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the membrane then covering the glans, The prognosis here is much more grave, back to the corona. Make lateral incisions but depends upon the extent of the injury on each side around to the frenum. Stitch and upon the presence or absence of wound the skin to the mucous membrane edge in of the lung. Treatment consists in general three or four points and apply carbolized treatment of shock, with rest, warmth, vaselin dressing on cotton.
stimulation, etc., and local cleanliness 10. Describe convergent strabismus and without disturbance of the wound unless give its surgical treatment.
for some definite indication. Answer : Convergent strabismus is char- 13. Mention the varieties of hip-joint acterized by the excessive convergence of dislocation, and describe in detail two of the visual lines but only in the binocular these varieties. visual act; when the healthy eye is cov- Answer: Dorsal, thyroid and suprapubic. ered, the squinting eye may be made to In the dorsal dislocation the head of the move freely in every direction.
femur lies on the dorsum of the ilium or Surgical Treatment.-Division of the in- lower down just posterior to the acetabuternal rectus muscle.
lum. It points backward. The limb is 11. Give the technic of trephining. rotated inward, flexed and adducted. It
Answer : Scrupulous A sepsis.-Shave en- is also shortened. tire head, clean thoroly. Mark any desired In thyroid dislocation the head is in the land-mark on the surface with iodin. Be- thyroid foramen. The limb is rotated fore incision puncture scalp and so mark slightly outward, adducted and flexed. on the bone the desired point of operation. There is some lengthening. Incision is V shaped with base down to in- 14. Give the diagnosis and treatment of sure nutrition of the flap.
aneurism of the femoral artery. Stop Hemorrhage-Elevate the peri- Answer : Diagnosis by the expansile pulcranium. Then central point of the tre sation, the bruit, the attachment of the phine is fixed at one-sixteenth of an inch tumor to the artery; the size of the tumor below the saw-edge and applied to the de- varies with pressure on the proximal or sired point. The motion is rotatory, to distal artery. and fro till a groove is produced. The Treatment.—The artery may be tied central pin is then withdrawn and the mo- above the tumor or below the tumor or tion is continued until the bone is cut thru, both, the blood supply being re-establisht with, however, frequent pauses to remove by anastomosing branches. the dust and examine the depth of the 15. Differentially diagnose chancre, groove with a probe.
chancroid and herpes progenitalis. 12, Give the differential diagnosis of Answer: Chancre is indurated, with penetrating and non-penetrating wounds rounded, smooth edges, and has a shining of the chest wall, with the prognosis and appearance, is single, is followed by contreatment of each.
stitutional symptoms; the period of incuAnswer : In non-penetrating wounds of bation is three to five weeks. the chest wall the shock to the patient is Chancroid is soft, has ragged and sharp comparatively slight. The extent of the edges and secretes more pus; is situated wound and character of the injuring only on the genitals. The incubation is weapons aid much in the diagnosis. The under three days. It is not followed by prognosis is good, the chief dangers being constitutional symptoms. Herpes is often inflammation of a large hematoma, and indistinguishable from chancroid, but may from possible rupture of the pleura by im- occur even without sexual connection. It proper probing of the wound.
