What is the condition of the eyeball in myopia? How may it be corrected? (January, 1900.) 564. Define (a) myopia, (b) hypermetropia, (c) astigma- tism. State the cause of each of these conditions. (May, 1899.) 563 and 564. (a) Collins and Rockwell's Physiology, page 260; (b) page 261; (c) page 262. 124 PHYSIOLOGY AND HYGIENE. XIII. THE REPRODUCTIVE ORGANS. 1. Female. 565. (a) Describe menstruation. (June, 1901.) 566. (a) Give the physiology of menstruation. {May^ 1897.) 567. (a) Give the physiology of menstruation, and (b) describe the menopause. {June, 1899.) 568. (b) What changes take place in the reproductive organs at the climacteric period? {September, 1893.) 569. (c) What is the average duration of menstrual life? {June, 1894.) 565 to 569. (a) Collins and Rockwell's Physiology, pages 273 and 274; (b) page 274; (c) page 274. 570. Where does the human ovum originate? Describe the progress of the human ovum from origin to final disposition. {May, 1900.) 571. Trace the ovum in its course from the ovary to the uterus, and give the changes that take place in it in impreg- nation. {January, 1894.) 570 and 571. Collins and Rockwell's Physiology, pages 275 to 277. 572. Describe the process of segmentation of the ovum. {September, 1894.) 572. Collins and Rockwell's Physiology, pages 282 to 284. 573. Give the present physiological conclusions in respect to the presence of the corpus luteum as a sign of pregnancy. {January, 1897.) 573. Collins and Rockwell's Physiology, pages 276 and 277. 574. What is the earliest period of gestation at which the sounds of the fetal heart may be reliably heard? {June, 1896.) 574. ''The pulsation of the fetal heart can seldom be heard before the twentieth week (the middle of pregnancy). 125 PHYSIOLOGY AND HYGIENE. A practised, skilful ear may recognize it two or three weeks earlier." (King's Manual of Obstetrics.) 575. Whence are derived the motor impulses of labor? {January, 1894.) 575. Collins and Rockwell's Physiology, page 306. 576. (a) Describe the placenta and its membranes, (b) Give the function of the placenta. {January, 1895.) 576. (a) Collins and Rockwell's Physiology, pages 289 to 291. ''The placenta at full term is a soft, spongy mass, irregularly saucer-shaped, seven or eight inches in diameter, three-quarters of an inch thick near the centre, and from one-eighth to one-fourth of an inch at the edge; average weight twenty ounces. It varies much in all these par- ticulars." (King's Manual of Obstetrics.) (b) *' Functions of the Placenta. It not only affords nutriment to the child, but is also its respiratory organ. The umbilical arteries carry blue (venous) blood to the placenta, where carbonic acid gas is given off to the maternal blood, and oxygen taken in from it, so that the umbilical vein brings back arterial (red) blood to the foetus. The placenta is also an organ of excretion for the infant." (King's Manual of Obstetrics.) 577. Give the process of regeneration of uterine mucous membrane following pregnancy. {January, 1895.) 577. ''After birth the thick muscular mass decreases in size, some of its fibres undergoing fatty degeneration. Within the lumen of the bloodvessels of the uterus itself there begins in the interna of these vessels a proliferation of the connective-tissue elements, whereby within a few months the bloodvessels so affected become completely occluded. The smooth muscular fibres of the middle coat of the arteries undergo fatty degeneration. The relatively large vascular spaces in the region of the placenta are filled by blood clots, which are ultimately traversed by out- growths of the connective tissue of the vascular walls." (Landois and Stirling's Text-book of Human Physiology.) 15 126 PHYSIOLOGY AND HYGIENE. 2. Male. 678. Describe briefly the processes of the phenomena of reproduction. {January, 1893.) 578. Collins and Rockwell's Physiology, pages 280 and 281. 579. Give the physiology of the male sexual organs. (Sep- tember, 1895.) 579. Collins and Rockwell's Physiology, pages 277 to 280. 580. (a) What is the function of the testes? {March, 1893.) 581. (b) How is the descent of the testicle in the scrotum accomplished? {January, 1899.) 580 and 581. (a) Collins and Rockwell's Physiology, page 278. (b) ''The means by which the descent of the testicles into the scrotum is effected are not fully and exactly known. It was formerly believed that a membranous and partly muscular cord, called the gubernaculum testis, which extends while the testicle is yet high in the abdomen, from its lower part, through the abdominal wall (in the situation of the inguinal canal) to the front of the pubes and the lower part of the scrotum, was the agent by the contraction of which the descent was effected. It is now generally thought, however, that such is not the case, and that the descent of the testicle is rather the result of a general process of development in these and neighboring parts, the tendency of which is to produce this change in the relative position of the organs. In other words, the descent is not the result of a mere mechanical action, by which the organ is dragged down to a lower position, but rather one change out of many which attend the gradual development and rearrangement of the organs. It may be repeated, however, that the details of the process by which the descent of the testicle into the scrotum is effected are not accurately known." (Kirkes' Physiology.) 582. (a) What is the composition of the seminal fluid f {June, 1893.) 127 PHYSIOLOGY AND HYGIENE. 585. (b) Describe the seminal fluid, and (c) explain how it is conveyed to the vesiculce seminales. {September, 1896.) 584' (c) How is the seminal fluid conveyed to the vesiculce seminales f (September, 1892.) 685. (d) Describe spermatozoa microscopically and physio- logically. {January, 1900.) 582 to 585. (a) Water 90 Albuminous material and extractives ... 6 Mineral material 4 (b) "Semen is white or slightly yellowish in color, semi- fluid, sticky, and of an opaque, non-homogeneous, milky appearance, which is due to the presence of white, opaque islets floating in the otherwise clear fluid; these consist almost entirely of the specific morphological elements of the semen, the spermatozoa. Its odor, strongly resembling that of fresh glue, is very characteristic, and is owing to the presence of spermin. It is generally attributed to an admixture of prostatic fluid, as the semen obtained from the vasa deferentia is odorless The reaction of human semen is slightly alkaline, and its specific gravity is greater than that of water, in which it readily sinks." (Simon's Clinical Diagnosis.) (c) Collins and RockwelFs Physiology, page 278; (d) page 278. XIV. MISCELLANEOUS. 586. What is the physiology of the so-called rest-cure? {September, 1897.) 587. What is the physiology of the so-called rest-cure? {January, 1899.) 586 and 587. "The essential feature of the treatment is rest. This promotes growth of tissue and repair of waste. To hasten the attainment of these ends, overfeeding with easily digested food is required. A part of the principle 128 PHYSIOLOGY AND HYGIENE. of true rest and repose is seclusion. In order to counter- balance any ill-effects due to prolonged rest in bed, and to assist in tissue metabolism, massage and the exercise of muscles by faradization are made adjuncts to the treat- ment. Hydrotherapy is frequently employed as an adjunct. . . . . Rest-cure consists, in brief, of rest, particular diet, artificial exercise, and isolation." (Foster's Practical Therapeutics.) The rest-cure is based on the fact that every movement of the body involves a certain amount of muscular energy, and the object of the cure is to conserve that energy. 588. Describe the physiological process by which the bite of a venomous snake or the hypodermic injection of the virus causes death. (June, 1894.) 588. In either case the virus reaches the tissues under the skin, whence it is taken by the lymphatics to the thoracic duct or right lymphatic duct, and is thus con- veyed into the venous system at the junction of the sub- clavian and internal jugular veins. From the heart it is distributed, by the systemic circulation, and produces death by causing perversion of function of one or more of the organs or tissues with which it comes in contact. 589. In what manner, physiologically, does a largely dis- tended stomach produce death? {November, 189 4.) 589. The distention of the stomach may cause displace- ment of the heart, and by mere mechanical pressure could cause arrest of circulation. The absorption of toxic products arising from the decomposition going on in the stomach might also cause death. Hypertrophy and dilata- tion of the heart caused by the venous stasis due to press- ure can be followed by death. 590. Give, with reference to a male adult aged thirty-five^ (a) average weight and height, (b) average lung expansion^ (c) average abdominal (waist) measure. (September, 1900.) 590. (a) Taking average height at 5 feet 9 inches, the 129 PHYSIOLOGY AND HYGIENE. weight would be about 148 to 150 pounds; (b) about 2 to 3 inches expansion (over 33 inches on expiration); (c) about 28 or 29 inches. 591. Give (a) the average weight, (b) the chest expansion^ and (c) the lung capacity of an adult 5 feet 6 inches in height. {April, 1897.) 591. (a) About 132 pounds; (b) about 2 inches (over 32^ inches on expiration) ; (c) about 220 to 240 cubic inches. 592. Give the (a) average normal weight, (b) chest measure- ment, (c) chest expansion, and (d) girth of abdomen of a man 6 feet in height. {September, 1896.) 592. (a) About 169 pounds; (b) 34f inches (on expira- tion) ; (c) about 3 inches (over b) ; (d) about 29J inches. 593. What should be (a) the height, (b) weight, and (c) chest measurement of a typical man aged 25 years? {Sep- tember, 1894.) 593. (a) Taking height at 5 feet 8 inches, (b) weight should be about 140 to 142 pounds, (c) and chest measure- ment about 33 inches (on expiration). 594. State what are, under normal conditions, the (a) adult pulse rate, (b) adult number of respirations per minute, (c) body temperature, and (d) average respiratory capacity. {April, 1894.) 594. (a) About 72 per minute; (b) about 18 per minute; (c) about 98.6° F. in the mouth; (d) about 225 to 250 cubic inches. 595. (a) What are the sources of income for the body? {June, 1893.) 596. (b) Through what organs is the expenditure or waste of the body? {September, 1893.) 595 and 596. (a) Collins and Rockwell's Physiology, page 137; (b) page 137. 597. Give the reactions of the following fluids, and state the cause of the reaction in each case: urine, blood, gastric juice, and pancreatic juice. {April, 1893.) 130 PHYSIOLOGY AND HYGIENE. 597. Urine Blood . . . Gastric juice Pancreatic juice Reaction. Acid Alkaline Acid Alkaline Cause. Acid sodium phosphate. Phosphates and carbonates of sodium. Hydrochloric acid. Sodium carbonate. 598. How does impairment of the function of one of the following affect the other two: (a) the skin, (b) the lungs, (c) the kidneys? {May, 1901.) 598. (a) Impairment of the function of the skin increases the amount of water and COj that must be thrown off by the lungs, and the water and sohds to be excreted by the kidneys, (b) Impairment of the function of the lungs causes imperfect oxidation of waste, increasing the difficulty of its excretion by the kidneys and skin, with consequent impairment of fimction by reason of irritation and over- work. If marked, it causes death, (c) Impairment of the function of the kidneys throws more work upon the skin which it can only partially perform; some of the work must also be performed by the lungs. If severe, or long continued, death ensues from autointoxication. 599. Describe the process of osmosis and give examples in the human economy. {September, 1894.) 599. Collins and Rockwell's Physiology, page 111. Examples are: the exchange of and COj in the pul- monary alveoli; gastric and intestinal absorption (see page 111); urine in the glomeruli; passage of blood plasma through the capillary walls. 600. Define and differentiate (a) ptomain and leucomain, (b) chyme and chyle, (c) secretion and excretion. {June, 1902.) 600. (a) Both ptomains and leucomains are alkaloids of animal origin; but the ptomains are the putrefactive 131 PHYSIOLOGY AND HYGIENE. products of dead animal tissues or fluids; whereas the leucomains are the products of the various vital processes of the body, (h) ColUns and Rockwell's Physiology, pages 47, 100 and 111; (c) page 115. 601. Describe the physiological aspect of atavism. (Jan- uary, 1895.) 601. ^^ Atavism (Lat. atavus, an ancestor) in the strict sense is a return to the peculiarity of the ancestral form of the species. As this ancestral form is generally unknown, the explanation of an unusual variation as due to atavism is in most cases merely conjectural. For example, the dark stripes that appear sometimes upon the back, shoul- ders, and legs of horses have been attributed to atavism by Darwin, Ewart, and others; the presence of these stripes being regarded as evidence of a striped ancestry when considered in connection with the coloring of other species of the genus Equus, like the zebra, quagga, etc. Another example of atavism is the occasional appearance of supernumerary mammae and teats in women and in men. In women they have been observed to produce milk. These are regarded as atavistic because in the Lemuroidea, the lowest group of Primates, there are, in addition to the well-developed functional mammse on the pectoral region, rudimentary teats upon the abdomen and groin. They thus approach the condition foimd in dogs and pigs, while in the apes and man there is normally but a single pair of mammse. '^ (Reference Handbook of the Medical Sciences.) 602. Define (a) aphonia, (b) aphasia, (c) asphyxia. Give the cause of any one of these conditions. (April, 1899.) 602. (a) "Aphonia is speechlessness due to direct or reflex disturbance of the fimctions of the organs of voice,, and not to central causes, as in aphasia. It may be due to congestion or inflammation of the larynx, especially from overuse, as in public speakers; to paralysis of the laryngeal nerves, or to hysteria.'' (Duane's Medical Die- 132 PHYSIOLOGY AND HYGIENE. . tionary.) (b) "Aphasia is a condition in which, without mental disease or lesion of the peripheral organs, there is impairment of the ability to receive ideas (apraxia) or communicate them (asymbolia) . In motor aphasia the patient, although knowing what he wishes to say, cannot express his ideas by speech or gestures; due to lesion of Broca's centre or fibres running from it to the bulbar nuclei. In graphomotor aphasia the patient cannot express his ideas in writing. In auditory aphasia sounds are heard, but their meaning is not understood. In visual aphasia objects are seen, but not comprehended.'^ (Duane's Medical Dictionary.) (c) "Asphyxia is a state of suffocation; the condition in which there is a permanent arrest of the respiratory movements and extreme deficiency of oxygen in the blood. It is marked by extreme cyanosis and a sense of suffocation, followed by coma. It may be due to strangulation, drowning, the inhalation of coal gas or other gases, or any other cause producing great impair- ment of respiration." (Duane's Medical Dictionary.) 603. Describe the perversions of junction that may cause icterus. {September, 1899.) 603. Obstruction of the bile-ducts (by parasites, foreign bodies, impaction of gallstones, inspissated bile or mucus, pressure from tumors of liver or pancreas, etc.) prevents the bile from entering the duodenum. The bile then enters the blood current, and is carried throughout the body, thus producing the characteristic yellow tint of skin and mucous membranes, and the deep-yellow color of the urine. 604. State where in the human economy the following substances are found: (a) fibrin, (b) mucin, (c) chondrin, (d) leucin, (e) hippuric acid. (June, 1899.) 604. (a) In blood and lymph; (b) in saliva and synovial fluid; (c) in bone, cartilage; (d) in pancreas, spleen; (e) in the urine. 133 PHYSIOLOGY AND HYGIENE. B. HYGIENE. I. DISEASES IN GENERAL. 605. (a) Define and (b) illustrate endemic, epidemic, pandemic. (May, 1902.) 606. (a) Define epidemic, endemic, (c) Do endemic dis- eases ever become epidemic? (June, 1899.) 605 and 606. (a) Egbert's Hygiene and Sanitation, page 51; (b) endemic, malaria; epidemic, scarlet fever; pandemic, influenza; (c) certainly. 607. What is the difference between a contagious and an infectious disease? Give an example of each. (April, 1897.) 608. Define contagion, infection. Give an example of each. (January, 1898.) 607 and 608. A contagious disease was formerly under- stood to be a disease communicated by direct personal contact, as by touch, or exhalations from the breath or skin; example, smallpox. An infectious disease is a disease caused by a known germ; example, typhoid. The distinc- tion is now unimportant. 609. Mention five preventable diseases. (January, 1892.) 610. Enumerate the preventable epidemic diseases. (July, 1893.) 609 and 610. Typhoid fever, yellow fever, tuberculosis, malaria, cholera, smallpox, typhus fever. 611. Mention diseases due to exposure to (a) high temper- ature, (b) variable temperature, (c) decreased atmospheric pressure. (June, 1902.) 611. (a) Sunstroke and heat exhaustion; (b) rheumatism and catarrhal troubles; (c) Egbert's Hygiene and Sanita- tion, page 68. 612. What infectious diseases may be conveyed through the medium of (a) air, (b) water or food? (c) Give, as far as known, the causative germ of each disease mentioned. (June, 1902.) 16 134 PHYSIOLOGY AND HYGIENE. 612. (a) Egbert's Hygiene and Sanitation, page 92; (b) pages 167 to 172. (c) Erysipelas is caused by the streptococcus erysipelatis ; scarlet fever (probably), by the bacillus of Class = diplococcus scarlatinas; diphtheria, by the Klebs-Loeffler bacillus; pneumonia, by the diplococcus pneumoniae; tuberculosis, by the bacillus tuberculosis; cholera, by the comma bacillus of Koch, or spirillum cholerse asiaticse; typhoid, by Eberth's bacillus ; dysentery (amoebic)/ by the amoeba coli; influenza, by the bacillus of Pfeiffer; variola (probably), by the micro-organism of Councilman; cholera infantum, in many cases, by Shiga's bacillus. 613. (a) What is understood hy the germ theory of disease f (b) Mention all diseases whose causes are known to he specific micro-organisms. {September, 1900.) 614. (b) What diseases are known to he caused hy a specific micro-organism? (c) Describe the micro-organism peculiar to each disease mentioned, {May, 1901.) 615. (a) Discuss micro-organisms as a cause of disease. {June, 1898.) 613 to 615. (a) Egbert's Hygiene and Sanitation, page 49; (b) Pneumonia, meningitis, Malta or Mediterranean fever, tuberculosis, leprosy, glanders, anthrax, diphtheria^ tetanus, malignant oedema, typhoid, cholera, influenza^ bubonic plague, relapsing fever, dysentery, actinomycosis^ scarlet fever, variola, measles, German measles, varicella, pertussis, typhus fever, malaria, gonorrhoea, septicaemia, and pyaemia, (c) For a description of these micro-organ- isms, see Abbott's or Archinard's Bacteriology. 616. (a) From what diseases may immunity he acquired in the case of persons who have once suffered from these dis- eases? (b) How is knowledge of this fact utilized in the prevention of certain diseases? {June, 1900.) 616. (a) As a rule one attack of the following diseases conveys immunity: Whooping-cough, rotheln, scarlet fever, typhoid, typhus, smallpox, varioloid, chickenpox, yellow fever, measles (not always), and mumps, (b) 135 PHYSIOLOGY AND HYGIENE. Egbert's Hygiene and Sanitation, pages 66 and 67; and persons who are thus immune are employed to care for those sick with any of the above diseases. 