Class _B_CJl_S_ Book — CopyrigM COWKIGHT DEPOSED State Board Examination Questions and Answers Reprinted from the MEDICAL RECORD $2.00 net WILLIAM WOOD & COMPANY NEW YORK America's leading medical weekly. Portrays world's progress in medicine and surgery. MEDICAL RECORD Weekly Journal of Medicine and Surgery Price, $5.00 a Year. Single Copies, 10 cts. Started in 1866, the Medical Record has for forty years held the first place among medical weeklies in America. Impartial, judicial, and scientific, its sin- gle aim has been to furnish to the Medical Profes- sion an independent, enterprising, and progressive medical newspaper conserving the best interests of the profession. The Medical Record believes that the proper scope of a medical newspaper is all that concerns the Science and Practice of Medicine and Surgery, and all that concerns the Physician and Surgeon. It is conducted on the broadest lines, sparing no expense in the employment of its Editorial Staff, in collecting news, in maintaining correspondents in various parts of the world, and in securing exclusive reports of meetings by cable and telegraph. The Medical Record is independent of the control of any group of individuals or of any personal policy. It is controlled by the best judgment that long ex- perience of the needs of the better class of American physicians can give. Such experience teaches that the enlightened sentiment of the Profession is the only safe guide in this respect. Copyright, 1907, by William Wood & Company STATE BOARD EXAMINATION QUESTIONS AND ANSWERS OF TWENTY-THREE STATES REPRINTED FROM THE MEDICAL RECORD FROM THE ISSUES OF THE PAST ELEVEN MONTHS A VALUABLE GUIDE TO THE MEDICAL STUDENT, GIVING AC CURATE ANSWERS THAT WILL PROVE HELPFUL IN PASSING STATE BOARD EXAMINATIONS Price, $2.00 net WILLIAM WOOD & COMPANY NEW YORK LIBRA-. 1 of CONGRESS 1 MO U uusef Received OCT 80 ISO? Copyright Entry Oc4> -3o, >9<*7 CLASS (X- XAc, No, COPY ft' CONTENTS. Pages Questions Answer? Arkansas 3 6 Delaware 7 I2 Florida 21 24 Georgia 29 31 Idaho 34 40 Illinois 52 57 Indiana 62 °7 Kansas 76 80 Michigan 88 92 Minnesota 103 107 Nebraska "5 II( ? Nevada 125 128 New York 139 144 North Carolina 153 156 Ohio 166 169 Oklahoma 1/9 183 Pennsylvania x 94 J 98 South Dakota 205 209 Texas 219 225 Vermont 233 237 Virginia 245 250 Washington 258 263 West Virginia 276 280 Requirements for Medical Licensure.. 292 Bulletin of Approaching Examinations. ' 292 Copyright, 1907, by William Wood & Company MEDICAL RECORD. " The progressive physician must have his medical weekly just as the business man his newspaper." State Ufcitral Sttwtmtuj Uttarfts. STATE BOARD EXAMINATION QUESTIONS.* Arkansas State Board of Medical Examiners. July 10, 1906. ANATOMY. i. At what time- in the development of the fetus is the hair formed? 2. Give the general classification of bones. 3. Name the bones of the upper extremity. 4. Describe the diaphragm, giving origin, insertion, nerve supply, and action. 5. Name the superficial group of the muscles of the abdomen. 6. Name the openings of the heart. 7. Name the branches of the anterior tibial artery. 8. Describe the pia-mater. 9. Describe the uterus. 10. Describe the gall-bladder. PHYSIOLOGY. 1. Name and describe the glands of the intestines and tell in which portion of the intestine each kind is situated. 2. Describe the glycogenic function of the liver and tell the destination of glycogen. •It is proposed in this department to publish from time to time the examination papers of the various State Boards, in order that a candidate may become familiar with the character of the examination and so in some measure free himself in advance from the nervousness and dread which the unknown inspires. In furtherance of the same object answers to some of the questions will be published in order to show the candidate what the examiners expect of him. Not all the questions of all the papers will be so treated, for the answers to many, especially in the anatomical papers, are obvious or can be found in the index of any textbook on the subject; the answers to other questions, especially in the surgical papers, must sometimes be omitted because of the space they would demand. The candidate for a medical license will not find in these answers a short and easy road to success in the examination, for he is not likely to meet the same questions in the papers placed before him by the examiners. The object of publishing the questions and answers is only, as noted above, to acquaint the candidate with the general character of these examinations and to inspire hirn with confidence in the result of his trial MEDICAL RECORD. "Acknowledged to be the leading independent medical weekly." 3. Give origin, distribution, and function of the fifth pair of cranial nerves. 4. (a) How is the nervous system arranged anatomi- cally? (b) Give a short sketch of each system. 5. How many pairs of spinal nerves are there? De- scribe them. CHEMISTRY. 1. What is albumin? 2. In what form in nature do we find albumin in its purest form? 3. In what case of poisoning do we use albumin as an antidote? 4. Name a metallic poison for which albumin is espe- cially recommended. 5. What is meant by toxicology? 6. What causes the decay of animal or vegetable matter when deprived of life? 7. What is meant by ptomain poison? 8. What is the origin of ptomain poison, or, in other words, how and from what are ptomains derived? 9. When the atmosphere we live in becomes charged with an excess of carbonic acid, how is it purified and made fit for the support of animal life? MATERIA MEDICA AND THERAPEUTICS. 1. What is an alkaloid, a tincture, a fluid extract? 2. Name four different classes of medicine, with an ex- ample of each class. Give dose of example. 3. What drugs would you use hypodermatically to meet the following requirements? (9.) To stimulate the heart's action ; (b) to produce emesis ; (c) to control hemorrhage. 4. What is the strength of normal salt solution? Give indications for its use and mode of administration. 5. Give principal alkaloid of belladonna and indications for its use; also dose. 6. Name the three (3) most used preparations of opium, and how much of each contains one grain of opium. 7. Give hypodermatic dose of the following: Sulphate of strychnine, sulphate of atropine, sulphate of morphine, apomorphin, hydrochlorate, nitroglycerin, and pilocarpine hydrochlorate. 8. Write a complete prescription for a diuretic contain- ing not less than three ingredients. MEDICAL RECORD. " Original Articles are of the highest scientific value and most practical character, by the foremost men of the world." 9. How are the cathartic effects produced by salines? 10. How is nitrite of amyl used, and for what purpose? PRACTICE. 1. Differentiate between acute alcoholism and apoplexy. 2. Give etiology, physical signs, and treatment of peri- carditis. 3. Give physical signs of acute lobar pneumonia. 4. Give etiology, diagnosis, and treatment of biliary colic. 5. What are the two common complications of typhoid fever during the second or third week? and give treat- ment. 6. Describe a case of acute catarrhal dysentery and give treatment. 7. Give etiology, diagnosis, and treatment of gon- orrhea. 8. Give diagnosis and treatment of acute articular rheu- matism. 9. Give etiology, morbid anatomy, period of measles in- cubation, common complications and their treatment. 10. Describe three stages of malarial paroxysm and give treatment in each stage. SURGERY. 1. Describe symptoms and operation for gallstones. 2. Through what would you pass, in the open method of operating for hydrocele? 3. What are the contraindications for hemorrhoidal operation? 4. How would you differentiate between gallstones, gas- tric ulcer, and appendicitis? 5. Give surgical treatment for Bright's disease. OBSTETRICS. 1. Describe the Fallopian tubes. 2. Describe the placenta and give its functions. 3. Give differential diagnosis of pregnancy from ovar- ian cystoma. 4. Give treatment for threatened abortion. 5. Write prescription for vaginitis. 6. Give treatment for placenta praevia. 7. What are the indications for vaginal tamponing? 8. Give method of performing cephalic version. g. Give treatment of uterine inertia. 10. Give management of normal labor. 5 MEDICAL RECORD. " Editorials on subjects of timely interest and of vital im- portance dealt with in a masterly and scholarly style." ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Arkansas State Board of Medical Examiners. July 10, 1906. ANATOMY. 1. Hair begins to develop at about the third month of fetal life. PHYSIOLOGY. 1. Lieberkuhn's glands are found throughout the small and large intestine; Brunner's glands are found in the duodenum; the solitary glands are found throughout the entire intestine, but are most abundant in the lower part of the ileum and the upper part of the large intestine ; Peyer's patches are found in the lower two-thirds of the small intestine, chiefly in the ileum. 2. The destination of elycoRen : It is converted into sugar (dextrose), is given off to the blood, and is finally oxidized in the tissues. CHEMISTRY. 1 Albumin is a protein substance, found in most ani- mal tissues and consisting of carbon, hydrogen, oxygen, nitrogen, and sulphur. It is soluble in pure water, and is coagulated by heat. 2. In the white of hen's egg. . 3. and 4. In mercurial poisoning (by corrosive sub- limated, also in poisoning by nitrate of silver. 5. By toxicology is meant that branch of medical science which appertains to poisons ; it includes their char- acter, origin, actions, symptoms produced, antidotes, treat ment. and detection. 6. The process of slow oxidation. 7. By ptomain poison is meant the poisonous products of putrefaction of dead animal tissues and fluids. 8. Ptomains are derived from dead animal matter. o. By the action of plants: the chlorophyl of which, under the influence of sunlight, decomposes the CO? into C and O2. The plants retain the carbon in organic combina- tion, and return the oxygen to the air. MATERIA MEDICA AND THERAPEUTICS. i. An alkaloid is an organic, nitrogenized substance, alkaline in reaction, and capable of combining with acids 6 MEDICAL RECORD. " European correspondents furnish medical news of special interest and reports of tlie principal foreign medical societies." to form salts in the same way that ammonia does. A tincture is an alcoholic solution of a nonvolatile substance. A fluid extract is a permanent solution of a vegetable drug, in which one cubic centimeter of the solution represents one gram of the drug. 2. (i) Emetics, as tartar emetic, dose one to two grains; (2) diuretics, as potassium acetate, dose five to sixty grains; (3) hypnotics, as chloral hydrate, dose five to twenty grains; (4) mydriatics, as atropine sulphate, dose one one-hundred-and-twentieth to one-twentieth of a grain. 3. To stimulate the heart's action, strychnine; to pro- duce emesis, apomorphine; to control hemorrhage, ergot. 6. Pulvis ipecacuanha? et opii, ten grains; tinctura opii, about ten minims; tincture opii camphorata, about half an ounce. ; , .\ 8. R- Potassii acetatis Potassii bitartratis Potassii citratis a a 5ij Aquae destillatse q.s ad oviij. Misce. Signa: One tablespoonful three times a day, in half a glass of water. 9. Salines cause a great increase in the amount of fluid secreted by the intestinal glands; they also hinder the re- absorption of this fluid. The result is an accumulation of fluid in the intestine, which, by distention, excites peri- stalsis. 2. Skin, dartos, intercolumnar fascia, cremasteric fascia, infundibuliform fascia, and the parietal layer of the tunica vaginalis. OBSTETRICS. 7. For controlling hemorrhage, either vaginal or uterine ; to exert pressure; to support the uterus; as a means of applying medication locally; and for depleting inflamma- tory conditions. STATE BOARD EXAMINATION QUESTIONS. Delaware State Medical Society Examining Board. December II, 12 and 13, 1906. therapeutics. I. What analogy exists between the nutrition of health, the disturbances of disease, and the action of remedies? MEDICAL RECORD. Not a local Journal, but International in its scope. 2. Give the origin of benzoin and menthol, with their therapeutical applications. 3. In uremic poisoning what remedies are required? 4. What is the physiological antagonism between bella- donna and morphia? 5. What are the principal preparations used as anti- periodics? 6. Of what therapeutic value is amyl nitrate? 7. What respiratory stimulants exalt the functions of the respiratory center of the medulla? 8. For what is stramonium used, what are its physio- logical actions? 9. Give the preparations and doses of the mineral acids with their therapeutic effects. 10. Give the preparations of bismuth, how admin- istered, and indications for use. MATERIA MEDICA. 1. Give the preparations and classifications of phenace- tin, somnal, and hydrogen dioxide. 2. What are the principal anthelmintics, mode of action? 3. Name twelve officinal alkaloids. 4. What are the officinal extracts, how obtained? 5. What is chrysarobin, where found and how applied? 6. Name the alkaloids of veratrum viride. 7. What are the preparations of guaiacum, give physi- ological action? 8. Name six motor excitants and six motor depressants. 9. Name the preparations of iron, their doses and in- compatibles. 10. What is picrotoxin, what combinatory action does it represent? CHEMISTRY. 1. What is analysis, and synthesis? 2. What is the difference between physical and chem- ical action? 3. What are the essential ingredients in air? Is it a mixture or a chemical compound? Give proof. 4. What are the chemical properties of phosphorus? 5. What is Labarraque's Solution, and upon what does its disinfectant value depend? 6. What are the physical and chemical properties of ammonia, and how does it differ from other alkalies? 7. Give method of disinfection in detail — 1st, with sul- phur; 2d, with formaldehyde. 8. Which is the more efficient, and why? MEDICAL RECORD. Keeps you strictly abreast of the times. 9. What are the best tests for albumin and sugar in urine ? 10. What is eucalyptol, and what are its uses in medical practice? HYGIENE. 1. Will the destruction of offensive odors remove the conditions injurious to health? 2. In what way may the application of fertilizers affect the public health, and how can it be avoided? 3. What are the nitrogenous constituents of food, from whence derived, and what are their functions? 4. What is the period and source of infection and the necessary time of quarantine, in (a) smallpox, (b) scarlet fever, (c) diphtheria, and what do you understand by quar- antine? 5. How would you manage an outbreak of contagion among school children? Answer in detail. 6. Describe a practical method for the disinfection of clothing, bedding, etc. 7. How would you provide for an infant who never has the breast available? Name food you would prefer, quan- tity you would advise, and frequency of feeding, according to age. 8. What general preventive measures would you recommend to stay the increase of tuberculosis? 9. Give the advantages or disadvantages of a state san- atorium for the treatment of tuberculosis. How should it be constructed and managed? 10. What in detail is the duty of physicians in attendance upon infectious disease, to prevent its spread? PATHOLOGY. 1. Give morbid anatomy of cerebral hemorrhage and name the common cause when it appears in early life. 2. How does the pathology of locomotor ataxia differ from that of ataxic paraplegia? 3. Define dementia and give its pathology. 4. State pathology of tinea circinata. 5. Define indicanuria, name its chief sources and the pathological conditions in which it is most usually found. 6. What is the pathological anatomy of pyelitis? 7. Name morbid anatomy of Hodgkin's disease. 8. Give pathology of biliary calculi. 9. State difference in pathology of catarrhal, ulcera- tive, and interstitial appendicitis. 10. How does tachycardia differ from bradycardia, and in what pathological conditions are they found respectively? MEDICAL RECORD. "Range of subjects embraces every branch of medicine and surgery." PHYSIOLOGY. 1. What is the function of the sudoriparous or sweat glands, where is the dominating sweat center located, ana how is this excited to action? 2. Name the functions respectively of the anterior and the posterior roots of the spinal nerves. 3. Give functions of the liver and name the blood-ves- sels entering it. 4. In what way does the blood circulate through the heart? 5. What are the mechanical uses of saliva? 6. What gases have we in the stomach ? 7. How do arteries differ from veins? 8. Are the movements of the lungs passive or active? 9. What changes are produced in the atmospheric air by respiration? 10. How does the function of an afferent or centripetal nerve differ from that of an efferent or centrifugal one? 1. In ligating the superficial femoral artery at its lower third, what structures are severed and what are the an- atomical relations ? 2. Describe traumatic inflammation. 3. How and why are fever and delirium induced by physical injuries? 4. Bone fractures are how classified? Diagnose and treat a typical fracture of each variety. 5. Dislocations are how classified? Diagnose and treat a typical case of each variety. 6. Explain reasons for preferring any special operation for amputation of both forearm and leg. 7. Explain method of procedure in operating for relief of fistula in ano. 8. In operating for relief of urinary calculi, what method would you use and why? 9. Differentiate hydrocele and chronic orchitis. 10. Deep seated pus cavities are how treated? ANATOMY. 1. The first vertebra is how attached to the skull? 2. Give shape, size, formation, and articulation of first and second vertebra. 3. Give shape, approximate size, origin, and insertion of trapezius muscles. 10 MEDICAL RECORD. Its prestige attracts articles by the best known writers. ' 4. Describe choroid plexus and situation of 4th ventricle of the brain. 5. Give origin and distribution of superior maxillary nerve. 6. Explain origin and distribution of brachial artery. 7. Give branches of internal carotid artery and their distribution. 8. Give structure, situation, and size of gall-bladder. 9. Give structure, formation, situation, and size of the gastrohepatic omentum. 10. Give location, shape, size, structure, and blood supply of the diaphragm. OBSTETRICS. 1. Name the internal female organs of generation and state the functions of each. 2. How would you diagnose pregnancy in the early months, before quickening? 3. Mention conditions that may require induction of pre- mature labor. How would you produce the same? 4. What is ectopic gestation? Name its varieties and state how its diagnosis may be established. 5. How would you proceed if called to a case of neglect- ed shoulder presentation? 6. Give causes, pathology, and treatment of ophthalmia neonatorum. What is the great danger? 7. State the causes and give the management of post- partum hemorrhage. 8. State causes and treatment of mammary abscess. 9. Name the important diameters and measurements of (a) the female pelvis, (b) the fetal head. 10. Give the positive and doubtful signs of pregnancy, beginning with those you consider of the most importance. PRACTICE OF MEDICINE. 1. Mention the conditions that contraindicate general anesthesia. 2. Define arteriosclerosis. Give its etiology and state the age at which it is most liable to occur. 3. What are the symptoms and treatment of acute laryngitis in children? 4. Mention five possible complications of typhoid fever and your treatment of each. 5. Give symptoms and treatment of acute lobar pneu- monia. 6. What is meant by immunity? In what ways may immunity be acquired]/ 7. Define neurasthenia. Give symptoms and treatment. 8. Differentiate tubercular arthritis from rheumatic ar- thritis. MEDICAL RECORD. "Therapeutic Hints contain many valuable formulae by the foremost medical men in the world." 9. State the symptoms and outline the treatment of (a) opium poisoning, (b) strychnine poisoning. 10. Give the symptoms and treatment of hydrophobia. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Delaware State Medical Society Examining Board. December 11, 12, and 13, 1906. THERAPEUTICS. 2. Benzoin is a balsamic resin derived from the Styrax Benzoin. It is an antiseptic and disinfectant; it renders the urine acid; it is used in acute rheumatism, acute laryn- gitis, chronic bronchitis, and chronic cystitis. Menthol is a stearopten derived from oil of peppermint It is used in neuralgias and migraine, vomiting of preg- nancy, gastralgia, and colic. 3. In uremic poisoning the first indication is to open up all the emunctories; measures must be taken to make the skin, kidneys, and bowels active ; the hot pack, elaterin, pilocarpin are suitable agents. Then the respiratory and circulatory functions must be sustained; this can be done with strychnine and digitalis. If convulsions are present or impending, chloral or chloroform or bromides are in- dicated. 4. The physiological antagonism between Belladonna and Morphia is as follows: Belladonna (1) acts as an ex- citant and stimulant of the cerebrum; (2) produces dila- tation of the pupil; (3) quickens the pulse; (4) first stimu- lates and then depresses the respiratory center; (5) de- creases all the secretions, except urine. Morphia (1) acts as a sedative on the cerebrum; (2) contracts the pupil; (3) slows the pulse; (4) does not at first depress respiration, but in overdose it paralyzes the respiratory center; (5) checks all the secretions except perspiration. 5. The principal antiperiodics are: — Cinchona bark and quinine, Warburg's tincture, arsenic, salicylic acid and the salicylates, eucalyptus, and iodine. 6. Arnyl nitrite is used for the relief of angina pec- toris, epilepsy, spasms, convulsions, whooping cough, asth- ma, laryngismus stridulus, strychnine poisoning, tetanus, and in threatened death from chloroform anesthesia. 7. Respiratory stimulants : — Strychnine, ammonia, digi- MEDICAL RECORD. " Surgical Suggestions that will appeal to th« student and the general practitioner." talis, alcohol, ether, atropine, apomorphine, hydrocyanic acid, cold douche. 9. Mineral acids, with their preparations and doses:— Dilute sulphuric acid, 30 minims; aromatic sulphuric acid, 15 minims; dilute nitric acid, 30 minims; nitrohydrochloric acid, 3 minims; dilute nitrohydrochloric acid, 15 minims; dilute hydrochloric acid, 15 minims; dilute phosphoric acid, 30 minims ; sulphurous acid, 30 minims ; boric acid, 7 grains ; (liquor antisepticus, 1 dram). MATERIA MEDICA. 1. Phenacetin is an antipyretic and analgesic; there are no official preparations. Somnal is a hypnotic; there are no official preparations. Hydrogen dioxide is an antiseptic; preparation, aqua hydrogenii dioxidi. 2. Anthelmintics are agents which kill or expel worms inhabiting the intestinal tract. Vermifuges (which expel the worms) are: — Scammony, jalap, and other purgatives. Vermicides (which kill the worms) are: — Turpentine, male fern, kousso, pomegranate, santonine, quassia, tannin, spigelia, chenopodium. 3. Twelve official alkaloids: — Strychnine, atropine, quinine, morphine, codeine, cocaine, caffeine, physostigmine, hyoscine, hyoscyamine, pilocarpine, sparteine. 4. Fluid extracts are liquid alcoholic preparations of vegetable drugs in which one cubic centimeter represents the medicinal properties of one gramme of the crude drug. They are obtained by percolation and partial evaporation with menstrua of alcohol (either pure or diluted). 5. Chrysarobin is a neutral principle obtained from Goa powder, which is found in the wood of Vouacoupoua Ara- roba in Brazil. It is applied externally in an ointment. 6. The alkaloids of veratrum viride are: — Veratrine, veratroidine, jervine, pseudojervine. 7. The preparations of guaiacum are : — Tincture of guaiac and ammoniated tincture of guaiac. Its action is : — diaphoretic, laxative, expectorant, and emmenagogue. 8. Six motor excitants : — Strychnine, digitalis, picrotoxin, pilocarpine, ergot, brucine. Six motor depressants : — Alcohol, opium, aconite, chloral, belladonna, tobacco. 9. The preparations of iron, with their doses, are:— 13 MEDICAL RECORD. " Keeps you in closest touch with the weekly progress ol medicine and surgery throughout the world." Reduced iron, i grain; ferrous sulphate, 3 grains; dried sulphate of iron, 2 grains; granulated ferrous sulphate, 3 grains; pills of ferrous carbonate, 2 pills; saccharated ferrous carbonate, 4 grains; syrup of ferrous iodide, 15 minims; pills of ferrous iodide, 2 pills; ferric chloride, 1 grain; solution of ferric chloride, \Vz minims; tincture of ferric chloride, 8 minims; Basham's mixture, 4 drams; solution of ferric subsulphate, 3 minims; ferric hydroxide with oxide of magnesium, 4 ounces ; ferric ammonium sul- phate, 7 grains ; soluble ferric phosphate, 4 grains ; tar- tarated iron, 4 grains; iron and ammonium citrate, 4 grains; iron and strychnine citrate, 2 grains; iron and ammonium tartrate, 4 grains; iron citrate, 4 grains; iron and quinine citrate, 4 grains; soluble iron and quinine citrate, 4 grains ; pyrophosphate of iron, 4 grains ; dialyzed iron, 10 to 30 minims. Incompatibles: — Acids, acid salts, alkalies and their car- bonates, and vegetable astringents. 10. Picrotoxin is a neutral principle found in the seeds of the Anamirta paniculaia. It represents the combined action of belladonna and nux vomica. CHEMISTRY. 1. Analysis is the splitting up of a compound into its elements or into simpler compounds. Synthesis is the building up of a compound from ele- ments or from simpler compounds. 2. "A bar of soft iron may be made to emit light when heated, or sound when caused to vibrate, or magnetism when under the influence of an electric current. Under the influence of these physical forces the iron suffers no change in composition, and, on cessation of the action of the inciting force, the iron returns to its original condition. But if the iron be heated in an atmosphere of oxygen, both the iron and a part of the oxygen disappear, and a new substance, a new chemical species, is produced, having properties of its own, different from those of either the iron or the oxygen. In this case there has been chemical action, causing change of composition, as the new sub- stance contains both iron and oxygen. The result of such action is, moreover, permanent, and the new product con- tinues to exist, until modified by some new manifestation of chemical action." — (Witthaus' Manual of Chemistry.) 3. The essential ingredients in air are: — Oxygen, nitro- gen, carbon dioxide, water vapor, argon, and ammonia. MEDICAL RECORD. " The most important and interesting items of tfa< latest medical news throughout the world." Air is a mixture, and not a chemical compound. This is proved by the following facts: — (i) the com- position is not always absolutely the same; (2) the pro- portion of the elements, oxygen and nitrogen, is not in any relation to their atomic weights ; (3) when oxygen and nitrogen are brought together in the proper propor- tions, no chemical action occurs, and yet the resulting mix- ture has the properties of air. 4. Chemical properties of phosphorus: — Phosphorus has an atomic weight of 31 and a molecular weight of 124, there being four atoms to the molecule; it has a valence of three or five; it combines readily with oxygen, chlorine, bromine, and iodine; it is a good reducing agent; it is not acted on by hydrochloric or cold sulphuric acid, but is oxidized by nitric acid. 5. Labarraque's solution, or solution of chlorinated soda, is an aqueous solution of several chlorine compounds of sodium. Its disinfectant value depends upon the presence of the chlorine which can be liberated. 6. Ammonia, Physical properties: — A colorless gas, with a pungent and irritating odor, and a caustic taste; it is very soluble in water and in alcohol. Chemical properties: — It combines directly with acids to form ammonium salts. It differs from the other alkalies in being volatile, hav- ing a pungent irritating odor, being a gas, and in its action with acids. 9. Good tests for albumin in the urine are: — (1) the heat test, and (2) the nitric acid test. Good tests for sugar in the urine are: — (1) Fehling's test, and (2) the fermentation test. 10. Eucalyptol is a neutral body obtained from oil of eucalyptus. It is used for lotions and nasal applications, also in malaria, bronchitis, gonorrhea ; on ulcers it has a disin- fectant and stimulating action. 1. The destruction of offensive odors does not neces- sarily remove the conditions injurious to health. 3. The nitrogenous constituents of food are derived chiefly from the flesh of animals, fish, fowl, milk, eggs, and certain vegetable products (wheat, oatmeal, peas, beans, etc.). The constituents and functions are shown in the following table adapted from Notter and Firth's Hygiene: IS MEDICAL RECORD. " Choice and important abstracts from the leading medical periodicals of the world In a condensed and practical form." Nitrogenous Substances Examples Functions All substances con taining nitrogen, of a composition iden tical with, or nearly that of albumin proportion of N to C being nearly as s to 7. Substances containing a larger proportion of N are apparently less nutritious; pro- portion of N to C about 2 to si. Extractive matters such as are con- tained in the juice of the flesh. Animal: Albumin Fibrin Syntonin Myosin Globulin Casein Albumoses Peptones Vegetable: Glutin Legumin Albumoses Gelatin Ossein Chondrin Keratin Formation and repair of tissues and fluids of the body. Regulation of the absorption and utilization of oxygea. May also form fat and carbohy- drate, and yield energy some- times. In most foods the above, both animal and vegetable, are largely converted into al- bumoses and peptones dur- ing digestion. These perform the above func- tions less perfectly, or only under particular circumstances. These substances appear essen- tially as regulators of digestion and assimilation, especially with reference to the gelatin group. 7. For an infant seven weeks old the following will do: — Cream, half an ounce ; milk, ten drams ; milk sugar, half a dram; a pinch of salt, and ten drams of water. This quantity should be given every two hours, except at night (from 11 p.m. to 5 a.m.). PATHOLOGY. 2. In locomotor ataxia the degeneration of the posterior columns is most marked in the lumbar region; in ataxic paraplegia it is equally or more intense in the dorsal region. In ataxic paraplegia the lateral columns are also involved. 5. Indkanuria means the presence in the urine of an excess of indican. It is derived from the indol produced in intestinal putrefaction. It is most usually found in gastric cancer, peritonitis, ileus, empyema, gangrene of the lungs. 6. The mucous membrane is congested and covered with mucus and desquamated epithelium. The inflammation (and pus) may extend into the substance of the kidney. When there is complete obstruction the calyces may be dilated, the kidney substance atrophied, and the entire kidney may become a sac of pus. 10. Tachycardia means increased frequency of the pulse. It is found in fevers, exophthalmic goiter, many forms of valvular disease of the heart, hemorrhage or tumor at the base of the brain, and after the ingestion of certain drugs. 