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the membrane then covering the glans, back to the corona. Make lateral incisions on each side around to the frenum. Stitch the skin to the mucous membrane edge in three or four points and apply carbolized vaselin dressing on cotton.

10. Describe convergent strabismus and give its surgical treatment.

Answer: Convergent strabismus is characterized by the excessive convergence of the visual lines but only in the binocular visual act; when the healthy eye is covered, the squinting eye may be made to move freely in every direction.

Surgical Treatment.-Division of the internal rectus muscle.

11. Give the technic of trephining. Answer: Scrupulous Asepsis.-Shave entire head, clean thoroly. Mark any desired land-mark on the surface with iodin. Before incision puncture scalp and so mark on the bone the desired point of operation. Incision is V shaped with base down to insure nutrition of the flap.

Stop Hemorrhage-Elevate the pericranium. Then central point of the trephine is fixed at one-sixteenth of an inch below the saw-edge and applied to the desired point. The motion is rotatory, to and fro till a groove is produced. The central pin is then withdrawn and the motion is continued until the bone is cut thru, with, however, frequent pauses to remove the dust and examine the depth of the groove with a probe.

12. Give the differential diagnosis of penetrating and non-penetrating wounds of the chest wall, with the prognosis and treatment of each.

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15. Differentially diagnose chancre, chancroid and herpes progenitalis.

Answer: Chancre is indurated, with rounded, smooth edges, and has a shining appearance, is single, is followed by constitutional symptoms; the period of incubation is three to five weeks.

Chancroid is soft, has ragged and sharp edges and secretes more pus; is situated only on the genitals. The incubation is under three days. It is not followed by constitutional symptoms. Herpes is often indistinguishable from chancroid, but may occur even without sexual connection. It yields promptly to cleaning and drying methods of treatment.

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aseptic precautions from fountain syringe and with large needle; in shock; acute inanition or depletion of the body by hemorrhage or in cholera or cholera infantum.

As rectal injection in same conditions, also in acute and chronic nephritis, or to cleanse the bowels in any local inflammatory condition or before a nutritive enema.

As detergent and cleansing wash in conjunctivitis and as neutralizing agent after silver nitrate application in similar cases. As cleansing solution in rhinitis, acute or chronic.

Sometimes as an emetic.

In surgery for irrigating cavities, operative field, etc.

2. State the causes of fatty infiltration of the liver.

Answer: Chronic poisoning from alcohol, phosphorus and arsenic.

Over-eating and lack of exercise. Phthisis and other wasting diseases. 3. State the composition and therapeutic uses of pulvis jalapæ compositus.

Answer: Jalap, 35 parts; potassium bitartrate, 65 parts.

As hydrogogue purgative; as in nephritis-uremia-dropsy from any cause.

Occasionally for severe constipation. 4. Give in detail the treatment of diphtheria.

Answer: All treatment is most efficacious when early applied.

General measures. Rest in bed and quiet, light, fresh air, isolated so far as possible.

Diet: Milk; fluid, e. g. beef juice and broth; semi-fluid, e. g. gruel; bread and milk. If necessary, gavage.

Steam in the room, with benzoin, creosote or carbolic acid added; best done by means of croup kettle.

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Answer: Prognosis is bad.

Treatment: Prophylaxis most important: viz., care in use of catheter, etc., and prompt treatment of cystitis.

Treatment of the nephritis is nephrotomy by exploratory incision unless sure diagnosis can be made by inspecting the bladder openings of the ureters. If pus cavity is found, drain and continue to treat the cystitis.

9. Mention the therapeutic uses of phenacetin.

Answer: Antipyretic. Has soothing ef fect. Analgesic as in neuralgia, sciatica, muscular pains, migrain and other headaches, and to some extent in locomotor ataxia. Local anodyne as in epithelioma; diminishes urine in polyuria.