617. (a) How are pathogenic micro-organisms conveyed? (b) What means can he taken to prevent their introduction into the system? (June, 1899.) 617. (a) By touch, by the air, water, and food; see Egbert's Hygiene and Sanitation, pages 92 and 167 to 172. (b) Isolation and quarantine of infectious cases; disinfec- tion of sick-rooms; good ventilation; air from outdoors; boiling of all food and beverages that are from infective sources; cleanliness; maintenance of bodily health and vigor, especially preventing all digestive disturbances. See, too, Egbert's Hygiene and Sanitation, page 32; and Q. 619 and 620. 618. What means should he employed to prevent the spread of epidemics? (Septemher, 1893.) 619. Enumerate in detail precaution to he ohserved for protection from infection in the treatment of an individual case of contagious disease. {June, 1900.) 620. Name the principal means for preventing the spread of contagious disease. (Novemher, 1891.) 618 to 620. Egbert's Hygiene and Sanitation, pages 339 to 342. . 621 . On what generally accepted theory are toxins used for the prevention and cure of disease? (April, 1897.) 621. Egbert's Hygiene and Sanitation, page 58 et seq. 622. Mention some of the safeguards against infection. {June, 1902.) 622. Egbert's Hygiene and Sanitation, pages 32, 56 et seq, 623. (a) To what diseases are negroes comparatively insusceptihle? (b) In middle states to what diseases are negroes more prone than whites? (June, 1896.) 623. (a) Yellow fever and dysentery, (b) Tuberculosis, venereal diseases, and keloid. 136 PHYSIOLOGY AND HYGIENE. 6 24. Of what import is heredity as a factor in disease? Illustrate. {April, 1898.) 624. Egbert's Hygiene and Sanitation, page 271. II. SPECIAL DISEASES. 1. Diphtheria. 625. (a) How long does a diphtheria patient remain infective? (b) How may it he proved that the infective period has ceased? (April, 1899.) 625. (a) Just so long as the specific bacillus persists in the mouth, throat, or nasal passages of the patient. As a rule, diphtheritic patients should not be allowed to associate with healthy people until at least fourteen to eighteen days after the disappearance of all membrane, (b) By the disappearance of all specific baciUi from the mouth, throat, and nasal passages of the patient. 626. (a) State the general results of observation on the hypodermic employment of antitoxin as a preventive of diphtheria. {January, 1896.) 627. (a) Can it he proved that the diminished death rate from diphtheria, so generally announced, is due to the use of the diphtheritic antitoxin? Give reasons. {January, 1897.) 628. (b) What is the present state of diphtheria antitoxin? {September, 1898.) 629. (c) Describe the manner in which antitoxin is pre- pared. {May, 1895.) 626 to 629. (a) Egbert's Hygiene and Sanitation, pages 65 and 66; (b) pages 63 to 67; (c) pages 63 to 65. 630. What instructions as to hygiene and sanitation should be given in a case of diphtheria? {May, 1898.) 631. Describe the hygienic and sanitary precautions that should be observed in a case of diphtheria occurring in a crowded tenement house? {May, 1902.) 137 PHYSIOLOGY AND HYGIENE. 630 and 631. Egbert's Hygiene and Sanitation, pages 339 to 343. 632. What is the value of preventive inoculation in (a) cholera, (b) diphtheria? {June, 1901.) 632. (a) ^^Haffkine made 70,000 injections on 40,000 people in India within a period of two years. By inoculat- ing only a part of any given population where cholera was raging, he was sure of a control by which he could judge of the value of the work. The rate of attack among those inoculated fell to about one-twentieth, and the mortality in about the same proportion. Preventive inoculation has been tried very extensively, and generally with at least fair results." (Harrington's Practical Hygiene.) (b) See Q. 626. 633. What explanation can he furnished of the greater prevalence of diphtheria and smallpox in cold than in warm weather? {April, 1895.) 633. In the cold weather there are greater and more frequent changes of temperature, and ventilation is poorer; hence the vitality of the body is lowered and there is a greater liability to take disease. 2. Tuberculosis. 63 Jf.. Discuss the theory of hereditary tendencies as applied to tuberculosis. {May, 1897.) 634. ''The original view that tuberculosis in a majority of cases is hereditary and that children of tuberculous ancestry were foredoomed to an early death from the disease is untenable in light of the facts regarding the Koch bacillus. A fair statement of the matter is as follows : Tuberculosis cannot exist without the influence of bacilli. For the bacillus to be transmitted by inheritance it must either pass to the embryo through the spermatozoon, the ovum, or from the maternal blood through the placental 138 PHYSIOLOGY AND HYGIENE. vessels. Tuberculosis of the generative organs is not rare, but the chance of even a single bacillus entering a sperm- atozoon or an ovum and occupying so large a part of such cell as its substance would necessarily do without destruc- tion of one organism or the other seems incredible. As for blood transmission of the bacillus through maternal vessels, while its possibility must be admitted to account for the few authentic cases of congenital tuberculosis reported, the presence of bacilli in the blood of the most advanced cases of tuberculosis is extremely rare excepting during the temporary accident of the perforation of a tuberculous mass into a bloodvessel as a forerunner of miliary tuberculosis. How, then, are the early cases of so-called hereditary tuberculosis to be explained? Of these not more than twenty have been described as actually congenital (Hahn). The remainder have all appeared at a considerable interval after birth. The nursing infant, weakened by the inheritance of poor vitality, is kept close beneath the bedclothing of a tuberculous mother, and cannot avoid inhaling bacilli which have escaped with her expectoration, transferred, perhaps, from handkerchief to sheet, and soon dried in the warmth of the bed, or perhaps the same handkerchief is used for the mother's sputum and the child's nose. The older infant is kissed by a tuberculous member of the family, bacilli from whose sputum can easily be found upon the beard or face, or it is allowed to crawl about upon a dusty, germ-impregnated carpet. The disease thus acquired and developed thus early in the ill-conditioned weakling makes rapid strides, and is easily attributed in error to ^heredity.' For ^heredity' in this sense should be substituted criminal negligence in matters hygienic." (Thompson's Practical Medicine.) 635. (a) Is consumption communicahlef (b) Give reasons for your conclusion and (c) offer hygienic suggestions. (January, 1899.) 635. (a) Yes; consumption is communicable, (b) The 139 PHYSIOLOGY AND HYGIENE. - disease is caused by a specific bacillus which is invariably present, and which is frequently discharged in enormous numbers in the sputum, which becomes dried and pulver- ized and in this condition floats in the air. The bacillus has great vitality, living for weeks in dried sputum. It has frequently been demonstrated in the nasal mucus of attendants upon tuberculous patients. Finally, there are innumerable examples of direct infection through association, and indirect through inhabiting the same apartments, though at different periods of time, (c) See Q. 636. 636. What hygienic precautions should he taken in treating a case of phthisis pulmonalisf (Mai/j 1899.) 636. ''The patient's quarters should be free from dust and admit of spending many hours daily in the open air in all weather, properly sheltered, and, if very ill, lying wrapped in a hammock or reclining chair. His bedroom should be well aired at night, draughts being avoided. The room should be uncarpeted and free from hangings. It should be often cleaned and periodically disinfected. All sputum should be collected in paper spit-cups, which should be burned daily. Smoking should be forbidden. Harm is done by any exercise which results in fatigue^ and while fever exists it should not be attempted at all. Patients should be taught the necessity of practising lung gymnastics and of breathing only through the nose, which should be kept clear and free from occlusion by secretions,. or an hypertrophied catarrhal mucosa The clothing should be woollen, but not too heavy, or sweating: is increased; and a flannel night-gown and loosely knit leggings should be worn at night in cool weather. The skin should be cleansed by daily sponge baths of luke- warm alcohol and water." (Thompson's Practical Med- icine.) 637. How may the spread of tuberculosis he prevented hy public health administration? {June, 1899.) 140 PHYSIOLOGY AND HYGIENE. 637. "The preventive measures which may be taken to reduce tuberculosis may be summarized as: (1) The compulsory notification of phthisis. (2) The removal of those conditions of domicile and of occupation which are known to promote the incidence of the disease, including the regulation of certain dusty trades. (3) The diffusion of knowledge (by medical men, leaflets, etc.) regarding the nature and modes of spread of the disease, and the pre- cautions which should be taken in order to prevent its extension. (4) The testing of sputum and other suspected discharges, and of milk, meat, etc., supposed to be tuber- culous — reports to be furnished free of charge. (5) Local authorities to undertake, without charge, the disinfection of houses recently occupied by phthisical persons. (6) The establishment of sanatoria and isolation accommodation for the cure of phthisical patients, and the isolation of those who are a distinct source of danger to fellow lodgers or workers: (7) The enforcement of measures against spitting in public conveyances and in places of public resort. (8) The efficient sanitary supervision of dairy farms, dairies, and milkshops. The periodical veterinary inspection and testing of milch cows, and the slaughter of tuberculous animals. The prohibition of the sale of milk of cows affected with tuberculosis. (9) The proper inspec- tion of meat in public abattoirs, and the adoption of due precautions for the control of imported meat and milk.'' (Parkes' Hygiene and Public Health.) 638. (a) What is the condition of the atmos'phere at high altitudes? (b) How do high altitudes affect respiration and hlood circulation? (c) How is the progress of pulmonary phthisis influenced by residence in a dry atmosphere of high altitude? {September, 1901.) 639. (d) Mention six desirable factors in the location of a resort for consumptives. {May, 1893.) 640. (d) What climate is best adapted to sufferers from phthisis pulmonalis? (c) Why? {November, 1894.) 141 PHYSIOLOGY AND HYGIENE. 638 to 640. (a) The atmospheric pressure is diminished; the air is rarefied, has greater movement, is more free from foreign matter, and contains more ozone; there is more sunUght and less humidity, (b) ''The breathing becomes more rapid, so that while less oxygen is taken in at each breath it is received into the blood more frequently; and with this more rapid respiration there is increased heart action, the heart pumping more blood through the lungs in a given space of time. This increased rapidity of heart beat and respiration is, however, only temporary, and gradually disappears. The amoimt of air taken in at each breath increases in volume as the chest expands, and the air cells, many of which, at lower altitudes, are often unused, become enlarged. The heart's cavities, having been stretched, are also hypertrophied, so that more blood is propelled at each stroke. Thus the blood's capacity for absorbing oxygen, the lung's capacity for taking air, and the heart's capacity for pumping blood are increased; the rapidity of respiration and pulse diminishes, but this rate becomes normal again as soon as this process of compensa- tion has effected a balance." {Reference Handbook of the Medical Sciences.) (c) There is less danger of reinfection and the conditions mentioned in (d) form an ideal climate for strengthening the body resistance, which is the rationale of treatment in this disease. The disease is therefore fre- quently arrested, sometimes cured, or its duration pro- longed. See also (b). (d) Pure air free from dust, equable temperature, protection from high winds, dry soil, dry air, high altitude, and plenty of sunlight. 3. Typhoid Fever. 641. What hygienic and sanitary measures should the attending "physician take in a case of typhoid fever? (June, 1898.) 642. What hygienic measures should he observed in the sick-chamber in a case of typhoid fever? (May, 1896.) 142 PHYSIOLOGY AND HYGIENE. 643. Give the hygiene of the sick-room in typhoid fever, {Septemher, 1896.) 6Jf.Jj.. What hygienic precautions would you take to prevent the spread of typhoid fever? {May, 1894.) 641 to 644. Egbert's Hygiene and Sanitation, pages 339 to 343, 328 to 330, and 415. 64^. How would you disinfect and dispose of the stools in typhoid fever? {July, 1893.) 646. How would you dispose of the dejecta of typhoid fever in city and in country? {March, 1892.) 645 and 646. See Q. 825. 647. What procedure should he employed to locate and remove the cause of an outbreak of typhoid fever in camp? {January, 1900.) 647. Egbert's Hygiene and Sanitation, pages 407 to 409^ 411, and 415. 4. Scarlet Fever. 648. Within what limit of time may scarlet fever he received by contagion? {September, 1892.) 648. Seven or eight weeks, or until the last evidences of desquamation have disappeared. 649. What steps should be used to prevent the spread of scarlet fever? {September, 18 94-) 649. See A. 641 to 644; also the patient should receive frequent baths during convalescence. Inunction with a mild antiseptic ointment is also much practised. Clothing and bed-linen should be thoroughly boiled as a preliminary to washing. The mouth and throat should also be thor- oughly cleansed at frequent intervals. 6. Miscellaneous. 660. State the period of incubation in (a) vaccinia, (b) parotitis, (c) pertussis, (d) varicella, (e) rotheln. {April, 1899.) 143 PHYSIOLOGY AND HYGIENE. 650. (a) About four or five days; (b) about two weeks; (c) from four to fourteen days; (d) from ten to sixteen days; (e) from ten to fourteen days. The above figures are averages. And see Egbert's Hygiene and Sanitation, pages 313 and 314. 651. Contrast the incubative stages of (a) measles and (b) scarlet fever. {November, 1892.) 652. Contrast the incubative stages of (c) variola and (a) measles. {September, 1896.) 651 and 652. (a) From ten to fourteen days; (b) from a few hours to six days; (c) from ten to fourteen days; These figures are approximate only. See also Egbert's Hygiene and Sanitation, pages 313 and 314. 653. Give the incubation period and the prodromata of ^(a) scarlatina, (b) measles, (c) pertussis. {May, 1902.) 653. For incubation periods see Q. 650 to 652. The prodromata are: (a) in scarlatina, vomiting or convulsions, sometimes a chill, often it begins suddenly; (b) measles, (Catarrh, sneezing, cough, discharge from nose ; (c) pertussis, coryza, discharge from nose, cough, fever, sneezing. 65J/.. How may public health administration be potent in preventing the spread of (a) smallpox, (b) diphtheria, and (c) scarlet fever? {September, 1902.) 655. What sanitary steps should be taken for the protection of public health in the treatment and management of (c) scarlet fever, (a) smallpox, and (b) diphtheria? {May, 1899.) 654 and 655. In general by abating nuisances; by enforced isolation as long as the case is infective or removal to special hospital, where this is impossible; by detention in quarantine of individuals who may reasonably be expected to contract the disease, such detention to last until the lapse of the incubative period from the last occasion of exposure shows them to be immune; by pro- viding for thorough disinfection by the most efficient methods of premises and fomites, under competent super- 144 , PHYSIOLOGY AND HYGIENE, vision. Specifically, in addition: (a) by compulsory or voluntary gratuitous vaccination of all exposed persons with vaccine of reliable properties, (b) By providing gratuitous administration of diphtheria antitoxin to those imable to pay, both for curative and immunizing purposes, (c) See general remarks above. 6. Scurvy. 656. What measures (including diet and medication) should he used on ship-hoard or in camp to eradicate scurvy (scorhutus)? (April, 1896.) 656. '^Abundant fresh air and sunlight, and a diet of fresh vegetables, especially potatoes, spinach, and fruits, with meat, eggs, fish, etc. If the stomach is irritable, fresh milk, eggs, and lime, orange or lemon juice may almost always be tolerated A mouth wash of saturated boric acid, alternating with a 2 per cent, solution of potassium permanganate, should be used every hour or two until the gums are healed." (Thompson's Practical Medicine.) 7. Heat Stroke. 657. How should a patient who has heen rendered un- conscious hy heat he treated? (September, 1896.) 657. (1) Thermic fever should be treated by cold baths; for the rest, symptomatic treatment is employed; chloral, chloroform, or bromides for convulsions; strychnine and digitalis for heart-failure, etc. (2) Heat exhaustion requires absolute rest, dry heat, and frictions ; stimulants in moderate quantities and easily assimilated food are indicated. 8. Yellow Fever 658. Mention methods to he employed for preventing epidemics of yellow fever in the tropics. (January, 1900.) 145 PHYSIOLOGY AND HYGIENE. 658. Isolation of cases, with screening by mosquito- netting; draining of all swampy places and filling in of all puddles of stagnant water; destruction of mosquitoes as far as practicable within the infected area. 9. Cholera. 659. What means can best he employed to exclude and prevent cholera? (July, 1893.) 659. Quarantine and disinfection of all ships coming from cholera ports. Complete isolation of patients, with thorough disinfection of all discharges — vomitus, dejecta, urine — and sterilization of all bed-clothes and wearing apparel. In case of death the corpse should be cremated or buried in quicklime or in hermetically sealed casket after being immersed in antiseptic solution. 10. Bubonic Plague. 660. (a) What is the bubonic plague f (b) What steps can be taken to limit or to extinguish such a scourge? (Janu- ary, 1899.) 660. (a) ^'Bubonic plague is an infectious febrile disease, characterized by a tendency to buboes or carbuncles, in addition to the phenomena of the typhoid state." (Tyson.) (b) ''Prophylaxis involves the most rigid sanitary cordon, compelling thirty days of isolation after recovery and ten days after exposure to infection ; vigorous sanitary measures should be maintained, such as' cleansing streets and houses with lime and 5 per cent, carbolic acid, removal of all pest holes, cremation of all excreta and cadavers, dis- infection of patients' bedding and clothing by superheated steam under pressure or prolonged boiling, formaldehyde fumigation of the sick-room, etc. All vermin, and especially rats, should be exterminated. Prophylactic inoculations are practised by Haffkine by sterilized attenuated bouillon 146 PHYSIOLOGY AND HYGIENE. cultures of the bacillus bubonicse The immunity, T^hen conferred does not appear to last longer than a few weeks/' (Thompson's Practical Medicine.) 11. Influenza. 661. Mention some of the remote consequences of epidemic influenza on public health. (November, 1892.) 