16 MEDICAL RECORD. " Special reporters in England, France, Germany, Austria, Turkey, Denmark, the Philippines, and the leading cities of the United States and Canada." Bradycardia means an abnormal slowness of the pulse. It is found in aortic stenosis, chronic myocarditis, during the puerperium, the convalescence from many fevers, hemor- rhage or tumor of the brain causing increased intracranial pressure, myxedema, from certain poisons in the blood (as alcohol, tobacco, opium, and lead), and after the ingestion of certain drugs. PHYSIOLOGY. i. The function of the sudoriparous glands is the se- cretion of sweat. The location of the sweat center or cen- ters has not been determined. There may be a dominating center in the medulla. The center is excited to action (i) by direct action on the central nervous system, (2) by stimulation of certain afferent nerves, and (3) by changes in the composition or quantity of the blood. 2. The anterior roots of the spinal nerves are efferent and motor, and cause contraction of the muscles to which the nerves are distributed. The posterior roots of the spinal nerves are afferent and sensory, and are distributed to the skin. 3. The functions of the liver are: (1) the secretion of bile, (2) the formation of glycogen, (3) the formation of urea and uric acid, (4) the manufacture of heat, and (5) the conversion of poisonous and harmful into inert mate- rial. The blood-vessels entering the liver are the hepatic artery and portal vein. 5. The mechanical uses of saliva are: (1) to moisten the mouth, (2) to assist in the solution of the soluble portions of the food, and thus (3) to administer to the sense of taste, (4) to lubricate the bolus of food, and thus (5) to facilitate the acts of mastication and deglutition. 6. Gases which may be found in the stomach are: — Air, oxygen, nitrogen, hydrogen, carbon dioxide, marsh gas, and sulphuretted hydrogen. 7- Arteries Veins Generally carry arterial blood Carry blood from the heart Do not collapse when cut Are found contracted and empty after death The middle coat is the thickest .... Do not have valves Generally carry venous blood. Carry blood to the heart. Collapse when severed. Are not found empty after death. The external coat is the thickest. The medium-sized veins have valves. MEDICAL RECORD. " Our reporters attend every convention of first-rate im- portance. The news is telegraphed or cabled exclusively to the MEDICAL RECORD." 8. The movements of the lungs are active in inspiration and passive in expiration. 9. The changes produced in the air by respiration are: Inspired Air Expired Air That of body. Dust 10. Efferent or centrifugal nerves carry impulses away from the nerve centers. Afferent or centripetal nerves carry impulses to the nerve centers. SURGERY. I. In ligating the superficial femoral artery at its lower third the following structures are severed : — Skin, superficial fascia, fascia lata, fibres of sartorius, and the aponeurotic roof of Hunter's canal. The anatomic relations of the artery here are: — An- teriorly, the structures just named and the internal cutane- ous and long saphenous nerves; posteriorly, the junction of the vastus internus with the adductor longus and mag- nus, femoral vein; externally, vastus internus and femoral vein ; internally, adductor longus and magnus. 9. In hydrocele the swelling is first noticed at the low- est part of the scrotum, and it increases in size slowly; it is tense, smooth, and fluctuates; there is no pain and no symptoms of inflammation; it is translucent. In orchitis the swelling comes on more rapidly; it is very painful and also tender to the touch ; the skin over the affected gland is red and shiny; it is not translucent. OBSTETRICS. 3. Conditions that may require the induction of prema- ture labor: — (1) Certain pelvic deformities, (2) placenta praevia, (3) pernicious anemia, (4) toxemia of pregnancy, (5) habitual death of the fetus toward the end of preg- nancy, (6) hydatidiform mole. 4. Ectopic gestation is a pregnancy in which the ovum is developed outside of the uterine cavity. Varieties: — Ovarian, tubal, interstitial, abdominal. 18 MEDICAL RECORD. " The only American medical Journal that prints a detailed report of the British Medical Association." Diagnosis: — "When extrauterine pregnancy exists there are: (i) The general and reflex symptoms of pregnancy; they have often come on after an uncertain period of sterility; nausea and vomiting appear aggravated. (2) Then comes a disordered menstruation, especially metror- rhagia, accompanied with gushes of blood, and with pelvic pain coincident with the above symptoms of pregnancy; pains are often very severe, with marked tenderness within the pelvis ; such symptoms are highly suggestive. (3) There is the presence of a pelvic tumor characterized as a tense cyst, sensitive to the touch, actively pulsating; this tumor has a steady and progressive growth. In the first two months it has the size of a pigeon's egg; in the third month it has the size of a hen's egg; in the fourth month it has the size of two fists. (4) The os uteri is patulous; the uterus is displaced, but is slightly enlarged and empty. (5) Symptoms No. 2 may be absent until the end of the third month, when suddenly they become severe, with spasmodic pains, followed by the general symptoms of collapse. (6) Expulsion of the decidua, in part or whole. Nos. I and 2 are presumptive signs; Nos. 3 and 4 are probable signs; Nos. 5 and 6 are positive signs." (American Text-Book of Obstetrics.) 9. (a) The diameters and measurements of the female pelvis are easily remembered from the following table: Anteroposterior Oblique Transverse 4 inches 4* " s 4} inches 4* " 4* " (b) The fetal head has the following diameters : Occipito- frontal, occipito-mental, bitemporal, biparietal, suboccipito- bregmatic, trachelo-bregmatic, and mento-bregmatic. Of these, the occipito-frontal is 4 1-2 inches, the occipito- mental is 5 1-2 inches, and all the others are approxi- mately 3 1-2 inches. 10. Positive signs of pregnancy: — (1) hearing the fetal heart sound; (2) active movements of the fetus; (3) bal- lottement; (4) outlining the fetus in whole or part by palpation; and (5) the umbilical or funic souffle. Doubtful signs of pregnancy: — (1) progressive enlarge- ment of the uterus; (2) Hegar's sign; (3) Braxton Hick's sign; (4) uterine murmur; (5) cessation of menstruation; (6) changes in the breasts ; (7) discoloration of the vagin* 19 MEDICAL RECORD. "We publish the proceedings of an association immediately after the meeting." and cervix; (8) pigmentation and striae; (9) morning sickness. PRACTICE OF MEDICINE. 1. The following contraindications for ether and chlo- roform are from Hare's Practical Therapeutics: "Ether. should not be used by inhalation in bronchitis or acute nephritis, because of its irritant properties; in peritonitis or gastritis, because it is apt to induce vomiting; in aneur- ysm or in the presence of marked vascular atheroma, be- cause it may rupture a blood-vessel by raising arterial pressure; nor in diabetes, lest it produce diabetic coma; and if anemia is present and an examination of the blood shows that the hemoglobin is below 50 per cent., the use of the drug should be avoided if possible. "Chloroform is not to be used in cases of fatty heart or dilatation of the heart, in those with a known idiosyncrasy, nor in the so-called lymphatic persons with overgrowth of lymphoid tissues, as, for example, adenoids. In the latter case it is particularly apt to cause sudden death. In valvu- lar disease of the heart chloroform may be used with caution, although ether is preferable. Given a case of valvular disease that must be subjected to operation, the chances are bettered with an anesthetic than without it, as the pain and mental shock are worse for the heart than is the anesthetic." 2. Arteriosclerosis is a condition in which the walls of an artery, especially the intima, become hard, dry, and thickened. Etiology: — Syphilis, alcoholism, gout, Bright' s disease, overeating, and excessive muscular gout. It is most liable to occur in old age. 6. Immunity is the power of resistance of cells and tissues to the action of pathogenic bacteria. Immunity may be acquired by:— (1) a previous attack of the disease; (2) inoculation, with small quantities of bacteria, so as to produce a mild attack of the disease; (3) vaccination; (4) the introduction of antitoxins; (5) the introduction of the toxins of the bacteria. 9. Opium poisoning: Symptoms: — In opium poisoning there may be three stages: (1) a period of excitement, in which the patient is active, talkative, and has hallucina- tions; (2) a period of drowsiness, in which the patient is sleepy, but may be aroused; his face is pale, lips livid, pupils contracted; this passes into (3) the stage of coma, from which the patient cannot be aroused; the reflexes are abolished, the pupils are very contracted, the pulse is 20 MEDICAL RECORD. " Since 1890 the MEDICAL, RECORD has had a cabled re- port of every International Medical Congress." slow and irregular, and the respirations are infrequent and shallow. Treatment consists in washing out the stomach, prefer- ably with a dilute solution of potassium permanganate; ambulatory treatment, to keep the patient awake; artificial respiration is indicated, and strong coffee should be ad- ministered by the mouth or rectum ; the bladder should be emptied by the catheter. Strychnine poisoning: Symptoms: — "Strychnine produces a sense of suffocation, thirst, tetanic spasms, usually opis- thotonos, sometimes emprosthotonos, occasionally vomit- ing, contraction of the pupils during the spasms, and death, either by asphyxia during a paroxysm, or by exhaustion during a remission. The symptoms appear in from a few minutes to an hour after taking the poison, usually in less than twenty minutes; and death in from five to six hours, usually within two hours. "Treatment : — The convulsions are to be arrested or miti- gated by bringing the patient under the influence of chloral or chloroform as rapidly as possible; the stomach is to be washed out, and the patient is to be kept as quiet as pos- sible." (Witthaus' Essentials of Chemistry.') STATE BOARD EXAMINATION QUESTIONS. Medical Examiners State of Florida; Regular Board. October 17 and 18, 1906. ANATOMY. 1. Name the bones and ligaments of the ankle joint. 2. What bones form the shoulder? 3. Facial artery — origin, course, and distribution. 4. Define and describe capillary circulation. 5. Mention the salivary glands and their ducts. State where these ducts open. 6. Give the gross anatomy of the stomach. 7. Into what and how far from the pyloric orifice of the stomach does the ductus communis choledochus normally open? 8. Describe the appendix vermiform. Locate McBur- ney's point for performing appendectomy. 9. What is the pons Varolii, and where situated? 10. Give origin, course, and distribution of median nerve. MEDICAL RECORD. " The most important contributions to the literature of medicine and surgery have been published first in the MEDI- CAL BECOBD." PHYSIOLOGY. 1. Describe the normal pulse; state the factors active in its maintenance, and give the rate during infancy, youth, and adult life. 2. Describe a complete physiological revolution of the heart. 3. Give the principal characteristics of gastric juice in man. 4. Describe the phenomena of (a) asphyxia, (b) syn- cope, (c) sleep. 5. What changes are produced in the air and in the blood by respiration? 6. Define (a) tonic muscular contraction; (b) clonic muscular contraction. Give an example of each. 7. State the function of the anterior spinal nerve roots. How is the function proved? 8. Describe the fetal circulation. 9. What is (a) an efferent nerve, (b) an afferent nerve? Give an example of each. 10. What is the composition of human milk? SURGERY. 1. Name five forms of bacteria and the surgical disease produced by each. 2. Describe thrombosis and embolism. Give the cause of each. 3. What causes gangrene? Name two varieties. Give treatment. 4. Define suppuration and give the cause. What is an abscess ? 5. Define inflammation and name three varieties. Give five cardinal symptoms of inflammation. 6. Give etiology, symptoms, and treatment of iritis. 7. Give the diagnosis and treatment of fracture of the clavicle. 8. What important structures would be divided in an amputation four inches below the knee joint? Q. Give the symptoms of a dislocation of the wrist joint. Method of reduction and treatment. _ 10. Describe the method of sterilizing the field of opera- tion, the hands of the operator and his assistants, and the instruments for a major surgical operation. GYNECOLOGY. 1. What is the normal size and position of the uterus? 2. What do you ascertain from a digital examination MEDICAL RECORD. " Book reviews of foreign and American publications keep you thoroughly informed of the newest literature." and what constitutes a complete gynecological exami-> nation? 3. Give symptoms and treatment of acute vaginitis. 4. What pathological conditions and symptoms usually follow laceration of the cervix uteri? 5. Give symptoms and treatment of retroversion of the uterus. 6. What is oophoritis, and how could you diagnose it? 7. Give etiology and treatment of salpingitis. 8. Enumerate symptoms of sarcoma of the mammary gland. 9. What are the nervous manifestations of amenorrhea? 10. What is a vesicovaginal fistula, and explain the operation for same. THERAPEUTICS. 1. Define what you understand to be the therapeutic limit of a drug, taking digitalis for an example. 2. Give the medicinal uses of belladonna, and state from what source it is obtained. 3. Write a prescription for intertrigo in infants. 4. Name the indications for the use of morphia sul- phate, atropia and aconite, and give the physiological doses of each. 5. What remedies would you prescribe to obtain intesti- nal antisepsis in typhoid fever? 6. Give the physiological action and therapeutic uses of the officinal digestive ferments. 7. Give the officinal name, composition, and therapeuti- cal uses of Lugol's solution. 8. Litharge. Officinal name and medicinal uses. 9. Manganese. Division into groups. The officinal salt most used, and doses of same. 10. Sedatives. Divide into classes, and state upon what conditions may a sedative become a stimulant. OBSTETRICS. 1. What are the three stages of normal labor? 2. Signs of pregnancy at end of first three months? 3. Define menstruation. 4. Symptoms of extrauterine pregnancy. 5. Mechanism of labor in R. 0. A. 6. Management of breasts after delivery. 7. Treatment of puerperal sepsis. 8. Treatment of pregnancy complicated by nephritis. 9. Treatment of eyes of new-born. 10. Give methods of preventing tears of perineum. MEDICAL RECORD. " The medical profession have been presented with the results of great discoveries by the MEDICAL RECORD in advance of any other publication." CHEMISTRY. i. Define the terms matter, solids, liquids, gases, and water of crystallization. 2. Name the five gaseous elements. 3. Give the chemical formula of nitric acid, and men- tion its properties. 4. What metals belong to the arsenic group? 5. Give the usual tests for sugar and albumin in the urine. 6. Describe the method of making tests for the diazo reaction in suspected urine. 7. Give antidote for arsenic poisoning, and how to pre- pare same. 8. Give antidotes for caustic potash poisoning. 9. Give tests for salts of sodium and potassium. 10. Name the element found in greatest abundance on our earth and mention its properties. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Medical Examiners, State of Florida; Regular Board. October ij and 18, 1906. physiology. 1. The pulse is the impulse conveyed to the column of blood in the arteries by the contraction of the ventricles and the propulsion of more blood into the already full arterial system. The characters of the pulse which are of most im- portance are its force, frequency, length, rhythm, and ten- sion. It is maintained by the ventricular systole, the elasticity of the arterial walls, and the volume of the blood in the vessels. In infancy the rate is about one hundred and twenty a minute; in youth about eighty-five, and in adult life about seventy. 3. It is a thin, colorless, acid fluid, with specific gravity of about 1.002, and containing from one-half to one per cent, of solids. The average daily amount has been placed anywhere between six and twelve pints. It contains (besides water) hydrochloric acid, pepsin, rennin, mucin, and salts of sodium, potassium, calcium, and magnesium. The pepsin is a proteolytic enzyme which will only act in an acid medium ; the rennin coagulates caseinogen. 5. The changes produced in the air by respiration are: 24 MEDICAL RECORD. "New instruments are portrayed and their use thoroughly explained." Oxygen Nitrogen Carbon dioxide. Other gases Watery vapor. . Temperature. . . Volume Bacteria Dust Inspired Air. 21 per cent. 79 per cent. 0.04 per cent. Rare. Variable. Variable. Varies. Always present. Always present. Expired Air. 16.6 per cent 79 per cent. 4-4 per cent. Often present. Saturated. That of body. Diminished. None. None. In the blood the changes take place in the capillaries of the lungs, and are: (1) the giving up of the CO s by the venous blood, (2) the absorption of oxygen during inspira- tion, (3) the blood is cooled, and (4) it also loses a small amount of watery vapor. 6. In tonic muscular contraction the muscle remains for some time in a state of rigid contraction. In clonic con- traction the muscle alternately contracts and relaxes. Tonic muscular contraction occurs in tetanus; clonic, in an ordi- nary convulsion. 9. Efferent nerves carry impulses away from the nerve centers. Afferent nerves carry impulses to the nerve cen- ters. The motor nerves are efferent; the sensory nerves are afferent. SURGERY. 1. (1) Streptococcus pyogenes, producing abscess; (2) bacillus tetani, producing tetanus; (3) bacillus anthracis, producing malignant pustule ; (4) bacillus tuberculosis, pro- ducing tuberculous disease of bones or joints; (5) strep- tococcus erysipelatis, producing erysipelas. 2. Cause of thrombosis: (1) changes in the walls of the blood-vessels, due to the presence of infection or foreign bodies; (2) changes in the blood, whereby its tendency to coagulate is increased; (3) diminished rate of the blood flow, due to weak heart action or obstruction. Embolism is generally due to thrombi, but is also caused by fragments of vegetations or atheromatous or calcareous masses from the cardiac valves or the intima of the arteries; other causes are parasites, pieces of new growths, pigment grannies, fluid fat, or air. 4. Suppuration is a special form of inflammation, in which the exudate is unusually prolific in cells, and in which pus is found The cause of suppuration is the invasion of 25 MEDICAL RECORD. " Bulletins of Examinations of State Medical Licensing Boards published bi-weekly." the tissues by pus-producing bacteria, when the said tissues are in a state of lowered vitality or are not capable of withstanding and disposing of the bacteria and their products. An abscess is a circumscribed collection of pus in a newly formed cavity. 8. Skin; fascia; bones, tibia, and fibula; interosseous membrane; muscles, tibialis anticus, tibialis posticus, ex- tensor longus digitorum, extensor proprius hallucis, flexor longus hallucis, flexor longus digitorum, peroneus longus, peroneus brevis, soleus, gastrocnemius, and the tendon of the plantaris; arteries, anterior tibial, posterior tibial, peroneal; veins, the venae comites of the arteries, external saphenous, internal saphenous; nerves, anterior tibial, pos- terior tibial, external saphenous, communicans peronei, musculocutaneous. GYNECOLOGY. 1. In the nulliparous adult the uterus is about three inches long, about two inches wide at the upper part, and about one inch thick. The uterus lies between the rectum behind and the bladder in front ; it is below the abdominal cavity and above the vagina. Its position is one of slight anteflexion, with its long axis at right angles to the long axis of the vagina. The anterior surface of its body rests on the bladder, and the cervix points backward toward the coccyx. The uterus is not fixed, but moves freely within certain limits. 2. From a digital examination can be learned the presence or absence of vaginismus ; the size, position, temperature, sensitiveness, moisture, and laxity of the vagina; the pres- ence of foreign bodies, hernia, fissures, or caruncles; the position, form, and consistency of the cervix uteri; lacera- tions (including position, number, extent, and direction), erosions, growths, or cysts on the cervix; prolapse, dis- placements, and size and position of the uterus. A complete gynecological examination would include (i) anamnesis, including family history; personal history, with special reference to menstruation, labors, and miscarriages; and present illness. (2) Examination of the abdomen (and breasts), including inspection, palpation, percussion, auscul- tation, and mensuration. (3) Inspection of the external genitals. (4) Vaginal examination, digital, bimanual, and with speculum. (5) Bimanual examination of uterus and appendages. (6) Sometimes the sound, or curette, may be required. (7) Chemical and microscopical examination of the urine. (8) Microscopical examination of discharges or uterine scrapings. (9) Rectal examination. (10) Cys- 26 MEDICAL RECORD. " Statistics of the health boards and many articles of scien- tific interest and items of general information." toscopic examination and perhaps ureteral catheterization, (n) In case of phantom tumor or pseudocyesis, anestheti- zation would be required. 4. Hemorrhage, sepsis, hypertrophy, and erosion of cervix, prolapse of uterus, subinvolution, endometritis, can- cer, and disease of the tubes and ovaries. 8. According to Gross "a tumor of soft, elastic, appa- rently fluctuating consistence, which attains the volume of an adult head in a few months, can scarcely be anything else than a small-celled sarcoma. On the whole, the diag- nosis is based upon their indolent origin, lobulated outline, rapid increase, large dimensions for the period of their existence, freedom from lympathic involvements, and marked tendency to ulcerate; upon the not infrequent dis- coloration of skin, enlargement of the subcutaneous veins, and possibly elevation of temperature; upon the suffering which they awaken late in the disease, and upon their greatest frequency after the thirty-fifth year." 9. Hysteria, paresis, tinnitus aurium, perspiration, defec- tive vision, acne, herpes, urticaria, headache, and flashes of heat. THERAPEUTICS. 3. I£. Amyli Acidi borici aa 3J- Misce. Signa : Apply as a dusting powder. 5. Guaiacol carbonate, salol, betanaphthol, naphthalin, thymol, carbolic acid, calomel, and corrosive sublimate. 6. Note that only two — pepsin and pancreatin — are officinal. 7. Liquor iodi compositus. Iodine, 5 parts; potassium iodide, 10 parts ; and water up to one hundred parts. It is used as a counterirritant and as an alterative; on bruises and sprains, also for pleurisy, synovitis, chronic rheumatism, intercostal neuralgia. It is also used internally, in doses of from one to ten minims, well diluted, for the vomiting of pregnancy, or after anesthetics. It is used, too, as an in- jection, for goiter, also into the various serous cavities in cases of chronic inflammations. 8. Plumbi oxidum. Used in the manufacture of lead plasters, and of some of the other lead salts, also as the basis of other plasters. It is further used as a protective agent against chafing from splints and other appliances, and to prevent bedsores. 9. Mangani dioxidum pracipitatum, dose four grains; mangani sulphas, dose four grains; mangani hypophosphis, dose three grains; and potassii permanganas, dose one grain. 27 MEDICAL RECORD. The MEDICAL, RECORD publishes no " Students' Number," for every issue is a students' number and a practitioners' number in one. CHEMISTRY. i. Matter is anything which occupies space. A solid is a form of matter in which the relative positions of the molecules are fixed and constant. In a liquid the molecules glide past each other and the substance assumes the form of its container. In a gas the molecules tend to get away from each other and to occupy a greater space. In a solid both volume and form are definite; in a gas both volume and form are indefinite ; and in a liquid the volume is defi- nite but the form is indefinite. 2. Hydrogen, oxygen, nitrogen, fluorine, and chlorine. 3. HNOs. It is a colorless liquid, with a strong acid taste and reaction. It is a strong oxidizing agent, and dissolves most metals, with the formation of nitrates. With hydrochloric acid, it forms aqua regia, which is capa- ble of dissolving the so-called "noble metals." In damp air it gives off white fumes. When strongly heated it is decomposed into H 2 0, N 2 0< and oxygen. 4. The answer to this question will depend upon the textbook used by the student (or examiner). Witthaus puts arsenic in the same group with nitrogen, phosphorus, and antimony; Remsen, in the same group with nitrogen, phosphorus, antimony, and bismuth; Simon, in the same group with antimony, tin, gold, platinum, and molybdenum ; Holland, in the same group with antimony and tin. 6. The reagent is made of two solutions, which should be kept in separate bottles. One is a saturated solution of sulphanilic acid in a mixture of 50 c.c. of hydrochloric acid and 950 c.c. of water. The other is a 0.5 per cent, solution of sodium nitrite. To make the test: 40 c.c. of the sulphanilic acid solution are mixed with 1 c.c. of the sodium nitrite solution, and the mixture is well shaken. Equal quantities of the urine and reagent are then shaken together in a test tube, and upon the surface of this mixture from 1 to 2 c.c. of ammonia are floated. A red band formed at the junction of the liquids implies an affirmative result 7. Freshly prepared ferric hydroxide, FejOsHe. The two following solutions should be kept in separate bottles, and when required should be mixed and administered: (1) 5. Liquoris ferritersulphatis. . . Jij Aquae destillatae Bvj. M. (2) rj. Magnesias 3iij Aqua; destillatae Jviij. M. 8. Dilute vinegar, vegetable acids, milk, and neutral oils. 28 MEDICAL RECORD. Save and bind your numbers; it will give you two great medical encyclopedias every year. g. Sodium colors the Bunsen flame yellow. With peri- odic acid (HIO«) in excess, it gives a white precipitate in not too dilute solution. Potassium colors the Bunsen flame violet With periodic acid it gives a white precipi- tate, sparingly soluble in water, and insoluble in alcohol. 10. Oxygen. A colorless, odorless, tasteless gas, slightly soluble in water. It has a strong tendency to combine with other elements, and forms binary compounds with all ele- ments except fluorine and bromine. Oxygen is necessary to the processes of life and combustion. STATE BOARD EXAMINATION QUESTIONS. Regular Board Medical Examiners., State of Georgia. April 3 and 4, 1906. CHEMISTRY. i. Give the formula of each of five compounds, giving the name in each case, and the dose. 2. Give the name and formula of Epsom salt, Glauber's salt, and Rochelle salt. 3. Mention five mineral poisons, and give the antidote for one of them. 4. Name the nonmetallic chemical elements, which in various combinations are found in the tissues of the body. 5. How may you decide whether a urinary deposit is urates or prosphates? ANATOMY. 1. Describe the inferior maxillary bone. 2. Name muscles of posterior tibio-fibular group, super- ficial, and deep, (a) Give origin and insertion of (1) Pectoralis major; (2) External oblique; (3) S'artorius; (4) Triceps muscles. 3. Give course, relations, and branches of external car- otid artery, (a) Give blood supply of rectum. 4. Give origin, course, and distribution of great sciatic nerve, (a) Give nerve supply of heart. 5. Describe the stomach. 1. Give treatment, constitutional and local, of Burns. 2. Name the varieties of fractures, (a) State the car- dinal principles in the treatment of fractures. 29 MEDICAL RECORD. "Acknowledged to be the leading independent medical weekly." 3. Describe an operation for the radical cure of oblique inguinal hernia. 4. Define hemorrhoids, (a) Give varieties and treat- ment. 5. Define a chancre, (a) State period of primary and secondary incubation, (b) Treatment, local and constitu- tional. MATERIA MEDICA AND THERAPEUTICS. i. Source of ergot; define its use in obstetrics. 2. Name four preparations of mercury; give dose of each. 3. Source of quinine; for what is it a specific? 4. What is meant by hemostatics? Describe their mode of action; name several of them. 5. Write a prescription for a general tonic with tincture nux vomica and a preparation of arsenic. OBSTETRICS AND DISEASES OF CHILDREN. 1. How would you manage a shoulder presentation? 2. Differentiate between a five-months pregnancy, ovarian cystoma, ascites and uterine fibroid. 3. What is the Braxton-Hick's sign of pregnancy? How obtained ? 4. Under what condition would you be jusified in inducing premature labor? 5. What direction would you give the nurse as to care of infant during first week? PHYSIOLOGY. 1. Describe a white blood corpuscle. Where are they formed? What is their function, and what is their ulti- mate end? 2. The salivary secretion is derived from what three glands? What is the physiological action of saliva? 3. What are the three motions of the heart, and their cause? 4. What is the volume of air taken in the body in an ordinary inspiration? How is this chemically represented, and how much of the O is absorbed? 5. What is the result of a lesion of the spinal cord in the cervical region? In the sacral region? PATHOLOGY. 1. Mention the pyogenic bacteria. 2. Describe the blood changes in pernicious anemia. 3. Give the structural changes which take place in chronic and acute appendicitis. 30 MEDICAL RECORD. " Original Articles are of the highest scientific value and most practical character, by the foremost men of the world." 4. Differentiate between a typhoid ulcer and a tubercu- lar ulcer of the intestines. 5. Describe the process of repair. GYNECOLOGY. 1. Define menorrhagia and metrorrhagia, (a) Give causes and treatment. 2. Describe an operation for the repair of a lacerated cervix. 3. Give symptoms of carcinoma of the uterus, (a) Treatment. 4. Define retroversion and retroflexion of the uterus, (a) Symptoms and treatment. 5. Give symptoms and treatment of ectopic gestation. PRACTICE. i. Define lobar pneumonia, (a) Give symptoms and treatment. 2. Define malaria, (a) Give prophylactic and medical treatment. 3. Differentiate between chickenpox and smallpox. 4. Define measles; point out the most dangerous com- plications. 5. Differentiate true croup and spasmodic. OBSTETRICS AND DISEASES OF CHILDREN. i. Give symptoms, causes, and treatment, of acute mas- titis? 2. Give principal causes and treatment of rupture of uterus. 3. Treatment of inertia uteri. 4. Differentiate between diphtheria and the disease with which it might be confounded. 5. Give treatment of bronchopneumonia. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Regular Board of Medical Examiners, State of Georgia. April 3 and 4, 1906. CHEMISTRY. 1. (1) Calomel, Hg 2 Cl 2 , dose one-twentieth of a grain to ten grains. (2) Chloral hydrate, CCl,CHO+H 2 0, dose twenty grains. 31 MEDICAL RECORD. "Editorials on subjects of timely Interest and of vital Im- portance dealt with In a masterly and scholarly style." (3) Potassium chlorate, KClOs, dose five to twenty grains. (4) Amyl nitrite, CsHnNOa, dose two to five minims (to be inhaled). (5) Bismuth subnitrate, BiONOs, dose five to thirty grains. 