10. Give the name of the alkaloid of calabar, and state its dose.

Answer: Physostigmine, called also eser

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The new law in Illinois requires that applicants for examination by the State Board of Medical Examiners be graduates from reputable medical colleges. The old law permitted nongraduates to apply for examination, and the last

examination under the old law will be held at the Great Northern Hotel, Chicago, June 21,22,23 and 24, '99. The examination will be in the following branches: Anatomy, physiology, chemistry, materia medica, pathology and bacteriology, surgery, theory and practice of medicine, obstetrics, gynecology, hygiene and medical jurisprudence. The fee for this examination is $20.00, which is returned if the applicant fails. The first examination under the new law will probably be held July 26th to 20th. Prospective applicants should write for details to J. A. Egan, M. D., Sec. Board of Health, Springfield, Ills.

Ulcers of the Tongue.

Avoid the use of caustics and all irritants in the treatment of chronic ulcers of the tongue. Such ulcers are usually malignant, tubercular or syphilitic. A trial treatment with anti-syphilitic remedies may prove both encouraging and deceptive from the fact that it is not uncom. mon for carcinomata and sarcomata to make some temporary improvement under the influence of mercury and iodides. The differential diagnosis is sometimes difficult to make, especially so, without micro

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Choice of Purgatives.

Steinbach (Deutsche Medicinal-Zeitung, Med. Review of in his subject, gives the following advice in his subject, gives the following advice in selecting purgatives for individnal cases:

1. When we wish to promote absorption of nutriment and peristalsis by one and the same remedy, we usually select mineral waters of the sodium-chlorid group, because they themselves are absorbed by the small intestine, and hence promote absorption in general, while also stimulating peristalsis. According to Pfaff, ox-gall has the same property.

2. If we do not wish absorption, but simply desire watery stools to flush out the colon, we employ salts of the sodium sulfate type, especially Epsom salts.

3. If we wish to stimulate peristalsis in the colon, with a view of producing plastic stools of a pultaceous consistence, we use rhubarb, senna, aloes, cascara, etc. Hegar's high-flushing of the colon has the

same effect.

4. In many cases the foregoing indications may be combined.-Med. Standard.

WORLD one year and Dr. Waugh's book, $5. You need them both.

Fever From Coitus During the Puerperium. In a recent issue of Woman's Medical Journal, Dr. F. H. Lee reports a case of this character. The case referred to was a V-para, in whom each confinement had been followed by chills and fever about the fifth day. In the confinement for which Dr. Lee attended the patient the temperature and pulse were normal until the fifth day, when the patient began having chills in the morning. The temperature was 103.5°, the expression anxious, the abdomen slightly distended and tender, and the patient complained of headache. On inquiry it was ascertained that the patient had had coitus on the night of the third and the morning and night of the fourth day-thrice in thirty-six hours. Interdiction of coitus reduced the temperature, and the patient made a good recovery On inthirteen days after confinement. quiry it was ascertained that coitus had been indulged in on the third and fourth days after each confinement, the chills and fever following.-Med. Standard.

The Coated Tongue.

The fur on the dorsum of the tongue consists of epithelial cells, detatcht papillæ, considerable granular matter, organic and inorganic, all of which is kept in a state of fermentation by schizomycetous fungi. Millions of these micro-organisms may be found in a small particle of the coating. These fungi consist of micrococci, sarcina, bacteria, spirilla, innocent or infectious, if an infectious disease exists in proximity. If one member of a family has tuberculous consumption, tuof the tongues of the other members. The bercle bacilli may be found in the coating micro-organisms thus found growing on stomach at every meal; thence are carried the tongue are constantly washt into the In this manner the blood may be supplied into the blood, probably thru the lacteals. with so many germs that infection sooner or later takes place.

From a clinical standpoint this coating. plays still another rôle, and should be lookt upon as a comparative index to the purity or impurity of the blood. To say dition of the stomach, or is simply of such that it indicates or depends upon the conand such a character in certain diseases, means nothing but the statement of a coincidence.