661. ''The disease is much more fatal in some epidemics than in others, and many deaths occur among those having long-standing chronic diseases or debility when attacked by influenza, so that the general mortality always rises during an epidemic Alcoholic subjects and old people are most liable to succumb to influenza pneu- monia." (Thompson's Practical Medicine). 12. Pregnancy. 662. What hygienic precautions should be observed by a pregnant woman? {January, 1893.) 663. What special hygienic care do parturient patients require? (January, 1892.) 662 and 663. She requires pure air, mild out-door exercise when possible, clothing free from constrictions of all kinds; cold and draughts must be avoided; warm baths should be taken at least three times a week; during the later weeks of pregnancy the nipples should be kept scrupulously clean, free from pressure, and softened by application of borated vaselin or cocoa-butter; sleep and ample rest are requisite ; coitus should be avoided ; crowded apartments, theatres, churches, etc., should be shunned; constipation should be corrected, and the urine should be examined every two weeks. (From King's Manual of Obstetrics.) 147 PHYSIOLOGY AND HYGIENE III. FOOD AND BEVERAGES. 1. Tea. 664. (a) Describe the method of making a cup of (green) tea, as a beverage or as a prescription. (November, 1894.) 665. (b) To what is the indigestion from excessive tea- drinking attributable? (a) State a formula for the prepara- tion of good tea. (January, 1896.) 666. (c) Mention the disorders to which "tea-tasters'' are subject. (January, 1894.) 664 to 666. (a) and (b) "Tea should be used only in the form of an infusion, made by pouring boiling water upon the requisite amount of leaves, and allowing it to stand a short while to "draw." It is used not uncommonly in the form of a decoction; that is, by boiling. This process is objectionable in two ways: first, the delicate aroma is lost by the expulsion of the very volatile essential oil; and second, the leaves are made to yield all their tannin and other extractives, which tend to bring about, sooner or later, derangement of the digestive function and a catarrhal condition of the stomach. The finest and most delicate portion of an infusion is that which is poured off within three or four minutes, for in this will be found a maximum of flavor with a minimum of bitterness and astringency. The excellence of an infusion is influenced considerably by the character of the water, which, if very hard, is slow in extracting the desirable soluble constituents, while, if very soft, it extracts not only these, but far too rapidly the less desirable principles." (Harrington's Practical Hygiene.) (c) Cardiac neuroses ("tea-drinkers' heart")^ gastric neuroses, gastric catarrh. 2. Coffee. 667. Mention some of the adulterations of ground coffee for sale in the shops. (May, 1893.) 148 PHYSIOLOGY AND HYGIENE. 667. Harrington, in his Practical Hygiene, mentions the following substances as adulterants of coffee: " Chicory , dandelion, and other roots; roasted cereals and legumes, sawdust, date stones, red slate, acorns, and other cheap articles/' 3. Butter. 668. What are the properties of oleomargarin butter com- pared with butter made in the usual way? (September, 1892.) 669. How is oleomargarin distinguished from butter? (September, 1894.) 668 and 669. Egbert's Hygiene and Sanitation, pages 456, 457 and 244. 4. Milk. 670. (a) What constitutes a thorough meat inspection? (b) How should an inspection of milk be conducted? (May, 1897.) 670. (a) ''In this country, under the inspection law of March 3, 1891, .... the animals are inspected before being slaughtered, and their carcasses are examined microscopically by officials of the Bureau of Animal Industry before being packed The United States inspectors are instructed to condemn all female animals in an advanced stage of gestation, and to prevent their slaughter for food Females in which parturition has recently occurred are likewise condemned as unfit for food The cattle diseases most prominent as causes of condemnation are tuberculosis, actinomycosis, and anaemia; next in order are septicaemia, pneumonia, peritonitis, pyaemia, icterus, abscesses, and Texas fever. In swine the most common diseases are hog cholera, swine plague, tuberculosis, icterus, pyaemia, abscesses, pneumonia, inflammations of the abdominal cavity, septicaemia and tumors. The most common causes of condemnation of sheep are anaemia and emaciation. 149 PHYSIOLOGY AND HYGIENE. bruises and injuries, tuberculosis, abscesses, pneumonia, uraemia, septicaemia, icterus, and pyaemia In inspecting meats, special attention should be paid to the connective tissue and glandular organs. The odor of a carcass should be sweet, and the meat should communicate no unpleasant smell to a wooden skewer thrust into it and withdrawn. The muscle should be firm and elastic, but not tough. Any variation from the natural color should be regarded with suspicion.'' (Harrington's Pmc^icai^ Hygiene.) And see Egbert's Hygiene and Sanitation, pages 247 and 248; (b) page 450. 671. Under what conditions is tyrotoxicon found in milk, cheese, meat, and other articles? (June, 1894.) 671. Egbert's Hygiene and Sanitation, page 240. 672. (a) What diseases arise from the ingestion of unclean and contaminated milk? (b) What safeguards should he adopted to mdlify the possibility of disease from such a source? (January, 1902.) 673. (a) What disease-carrying bacilli may he conveyed to the system by the ingestion of milk? (c) What are the microscopic characteristics of such bacilli? (June, 1900.) 674' (a) What infectious diseases may be carried by milk? (d) By what means are the germs of these diseases introduced into milkf (January, 1901.) 675. (a) Name four diseases that are communicable to man through coios' milk? (January, 1896.) 672 to 675. (a) Egbert's Hygiene and Sanitation, page 241; (b) page 242; (c) see Q. 614 (c); (d) Egbert's Hygiene and Sanitation, pages 240 to 243 ; and see A. 676 and 677. 676. How may milk be the means of transmitting the germs of typhoid fever? (April, 1899.) 677. State in what way the germs of typhoid fever may he conveyed in milk drawn from healthy cows and used for food? (June, 1893.) 676 and 677. By the use of water containing Eberth's 18 150 PHYSIOLOGY AND HYGIENE. bacillus (of typhoid) for the purposes of either diluting the milk or washing the milk cans and bottles. 678. Mention at least three adulterations of milk. (April,. 1894.) 679. What are the principal adulterations of milk? {April, 1895.) 678 and 679. Milk is adulterated (1) by skimming, (2) by the addition of water, (3) by the addition of coloring matters such as annatto or caramel, (4) by the addition of preservatives, as boric acid, formaldehyde, salicylic acid, or salicylates, and (5) by the addition of arrowroot, flour, sugar, etc. 680. Describe what should he done to insure milk from impurities from the moment it has been received from the cow to the time of its delivery to families. {January, 1894.) 680. All receptacles should be scalded with boiling water. Milkers should wipe the teats, and also wash their own hands before milking. Stables should be kept scrupulously clean and freely ventilated. All accidental contamination should cause the rejection of that particular pail of milk. The milk should at once be strained and cooled to about 40° F. and kept at not above that temperature until delivery to the consumer. Delivery should be as prompt as possible. 5. Meat. 681. What conditions and diseases in animals render their fesh unfit for food? {September, 1895.) 681. Egjbert's Hygiene and Sanitation, pages 247 and 248; and see A. 670 (a). IV. ALCOHOL AND TOBACCO. 1. Alcohol. 682. Name the principal adulterations of wine. {Sep- tember, 1893.) 151 PHYSIOLOGY AND HYGIENE. 682. Water, alcohol, alum, glycerin, logwood, nux vomica, cream of tartar, prunes, dates, raisins, bitter almonds, orange peel, various berries, coal-tar products, salicylic acid, formaldehyde, sugar, gypsum. 683. What are the diseases the predisposition to which is greatly increased by the habitual use of alcoholics? (April, 'l896.) OSJf.. To what diseases does the excessive use of alcoholics predispose, and why? {September, 1895.) 685. Describe the disturbances of function produced by the excessive imbibition of alcohol. (JSfovember, 1893.) 683 to 685. It increases the predisposition to all the infectious diseases and stands in more or less direct causal relation to the following: Acute and chronic catarrhal gastritis, catarrhal duodenitis, fatty liver, hepatic cirrhosis, cardiac hypertrophy and dilatation, fatty infiltration of the heart, chronic myocarditis, arteriosclerosis, aneurysm, nephritis (acute, chronic, parenchymatous, and interstitial), gout, neuritis, pachymeningitis, apoplexy, epilepsy, delir- ium tremens, and the chronic psychoses. 686. What effect have strong alcoholic stimulants on the gastric juice? {September, 1892.) 686. Taken occasionally, and in small quantities, they increase its secretion and facilitate digestion; imbibed in large quantity, they cause acute catarrhal gastritis with impairment or suspension of secretion; if frequently re- peated, the constant stimulation may induce a chronic catarrhal gastritis, with diminution or cessation of secretion. 2. Tobacco. 687. Mention some of the results of tobacco smoking in growing school-boys, in respect to (a) the circulation, (b) air passages, (c) vision, and (d) mental application. {March, 1893.) 152 PHYSIOLOGY AND HYGIENE. 688. What are the possible results of the use of tobacco hy growing hoys in regard to (a) circulation, (c) vision, (b) air- passages 9 (September, 1902.) 687 and 688. (a) The circulation is slowed, arterial tension lowered and afterward raised, the heart is depressed, and some times palpitation is produced, (b) The air pass- ages are irritated and slightly inflamed, (c) Vision may be impaired by a mild conjunctivitis or amblyopia, (d) Mental application is lessened. If used in excess the results may be fatal. 689. Mention some of the chief diseases, local and consti- tutional, produced in tobacco smokers and chewers. (Sep- tember, 1893.) 690. What evil consequences frequently result from the excessive use of tobacco? {September, 1896.) 689 and 690. ^^ The continued use of tobacco, by smoking or chewing it to excess, produces granular inflammation of the fauces and pharynx, atrophy of the retina, dyspepsia, lowered sexual power, sudden faints, nervous depression, cardiac irritability, and occasionally angina pectoris. Used by the young it hinders the development of the higher nerve centres and impairs the mitrition of the body by interfering with the processes of digestion and assimilation. It has been credited with causing cancer of the lips and tongue, blunting of the moral sense, mental aberration and even insanity. The so-called 'tobacco heart' includes many forms of nervous, painful, or oppressed cardiac action, depending on the age of the subject, the quantity consumed, and other circumstances." (Potter's Materia Medica, etc.) V. WATER AND ICE. 1. Water. 691 . What is the temperature (a) of tepid water; (b) of hot water; (c) of boiling water? (April, 1894.) 691. (a) 75° to 85° F.; (b) 100° to 110° F.; (c) 212° F. 153 PHYSIOLOGY AND HYGIENE. 692. (a) What should he the characteristics of 'potable water? (b) What amount of solid matter is permissible in potable water? {June, 1899.) 692. (a) Egbert's Hygiene and Sanitation, pages 164 and 166, and 213; (b) page 213. 693. Name the physical properties of pure water. {No- vember, 1891.) 694- What physical characteristics should be observed in the examination of water for sanitary purposes? (May, 1901.) 693 and 694. Egbert's Hygiene and Sanitation, pages 213 and 441. 695. What constitutes (a) hard water, (b) soft water? {September, 1898.) 695. (a) Egbert's Hygiene and Sanitation, page 151; (b) freedom from the salts of calcium or magnesium in solution. 696. (a) What is the best water for drinking purposes? (b) Describe an emergency water-filter. {April, 1899.) 697. (b) How can a water filter he extemporized? {March, 1892.) 696 and 697. (a) Egbert's Hygiene and Sanitation, page 164; (b) pages 192 to 205. 698. (a) Mention the natural and the artificial sources of water supply, (b) What is the possible action of water on lead pipe? {June, 1901.) 699. (c) Mention at least three prominent symptoms of poisoning by lead received through drinking water or any other source. {September, 1892.) 700. (a) Give the principal sources of the water supply of cities, (d) How may these sources become contaminated? {June, 1900.) 701. (a) What are the reliable sources of a pure water supply? {April, 1898.) 154 PHYSIOLOGY AND HYGIENE. 702. (e) Mention some of the objections to curbed or driven wells in streets or houses, with respect to the purity of the water coming from these wells. {May, 1895.) 698 to 702. (a) Egbert's Hygiene and Sanitation, page 148 et seq.; (b) page 168; the oxide of lead which is formed upon the surface of the lead pipe is constantly dissolved and carried away in the water, (c) Pain in the region of the umbilicus, blue line on the gums (due to the formation of lead sulphide), wrist-drop, anaemia or cachexia, with a notable decrease in the number of red blood corpuscles. (d) Egbert's Hygiene and Sanitation, pages 148 to 166; (e) pages 162 to 164. 703. Describe a method of purifying water for (1) public supply; (2) domestic use. {May, 1902.) 704. What means may be employed to purify polluted water? {June, 1892.) 705. Describe a process for purifying water. {May, 1899.) 706. What steps should he taken to render polluted water harmless? {January, 1896.) 707. What are some of the common impurities of drinking water? How may such impurities be rem,oved? {January^ 1898.) 703 to 707. Egbert's Hygiene and Sanitation, pages 152, 155, 172 and 206 to 213. 708. (a) Name three tests for detecting impurities in water. {November, 1891.) 709. (b) Now should a specimen of water be examined to determine the presence of gases indicative of fermentation or putrefaction? {September, 1901.) 710. (c) // a chemical analysis of water revealed the presence of nitrates and nitrites, would this condemn it for drinking purposes? If so, why? {May, 1896.) 708 to 710. (a) Egbert's Hygiene and Sanitation, pages 205 to 213, and 441 to 449; (b) pages 444, 443 and 448; (c) pages 211 and 212. 155 PHYSIOLOGY AND HYGIENE. 711. Mention some objections to the use of river water for drinking purposes. (April, 1897.) 711. Egbert's Hygiene and Sanitation, page 152. 712. (a) What infectious diseases may he due to impure drinking water? (May, 1897.) 713. (b) What diseases may arise from drinking impure water? (June, 1895.) 712 and 713. (a) Egbert's Hygiene and Sanitation, page 168; (b) pages 167 to 172. 714' What is accomplished by the aeration of water which is distributed in a city supply? (April, 1895.) 714. Little beyond oxidation of offensively smelling organic material. Bacteria in general are not much affected unless direct sunlight is coincidently employed. 715. What impurities may he found in rain-water stored in cisterns? (April, 1894.) 716. Mention some of the objections to storage cisterns under ground. What are the objections to rain water as a drink? (May, 1898.) 715 and 716. Egbert's Hygiene and Sanitation, pages 149 to 151. 2. Ice. 717. (a) Give the best sources of ice supply, (b) What precautions should he taken in making artificial ice? (Sep- tember, 1896.) 111. (a) Artificial ice is the best; next to this is natural ice from a pond or lake free from all contamination, (b) It should be made from boiled or distilled water. 718. State the properties or qualities of artificial ice as contrasted with natural ice. (September, 1894.) 719. Mention some of the advantages of carefully prepared artificial ice, as compared with natural ice. (June, 1896.) 718 and 719. If properly manufactured, artificial ice is 156 PHYSIOLOGY AND HYGIENE, generally cleaner and safer to use on account of impurities generally to be found in the natural commercial product. 7£0. What impurities of ice are likely to cause disease? (May, 1894.) 721. What are some of the dangers involved in the domestic use of icef (November, 1892.) 720 and 721. See under ''Water/' Egbert's Hygiene and Sanitation, pages 167 et seq., and 205. VI. AIR AND VENTILATION. 722. Describe the effect of a hot and moist atmosphere on the human system and state the class of diseases this atmos- phere is likely to induce. (May, 1900.) 722. It depresses all vital functions, renders the circula- tion sluggish, soothes the mucous membranes, markedly increases the amount of sensible perspiration because of diminished evaporation, and causes general languor and lassitude. It predisposes to all diarrhceal troubles, and may directly cause thermic fever or heat exhaustion. 723. (a) Define humidity of the atmosphere, (b) Why should a humid atmosphere cause rheumatic and gouty persons increased sensitiveness f (May, 1897.) 723. (a) Humidity is the amount of watery vapor con- tained in the atmosphere. Expressed in degrees, it denotes the approach to the saturation point at the existent temperature. See Egbert's Hygiene and Sanitation, pages 71 and 72. (b) Because of its general depressant effect it diminishes the circulatory action and oxidation processes, which, in these subjects, are already below normal, and therefore causes large production of toxic substances. ^; -. 724. What are the effects of humidity on the systemf {January, 1895.) 724. See Q. 722 and 723. 725. (a) What is the nature of air in soils f (b) In what manner are such diseases as typhoid fever, cholera, dysentery 157 PHYSIOLOGY AND HYGIENE. and diarrhoea produced by telluric influence? (c) What means of correction should he employed? (January, 1897.) 726. (a) How is soil air polluted? {June, 1897.) 725 and 726. (a) Egbert's Hygiene and Sanitation, pages 87 to 89; (b) page 98. '^It is believed quite generally that typhoid is connected in some way with soil conditions as well as with drinking-water. Indeed, there are some authorities who regard the soil as of infinitely greater importance in the causation of epidemics of this disease and of cholera than drinking-water, which to their minds has absolutely no influence one way or another. The Pettenkof er theory of the cause of these outbreaks attributes it to the soil, from which the exciting cause is distributed by the ground air, which is in constant movement. Ac- cording to the distinguished originator of the soil theory, the unknown poison is introduced into the soil, where under proper conditions of organic filth, and other influ- ences, a species of fermentation occurs, the end product of which is the exciting cause, which is then capable of inducing the disease in those by whom it is inhaled. All important in this process is the vertical movement of the ground water, and it is certainly true that over a long period of years of observation at Mimich there was a most remarkable coincidence between epidemics of typhoid fever and fluctuations in the ground-water level Concerning the relations of cholera to the soil there is but little to be said. Prior to the discovery of the specific organism, the soil theory of the origin of epidemic out- breaks had considerable vogue; but now it is known that, even in times of greatest prevalence of the disease, the organism has never been found under natural conditions in the soil. It can be kept alive under certain favorable conditions of moisture and heat for varying periods; but under natural conditions it is one of the least resistant bacteria and quickly dies. We have no evidence whatever that cholera is a soil disease With regard to the connection which may exist between the soil and 19 158 PHYSIOLOGY AND HYGIENE. dysentery, concerning the organism of which we are in the dark, it is best to admit frankly that ive do not know^ rather than to make general statements based on imagin- ings Beyond the observance of a few coinci- dences, no connection has been proved to exist between diarrhoea and the soil." (Harrington's Practical Hygiene.) (c) Proper drainage; and see, too, Egbert's Hygiene and Sanitation, page 88. VII. PERSONAL HYGIENE. 