2. Epsom salt is magnesium sulphate, MgS04; Glauber's salt is sodium sulphate, Na 2 SO«; Rochelle salt is potassium sodium tartrate, KNaGEM)* 3. Potassium cyanide, tartar emetic, arsenic trioxide, potassium nitrate (saltpeter), and corrosive sublimate. The antidote for corrosive sublimate is the white of egg, or milk, followed by an emetic. 4. The nonmetallic elements found, in various combina- tions, in the tissues of the body are hydrogen, oxygen, fluorine, chlorine, iodine, sulphur, nitrogen, phosphorus, carbon, and silicon. 5. Urates are found in acid urine, have a pinkish color, dissolve on being warmed, and, microscopically, are gen- erally amorphous, but may be crystalline. Phosphates occur in alkaline urine, and do not dissolve on being heated. MATERIA MEDICA AND THERAPEUTICS. 4. Hemostatics are agents which, on being administered internally, arrest hemorrhage. Agents which act in this manner on being applied locally are called styptics. The former act by causing the vessels to contract; the latter sometimes in the same way and sometimes by promoting clot formation in the mouths of the wounded and bleeding vessels. Ergot, gallic acid, digitalis, hamamelis, and ipecac are hemostatics. As styptics may be named the actual cautery, acids, nitrate of silver, alum, collodion, and vege- table astringents. 5. B: Liquoris potassii arsenitis TTRxxx Tincturae nucis vomicae 3iss Aquae destillatae q.s. ad 3"i Misce, et signa. Shake the bottle. Take one teaspoon- ful in water, three times a day, after meals. PHYSIOLOGY. 1. The white blood cells are spheroidal masses, varying in size, having no cell wall, and containing one or more nuclei ; there are about 7,000 to 10,000 of them in each cubic millimeter of blood. They differ much in appearance, and are divided into (1) small mononuclear leucocytes, or 32 MEDICAL RECORD. " European correspondents furnish medical news of specia^ interest and reports of the principal foreign medical societies." lymphocytes, (2) large mononuclear, (3) transitional, (4) polynuclear, or polymorphonuclear, or neutrophile, and (5) eosinophile. They are all more or less granular, particu- larly the last two varieties named. They are probably formed in the spleen, lymphatic glands, and lymphoid tis- sues. Their fate is uncertain; it has been asserted that they are converted into red blood cells ; they play a part in the formation of fibrin ferment; they are sometimes converted into pus cells. Their functions are (1) to serve as a protection to the body from the incursions of patho- genic microorganisms ; (2) they take some part in the proc- ess of the coagulation of the blood; (3) they aid in the ab- sorption of fats and peptones from the intestine ; and (4) they help to maintain the proper proteid content of the blood plasma. 4. The volume of air taken into the body in an ordi- nary inspiration is about twenty-five to thirty cubic inches. As the air is a mixture and not a definite chemical com- pound it cannot be represented chemically. Roughly, the air inspired contains about twenty-one parts of oxygen and seventy-nine parts of nitrogen. Of this the nitrogen is expired again, and about 5 per cent, only of the oxygen is absorbed. PATHOLOGY. 4. In the typhoid ulcer (1) the main axis of the ulcer lies parallel with that of the intestine; (2) it lies opposite to the mesenteric attachment; (3) it has smooth floor and undermined edges; (4) it commonly leads to perforation. In tubercular ulcer (1) the Long axis of the ulcer lies at right angles to that of the intestine; (2) it is not neces- sarily situated opposite the mesenteric attachment; (3) its floor is not smooth nor are its edges undermined, but rather funnel-shaped and irregular ; (4) it is not apt to perforate, but it does not tend to heal, rather to spread. PRACTICE. 5. True croup is either laryngeal diphtheria or a strep- tococcus infection. In either case there is a prior stage of malaise, accompanied by chills, fever, and sore throat. The fever may become very high. A membrane forms, in which are found the Klebs-Loeffler bacillus or streptococci. Spasmodic croup generally comes on suddenly, at night. There is no appreciable fever, no previous malaise or sick- ness, and often the patient is asleep again by the time the physician arrives. There is frequently a thick tenacious 33 MEDICAL RECORD. "Nat a local Journal, but international In ita scope." mucus, but neither Klebs-Loeffler bacilli nor streptococci are present. It is entirely a local disturbance. OBSTETRICS AND DISEASES OF CHILDREN. 2. Pregnancy : the tumor is hard and does not fluctuate, is situated in the median line, and may give fetal heart sounds and movements; the cervix is soft, and the other signs of pregnancy are present. The rate of growth of the tumor, and the general condition of the patient's health may also help in arriving at a diagnosis. Ovarian cystoma : absence of the chief signs of pregnancy ; there may be the characteristic facies, the tumor is soft, fluctuating, is more to one side, and does not show fetal signs. Ascites : absence of the signs of pregnancy ; the abdomen is distended, but the shape varies with the position of the patient ; on lying down there is bulging at the sides ; the tumor fluctuates, and percussion shows dullness in the flanks, with resonance in the median line, but the dullness varies with the position of the patient. Uterine fibroid: menstruation is irregular and sometimes very profuse; absence of the signs of pregnancy; the tumor is nodular, firm, irregular in outline, and while generally placed somewhat centrally is not in the median line, and is not symmetrical; the rate of growth is irregular, being, as a rule, slow, and sometimes extending over years. 3. Braxton Hicks' sign of pregnancy is the rhythmical contraction of the walls of the uterus, lasting for from thirty to sixty seconds, and occurring at irregular intervals, of from five to about twenty minutes. It is always found in pregnancy, whether the fetus is alive or dead, but it is also found in some other conditions. It may be ob- tained by simply grasping the uterus through the abdom- intal wall ; this should be done gently, and without making pressure. STATE BOARD EXAMINATION QUESTIONS. Idaho State Board of Medical Examiners. October 2, 1906. SURGERY. 1. Spondylitis deformans : (a) How is it characterized? (b) Symptoms and pathology? 2. Bilateral dislocation of lower jaw: Give symptoms, causes, and treatment. Is the capsular ligament usually ruptured? 34 MEDICAL RECORD. Keeps you strictly abreast of the times." 3. Fracture through surgical neck, and head of humerus. Give diagnosis, treatment, exciting, and predisposing causes. 4. (a) From what source of blood supply is extradural hemorrhage due? Subdural? (b) What are the symptoms of general brain compression from hemorrhage? Give special symptoms. 5. Castration : (a) What are the indications for the removal of the testicles? (b) Describe the method of castration in aseptic and septic cases. 6. Strangulated Hernia: (a) What three conditions constitute a strangulated hernia? (b) Where is the seat of most marked pathologic changes? and why? (c) Give the local and general symptoms. 7. Describe the operation you would employ for ectro- pion. 8. Tracheotomy: (a) State methods employed in this operation. What is the after-treatment? (b) Which is the more dangerous and difficult, tracheotomy or laryn- gotomy, and why? 9. Suppurative otitis media: (a) In a mixed infection what bacteria are usually present? (b) What is the treat- ment indicated? 10. Cholecystotomy : (a) Give technique, position of patient, line of selection for incision; (b) how are stones from the duct removed? (c) What are the complications to be ascertained and removed? (d) What is the defini- tion of "Ideal" cholecystotomy? OBSTETRICS. 1. Give differential diagnoses of pregnancy. 2. On what signs is multiple pregnancy diagnosed? 3. Give treatment of pernicious vomiting of pregnancy. 4. Give five things to be observed by a pregnant woman. 5. How do you treat threatened abortion? 6. How secure asepsis in confinements as to external maternal parts? How maintain asepsis during labor? after labor? Why is a routine postpartum douche a bad prac- tice? Mention the indications for a postpartum douche. 7. Describe treatment for puerperal eclampsia. 8. Give treatment for placenta previa. 9. Define dystocia, hydrocephalus, funis, phlebitis, caput succedaneum, ectopic gestation, hyperemesis, polyhydram- nios, sapremia, gastrohysterotomy. 10. Forceps, (a) Indications for use; (b) conditions necessary for use; (c) describe preparation of patient; (d) use of anesthetic; (e) describe application of forceps and extraction of fetus. 35 MEDICAL RECORD. " The progressive physician must have his medical weekly Just as the business man his newspaper." PRACTICE. i. Describe three varieties of intestinal obstruction, and give the treatment in each case. 2. Give the etiology, symptoms, and treatment of ex- ophthalmic goiter. 3. Give the etiology, symptoms, and treatment of hay fever. 4. Make a differential diagnosis between ulcer and carcinoma of the stomach. 5. Give the etiology and treatment of chloasma. 6. Give etiology, symptoms, and treatment of cystitis. 7. Describe the symptoms and treatment of laryngismus stridulus. 8. Give the symptoms and treatment of aortic regurgita- tion. 9. Give the symptoms and treatment of spotted fever (tick fever) of the Rocky Mountains. 10. Describe the dietetic treatment of diabetes mellitus. GYNECOLOGY. 1. Name five primary causes of menorrhagia. Detail the treatment of the form due to subinvolution. 2. Name the varieties of dysmenorrhea. Give the treat- ment of mechanical dysmenorrhea. 3. Outline the treatment of gonorrheal endometritis. 4. Give the etiology and treatment of acute oophoritis 5. Make a differential diagnosis between fecal impac- tion and an inflamed ovary. 6. Give etiology, symptoms, and treatment of pelvic cellulitis. 7. Name the uses of the uterine sound. Enumerate contraindications and dangers attending its use. 8. Give etiology, symptoms, and treatment of vulvo- /aginal cyst. 9. Name five genital fistula?. 10. Describe symptoms and treatment of uterine car- cinoma. ANATOMY. 1. Bones. Name five foramina and give structures pass ing through them. 2. Muscles. Give origin and insertion of ten muscles. 3. Nerves. Give the distribution of the cranial nerves 4. Circulation. Give the blood supply of ten structures of the body. 5. Special, (a) Name three fissures of the brain, (b) 36 MEDICAL RECORD. "Range of subjects embraces every branch of medicine and surgery." What are the chordae tendinese? (c) Pineal body? (d) Describe the course of the vas deferens, (e) Locate corpus callosum. HISTOLOGY. 1. Name the three primary blastogenic layers. 2. Name the structures derived from each. 3. Describe the minute structure of the kidney. 4. Give variety of glands with example of each. 5. Define leucocyte, osteoblast, stroma, dentine, perios- teum, circumvallate papillae, Peyer's patches, discus pro- ligerus, zona pellucida, corpus luteum. DIAGNOSIS. r. What is meant by the term pathognomonic? Give four examples. 2. Give methods of handling sputum to determine, microscopically, if (a) tuberculosis exists; (b) pneumonia. 3. What would be the findings in an examination of the blood in pernicious anemia. 4. Differentiate the mitral lesions of the heart. 5. Differentiate the diseases of which dropsy is a symptom. 6. In what diseases are the following conditions found: (a) Clubbing of the fingers; (b) loss of patellar reflex; (c) Cheyne-Stokes respiration; (d) wrist-drop; (e) pain in the knee; (f) barrel-shaped chest; (g) Koplik's spots; (h) pain in testicle and glans penis; (i) Argyll-Robertson pupil; (j) strawberry tongue. 7. On what signs would you base a diagnosis of large left-sided pleural effusion without resorting to puncture? 8. Give the differential diagnosis between mastoiditis and acute inflammation of the middle ear. 9. Give diagnosis of acute cystitis in a female. 10. Differentiate intestinal colic from other lesions which might be mistaken for it. 1. Name some diseases, one attack of which ordinarily renders the subject immune from subsequent attacks. 2. Name and describe the principal chemical element! of food, giving the use of each class. 3. Indicate the proper diet in a case of diabetes mellitus, obesity, typhoid fever, tuberculosis. 4. What relation have certain insects to the cause and spread of disease? 37 MEDICAL RECORD Its prestige attracts articles by the best known writers. 5. Give some directions for the sanitary care of a small city. 6. What is the difference between an infectious and contagious disease? Name two of each class. 7. Give some directions for the disposal of sewage and other waste matter from farm houses, and the proper pro- tection of drinking water. 8. What is the influence of climate and altitude on health? 9. Name some diseases which may be to a large extent prevented by proper hygienic care. 10. What is the effect of alcohol upon the nerve cen- ters, upon the circulation? PHYSIOLOGY. 1. Describe the change that takes place in the eye in changing from far to near vision. 2. Describe the patellar reflex and state upon what its integrity depends. 3. Locate the moter centers of the brain. 4. What is the lymphatic system and what is its office? 5. Of what is the pancreatic juice composed and what part does it play in digestion? 6. How is inspiration accomplished? 7. Describe minutely the formation, elimination and passage of urine. 8. Give time and order of eruption of both temporary and permanent teeth. Tabulate, if you wish. 9. Name the different portions of the alimentary canal in order from mouth to anus. 10. What are the functions of the skin? CHEMISTRY AND TOXICOLOGY. 1. What are (a) carbohydrates? (b) proteids? 2. What is the difference between a physical and a chemical change? To which does the emulsification of fats belong? 3. Define organic and inorganic chemistry. 4. Starch (CeHjoOs), grape sugar (C 8 H 1S 6 ), alcohol (CsHaO). Show the chemical reaction and equivalents in the change of starch to grape sugar and of grape sugar to alcohol. 5. Give in detail two reliable tests for sugar in the urine. 6. Give chemical test for pus in the urine. 7. Give antidote for each of the following: (a) corrosive sublimate, (b) arsenicum, (c) silver nitrate, (d) iodine, (e) phosphorus. 38 MEDICAL RECORD. " Therapeutic Hints contain many valuable formulae by the foremost medical men in the world." 8. Give a reliable test for arsenic in contents of stomach. 9. In what class of poisons would you consider the stomach pump contraindicated? 10. What would you consider the maximum safe adult dose hypodermically of (a) atropine, (b) morphine, (c) strychnine, (d) apomorphia, (e) nitroglycerine? PATHOLOGY. 1. Micrococcus lanceolatus : (a) Describe process of staining, (b) What is its significance, and in what inflam- matory conditions is it often observed? 2. Describe the pathological changes that take place in the liver from the effects of chronic interstitial hepatitis. 3. What are the alterations or changes that take place in a muscle while undergoing progressive muscular atrophy? 4. Carcinoma of stomach: (a) Is it usually primary, or secondary to carcinoma elsewhere? (b) Where is it usually situated, and give most common type. 5. Tuberculous enteritis : (a) What particular parts are usually involved? (b) Describe the degenerative changes, (c) In which direction to the axis of the gut does ulcera- tion extend most rapidly? 6. Write the characters of the Bacillus anthracis, ray fungus, Bacillus typhosus. 7. (a) What is a thrombus? (b) What is thrombosis? (c) Describe the three changes that may take place in a thrombus. 8. What is your method of making a postmortem exami- nation? 9. What is understood by the terms pathological physi- ology, pathological morphology, special pathology? 10. The etiology of tumors, (a) What influence has age especially as to the connective-tissue type? (b) Sex, if a significant factor, denotes a predisposition to what? (c) Heredity, and local predisposing factors, (d) What proportion of malignant tumors in males compared to fe- males? MATERIA MEDICA AND THERAPEUTICS. I. Under what conditions would you prescribe, (a) ergot; (b) bromide of potassium; (c) iodine; (d) hyos- cyamus 2. Treat a case of apoplexy. 3. Name five sedatives and give indications for the use of each. 4. Give complete treatment for a case of dysentery. 39 MEDICAL RECORD. " Keeps you in closest touch with the weekly progress of medicine and surgery throughout the world." (£ Name four methods of introducing medicine into the system and give relative dose by each method. 6. Give classification, properties, dose, physiological action, and therapeutic use of Fowler's solution. 7. Same of belladonna. 8. Give treatment for vomiting of cerebral origin; (b) acute gastritis. 9. What are the therapeutic uses of iron? 10. Give official terms, the part used, and the active principles of deadly nightshade, henbane, foxglove, monks- hood, dogbutton. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Idaho State Board of Medical Examiners. October 2, 1906. 1. "Spondylitis deformans is the name given to a disease which affects the vertebral column, and is the same, or of the same nature, as that termed 'chronic rheumatic arthritis' when affecting other parts. As a consequence of absorp- tion of the articular cartilages and of the intervertebral discs, and the development of osteophytic prominences from the edges of the vertebral bodies, and ossification of the ligaments, especially the anterior common ligament, the spine becomes bent and rigid, and a very characteristic de- formity is the result. "Kyphosis is produced, and as the disease frequently affects the whole or major part of the column, there is one long antero-posterior curve, the patient has a constant stoop, his stature is diminished, there is complete rigidity of his spine, and his movements are awkward and con- strained. In lesser grades of the disease the cervicodorsal or the lumbodorsal regions may be alone affected, and the signs are less pronounced. With advance of the disease the spinal muscles waste, and the curvature becomes more prominent, the head is poked forward, the shoulders appear unusually round, and the patient is obliged to sup- port himself with a stick." (Treves' Manual of Surgery.) 2. As a rule the capsular ligament is not ruptured. 4. (a) Extra-dural hemorrhage is generally from the middle meningeal artery or one of its branches, or the su- 40 MEDICAL RECORD. " Surgical Suggestions that will appeal to the student and the general practitioner." perior longitudinal, lateral, or occipital sinus ; occasionally it is from the internal carotid artery. Sub-dural hemorrhage is generally from the middle men- ingeal artery or one of its branches, small veins, capillaries, or one of the sinuses. (b) "If after an injury to the head a patient be found absolutely unconscious, it being imposible to arouse him or to make him answer questions, with fixed dilated pupils, slow, deep, stertorous breathing with flapping of the cheeks during expiration, slow, full, labored pulse, retention of urine and involuntary passage of feces, and paralysis, gen- eral or of one side of the body only, these symptoms are caused by compression of the brain. ... If the symp- toms have come on gradually and at short intervals after the accident ''an interval during which the patient may have been quite conscious, or showing more or less evidence of brain concussion), or if while under observation it be noted that the signs of compression are increasing, the coma be- coming more deep and the paralysis more extensive, it clearly indicates intracranial hemorrhage. When there has been an interval of consciousness between the injury and the oncoming of the symptoms of concussion, showing that the brain has not been seriously shaken or contused ; and, further, if the paralysis is or was at first unilateral, we may diagnose that the hemorrhage has taken place betweeen the bone and the dura mater from rupture of a meningeal artery or wound of a sinus ; while under the other con- ditions we have evidence of more severe direct injury to the brain, making it probable that the blood clot is situated on or in the brain." (Gould's Surgical Diagnosis.) 5. The indications for castration are: — malposition of the testicle, tuberculous disease, old standing hematocele, cancer, or other tumors, and chronic enlargement of the prostate gland. 6. (a) The three conditions which constitute a strangu- lated hernia are: 1. A constriction so tight that reduction is impossible; 2. Interference with the circulation, which may possibly lead to gangrene; 3. If intestine is present, gas and feces are unable to pass. (b) The most marked pathological changes are found inside the sac — on account of pressure and the interference with the circulation. 8. (b) Tracheotomy is the more dangerous and diffi- cult operation as a rule, it takes longer, and requires more assistance. But laryngotomy cannot be performed on a 41 MEDICAL RECORD. "We publish the proceedings of an association immediately after the meeting." patient under thirteen years of age owing to the smallness of the crico-thyroid membrane; it is also more difficult to insert a laryngotomy tube than a tracheotomy tube. 9. (a) The Staphylococcus pyogenes aureus and albus, Streptococcus pyogenes; sometimes the tubercle bacillus, bacillus of influenza, Friedlander's bacillus, Fraenkel's pneumococcus. 10. (d) Ideal cholecystotomy is an operation which in- cludes opening the gall-bladder, removing the calculi, and suturing the incision. OBSTETRICS. 2. Multiple pregnancy may be diagnosed by the follow- ing signs: (1) The abdomen may be irregular in shape and may show a sulcus indicating the space between the two fetal sacs; (2) persistent and increased tension of the uterine walls; (3) two fetal heart sounds may be heard; (4) multiplicity of small parts; (5) two fetal heads or backs may be palpated; (6) diminished fetal mobility Sometimes it is difficult to diagnose the condition before the birth of one child. 4. (1) The diet should be easily digestible and nutritious; (2) the clothing should be warm, and free from con- strictions; (3) gentle and moderate exercise should be in- dulged in, if possible in the open air; (4) the bowels and bladder should be kept properly regulated; (5) sexual inter- course should cease. 5. Absolute rest in bed, with head lowered, and in a darkened room; opium or chloral should be administered; the diet should be liquid ; the bowels and bladder should be attended to; if the hemorrhage is excessive the pelvis may be elevated ; but ergot and tampons are contraindicated. 9. Dystocia means difficult or obstructed labor. Hydrocephalus is a condition in which there is marked enlargement of the head ducts to serous effusion within the cranium. Funis is the umbilical cord. Phlebitis is an inflammation of the veins, generally septic. Caput succedaneum is an edematous swelling developed on the presenting part of the fetus during birth. Ectopic gestation is a pregnancy in which the fetus is elsewhere than in the uterine cavity. Hyperemesis is an extreme and exaggerated condition of nausea and vomiting. Polyhydramnios is an increased amount of liquor amnii. MEDICAL RECORD. " Choice and important abstracts from the leading medical periodicals of the world in a condensed and practical form." Sapremia is a septic condition due to the entrance into the blood of the products of putrefactive bacteria. Gastrohysterotomy is another name for cesarean sec- tion, or the delivery of a fetus through an incision in the walls of the abdomen and the uterus. 10. (a) Indications for the use of forceps are, : "i. Forces at fault : Inertia uteri in the presence of con- ditions likely to jeopardize the interests of mother or child, (a) Impending exhaustion; (b) arrest of head, from feeble pains. 2. Passages at fault: Moderate narrowing, 2> X A to zYa inches, true conjugate; moderate obstruction in the soft parts. 3. Passenger at fault: A. Dystocia due to (a) occipito-posterior, (b) mento-anterior face, (c) breech ar- rested in cavity. B. Evidence of fetal exhaustion (pulse above 160 or below 100 per minute). 4. Accidental compli- cations : Hemorrhage ; prolapsus funis ; eclampsia. All acute or chronic diseases or complications in which imme- diate delivery is required in the interest of mother or child, or both." (From Jewett's Practice of Obstetrics. (b) Conditions necessary for the use of forceps are: (1) The rectum and bladder must be empty; (2) the os uteri must be fully dilated; (3) the membranes must be rup- tured; (4) the pelvis must be of sufficient size. PRACTICE. 4. Ulcer of stomach is generally caused by injury or bacteria, is most apt to occur between the ages of twenty and forty-five; after eating there is pain localized in the stomach, vomiting occurs soon after eating, hematemesis is common, there is localized tenderness over the stomach, and examination of the gastric contents shows an excess of free HC1. Cancer of stomach does not usually occur before forty years of age, is more common in males, the pain is local- ized and constant, vomiting is copious and occurs some- time after eating; the vomitus contains "coffee ground" material; hemorrhages are common; a tumor may be pal- pated, and examination of the gastric contents shows ab- sence of free II CI and presence of lactic acid; there is pro- gressive emaciation ; severe anemia and cachexia are also present. 5. The etiology of chloasma is unknown. The pigmen- tation may be due to the chemical action of the rays of the sun upon the constituents of the blood ; another theory is that it is due to extravasated blood undergoing changes; there is also a relation between chloasma uterinum and the 43 MEDICAL RECORD. " Our reporters attend every convention of first rate im- portance. The news is telegraphed or cabled exclusively to the MEDICAL RECORD." uterus, as is shown by the fact that the chloasma usually disappears either after parturition, the cure of the uterine disorder, or the attainment of the menopause. The treatment is unsatisfactory. If possible remove the cause. Glacial acetic acid, or bichloride of mercury in one or two per cent, solution may remove the spots, but they are apt to return. Pure carbolic acid applied with a swab has been recommended. The part may be washed with alcohol, and a mercurial plaster applied. (From Jack- son's Diseases of the Skin.) 7. The symptoms of laryngismus stridulus are: The child holds his breath, the face becomes congested and cyanotic, the glottis is closed, inspiration is suddenly arrested, and ends in a shrill crowing sound ; there may be spasms or convulsions ; the attack is sudden, and may be repeated ; there is no fever, coryza, nor cough. Treatment: Cold water should be dashed on the face and chest; ammonia may be applied to the nostrils; an emetic may be administered, bromides or chloral should be given ; attention must be paid to the diet and general hygiene of the child. 8. The symptoms of aortic regurgitation are: Palpi- tation on slight exertion; dsypnea, headache; dizziness with faintness, most marked on rising quickly; precordial pain; the apex-beat is displaced downward and to the left; the heart is hypertrophied ; there is a diastolic murmur over the aortic area; pulsation is observed in the carotids; the oulse has the water-hammer characteristic. 9. Symptoms of tick fever of the Rocky Mountains: "There is a period of incubation of about a week. The patient complains of nausea, general malaise, and a chill; this latter is followed by a fever which reaches its highest point about the tenth day, is characterized by evening rise and morning remissions, lasts about two weeks, and may be followed by subnormal temperature. In severe cases the morning remissions may be absent, and the fever re- mains high (from 104 to 106 F.). There are general pain and soreness, particularly during the first week, coated tongue with red edges, sordes, constipation, nausea which persists in severe cases, scanty urine with albumin and casts, and epistaxis. The liver and spleen may be en- larged. The pulse is high, and out of all proportion to the fever; the respiration is also increased. An examina- tion of the blood shows (1) the parasite, (2) a decrease in the percentage of hemoglobin, (3) a decrease in the MEDICAL RECORD. " Bulletins of Examinations of State Medical Licensing Boards published bi-w e ekly." number of the red blood cells, (4) a slight leucocytosis, chiefly of the large mononuclears. Bronchitis is present dur- ing the second week; and in severe cases lobar pneumonia supervenes, with a grave prognosis. "'The eruption appears usually on the third day, first on the wrists and ankles, then on arms, legs, forehead, back, chest, and, last and least, on the abdomen. It is never very abundant on the abdomen, but the other por- tions of the body, in some cases, are literally covered by the eruption. "At first the spots are of a bright red color, macular at all times, from a pin point to a split pea in size. At first they disappear readily on pressure and return quickly; but if the case is a severe one they soon become darker and in some cases are almost purple. From about the sixth to the tenth day of the disease they fail to disap- pear on pressure and are distinctly petechial in character. In favorable cases, about the fourteenth day, they begin to lose their petechial character and disappear slowly on pressure. In some cases the eruption consists of small, brownish spots, giving a turkey-egg appearance. "As the fever declines the eruption begins to fade ; but a slight return of fever or a free perspiration will cause it to show distinctly." "Treatment is unsatisfactory. Quinine in large doses has been tried with some success, but must be given persist- ently. The treatment is otherwise symptomatic and in- cludes cardiac stimulants, Dovers' powder for the pains and soreness, tepid baths for the fever, and plenty of water to flush out the kidneys. The site of the tick-bite should be cauterized with 95 per cent, carbolic acid." (From Reference Handbook of the Medical Sciences.) 10. The dietetic treatment of diabetes mellitus: "All sugars should be rejected. The same is true of starches. Bread is the most difficult of foods to deal with. The purer gluten flours may be used, but they are difficult to obtain. Aleuronat or almond flour may be . substituted. Most meats and fish are permissible, and the greens and relishes may be taken freely. Farinaceous foods and pota- toes or other vegetables rich in carbohydrates must be avoided. Eggs, butter, cheese, and milk are allowed. Sac- charm may be used in place of sugar for sweetening. "The chief articles prohibited are liver, wheat bread, corn flour, rice, sago, arrow-root, barley, oatmeal, tapioca, macaroni, puddings, beet root, sweet vegetables, potatoes, carrots, peas, beans, parsnips, turnips, all sweet fruits, ap- 45 MEDICAL RECORD. The MEDICAX RECORD publishes no " Students' Number," for every Issue is a students' number and a practitioners' number in one. pies, pears, plums, grapes, oranges, apricots, peaches, gooseberries, dates, watermelon, sweet wines, cordials, porter, lager beer, cider, mustard, honey, sweets, ices, jams, treacle." (Gould and Pyle's Cyclopedia of Medicine and Surgery.) GYNECOLOGY. i. Five primary causes of menorrhagia : Tumors, uter- ine displacements, endometritis, tubal and ovarian diseases, and subinvolution. 