yields promptly to cleaning and drying The treatment is simply antiseptic pre methods of treatment. cautions, closing the wound and dressing. Penetrating wounds may or may not in
QUESTIONS IN THERAPEUTICS, PRACTICE AND jure the lung. If not the diagnosis may
MATERIA MEDICA. not be made unless the wound is large. If
Questions prepared by the Board of Examiners representing large the wound may allow hernia of the the Medical Society of the State of New York. lung; pneumothorax or emphysema of the 1. Describe the therapeutic uses of sochest wall may result. If the wound dium chlorid. penetrates the lung, hemorrhage into the Answer: Usually used in “ normal solubronchi with consequent bloody sputum, tion,” i. e., Zi to the pint. or hemothorax will make the diagnosis As injection-either intravenous or more clear; the escape of air is a valuable sign. commonly subcutaneous - under strict
aseptic precautions from fountain syringe whisky or brandy, in small repeated doses, , and with large needle; in shock; acute diluted. Strychnin may be used, also inanition or depletion of the body by hem- digitalis. orrhage or in cholera or cholera infantum. 5. What is the physiologic action of
As rectal injection in same conditions, camphor in medicinal doses on (a) the skin, also in acute and chronic nephritis, or to (b) the circulation ? cleanse the bowels in any local inflamma- Answer: Camphor. On the skin; externally tory condition or before a nutritive enema. a direct stimulant, dilating the vessels,
As detergent and cleansing wash in con- causing warm sensation, followed by slight junctivitis and as neutralizing agent after degree of anesthesia. Internally, mildly silver nitrate application in similar cases. diaphoretic thru the central nervous sys
As cleansing solution in rhinitis, acute tem, or chronic.
On the circulation: Leucocytes are said Sometimes as an emetic.
to be increast in the blood. Heart is In surgery for irrigating cavities, opera- stimulated directly as well as reflexly from tive field, etc.
the stomach, 2. State the causes of fatty infiltration 6. Describe the forms of chronic ergotof the liver.
ism. Answer : Chronic poisoning from alcohol, Answer: First: Anesthesia and convul. phosphorus and arsenic.
sions; itching, tingling, formieation fol. Over-eating and lack of exercise.
lowed by numbness and local anesthesia Phthisis and other wasting diseases. gradually spreading from hands and feet
3. State the composition and therapeutic over whole body. Tonic contraction of uses of pulvis jalapæ compositus.
various muscles, muscular weakness. Answer: Jalap, 35 parts; potassium bi- Later diminisht sensation, vomiting, tartrate, 65 parts.
diarrhea. Death from respiratory spasm As hydrogogue purgative; as in nephri- or paralysis. tis-uremia-dropsy from any cause.
Second : Gangrene of extremities, of Occasionally for severe constipation. nose, cheeks, etc., due to prolonged con
4. Give in detail the treatment of diph- traction of arteries. theria.
7. In what pathologic conditions is veraAnswer: All treatment is most efficacious trum virid useful? when early applied.
Answer: Puerperal eclampsia. General measures. Rest in bed and The sthenic condition, as in early stages quiet, light, fresh air, isolated so far as of pneumonia. possible.
Cardiac hypertrophy with over-action. Diet: Milk ; fluid, e. g. beef juice and 8. What is the prognosis of suppurative broth ; semi-fluid, e. g. gruel ; bread and nephritis secondary to cystitis? Outline milk. If necessary, gavage.
the treatment of this condition. Steam in the room, with benzoin, creo- Answer: Prognosis is bad. sote or carbolic acid added ; best done by Treatment: Prophylaxis most impormeans of croup kettle.
tant: viz., care in use of catheter, etc., Local treatment: Irrigation
and prompt treatment of cystitis. and throat every two hours by means of Treatment of the nephritis is nephrotomy soft rubber ball syringe, or fountain syr. by exploratory incision unless sure diaginge, thru the nostrils. Best solutions are nosis can be made by inspecting the bladwarm boric acid, saturated solution, warm der openings of the ureters. If pus cavity normal salt, or bichlorid of mercury is found, drain and continue to treat the 1.10,000.
cystitis. In laryngeal obstruction threatening 9. Mention the therapeutic uses of phesuffocation-intubation or tracheotomy. nacetin.
Systemic treatment. Subcutaneous in- Answer: Antipyretic. Has soothing efjection of diphtheria antitoxin, with aseptic fect. Analgesic as in neuralgia, sciatica, precautions, and within three days of the muscular pains, migrain and other headonset of disease. Dose, under two years of aches, and to some extent in locomotor age, 600 to 1000 units, according to se- ataxia. Local anodyne as in epithelioma; verity. Over two years, 1000 to 2000 or diminishes urine in polyuria. even 3000 units. The antitoxin repeated in 10. Give the name of the alkaloid of 12 to 24 hours, once or twice if necessary. calabar, and state its dose.