When the urine stands for a time in an unclean vessel, the solids, including both

organic and inorganic constituents, are precipitated. The larger the amount of waste matter drawn from the blood and the denser the urine, the greater will be the amount of the precipitate. The same changes occur in all the other fluids, excretions and secretions of the body when their temperature and normal conditions vary.

The salivary secretion is composed of certain normal constituents. Besides these normal constituents, which vary within certain limits, there are undoubtedly some abnormal elements which are carried out thru the glands from the blood when it is surcharged with impurities. Now, when this abnormal saliva is thrown into the mouth and subjected to the action of the numerous micro-organisms of fermentation, more or less of the solid matters are thrown down and constitute a salivary precipitate, which lodges on the teeth and on the dorsum of the tongue, also on the gums and lips, which, in cases of typhoid fever, is known as sordes. This salivary precipitate can be recognized on the teeth, as it roughens their surface. It is easily removed by the use of the toothbrush. It covers the teeth as a whitish deposit which microscopically shows the different forms of micrococci and bacilli. Upon the tongue

it is allowed to remain until it becomes

occurs.

very offensive, unless it is systematically removed by scraping. It undergoes fermentation very readily, and is usually of the same character, consequently communicating an odor to the breath which is recognized as being the same whenever it In Bright's disease, in diabetes, and in almost any disease in which the nutrition and excretory organs are disordered, the coating becomes very foul, and the fouler the tongue the more serious the condition of the patient, the more sluggish his excretory organs, and the more heavily loaded his blood is with toxins. In some diseases the odor of the breath, as well as the color and character of the coating, is peculiar to the disease, depending upon the peculiar form of toxins with which the blood is charged.

Besides the systemic germ infection, it is a question if the highly offensive odor, noticeable in any case in which the tongue is heavily coated, has not also a considerably depressant effect on the nervous system, if not on the nutrition, acting much like a gaseous poison, as all the inspired air is laden with it as well as the expired

air.

It has been my custom, when consulted regarding a foul breath or coated tongue, to advise the patient to procure a tongue scraper and diligently clean the tongue every morning as a part of the morning toilet, using after it a disinfectant mouth wash on the tongue and as a dentifrice. This method will remove the foulest odors from the breath. The same deposit appears on the tongue every morning and must be removed as often.

Every surgeon who has a coated tongue and wishes to be aseptic should look to this possible source of infection, for in coughing, sneezing, or even speaking, it is known that the breath takes with it particles of moisture from the mouth and throat. And every patient who is to have an operation about the mouth or throat should have his tongue cleaned and disinfected. Every fever patient should have his tongue systematically cleaned to remove just that much self-infection. And every person who wishes to be agreeable in the society of others should remove the foul coating on the tongue and with it the offensive odor of the breath.-Dr. W. H. Weaver, of Chicago, in N. Y. Med. Jour.

Patients who struggle violently while being anesthetized should receive extra care and attention. They are said to represent a large percentage of those who

succumb while under the influence of an anesthetic.-Penna. Med. Jour.

Tobacco Rendered Harmless.

Rather more than a year ago Dr. Hugo Gerold, of Halle, received a United States patent for a process of treating tobacco by which the nicotin_contained in it is rendered insoluble. Tannic acid is the agent which produces insolubility of the nicotin, and that substance had been used for the purpose before, but from the commercial point of view it was not free from objection; if too little of it was used the desired object was not attained, while if too much was employed the product was spoiled, for it became very brittle and of deteriorated appearance, flavor and smell. These objections Dr. Gerold has overcome by the associated use of oil of origanum. We learn that cigars made from tobacco treated by the Gerold process are soon to be put on the market.-N. Y. Med. Jour.

Dr. D. W. Vowles, of Fowler, Ills., writes: "You publish one of the most instructive magazines in the world. The enclosed $1 is merely nominal pay for its inestimable value."

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