1. Bathing. 727. State the value of piiblic haths to the health of a large city. (May, 1899.) 727. Under proper inspection for excluding persons suffering from obvious contagious diseases, and with other common-sense precautions, they are of great value in promoting cleanliness and health among the poorer popula- tion, particularly in hot weather. But if any precautions be neglected, they may become prolific sources of disease. 728. Give the physiological effects of (a) cold haths, (b) warm haths. (May, 1901.) 728. (a) ''Cold bathing is essentially stimulant; the cutaneous vessels contract at once, and send the superficial blood supply inward; the respiration is momentarily gasp- ing in character, and then slowed and increased in depth. The whole nervous system and all of the mental faculties receive an immediate powerful stimulus. The pulse is somewhat slowed. On emerging from the cold water, the respiration and pulse return to their normal rates, the cutaneous vessels relax and dilate, and the return of the blood in increased volume to the surface gives a sensation of warmth, which is increased by the process of 'rubbing down.' This is known as the 'normal reaction.' ' ' (Harring- ton's Practical Hygiene.) (b) "Warm and hot bathing 159 PHYSIOLOGY AND HYGIENE. cause dilatation of the cutaneous vessels and more or less profuse perspiration. Respiration and pulse are increased in frequency, and a general soothing effect is produced. Hot bathing is a most grateful means of reducing soreness of the muscles after violent exercise, and a valuable assistant in the treatment of insomnia.'' (Harrington's Practical Hygiene.) 729. (a) What are the henefits and (b) ivhat the dangers of the Turkish hath? (September, 1896.) 730. (b) Mention some of the dangers of the Turkish hath. (May, 1893.) 731 . (b) What physical conditions would render the taking of a Turkish hath inadvisable? Why? {June, 1895.) 729 to 731. (a) 1. Cleansing. 2. '^When the skin or Mdneys are torpid, to aid in the elimination of impure and effete materials from the blood and tissues." (Hare's Practical Therapeutics.) (b) Dangers are overheating, and cardiac failure; therefore very corpulent people or those suffering from heart disease should take them only by medical advice or not at all. 732. State physical conditions that make the practice of taking hot baths inadvisable. Give reasons. (April, 1896.) 732. Organic diseases of the heart and brain, aneurysm, acute inflammations, and tuberculosis; and see Q. 728 (b), and 729 to 731 (b). 2. Exercise. 733. Discuss the healthfulness of bicycle riding. (June, 1895.) 733. '' Wheeling involves very largely the entire mus- cular system, and brings into play groups of muscles the existence of which has not before been appreciated by the beginner. With the wheel, one may take any desired amount of gentle, moderate, or violent exercise. It gives a constant change of scene and the pleasurable sense of 160 PHYSIOLOGY AND HYGIENE. motion, both of which are of value to the tired mind. It is not the particular form of muscular exertion that is the incentive to long exercise on the wheel, but the pleasure which it gives.'' (Harrington's Practical Hygiene.) 734. Give an opinion and the reasons therefor as to whether bicycling or horseback riding is the preferable method of reducing obesity in a male patient. (September, 1896.) 734. Bicycling is probably preferable, inasmuch as it brings into play a greater number of muscles, and as it means more muscular action it also involves more rapid oxidation of the tissues. 735. Give the diet and the exercise, etc., required physio- logically in the process of skilful training for physical contests. {January, 1897.) 735. The following '^studies" of the Harvard Crews are quoted in Thompson's Practical Dietetics: ^^ The men arose at about 7 o'clock After a short run breakfast was served at 7.30 o'clock and was quite a hearty meal, consisting principally of oranges, a breakfast cereal, hot meat or fish, and potatoes. During the morning there was usually a practice row on the river, followed by a light lunch at about 11.30 to 12 o'clock. The principal meal of the day was taken early in the afternoon. In the late afternoon the crew had another season of hard work on the river, after which another hearty meal was served. Leisure time was spent in study or recreation." .... ''The diet allowed was a very generous one, consisting of a hearty breakfast at 7.30, lunch at 1, and dinner after the evening row. For breakfast the fare consisted of fruit, oatmeal or shredded wheat, eggs, some form of meat, bread and butter, potato, and milk. At noon there was cold meat, potato, bread and butter, marmalade, preserved fruit, and milk. Dinner comprised soup, occasionally fish, roast beef or some other hot meat, several vegetables, bread and butter, and a simple dessert. No tea or coffee was allowed, but ale or claret was permitted at dinner, 161 PHYSIOLOGY AND HYGIENE. also water in small amounts, as desired. During the last week before the race each man received a dish of calf's foot jelly with sherry wine after the morning row, and a light lunch of oatmeal, milk, and bread was served at 4 o'clock in the afternoon.'' 736. Mention some of the exercises that injuriously affect the heart. State the reasons for your conclusion. (January, 1900.) 736. Overindulgence in almost any form of exercise, particularly running, wrestling, cycling, and rowing, may cause hypertrophy and dilatation of the heart. 737. What physical training would you recommend for 'persons with weak respiration? {January, 1894.) 737. Active walking, calisthenics, and particularly dumb- bell and Indian club exercises. Later, slow running, in moderation. 738. How does overexertion affect the body tissues? {Mayt 1899.) 738. ^' While the metabolic changes during violent exer- cise doubtless produce toxins — ^fatigue products' — affecting the nutrition of the heart, and causing relaxation of its tonus, the effects are largely mechanical. The heart is called upon to do more work than when at rest, to receive and send out more blood, and to do this imder different conditions of blood pressure and nutrition The peripheral blood pressure shows, during active exercise, a temporary increase, which is followed, even if the exercise continues, by a very marked decrease. In a recent exami- nation of the contestants in a twenty-five-mile running race, this fall was invariably present in men examined at the finish, and was shown by direct study of the blood pressure and by the sphygmograph. The temporary rise is due to increased output of the heart. The pressure of the muscles of the extremities on the large veins, the sunilar action of the muscles of the abdomen and dia- 162 PHYSIOLOGY AND HYGIENE. phragm on the portal system, and the increased activity of the respiratory apparatus, all favor the flow of blood to the right auricle, and through the lungs to the left heart. For a while the increased output causes an increase in arterial tension and increased work for the left ventricle, but there is soon a dilatation of the peripheral vessels, especially in the muscles, and a consequent fall of pressure with relief to the left heart. According to Allbutt, when this adjustment is accomplished the phenomenon of 'second wind' occurs." (Reference Handbook of the Medical Sciences.) 739. State some of the sequelce of (a) overstrain, (b) over- exertion, (c) overtraining. (April, 1896.) 739. (a) Fractures, dislocations, hernia, apoplexy, dis- ease or rupture of heart, muscles, or ligaments, (b) See Q. 738 and 929 (b). (c) Loss of appetite, digestive disturb- ances, mental and bodily weakness. 7Jfi, What is the physical training for a weak heart when no valvular lesions exist t (November, 1893.) 740. See A. to 737. 3. Clothing. 741 . What are the respective merits of cotton, wool, and silk tvhen used in underwear? (June, 1896.) 7U2. What arguments can be advanced in favor of wool as material for winter clothing? (September, 1902.) 741 and 742. Egbert's Hygiene and Sanitation, pages 289 and 290. VIII. OCCUPATION. 743. Mention some of the diseases induced by industrial pursuits and give the special cause in each disease mentioned. (January, 1902.) 744. Name some of the occupations most injurious to health and give the reasons for so classifying them. (June, 1892.) 163 PHYSIOLOGY AND HYGIENE. 74^. Mention some of the diseases to which artisans are specially liable. (May, 1898.) 74.6. In the -pursuits of what trades is there a predisposition to pulmonary diseases? {June, 1894-) 743 to 746. ''Pulmonary phthisis: accountants, book- keepers, clerks, compositors, pressmen, marble and stone- cutters. Fibroid phthisis, from dust : grinders, file-cutters, potters, glass pohshers, wool and cotton spinners, mil- lers. Anthrax: skin handlers. Internal anthrax: wool and rag sorters. Glanders and tetanus : hostlers. Anaemia, gastric ulcer, eczema, erythema nodosum: domestic servants (female) . Varicose veins : coachmen, shop-girls, and others accustomed to long maintenance of the standing or part- standing position. Writers' cramp (scriveners' palsy): clerks and writers. Septic infection : butchers and slaughter- house employes. Conjunctivitis: electric-light workers (probably caused by actinic rays). Nystagmus: miners. Emphysema: players upon wind instruments. Insomnia, dyspepsia, disease of liver and kidneys, neurasthenia, irritable heart, apoplexy, and paralysis: brain workers. Typhoid fever, pneumonia, cardiovascular and renal dis- ease, morphine and cocaine habits: physicians. Lead poisoning: lead miners and smelters, painters, gilders, makers of white and red lead, seamstresses (from silk thread loaded with acetate of lead), makers of artificial flowers. Mercurial poisoning: cinnabar miners, makers of cheap looking-glasses or mirrors, and makers of felt hats. Arsenical poisoning: wall-paper workers (formerly), workers on artificial flowers and fancy glazed-paper boxes. Phosphorus poisoning : matchmakers. Chromium and zinc poisoning: 'founders' ague' in brass foundries. Disease of hair follicles : operatives in oil refineries and paraflin works." (Butler's Diagnostics of Internal Medicine.) 747. Mention the effects of working in phosphorus, as in the manufacture of phosphorus matches. How can the dangers he limited or prevented? (January, 1899.) 164 PHYSIOLOGY AND HYGIENE. 747. ^' In chronic poisoning by phosphorus, when, by the inhalation of its fumes, systemic changes occur, the most common lesion is necrosis of the lower jaw, which may be widespread or limited. It never occurs in those who have no solution of continuity in the teeth or gums, and for this reason it is necessary that the employes in match factories should have their teeth and gums constantly attended to. It has been said that pans containing turpentine when set around the work-room will protect the workmen, but this is certainly incorrect." (Hare's Practical Therapeutics.) In addition it may be stated that red phosphorus is much less toxic than the yellow form. 748. (a) What occupations are a menace to public health? (b) Whyf (June, 1898.) 748. (a) The chief occupations that are a menace to public health are: blood boiling, bone boiling, tripe boil- ing, soap boiling, tallow melting, and fellmongering. (Id) The chief sources of nuisance are : filthy and imsuit- able premises, offensive vapors, improper storage of mate- rial, improper disposal of waste or refuse material. 749. Name two important industries the presence of which is prejudicial to health in large cities? (March, 1892.) 749. Smelting and chemical manufactures. 750. Give the special hygiene of factories in which women and children are employed. (January, 1892.) 750. In addition to the ordinary hygiene of factories and workshops, such as proper space, air, ventilation, lighting, heating, and ordinary cleanliness, care should be taken that women and children do not work too long at a time or at occupations involving the use of poisonous or deleterious materials, that there are ample toilet and lavatory accommodations, and that these are separate and away from those used by men; there should also be opportunity to sit, and women should not be expected to remain standing for long periods of time. 165 PHYSIOLOGY AND HYGIENE. IX. HABITATIONS. 761. Describe briefly a proper location for a dwelling-house in the country. (March, 1892.) 752. In the selection of a site for a dwelling what is the best sanitary soil, sub-soil, and topography 9 {January, 1892.) 751 and 752. '^ One of the first requirements of a sanitary home is a salubrious building site with a thorough exposure to air and sunlight; the top of a small elevation is always to be preferred, because of better natural drainage, purer air, freedom from dampness, and greater safety from inundations. The tops of the highest hills are usually too much exposed to the wind, and when chosen in certain climates the house should be protected by trees on the windward side; next to the top of a hill, the slopes should be preferred with a southern, southeastern, or southwestern exposure, on account of the advantages of sunlight and greater cheerfulness. Sites located in depressions which receive the natural drainage from surrounding slopes should be avoided, as they are not only damp, but likely to be surrounded with cold air and chilling mists. It is scarcely necessary to insist that so-called ^made soil' and close proximity to marshes and injurious industrial estab- lishments should be avoided. Next to the topography of the site the character of the soil is important in its influence upon the healthfulness of the home. In a general way a gravelly, sandy, or chalky soil of good depth on a slope makes the best building site, provided soil pollution has not taken place and the deposit is not upheld by some imper- meable stratum of clay or rock near the surface. Clay, marl, peat, and made soils should be avoided, because they are damp and the presence of organic matter, apart from favoring the proliferation of disease germs, also tends to pollute the ground air which is in constant communication and interchangeable with the atmosphere.'' {Reference Handbook of the Medical Sciences.) 20 166 PHYSIOLOGY AND HYGIENE. 758. Is green wall paper objectionable? If so, whyf (January, 1898.) 753. Yes; because it may contain arsenic which is liable to become detached from the paper, and may be present in the air of the room, and then be inhaled. 754' What are the near and remote effects of too much shade around a dwelling-house? {April, 1893.) 755. Name the chief objections to the presence of shade trees near a divelling-house. (April, 1895.) 756. Mention the dangers of excessive shade about dwellings. {September, 1898.) 754 to 756. Shade favors dampness and the m\iltiplica- tion of molds and bacteria, which are readily carried by the ground air into the house. Apart from this, absence of sunlight is an important cause of anaemia and debility. See, too, Egbert's Hygiene and Sanitation, pages 294 et seq. 757. Give some of the requisites for the sanitary construc- tion of house foundations and cellars. (September, 1893.) 757. Egbert's Hygiene and Sanitation, page 88. 758. The excavation of streets in cities is frequently followed by the outbreak of diseases such as diphtheria and typhoid; what is the cause? (May, 189 J/..) 758. It exposes to the drying action of the air, soil which contains these bacteria in quiescent state. The dust result- ing is carried about and is taken in with the air and food which it thus infects. 759. How may pathogenic micro-organisms be conveyed from the soil and produce disease? Illustrate. (May, 1902.) 759. See Q. 758; and Egbert's Hygiene and Sanitation, pages 88 and 89. 760. Mention certain diseases produced by damp soils and ground water. (January, 1895.) 760. It is doubtful in the light of present knowledge if these directly cause disease, but they are important factors 167 PHYSIOLOGY AND HYGIENE. in the etiology, notably of rheumatism, malaria, typhoid and intestinal disorders. See, too, A. 725 (b). 761. What diseases may arise from soil pollution? (Sep- tember, 1899.) 761. Egbert's Hygiene and Sanitation, pages 92 and 98. 762. Describe the best method of ventilating dwellings. {January, 1892.) 762. Egbert's Hygiene and Sanitation, page 115. 763. Describe a system of ventilation for a large public building. {April, 1894.) 763. Egbert's Hygiene and Sanitation, page 119. 764. In what part of an occupied room is the most impure air found? Explain. {September, 1902.) 764. Egbert's Hygiene and Sanitation, page 115. 765. What should be the proper temperature for a living room in winter? {January, 1893.) 765. Egbert's Hygiene and Sanitation, page 123. 766. Give an opinion as to the sanitary effects of the different methods of heating houses. {May, 1898.) 767. From the standpoint of pure air, what are the advan- tages and disadvantages of heating by (1) open fires, (2) stoves, (3) hot pipes, (4) mechanical ventilation? {June, 1901.) 766 and 767. Egbert's Hygiene and Sanitation, pages 125 et seq., and 119. 768. State some of the results to animal life of the combustion of artificial fuel in a room without chimney connection or other ventilation. {June, 1893.) 768. Egbert's Hygiene and Sanitation, page 95. 769. What principal means are employed for producing artificial light in dwellings and what are their relative advan- tages? {September, 1901.) 769. Egbert's Hygiene and Sanitation, pages 83 to 85. 168 PHYSIOLOGY AND HYGIENE. X. SCHOOLS. 770. (a) What is the minimum number of cubic feet of atmosphere which should be allowed to each pupil in a public school-room? (June, 1892.) 771. (b) State the minimum of cubic space to which children should be subjected in the school-room. {September, 1892.) 770 and 771. (a) 1800 cubic feet of fresh air per hour; (b) 150 cubic feet of space, 15 square feet of floor space. 772. Describe a system of school ventilation. {September, 1900.) 772. Egbert's Hygiene and Sanitation, page 308. 773. In what position would you place the desk and bench of a school child in respect to the admission of light? {May, 1893.) 773. Egbert's Hygiene and Sanitation, page 307. 774. What deformities are liable to result from improperly constructed desks and seats in school-rooms? {November, 1891.) 774. Compression of the thorax, spinal curvature, round shoulders; and see Egbert's Hygiene and Sanitation, page 305. 775. (a) What abnormal conditions of the eyes is most common in school children? {November, 1892.) 776. (b) What habits of school children tend to produce myopia? {January, 1893.) 777. (c) What directions to prevent defects of vision should be given children attending school? {September, 1896.) 775 to 777. (a) Myopia, hypermetropia, astigmatism, stra- bismus, and trachoma, (b) Reading of fine or indistinct print, reading in poor illumination, improper positions in reading or writing, using the eyes when tired; excessive study, particularly when accompanied by insufficient exer- cise, is also conducive to myopia, (c) Avoidance of (b). 