2. The varieties of dysmenorrhea are : Congestive, neuralgic, obstructive, ovarian, and membranous. 3. Dilatation of the cervix ; curettage ; the uterine cavity is then to be flushed out with some antiseptic solution, and then swabbed with iodine or carbolic acid to prevent reinfection; the patient must remain in bed for from seven to ten days after the operation. 5. In fecal impaction there will be a history of consti- pation ; a vaginal examination will also demonstrate the presence of this condition; active purgation will clear up any doubt on the subject. 7. The uses of the uterine sound are: (1) To demon- strate the mobility of the uterus; (2) to show the size of the uterus ; (3) the presence of intrauterine growths ; (4) deviations in the cervical canal; and (5) as an aid in the diagnosis of uterine displacements. Contraindications: (1) The least suspicion of even the possibility of pregnancy; (2) menstruation; (3) acute endometritis; (4) malignant disease of the uterus or vagina; (5) acute pelvic inflammation. Dangers: (1) Abortion; (2) sepsis; (3) peritonitis; (4) hemorrhage; (5) perforation of the uterus. 9. (1) Vesicovaginal; (2) rectovaginal; (3) vesico- uterine; (4) urethrovaginal; (5) vesicouterovaginal. 10. Symptoms of uterine carcinoma : Irregular hem- orrhages, pain, and offensive discharge ; advancing years ; microscopic examination of intrauterine scrapings will clinch the diagnosis. Treatment: Complete abdominal hysterectomy, unless contraindicated by the debilitated condition of the pa- tient. ANATOMY. 1. (1) Foramen magnum: The medulla and its mem- branes, vertebral arteries, spinal accessory nerves, anterior 46 MEDICAL RECORD. Save and bind your numbers; it will give you two great medical encyclopedias every year. and posterior spinal arteries, and the occipitoaxial liga- ment. (2) Jugular foramen: Inferior petrosal sinus, lateral sinus, meningeal branches of occipital and ascending pharyngeal arteries ; glossopharyngeal, pneumogastric, and spinal accessory nerves. (3) Inferior dental foramen: Inferior dental vessels and nerve. (4) Foramen rotundum : Superior maxillary division of fifth cranial nerve. (5) Foramen ovale: Inferior maxillary division of fifth cranial nerve. 5. (a) Fissure of Rolando; fissure of Sylvius; parieto- occipital fissure. (b) The chorda tendinea are tendinous cords attached above to the segments of the tricuspid and mitral valves, and below to the musculi papillares of the ventricles of the heart. (c) The pineal body is a small conical body situated in the brain, between the anterior corpora quadrigemina and immediately behind the posterior commissure. (d) The vas deferens begins at the lower part of the globus minor of the testis and proceeds along the posterior border of the testis and inner side of the epididymis, alon? the back part of the spermatic cord, through the ex- ternal abdominal ring, inguinal canal, and the internal ab- dominal ring. It then curves round the outer side of the epigastric artery, crosses the external iliac vessels, and goes to the side and base of the bladder, passing to the inner side of the ureter. It lies between the base of the bladder and the rectum. (e) Corpus callosum is situated at the anterior part of the base of the great longitudinal fissure of the cere- brum, and connects the two hemispheres together. DIAGNOSIS. 1. Pathognomonic is a term applied to signs and symp- toms which are specially characteristic of a disease, and the presence of which makes its diagnosis absolute. Examples: (1) Escape of cerebrospinal fluid in frac- tures of the base of the skull; (2) Koplik's spots in measles; (3) hearing the fetal heart sound in pregnancy; (4) water-hammer or Corrigan's pulse in aortic regurgita- tion. 3. In pernicious anemia the blood would show: (1) A diminution in the number of red corpuscles; (2) a rela- 47 MEDICAL RECORD. "New instruments are portrayed and their use thoroughly explained." tive increase in the amount of hemoglobin; (3) poikilo- cytosis; (4) the presence of nucleated red cells; (5) variation in the size of the red cells; (6) the leucocytes may be diminished. 6. (a) Clubbing of the fingers is found in pulmonary phthisis, emphysema, pulmonary osteoarthropathy, valvu- lar cardiac disease (sometimes). (b) Loss of patellar reflex, in locomotor ataxia, anterior poliomyelitis, peripheral neuritis. (c) Cheyne-Stokes respiration, in apoplexy, uremia, cere- bral tumors, tuberculous meningitis. (d) Wrist drop, in lead, or arsenic, or alcohol poison- ing, multiple neuritis, pressure from crutches, etc. (e) Pain in the knee, in hip joint disease, obturator her- nia. (f) Barrel-shaped chest, in emphysema, chronic bron- chitis, bronchial asthma. (g) Koplik's spots, in measles. (h) Pain in testicle and glans penis, in renal calculus. (i) Argyll-Robertson pupil, in locomotor ataxia, cerebral syphilis, progressive paralysis of the insane, (j) Strawberry tongue, in scarlet fever. 1. As a rule one attack of the following diseases con- veys immunity: Whooping cough, rotheln, scarlet fever, typhoid, typhus, smallpox, varioloid, chickenpox, yellow fever, mumps. 4. Malaria and yellow fever are transmitted by the mosquito; bubonic plague may be conveyed by fleas, flies, and bugs ; typhoid may be conveyed by flies ; tick fever (or spotted fever) is carried by the tick; sleeping sickness is generally transmitted by a biting fly. 9. Typhoid, tuberculosis, smallpox, cholera, yellow fever, ophthalmia neonatorum. PHYSIOLOGY. 1. In accommodating the eye for near vision the ciliary muscle contracts, the suspensory ligament relaxes, and the lens bulges and becomes more convex. 2. The patellar reflex consists of a contraction of the extensor muscles of the leg and a movement of the foot forward when the ligamentum patella is struck; the quad- riceps extensor must first be slightly stretched by putting one knee over the other. Its integrity depends upon a healthy condition of the entire reflex arc, consisting of MEDICAL RECORD. " The medical profession have been presented with the re- sults of great discoveries by the 3IEDICAL KECOKD in ad- vance of any other publication." tendon, afferent or sensory nerve, posterior roots, and anterior horn of the spinal cord, the efferent or motor nerve, and the muscle itself. 10. The functions of the skin are : Protection, sense of touch, excretion, regulation of body temperature, ab- sorption, and respiration. CHEMISTRY AND TOXICOLOGY. i. (a) Carbohydrates were formerly defined as sub- stances of unknown constitution, composed of carbon, hydrogen, and oxygen; the last two being in the propor- tion to form water. (b) Proteids are substances of very complex compo- sition and of unknown constitution, and are necessary to the phenomena of life. The molecule contains carbon, hydrogen, oxygen, nitrogen, sulphur, and sometimes phos- phorus, iron, or some other element. 2. In a physical change the composition of the sub- stance is not altered. In a chemical change the compo- sition of the substance is altered. The emulsification of fats is a physical change. 3. Organic chemistry is the chemistry of substances which contain carbon. Inorganic chemistry is the chem- istry of substances which do not contain carbon. 4. (1) C.H M 0.+H,0=C.H 11 0.. (2) C.H„0.=2CO,+2C,H.O. 5. The urine should first be tested for albumin. If this be present, it should be removed by heatinc the urine to near the boiling point, and filtering from the coagulum. (1.) Fehling's test: Place in a test-tube a few c.c. of the liquid prepared as stated below, and boil ; no reddish tinge should be observable, even after five minutes' repose. Add the liquid under examination gradually, and boil after each addition. In the presence of sugar a yellow or red precipi- tate is formed. In the presence of traces of glucose, only a small amount of precipitate is produced, which adheres to the glass, and is best seen when the blue liquid is poured out. [The reagent must be kept in two solutions, which are to be mixed immediately before use. Solution I consists of 34.653 gms. of crystallized CuSO«, dissolved in water to 500 c.c; and Solution II of 130 gms. of Rochelle salt dis- solved to 500 c.c. in NaHO solution of sp. gr. 1.12. When required for use equal volumes of the two solutions are mixed, and the mixture diluted with four volumes of writer.] 40 MEDICAL RECORD. " The most important and Interesting items of th« very latest medical news throughout the world." (2.) Boettger's test: Render the urine strongly alkaline by addition of Na 2 COs. Divide about 6 c.c. of the alkaline liquid in two test-tubes. To one test-tube add a very minute quantity of powdered subnitrate of bismuth, to the other as much powdered litharge. Boil the contents of both tubes. The presence of glucose is indicated by a dark or black color of the bismuth powder, the litharge retaining its natural color. (From Witthaus' Essentials of Chem- istry.) 6. Chemical test for pus in the urine: Acidify the urine with acetic acid, then filter it, and treat the filter with a few drops of freshly prepared tincture of guaiacum ; a deep blue color denotes the presence of pus. 7. The antidote for (a) corrosive sublimate is white of egg, in not too great a quantity; for (b) arsenicum is freshly prepared ferric hydroxide; for (3) silver nitrate is salt and water and white of egg; for (4I iodine is starch solution and emetics; for (5) phosphorus is old French oil of turpentine. 8. Test for arsenic : Reinsch's test is as follows : To the suspected fluid add a little pure HC1 ; suspend in the fluid a small strip of bright copper foil, and boil. If a deposit forms on the copper, remove the copper, wash it with pure water, dry on filter paper, but be careful not to rub off the deposit. Coil up the copper, and put it into a clean dry glass tube, open at both ends, and apply heat at the part where the copper is. If arsenic is present there will ap- pear in the cold part of the tube a mirror, which will be found on microscopical examination to consist of octa- hedral crystals of arsenic trioxide. 9. The stomach pump is contraindicated when cor- rosives have been taken. PATHOLOGY. 1. The Micrococcus lanceolatus is better known as the Diplococcus lanceolatus, or the pneumococcus of Fraenkel and Weichselbaum. (a) Process of staining: Spread a cover glass with a smear containing the bacteria, dry it, then fix it in a flame. It can then be stained for from five to ten minutes in Ehrlich's solution ; it is then to be washed in water and afterwards immersed in Gram's solution for two or three minutes. It is then washed in 95 per cent, alcohol. While in the Gram's solution the specimen is very dark brown, but it becomes violet or blue again on application of the alcohol. (b) It is found in lobar pneumonia; it has also been 50 MEDICAL RECORD. " Since 1890 the MEDICAL RECORD has had a cabled report of every International aiedical Congress." found occasionally in cerebrospinal meningitis, pleurisy, peritonitis, pericarditis, acute abscesses, otitis media, and other conditions. 3. The alterations or changes that take place in a muscle while undergoing progressive muscular atrophy are as follows: "The muscles become pale and rather flabby. Microscopically the fibers show various forms of degener- ation. Fragmentation in a longitudinal or in a transverse direction, coagulation necrosis, and occasionally fatty de- generation of the fibers may be seen. Sometimes the fibers seem to grow smaller by a simple atrophic process. Coin- cidently reactive proliferation is seen in the connective tissue between fibers, and doubtless this to some extent causes further muscular degeneration. The muscle cells themselves may proliferate quite extensively." (Stengel's Pathology.) 4. Carcinoma of the stomach (a) is usually primary. (h) It is usually situated at or near the pylorus, and the most common type is the cylindrical celled adenocar- cinoma. 5. According to Osier, "The affection begins in the soli- tary and agminated glands or on the surface of or within the mucosa. The caseation and necrosis lead to ulceration, which may be very extensive and involve the greater per- tion of the mucosa of the large and small bowels. In the ileum the Peyer's patches are chiefly involved, and the ulcers may be ovoid, but in the jejunum and colon they are usually round or transverse to the long axis." 7. (a) A thrombus is a plug or clot in a blood-vessel remaining at the site of its formation. (b) Thrombosis is the coagulation of the blood within the vessels or heart during life. The changes that may take place in a thrombus are : Organization, calcifica- tion, softening, infection, and putrefaction. 9. Pathological physiology is that branch of science which deals with the study of disturbances of function. Pathological morphology is that branch of science which deals with the study of the structural changes in disease. Special pathology deals with pathological processes in individual or special diseases, or organs or parts. 10. Tumors: (a) Connective tissue tumors are most common in early life when the connective tissues grow most vigorously. (b) Sex has little bearing on the etiology of tumors, except in the case of cancer, which is more common in females. 5i MEDICAL RECORD. " Book reviews of foreign and American publication! keep you thoroughly informed of the newest literature." (c) Heredity is considered by some to be an etiological factor; but the more probable view is that the predispo- sition to tumors and the weakened resistance of the tissues are hereditary. Local predisposing factors are slight. Places where various different embryological structures meet are the most liable to malignant tumors. (d) Malignant tumors are more common in females than in males. MATERIA MEDICA AND THERAPEUTICS. 5. By mouth, by hypodermic injection, by rectum, and by inhalation. If the dose by mouth is one grain, the hypodermic dose would be about one-half a grain, and the dose by rectum about one and a half grains. io. — Official Name. Part Used. Active Principle. Deadly night shade. Henbane Foxglove Monkshood. . Dogbutton.. Atropa Belladon- na. Hyoscyamus Ni- ger. Digitalis Purpurea Aconitum Napel- lus. Strychnos nux vomica. Leaves and root Leaves and flow- Root. Seeds. Atropine and Bella- donnine. Hyoscyamine and Hyoscine. Digitalin, Digitalein, Digitin, Digitonin and Digitoxin. Aconitine. Strychnine and Bru- cine. STATE BOARD EXAMINATION QUESTIONS. Illinois State Board of Health. October 17-19, 1906. ANATOMY. or varieties of 1. Name the three principal forms fibrous connective tissue. 2. Of what layers does the blastodermic membrane con- sist? 3. Name the membranes investing the fetus. From what is each of them developed? 4. With what bones does the astragalus articulate? 5. From where are the cerebral arteries derived and what remarkable anastomosis is formed by these arteries? 6. What is the use of the right ventricle of the heart? What is the use of the left one? 52 MEDICAL RECORD. "The most important contributions to the literature of medicine and surgery have been published first in the MEDI- CAL RECORD." 7. What is the origin, insertion, action, and nerve sup- ply of the rectus femoris muscle? 8. What ligaments connect the os innominatum and the femur? 9. What is the general nerve supply of all the viscera in the abdominal cavity? _ 10. What main branches are given off by the external iliac artery? PHYSIOLOGY. 1. Describe circulation of lymph. 2. What ferments are found in the intestinal juice and give their action. 3. Name the bile salts. Name the bile pigments. 4. Name salivary glands and their ducts. 5. Give the blood supply of the stomach. 6. Give composition of blood and amount found in the body. 7. Describe the pancreas and name its secretions. MATERIA MEDICA AND THERAPEUTICS. 1. Name four cardiac depressants and explain mode of action and therapeutic uses of one of them. 2. Name two vasodilators and give therapeutic indica- tions. 3. Name one drug which dilates and one which con- tracts the pupil, mode of action and uses of each. 4. Give derivation, physiological action, dose and thera- peutic uses of pilocarpin. 5. Physiological action and therapeutic uses of quinine. 6? Name one urinary antiseptic, give dose and thera- peutic uses and indication. 7. Name one immunizing serum, dose, mode of admin- istration arid indication for use. &.• In case of general venous engorgement, what drugs would you employ and why? 9. Give action of absorbable metal upon the circula- tion ; name one and explain its therapeutic uses. 10. Name three diuretics. Explain mode of action and give uses of one of them. CHEMISTRY. i. Complete this formula: FeS4-H,SO«= 2. Complete this formula, give name of compounds and resultant compound: Mno 2 +¥{SO t -\-2UC\=MnSO t -\- 53 MEDICAL RECORD. " Statistics of the health boards and many articles of scien- tific interest and items of general information." Why do urates form deposits in joints and cartil- ages 4. Of what elements are albuminoids principally com- posed? 5. What is the normal amount of urine in twenty-four hours? State the average specific gravity of normal urine and its variations under various conditions. PATHOLOGY. 1. What are the pathological changes met with in en- terocolitis? 2. Give the pathology of cirrhosis of the liver. 3. Give the pathology of chronic gastritis. 4. Describe the structural changes that occur in tuber- cular joints. 5. What pathological conditions give rise to aphonia? BACTERIOLOGY. 1. Describe fully the Klebs-LoefHer bacillus, giving its characteristics and methods of staining. 2. Describe the microorganism commonly present in characteristic lobar pneumonia. 3. Describe the gonococcus of Neisser, also give the media upon which it grows. 4. Give fully the procedure adopted in carrying out the Widal test. 5. What bacteria are associated with inflammation and suppuration ? ETIOLOGY AND HYGIENE. i. Name three diseases caused by specific microorgan- isms, and name the microorganisms causing such. 2. What is the etiology of eclampsia? 3. Describe the principal methods by which tuberculosis is spread. 4. How do you manage a case of scarlet fever in order to prevent the spread of the disease? 5. How do we determine whether a certain organism is or is not pathogenic? PRACTICE OF MEDICINE. 1. Diagnosis and medical treatment of ulcer of stom- ach. 2. Give the etiology, symptoms, signs, prognosis, and treatment of cirrhosis of the liver. 3. Give the etiology, symptoms, signs, dangers, and treatment of general arteriosclerosis. 54 MEDICAL RECORD. " The only American medical journal that prints a detailed report of the British aiedical Association." 4. Give the etiology, symptoms, signs, dangers, and treatment of thrombophlebitis of femoral vein. 5. Give the etiology, symptoms, prognosis, and treatment of bronchial asthma. 6. Give the diagnosis, dangers, and treatment of nasal diphtheria. 7. Give danger and treatment of pulmonary hemorrhage from lungs as complication of pulmonary tuberculosis. 8. Give etiology, symptoms, complications, and treat- ment of acute articular rheumatism. 9. Diagnosis and treatment of diabetes. 10. Give diagnosis and treatment of myxedema. NEUROLOGY. 1. Give the diagnosis of paralysis agitans. 2. Give the diagnosis and treatment of neurasthenia. 3. Give the diagnosis of epilepsy. SURGERY. 1. What is a carbuncle? Where is it usually situated? Give treatment. 2. What are the indications for amputation in gangrene of an extremity? 3. What are the cardinal symptoms of luxation or dis- location? What complications may attend dislocations and how is each met? 4. Give the etiology, usual termination, and treatment of local periostitis. 5. What conditions may give rise to continued symp- toms after complete reduction of hernia? 6. Outline two methods of operative treatment for in- ternal hemorrhoids. 7. Give etiology, symptoms, and treatment for epi- didymitis. 8. Describe the preparation of a patient for abdominal section from two days before to the time of incision. 9. Give the etiology, symptoms, and treatment of hydro- cele of the tunica vaginalis testis. 10. Describe an operation for the treatment of tuber- culous cervical adenitis. OBSTETRICS. 1. Define the terms uterine souffle, funic souffle, fetal shock. Tell the cause of each. 2. Discuss the use of douches, or antiseptic douches, during pregnancy, giving their advantages and disadvan- tages and their indications and contraindications. 55 MEDICAL RECORD. " Special reporters in England, France, Germany, Austria, Turkey, Denmark, the Philippines, and the leading cities of the United States and Canada." 3. Describe the management of second stage of normal labor. 4. Give the symptoms, prognosis, and treatment of eclampsia. 5. Give the diagnosis of ectopic pregnane}'. 6. Give the causes and treatment of inertia uteri or de- layed labor. 7. What is the management of delay in labor due to impaction of the presenting breech? 8. Name at least three diseases in the fetus causing increase in size which may delay or interfere with labor. 9. Name the varieties of placenta prsevia. What is the treatment of placenta prsevia after the fetus is viable? 10. Give the etiology and treatment of post partum hemorrhage. GYNECOLOGY. 1. Differentiate between a partial inversion of the uterus and a polypus of the uterus. 2. Give the etiology, symptoms, and treatment of a vesicovaginal fistula. 3. Give the etiology, symptoms, and treatment of pelvic peritonitis. 4. Give the nonsurgical treatment for inflammation of the uterine appendages. 5. What dangers may arise when an ovarian tumor is complicated by a pregnancy? Give treatment. 6. Discuss the systemic, topical, and surgical treatment of chronic endometritis. LARYNGOLOGY AND RHIN0LOGY. 1. Give the characteristic lesions in tubercular laryn- P tis - . . . 2. Give pathology of acute rhinitis. MEDICAL JURISPRUDENCE. 1. Differentiate between melancholia and mania. 2. Define and illustrate delusion, illusion, and hallucina- tion. PHYSICAL DIAGNOSIS. 1. Give differential diagnosis between lobar pneumonia and pleurisy with effusion. 2. What is hydronephrosis? Give cause. 3. What valvular lesion would be indicated by murmur loudest at apex and during systole of heart? ,S6 MEDICAL RECORD. " Our reporters attend every convention of first-rate im- portance. The news is telegraphed or cabled exclusively to the MEDICAL RECORD." 4. Give diagnostic symptoms of hydrothorax and pyo- thorax, differentiating the two conditions. 5. Give definition of ascites. Under what conditions does it occur? OPHTHALMOLOGY AND OTOLOGY. 1. Give the etiology and treatment of plastic iritis. 2. What is the diagnostic value of the tuning fork in otology? 3. Name ten frequent causes of deafness. PEDIATRICS. 1. How do the symptoms of malarial infection in young children differ from the same in adults and older children, and at what age are these symptoms found to dif- fer? 2. What in your opinion is the chief danger that may occur either as a complication or a sequel to: (a) scarlet fever, (b) measles, (c) rheumatism, (d) whooping-cough? ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Illinois State Board of Health. October 17-19, 1906. 3. The membranes investing the fetus are: (1) the amnion, derived from the ectoderm and mesoderm; (2) the chorion, derived from the ectoderm and mesoderm, and (3) a thin layer of the placenta, derived from the maternal uterine mucosa. PHYSIOLOGY. I. The lymphatic circulation is, strictly speaking, not a circulation at all, since the lymph flows only in one direc- tion, namely, toward the heart. The lymph capillaries take up any excess of the blood plasma which is not required for the nutrition of the tissues. These capillaries consist of a single layer of epithelium, and empty themselves into vessels very like the veins. The lymph vessels are well provided with valves, which are so closely approximated a3 to give the vessels a beaded appearance. All the lymphatic vessels, except those of the right upper half of the body, empty into the thoracic duct, which terminates in the left 57 MEDICAL RECORD. " Original Articles are of the highest scientific value and most practical character, by the foremost men of the world." subclavian vein, where the left internal jugular vein also enters. Those from the right upper half of the body dis- charge into the right lymphatic duct, which, in turn, empties into the right subclavian vein at its junction with the right internal jugular vein. 3. The bile salts are sodium glycocholate and sodium taurocholate. The bile pigments are bilirubin, biliverdin, and urobilin ; in gallstones there may be found, in addition, bilifuscin, biliprasin, bilihumin, and bilicyanin. 7. The secretions of the pancreas are the pancreatic juice and an internal secretion. MATERIA MEDICA AND THERAPEUTICS. 9. Mercury is an absorbable metal. Its action on the circulation: In small doses it has a tonic effect; in larger doses it diminishes the number of red-blood cells, impover- ishes the blood, and thus upsets the digestion, and dis- turbs the general nutrition of the body. CHEMISTRY. 1. FeS + H 2 S0 4 = H,S + FeSO< 2. MnO, + H 2 S04 + 2HCI = MnS0 4 + 2H,0 + CI, The names of the compounds are, in order: manganese dioxide, sulphuric acid, hydrochloric acid, manganese sul- phate, hydrogen monoxide (or water), and chlorine (which is an element and not a compound). 3. The reasons assigned are : On account of the dimin- ished alkalinity of the blood and tissue fluids of those parts, and the comparative slowness of the circulation in those parts, which, when the blood contains an excess of uric acid, causes a necrosis of the cells, and hence weakens their powers of resistance and lowers their vitality. 4. Albuminoids are composed of carbon, hydrogen, oxy- gen, nitrogen, and sulphur. 5. The normal amount of urine passed in twenty^four hours is about fifty ounces. The average specific gravity is about 1.015 to 1.025; it may vary from about 1.003 to about 1.040. PATHOLOGY. I. There are two important forms of cirrhosis of the liver, hypertrophic and atrophic. The following table (from Thayer's "Pathology") will assist in distinguishing them : . , ^. Synonyms. Charcot's, Hy- Laennec s, Atrophic, Multi- pertrophic, Unilobular, lobular, Hematogenous, Hepatogenous, Biliary. Hob-nail liver. Jaundice. Early and Late and slight, bile usually marked, bile often absent present. from feces. 58 MEDICAL RECORD. " Keeps you in closest touch with the weekly progress of medicine and surgery throughout the world." Ascites. Late and unimpor- May be early ; often enor- tant. mous. Spleen. Enlarged early and Late and less. markedly. Alimentary hemorrhage, Common. piles. Not common. Liver. Large, smooth, mot- Small, rough, pale or yel- tled, green. low. New fibrous tissue. In fine In broad bands, making lines and strands between prominent islands in acini and cells, involving which the single acinus all parts equally. may appear nearly nor- mal ; distributed irregu- larly. 4. The synovial membrane becomes thickened and edematous, and sometimes ulcerates; the joint cavity be- comes filled with a serous exudate; the joint and synovial membrane are invaded by the tubercles, and the synovial membrane now becomes shiny, smooth, and nodular. Fringes of the synovial membrane spread over the borders of the articular cartilage, and become adherent to it; the cartilage becomes eroded and destroyed, and pieces of it become detached, leaving the bone denuded. The bone now is attacked by the tuberculous process. There may be adhesions, subluxation, erosion of the socket, or other joint deformity. 5. Aphonia may be caused by: (1) Paralysis of the recurrent laryngeal nerve, which may be central (as in bulbar palsy), or peripheral (due to pressure of an an- eurysm or tumor of the mediastinum) ; (2) injuries and diseases of the larynx, such as inflammations, tumors, for- eign bodies, or stenosis; (3) excessive use or misuse of the voice. BACTERIOLOGY. 5. The bacteria associated with inflammation and sup- puration are : staphylococcus pyogenes aureus, staphylo- coccus pyogenes albus, staphylococcus pyogenes citreus, streptococcus pyogenes ; also sometimes the pneumococcus, gonococcus, bacillus coli communis, bacillus pyocyaneus, ba- cillus typhosus, and bacillus epidermidis albus. ETIOLOGY AND HYGIENE. 5. To prove the pathogenicity of a microorganism, it is essential: (1) that the microorganism be found in the tis- sues, blood, or secretions of a person or animal sick or dead of the disease; (2) the microorganism must be iso- lated and cultivated from these same sources ; it must also 59 MEDICAL RECORD. " Choice and important abstracts from the leading medical periodicals of the world in a condensed and practical form." be grown for several generations in artificial culture media; (3) the pure cultures, when thus obtained, must, on inoculation into a healthy and susceptible animal, produce the diseases in question, and (4) the same microorganisms must again be found in the tissues, blood, or secretions of the inoculated animal. SURGERY. 2. In dry gangrene, the general rule is to wait for a line of demarcation, and then amputate high up ; but in senile gangrene, if the patient is exhausted or sepsis ensues, the amputation should be done at once, and high up, without waiting for the line of demarcation. In moist gangrene, after the formation of the line of demarcation, amputate high up. In traumatic gangrene, if spreading, amputate at once, and high up, without waiting for a line of demarca- tion. 3. The complications that may attend dislocations are: fracture of the bone, rupture of blood-vessels or nerves, extensive injury to the soft parts, the capsule may be rent, or even torn away from the bone, the head of the bone may be bruised by impact against the edge of the socket, and bony prominences may be torn off. 5. (1) The anesthetic may give rise to vomiting; (2) the effect of the constriction may remain after reduction, and the intestine continue paralyzed ; (3) this may be fol- lowed by inflammation, ulceration, perforation, peritonitis, toxemia, and death; (4) the presence of another hernia, not reduced; (5) recurrence of the same hernia; (6) re- duction en masse; (7) reduction into a diverticulum of the abdominal wall. OBSTETRICS. 1. The uterine souffle is a rhythmical, soft, blowing sound, synchronous with the maternal heart-beat. It is due to the passage of blood through the enlarged uterine arteries. The funic souffle is a sharp, whistling or blow- ing sound, synchronous with the fetal heart-beat. It is caused by some interference with the circulation in the umbilical arteries. Fetal shock is the discomfort experi- enced by the pregnant woman, due to the movements of the fetus in the uterus. 8. General dropsy, hydrocephalus, and spina bifida. GYNECOLOGY. 