Stimulants if necessary; best alcohol, Answer: Physostigmine, called also eserine; gr. 1-100 to 1-60 of sulphate or sali- 4. What are tube.casts? How are they cylate.
recognized and what is their clinical sig. 11. Give the etiology and treatment of nificance ? tubercular peritonitis.
5. How do the diphtheritic exudates Answer: May be primary or secondary differ from simple catarrhal exudates?
If secondary, the other lesions may be 6. What structural changes take place in the pleura or pericardium, or in the in- in cirrhois of the liver ? testine or retroperitoneal glands, in the 7. Through what avenues de bacteria female genital organs, or in more distant enter the system and how are they elimiparts, lungs, etc. The peritoneal inflam- nated ? mation may be part of a general miliary 8. What secondary changes take place tuberculosis.
in the heart in chronic mitral regurgitaTreatment: Surgical ; peritoneal cavity tion ? freely opened, effusion evacuated, cavity 9. What aids to diagnosis are utilized irrigated with normal salt solution, and in the treatment of persons affected with wound closed with or without drainage as stomach lesions ? indicated.
10. What causes general anemia? Make General treatment; hygienic, tonic, stim- a diagnosis of general anemia. ulating and symptomatic.
11. Mention and differentiate the species 12. Mention the salts of lithium and de- of taenia. scribe their medicinal uses.
12. Give the normal boundaries of the Answer: Lithii carbonas; citras, citras liver. effervescence; solvents of uric acid, diuretic, 13. What are the characteristic lesions and render urine alkaline. Useful in goutof typhoid fever? Give pulse and temgravel and calculus. The bromid, of simi- perature chart. lar use as the other bromids for quieting 14. Differentiate varicella from variola. the nervous system. The benzoate and 15. Make a diagnosis of renal colic by salicylate, little used.
exclusion. 13. What are the therapeutic uses of [Answers will appear in next WoRLI).] lobelia ? Answer: Lobelia, to relax the muscular
The new law in Illinois requires that applispasm in bronchi in asthma.
cants for examination by the State Board of In laryngeal spasm of neurotic origin. Medical Examiners be graduates from reputable In bronchitis with spasmodic dyspnea. medical colleges. The old law permitted pon14. Give the prophylactic treatment of graduates to apply for examination, and the last
examination under the old law will be held at the gout.
Great Northern Hotel, Chicago, June 21,22,23 and Answer: Diet: Restrict albuminoid mat
24, '99. The examination will be in the following ters, as meat, fowl, game and cheese. In- branches : Anatomy, physiology, chemistry, macrease vegetables, bread, rice, etc.
teria medica, pathology and bacteriology, surAbstinence from alcoholic drinks. gery, theory and practice of medicine, obstetrics, Restrict the use of sodium chlorid, sub
gynecology, hygiene and medical jurisprudence.
The fee for this examination is $20.00, which is stituting potassium chlorid.
returned if the applicant fails. The first exitin Medicinal: Alkaline carbonates, sali
nation under the new law will probably be held cylates, lithia salts.
July 26th to 25th. Prospective applicants should In general : No excess in diet, drink or write for details to J. A. Egan, M. D., sec. work.
Byard of Health, Springfield, Ills.
Ulcers of the Tongue. 15. Mention the official preparations of Avoid the use of caustics and all irricopper. Give the dose of each.
tants in the treatment of chronic ulcers Answer: Capri sulphas, gr. to gr. 5. of the tongue. Such ulcers are usually Cupri acetas, external use.
malignant, tubercular or syphilitic.
trial treatment with antisyphilitic remeQUESTIONS IN PATHOLOGY AND DIAGNOSIS,
dies may prove both encouraging and de1. Describe the process of bone repair. ceptive from the fact that it is not uncom.