169 PHYSIOLOGY AND HYGIENE. 778. What are the usual systemic effects ^produced on grow- ing children in attendance at a school where light is insufficient and poorly distributed and where ventilation is had? (May, 1898.) 778. Egbert's Hygiene and Sanitation, page 300. 779. (a) What diseases common to children may he traced to school attendance and school associations? (September, 1899.) 780. (a) Name the principal diseases incident to school life. (January, 1896.) 781 . (b) Mention the most common communicable diseases of school children. (January, 1898.) 782. (a) What diseases are incident to school life? (c) HoiD may these diseases be prevented? (September, 1900.) 779 to 782. (a) Egbert's Hygiene and Sanitation, pages 300 to 305, and 314; and ringworm, pediculi, eyestrain, and diphtheria, (b) Egbert's Hygiene and Sanitation, page 314 ; and diphtheria, pedicuh,and ringworm, (c) By proper hygiene of the school-room, including warmth, light, ventilation, and disinfection; limiting the amount of work to be done at home; suitable desks properly arranged; frequent medical inspection and prompt exclusion of chil- dren who are ill, with quarantine of persons exposed to infectious diseases. 78S. State, in a general way, the maximum number of hours a day that primary pupils in the public schools be kepi at their tasks, and how frequently and in what manner such tasks should be varied and broken. (January, 1895.) 783. Each lesson should last not longer than half an hour, when the subject should be changed. At the end of each hour there should be an intermission of five or ten minutes. The whole morning session should not exceed three hours. After a two hours' recess for lunch and recreation the after- noon session should follow, with tasks limited as before. 784. Give the sanitary dimensions of a school class-room for 50 pupils. (May, 1895.) 170 PHYSIOLOGY AND HYGIENE. 784. The room should be 40 feet long, 30 feet wide, and 15 feet high; this will allow 360 cubic feet of space for each pupil. 785. Describe in detail the hygienic characteristics of a model school-room accommodating 50 'pupils. {May, 1902.) 786. Describe conditions necessary to make a school-house sanitary. (September, 1901.) 787. What hygienic defects should be guarded against in the construction of school buildings? {January, 1900.) 785 to 787. Egbert's Hygiene and Sanitation, pages 307 to 311. XI. HOSPITALS. 788. Describe a simple form of extemporized ventilation in a sick-room, by windows, doors, or otherwise. {September, 1894.) 788. Egbert's Hygiene and Sanitation, pages 113 and 114. 789. How should a hospital be ventilated and heated f (January, 1900.) 790. What should be the hygienic characteristics of a hospital ward? (May, 1900.) 791. Give the^pecial hygiene of hospital wards. (January, 1892.) 789 to 791. Egbert's Hgyiene and Sanitation, pages 113 and 114, 119 to 123, and 140 to 142. 792. Discuss detached wards versus many-storied buildings for a proposed hospital. (September, 1895.) 792. The detached-ward plan is much the preferable, as infection can be more perfectly localized, and patients will not be subject to the baneful effects upon vitality conse- quent upon superimposition. I«i detached wards the ventilation is better, supervision easier and more efficient, and in case of fire the patients can be removed quicker. See, too, Egbert's Hygiene and Sanitation, page 404, under ^'Barracks." 171 PHYSIOLOGY AND HYGIENE. 793. Give the requisites of a good site for a quarantine hospital. (June, 1898.) 793. Egbert's Hygiene and Sanitation, page 352. 794. Outline the construction of a camp hospital, especially providing for the care {with least danger to other patients, medical and surgical) of those suffering from contagious diseases. {May, 1901.) 794. Egbert's Hygiene and Sanitation, page 404; in addition the wards should be detached; there should be ample provision for burning all discharges, dejecta, dress- ings, and infected material ; fresh air, sunlight, heating and ventilation are prime requisites. XII. DISPOSAL OF SEWAGE. 795. What is (a) drainage, (b) sewerage? What should he the characteristics of (c) drainage pipes, (d) sewerage pipes? Explain. {June, 1902.) 796. Explain (a) drainage, (e) sewage, and (b) sewerage, {May, 1896.) 795 and 796. (a) Drainage is the removal of the surface and soil water. See also Egbert's Hygiene and Sanitation, page 368 et seq. (b) Sewerage is the process of systematically collecting and removing sewage from dwellings and other buildings, (c) Egbert's Hygiene and Sanitation, page 371; (d) page 369 (Soil-pipe); (e) pages 363 and 364. 797. What is the most sanitary way of disposing of city garbage? {January, 1893.) 797. Egbert's Hygiene and Sanitation, pages 363 and 364. 798. What is the best sanitary disposition of stable manure in large cities? {April, 1895.) 799. Describe the best way of disposing of stable manure in cities. {November, 1892.) 798 and 799. The liquid part should be properly drained into the sewer, and the solid manure should be cremated' 172 PHYSIOLOGY AND HYGIENE, or, if this latter is impossible, it should be stored in properly- covered receptacles or pits, care being taken to keep out rain or other water, and then at frequent and regular intervals it should be taken into the country to be employed for agricultural purposes; it is important to keep it as dry as possible. 800. (a) What is sewer gasf (b) How does the inhalation of sewer gas in large quantities affect the system? {April, 1898.) 801. (b) What evil effects may result from inhaling sewer gases? {January, 1901.) 800 and 801. (a) Egbert's Hygiene and Sanitation, page 86; (b) page 98. 802. What is the best means for preventing the access of sewer gas in dwellings? {June, 1893.) 802. Egbert's Hygiene and Sanitation, page 374 et seq. 80S. How does sewage become dangerous to health? {June, 1898.) 803. After a short time decomposition takes place, and noxious gases are given off; and in some cases specific germs of disease are found in the excreta. Water and air are both polluted, and both may be the means of convey- ing disease to the system. See, too, Egbert's Hygiene and Sanitation, pages 98 and 152. 804. Give approved methods of sewage disposal. {May, 1900.) 805. What is the best sanitary plan for the disposal of sewage? {November, 1891.) 806. Outline a method for the final disposal of the sewage of cities. {January, 1902.) 804 to 806. Egbert's Hygiene and Sanitation, pages 391 to 399. 807. In what way can the sewage of a city be best utilized? {September, 1893.) 173 PHYSIOLOGY AND HYGIENE. 807. Egbert's Hygiene and Sanitation, pages 393 and 394. 808. Describe the essential features of a satisfactory system of house sewage. {May, 1899.) 808. Egbert's Hygiene and Sanitation, pages 368 to 386. 809. (a) What evils arise from outside 'privy vaults? (b) How may such evils he averted in cases where outside privy vaults cannot he supplanted hy more modern contrivances? {Septemher, 1898.) 810. (b) How may a privy in city or country he kept while in use from becoming a nuisance? {April, 1895.) 809 and 810. (a) The air in their vicinity becomes saturated with noxious odors; their contents overflow, saturate the ground in the neighborhood, and possibly find their way into wells, (b) Egbert's Hygiene and Sanitation, page 366. XIII. DISINFECTION. 811. Define (a) disinfectant, (b) deodorant, (e) germicide, (c) antiseptic, (f) aseptic, (g) fomites, (d) quarantine. {September, 1899.) 811. Egbert's Hygiene and Sanitation, (a) page 317; (b) page 318; (c) page 318; (d) page 344; (e) a substance capable of destroying bacteria; (f) absence of germs; (g) substances capable of conveying contagion. 812. Mention in order of importance the different physical and the different chemical agents that are used for disinfection. {September, 1902.) 812. Egbert's Hygiene and Sanitation, pages 339 and 321 to 337. 813. What is the lowest temperature of steam heat at which pus cocci are destroyed? {January, 1894.) 813. Egbert's Hygiene and Sanitation, page 321. 21 174 PHYSIOLOGY AND HYGIENE. 814' (a) Describe a desirable operating-table, (b) Mention the essentials for properly safeguarding the patient from septic influences during and after an operation for amputation of the foot. (September, 1897.) 815. (b) Describe the preparation of patient, surgeon, assistants, instruments, and surroundings for operative pro- cedures. (January, 1900.) 814 and 815. (a) It should be made of forged iron or steel frame, with glass top properly guttered for drainage. Its construction should be of medium weight, but very rigid. All metal should be finished in baked enamel. Its top should be capable of tilting to an angle of 45° in either direction, and the mechanism for accomplishing this should be simple, strong, and operable with one hand. It should be furnished with leg holders and other appliances for supporting the patient in any of the ordinary operating positions, and should move freely upon castors, (b) The operating-room should be as devoid of furnishings, hangings, etc., as possible, and should be freely ventilated, light, and warm. Its floor and walls should be frequently scrubbed and washed with antiseptics. Windows, when open, should be properly screened to prevent the ingress of insects. Instruments should be boiled for twenty minutes in 5 per cent, soda solution. Ligatures (catgut) may be prepared by any of the usual methods: boiling in alcohol, boiling in cumol, the formalin method, or soaking in potassium-iodide- iodine solution. Silk and silkworm-gut should be repeatedy boiled in saline solution. All dressings should be sterilized by steam or prolonged immersion in bichloride solution 1 : 2000. Paraphernalia of the operating-room should be wiped with a cloth dipped in bichloride solution, 1 : 1000, shortly before operation. Patient should, if possible, receive a full bath and a cathartic the night before opera- tion. The operation site should be scrubbed with soap and warm water, and an antiseptic dressing applied, which should be removed just before operation, the site again washed with soap and water, followed by alcohol, ether. 175 PHYSIOLOGY AND HYGIENE. and bichloride solution 1 ; 2000. The whole patient should then be covered by a sterilized sheet or sterilized towels securely pinned together. The surgeon and assistants should don sterilized caps and masks. The hands and forearms should be thoroughly scrubbed with soap and running hot water for five minutes, special attention being paid to the nails, and the subungual space cleaned by a wooden stick, then immersed in alcohol followed by bichloride 1:2000 for three minutes, or in a saturated potassium permanganate solution, with or without the addition of bichloride 1 : 2000. This may remain on the hands during the operation, or the hands may at once be decolorized by saturated solution of oxaUc acid, after which they are rinsed in sterile saline or a dilute bichloride solution 1: 3000. The surgeon should then don a sterilized gown. All subsequent dressings should be done under antiseptic precautions as regards wound, dressings, instru- ments, and hands. 816. Describe briefly an approved means for disinfecting a room. (March, 1892.) 817. Hoiv should an apartment be disinfected after an infectious disease? {June, 1899.) 816 and 817. Egbert's Hygiene and Sanitation, pages 340 to 342. 818. Describe a process of disinfecting an infected hospital ward. (April, 1899.) 819. How should a hospital ward in which there has recently been a case of scarlatina be disinfected? (June, 1900.) 818 and 819. Egbert's Hygiene and Sanitation, pages 341 to 343. 820. State the most approved means of disinfecting private apartments after scarlatina. (January, 1897.) 820. See Q. 817. 821. How should clothing and bedding used in a case of scarlet fever be disinfected? (September, 1901.) 176 PHYSIOLOGY AND HYGIENE 821. Egbert's Hygiene and Sanitation, pages 341 and 342. 82£. Hoiv would you disinfect a hospital ward after its recent occupation by puerperal diseases? (November, 1893.) 822. See A. 819; in addition, do not use it for surgical or confinement cases for a period of one month. 823. State the best means of disinfecting sputum. [Janu- ary, 1901.) 823. ^^In pneumonia and pulmonary tuberculosis, the sputum should be received in spit-cups partly filled with disinfectant solution, and kept covered when not in actual use. It may be treated with 5 per cent, of carbolic acid, or about 5 per cent, of any of the cresol compounds, or 1 per cent, of formaldehyde. Milk of lime and chlorinated lime are also efficient. Corrosive sublimate is very un- certain. By reason of its consistency and adhesive prop- erties, sputum is one of the most difficult materials to sterilize." (Harrington's Practical Hygiene.) 82Jj.. Describe a method of disinfecting (a) excreta, (b) the person of the convalescent, (c) clothing, (d) the vacated sick- room. (September, 1900.) 824. (a) See Q. 825; (b) general hot water and soap bath with scrubbing, followed by washing with diluted Labar- raque's solution, or a 1 per cent, carbolic acid or 1 : 3000 bichloride solution, nasal douche of warm saline with listerine or some similar preparation, mouth wash and repeated gargles of the same, and a complete change of wearing apparel; (c) see Q. 821; (d) see Q. 816 and 817. 825. Describe the procedure of disinfecting and disposing of typhoid-fever stools. (June, 1902.) 825. ^'The discharges from the bowels in typhoid fever, dysentery, cholera, and intestinal tuberculosis should be received in vessels containing an amount of disinfectant solution equal to or, better, larger than the probable volume of the discharges. Whatever the agent used, it 177 PHYSIOLOGY AND HYGIENE. should be brought into immediate contact with the entire mass of the discharge by thorough mixing, and the whole should stand under cover for about an hour before final disposition. Milk of lime, although efficient, leaves a bulky residue, which cannot be conveniently disposed of through the usual channels. Chlorinated lime is also efficient, but is disagreeable in odor. Corrosive sublimate is unsuitable ; phenol in 5 per cent, solution, with or without the addition of mineral acids or common salt, and the various cresol disinfectants may be employed, but their odor is not always tolerable to the patient. Dilute formalin presents no objections, and is very efficient and rapid in action." (Harrington's Practical Hygiene.) 826. What means would you adopt in fumigating and dis- infecting (a) a ship or (b) house in which there had been a contagious disease f (June, 1893.) 827. fa) How should a ship he disinfected in case of cholera f (May, 1899.) 828. (b) What constitutes ship or cargo disinfection at the quarantine stations in the United States f (June, 1894.) 826 to 828. (a) Egbert's Hygiene and Sanitation, pages 352 to 356; (b) pages 330 to 343. XIV. VACCINATION. 829. State the accepted belief in respect to the limitation of protection from vaccination. (May, 1893.) 829. ' ' The protection conferred by vaccination is greatest during the year succeeding the operation, and appears to diminish gradually during the succeeding five or six years ; but the modifying power does not diminish equally fast. The protective influence can be re-established by a repeti- tion of the operation, and during epidemics, or when about to visit countries where vaccination is not practised and smallpox is endemic, re vaccination is always advisable. If the operation is negative in its results, the individual is 178 PHYSIOLOGY AND HYGIENE. regarded as immune or partially protected; but in the case of a first vaccination it is customary to repeat the operation until success is attained." (Harrington's Practical Hygiene,) 830. Which, in your judgment, is to he preferred in vaccination, animal or humanized virus, and why? {July, 1893.) 830. Animal or bovine virus is to be preferred because in the use of humanized virus there is a possibility of contami- nation with syphilis or other disease, and there is a more constant supply of bovine virus than of humanized virus. 831. What is your view concerning the propriety or necessity of inserting vaccine virus in multiple places? {No- vember, 1893.) 831. It is generally conceded that where the vaccine virus is inserted in three or four places the vaccination is more effectual than where only one or two insertions have been made. 832. Describe the progressive changes in a healthy infant after the introduction of pure vaccine beneath the skin. {April, 1894.) 832. ^'When fresh vaccine lymph is introduced, local effects are not usually noticeable within the first forty- eight hours. The period of incubation is brief, and if the vaccination is successful, at about the end of the second day a slight redness and swelling are observed at the seat of insertion. On the third or fourth day a little vesicle appears at the summit of the papule, filled with a clear liquid, which gradually grows larger and larger. As the size of the efflorescence increases, an umbilication appears, similar to that of the genuine variola pustule, which corre- sponds to the shape of the original wound of insertion ; an insertion by simple puncture producing a circular vesicle, and an insertion by a longitudinal incision producing an oval vesicle. The vesicle attains its largest size about the seventh or eighth day, when it contains a clear liquid, 179 PHYSIOLOGY AND HYGIENE. which, if the vesicle is punctured, will ooze out upon the surface sparingly. The construction of the vesicle is cellular, like that of the pustule of variola. After the eighth day, and sometimes a few hours earlier, a ring of inflammation called the areola begins to form about the base, and the vesicle and areola together continue for the next two days to spread. The areola is circular, and when fully developed has a diameter of 1 to 3 in. (2^ to 7 cm.). It is often attended with considerable hardness and swelling of the subjacent tissues. The establishment of the areola demands attention as the evidence that the specific effects of vaccinia have been produced. If several insertions have been made near each other, the areolae coalesce. After the tenth day the areola begins to fade, the vesicle begins to dry in the centre, the lymph remaining in it becomes opaque, the pearly colored pustule becomes yellowish, while at the centre, at the location of the original insertion of the virus, a cr\ist has begim to form. By the fourteenth day the crust has become dry and hard, and gradually assumes a darker hue, and usually falls off from the twen- tieth to the twenty-fifth day, leaving a cicatrix, commonly permanent, which is usually circular, slightly depressed, foveated, or indented with minute pits, and sometimes radiated. There are also constitutional symptoms more or less severe, in proportion to the intensity of the local symp- toms. There are fever, restlessness, derangement of the digestive organs, and occasionally swelling of the axillary glands. The constitutional symptoms are usually most severe at or a httle before the time when the areola has reached its fullest development.'' {Reference Handbook of the Medical Sciences.) 833. (a) State your views on compulsory vaccination and (b) relate the safeguards which should he employed in all cases of vaccination. {June, 1894.) 833. (a) In view of the figures given in Egbert's Hygiene and Sanitation, pages 315 and 360, vaccination should be 180 PHYSIOLOGY AND HYGIENE. compulsory. The public at large has rights which far exceed the ^'personal liberty" or whims of a few erratic individuals, (b) Fresh, pure, bovine virus should be employed; the operation should be aseptic and efficacious. (See A. 832.) SSJj.. State the objections usually advanced against vacci- nation as a preventive of smallpox. (April, 1897.) 