1. In the case of polypus, the body and fundus of the uterus are in their normal position in the abdomen, a sound can be passed into the uterus, the uterine and cervical canals are not obliterated, the polypus does not bleed easily, 60 MEDICAL RECORD. " Therapeutic Bints contain many valuable formulae by the foremost medical men in the world." and is not particularly sensible to pain. The inverted uterus shows : — absence of body and fundus from normal position, will not permit passage of a sound into uterine cavity, the uterine and cervical canals are absent, the inverted uterus tends to bleed easily, and is very sensible to pain. 4. As far as possible, remove the causes, correct bad habits (such as constipation, masturbation, excessive coitus), rest in bed, hot vaginal douches, tampons of ichthyol and glycerin or of iodine and glycerin, diet of a nourishing and easily digested kind, plenty of pure water to be drunk, general massage (unless contraindicated), such tonics and other medication as may be indicated by the general condition of the patient, hydrotherapy, and, in chronic cases, mild exercises, abdominal support by a binder, clothing so adjusted as to take pressure away from the abdomen. 5. The chief dangers are: pressure symptoms causing impaired respiration, twisting of the tumor on its pedicle, incarceration of the tumor in the pelvis, death of the fetus, difficult labor, and death of the mother. The treatment is to remove the ovarian tumor as soon as it is diagnosed. LARYNGOLOGY AND RHIN0L0GY. I. The mucous membrane of the larynx is usually very pale; there may be a few dilated capillaries on one vocal cord; round cell infiltration, with the formation of giant cells, is quite pronounced; considerable edema is present; the epiglottis is swollen on its free margins, and becomes turban shaped ; ulceration occurs in any part where infiltra- tion has been found, and appears in several places as small superficial ulcers, which coalesce and form a large irregular ("mouse-nibbled") ulcer; this is apt to be covered with a grayish white exudate in which the tubercle bacilli may be found. MEDICAL JURISPRUDENCE. 1. In both melancholia and mania there is a general perversion of the mental faculties, but the former is usually accompanied with more or less depression, and the latter with more or less excitement. 2. A delusion is a belief in something which has no real existence, but is purely imaginary; and out of which the person cannot be reasoned. An illusion is a false or per- verted impression, received through one of the senses. An hallucination is the same as an illusion, but without any material basis. If an individual believes himself to be made of glass, and 61 MEDICAL RECORD. "Book reviews of foreign and American publications keep you thoroughly informed of the newest literature." is afraid of being touched lest he be broken, he is suffering from a delusion. If the whistling of the wind were mistaken for a voice telling a person to do a certain thing — that would be an illusion. If a person fancied he heard a voice when there was nothing at all to be heard, that would be an hallucination. PHYSICAL DIAGNOSIS. 3. Mitral regurgitation. 4. In pyothorax^ there will be found the general symp- toms of sepsis, chills, fever high and irregular but per- sistent, pallor, the presence of leucocytosis, and on aspira- tion pus may be obtained. In hydrothorax there will be no fever, no pain, and the fluid is nonpurulent. 5. Ascites is an accumulation of serous fluid in the peritoneal cavity. It may occur in cirrhosis of the liver, chronic peritonitis, anemia, nephritis, heart disease, com- pression of the portal vein, or obstruction of the thoracic duct. OPHTHALMOLOGY AND OTOLOGY. 3. (1) aural polypi, (2) inflammation of the membrane lining the Eustachian tubes, (3) inflammation of the middle ear, (4) inflammation of the internal ear, (5) disease of the auditory nerve, (6) perforation of the membrana tympani, (7) parotitis, (8) diseases of the throat, blocking up the end of the Eustachian tube, (9) certain drugs, as salicylic acid, quinine, etc., (10) impacted cerumen. PEDIATRICS. 2. (a) otitis media; (b) bronchopneumonia; (c) endo- carditis; (d) bronchopneumonia. STATE BOARD EXAMINATION QUESTIONS. Indiana State Board of Medical Registration and Examination. October 23, 1906. chemistry. 1. What is carbolic acid? Give antidote. 2. What is calomel? 3. What is the specific gravity of healthy urine? Give test for albumen, sugar, blood. 4. What is double decomposition? 5. What is the difference between the mercurous and the mercuric compounds? 62 MEDICAL RECORD. "The most important contributions to the literature of medicine and surgery have been published first in the MEDI- CAL RECORD." MEDICAL JURISPRUDENCE. 1. What is rigor mortis? How soon after death does it begin ? 2. How would you determine whether an infant was still born or had been killed after birth? NEUROLOGY. 1. Give cause, symptoms, and diagnosis of epilepsy. 2. Give the definition of dementia. 3. Give difference between concussion and compression of the brain. OPHTHALMOLOGY AND OTOLOGY. 1. How do you distinguish whether deafness is due to nerve lesions or aural lesions? 2. Give etiology, diagnosis, terminations, and treatment of chronic inflammation of the membrana tympani. 3. Give etiology, symptoms, and treatment of iritis. PEDIATRICS. 1. Give cause and treatment for intestinal worms. 2. Give cause and treatment of nystagmus. PHYSICAL DIAGNOSIS. 1. Define the "Argyll-Robertson" pupil. In what dis- ease is this condition often found? 2. How would you ascertain the shape and position of the stomach? 3. At what age is the pulmonic second sound more in- tense than the aortic? At what age does the aortic second sound predominate? 4. Give causes and symptoms of pulmonary atelectasis. 5. How would you diagnose alcoholic coma from the coma of epilepsy? PHYSIOLOGY. 1. Explain cell division. 2. What are the elementary tissues or structures of which the human organism is composed? 3. Give the physiologic composition of the blood with the function of each part. 4. If a sympathetic nerve be divided, what is the effect upon the blood-vessels in the parts to which the nerve is distributed, and why? 5. How long will an animal survive deprived of water? 6. Give the manner of the transmission of motor im- pressions. 63 MEDICAL RECORD. "We publish the proceedings of an association immediately after the meeting." 7 Give the origin, course, and distribution of the motor impressions that effect respiratory movements. RHIN0L0GY AND LARYNGOLOGY. i. Give some of the constitutional causes of epistaxis. 2. Give symptoms and treatment of chronic rhinitis. ANATOMY. i Give diagram or brief description of (a) simple tubu- lar, (b) simple convoluted, (c) compound racemose, and (d) compound tubular glands. 2. Give the boundaries of the thorax. 3 Give the muscles of the orbital region. 4. Give, in the order of their origin, the branches of the external carotid artery. 5. Give, in the order of their origin, the branches ot the femoral artery. . 6. From what regions do the lymphatic vessels convey lymph to the axillary glands? _ 7 Give the openings communicating with the pharynx. 8. What muscles attach to the trochanter major? 9 Give general description of the spinal cord. 10. Give the principal nerve trunks of the arm, with location of each. ETIOLOGY AND HYGIENE. Give cause and hygienic measures for the prevention of (1) tuberculosis, (2) typhoid fever, (3) diphtheria, (4) scarlatina, (5) variola (smallpox). GYNECOLOGY. i. Give pathology, etiology, and treatment of pelvic tj„ " „,~.,i,4 ,,™, ™tiHnrt a nhvsical examination? In lllllb. . . •> How would you conduct a physical examination r what position would you place your patient i 3 Describe the operation of trachelorrhaphy. 4. What are the indications for dilatation of the uterus ? Give technique of dilatation. _ 5. Give after-treatment in major operations (abdominal Se 6. 10 Define chronic metritis. Give etiology and pathology. INTERNAL MEDICINE. i. Define inherent body resistance to disease, and state how it may be increased. 2. Give source, habitat, symptoms, and treatment ot taenia solium (tapeworm). _ 3. Give symptoms of true angina pectoris, and me pathological conditions causing it. 64 MEDICAL RECORD. " European correspondents furnish medical news of specla interest and reports of the principal foreign medical societies." 4. Give clinical history of gastric ulcer, and differentiate from (a) gastric carcinoma, (b) duodenal ulcer. 5. Give causes, symptoms, remote results, and treatment of cirrhosis of the liver. 6. Define hematuria, and state how you would determine the probable source of the hemorrhage. 7. Give cause, means of prevention, and treatment of bed sores. 8. In what class of diseases is general aching a pro- nounced symptom? 9. Give etiology, symptoms, and treatment of dysentery occurring in the temperate zones. 10. Give diagnosis and treatment of pertussis (whooping cough). MATERIA MEDICA AND THERAPEUTICS. i. Define preventive medicine, and give illustration of its application. 2. Give derivation of ichthyol, and its therapeutic appli- cation. 3. Give technique of introducing medicinal agents into the organism hypodermatically. 4. Name three therapeutic agents which increase the renal function. <§. Name three therapeutic agents which increase the hepatic function. 6. Name some therapeutic agents which promote con- structive metabolism. (jj) Name some therapeutic agents which promote de- structive metabolism. .8. Name some therapeutic agents which excite the func- tions of the spinal cord and sympathetic. 9. Name some therapeutic agents which depress the functions of the spinal cord and sympathetic. id Name some therapeutic agents which are germicidal in their action. PATHOLOGY AND BACTERIOLOGY. i. Explain the difference between active and passive hyperemia. 2. Give the modes of infection by the tubercle bacilli; by the malarial hematozoa. 3. To what pathological conditions may passive hypere- mia of the stomach be due, and to what may it lead? 4. What pathological conditions may result from abnor- mal conditions of the thyroid gland? 5. Give the conditions of the urine in nephritis. MEDICAL RECORD. The MEDICAL RECORD publishes no " Students' Number," for every issue is a students' number and a practitioners' number in one. 6. Describe in detail the various forms of bacteria which are known to be the cause of pneumonia. 7. Name the bacteria which may cause meningitis. 8. What tissues are usually invaded by the typhoid bacilli during typhoid fever? 9. How would you prepare Loffler's blood serum? 10. Describe the staining properties of the smegma bacillus. OBSTETRICS. 1. Describe the fetal circulation. 2. How and when should the umbilical cord be ligated and cut? 3. State causes of the rupture of the perineum and how prevented. 4. Give diagnosis and probable cause of tubal preg- nancy. 5. Name diseases most commonly affecting the mammae of the nursing mother. 6. Give cause and treatment of aphthze. 7. Give indications and contraindications for the em- ployment of chloroform in labor. 8. When should ergot be employed in obstetric practice? 9. State cause, diagnosis, and treatment of porrigo lar- valis, or crusta lactea. 10. Give cause and treatment of vomiting of pregnancy. SURGERY. 1. What is a compound fracture? 2. Give diagnosis of inguinal hernia. 3. What is an aneurysm? 4. Give diagnosis and treatment of appendicitis. 5. What conditions justify amputation of a limb? 6. Give symptoms and treatment of intestinal obstruc- tion. 7. Give a description of Chopart's operation. 8. What are the symptoms and treatment of depressed fracture of skull? 9. Give symptoms and treatment of hydrocele. 10. Give symptoms and treatment of downward disloca- tion of head of humerus. 66 MEDICAL RECORD. "Special reporters in England, France, Germany, Austria, Turkey, Denmark, the Philippines, and the leading cities of the United States and Canada." ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Indiana State Board of Medical Registration and Examination. October 23, 1906. CHEMISTRY. 1. Carbolic acid is phenyl hydroxide : CeHeOH. Its anti- dote is alcohol or magnesium sulphate. 2. Calomel is mercurous chloride : Hg2Cl 2 . 3. The specific gravity of healthy urine is from 1015 to 1025. Test for Albumin. — The urine must be perfectly clear. If not so, it is to be filtered, and, if this does not render it transparent, it is to be treated with a few drops of magnesia mixture, and again filtered. The reaction is then observed. If it be acid, the urine is simply heated to near the boiling point. If the urine be neutral or alkaline, it is rendered faintly acid by the addition of dilute acetic acid, and heated. If albumin be present, a coagulum is formed, vary- ing in quantity from a faint cloudiness to entire solidifica- tion, according to the quantity of albumin present. The coagulum is not redissolved upon the addition of HNO3. Test for Sugar. — Render the urine strongly alkaline by addition of Na 2 COa. Divide about 6 c.c. of the alkaline liquid in two test tubes. To one test tube add a very minute quantity of powdered subnitrate of bismuth, to the other as much powdered litharge. Boil the contents of both tubes. The presence of glucose is indicated by a dark or black color of the bismuth powder, the litharge retaining its nat- ural color. Te. c t for Blood. — To the urine add a solution of potas- sium hydroxide to distinct alkaline reaction ; heat nearly to boiling (do not boil). A red precipitate is produced. (Witthaus' Essentials of Chemistry.) 4. Double decomposition is a reaction in which both of the reacting compounds are decomposed to form two new compounds. 5. The mercurous compounds contain the bivalent group /Hgv\" / V I I ) Jo r l Hg 2 1 ; whereas the mercuric compounds con- tain the single, bivalent atom Hg". They also differ in their analytic characters ; thus with potassium hydroxide the mer- 67 MEDICAL RECORD. «• Surgical Suggestions that will appeal to the student and the general practitioner." curous salts give a black precipitate, and the mercuric salts a yellow precipitate. MEDICAL JURISPRUDENCE. 1. Rigor mortis is the condition of rigidity or contraction into which the muscles of the body pass after death. It begins at a period varying from about fifteen minutes to about six hours. NEUROLOGY. 2. "Dementia, when confirmed, consists in a total ab- sence of all reasoning power, and an incapacity to perceive the true relations of things ; the language is incoherent, and the actions are inconsistent; the patient speaks without being conscious of the meaning of what he is saying ; mem- ory is lost, and sometimes the same word or phrase is re- peated for many hours together ; words are no longer con- nected in meaning, as they are in mania and monomania." (Taylor's Medical Jurisprudence.) 3 — CONCUSSION OF THE BRAIN. Unconsciousness is incom- plete; patient can be made to answer, though it may be briefly, and in simple words. Special senses, though greatly blunted, are not abolished. Power of movement not destroyed; if the po- sition of a limb be changed the patient will resist or briner it imme- diately into the original position. Respiration is quiet and feeble. Pulse feeble, frequent, and intermittent. The stomach sickens and rejects its contents. COMPRESSION OF THE BRAIN. Complete unconsciousness ; may scream into patient's ear at the top of the voice, but will receive no answer. Special senses entirely sus- pended. Complete or partial paral- yis; in most cases hemi- plegia. Respiration full and noisy. Pulse full and slow, and sometimes laboring. The stomach is insensible to any impression; no nausea or vomiting. 68 MEDICAL RECORD. " Bulletins of Examinations of State Medical Licensing Boards published bi-weekly." CONCUSSION OF THE BRAIN. The feces may be dis- charged incontinently, as may also the urine, though not usually. Deglutition little impaired. Pupils variable, though generally cont r ac t e d; the eyelids somewhat open. Temperature of the body less than natural. COMPRESSION OF THE BRAIN. Bowels are torpid, and the bladder incapable of emp- tying itself, though the urine may escape by overflow. Deglutition difficult or im- possible. Pupils variable, though generally much dilated, and the eyelids closed. Temperature almost nat- ural, a little below the normal standard. (From Treves' Manual of Surgery.) OPHTHALMOLOGY AND OTOLOGY. I. "If the ticking of a watch or the vibrations of a tuning fork are heard faintly or not at all when held at varying distances from the ear (aerial conduction), but become distinctly audible when the watch or the handle of the fork is placed in contact with the skull or mastoid process (bone conduction), the deafness is of the ordinary variety and due to aural disease. If, on the other hand, watch and fork are heard indistinctly or not at all, both in contact and at a distance, the deafness is due to some lesion of the nerve or its connections. In the first case the nerve is normal and can appreciate vibrations brought by the bone, while, through some fault in the mechanism, aerial vibra- tions are not transmitted to the nerve endings. In the second case the nerve is at fault and cannot appreciate vi- brations, no matter how well they may be conducted." (Butler's Diagnostics of Internal Medicine.) PEDIATRICS. I. Tapeworm is caused by eating raw or insufficiently cooked meat containing cysticerci. Treatment: Give a dose of castor oil at night, and the following morning give half a dram of freshly prepared extract of male fern, and a few hours later give another dose of castor oil. Roundworm is caused by swallowing with the food the ova of the ascaris lumbricoides. Treatment: A dose of santonin and calomel should be given at bedtime for a few nights, and a dose of castor oil the morning after the last powder. 69 MEDICAL RECORD. " The progressive physician must have his medical weekly just as the business man his newspaper." Seatworm, or Pinworm, is caused by swallowing the ova of the oxyuris vermicularis with the food or water, or it may be conveyed to the mouth by the fingers. Treatment: A large enema of a cold infusion of quassia. Care must be taken to prevent reinfection. 2. Nystagmus is caused by some irritation affecting the muscles of the eye. It may be vertical or lateral, and may be due to the eye or to the central nervous system. The cause can only be determined by a study of the other symp- toms associated with it. Treatment: Tonics or bromides are sometimes useful. Remove the cause if possible. If due to occupation, the work must be changed; strabismus, or errors of refraction, must be corrected. PHYSICAL DIAGNOSIS. 1. Argyll-Robertson pupil is a condition in which the pupil accommodates for distance but not for light. The condition is chiefly found in locomotor ataxia and paretic dementia. 3. The pulmonic second sound is more accentuated in childhood ; the aortic second sound is more accentuated in adult life. 5. Alcoholic coma: The patient can generally be aroused ; the coma is not, as a rule, complete ; the face may be flushed; the pupils are normal or dilated; the respira- tions are normal in frequency, but deep; the skin is cool and moist, and the body temperature may be below normal. Coma of epilepsy: History of attack, with previous con- vulsion ; the coma is of brief duration, and the unconscious- ness gradually becomes less; there may be a bitten tongue or other scars. PHYSIOLOGY. 2. Epithelial tissues, connective tissues, muscular tis- sues, and nervous tissues. 3. Physiological composition of the blood : 1. Plasma. ( Colored. 2. Corpuscles -J Colorless. ( Blood-plates. Functions : Plasma conveys nutriment to the tissues ; it holds in solution the carbon dioxide and water which it receives from the tissues, and takes them to be eliminated by the lungs, kidneys, and skin ; it also holds in solution urea and other nitrogenous substances that are taken to and excreted by the liver or kidneys. 70 MEDICAL RECORD. " Statistics of the health boards and many articles of scien- tific interest and items of general information." Colored corpuscles carry oxygen from the lungs to the various tissues of the body. Colorless corpuscles act as a protection against bacterial invasion. Blood-plates are supposed to take some part in the process of coagulation. 4. If a vasoconstrictor nerve is divided, the arteries sup- plied by it are relaxed, more blood flows to the part, the blood current is accelerated, and congestion results. If a vasodilator nerve is divided, there is little or no change in the blood-vessels supplied by it. 5. From seven to ten days, without either water or food. 6. Motor impressions travel from the cortex of the cerebrum, through the corona radiata, internal capsule, crus, pons, medulla, crossed or direct pyramidal columns, to the motor cells in the anterior horn of the spinal cord; thence through the motor nerves to the muscles indicated. 7. The origin of the impulses is at the respiratory cen- ter in the medulla. The phrenics and intercostals are the chief nerves conveying the impulses ; and they are distrib- uted to the diaphragm and intercostal muscles, respectively. RHIN0L0GY AND LARYNGOLOGY. I. Some of the constitutional causes of epistaxis are: Hemophilia, pernicious anemia, leukemia, scurvy, purpura hemorrhagica, cerebral congestion, hypertrophy, and valvular lesions of the heart. I. — ETIOLOGY AND HYGIENE. Tuberculosis Typhoid fever Diphtheria Scarlatina Variola Caused by. Bacillus tuberculosis, of Koch. Bacillus typhosus, of Eberth. Bacillus diphtherial, of Klebs-Loeffler. Microorganism not yet ascertained. Microorganism not yet ascertained. INTERNAL MEDICINE. 2. Tcenia Solium. Source : The encysted larvae or scolices, which come from the proscolices, which in turn are derived from the ova of the tapeworm. Habitat : In the larval state this parasite exists in the hog. Symptoms: Often there are no subjective symptoms; there may be dyspepsia, emaciation, ravenous appetite, nausea, vomiting, colicky pains, vertigo, chorea, itching of the nose. The diagnosis is made from finding segments or eggs in the dejecta. Treatment: The patient should be limited to a 7i MEDICAL RECORD. " The medical profession have been presented with the re- sults of great discoveries by the MEDICAL, RECORD in ad- vance of any other publication." liquid diet for two days; salines should then be adminis- tered; then the oleoresin of aspidium in a dose of one to two drams, followed in a few hours by another saline. The treatment can only be considered successful when the head of the worm is found in the dejecta. 3- The symptoms of true angina pectoris are: Excru- tiating pain radiating from the heart to the neck, shoulder, and arm (generally the left) ; a sense of impending death; cardiac constriction; the face is anxious and pale; cold perspiration and sometimes dyspnea The pathological conditions causing it are : Arterio- sclerosis, chiefly of aorta and coronary arteries ; there may be myocarditis and endocarditis, chiefly associated with aortic regurgitation or adherent pericardium; the predis- posing causes of arteriosclerosis may also be present, chiefly syphilis, alcoholism, and gout. 4. Diagnosis: Gastric ulcer is generally caused by in- jury or bacteria, is most apt to occur between the ages of twenty and forty-five; after eating there is pain localized in the stomach, vomiting occurs soon after eating, hematemesis is common, there is localized tenderness over the stomach, and examination of the gastric contents shows an excess of free HC1. Gastric carcinoma does not usually occur before forty years of age, is more common in males, the pain is localized and constant, vomiting is copious and occurs some time after eating; the vomitus contains "coffee ground" material; hemorrhages are common ; a tumor may be palpated, and examination of the gastric contents shows absence of free HC1 and presence of lactic acid; severe anemia and ca- chexia are also present. In Duodenal ulcer the pain is apt to be more to the right, and to occur at an interval of two or three hours after meals ; the hemorrhages will be intestinal, and the blood will be passed by way of the bowels, and not vomited. In many cases the symptoms are identical with those of gastric ulcer. 6. Hematuria means blood in the urine. In renal hema- turia the blood and urine are intimately mixed, tube casts are apt to be present, and there may be renal colic or pain in the lumbar region. In vesical hematuria the blood and urine are not so well mixed, and pure blood is apt to be passed at the end of urination. In urethral hematuria the urine first passed is bloody. 7. Bedsores may be caused by undue pressure and irri- tating secretions; a crease or fold in a sheet, a crumb of MEDICAL RECORD. " The most important and Interesting items of the very latest medical news throughout the world." bread, a feather, or a bit of string on the sheet may cause them. Especially is this so when the skin is irritable from excessive perspiration, inefficient washing, or involuntary passages of urine. Bedsores are particularly common in spinal affections and in wasting diseases. Prevention consists in reducing the pressure, careful re- peated washing, drying, and dusting with zinc oxide, and subsequent protection with lint or cotton-wool, etc. Leather- backed adhesive plaster may be applied over bony promi- nences, or, if seen early, collodion may be used. Frequent rubbing with alcohol may prove a preventive. When con- gestion appears, a water-bed or air-cushion may be used. Spirits of camphor or glycerol of tannin may be rubbed in twice daily, to harden the skin. Salt and alcohol (two drams to the pint) may also be used. Treatment: A solution of silver nitrate may be used when the skin is about to break, in the strength of gr. 20 to the ounce; and in solution of gr. 10, daily, when the skin breaks. The sloughs should be removed as fast as they form. Stimulation, good nourishment, and sleep are valu- able in treatment. (From Gould and Pyle's Cyclopedia of Medicine and Surgery.) 8. General aching is a pronounced symptom in some of the acute infectious fevers such as influenza, dengue, and smallpox. It may also be present in tonsilitis, rheumatism, and syphilis ; also in poisoning by lead or mercury. MATERIA MEDICA AND THERAPEUTICS. 1. Preventive medicine is the application of medical sci- ence to the task of preventing or mitigating disease. Ex- ample : Vaccination to prevent smallpox. 2. Ichthyol is obtained from ichthyosulphuric acid, which comes from a crude oil obtained by destructive distillation of fossil fish found in the earth in the mountains of Tyrol. It is used in inflammatory conditions generally, erysipelas, rheumatism, and certain chronic skin diseases. 4. Three therapeutic agents which increase the renal function: (1) Water, (2) alcohol, ('O spirits of nitrous ether. 5. Three therapeutic agents which increase the hepatic function: (1) Sodium salicylate, (2) corrosive sublimate, (3) podophyllin. 6. Some therapeutic agents which promote constructive metabolism : Iron and its preparations, potassium perman- ganate, bismuth, arsenic, cinchona and its preparations, mineral acids, phosphorus, massage, fresh air. 7. Some therapeutic agents which promote destructive 73 MEDICAL RECORD. " Since 1890 the MEDICAL RECORD has had a cabled re- port of every International 3Iedical Congress." metabolism: Iodine, potassium, sodium, lithium, mer- cury, calcium, barium and their preparations ; vegetable acids. 8. Some therapeutic agents which excite the functions of the spinal cord and sympathetic : Alcohol, strychnine, elec- tricity, massage, ether, camphor, digitalis, sparteine, ergot. 9. Some therapeutic agents which depress the functions of the spinal cord and sympathetic: Opium, belladonna, large quantities of alcohol, chloral hydrate, aconite, physos- tigma, pilocarpus, tobacco, amyl nitrite. 10. Some therapeutic agents which have a germicidal action: Oxygen, sulphur, corrosive sublimate, carbolic acid, iodine, chlorine, staphisagria, heat, formaldehyde, creolin. PATHOLOGY AND BACTERIOLOGY. 1. Active hyperemia means that there is an excess of arterial blood in a part, and is generally accompanied by an increase in the rate of blood flow. In passive hyperemia there is still an excess of blood, but it is in the veins and capillaries ; and the blood flow is retarded. 2. Modes of infection by the tubercle bacilli: (1) By inhalation, (2) by inoculation, (3) by being taken in with food. Mode of infection by the malarial hematozoa : By the bite of the anopheles mosquito. 3. Passive hyperemia of the stomach may be due to cirrhosis or other hepatic diseases causing portal obstruc- tion, also to some pulmonary disorders which interfere with the flow of blood from the right ventricle. It may lead to chronic gastritis. 4. Cretinism, goiter, myxedema, cachexia strumipriva. 5. "Acute Diffuse Nephritis. — The urine is nxeatly dimin- ished in amount (four or five ounces in twenty- four hours), or is even totally suppressed. It is smoky, black- ish, or of a chocolate color. The specific gravity is high. Albumin is found in larre amount, and the heavy deposit contains abundant red corpuscles, blood, hyaline, and epi- thelial tube casts. The total urea is lessened. "Chronic Diffuse Nephritis. — The quantity of urine is diminished, it is cloudy from urates, the specific gravity may be high in the early, but is low in the later stages. Albumin is abundant, sometimes more so than in any other disease. The heavy sediment contains large numbers of nearly all the varieties of tube casts, hyaline, epithelial, granular, and fatty. The latter are especially characteristic. Occasional red corpuscles, many leucocytes, and numbers of degenerated epithelial cells are also found. The amount of urea is decreased. MEDICAL RECORD. "Editorials on subjects of timely interest and of vital Im- portance dealt with in a masterly and scholarly style." "Chronic Interstitial Nephritis. — The urine is increased in quantity, light yellow, clear, with a persistently low spe- cific gravity. Albumin is scanty, occurring in traces, and is sometimes absent. A few narrow hyaline casts are al- most constantly found in the very small deposit. Cellular elements are as a rule no more abundant than in normal urine. Polyuria, persistent low specific gravity, and the presence of a few hyaline casts constitute the urinary signs of this disease. Albumin may or may not be present in small quantity." (Butler's Diagnostics of Internal Medi- cine.) 7. The bacteria which may cause meningitis are: (1) Diplococcus intracellulars meningitidis, (2) the pneumo- coccus, (3) Streptococcus pyogenes. 8. The tissues usually invaded by the typhoid bacilli dur- ing typhoid fever are : The lymphoid tissue of the small intestine, lymph nodes of the mesentery, the spleen, gall- bladder, urinary bladder. 9. Loffler's blood serum consists of one part of bouillon (containing one per cent, of glucose) and three parts of liquid blood serum. This should be well mixed, poured into tubes, and sterilized, or raised to 65° C. one hour a day for three days. 10. The smegma bacillus is like the tubercle bacillus in that it stains with carbolfuchsin and resists the decolor- izing action of dilute mineral acids. But it is decolorized by absolute alcohol. OBSTETRICS. 