2. Describe the process and terminations mon for carcinomata and sarcomata to of simple inflammation. What is productire make some temporary improvement under inflammation
the influence of mercury and iodides. The 3. What degenerative changes take place differential diagnosis is sometimes difficult n arteries?
to make, especially so, without micro
scopic examination, but when made active, Fever From Coitus During the Puerperium, treatment should begin at once. A cancer In a recent issue of Woman's Medical must be excised wide of all suspected tis- Journal, Dr. F. H. Lee reports a case of sue and all enlarged tributary glands be this character. The case referred to was removed. Actual cautery is necessarily a V.para, in whom each confinement had limited to the primary sore, and conse- been followed by chills and fever about quently is insufficient. " Radical treat- the fifth day. In the confinement for ment or no treatment" is a dictum em
which Dr. Lee attended the patient the phasized by all experience. Lupus of the temperature and pulse were normal until tongue should be thoroly curetted under
the fifth day, when the patient began hav. local anesthesia, the base of the ulcer ing chills in the morning. The temperaseared with Paquelins or electro cautery ture was 103.5°, the expression anxious, and then be painted every day for a week the abdomen slightly distended and tender, with tincture of iodin. If the ulcer be
If the ulcer be and the patient complained of headache. specific, it will gracefully yield to the On inquiry it was ascertained that the mercuric and iodidic persuasion.-Med. patient had had coitus on the night of the and Sarg. Monitor.
third and the morning and night of the
fourth day-thrice in thirty-six hours. InBaldness.
terdiction of coitus reduced the tempera
ture, and the patient made a good recovery Yes, I have been getting more and more
On inbald every year and the only thing I have
thirteen days after confinement. not tried is the following, which is said to quiry it was ascertained that coitus had be good :
been indulged in on the third and fourth
days after each confinement, the chills B
and fever following.-Med. Standard. Hydrochloric acid
75 drops Alcohol .
2,250 drops M.
The Coated Tongue. Rub the hairy scalp every night with this The fur on the dorsum of the tongue liquid.-Dr. I. N. Love.
consists of epithelial cells, detatcht papil
læ, considerable granular matter, organic Choice of Purgatives.
and inorganic, all of which is kept in a
state of fermentation by schizomycetous Steinbach (Deutsche Medicinal-Zeitung, fungi. Millions of these micro-organisms Med. Review of Reviews), in introducing his subject, gives the following advice in coating. These fungi consist of micro
may be found in a small particle of the selecting purgatives for individnal cases : 1. When we wish to promote absorption
cocci, sarcinæ, bacteria, spirilla, innocent
or infectious, if an infectious disease ex. of nutriment and peristalsis by one and
ists in proximity. If one member of a the same remedy, we usually select min- family has tuberculous consumption, tueral waters of the sodium-chlorid group, bercle bacilli may be found in the coating because they themselves are absorbed by the small intestine, and hence promote micro-organisms thus found growing on
of the tongues of the other members. The absorption in general, while also stimulating peristalsis. According to Pfaff, ox.gall stomach at every meal; thence are carried
the tongue are constantly washt into the has the same property.
into the blood, probably thru the lacteals. 2. If we do not wish absorption, but
In this manner the blood may be supplied simply desire watery stools to flush out
with so many germs that infection sooner the colon, we employ salts of the sodium
or later takes place. sulfate type, especially Epsom salts.
From a clinical standpoint this coating 3. If we wish to stimulate peristalsis in the colon, with a view of producing plastic fookt upon as a comparative index to the
plays still another rôle, and should be stools of a pultaceous consistence, we use
purity or impurity of the blood. To say rhubarb, senna, aloes, cascara, etc.
that it indicates or depends upon the conHegar's high-flushing of the colon has the
dition of the stomach, or is simply of such same effect.
and such a character in certain diseases, 4. In many cases the foregoing indica
means nothing but the statement of a cointions may be combined.-Med. Standard.