835. State the objections usually made to vaccination by those who do not believe in its efficacy. {September, 1899.) 834 and 835. The chief objections urged against vacci- nation are the following: (1) that vaccination does not protect from smallpox; (2) that it is an infringement of personal liberty; (3) that smallpox is caused by filth and not by contagion, and therefore vaccination is imnecessary ; (4) that vaccination is responsible for the introduction of other diseases besides vaccinia, notably syphilis, tetanus, septicaemia, and pysemia; (5) that vaccination is responsible for an increased death rate. XV. QUARANTINE. 836. (a) Define the term quarantine, (b) Mention the principal quarantinable diseases and (c) give the rules for determining the length of time each should be quarantined. (January, 1901.) 837. (b) Name at least six diseases subject to quarantine. (May, 1893.) 838. (b) Name the diseases which require seaport quaran- tine. (June, 1893.) 839. (b) What diseases require quarantining and (d) what purpose is accomplished by the quarantine? (September, 1896.) 8Jf.O. (b) What are the principal quarantinable diseases? (e) Describe methods of procedure for establishing quarantine in the case of any one of these diseases. (September, 1897.) 8Jf.l . (d) What is the object of quarantine and (h) what diseases require it? (June, 1892.) 181 PHYSIOLOGY AND RYGIENE. 84^. (b) Enumerate the diseases that should he reported to the health authorities as subject to quarantine, (c) When may the quarantine he safely raised in each disease? {June, 1901.) 836 to 842. (a) Egbert's Hygiene and Sanitation, page 344; (b) pages 347, 349; and add ''plague"; (c) pages 356, 313 and 314 (''tables of incubation period"); (d) pages 345, 346; (e) pages 346, 352. 84s. Give a medical and hygienic plan for the inspection of immigrants who have just arrived at a seaport. {May, 1896.) 843. Egbert's Hygiene and Sanitation, pages 347, 353 and 355. XVI. DISPOSAL OF THE DEAD. 844. What injurious influences, if any, do cemeteries exert on the health of persons living in their vicinity? {June, 1895.) 844. "It is charged against earth burial, that the places used for the purpose are offensive; that the air becomes poisoned; that the soil becomes laden with disease germs of all descriptions, which are preserved indefinitely, and that water supplies are converted to dilute poisons of great potency; that is to say, cemeteries predispose to and act as direct causes of disease." (Harrington's Practical Hygiene.) 845^ Give the arguments in favor of incineration as the hest method of disposing of the dead. {May, 1894-) 846. State the advantages of cremation over earth burial. {May, 1898.) 845 and 846. The advantages of cremation are: (1) Economy ; not only is the actual process very much cheaper than is burial, but there is no necessity for a community to purchase large tracts of valuable land for the dead. Under the burial system the living are being gradually crowded out by the dead. (2) From a sanitary stand- I)oint, all the evils mentioned above in A. 844 are ob- 90 182 PHYSIOLOGY AND HYGIENE. viated. (3) Body-snatching and would be no longer possible. desecration of tombs XVII. VITAL STATISTICS. 847. Give a fair average death rate (a) in rural districts, (b) in towns of from 5000 to 20,000, and (c) in cities of over 100,000 inhabitants. (September, 1895.) 8J^8. Give the ordinary average death rate in (a) rural districts, (c) cities. {June, 1897.) 849. (d) State the ordinary death rate of each of four cities having respectively a population of more than 50,000. {May, 1900.) 847 to 849. (a) Egbert's Hygiene and Sanitation, page 430; (b) page 430; (c) page 430; (d) according to the census of 1900: Population. Death Rate. New York Chicago Philadelphia St. Louis 3,437,202 1,698,575 1,293,697 575,238 20.4 16.2 21.2 17.9 850. (a) What is zymotic death rate? (b) State causes that make the death rate high among infants and young children? {May, 1902.) 850. (a) Egbert's Hygiene and Sanitation, page 430; (b) page 431. 851. What is the expectation of life of a professional man in active practice at the age of forty-five f {September, 1892.) 851. Between twenty-three and twenty-four years. XVIII. MISCELLANEOUS. 852. Give the presumptions of survivorship and the reasons therefor, in the following from Casper: A is killed by a thrust 183 PHYSIOLOGY AND HYGIENE. of a sabre on the head, B by that of a bayonet in the hearty and Cby a shot which has torn open the jugular vein, {Janu- ary, 1896.) 852. ''If we suppose three men to be slain in the same tumult, A by a sabre cut on the head, B by a bayonet thrust in the heart, and C by a gunshot wound through the jugular vein, no one would hesitate to declare that in such a case B must have died first, that C must have borne his hemorrhage a little longer ere he died, and that A must have succumbed to his wound last of all." (Casper's Forensic Medicine.) 863. What is the chief unsanitary condition of sea-going vessels? {January, 1899.) 853. Overcrowding; want of ventilation; presence of bilge-water, dampness, and dirt. 854' Admitting that baldness is more common in men than in women, state some of the reasons why it is so. {June, 1896.) 854. ''Premature loss of hair is more common in men than in women, and this fact is no doubt principally due to the large quantity of subcutaneous fat in women. It is also owing to the attention that woman devotes to this. Nature's ornament, with which she is usually abundantly supplied, that she enjoys greater immunity than man from its premature loss. Women are more apt, through the fact of the length and the constant dressing of their hair, to detect the first inroads of the disease, and to apply at once suitable remedies. They are able, through the various methods of dressing the hair now in vogue, to conceal (more often the case than generally supposed) any and all evidence of thinning and baldness." (Shoe- maker, Diseases of the Skin.) 855. State the powers and duties of a board of health. {September, 1892.) 855. A local board of health is expected to do whatever is necessary and proper for the preservation of life and 184 PHYSIOLOGY AND HYGIENE, health; to suppress nuisances and whatever is detrimental to the public health; it may issue subpoenas, compel the attendance of witnesses, administer oaths to witnesses, and compel them to testify, and for such purposes it has the same powers as a justice of the peace; it may issue warrants for the arrest or removal of such persons as cannot otherwise be subjected to its orders; it may impose penalties for failure to comply with its regulations. The functions of a State board of health may be classed as follows: '^(1) to promote the organization of local and municipal boards ; (2) to obtain medical and vital statistics ; (3) to investigate the causes of undue sickness and mor- tality; (4) the removal of these causes, acting as far as possible through the local sanitary authorities; (5) the supervision of the hygiene of State institutions; (6) the supervision of quarantine." {Reference Handbook of the Medical Sciences.) 856. Define (a) leucomain, (b) ptomain. (January, 1897.) 857. (b) What are ptomains and (c) how are they pro- duced? (June, 1897.) 858. (b) What are ptomainsf (c) Mention foodstuffs the ingestion of which occasionally causes ptomain poisoning. (April, 1898.) 859. (b) Define ptomain and (c) give not less than five sources of the origin of such a product. (May, 1895.) 860. (d) Describe the agency of the ptomains in inducing disease and the disorders produced by them. (April, 1893.) 856 to 860. (a) A leucomain is ''an alkaloid developed in living animal tissues as a result of the normal vital processes." (Dxisme's Medical Dictionary.) (b) ''A ptomain is ''a putrefactive or animal alkaloid; a nitrogenous base produced as the result of putrefactive or morbid processes in animal or vegetable tissues. The term is sometimes restricted to the non-poisonous or very slightly poisonous members of this group, the poisonous ptomains being called 1S5 PHYSIOLOGY AND HYGIENE. toxins." (Duane's Medical Dictionary.) (c) Tainted meat, pork, ham, sausages; milk, ice-cream, cheese; fish, shell-fish, (d) They are generally extremely irritating, and upon being absorbed cause abdominal distress and griping, with vomiting and diarrhoea; the pulse is small, weak, thready, and very rapid, or may be abnormally slow; the countenance is sunken and pale, the extremities cold and clammy, and the temperature subnormal; or the}^ may cause febrile disturbance with delirium and erythematous eruptions. 861. Give the prophylaxis of the filth diseases. {November, 1893.) 861. The prophylaxis includes general cleanliness of person, clothes, food, habits, and habitation; pure air, proper ventilation, sufficient sunlight, adequate warmth; where possible preventive inoculation; avoidance of those suffering from disease; disinfection and isolation to be practised where necessary. See, too, under special diseases, Q. 616 to 622, 631, 635 to 637, 641 to 647, 649, 655, 656, 660. 862. What conditions of ill health make residence in high altitudes dangerous? Whyf {April, 1896.) 862. ''The contraindications to the high altitude resorts are: (1) advanced age; (2) the septic state, in which the disease is active and pyrexia constant; (3) double cavities with or without pyrexia; (4) cases in which there is great irritability of the nervous system ; (5) diseases of the kidney, liver, or heart; (6) diabetes; (7) great loss of pulmonary tissue; (8) emphysema; (9) tuberculous laryngitis. In regard to the latter disease there is some difference of opinion.'' {Reference Handbook of the Medical Sciences.) And see Q. 638. 863. Mention the advantages which the public would realize from a perfected system of public roads. {January, 1893.) 186 PHYSIOLOGY AND HYGIENE, 863. Better means of locomotion, cheaper provisions, easier access to schools, etc.; greater health owing to drainage. If the roads are kept clean, the health of those whose homes abut the road, and the children who make a playground of the public streets, will be improved. 864- Define the word nuisance in a broad, hygienic sense. {September, 1894.) 864. A nuisance is anything that injuriously affects the health or comfort of any members of a community. 865. Name some of the nuisances dangerous to health. (July, 1893.) 865. Carpet beating and cleaning, sandblasting of glass, keeping of certain live animals near human habitations, storage of animal matters; killing of animals, fat render- ing, lard refining, bone and blood boiling, tanning, gut cleaning. And see Q. 748 and 749. 866. Give (a) the symptoms and (b) phenomena of auto- infection. {January, 1898.) 866. (a) " The symptoms of autoinfection are headache, vertigo, insomnia, lassitude, neurasthenia, migraine, and cerebral congeston. Sometimes fever and a multiform cutaneous eruption are present." (b) " Autoinfection is infection caused by certain processes that originate and develop in the organism itself. It usually refers to the absorption of poisonous substances produced in the gastro- intestinal tract. These substances occur in normal digestion as well as in abnormal digestion, and, normally, they should be eliminated. The causes, therefore, are diseased conditions of the digestive tract, allowing these substances to be produced in excess, and disorders of the organs whose function is to eliminate such poisons." (Gould's Pocket Cyclopedia of Medicine and Surgery.) 867. A law to prevent owners of land, in the narrow streets of New York City from erecting buildings more than twelve stories in height is being agitated. Give sanitary and hygienic reasons (a) for or (b) against. {June, 1896.) 187 PHYSIOLOGY AND HYGIENE. 867. (a) Reasons in favor of high buildings : The inhabi- tants of the upper floors would have good light, sunshine, and pure air; would not be disturbed by street noises and dust; would not be injured by soil-air and water, (b) Against: The inhabitants of the neighborhood are de- prived of sunlight and ventilation. In case of fire there is more difficulty in extinguishing it, and the occupants of the upper floors may find it more difficult to escape. 868. At what distance for sanitary reasons should shade trees he placed in city or village streets? (January, 1894-) 868. The exact distance will depend on the kind of trees and the pruning that they receive; in any case the distance should be such that the trees do not touch the houses, and also do not interlace with each other except at a distance of at least thirty or forty feet above the ground. 869. State the effect of vegetation on climate. (January, 1902.) 870. How do forests benefit public health? (January, 1895.) 869 and 870. ''In cold climates trees and shrubs obstruct the passage of the sun's rays to the soil, which is therefore liable to be cold and moist ; but in hot climates the evapora- tion of water from the leaves tends to dry the soil, while the temperature of the air is lowered, and the ground is sheltered from the direct rays of the sun and kept cool. Thus, the heat of summer is lowered and the cold of winter lessened by the presence of trees, and, having a lower temperature than the neighboring earth's surface, high forests increase the rainfall Probably in all climates a due admixture of herbage, shrubs, and trees, without dense undergrowth, but admitting the passage of free currents of air in every direction, is the most conducive to health. Large tracts of country destitute of trees and vegetation are in hot climates unbearably warm and dry, and in cold climates are exposed to every chilling wind 188 PHYSIOLOGY AND HYGIENE. and to every extreme of temperature, according to the season of the year. In such districts, too, rainfall is often absent or very slight in amount, the attractive influence exerted by trees and vegetation generally upon water- charged clouds being wanting.'^ (Parke's Practical Hy- giene.) APPENDIX. Questions asked January, 1903. 871. (a) Describe by diagram or otherwise the human red blood corpuscle, and (b) give its chemical composition and (c) biological changes. 871. (a) See Q.'83 (b); (b) see A. to 947 (a); (c) Collins and Rockwell's Physiology, pages 34 to 38. 872. What are the enzymes of the pancreatic juice, and what office does each one perform in the process of digestion? 872. See Q. 235. 873. Give the physiological changes that occur at puberty in (a) the male, (b) the female. 873. (a) The voice changes, becoming deeper; hair appears on face, pubes, and other parts of the body ; sexual feelings are experienced; the genitals enlarge and secrete fluids, and spermatozoa are produced, (b) Cdllins and Rockwell's Physiology, page 274. 874' Describe the functions of the liver. 874. See Q. 242 to 244. 875. (a) What is the endocardium? (b) How is the endo- cardium nourished? 875. (a) The endocardium is a thin, smooth, transparent membrane, lining the internal surface of the heart, and is continuous with the inner coats of the bloodvessels, (b) The endocardium is nourished by its own capillary supply. 876. Give the functions of the trigeminal nerve. 876. See Q. 494. ( 189 ) 23 190 APPENDIX, 877. (a) Describe the function of the kidneys, (b) Do both kidneys act constantly? Explain. 877. (a) See Q. 367 and 368. (b) Collins and Rockwell's Physiology, page 133. 878. What does each of the following contribute to vital activity: (a) proteids, (b) fats, (c) carbohydrates? 878. Egbert's Hgyiene and Sanitation, pages 215 to 217. 879. Give the particular function of each heart valve. 879. Collins and Rockwell's Physiology, page 53. 880. (a) What constitutes the respiratory apparatus? (b) Describe in detail both the inspiratory and the expiratory movements of respiration and (c) the movements of the glottis in connection with each. 880. (a) The respiratory apparatus consists of the nose, nasopharynx, oropharynx, larynx, trachea, bronchi, lungs, and thorax, (b) See Q. 158 to "^167 (b). (c) The vocal cords separate during inspiration, and approach each other during expiration. 881. What evidences of contamination of drinking-water may be obtained by chemical analysis? 881. Egbert's Hygiene and Sanitation, pages 209 to 213. 882. How should disinfectants be applied to (a) the hands of the operator in preparation for surgical work, (b) bed linen and clothing, (c) feces and urine? 882. (a) See Q. 815; (b) see Q. 821; (c) see Q. 825. 88S. Describe the procedure of (a) establishing a quarantine in contagious diseases, (b) lifting a quarantine in contagious diseases. 883. (a) See Q. 840 (e); (b) see Q. 836 to 842 (c). 884. Describe the best method of constructing a house drain. 884. Egbert's Hygiene and Sanitation, pages 368 et seq. 885. Mention and describe the diseases of animals that are communicable to man, and state the means that should be employed for the prevention of these diseases in man. 191 APPENDIX. 885. Tuberculosis, actinomycosis, diphtheria, vaccinia, septicaemia, hydrophobia, anthrax, glanders, bubonic plague, intestinal parasites, trichiniasis, hydatid disease, ringworm; and see Q. 670 (a); for description and prophy- laxis, see Thompson's Practical Medicine. Questions asked May, 1903. 886. Where in the body may the following epithelial cells he found: (a) squamous, (b) ciliated, (c) polyhedral, (d) columnar, (e) transitional? 886. (a) In the superficial layer of the skin and its extensions, the alveoli of the lungs, glomerulus, and Henle's tube in the kidneys, ureter, bladder, vagina, oesophagus, (b) in the Eustachian tube, tympanum, respiratory part of nasal fossae, trachea, bronchi, larynx. Fallopian tube, ventricles of the brain, efferent ducts of the testis; (c) in the salivary glands; (d) in the stomach, intestines, and ducts of most glands; (e) in the pelvis of the kidney, ureter, and bladder. 887. Describe (a) the development and (b) functions of teeth. 887. (a) See Q. 52; (b) see Q. 51 (c). 888. (a) Describe the systemic blood circulation, (b) State in detail the changes that take place in the character of the systemic blood. 888. (a) See Q. 105 to 111 (b); (b) see Q. 95 to 97 (b). 889. Mention the forces at work in the absorption of digested food. 889. See Q. 289 to 291. 890. State the functions of the medulla oblongata. 890. Collins and Rockwell's Physiology, page 188. 192 APPENDIX. 891. Describe the normal heart sounds and state where they are best heard. 891. See Q. 126 to 128. 892. Give the perversion of function that may cause (a) vomiting, (b) hiccup. 892. (a) Collins and Rockwell's Physiology, page 101; (b) page 89. 893. Describe the function of the kidney. 893. See Q. 367 and 368. 894. What would be the effect of an exclusive diet of (1) nitrogenous food, (2) fats and carbohydrates? Explain. 894. Egbert's Hygiene and Sanitation, pages 228 to 237, and 215. 895. (a) In what part of the body is the sense of touch most delicate? (b) Describe the nervous mechanism on which the sense of touch depends. 895. (a) Collins and Rockwell's Physiology, page 224; (b) page 222. 896. Give the rationale of the use of the various antitoxins. 896. Egbert's Hygiene and Sanitation, pages 58 et seq. 897. (a) Mention some pathogenic bacilli found in drink- ing-water, and (b) state what means should be employed to destroy their infectiousness, (c) How may such impure water contaminate a milk supply? 