4. Diagnosis: "When extrauterine pregnancy exists there are: (1) The general and reflex symptoms of preg- nancy; they have often come on after an uncertain period of sterility; nausea and vomiting appear aggravated. (2) Then comes a disordered menstruation, especially metror- rhagia, accompanied with gushes of blood, and with pelvic pain coincident with the above symptoms of pregnancy; pains are often very severe, with marked tenderness within the pelvis ; such symptoms are highly suggestive. (3) There is the presence of a pelvic tumor characterized as a tense cyst, sensitive to the touch, actively pulsating; this tumor has a steady and progressive growth. In the first two months it has the size of a pigeon's e^; in the third month it has the size of a hen's ege; in the fourth month it has the size of two fists, (d) The os uteri is patulous; the uterus is displaced, but is slightly enlarged and empty. (O Symptoms No. 2 may be absent until the end of the third month, when suddenly they become severe, with spasmodic pains, followed by the general symptoms of collapse. (6) 75 MEDICAL RECORD. "Acknowledged to be the leading independent medical weekly." Expulsion of the decidua, in part or whole. Nos. I and 2 are presumptive signs;. Nos. 3 and 4 are probable signs; Nos. s and 6 are positive signs." (American Text-Book of Obstetrics.) Probable cause : Some pathological condition in the Fallopian tube which obstructs the passage of the fecun- dated ovum. The most common condition is salpingitis, especially of the gonorrheal variety. 5. Sore nipples; caked breast; mastitis, which may be subcutaneous, parenchymatous, or submammary; galacto- cele. 6. Cause of Aphtha?: Predisposing causes are unclean- liness, lack of hygienic conditions, improper feeding. The exciting cause is unknown ; various microorganisms have been found in this condition, but none of them is recog- nized as the etiological factor. Treatment : Cleanliness, proper hygiene, proper feeding, mouth wash of salt solution or boric acid ; the ulcers may be brushed with a nitrate of silver solution (5 to 10 grains to the ounce), and a dose of castor oil or a few grains of calomel (in divided doses) should be administered. SURGERY. 5. Conditions which justify amputation of a limb are: "Any injury, disease, or malformation rendering retention of the limb incompatible with life or comfort; avulsion of limb ; compound fracture ; compound dislocation ; fracture with great comminution of bone; laceration of important vessels ; extensive contusion ; extensive laceration ; gunshot injuries; aneurysm; effects of heat and cold; gangrene; ex- tensive bone disease ; tumors ; elephantiasis ; tetanus ; snake bite; deformities." (Bickham's Operative Surgery.) STATE BOARD EXAMINATION QUESTIONS. Kansas State Board of Medical Registration and Examination. October 9, 1906. ANATOMY AND HISTOLOGY. 1. Locate the brachial plexus and its branches, naming the latter. 2. Describe the medulla oblongata. 3. Locate and describe a femoral hernia and name its coverings, beginning with the surface. 4. Describe the intestinal tract and name its divisions. /6 MEDICAL RECORD. Not a local Journal, but International in Its scope. 5. Locate and describe the omentum, giving the histol- ogy of the same. 6. Describe the vulvulae conniventes. 7. Locate and describe the pancreas, giving its histology. 8. Give the histology of the arteries. Does it differ from the histology of the veins? If so, how? 9. Describe the sympathetic nerve, naming its divisions, and number of ganglia in each. 10. How many bones are there in the human skeleton? CHEMISTRY AND TOXICOLOGY. 1. What is galvanism? 2. How can it be demonstrated that hydrogen is lighter than air? 3. What is analysis and what is synthesis? 4. What is the effect of inhaling air rich with ozone on the respiratory organs? 5. In what manner does arsenic prove poisonous? 6. How does CO act as a poison? 7. What is the action of KOH on the tissues? 8. What is the antidote for acute poisoning by HgCla? 9. What is the reaction of blood during gout? 10. What is Trommer's test for sugar in urine? OBSTETRICS. 1. Write a page on deformities of the pelvis. 2. What would you do in a case of postpartum hemor- rhage ? 3. How would you treat a case of hour-glass contrac- tion? 4. Write a page on puerperal eclampsia. 5. How would you treat a case of pelvic cellulitis? 6. Into how many stages is labor divided? 7. How would you treat a case of face presentation ? 8. How would you treat a case of adherent membranes? 9. Write a page on the use of the forceps. 10. How would you treat fibroid tumors of the uterus? PATHOLOGY. 1. Define gangrene. 2. What is a sarcomatous tumor? Give its pathology. 3. Define chronic gastritis and give its pathology. 4. Give symptoms, etiology, pathology, diagnosis and prognosis of herpes zoster. 5. Give symptoms, etiology, and prognosis of erysipelas. 6. Give etiology, symptoms, diagnosis, and prognosis of neuritis (multiple). 7. Define lilhemia. 8. Define purpura hsemorrhagica. 77 MEDICAL RECORD. " Range of subjects embraces every branch of mediein« and surgery." 9. Give differential diagnosis of septicemia and pyemia. 10. Describe the pathology of rachitis. BACTERIOLOGY. i. How do bacteria multiply? 2. What is essential to the life of bacteria? 3. Name and describe the malarial parasites. 4. What disease does the bite of an infected Stegomyia fasciata produce? 5. Name five culture media. 6. Name and describe the pus-producing germs. 7. Describe Widal's test for typhoid fever. 8. What are leucocytes, and what occurs when they come in contact with pathogenic bacteria ? 9." What are ptomaines and toxins? 10. What are sterilization, antiseptics, disinfectants, and germicides ? PHYSIOLOGY. 1. What are the functions of the spinal cord? 2. What is the origin of urea and of uric acid ? 3. (a) Describe the vasomotor nervous system and explain its functions, (b) Where is the vasomotor center located? 4. (a) Give the function of the suprarenal glands, (b) What is result of their extirpation? 5. What kind of membrane lines the mastoid cells, and why? 6. Explain the portal circulation. 7. (a) What are the functions of bile? (b) Give its con- stituents. 8. Describe the pleurae, giving kind of tissue and func- tions. 9. (a) Give functions of the cerebellum, (b) What is the result of its extirpation? 10. Give the functions of the medulla oblongata, (a) Name the "centers" located in the bulb. SURGERY. 1. What class of patients take ether better than chloro- form, and why? What class take chloroform better, and why? 2. What are the signals of danger in general anesthesia? 3. How would you treat a suppurating cavity of the thorax ? 4. What is the proper surgical treatment of a chronic varicose ulcer of the leg? Give details. 78 MEDICAL RECORD. " New Instruments are portrayed and their use thoroughly explained." 5. What is osteoplasty, and in what part of the body is it most frequently called for? Give an example. 6. Give the cause and treatment of painful cicatrix, ad- herent cicatrix, contracted cicatrix, and exuberant cicatrix. 7. What kinds of tumors are most safely removed? What kinds are the least safely removed ? 8. How would you treat an ingrowing toenail? Give full details. 9. What is the best surgical treatment for hemorrhoids? Give details. 10. What bone in the body is frequently fractured and is the most difficult of all bones to reunite by bony union? How should it be treated when fractured? Give details. OPHTHALMOLOGY, OTOLOGY, RHINOLOGY, AND MEDICAL JURIS- PRUDENCE. 1. Name some causes of ozena. 2. Discuss the pathological characteristics of nasopharyn- geal adenoids. 3. Define strabismus. What causes it? 4. Describe the crystalline lens and give its relations. 5. The vast majority of all the diseases of the ear have their origin in inflammations of what particular membrane? 6. Prescribe for chronic case of otitis media purulenta. 7. Nasal polypi — give diagnosis and surgical treatment. 8. What do you understood by medical jurisprudence? 9. What constitutes a dying statement, and what condi- tions are necessary to make it admissible as evidence in a court of justice? 10. Give diagnostic symptoms between diphtheria and follicular tonsillitis. THEORY AND PRACTICE. 1. Write a page on epidemics. 2. Write a page on the treatment of typhoid fever. 3. Give diagnosis and treatment of scarlet fever. 4. Give treatment of erysipelas. 5. Give diagnosis and treatment of rickets. 6. Give diagnosis and treatment of acute laryngitis. 7. Write a page on pneumonia. 8. Describe the different murmurs of the heart and tell what they indicate. 9. Give treatment for acute peritonitis. 10. Write a page on Bright's disease. MATERIA MEDICA. £» In what disease is opium used principally? £. Name the excitomotors. 79 MEDICAL RECORD. Save and bind your numbers; it will give you two great medical encyclopedias every year. 3. What are the preparations and doses of conium? 4. Is ether ever used as a cardiac stimulant? JJ:? How should poisoning by digitalis be treated? 0- What are the medicinal uses of ipecac? 7. What substances are incompatible with belladonna? 8. What are the effects, uses, and doses of calcium chloride? 9. What are the preparations and doses of gold salts? 10. Name the mineral tonics. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Kansas State Board of Medical Registration and Examination. October 9, 1906. CHEMISTRY AND TOXICOLOGY. 1. By the term Galvanism is meant current electricity derived from chemical action, in opposition to that pro- duced by heat or induction. The term is no longer used scientifically; but is laxly employed to denote the constant current as distinguished from the induced current (which is sometimes called Faradism or Faradization). 2. Soap-bubbles or a toy balloon, if filled with hydrogen gas, will rise rapidly in the air. 3. Analysis is the splitting up of a compound into its elements or into simpler compounds. Synthesis is the build- ing up of a compound from elements or from simpler compounds. 4. It causes severe coryza and hemoptysis. 5. By the ingestion of flypaper, or the water in which it has been placed, poisoning by elementary arsenic may be caused. By the inhalation of hydrogen made from zinc and sulphuric acid containing arsenic, poisoning by Arsin may be produced. Arsenic trioxide can cause poisoning by being absorbed from the mouth, stomach, rectum, vagina, or urethra; or by absorption from the skin in the use of parasiticides or cancer cures containing arsenic; also by inhalation of dust from wallpapers containing arsenic; from clothes dyed with arsenic; and by the ingestion of rat poisons, etc. 6. By uniting with the hemoglobin of the blood and forming a more stable compound than oxyhemoglobin. In this way the power of the red corpuscles to carry oxygen from the air to the tissues is destroyed; and asphyxia is thus produced. 80 MEDICAL RECORD. " The only American medical journal that prints a detailed report of the British Medical Association." 7. _ It acts as a caustic on living tissues ; and disintegrates all tissues, whether dead or alive. 8. White of egg, in not too large a quantity, and fol- lowed by an emetic. 9. Alkaline ; but the degree of alkalinity may be lowered, and uric acid crystals may be found in the blood. 10. Place in a test tube some urine free from albumin; add a few drops of a solution of cupric sulphate, and then some liquor potassae (about half as much as the urine) ; shake and boil. A yellow or red precipitate is formed in the presence of sugar. OBSTETRICS. 3. First, give a hypodermic of morphine and atropine, or a dose of chloral or an anesthetic, and then, with one hand in the vagina, gently introduce the index and middle fingers into the uterus and through the constricting band. After a time the resistance of the constriction will be thus overcome. By pressing the uterus downward, the fingers and the border of the placenta are brought in con- tact. Effort is then made to bring part of the placental mass through the constriction ; the placenta being removed as in case of adherent placenta. 5. The vagina should be made as aseptic as possible, by means of vaginal douches of bichloride of mercury 1 :2,ooo. The vaginal vault and the cervix uteri can then be painted with tincture of iodine ; sometimes the insertion of a vaginal suppository containing about thirty grains of iodoform is of benefit. In case suppuration occurs, the abscess should be opened; if it bursts into the rectum or vagina, measures must be instituted for drainage and dis- infection. Very frequently an abdominal operation is neces- sary. Antipyretics should be given for the fever; and for the pain cold compresses or ice bags should be applied to the perineum and lower part of the abdomen. 7. If the chin is presenting anteriorly, expectant treat- ment may suffice; but care must be taken to observe that the chin does not rotate backwards. Spontaneous version may occur, and the presentation become a vertex one. Fail- ing this, or as a means of favoring this, postural treatment, such as Walcher's position, has been recommended. If, in spite of this, engagement has not occurred, cephalic version is indicated, care being taken not to rupture the membranes. If this is not successful, podalic version should be tried. If, after all these manipulations, the child is still alive and the head is engaged, symphyseotomy is indicated; if the child is dead, craniotomy should be performed. 81 MEDICAL RECORD. Its prestige attracts articles by the best known writers. PATHOLOGY. 1. Gangrene is the complete and permanent loss of vitality in a considerable area of tissue. 2. A sarcomatous tumor is one arising from connective tissue, with excessive cell formation and very little intercel- lular substance. The cells are either embryonic or imper- fectly developed connective tissue cells. Sarcomata arc always mesoblastic in origin ; their blood supply is abun- dant, and it is through this channel that they are dis- seminated; of their lymphatics and nerve supply nothing i.s known. In gross appearance sarcomata are of a more or less homogeneous nature, the color depending upon the quantity of blood present ; occasionally a milky fluid can be expressed, but there is never anything corresponding to the "cancer-juice" of carcinomata. Sarcomata may undergo various secondary changes, such as fatty degeneration, hemorrhages, and mucoid softening. Sarcomata are malig- nant, hence they have a tendency to spread to distant organs (metastasis), are heterologous, have no definite limiting capsule, tend to infiltrate the surrounding tissues, tend to recur after removal, and cause cachexia and death. They have been classified in a variety of ways: (i) according to the cells, as round cell sarcoma, spindle cell sarcoma, giant cell sarcoma, mixed cell sarcoma; (2) according to the stroma, as fibrosarcoma, myxosarcoma, chondrosarcoma, osteosarcoma; and (3) according to secondary changes, as melanosarcoma, liposarcoma, chloroma, 7. Lithemia is a condition due to imperfect metabolism, and is characterized by an accumulation of uric acid or urates in the blood. It differs from gout in the absence of joint involvement. 8. Purpura Hemorrhagica is a disease of unknown or- igin, and is characterized by hemorrhages into the skin and mucous and serous membranes, and usually runs a rapid and fatal course. 9. Septicemia begins with a rigor, followed by a rise of temperature up to about 104° F., which remains constant. The pulse is weak and progressively rapid; there is an- orexia and constipation, which is followed by diarrhea ; the urine contains albumin ; the temperature may become subnormal. There are no repeated rigors and no secon- dary (metastatic) abscesses. Pyemia begins with a rigor, which may last for half an hour, and is repeated every one or two days. The temperature rises as in septicemia, but rapidly falls, and at the same time the patient suffers a profuse perspiration. The pulse is weak and rapid ; there is anorexia; and there may be delirium, with jaundice and 82 MEDICAL RECORD. " Keeps you strictly abreast of the times." signs of abscesses in the lungs, joints, etc. In pyemia there are repeated rigors and secondary abscesses. BACTERIOLOGY. 1. Bacteria multiply by fission and by sporulation. 2. Most bacteria require (i) proper temperature, gen- erally at or near that of the body; (2) oxygen is generally needed, those that cannot live without it being called aerobic, and those that can grow without it, anaerobic; (3) nutriment of a proper kind, containing both organic and inorganic material; (4) a slight degree of moisture; (5) a medium of slightly alkaline reaction; and (6) rest. Indi- vidual bacteria may require modifications of the above essen- tials. 4. Yellow fever. 5. Gelatin, agar, potato, bouillon, and blood-serum. 6. The pus-producing bacteria are : staphylococcus pyo- genes aureus, staphylococcus pyogenes albus, staphylococ- cus pyogenes citreus, staphylococcus cereus aureus, staphy- lococcus cereus albus, staphylococcus cereus flavus; strep- tococcus pyogenes; micrococcus tetragenus, micrococcus pyogenes tenuis ; gonococcus ; pneumococcus ; bacillus pyo- cyaneus, bacillus typhosus, and bacillus tuberculosis. 8. Leucocytes are white blood corpuscles. When they come in contact with pathogenic bacteria, if the conditions are favorable, they devour and destroy the bacteria (phago- cytosis) ; sometimes, however, the bacteria manage to de- stroy the leucocytes. 9. Ptomaines are the putrefactive products of dead ani- mal tissues or fluids. Toxins are the products of pathogenic bacteria or of pto- maines or leucomaines, and are actively poisonous. 10. Sterilisation is the process of freeing a substance from the live bacteria that may be on it or in it. Antiseptics are agents which prevent or restrain putre- faction. Disinfectants are agents which restrain infectious diseases by destroying or removing their specific poisons. Germicides are agents whch destroy bacteria and their germs. PHYSIOLOGY. 1. The functions of the spinal cord are: (1) the conduc- tion of nerve impulses; (2) reflex action ; (3) coordination; it also contains special centers which preside over definite functions. 2. Urea is derived from the nitrogenous food ingested; it is manufactured by the cells of the liver. Uric acid: "In man uric acid has a twofold origin; one portion, coming from the breaking down of the nuclein- containing tissues or cell elements of the man's own body, 83 MEDICAL RECORD. " Therapeutic Hints contain many valuable formulae by the foremost medical men in the world." and hence is of endogenous origin, while the other portion — usually the larger — is of exogenous origin, coming from the transformation of free and combined purin compounds present in the food." (Chittenden.) 3. The vasomotor nervous system consists of (1) a vasomotor center in the bulb, (2) of some subsidiary centers in the spinal cord, and (3) of vasomotor nerves, which are of two kinds : (a) those causing constriction of the vessels, and so-called vasoconstrictor nerves; and (b) those causing dilatation of the vessels, and so-called vaso- dilator nerves. These nerves supply the muscle tissue in the walls of the blood-vessels and regulate their caliber, thus influencing the quantity of blood supplied to a part; at the same time they regulate the quality of blood supplied to a part; they also regulate the nutrition of a part, also secretion and heat production. They are concerned, too, in the control of the heart-beat. The center is in the medulla, in the floor of the fourth ventricle, near the calamus scrip- torius. 4. The function of the suprarenal glands is unknown; it is supposed that they are able to destroy or remove some toxic substance produced elsewhere in the body. Re- moval of these glands is rapidly followed by death. 5. The mastoid cells are lined by epithelium, continuous with that of the tympanic cavity. 7. The functions of the bile are: (1) to assist in the emulsification and saponification of fats; (2) to aid in the absorption of fats; (3) to stimulate the cells of the intestine to increased secretory activity, and so promote peristalsis, and at the same time tend to keep the feces moist; (4) to eliminate waste products of metabolism, such as lecithin and cholesterin; (5) it has a slight action in converting starch into sugar; (6) it neutralizes the acid chyme from the stomach, and thus inhibits peptic digestion; (7) it has a very feeble antiseptic action. The constituents of the bile may be shown in the follow- ing table, which presents the averages of three analyses given by Hammarsten ; the results are given in parts per thousand: Water 97I . 3 8o bohds 28.620 Mucin and pigments 4.910 Bile salts 12.197 Taurocholate 2.431 Glycocholate 9.766 Fatty acids from soaps 1.243 Cholesterin 1.200 84 MEDICAL RECORD. " European correspondents furnish medical news of special interest and reports of the principal foreign medical societies." Lecithin and fats 0.970 Soluble salts 7.360 Insoluble salts 0.317 9. The functions of the cerebellum are: (1) coordina- tion, (2) equilibrium. Removal of the cerebellum causes loss of these functions. 10. The functions of the medulla are: (1) Conduction of nerve impulses and impressions, (2) as an independent reflex center. The "centers" located in the bulb are: (1) center for mastication, (2) for secretion of saliva, (3) for sucking, (4) for deglutition, (5) for vomiting, (6) for voice, (7) center for expression (8) cardiac centers, (9) respiratory centers, (10) vasomotor centers. SURGERY. 2. The danger signals are: (1) lividity or extreme pallor of the face, (2) feeble, irregular, or intermittent pulse, (3) slow and shallow respiration, (4) dilatation of the pupils during deep narcosis. 5. By osteoplasty is meant the transplantation of bone (with periosteum). It is most frequently performed on the skull. 6. Painful cicatrix is caused by the pressure of a con- tracting cicatrix upon the cut end of a nerve or by thy inclusion of a nerve in the scar of an amputation stump. In the former case the painful part should be excised; in the latter the stump must be opened and the end of the affected nerve removed. Adherent cicatrix is caused by simultaneous injury (such as burns or scalds) to contiguous and approximated parts, such as the fingers, or the pinna and the side of the head. A plastic operation is indicated. Contracted cicatrix is most apt to occur in the flexure of a joint; a serious burn of the hand may cause flexion- contracture of the fingers. The treatment is to divide the cicatrix, dissect out the scar, and follow with skin-grafting. Exuberant cicatrix consists of a hyperplasia of scar tissue, it is most often found in tuberculous patients, and is of unknown etiology. Excision is useless, as it is very apt to recur. Sometimes it disappears spontaneously. 10. The patella. It is best treated by open operation and wiring. OPHTHALMOLOGY, OTOLOGY, RHIN0L0GY, AND MEDICAL JURIS- PRUDENCE. I. (1) Atrophic nasal catarrh, due to syphilis, glanders, caries, or necrosis of the nasal bones ; (2) ulcers of a 85 MEDICAL RECORD. The MEDICAL, RECORD publishes no " Students' Number," for every issue is a students' number and a practitioners' number in one. syphilitic, lupoid, or tuberculous origin ; (3) foreign bodies and new growths in the nose or nasopharynx. 2. Adenoids consist of lymphoid tissue, which is com- posed of masses of round cells held together by connective tissue. Mucous glands may be found in the deeper parts of the lymphoid tissue; and the whole is covered with cil- iated columnar epithelium. 3. Strabismus, or squint, is a condition in which the lines of sight of the two eyes are not directed towards the same object of vision. The causes are: (1) disturbances of equilibrium ot the ocular muscles; (2) errors of refraction; (3) opacities in the cornea or lens; (4) intraocular disease. 5. The membrana tympani. 6. IjL Acidi borici gr. xxx Zinci sulphatis gr.xvj Glycerin 3ij Aquae destillatae 3»j. M. Sig. A few drops to be instilled into the ear several times a day. 8. Medical jurisprudence is the application of the knowl edge of any of the branches of medicine to the problems and reauirements of the law. 9. Any statement made by a dying person who believe> that he cannot recover and that he is, at that very time, in actual danger of death. The statement need not be sworn to; it should be voluntary and sincere; and it is admissible as evidence in a court if the individual dies. 10. In diphtheria the onset is more gradual; the temper- ature rises to about 101 to 103 F. ; the tonsils are not much enlarged; there is an exudate of a thick grayish mem- brane which is very adherent, is removed only with diffi- culty, and leaves a bleeding surface; this membrane soon re-forms and may be found on the fauces and pharynx as well as on the tonsils; in the exudate the Klebs-Loffler bacilli may be found. In follicular tonsillitis the onset is more sudden; the tem- perature may be a little higher than that of diphtheria ; ther* is no membrane, but the tonsils are red and swollen, and in the crypts are seen white cheesy spots or plugs, which consist of broken-down epithelium, and are easily brushed away; Klebs-Loffler bacilli are not found. THEORY AND PRACTICE. 8. (1) A systolic murmur, soft and blowing, heard best at the apex, and transmitted to the left axilla and toward the angle of the left scapula, indicates mitral regurgitation. 86 MEDICAL RECORD. " Book reviews of foreign and American publications keep you thoroughly informed of the newest literature." (2) A presystolic murmur, harsh and rough, heard best very near the apex, and not transmitted, denotes mitral stenosis. (3) A diastolic murmur, soft, heard best in the second right intercostal space, and transmitted down the sternum or toward the apex, denotes aortic regurgitation. (4) A systolic murmur, harsh, heard best in the second right intercostal space, and transmitted into the carotids, denotes aortic stenosis. (5) A systolic murmur, heard best over the lower end of the sternum, denotes tricuspid regur- gitation. (6) A presystolic murmur, heard best over the ensiform cartilage, and not transmitted, denotes tricuspid stenosis. (7) A diastolic r.iurmur, heard best in the second left intercostal space, denotes pulmonary regurgitation. (8) A systolic murmur, heard best in the second left inter- costal space, and not transmitted to the large vessels of the neck, denotes pulmonary stenosis. (9) A murmur, usually systolic, soft, and blowing, heard best over the pulmonic area, associated with evidences of chlorosis or anemia, and affected by the position of the patient, is a hemic or func- tional murmur, and denotes as a rule an impoverished con- dition of the blood. MATERIA MEDICA. i. In diabetes ; particularly diabetes mellitus. 2. Nux vomica and ignatia (and their alkaloids strych- nine and brucine), thebaine, ammonia, ether, chloroform, opium, ergot, alcohol in small doses. 3. Conium, three grains; fluid extract of conium, three minims. 4. Yes; on account of the rapidity of its action, ether is a very valuable cardiac stimulant. 5. The patient must be kept in the recumbent position; the stomach should be washed out with infusion of tea; give stimulants and keep the patient warm ; tannic acid may be given, as the chemical antidote ; and tincture of aconite, as the physiological antidote. 6. Ipecac is used externally as an antiseptic, in cases of anthrax. Internally as a stomachic, an expectorant, an emetic, a diaphoretic, and a cholagogue. It is given in cases of dyspepsia, dysentery, bronchitis, asthma, croup, and in the vomiting of pregnancy. 7. The caustic alkalies are incompatible with belladonna. 8. It is an irritant; applied externally it hastens the coagulation of the blood and makes a firmer clot. It is used in cases of gastric catarrh and fermentative dyspepsia, in hematemesis and hemoptysis, in glandular swellings of tuberculous patients. It has also been employed in the treat- 87 MEDICAL RECORD. "The most important contributions to the literature of medicine and surgery have been published first in the B1EDI- CAE RECORD." ment of pneumonia and phthisis. The dose is seven and a half grains. 9. Auri et sodii chloridum is the only official gold salt; dose, one-tenth of a grain. 10. Iron, manganese, arsenic, bismuth, and phosphorus. STATE BOARD EXAMINATION QUESTIONS. Michigan State Board of Registration in Medicine. October 9, 10, II, 1906. anatomy. 1. Describe the chief processes and general character- istics of the humerus. 2. What are the muscles of the forearm? 3. Describe the femoral artery. 4. Describe the collateral circulation after ligature of the common carotid artery. 5. Mention the principal convolutions of the brain. What are the ventricles of the brain? 6. What are the cranial nerves, and what do they sup- ply? 7. Name the subdivisions of the alimentary tract and the accessory organs. 8. What are the lobes and fissures of the liver? De- scribe the gall-bladder. 9. What is the trigone vesical? 10. What are the muscles of the tympanum? What is the nerve supply to the tympanum? PHYSIOLOGY. 1. Metabolism. Define and give classification. 2. When can a given amount of starch be said to have been completely digested? 3. Mention and give function of some one large system of veins beginning and ending in capillaries. 4. Give function of liver other than the secretion of bile — and mention varieties of blood found within the organ. 5. Blood. Trace its course through the heart and lungs, beginning at the right auricle. Describe the changes that take place. 6. Describe the function of the stomach. 7. Name all the valveless veins, and state why they have no valves. 8. Give function of kidneys. MEDICAL RECORD. " Original Articles are of the highest scientific value and most practical character, by the foremost men of the world." 9. State function of sympathetic nervous system. 10. Mention four elementary principles essential to health. HISTOLOGY AND EMBRYOLOGY. 1. Name and describe the various forms of epithelial tissue. 2. Name the elementary tissues of special function. 3. Define and describe the lymphatic circulation. 4. Describe the formation and growth of the nails. 5. Give the structure of Peyer's patches. CHEMISTRY AND TOXICOLOGY. i. Define acid and base. 2. What is meant by "valence"? What is the valence of Ca, Na, and K? 3. How is ammonia prepared? 4. Define the term anhydride. 5. Classify ferments found in the body. Name one member of each class. 6. Give the composition of the gastric juice. Give tests. 7. Give symptoms and treatment of poisoning from bichloride of mercury. 8. Describe opium poisoning. Distinguish between opium and alcoholic poisoning. 9. Describe cocaine poisoning. 10. Give symptoms of poisoning from the continuous use of acetanilide. Treatment. BACTERIOLOGY. 1. Define bacteria; state methods for recognition, culti- vation, and the conditions most favorable for growth, and the different ways of entering the body to produce disease. 2. Give details for the examination of sputum for the tubercle bacillus. 3. Describe method for determining the bacillus of tetanus, and state origin, form, properties, and growth. 4. What are ptomains, toxins, toxoids? What is an antitoxin — an antitoxic unit? 5. How would you make a bacteriological examination in suspected diphtheria? State dosage of diphtheritic anti- toxin in pharyngeal and laryngeal cases, and in the differ- ent stages ; also dosage for immunizing or prophylactic purposes. SURGERY. 1. Local anesthesia. _ Describe agents and methods. 2. What is sepsis, giving symptoms and stages? 89 MEDICAL RECORD. " Bulletins of Examinations of State Medical Licensing Boards published bi-weekly." 3. Describe the different amputations at the ankle joint. 4. Describe inguinal colostomy, giving indications for same. 5. Give differential diagnosis of dislocation of the femur. 6. Describe the complications of fracture, with treat- ment. 7. Describe osteomyelitis, giving etiology, differential diagnosis, sequelae, treatment. 8. Give the surgical consideration of gastric ulcer. 9. Give diagnosis, cause, and surgical treatment of cal- culus. 