When the urine stands for a time in an WORLD one year and Dr. Waugh's book, $5. You need them
unclean vessel, the solids, including both
organic and inorganic constituents, are It has been my custom, when consulted precipitated. The larger the amount of regarding a foul breath or coated tongue, waste matter drawn from the blood and to advise the patient to procure a tongue the denser the urine, the greater will be scraper and diligently clean the tongue the amount of the precipitate. The every morning as a part of the morning same changes occur in all the other fluids, toilet, using after it a disinfectant mouth excretions and secretions of the body when wash on the tongue and as a dentifrice. their temperature and normal conditions This method will remove the foulest odors vary
from the breath. The same deposit apThe salivary secretion is composed of pears on the tongue every morning and certain normal constituents. Besides these must be removed as often. normal constituents, which vary within Every surgeon who has a coated tongue certain limits, there are undoubtedly some and wishes to be aseptic should look to abnormal elements which are carried out this possible source of infection, for in thru the glands from the blood when it is coughing, sneezing, or even speaking, it is surcharged with impurities. Now, when known that the breath takes with it partithis abnormal saliva is thrown into the cles of moisture from the mouth and throat. mouth and subjected to the action of the And every patient who is to have an oper. numerous micro-organisms of fermenta- ation about the mouth or throat should tion, more or less of the solid matters are have his tongue cleaned and disinfected. thrown down and constitute a salivary Every fever patient should have his tongue precipitate, which lodges on the teeth and systematically cleaned to remove just that on the dorsum of the tongue, also on the much self-infection, And every person gums and lips, which, in cases of typhoid who wishes to be agreeable in the society fever, is known as sordes. This salivary of others should remove the foul coating precipitate can be recognized on the teeth, on the tongue and with it the offensive as it roughens their surface. It is easily odor of the breath. - Dr. W. H. Weaver, removed by the use of the toothbrush. It of Chicago, in N. Y. Med. Jour. covers the teeth as a whitish deposit which microscopically shows the different forms
Patients who struggle violently while of micrococci and bacilli. Upon the tongue being anesthetized should receive extra it is allowed to remain until it becomes
care and attention. They are said to repvery offensive, unless it is systematically resent a large percentage of those who removed by scraping. It undergoes fer
succumb while under the influence of an mentation very readily, and is usually of anesthetic.Penna. Med. Jour. the same character, consequently como municating an odor to the breath which is recognized as being the same whenever it
Tobacco Rendered Harmless. occurs. In Bright's disease, in diabetes, Rather more than a year ago Dr. Hugo and in almost any disease in which the
Gerold, of Halle, received a United States nutrition and excretory organs are dis
patent for a process of treating tobacco by ordered, the coating becomes very foul,
which the nicotin contained in it is renand the fouler the tongue the more serious
dered insoluble. Tannic acid is the agent the condition of the patient, the more
which produces insolubility of the nicotin, sluggish his excretory organs, and the and that substance had been used for the more heavily loaded his blood is with tox- purpose before, but from the commercial ins. In some diseases the odor of the point of view it was not free from objeebreath, as well as the color and character tion ; if too little of it was used the desired of the coating, is peculiar to the disease, object was not attained, while if too much depending upon the peculiar form of tox- was employed the product was spoiled, for ins with which the blood is charged.
it became very brittle and of deteriorated Besides the systemic germ infection, it appearance, flavor and smell. These obis a question if the highly offensive odor, jections Dr. Gerold has overcome by the noticeable in any case in which the tongue associated use of oil of origanum. We is heavily coated, has not also a consider- learn that cigars made from tobacco ably depressant effect on the nervous sys
treated by the Gerold process are soon to tem, if not on the nutrition, acting much
be put on the market.-N. Y. Med. Jour. like a gaseous poison, as all the inspired air is laden with it as well as the expired Dr. D. W. Vowles, of Fowler, Ills., writes: "You publish one air.
of the most instructive magazines in the world. The enclosed $1 is merely nominal pay for its inestimable value."