897. (a) Egbert's Hygiene and Sanitation, pages 167 to 169; (b) pages 176 et seq.; note particularly page 200; (c) by being used to dilute the milk or to wash the containers. 898. Mention some of the diseases incidental to school life. 898. See Q. 779 to 782 (a). 899. Mention fiye occupations prejudicial to health. Explain. 899. See Q. 743 to 749. 193 APPENDIX. 900. (a) Give the nervous and muscular mechanism o] respiration, (b) Where is the respiratory centre located? 900. (a) See Q. 175; (b) see Q. 204. Questions asked June, 1903. 901. Mention the waste products of metabolism and state how they escape from the body. 901. See Q. 596 (b). 902. Give the complete physiology of (a) stomach digestion, (b) small intestine digestion. 902. (a) Collins and Rockwell's Physiology, pages 97 to 100; (b) page 101. 903. Describe the colorless corpuscles of the blood as to (a) development, (b) size, (c) form, (d) number, (e) function. 903. (a) Collins and Rockwell's Physiology, page 39; (b) page 38; (c) pages 38 and 39; (d) page 32; (e) page 40. 904. (a) What organs and forces are concerned in blood circulation? (b) Trace the complete course of the circidation, beginning at the right ventricle. 904. (a) Collins and Rockwell's Physiology, page 48; (b) page 49. ' 905. Describe spermatozoa microscopically and physio- logically. 905. See Q. 585. 906. Mention the varieties of epithelium. State the function of epithelium. 906. See Q. 24. 907. Give the origin, distribution, and function of the olfactory nerves. 907. Collins and Rockwell's Physiology, pages 230 to 232. 194 APPENDIX. 908. Mention the conditions that control body temperature. 908. See Q. 443 to 445. 909. (a) How is uric acid developed in the human system? (b) What class of foods increases the development of uric acid? 909. (a) ''Uric acid represents one of the metabolic products of the nucleic acids. The latter are present in the diet in variable quantities and occur in nature in the so- called nucleoproteids (nucleates), which are salts of proteids with nucleic acid. On decomposition the nucleic acids yield one or more of the purin derivatives, usually adenin or guanin, which undergo oxidation in the body. Uric acid is an intermediate stage in the complete decomposition; when introduced as such into the body it is largely burned up. Experiments by Mendel and others make it probable that the liver is the seat of the oxidations referred to. There is no evidence that the spleen is involved, as has been assumed. While the possibility of a synthetic for- mation of uric acid has not been absolutely excluded, it cannot play any important role under ordinary conditions. In the absence of purin compounds in the diet, the uric acid output in man does not ordinarily exceed 300 mgm. per day. Uric acid bears no direct relation to urea in metabolism, although the latter may be formed from it." (Reference Handbook of the Medical Sciences.) (b) Fresh meats chiefly, particularly flesh of growing animals; also tea, coffee, and cocoa. 910. What is (a) reserve air, (b) residual air? (c) What is meant by the vital capacity of the lungs? 910. (a) See Q. 163 to 165 (e) ; (b) see Q. 164 to 166 (h) ; (c) Collins and RockwelFs Physiology, pages 83 and 82. 911. Describe (a) hard water, (b) soft water, (c) How may hard water be converted into soft water for drinking purposes? 911. (a) See Q. 695 (a) ; (b) see Q. 695 (b) ; (c) by boiling, or by the addition of lime and caustic soda or sodium carbonate. 195 APPENDIX. 912. State the impurities that may exist in (a) natural ice, (b) artificial ice. 912. (a) See under Water Impurities, Egbert's Hygiene and Sanitation, pages 152, 167 and 176; (b) see (a); if the water is first boiled, bacteria are killed; if distilled, ammonia is the only impurity present; and see Q. 720 and 721. 918. What are (a) the physical and (b) the chemical properties of sweat? (c) What is the influence of the nerves on the excretion of sweat? 913. (a) Collins and Rockwell's Physiology, pages 124 and 125; (b) see Q. 391; (c) see Q. 393. 914' (a) What conditions of soil and climate are most favorable for the residence and treatment of tuberculous patients? (b) Mention three localities in the United States where these conditions may be found. 914. (a) See Q. 640; (b) Colorado, New Mexico, Adiron- dacks. 915. (a) Mention the diseases that may be transmitted by the ingestion of contaminated meat and fish, (b) What means should be adopted to prevent such diseases? 915. (a) Ptomain poisoning, dysentery, tuberculosis, tape-worms, round-worm, trichiniasis, hydatid disease; (b) see Q. 885. Questions asked September, 1903. 916. Describe cell growth. Illustrate. 916. See Q. 14 and 15. 917. Describe in detail each step in the digestion of a meal containing proteids, carbohydrates, fats, water, and inorganic salts. 917. See Q. 281 to 288. 918. Compare (a) lymph and chyle, (b) blood and lymph. (c) What is chyme? 196 APPENDIX. 918. (a) See Q. 317 to 319; (b) Collins and RockwelFs Physiology, pages 46 and 47 ; (c) see Q. 320 (a) . 919, (a) Describe the fetal circulation, (b) Mention the changes that take "place in the circulation of the blood imme- diately after birth. 919. (a) See Q. 117 and 118; (b) Collins and Rockwell's Physiology, page 296. 920. What would be the effect of a division of the third cranial nerve? 920. See Q. 492 (d). 921. What theories have been advanced regarding the function of (a) the spleen, (b) the suprarenal capsule, (c) the thyroid gland? 921. (a) See Q. 434. (b) '^The removal of the supra- renal capsules is more quickly fatal than the removal of the thyroids, death occurring in a few hours or a few days. The symptoms are muscular weakness, loss of vascular tone, and great prostration, resembling those of Addison's disease, which involves lesions of the adrenals. The glands may normally be supposed to remove toxic substances from the body, which are formed chiefly in the muscles." (Guenther's Physiology.) (c) ''It appears that the thyroids and accessory thyroids, on the one hand, differ from the parathyroids, on the other, in that removal of the first causes slow trophic disturbances, while removal of the last results in acute disturbances and quick death. These glands may be regarded as functionating in two ways. They may either antagonize toxic substances that are foimd in the blood, or may produce a secretion which is necessary to the metabolism of the body in general, and particularly of the central nervous system." (Guenther's Physiology.) 922. (a) State the physiological cause of fatigue of muscles. (b) Describe rigor mortis. 922. (a) See Q. 402; (b) see Q. 405 to 409 (a). 197 APPENDIX. 923. (a) What is understood hy accommodation of the eye? (b) Give the mechanism of accommodation of the eye. 923. (a) Collins and RockwelFs Physiology, page 250; (b) see Q. 558 (a). 924. Beginning at the 'pelvis of the kidney, describe in detail the nervous and muscular mechanism by which the urine is discharged from the body. 924. Collins and Rockwell's Physiology, pages 133 and 129. 926. Give the cause of (a) aphasia, (b) asphyxia. 925. (a) See Q. 602 (b) ; (b) see Q. 195 to 203 (b) and (c); and 602 (c). 926. (a) What evidences of contamination of drinking- water may be obtained by bacteriological analysis? (b) Compare the value of chemical analysis with that of bacterio- logical analysis. 926. (a) Egbert's Hygiene and Sanitation, pages 167, 207 and 213. (b) Chemical analysis is of value only as indicating the degree of contamination and the possible source. It does not indicate the degree of danger to health. 927. State the relative value of the following methods of sewage disposal: (a) seioage irrigation, (b) sewage filtration, (c) the pail system, (d) chemical treatment. 927. (1) Sewage irrigation; (2) the pail system; (3) sewage filtration; (4) chemical treatment. See Q. 804 to 806. 928. (a) Discuss the immunizing power of vaccination. (b) State the possible dangers of vaccination. 928. (a) Egbert's Hygiene and Sanitation, pages 360 to 362; (b) see Q. 834 and 835 (4). 929. (a) How does proper physical exercise promote health and strength? (b) What is the effect of continued excessive exercise? 929. (a) Egbert's Hygiene and Sanitation, pages 278 et seq.; (b) cardiac hypertrophy and dilatation, valvular 2i 198 APPENDIX. insufficiency with its results, arteriosclerosis, aneurysm^ chronic interstitial nephritis, etc. ; and see Q. 738 and 739. 930. Give a complete method of room disinfection after the removal of an infected patient. 930. See Q. 816 and 817. Questions asked January, 1904. 931. Enumerate the ultimate chemical elements that are physiologically present in the tissues of the human body. 931. Collins and Rockwell's Physiology, pages 24 and 26. 932. Mention and illustrate the varieties of epithelium and indicate their functions. 932. See Q. 24 to 29. 933. Give in regard to hone (a) structure, (b) method of nourishment, (c) physical and chemical properties, (d) functions. 933. (a) ' ' A thin, transverse section of a decalcified bone, when examined microscopically, reveals a number of small, round, or oval openings, which represent transverse sections of canals which run through the bone, for the most part in a longitudinal direction, though frequently anastomosing with one another. These so-called Haversian canals in the living state contain bloodvessels and lymphatics. Around each Haversian canal is a series of concentric laminae, composed of white fibres. Between every two laminae are found small cavities (lacunae), from which radiate in all directions small canals (canaliculi), which communicate freely with one another. The Haversian canals, with their associated lacunae and canaliculi, form a system of inter- communicating passages, through which lymph circulates destined for the nourishment of bone. Each lacuna con- tains the bone corpuscle, which bears a close resemblance to the usual branched connective-tissue corpuscle, and 199 . APPENDIX. whose function appears to be the maintenance of the nutrition of the bone. The surface of every bone in the recent state is invested with a fibrous membrane, the peri- osteum, except where it is covered with cartilage. The inner surface of this membrane is loose in texture, and supports a fine capillary plexus of bloodvessels and numer- ous protoplasmic cells — the osteoblasts. As this layer is directly concerned in the formation of bone, it is spoken of as the osteogenetic layer.'' (Brubaker's Physiology.) (b) See Q. 44 to 46 (a), (c) ''Bone is one of the hardest structures of the animal body; it possesses also a certain degree of toughness and elasticity. Its color, in a fresh state, is of a pinkish-white externally and deep red within. On examining a section of any bone, it is seen to be com- posed of two kinds of tissue, one of which is dense and ■compact in texture, like ivory; the other consists of slender fibres and lamellse, which join to form a reticular structure; this, from its resemblance to lattice-work, is called cancel- lous. The compact tissue is always placed on the exterior of the bone ; the cancellous is always internal. The relative quantity of these two kinds of tissue varies in different bones, and in different parts of the same bone, as strength or lightness is requisite. Close examination of the compact tissue shows it to be extremely porous, so that the differ- ence in structure between it and the cancellous tissue depends merely upon the different amount of solid matter, and the size and number of spaces in each; the cavities being small in the compact tissue and the solid matter between them abundant, while in the cancellous tissue the spaces are large and the solid matter in smaller quantity.'' (Gray's Anatomy.) The chemical composition is given as : Gelatin and bloodvessels 33 per cent. Phosphate of calcium 57 " Carbonate of calcium 8 " Fluoride of calcium 1 " Phosphate of magnesium 1 " 100 per cent. (Dunglison's Medical Dictionary.) 200 APPENDIX. (d) To act as the framework of the body and to give it stabiUty; to protect organs and viscera; to assist in the formation of joints; to furnish points of attachment for muscles, and to serve as levers. 934. Mention the digestive glands and state the 'particular function of each. 934. See A. 231 to 239 (e); and table of secretions in Collins and Rockwell's Physiology, page 136. 935. Describe (a) serous membranes, (b) synovial mem- branes, (c) State the functions of each, (d) Enumerate the serous membranes of the body. 935. (a) See Q. 411; (b) see Q. 411; (c) see Q. 412; (d) the peritoneum, the pleura, the pericardium, and the tunica vaginalis of the testis. 936. Define and describe (a) lymphatics, (b) chyme, (c) chyle. 936. (a) See Q. 306 and 307; (b) see Q. 320 (a); (c) see Q. 320 (b). 937. (a) Where and how is urea formed in the body? (b) In what quantity is urea excreted by an adult in 21^ hours? 937. (a) See Q. 382 to 384; (b) see Q. 380 (f). 938. How is the heat of the body (a) produced, (b) dissi- pated? (c) Mention the functions of the skin. 938. (a) See Q. 439 to 445 (b); (b) Collins and Rock- well's Physiology, page 141; (c) see Q. 385 to 387. 939. State the effect on respiration of section of (a) one phrenic nerve, (b) both phrenic nerves. 939. (a) Slight impairment of diaphragmatic action ; (b) paralysis of the diaphragm, greatly impairing respiration, and causing dyspnoea. 94.0. Mention the forces that produce and maintain the circulation of the blood in the arteries, capillaries, and veins. 940. Collins and Rockwell's Physiology, pages 56, 54 and 55. 201 APPENDIX. 941 ' (a) Give the ordinary composition of atmospheric air. (b) State the permissible limit of CO^ in air. 941. (a) Egbert's Hygiene and Sanitation, page 68; (b) pages 71 and 75. 94-2. Describe the hygienic construction of a bedchamber for two adult persons, touching on size, shape, air inlets and outlets, heating and lighting. Give reasons. 942. The room should be not less than about twenty feet long by ten feet wide, and not less than ten feet high. For air inlets and outlets, see Egbert's Hygiene and Sanitation, pages 121 to 123. Heating should be, preferably, by hot-air furnace; and lighting by incandescent light or Welsbach light. 94s. What appliances are commonly employed for the heating of houses? What is their comparative value f Give reasons for conclusion. 943. See Q. 766 to 768. 944- State in detail the means that may be employed to prevent the spread of epidemics of (a) Asiatic cholera, (b) bubonic plague, (c) smallpox. 944. (a) Egbert's Hygiene and Sanitation, page 353 et seq.; and see Q. 659; (b) see Q. 660 (b) ; (c) see Q. 655 (a). 945. Give an analysis {parts per 10,000) of a proper drinking-water. State parts per 10,000 of the following which render a water non-potable: free ammonia, albuminoid ammonia, nitrogen as nitrates, nitrogen as nitrites, chlorin, volatile residue, fixed residue. 945. The following table is compiled from figures given in Harrington's Practical Hygiene; the figures given in column A denote a ^' water of undoubted purity;" those given in colunm B are '' sufficient for unqualified condem- nation." The figures have been reduced to parts in 10,000, in conformity with the question: 202 APPENDIX. A B Free ammonia Albuminoid ammonia Nitrogen as nitrates Nitrogen as nitrites Chlorin Volatile residue Fixed residue 0.00002 0.00018 0.00240 0.00000 0.00700 0.12500 0.16000 0.04750 0.00585 0.46000 0.00540 0.42700 1.11000 2.33000 Questions asked May, 1904. 9Ji.6. (a) What is the purpose of water in the organism? (b) What proportion of the body weight is water? (c) State the principal sources from which this water is derived, and (d) mention the avenues through which it is discharged from the body. 946. (a) ''Water is the most important of the inorganic constituents, as it is indispensable to life. It is present in air the tissues and fluids without exception. Much of the water exists in a free condition, and forms the chief part of the fluids, giving to them their characteristic degree of fluidity. Possessing the capability of holding in solution a large number of inorganic as well as some organic com- pounds, and being at the same time diffusible, it renders an interchange of materials between all portions of the body possible. It aids in the absorption of new material into the blood and tissues, and at the same time it transfers waste products from the tissues to the blood, from which they are finally eliminated, along with the water in which they are dissolved. A portion of the water is chemically combined with other tissue constituents, and gives to the tissues their characteristic physical properties. The con- 203 APPENDIX. sistency, elasticity, and pliability are, to a large extent, conditioned by the amount of water they contain." (Brubaker's Physiology.) (b) About two-thirds, or 66 per cent, (c) The food and water ingested, and it is also formed in the body, (d) By the kidneys as urine, by the skin as perspiration, by the limgs as watery vapor, and by the intestines in the feces. 947. (a) Give the composition of blood, (b) Under what conditions does blood clot in the vessels? 947. (a) ''Analysis of the blood proves it to be composed of 775 to 800 parts of water and 200 to 225 parts of solids. The solids are 192 to 217 parts of organic and 7 to 8 parts of inorganic matter. The organic matter is composed of haemoglobin, of proteids, fats, and traces of sugar, while the inorganic matter is composed of NaCl, KCl, NaHCOg, Na^HPO,, CaHPO,, CaSO,, MgCl^, etc. The best idea of the chemical composition of the blood as a whole may be obtained by first separating the blood into plasma and corpuscles by centrifugation, and then analyzing each separately. Human blood so treated would give approxi- mately the results recorded in the following table, which is the result of an analysis reported by Halliburton: 204 APPENDIX. Plasma Take 100 parts. Per cent. Water 90.29 Solids 9.71?^ Organic 8.86 5i Inorganic 0.85^ Proteids Serum albumin Serum globulin Fibrin .... Extractives : fats, etc. f NaCl Soluble J KCl salts 1 NaHCOg L Na,HP04 Insoluble / CaHP04 salts t CaS04 7.9 0.4 0.56 0.85 100. 00 Cor- puscles Take 100 parts. Water 68.80 f Organic 30.4^ Solids 31.2?^ f Proteids I 29. 79?^ Fats Hsemo- (Hsema- globin •{ tin , 27 (Globulin Globulin m ) 27.36 2.43 Lecithin \ Cholesterin j 0.61 f KCl Inorganic ' g^g 0-8?^ i Ca^HPU 0.80 L Mg3(P04^2 J Fe [See Hsematin.] 100. OO (Hall's Text-hook of Physiology.) (b) Collins and Rockwell's Physiology, page 45. 948. (a) By what means is the heart nourished? (b) How may endocardiac pressure he recorded? 948. (a) Collins and Rockwell's Physiology, page 63. (b) By a manometer connected with a cannula inserted directly into the cavity of the auricle or ventricle, the manometer actuating a recording style giving a tracing on blackened paper moving at a uniform rate of speed. 949. (a) What are the sources of the heat of the body? (b) Through what channels is heat lost from the body? 949. (a) See Q. 439 to 445 (b). (b) Collins and Rock- well's Physiology, page 141. 950. (a) Describe the mucous membrane of the stomach. (b) Mention the changes that take place in the gastric glands during secretion. 950. (a) Collins and Rockwell's Physiology, pages 96 and 97; (b) page 97. 205 APPENDIX. 951. Define and illustrate (a) osmosis, (b) diffusion, (c) filtration. 951. (a) Collins and Rockwell's Physiology, page 111. (b) Diffusion is a property of gases, by virtue of which two or more gases present in the same container tend individu- ally to occupy its every part, resulting in the intimate mixture of the gases. Example: alveolar air in the lungs with the atmospheric air inspired, (c) Filtration is the process of a liquid or gas passing directly through the pores of a substance dense enough to arrest solid particles. 