10. Give diagnosis and surgical resources of intestinal obstruction. GYNECOLOGY. 1. Describe the pathological effects caused by laceration of cervix, and all reflex disturbances therefrom. 2. What pathological conditions follow lacerated per- ineum ; their immediate and remote manifestations, and, if operation be required, how soon should it be made, if not immediately following the injury? 3. What is vaginismus, its cause, and treatment? 4. What are the sources of streptococci poisoning in the puerperium, and in what per cent, of such cases does it occur? How should the local and constitutional mani- festations of the disease be treated? 5. What is cystocele? Give symptoms and treatment. OBSTETRICS. 1. External pelvimetry. Give procedure of taking ex- ternal measurement, and enumerate the various normal diameters. 2. Tuberculosis. What influence does gestation have on the course of this disease? 3. Mention regulations for diet during normal preg- nancy. 4. Give treatment of asphyxia of newly born. 5. Funicular presentation. Give etiology, diagnosis, and treatment. PATHOLOGY. 1. Hyaline degeneration. Give its etiology and seats. 2. What is metabolism in diabetes? 3. Describe the lesions produced by excessive cold and heat. 4. Describe hypertrophy, and give its etiology and pathological anatomy. 90 MEDICAL RECORD. " Keeps you in closest touch with the weekly progress of medicine and surgery throughout the world." 5. Describe briefly the general structure of tumors, and discuss their classification. 6. Describe and give the pathology of congenital ate- lectasis. 7. Distinguish between fibrinous, catarrhal, purulent, and fibrous pneumonia. 8. Give pathology of chronic salpingitis. 9. Differentiate between caries and necrosis, giving eti- ology and pathological anatomy of the latter. 10. What is osteomalacia? PRACTICE OF MEDICINE. i. What are the remote effects of syphilis of the nervous system ? 2. Mention some of the more common diseases of the heart; their diagnosis, prognosis, and treatment. 3. Describe pleurisy, both serous and purulent; diag- nosis. 4. What is the prognosis in serous pleurisy? 5. What is the prognosis in purulent pleurisy? 6. What are the symptoms in gastric ulcer? Differen- tiate from duodenal ulcer. 7. Describe the characteristic physiognomy in typhoid fever, tetanus, and exophthalmic goiter. 8. Give the dietetic management of acute pneumonia, gastrointestinal indigestion, and chronic parenchymatous nephritis. 9. What is the clinical difference between diphtheria and streptococcic infection of the throat? 10. The cause and treatment of scurvy? EYE, EAR, NOSE, AND THROAT. 1. What is trachoma; its cause; symptoms; course; prognosis; medical and operative treatment? 2. Describe the Argyll-Robertson pupil, and give its significance. 3. Describe the organs of the nerve supply of the function of hearing. 4. What is chronic nasal catarrh — its pathological anat- omy, and treatment? 5. Describe the larynx and its cartilages — the laryngeal ligaments and the vocal cords. MEDICAL JURISPRUDENCE. i. What do you understand by the term medical juris- prudence? 2. A dead body is discovered in some sequestered spot, 01 MEDICAL RECORD. "Acknowledged to be the leading independent medical weekly." with or without marks of external violence. How would you proceed to make an examination of said body? 3. Differentiate between wounds inflicted before death, and those inflicted after death. 4. Define insanity from a medicolegal standpoint. 5. What constitutes malpractice? HYGIENE AND PUBLIC HEALTH LAWS. i. Define the term hygiene as related to the science of medicine, and state what you understand by health laws. _ 2. What diseases may develop from the use of impuri- ties in water? Impurities in milk? 3. What deleterious gases accumulate in an imperfectly ventilated school room, and state amount of fresh air re- quired per minute for each child; also state evil effects from the inhalation of air rendered impure by respiration. 4. Name most improved methods of disinfecting living rooms. State what precautions should be observed in typhoid fever, and with regard to the sputum of tubercular patients. 5. What diseases must be reported to the board of health? State fully the duties of the physician as required by our statutes. MATERIA MEDICA AND THERAPEUTICS. 1. Explain what is meant by empirical use of remedies and their intelligent employment, and give examples. 2. Describe some of the so-called remedies much in vogue during the past fifty years which are now deemed worthless, if not harmful in certain cases. (g; Describe hypnotics, and the two classes into which they may be divided. Give examples. *\ — -4. What are anthelmintics? Vermifuges? Vermicides? What are the parasites against which they are directed? 5. What are the physical properties of amyl nitrite? Give its effects and therapeutics. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Michigan State Board of Registration in Medicine. October 9, 10, and 11, 1906. ANATOMY. 4. The collateral circulation is through (1) the internal carotid and vetebral of one side with those of the other, through the circle of Willis ; (2) superior thyroid with 92 MEDICAL RECORD. Its prestige attracts articles by the best known writers.' inferior thyroid; (3) deep cervical of superior intercostal with princeps cervicis of occipital ; (4) superior thyroid, lin- gual, facial, occipital, and temporal branches of external carotid, with corresponding arteries of the other side. PHYSIOLOGY. 1. Metabolism is a name given to the entire series of changes that occur in a cell or organism during the proc- esses of nutrition. It is of two kinds: (1) anabolic, or constructive, and (2) catabolic, or destructive. 2. When, in the small intestine, by the action of the pancreatic enzyme amylopsin, it has been entirely converted into maltose and dextrose. 3. The portal system of veins begins and ends in capil- laries. Its function is to carry to the liver blood loaded with material absorbed from the contents of the stomach and intestines. 4. The functions of the liver other than the secretion of bile are: (1) the formation of glycogen, (2) the for- mation of urea and uric acid, (3) the manufacture of heat, and (4) the conversion of poisonous and harmful into inert material. 5. The changes take place in the capillaries of the lungs, and are: (1) the giving up of the CO2 by the venous blood, (2) the absorption of oxygen during inspiration, (3) the blood is cooled, and (4) it also loses a small amount of watery vapor. 6. The functions of the stomach are: (1) to receive the food after mastication and deglutition; (2) to secrete the gastric juice, which can act upon the food after it has entered the stomach; (3) by means of its muscular move- ments to blend and incorporate the gastric juice with the food it has received ; (4) to absorb such parts as are ready for absorption. 7. The valveless veins are: the venae cavse, hepatic veins, portal vein and its branches, renal, uterine, ovarian, pul- monary, cerebral, spinal, and umbilical veins. The sinuses of the skull and very small veins are also without valves. These veins, not being liable to pressure, do not require the action of the valves, the chief function of which is to prevent a reflux of blood back towards the capillaries. 9. The function of the sympathetic nervous system is to supply (1) the muscles of the vascular system, by means of the vasoconstrictor and vasodilator nerves, also the accelerator and inhibitory nerves of the heart; (2) the muscles of the various viscera ; (3) various glands, such as the lacrymal and parotid glands. 93 MEDICAL RECORD. "Since 1890 the MEDICAL RECORD has had a cabled re- port of every International Medical Congress." 10. Proteids, carbohydrates, fats, and water are all es- sential to health. HISTOLOGY AND EMBRYOLOGY. 3. The lymphatic circulation is, strictly speaking, not a circulation at all ; since the lymph flows only in one direc- tion, namely, toward the heart. The lymph capillaries take up any excess of the blood plasma which is not required for the nutrition of the tissues. These capillaries consist of a single layer of epithelium, and empty themselves into vessels very like the veins. The lymph vessels are well provided with valves, which are so closely approximated as to give the vessels a beaded appearance. All the lymphatic vessels, except those of the right upper half of the body, empty into the thoracic duct, which terminates in the left subclavian vein, where the left internal jugular vein also enters. Those from the right upper half of the body dis- charge into the right lymphatic duct, which, in turn, empties into the right subclavian vein at its junction with the right internal jugular vein. 4. About the end of the third month of fetal life the primitive epidermis, over the end of the digits, thickens, and the nail area is outlined by a furrow. The root of the nail is then marked by an ingrowth of the rete Mal- pighii. A little later, the upper cells of the Malpighian layer become covered with granules, which eventually be- come hardened to form the nail substance; at the same time the stratum lucidum cells increase in number, and help to form the body of the nail. Last of all, the free edge of the nail is formed by the shedding of the stratum lucidum. The growtli of the nail is caused by the addition of cells at the posterior margin ; it gains in thickness by additions from the stratum mucosum at the lunula. 5. Peyer's patches are large, oval groups of lymph fol- licles, closely packed together, and held in place by adenoid tissue. They are chiefly found in the ileum. CHEMISTRY AND TOXICOLOGY. 1. An acid is composed of an electro-negative element or radical with hydrogen, part or all of which hydrogen it can part with in exchange for an electro-positive element, without the formation of a base. A base is a substance which can enter into double decomposition with acids to produce a salt and water. 2. Valence is the combining power of an atom of an element as compared with that of an atom of hydrogen. Calcium is bivalent; sodium and potassium are univalent. 94 MEDICAL RECORD. " Choice and important abstracts from the leading medical periodicals of the world in a condensed and practical form." 3. Ammonia is prepared by heating a solution of am- monium hydroxide : NH*HO=NHs+H s O 4. An anhydride is an oxide capable of combining with water to form an acid. 5. Ferments of the body are: (1) proteolytic, e.g. trypsin; (2) amylolytic, e.g. ptyalin ; (3) steatolytic, e.g. steapsin; (4) inverting, e.g. invertin; (5) coagulating, e.g. milk curdling ferment. 6. Gastric juice consists of ninety-nine and a half per cent, water and half of one per cent, solids. It contains hydrochloric acid, pepsin, a curdling ferment, mucin, salts, and water. The amount of free hydrochloric acid is about two parts in a thousand. Tests for free hydrochloric acid : (1) Add to a few drops of filtered gastric juice one drop of a solution of dimethyl-amido-azo-benzol ; a cherry red color develops. (2) The reagent is prepared by dissolving two grams of phloroglncin and one gram of vanillin in 100 c.c. of 90 per cent, alcohol ; then place an equal number of drops of this reagent and of gastric juice (filtered) on a porcelain dish, and allow the fluid to evaporate slowly ; a rose tint appears at the edge. 7. Symptoms of poisoning by bichloride of mercury are : a burning pain in the mouth, pharynx, and stomach ; the mouth and tongue are white ; the vomitus is white, with shreds of mucous membrane, and tinged with blood; bloody stools, also salivation may occur. Treatment : the antidote is white of egg, but too much must not be given at one time; this should be followed by an emetic. 8. In opium poisoning there may be three stages: (1) a period of excitement, in which the patient is active, talk- ative, and has hallucinations ; (2) a period of drowsiness, in which the patient is sleepy, but may be aroused ; his face is pale, lips livid, pupils contracted; this passes into (3) the stage of coma, from which the patient cannot be aroused, the reflexes are abolished, the pupils are very contracted, the pulse is slow and irregular, and the respirations are infrequent and shallow. In alcoholic poisoning the pupils are not contracted, the respirations are about normal, and the skin is cooler than in opium poisoning. 9. In cocaine poisoning there will be found pain and fullness in the head, pulse first quick, later feeble and slow, extremities cold. The symptoms are not constant. 10. The continuous use of acetanilide may give rise to 95 MEDICAL RECORD. "We publish the proceedings of an association immediately after the meeting." decrease in the number of red blood cells; the face is livid and covered with perspiration, the respirations become slow and shallow, the pulse soft, compressible, and gradu- ally weaker. Treatment: stop further administration of the drug, then support the patient by stimulants, warmth, and strychnine. BACTERIOLOGY. 1. Bacteria are unicellular organisms of vegetable na- ture, devoid of chlorophyl, and multiplying by fission. They are recognized by their shape, size, mobility, grouping, growth, and behavior to cultures and staining reagents. The chief culture media are : milk, blood serum, bouillon, gelatin, agar, potato. The conditions favorable for their growth are moisture, temperature of between io° and 40 C, nutritive material in the shape of decomposable organic matter, a medium of neutral or faintly alkaline reaction, and rest. Bacteria enter the body through the abraded skin or mucous membrane, or through the respiratory, ali- mentary, or genito-urinary tracts. 2. The sputum must be recent, free from particles of food or other foreign matter ; select a cheesy-looking nodule and smear it on a slide, making the smear as thin as possible. Then cover it with some carbolfuchsin, and let it steam over a small flame for about two minutes, care being taken that it does not boil. Wash it thoroughly in water and then decolorize by immersing it in a solution of any dilute mineral acid for about a minute. Then make a contrast stain with solution of Loeffler's methylene blue for about a minute ; wash it again and examine with oil immer- sion lens. The tubercle bacilli will appear as thin red rods, while all other bacteria will appear blue. 3. The bacillus of tetanus is characterized by its peculiar spore, formed at one end of the bacillus, and giving it the appearance of a pin ; it is purely anaerobic, and cannot be developed at all in the presence of oxygen. It generally comes from the soil, and is found in penetrating wounds. It appears in two forms, the spore-bearing form, as de- scribed above, and the vegetative form, which is a short bacillus with rounded ends, and which may occur singly or in pairs, or may form long filaments. It grows in gelatin stab cultures in the middle of the medium, and the colonies look something like a fir tree ; its growth is slow, and a disagreeable odor is at the same time emitted. In bouillon, it grows near the bottom of the tube, and produces gases. 4. Ptomaines are the putrefaction products of dead ani- mal tissues or fluids. 96 MEDICAL RECORD. " Bange of subjects embraces every branch of medicine and surgery." Toxins are the products of pathogenic bacteria or of ptomaines or leucomaines, and are actively poisonous. Toxoids are toxins whose poisonous properties have been reduced or modified. An antitoxin is a substance formed in the body, of a protective character, and capable of rendering inert the poisonous products of bacteria. An antitoxic unit is the quantity of antitoxin, which, on being inoculated into a guinea pig weighing 250 grams, will neutralize one hundred times the lethal dose of toxin, 5. A sterile swab is rubbed over any visible membrane on the tonsils or throat, and is then immediately passed over the surface of the serum in a culture tube. The tube of culture, thus inoculated, is placed in an incubator at 37° C. for about twelve hours, when it is ready for examina- tion. A sterile platinum wire is inserted into the culture tube, and a number of colonies of a whitish color are removed by it, and placed on a clean cover slip, and smeared over its surface. The smear is allowed to dry, is passed two or three times through a flame to fix the bac- teria, and is then covered for about five or six minutes with a Loeffler's methylene-blue solution. The cover slip is then rinsed in clean water, dried, and mounted. The bacilli of diphtheria appear as short, thick rods with rounded ends ; irregular forms are characteristic of this bacillus, and the staining will appear pronounced in some parts of the bacilli and deficient in other parts. The dose of diphtheria antitoxin is from 2,000 to 3,000 units to be injected as soon as possible, and, if necessary, to be repeated in twelve hours ; in severe cases it may be repeated earlier. In laryngeal and severe pharyngeal cases a larger dose may be used, up to 5,000 units. The im- munizing or prophylactic dose is from 200 to 500 units. SURGERY. 1. Local anesthesia can be caused by applying a mixture of salt and ice, or by spraying the part with ether or with ethyl chloride. Cocaine hydrochloride, in watery solution of about 5 to 8 per cent., can also be applied to a mucous surface, or in a one per cent, solution it can be dropped into the eye. The same drug can be used hypodermically in solution of from one to four per cent., but it does not act on inflamed tissues. When injected into a finger or toe, its action can be increased by the application of a tourniquet, which prevents the solution from being carried away in the blood current. Hypodermic injections of sterile water are said to have the same effect as those of cocaine. 97 MEDICAL RECORD. " New instruments are portrayed and their use thoroughly explained." 2. Sepsis is a condition due to the entrance and multi- plication of bacteria in the body, or by the absorption of their products. The stages are (i) that of septic fever, with rapid rise of temperature, remitting each morning, pulse full and rapid, anorexia, furred tongue, dry skin, constipation, scanty, high-colored urine, headache; (2) hectic fever, due to retention of discharges, with fever, flushed face, anorexia, tongue dry and red, diarrhea, pro- fuse sweating, urine loaded with urates, and tendency to formation of bedsores; (3) in long-standing cases amyloid disease may follow, especially when there is a long-con- tinued discharge; albuminuria and diarrhea are commonly present in this stage. 4. The indications for inguinal colostomy are: (1) congenital absence of the rectum when incision by the per- ineal route fails to reach the intestine; (2) chronic ob- struction of the large intestine, which cannot be relieved by other means ; (3) volvulus of the sigmoid flexure which cannot be otherwise reduced ; (4) cancer of the rectum when a radical operation is inadvisable; (5) as a prelim- inary operation to excision of the rectum. 6. The chief complications of fracture are: compound fracture, injury to blood-vessels, gangrene, degeneration and contraction of muscles, stiff joint, atrophy of limb, suppuration, injury to nerves, fracture into joint, disloca- tion, septicemia, fat embolism, pneumonia, and delirium tremens. GYNECOLOGY. 1. Laceration of the cervix may cause hypertrophy, elon- gation, sclerosis, cystic degeneration, or carcinoma of the cervix; subinvolution, or displacements of the uterus, also endometritis. Other results may be pain on walking, on defecation, or during coitus; sterility or abortion; head- aches, backache, neuralgic pains, neurasthenia, indigestion, constipation. 2. Lacerated perineum may be followed by local tender- ness, irritable scar, reflex disturbances, subinvolution of the uterus, rectocele, cystocele, prolapse of the uterus, and in- continence of feces. 3. Vaginismus is a condition of painful and spasmodic contraction of the vaginal orifice, which renders coitus either painful or altogether impossible. Its causes are irri- table hymen, ulcer, or fissure anywhere in the immediate vicinity, urethral caruncle, caruncute myrtiformes, a long perineum with vaginal orifice placed too anteriorly. The treatment consists in removing the cause when possible, 98 MEDICAL RECORD. "The most important and interesting items of the very latest medical news throughout the world." tonics and general constitutional treatment, dilatation of the vaginal orifice; local application of a five per cent, solution of cocaine will relieve the hyperesthesia and allow of coitus. 4. The sources of streptococcic poisoning in the puer- perium are the hands of the physician, nurse, midwife, or of the patient herself; unclean instruments and catheters; coitus during the time immediately preceding labor ; contact with secretions from wounds of any kind, no matter where situated ; general unhygienic surroundings, and contact with a patient suffering from scarlet fever or erysipelas on the part of any one attending on the woman. The percentage of such cases will depend on the care exercised by doctor, nurse, etc. ; when infection does occur, it is generally streptococcic infection, either pure or mixed with other germs. OBSTETRICS. 1. In external pelvimetry four measurements are gen- erally taken: (1) between the anterior superior spines of the ileum, normally about ten and a quarter inches; (2) between the external edges of the iliac crests, normally about eleven inches; (3) between the heads of the two great trochanters, normally about twelve and a quarter inches; and (4) between the spinous process of the .last lumbar vertebra and the upper margin of the anterior sur- face of the symphysis pubis, normally about eight inches. 2. It was formerly held that pregnancy had a beneficial effect upon tuberculosis, that the mother was likely to improve as long as the pregnancy lasted, though she might rapidly fail after the birth of the child. The more recent view is that pregnancy exercises a harmful effect; that pregnancy, labor, and lactation only weaken the patient, lower the vitality still further, and hasten the end. 3. The patient should be advised to avoid indigestible or very highly seasoned articles of food; her diet should be nutritious and sufficient. In patients who have previously had unduly heavy children it would be well to restrict the carbohydrates and fluids during the last two or three months of pregnancy. The tendency to constipation, which may be increased during pregnancy, should be overcome by laxative foods or fruit. PATHOLOGY. 1. The etiology of hyaline defeneration is somewhat obscure; it is said to be caused by infections and intoxica- tions, such as lead, alcohol, and syphilis. The seats are: the blood-vessels in the brain, lymphatic glands, voluntary 99 MEDICAL RECORD. " The medical profession have been presented with the results of great discoveries by the MEDICAL RECORD In advance of any other publication." muscles, and ovaries. Aneurysms, sclerosed arteries, the heart in endocarditis, and gummata may also undergo hya- line degeneration. 2. Normally, the blood contains about o.i per cent, of grape sugar, which is chiefly derived from the carbo- hydrates in the food, but also by a splitting up and re- arrangement of the elements of the protelds, and possibly also from the fats. This and other changes are supposed to take place in the liver, which, together with the muscles, converts the sugar into glycogen, and also acts as a storage place for the glycogen. The glycogen is changed again into sugar and passed into the blood, which is thus kept supplied with its proper amount. In diabetes this arrangement be- comes disturbed, with the result that some of the sugar delivered to the blood is not utilized. According to Tyson, this may be brought about in several ways: (i) It may be that the glucose arising by a reconversion of the glycogen stored in the liver is contributed to the blood too rapidly to be oxidized; (2) It may be that, although the glucose is delivered in normal quantity, it is still not consumed be- cause of some defect in the oxidizing mechanism, some de- ficiency in the glycolytic ferment; (3) It may be that the glucose arising from sugar and starch digestion in the in- testine is not first converted into glycogen as in health, but passes directly through that organ to the vena cava too rapidly or in too large quantity to be utilized, or lacking some molecular quality which permits its oxidation. 3. In extreme cold the skin is pale and waxy, with irreg- ular dusky, reddish patches ; the superficial parts are blood- less, while the viscera, including the brain, are congested ; the heart and large vessels leading from it are full of blood, and the blood is of a brighter red color than usual. In extreme heat, the lesions are great congestion of the viscera, early rigor mortis and putrefaction, the red blood corpuscles are broken up, and otherwise altered in appear- ance, there is also coagulation of the proteid matter in the tissues, and the kidneys have a reddish-brown color. 7. Fibrinous pneumonia is the same as lobar pneumonia ; catarrhal is the same as lobular or bronchopneumonia; purulent is any form of pneumonia in which pus is formed; fibrous pneumonia is the same as interstitial pneumonia, and is often called fibroid phthisis, or cirrhosis of the lung. 8. Caries means molecular death and disintegration of bone, attended with suppuration. Necrosis implies that a portion of bone has died en masse, molar death of bone. IOO MEDICAL RECORD. "Editorials on subjects of timely interest and of vital im- portance dealt with in a masterly and scholarly style." These two terms are used in regard to bone, in the same way that ulceration and sloughing are, with regard to the soft tissues. PRACTICE OF MEDICINE. i. The remote effects of syphilis of the nervous system are : Mania, melancholia, paretic dementia, pseudoparesis, myelitis, meningomyelitis, paraplegia, hemiplegia, locomotor ataxia, general paresis, neurasthenia, hysteria, epilepsy and neuralgia. 6. In duodenal ulcer the pain is apt to be more to the right and to occur at an interval of two or three hours after meals; the hemorrhages will be intestinal, and the blood will be passed by way of the bowels, and not vomited. In many cases the symptoms are identical with those of gas- tric ulcer. 7. In typhoid fever there is a dull and apathetic ex- pression, the cheeks may be flushed, the tongue dry, and the teeth covered with sordes. In tetanus the jaws are firmly closed, the corners of the mouth are drawn up, and the forehead is wrinkled. In exophthalmic goiter there is a staring expression, accompanied with more or less protrusion of the eyeballs. 9. S'treptococcic infection of the throat presents symp- toms that are apt to be more severe than those of diph- theria. The temperature runs as high as 104 to 106 , but the only sure test is in the absence of the Klebs-Loeffler bacillus. EYE, EAR, NOSE, AND THROAT. 2. In the condition known as the Argyll-Robertson pupil, the pupil responds to accommodation, but not to light. It is found in locomotor ataxia, general paralysis of the insane, and sometimes in cerebral syphilis. MEDICAL JURISPRUDENCE. I. Medical jurisprudence is the application of the knowledge of any of the branches of medicine to the prob- lems and requirements of the law. 4. According to Taylor, the term insanity is applied to "those states of disordered mind in which a person loses the power of regulating his actions and conduct according tn (lie ordinary rules of society. In all cases of real in- sanity the intellect is more or less affected." 5. Malpractice includes any act, whether willful, or through negligence or ignorance, by which a physician or surgeon causes a person under his care to suffer death or unnecessary injury. The physician is not supposed to guar- 101 MEDICAL RECORD. " Our reporters attend every convention of first-rate im- portance. The news is telegraphed or cabled exclusively to the 31EDICAL RECORD." antee a cure, but is expected to do his best to bring about a cure. HYGIENE AND PUBLIC HEALTH LAWS. 1. Hygiene is the science and art of all that tends to the maintenance and improvement of health, the prevention or shortening of the duration of diseases, and the prolonga- tion of life. ' Health laws are such regulations, ordered and enforced by the proper powers in a community, as deal with the subjects comprehended under hygiene, and include the arrangement and building of houses, schools, etc., their ventilation, water supply, lighting, and the removal 01 refuse and excreta ; the regulation of dairies and slaughter- houses, the management of infectious diseases, the regula- tion of trades, the supervision of nuisances, and the dis- posal of the dead. 2. Impure water may cause typhoid fever, dysentery, diarrhea, indigestion, goiter, vesical calculi, cholera, yellow fever, scarlet fever, diphtheria, tapeworms, and lead poison- ing. ' Impure milk may cause tuberculosis, scarlet fever, diphtheria, typhoid fever, and cholera. 3. CO», organic matter, or crowd poison may accumu- late. As an adult is supposed to require 3.000 cubic feet of fresh air per hour, a child may be supposed to require, say, 2,400 cubic feet per hour, or forty cubic feet per min- ute. MATERIA MEDICA AND THERAPEUTICS. I By the empirical use of remedies is meant the em- ployment of them, because it has been found by experience that they are of benefit in conditions similar to the one under treatment; e.g., colchicum in gout, opium to relieve pain. By the intelligent employment of remedies is under- stood their use based upon a knowledge of the physiological action of the drug and a further knowledge of the patho- logical condition present; e.g. the use of digitalis in mitral lesions of the heart. 2. Among the so-called remedies now relegated to a judicious oblivion may be mentioned the use of quinine in typhoid, potassium chlorate in diphtheria, large doses of creosote in pulmonary tuberculosis, bleeding for nearly everything, methylene chloride as an anesthetic, condu- rango for cancer, and sarsaparilla for syphilis. 3! Hypnotics are agents used to induce sleep. The two classes into which they may be divided are: (1) those which relieve pain and produce sleep, and (2) those which MEDICAL RECORD. " Statistics of the health boards and many articles of scien- tific interest and items of general information." will produce sleep, but will not relieve pain. Opium is an example of the former class, and chloral of the latter. 4. Anthelmintics are drugs used for the purpose of re- moving intestinal worms. Vermifuges cause the expulsion of these worms, and vermicides destroy them. The para- sites against which they are directed are: (1) the round worm (Ascaris lumbricoides) ; (2) the tapeworm (Tcsnia solium, T. saginata, and Bothriocephalus latus) ; (3) the seat worm, or round worm, or pin worm (Oxyuris vermi- cularis) ; and (4) An-kylostoma duodcnalc. STATE BOARD EXAMINATION QUESTIONS. Minnesota State Board of Medical Examiners. January, 1907. ANATOMY AND HISTOLOGY. i. Describe the membranes covering the brain, in their order, from without, inward, giving the number of and peculiarities of each. 2 Describe the mammary glands and give the blood and nerve supply. 3. Describe the stomach, fully, giving blood and nerve supply and its anatomical relations to surrounding parts. 4. Give the fetal circulation. 5. Describe the shoulder joint and name the muscles covering it and their relation to it. 6. Define Histology. 