952. (a) How and where is glycogen formed f (b) Explain the condition known as alimentary glycosuria. 952. (a) Collins and Rockwell's Physiology, pages 110, 114 and 145. (b) If a person takes in with his food more sugar than the liver and muscles can convert into glycogen, the surplus is excreted by the kidneys and appears in the urine; this is called ''alimentary glycosuria.'' 953. What is the difference between myopia and pres- byopia? 953. Collins and Rockwell's Physiology, pages 260 and 261. 954- State the functions of the pneumogastric nerve. 954. See Q. 498 to 500. 955. Give the normal pulse, temperature, and respiration at (a) birth, (b) the age of 21, (c) the age of 70. 955. (a) at birth (6) at age of 21 (c) at age of 70 Pulse. 130 72 65 Temper ATUKE. 99° to 99.7° F. 98.6° F. 99.7° down to 97° F. Respiration. 44 16 to 20 16 to 20 956. Describe a site and mention the requisites for a hospital for smallpox patients. •Jo 206 APPENDIX. 956. See Q. 793 and 794. 957. How may milk he the cause of disease? Explain. 957. See Q. 672 to 677. 958. (a) What hygienic rules should he ohserved in hathingf (b) Give a description of a Turkish hath. 958. (a) Egbert's Hygiene and Sanitation, page 286; (b) page 287. 959. (a) Mention the physiological changes that take place in the middle period of life in woman, (b) What hygienic rules should he ohserved at that time? 959. (a) Collins and Rockwell's Physiology, page 274. (b) ^^A chief point is to keep the bowels open, preferably by means of aperient salts or waters. . . . Derivation to the skin by washing the whole body with cold water and rubbing the skin well with Turkish towels is both pleasant and useful. For the loaded urine it is good to drink a siphonful of Vichy, Rheus, or Seltzer water in the course of the day, or to take bicarbonate of soda one-half drachm in a tumblerful of water. The congestion of the head and visual disturbance are often much benefited by the use of hot footbaths, with or without mustard; and of the cold eye-douche five minutes, three times a day. . . . A lukewarm general bath, taken two or three times a week, keeps the skin in good order and tranquillizes the nerves. The diet should be bland, but must vary according to the constitution. In those women who have a tendency to stoutness it ought to be as much restricted as possible, and all fat-producing food (cereals and sugar) ought especially to be taken in very small quantities; milk and beer are prohibited Those more exceptional women who lose flesh must be well fed and have chocolate and plenty of milk to drink. . . . . She must beware of cold feet or a wet skin when she has her menses, not wash her genitals with cold water, and still less take a cold bath when the menses are present She should 207 APPENDIX. abstain from sexual intercourse. When first the menopause is well established marital relations may be resumed. The mental diet is of no less importance than the physical. The physician may relieve much unnecessary anxiety by giving a good prognosis. The patient should occupy her mind by useful work, and likewise as much self-control as her mental condition and acquired habits will allow.'' (Garrigues' Diseases of Women.) 960. Compare the relative merits of disposing of the dead hy (a) burial, (b) incineration. 960. See Q. 846. Questions asked June, 1904. 961. Define (a) physiology, (b) hygiene, (c) secretion, (d) excretion, (e) function. Illustrate. 961. (a) Collins and Rockwell's Physiology, page 17; (b) Egbert's Hygiene and Sanitation, page 17; (c) Collins and Rockwell's Physiology, page 115; (d) page 115. (e) A fimction is the characteristic work done by any organ or part of the body ; thus, excretion of urine is the function of the kidneys. 962. (a) Mention the gases found in the blood, (b) What is the comparative amount of these gases, and (c) what dis- position is made of them in the process of nutrition? 962. (a) Collins and Rockwell's Physiology, page 42; (b) page 42. (c) Oxygen is carried by the red blood cor- puscles and given up to the tissues, which combine with it to form water; and carbon dioxide, which is taken up by the blood and carried back to the lungs, passes by osmosis and diffusion into the atmosphere. 963. Give a physiological description of the intestinal mucous membrane. 963. Collins and Rockwell's Physiology, pages 101 to 104. 208 APPENDIX. 964- Describe the composition and the function of (a) pancreatic juice, (b) hile. 964. (a) See Q. 233; (b) Collins and Rockwell's Physi- ology, pages 107 and 109. 965. Describe the action of the diaphragm in (a) respira- tion, (b) hiccough, (c) vomiting. 965. (a) See Q. 171 to 173 (e); (b) see Q. 173 (f); (c) Collins and Rockwell's Physiology, page 101. 966. Differentiate voluntary muscles and involuntary muscles. Illustrate. 966. See Q. 56. 967. (a) Mention the organic constituents of food sub- stances, and (b) state how these constituents should be pro- portioned for the maintenance of health and strength. 967. (a) Collins and Rockwell's Physiology, pages 28 and 29; (b) Egbert's Hygiene and Sanitation, page 228. 968. (a) Describe the mechanism of patellar reflex, (b) Give two other examples of reflex action. 968. (a) It is dependent upon the integrity of (1) an afferent sensory nerve leading to (2) a centre in the lumbar part of the cord, from which issue (3) efferent fibres dis- tributed to the quadriceps extensor femoris in such a way that when the tense patellar tendon is struck the quadriceps is reflexly stimulated to momentary contraction, (b) See Q. 474. 969. Give a general description of the organs and mech- anism concerned in the production of the voice. 969. See Q. 455 to 459. 970. What physiological changes take place in the uterus (a) during menstruation, (b) during pregnancy, (c) after parturition? 970. (a) '^Just before the flow the membrane becomes much thicker, congested, and thrown into shallow folds. Then it undergoes disintegration by fatty degeneration, 209 APPENDIX. and is thrown off with the blood that flows from the opened capillary bloodvessels. There exists some dis- crepancy of opinion as to how much of the mucous mem- brane is thrown off each month, but no doubt exists as to the fact of its becoming physiologically hypertrophied just before the menses, and of its undergoing a certain degree of fatty atrophy and degeneration during and immediately after the period. Shortly after menstruation a new mucous membrane is already in course of prepara- tion." (King's Manual of Obstetrics.) (b) ''The increased vascularity, hypertrophic thickening, and shallow folding of the uterine mucous membrane, which begin at each menstrual period, progress, after the stimulus of impreg- nation, with rapidity. The membrane becomes extremely thick, vascular, and deeply convoluted (except near the orifices of the Fallopian tubes and os internum), so as to obliterate, or almost fill, the cavity of the womb. The hypertrophied mucous membrane thus formed on all sides of the uterine cavity is called the decidua vera. ... In a few months the uterus increases in size (from 3 to 12 inches in length; from IJ to 9 in width); in weight, from about an ounce to about two pounds, not including its contents. The capacity of its cavity is enlarged 519 times. The area of its external surface is increased from 16 square inches to 339 square inches. All of its tissues — its muscles, ligaments, arteries, veins, lymphatics, nerves, and nerve- ganglia — become tremendously hypertrophied. The uterus itself changes its position, prolapsing during the first two months, and gradually rising after the third." (King's Manual of Obstetrics.) (c) See Q. 577. 971. What sanitary provisions should be considered in deciding on a method of heating a dwelling-house f 971. Egbert's Hygiene and Sanitation, pages 115 et seq, 972. State in detail the means that may be employed to prevent the spread of epidemics of (a) typhoid fever, (b) yellow fever. 210 APPENDIX. 972. (a) See Q. 641; (b) see Q. 658. 973. Mention the four conditions {the ^postulates of Koch) that are essential to prove that a micro-organism is the cause of an infectious disease. 973. Egbert's Hygiene and Sanitation, page 53. 974. Give in detail the most advantageous method for the disposal of garbage in large communities, by municipal authority. 974. Egbert's Hygiene and Sanitation, page 363. 975. What is (a) natural ventilation, (b) artificial venti- lation? Mention the main forces concerned in each of these methods of ventilation. 975. (a) Egbert's Hygiene and Sanitation, page 108; (b) pages 108 and 119. Questions asked September, 1904. 976. Mention the differences between white fibrous tissue and yellow elastic tissue in regard to structure, distribution, and function. 976. See Q. 34. 977. Describe the manner in which the mammary glands perform their functions. 977. '^The cells of the mammary glands, which during pregnancy become active for the first time, undergo histological changes of such a nature that each cell increases in size, undergoes a fatty metamorphosis, the nuclei divide, and then a portion, at least, of the cell, if not the whole of it, disintegrates. The fragments form the constituents of the milk. There are known instances where the secre- tion of milk has been suppressed by strong emotions, epileptic attacks, etc., indicating a control of the central nervous system. The connection between the gland and the uterus, which stand in close relation, is mainly through 211 APPENDIX. the blood. That the secretion of milk may be continuous is not known with certainty, but it is probable that as it accumulates in the sacculated ducts of the gland the tension finally inhibits further secretion. The emptying of the ducts is the normal stimulus, either directly or reflexly^ for a renewed activity of the gland. Otherwise the cells undergo retrogressive changes, but they never become as they were before the first pregnancy." (Guenther's Physiology.) 978. (a) State the origin of fats in the body, and (b) give the ultimate fate of the absorbed fat. 978. (a) ''The origin of fat was at first supposed to be simply that which was taken in as food, but the history of fat as seen microscopically showed that it was not simply deposited, and it was soon demonstrated that in cows and pigs an amount of fat might be formed out of all proportion to the amount ingested. In addition to this it was found that the fat of an animal differed in kind from that which was taken in as food. It has been defi- nitely decided that only under special conditions, as when an animal is richly supplied with fats, are the latter stored directly. Usually the fat of the food is completely oxidized, and that which is stored is derived from carbohydrates and proteids. The latter are an important source; the theoretical maximum that tbey can yield is about 51.5 per cent. It has been shown that in a young pig the amount of fat laid on in a given time was greater than that obtained from the food directly, plus the theoretical maximum obtainable from proteids, so that it must have come from the ingested carbohydrate food. It is of interest that the Banting diet for reducing obesity is characterized by the absence of carbohydrates and the excess of proteids.'^ (Guenther's Physiology.) (b) The ultimate fate of the absorbed fat, after being conveyed by the blood to the tissues, is: (1) to serve as a source of energy, (2) as a source of muscular work, and (3) to help in the main- 212 APPENDIX. tenance of the body temperature; (4) its final oxidation products are COg and H2O. 979. (a) What is the ordinary composition of feces? (b) Give the nervous and the muscular mechanism of defecation. 979. (a) See Q. 301; (b) See Q. 303. 980. State the average respiration and pulse heat a minute and give the average temperature of (a) the newborn, (b) the youth, (c) the adult, (d) the aged. 980. (a) the newborn (b) the youth (c) the adult (d) the aged Average Respiration A Minute. 44 22 18 16 Average Pulse-beat A Minute. 130 90 72 65 Average Temperature (in Mouth). 99.5° F. 98.8° F. 98.6° F. 99.0° F. 981. Give the specific gravity, reaction, temperature, and microscopic character of the Mood. 981. Collins and Rockwell's Physiology, pages 31 and 32. 982. Give a comprehensive description of the processes hy which digested food is absorbed. 982. Collins and Rockwell's Physiology, pages 111 to 114. 983. Describe (a) the cornea, (b) the iris. State the functions of each. 983. (a) Collins and Rockwell's Physiology, pages 246 and 247; (b) pages 248 and 259. 984-. What is the physiology of ( ) hunger, (2) thirst f 984. See Q. 535. 985. (a) Mention the nutritive fluids of the body and (b) state the functions of any one of those mentioned. 985. (a) The nutritive fluids are chyle, blood, and lymph. (b) Collins and Rockwell's Physiology, pages 46 and 47. 213 APPENDIX. 986. Describe a method of disinfecting excreta, the 'person of the convalescent, the clothing, and the vacated sick-room. 986. See Q. 824. 987. Mention the reliable sources of a pure water supply. 987. See Q. 701. 988. Mention the communicable diseases that come within the scope of public health administration. 988. The diseases required by the New York State Department of Health to be reported are : Asiatic cholera, yellow fever, typhoid fever, typhus fever, smallpox, scarlet fever, measles, diphtheria, and membranous croup. In addition to the above diseases, the New York City Depart- ment of Health requires the reporting of chickenpox, membranous croup, spotted fever, relapsing fever, con- sumption, and malaria. 989. Describe (a) the care of the person in the tropics as to (b) clothing, (c) diet, (d) habits of life and (e) use of alcohol. Give reasons for conclusion. 989. (a) "Care of the Person. — The irritating effect of hot winds, which frequently carry fine particles of sand and dust, and the glare of the sun, which conduces to troubles with the eyes, should be guarded against. Not infrequently the ears, too, are affected injuriously by hot winds, but they are easily protected by external coverings or by cotton-wool plugs. The nose and lips are subject to cracking and luicomfortable dryness, which may be helped by cold cream or some similar application. The nails should be kept closely pared, since they become brittle and crack off. The skin, having a very important function to fulfil, should be kept thoroughly clean, if on no other account; but bathing in too cold water or for too long a time should be avoided. Parasites abound in tropical climates, and should be looked for on the person and removed with all care Diarrhoea and constipation are alike to be avoided. The former should 26 214 APPENDIX. be checked at once, and should on no account be allowed to continue without treatment Constipation should be avoided by the acquirement of a regular habit/' (b) ^^ Clothing. — One is advised to take plenty of light cotton, linen, and merino underwear, a generous assort- ment of trousers and coats of white duck or flannel, and light merino stockings. High boots, well oiled and with hob-nails, laced boots, leggings of cloth and leather, and light footwear for indoor and city use should be included. Light waterproof outer garments with cape and hood are recommended, and, for protection against the sun, white umbrellas lined with blue or green material, and spectacles with green or blue colored glasses. The head-covering should be selected with the double consideration of comfort and protection for the head and neck. A puggery affords additional protection If one is to do much riding, it is advised that as much care be expended in the selection of a saddle as in selecting boots, since comfort in horseback riding in the tropics is very largely dependent upon the fit of the saddle." (c) "Diet. — The question of diet in the tropics is a very serious one, for errors may be followed by disastrous results. Since prolonged heat exerts an unfavorable influence on digestion, this function should not be made to bear too heavy a burden, and it becomes necessary to restrict the diet in several particulars. No more food should be taken than can comfortably be digested, for both dysentery and diarrhoea are favored by the irritation caused in the intestines by food partially digested or undergoing fermentative processes. But the change from the accustomed diet should not be made with too great abruptness. The natives depend chiefly upon a vegetable diet, in which rice and beans and fruits of all kinds play prominent parts. Meat, if eaten at all, is taken usually in very small quantities. As a rule, in hot climates, it is not tender, for it cannot be hung days and weeks, as with us, to ripen, but must be cooked and eaten within a very few hours after slaughtering. Fish 215 APPENDIX. should not be used unless very fresh, and shell-fish of all kinds should be avoided. Fresh milk is ordinarily not to be had or, at least, is difficult to obtain. It speedily sours and becomes unfit to drink. Condensed milk of good quality is more to be depended upon. Vegetables should be thoroughly cooked, or they will seriously tax the digestive organs. Fruits should be perfectly ripe and sound; overripeness is quite as objectionable as greenness. Overindulgence in fruit, even of the best quality, and especially in the sour fruits, is particularly to be avoided. Tea, coffee, and chocolate are advised in moderation. Lime-juice with water or cold tea makes a most refreshing drink. Tamarinds in water are also most grateful.'' (d) " Hahits of Life. — All authorities agree in at least one particular, and that is, in urging moderation in all things — diet, drink, work, exercise, dress. The diet should be chosen with care, and iced drinks taken in great moderation, if at all. The ^clothing should be chosen with judgment both as to protection from the heat of the sun and against chilling of the body. Work should not be excessive, nor should it be performed in the sun during the hottest part of the day One should never go out with an empty stomach nor do work immediately after a meal. After dinner, a walk or some form of recreation until 10.30 or thereabouts, which is the proper time for retiring. One is advised strongly not to expose one's self to the cool external night air; to avoid cold bathing and cold drinks while perspiring, and especially to avoid standing for a long time in the shade in garments wet with perspi- ration. If one is compelled to be exposed to the sun for long, the protection afforded by umbrellas and colored spectacles against heat and glare should be sought. The consequences of exposure may be exceedingly severe or even fatal." (e) ''The Use of Alcohol in the Tropics. — Writers on tropical hygiene are almost unanimous in the opinion that, whatever may be said for and against the use of alcoholic drinks in other climates, their use in the 216 APPENDIX, tropics constitutes a distinct danger, and that much of disease commonly attributed to chmate is due actually to alcohol. Especially is this true of the various renal and hepatic troubles If alcohol in any form is desired, the light wines diluted with water are recom- mended more highly than beer. Spirits are generally condemned, but there appears to be no valid reason why, when very largely diluted with water or soda water, they should exert a more pernicious influence than wine only moderately extended. In any event, alcohol should be taken only with food." (Harrington's Practical Hygiene.) 990. What hygienic methods may he employed to prevent diphtheria? 990. See Q. 630 to 632. "V*