7. Name the four fundamental elementary tissues. 8. Define Metabolism. 9. Describe lung tissue (a terminal bronchiole and pyr- amidal mass that it leads to) fully. 10. A hair is composed of how many strata? Name them in their order. PHYSIOLOGY. 1. Give, somewhat in detail, the physiology of the kidney, with a sufficient anatomical description (preferably with diagram), to make your meaning plain. 2. The same of the liver. 3. Of what does the sympathetic nervous system con- sist, and where is it located, and how divided as regards location, and what is its function? 4. What centers are located and arranged alongside the fissure of Rolando? 5. Describe human blood, giving reaction, specific grav- ity, constituents, etc. 103 MEDICAL RECORD. "The progressive physician must have his medical weekly just as the business man his newspaper." 6. What are the functions of epithelial tissue? 7. In a lesion involving the third frontal convolution on the left side (in a right handed person), what function would be interfered with? 8. Describe the pulmonary circulation, and the changes which are produced in the blood by aeration. 9. Trace the different steps in the digestion of a bolus of food consisting of proteids, fats, starches, and sugars. 10. What is the composition, reaction and function of the pancreatic juice? CHEMISTRY, TOXICOLOGY, AND URINALYSIS. 1. How would you determine the presence of mercury in a solution? In a solid or powder? 2. How would you determine the presence of silver in a solution? In a solid? 3. Give test of iodine. 4. Give test for the presence of hydrocyanic acid. 5. Give test for the presence of morphia. 6. Give test for the presence of strychnia. 7. How determine if urea or the urates are present in excess? 8. How determine the presence of acetone? 9. How determine the existence of oxaluria? 10. Give symptoms and treatment of acute peisoning by salicylic acid or the salicylates. MEDICAL JURISPRUDENCE. i. Define illusion, hallucination, and delusion, and give example of each. 2. What are the post mortem signs found after asphyxia in the new born? After strangulation? 3. How is criminal abortion commonly produced? How detected in the living and dead? 4. What are the effects of prolonged exposure to cold, and the post mortem appearances which follow? 5. Upon what does the poisonous action of coal gas depend? PREVENTIVE MEDICINE. 1. A case of small-pox is discovered in a lodging house; what steps should be taken to prevent the spread of the disease? 2. What are the dangerous impurities in the air of crowded and unventilated rooms? 3. Describe sand filtration of water on large scale, con- struction of filter ; and explain action in purifying water. 104 MEDICAL RECORD. " Surgical Suggestions that will appeal to the student and the general practitioner." 4. Give some simple precautions for the conduct of the tuberculous patient to prevent the spread of the disease. 5. In a system of house plumbing, what is a trap, give construction, location and use. MATERIA MEDICA AND THERAPEUTICS. 1. Name the official soluble Salts of Iron. 2. Opium: (a) Give action on man of Therapeutic and of Toxic doses. (b) Name chief preparations of (not alkaloids), with dose of each. (c) Contraindications for use. 3. You wish to prescribe Ammonium Salicylate, but find your druggist out of stock; write an extemporaneous pre- scription which will give the required drug in solution in proper dosage for a case of acute inflammatory rheumatism. 4. Give the average adult dose of the following: (a) Arsenous Acid. (b) Fl. Ext. Cannabis Indica. (c) Ext. Hyoscyamus. (d) Heroin Hydrochlorid. (e) Hydrocyanic Acid dilute. (f) Tr. Aconite, U. S. P. (g) Lead Acetate. (h) Guaiacol Carbonate, (i) Sulphonal. (j) Acetanilid. 5. Criticise the following prescription : # Tr. ferri Chloridi dr. ij. Acid Acetic dil. dr. iij. Liq. Ammon. Acetatis. oz. iij. Liq. Potas. Arsenitis dr. ss. Glycerin I , Elix. Aromat.f aadr - vl - Aquas pur. q. s. ad oz. vi. Misce et sig. A tablespoonful in a little water three times a day after eating. 6. What is the action of strychnia upon the sympathetic nervous system? 7- Give directions and write a prescription for the treat- ment of chronic dry eczema of the hands. 8. Outline treatment for a case of hemoptysis, and give your reasons for the treatment you advocate. 0. Discuss the use of the nitrite group of drugs in shock. 10. Give directions and write a prescription for the treatment of scabies. 105 MEDICAL RECORD. " Special reporters in England, France, Germany, Austria, Turkey, Denmark, the Philippines, and the leading cities of the United States and Canada." PATHOLOGY. i. Describe the morbid anatomy of the various forms of cystitis. 2. What are the three main factors recognized as caus- ing hemopholis? 3. Describe the pathology of myxedema and cretinism. 4. Describe the pathological changes of the vermiform appendix in the different forms of appendicitis. 5. Give the pathology of chronic interstitial hepatitis. BACTERIOLOGY. 1. What are the five nutrient media generally employed in the culture of pathogenic bacteria? 2. Give a brief history of the method of immunization against three infectious diseases where causative agents are known. 3- What bacteria may we expect to find in a phlegmon? What in a so-called "cold abcess?" 4. What are the microscopic findings in actinomycosis in the human being? 5- Give method of staining tubercle bacillus. MEDICINE. 1. From what conditions must apoplexy (cerebral hemorrhage) be differentiated? 2. Compare the physical signs of pericardial effusion and of an enlarged heart. 3. What is leukemia? 4. Pneumothorax : definition, cause, symptoms. 5- Give the symptoms and prognosis of peripheral facial paralysis. 6. Give the symptoms and dietetic treatment of infantile scurvy. 7. Define impetigo. 8. Contrast the period of incubation, stage of invasion and character of the eruption in measles and scarlet fever. 9. How does syphilis affect the bones? 10. Name a common form of tape worm and describe its life history. SURGERY. 1. Normal or physiologic salt solution, its composition, preparation and uses in surgery. 2. Forward luxation of head of radius; symptoms, signs, and treatment. 3. Describe briefly a compound comminuted fracture of the long bones, prognosis and treatment. 106 MEDICAL RECORD. Save and bind your numbers; it will give you two great medical encyclopedias every year. 4. Acute osteomyelitis, pathology, and differential diag- nosis. 5. Prostatic enlargement, pathologic varieties, symptoms and treatment. 6. Differential diagnosis between gastric and duodenal ulcer. 7. Differential diagnosis between nephrophthisis and nephrolithiasis, and how do you determine on which side the lesion exists? 8. Carbuncle, description and treatment. 9. Pterygium; describe in detail. Operation for its successful removal. 10. Traumatic cataract, treatment. OBSTETRICS. 1. Bound the true pelvis? Define brim? False pelvis? 2. Give etiology, prognosis and general management of puerperal insanity? 3. Name and define five of the most important signs of pregnancy at four months. 4. Give early symptoms of placenta prasvia; also, your management of a case including active treatment. 5. Case : primipara in labor at term — pains have con- tinued six hours — os rigid and undilated. Give your method of procedure. DISEASES OF WOMEN. i. Name three varieties of vaginitis with causes and symptoms of each? 2. Give causes and treatment of chronic non-specific endometritis? 3. What is the significance of uterine hemorrhage inde- pendent of menstruation or pregnancy? 4. What are the indications for trachelorrhaphy? Describe the operation fully? 5. In what gynecological diseases and conditions do we find painful defecation a prominent symptom? Bearing down feeling? Leucorrheal discharge? ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Minnesota State Board of Medical Examiners. January, 1907. anatomy and histology. 10. The layers of a hair, in order, from without in- wards, arc : 107 MEDICAL RECORD. Not a local journal, but international in its scope. Dermal sheath. Hyaline layer. External epidermic coat. SHenle's layer. Huxley's layer. Cuticular layer. Cortex. Medulla. PHYSIOLOGY. 3. "The sympathetic nervous system consists of (1) a series of ganglia connected together hy a great ganglionic cord, the gangliated cord, extending from the base of the skull to the coccyx, one gangliated cord on each side of the middle line of the body, partly in front and partly on each side of the vertebral column; (2) of three great gangliated plexuses or aggregations of nerves and ganglia, situated in front of the spine in the thoracic, abdominal, and pelvic cavities respectively; (3) of smaller or terminal ganglia, situated in relation with the abdominal viscera; and (4) of numerous fibers." (Gray's Anatomy.) Its functions: "It may safely be said that the sympa- thetic system has, to a great extent, a controlling influ- ence over the secretion of most of the glands, the lacry- mal, the salivary, the sweat glands, the glands of the stom- ach and intestines, the liver, the kidney, etc. ; that it pre- sides over the circulation by regulating the caliber of the blood-vessels and the action of the heart; that it influences respiration ; and, finally, that all involuntary muscles, those of the digestive apparatus, of the genitourinary system, of the hair follicles (pilomotor nerves), are under its control to such extent that, for instance, in certain mammalians the bladder still continues to fulfill its function for weeks after all the cerebrospinal motor nerves leading to it have been severed. In short, we find that all vegetative life of the organism is, to a greater or less extent, under the con- trol of the sympathetic system. Therefore it may prop- erly be called the vegetative nerve system par excellence." (Reference Handbook of the Medical Sciences.) 4. The motor centers are located and arranged alongside the fissure of Rolando. At the upper part of the convolu- tions on each side of this fissure are areas connected with the movements of the lower extremities; then from above downwards are located the centers for movements of the shoulders, arms, wrists, fingers, face, lips, tongue, and larynx and pharynx. 6. The functions of epithelial tissue are: (1) Protec- tion, (2) secretion, (3) motion (ciliary), (4) special sen- sation, (5) absorption. 108 MEDICAL RECORD. Keeps you strictly abreast of the times." 7. The lesion described would produce motor aphasia. 10. Pancreatic juice. Composition : Water and solids, the latter consisting of three enzymes (trypsin, amylopsin, and steapsin), proteid material, soaps, fats, lecithin, and inorganic salts (carbonate of sodium, chloride of sodium, and phosphates of sodium, calcium, and magnesium). The reaction is alkaline, due to sodium carbonate. The functions: (1) It changes proteids into proteoses and peptones, and afterwards decomposes them into leucin and tyrosin; (2) it converts starch into maltose; (3) it emulsifies and saponifies fats ; and (4) it causes milk to curdle. CHEMISTRY, TOXICOLOGY, AND URINALYSIS. 1. To determine the presence of mercury in a solution: Add sulphuretted hydrogen; a black precipitate results, which is insoluble in hot nitric acid. To determine the presence of mercury in a solid or pow- der: Heat in a glass tube with sodium carbonate; a gray sublimate of metallic mercury will be deposited on the cold part of the tube. 2. To determine the presence of silver in a solution: Add hydrochloric acid ; a white, curdy precipitate results, which is soluble in ammonia, insoluble in acids, and be- comes dark on exposure to the light. To determine the presence of silver in a solid : Fuse on charcoal ; a silver globule results. 3. Test for iodine: Add starch paste; a deep blue color results. 4. Test for presence of hydrocyanic acid: Add am- monium sulphydrate and evaporate to dryness ; then add solution of ferric chloride ; a red color results. 5. Test for presence of morphia: Add solution of neu- tral ferric chloride ; a blue color results. 6. Test for presence of strychnia : Add concentrated sulphuric acid; a colorless solution is formed. If a crystal of potassium bichromate be drawn through this solution, it is followed by a track of color which is first (for an in- stant) blue, then violet, then rose-colored, and finally yel- low. 8. To determine the presence of acetone: Add a few drops of freshly prepared solution of sodium nitroprusside, and then some potassium hydroxide solution; the fluid is _ colored ruby red, and on supersaturation with acetic acid becomes purple. q. To determine the presence of oxaluria: Microscopic- ally examine the sediment of the urine; note the presence of dumb-bell shaped crystals, or highly refracting octahedral crystals. 109 MEDICAL RECORD. " Editorials on subjects of timely interest and of vital im- portance dealt with in a masterly and scholarly style." io. Symptoms of acute poisoning by salicylic acid or the salicylates: "Profuse .sweating, roaring in the ears, dim- ness of vision, headache, partial or total deafness, and a decided fall in temperature. The pulse becomes weak and relaxed, and finally ptosis, strabismus, and general paralysis ensue. The urine and feces are passed involuntarily, and the urine is olive-green in color. The respirations at first are quickened and deepened, but finally become shallow and feeble, death ensuing from respiratory failure. If the dose is sufficiently large, the blood is involved and the cor- puscles rapidly break down." (Hare's Therapeutics.) Treatment: Lavage, purgatives, milk, and white of egg. MEDICAL JURISPRUDENCE. I. A delusion is a belief in something which has no real existence, but is purely imaginary; and out of which the person cannot be reasoned. An illusion is a false or per- verted impression, received through one of the senses. An hallucination is the same as an illusion, but without any material basis. If an individual believes himself to be made of glass, and is afraid of being touched lest he be broken, he is suffering from a delusion. If the whistling of the wind is mistaken for a voice telling a person to do a certain thing — that would be an illusion. If a person fancied he heard a voice when there was nothing at all to be heard, that would be an hallucination. 4. Prolonged exposure to cold causes first a lividity and then a whiteness of the extremities, ears, nose, and cheeks; this may be followed by gangrene. Pain, depres- sion, stiffness, and congestion follow; stupor, coma, and death may supervene. Post-mortem appearances: The skin is pale and waxy, with irregular dusky, reddish patches; the superficial parts are bloodless, while the viscera, including the brain, are congested; the heart and large vessels leading from it are full of blood, and the blood is of a brighter red color than usual. 5. The poisonous action of coal gas depends upon the presence and action of carbon monoxide. This carbon monoxide unites with the hemoglobin of the blood, forming a very stable compound, which is not oxidized in the lungs ; thus internal asphyxiation is produced. MATERIA MEDICA AND THERAPEUTICS. I. The official soluble salts of iron are: Ferri sulphas, ferri chloridum, ferri et ammonii sulphas, ferri phosphas solubilis, ferri et potassii tartras, ferri et ammonii citras, no MEDICAL RECORD. '•Acknowledged to be the leading independent medic a weekly." ferri et strychninae citras, ferri et ammonii tartras, ferri citras, ferri et quininae citras, ferri et quininse citras solu- bilis, ferri pyrophosphas solubilis. 3. IJ. Acidi salicylici, Siijss. Ammonii carbonatis, gr. lxxij. Spiritus menthas piperitae, TTgv. Glycerin, 3iv. Aquas distillatae, q.s. ad Biij. M. Sig: One teaspoonful every three hours. 4. The average adult dose of the following: (a) Arsenous acid, gr. 1/30. (b) Fl. ext. Cannabis Indica, Trg jss. (c) Ext. hyoscyamus, gr. j. (d) Heroin hydrochlorid, gr. 1/10. (e) Hydrocyanic acid dilute, TTE jss. (f) Tr. aconite, U. S. P., W x. (g) Lead acetate, gr. jss. (h) Guaiacol carbonate, gr. xv. (i) Sulphonal, gr xv. (j) Acetanilid, gr. iv. PATHOLOGY. 2. The three main factors recognized as causing hemo- philia are: (1) Hereditary predisposition transmitted through the female line, (2) male sex, and (3) early life. Of course, there must be a trauma as the exciting cause. BACTERIOLOGY. I. The five nutrient media commonly employed in the culture of pathogenic bacteria are : Bouillon, gelatin, agar- agar, blood-serum, and potatoes. 3. The bacteria that may be found in a phlegmon are : Streptococcus pyogenes, and sometimes some of the fol- lowing: Staphylococcus pyogenes aureus, Staphylococcus pyogenes albus, Staphylococcus pyogenes citreus, Micro- coccus tetragenus, Bacillus pyocyaneus. In a cold abscess there may be the Bacillus tuberculosis, and occasionally a few of those just named. 4. In actinomycosis the microscopical findings induce tbe actinomyces, round cell infiltration with granulation tis- sue, and cicatricial bands; much connective tissue is pro- duced. There are small granulation tumors consisting of giant cells, epitheloid cells, and small round cells. 5. Take a small particle from the sputum or other ma- terial and smear it on a slide, making the smear as thin as possible. Then cover it with some carbolfuchsin, and let it steam over a small flame for about two minutes, care MEDICAL RECORD. " Original Articles are of the highest scientific value and most practical character, by the foremost men of the world." being taken that it does not boil. Wash it thoroughly in water and then decolorize by immersing it in a solution of any dilute mineral acid for about a minute. Then make a contrast stain with solution of LoefHer's methylene blue for about a minute; wash it again and examine with oil im- mersion lens. The tubercle bacilli will appear as thin red rods, while all other bacteria will appear blue. I. Apoplexy (cerebral hemorrhage) must be differen- tiated from the coma of opium, of alcoholism, of uremia, of epilepsy, of hysteria, of diabetes. 2. PERICARDIAL EFFUSION. Area of dullness is pear- shaped and the enlarge- ment is chiefly upward. Dullness may extend to left of apex-beat. Generally rapid develop- ment. Apex-beat is feeble or lost. The heart sounds are not clearly heard. ENLARGED HEART. Area of dullness is not pear- shaped, and the enlarge- ment is chiefly downward. Dullness does not extend to left of apex-beat. Usually slow development. Apex-beat is generally ap- parent, and may be power- ful. The heart sounds are gen- erally clearly heard. 3. Leukemia is a condition in which the white blood corpuscles are increased in number, and is accompanied by pathological changes in the spleen, lymphatic glands, and bone marrow. 8. Measles. Period of incubation, ten to twelve days. Stage of invasion, four days. Character of eruption, small dark red papules with crescentic borders, beginning on face and rapidly spreading over entire body; desquamation is branny. Scarlet fever. Period of incubation, from a few hours to seven days. Stage of invasion, twenty-four hours. Char- acter of eruption, a scarlet punctate rash, beginning on neck and chest, then covering face and body; desquamation is scaly or in flakes. 9. There may be periostitis, osteitis, gummata, necrosis, tenderness, osteoscopic pains, and sometimes ulceration. SURGERY. I. Normal salt solution. Composition : 0.7 per cent of MEDICAL RECORD. Save and bind your numbers; it will give you two great medical encyclopedias every year. sodium chloride in sterilized water. Chemically speaking, it is practically a decinormal solution. Preparation : It is made by putting one and a half drachms of sterilized salt in a quart of distilled water in a glass flask. The mouth of the flask should be plugged with sterilized cotton. Uses: Intravenous injection or infusion, irrigation of fresh wounds, removal of blood or foreign bodies, cleans- ing of mucous or serous surfaces. 4. Pathology of acute osteomyelitis: "When exposed to septic infection the marrow in long bones is only too favorably placed for the diffusion of violent inflammation. Confined within a rigid shell, and in free communication from end to end by its abundant blood and lymph vessels, the medullary tissue, when inflamed, suffers double disas- ter from the rapidity of the spread of the inflammation, and the impossibility of relief by swelling. Its soft sensitive tissues are strangulated by their own proliferation, and the bone, cut off from its most important blood supply, suffers death. In the compact bone the incompressible veins may serve to carry infection to the system, and fatty embolism from a similar source is not unknown. "The naked-eye appearances of a bone affected with acute osteomyelitis are striking and characteristic. The compact tissue is pink generally, or in patches; the can- cellous bone is of a bright or dusky red color, and the marrow is transformed into a semifluid, often stinking ma- terial, made up of pus and diffluent fat, and exhibiting red streaks and patches representing injected vessels and extravasated blood. In some cases, especially in the non- traumatic variety, a subperiosteal abscess forms. This is usually found where the compact bone is thinnest, and its foramina most numerous ; that is to say, above the epiphy- ses, near the joint. In this situation suppurative inflamma- tion of the epiphysial cartilage is peculiarly liable to take place, leading to disjunction of the epiphysis from the shaft, and producing the condition known as 'acute epiphysitis.' "The usual termination of those cases which do not rapidly prove fatal from general septic infection, is in necrosis of the whole bone, or, more frequently, of the shaft between the epiphyses. The further history of the disease is then simply that of necrosis of bone. "The minute anatomy is a compound of cellular prolifer- ation, vascular blocking, diffluence of fatty tissue, and gen- eral infiltration with microorganisms. The bony tissue proper, suddenly cut off from its nutritive supply and rap- idly dying, has had no opportunity of exhibiting the signs "3 MEDICAL RECORD. " New Instruments are portrayed and their use thoroughly explained." of inflammation and is essentially unchanged." (Treves' Manual of Surgery.) 6. In the great majority of cases no differential diag- nosis can be made between gastric and duodenal ulcer. But (i) sudden and recurring intestinal hemorrhage of suf- ficient severity to produce anemia, (2) pain in the right hypochondriac region, coming on two or three hours after eating and (3) violent gastric crisis of pain, are supposed to be indicative of duodenal ulcer. 7. In nephrolithiasis there is more likely to be hem- orrhage. In nephrophthisis the tubercle bacilli will be found in the urinary sediment, and a focus of tuberculosis will be found somewhere. Catheterization of the ureters will determine on which side the lesion exists. 9- "The pterygium may be dissected away with a sharp scalpel or Beer's knife, and cut off, the conjunctival defect being closed by uniting the upper and lower borders, un- dermining the conjunctiva if necessary to bring the edges together. The apex of the pterygium must be thoroughly excised from the cornea, and its attachment in this sit- uation scraped or cauterized with the actual cautery, to prevent recurrence. Instead of cutting off the pterygium, it may be dissected up and stitched underneath the detached conjunctiva, either above or below; or it may be divided into two halves, of which one is transplanted above and the other below, being held in the conjunctival pocket by a stitch." (May's Diseases of the Eye.) 10. "Immediately after the injury, absolute rest, iced compresses, and atropine are to be employed. If the rapid swelling of the lens causes inflammation or much increase of tension, the cataract should be removed by extraction. But if such complication do not arise, it is wiser to allow absorption to proceed, and to defer operative intervention until there is no irritation or inflammation, and spontaneous improvement has come to a standstill." (May's Diseases of the Eye.) OBSTETRICS. 1. The true pelvis is bounded above by a plane passing through the iliopectineal line; in front by the pubic bones and the obturator membrane ; behind by the concavity of the sacrum ; laterally by the obturator membrane, the sacro- sciatic ligaments and the internal surface of the acetabu- lum. The brim is the edge of the superior strait of the pelvis. 114 MEDICAL RECORD. " Statistics of the health boards and many articles of scien- tific Interest and items of general information." The false pelvis is that part of the pelvis situated above the superior strait. DISEASES OF WOMEN. 3. Uterine hemorrhage, independent of menstruation or pregnancy, generally denotes some form of new growth (polypus, fibroid, sarcoma, or carcinoma) of the uterus or cervix; it may also be due to some injury, either during coitus or as the result of some accident. 4. Trachelorrhaphy is indicated in cases of lacerated cervix in which the loss of tissue is but slight, and there is no cystic degeneration or induration. 5. Painful defecation is a prominent symptom in: Pro- lapsed and cystic ovary, pelvic cellulitis or abscess, in- flammation of tubes or ovaries, and retroflexion or retro- version of the uterus. Bearing-dozun feeling is a prominent symptom in: Pro- lapsed uterus, badly lacerated perineum, cystocele, rec- tocele, hyperplasia of cervix, inversion of the uterus, for- eign body in the vagina. Leucorrheal discharge is a prominent symptom in : Pelvic congestion, endometritis, retroversion of uterus, vulvitis, vaginitis, gonorrhea, benign and malignant growths. STATE BOARD EXAMINATION QUESTIONS. Nebraska State Board of Health. May 29-31, 1906. ANATOMY. 1. Briefly describe the animal cell and the reproductive cell. 2. Name contents of the mediastinum. 3. Describe the occipital bone, naming articulations. 4. Describe the pleural membranes, and name arteries and nerves. 5. Give origin and distribution of the fifth pair of cranial nerves. 6. Give origin and insertion of the flexor muscles of the thigh. 7. Give origin and distribution of the sciatic nerve. 8. Describe the orifices of the diaphragm, naming struc- tures that pass through each. 9. Locate the arch of the aorta, and name its branches. 10. Describe the prostate gland. US MEDICAL RECORD. " Special reporters in England, France, Germany, Austria, Turkey, Denmark, the Philippines, and the leading cities of the United States and Canada." PHYSIOLOGY. 1. Describe the red blood corpuscles as to (a) origin and fate, (b) form, (c) size, (d) number, (e) function. 2. What is understood by endocardiac pressure? State the causes of the pressure in the arteries, capillaries, and veins. 3. Give the accepted theory regarding the mechanism of the secretion of urine. 4. Give the successive steps in the digestion of a meal of roast beef and potatoes. 5. Describe the temporary and permanent teeth, and the usual age for the eruption of each. 6. Describe the normal sounds of the heart, and state how they are produced, and where they can be most dis- tinctly heard. 7. Describe the bile and its uses. Give test for bile. 8. Name one property common to all blood leucocytes. Give some of their physiological uses. 9. Write briefly on internal secretions. 10. Discriminate between the corpus luteum of preg- nancy and the corpus luteum of menstruation. MATERIA MEDICA AND THERAPEUTICS. 1. (a) What is the physiological action of heat upon the heart, vessels, nervous system, and eli:^r'nation per skin, kidneys, bowels? (b) What therapeutical advantage may it be on the same in nephritis, fevers, swelling after traumatism, septic infection, and how? (c) In continued fever, when and why use tepid or hot water, instead of cold water ? 2. (a) Quinine; physiological action in doses to 5 grs. on the blood, nervous system, heart, and respiration? (b) How eliminated? (c) What the action in congestion and inflammation? How explained? (d) What action is re- garded as specific? (3) (a) What are the leading uses of digitalis? (b) What is the best preparation as a diuretic, and why? (c) What danger in its use in nephritis? (d) What danger in calcareous deposits in the blood-vessels? 4. (a) What uses can you make of adrenalin, thyroid ext., thymus ext.? (b) What is codeine, heroin, and dio- nine derived from? t Describe the Brandt treatment of typhoid fever. Give the nonmedicinal treatment of cardiac insuf- ficiency. 116 MEDICAL RECORD. " The medical profession have been presented with the re- sults of great discoveries by the MEDICAL RECORD in ad- vance of any other publication." f Detail the treatment of diphtheria. Give the hygienic and dietetic treatment of croupous pneumonia. 9. Select a climate for cases of pulmonary tuberculosis, /"asthma, chronic bronchitis, hay fever, and mention indica- tions for the change. 10. Detail the hygienic and sanitary treatment of scarlet fever. CHEMISTRY. i. Define organic chemistry, atom, and element. 2. How modify cow's milk to approximate human milk? 3. Write an equation showing production of H. and laughing gas. 4. Give chemical tests for strychnine and arsenic. 5. Define fermentation and putrefaction. 6. Describe accurately Heller's test for albumen. 7. What reaction, normal or abnormal, may be pro- duced by that test? 8. What average amount of solids in urine, and how estimated? 9. What are the common determinations in chemical examinations of gastric juice? 10. What is the composition of proteids? SURGERY. i. Name the most common curvatures of the spine; give etiology, symptoms, treatment of lordosis. 2. Give etiology, symptoms, and treatment of empyema ; give diagnosis of empyema, hemothorax, and bronchiectasis. 3. What is a ranula? Treatment. 4. Give differential diagnosis of the following condi- tions : Intussusception, floating kidney, stricture of pylorus, bubonocele, varicocele, and undescended testicle. Describe fully the technique of operation for varicocele. 6. How would you treat a lacerated and contused wound of the hand? 7. Etiology, symptoms, clinical history of carcinoma oi breast. Describe in detail operation. 8. Give technique of amputation through middle third of the thigh. 9. What is the significance of pain in the abdominal region ? 10. Describe in detail two of the most common varieties of clubfoot, and give surgical treatment of each. 117 MEDICAL RECORD. " Since 1890 the MEDICAL RECORD has had a cabled re- port of every International Medical Congress." OBSTETRICS AND GYNECOLOGY. i. Describe the human embryo at the second, fifth, seventh, and ninth months, giving size and weight. 2. Describe the symptoms, and give the management of an incomplete abortion. 3. Describe a case of phlegmasia alba dolens, giving diagnosis, time of occurrence, cause, termination, and treatment. 4. Differentiate ovarian cyst, ascites, and pregnancy at beginning of fifth month. 5. Describe a case of puerperal fever, giving cause, time of invasion, symptoms, and course. 6. Name and describe fully the contents of the uterus at full term, before labor begins, detailing the presentation and position of the child most frequent, in an uncompli- cated, healthy case. 7. Enumerate the symptoms which indicate the death of the child in utcro, and state what course should be pur- sued in such a condition. 8. Describe in detail operation for repair of (a) lacer- ated cervix, (b) for complete laceration of perineum. 9. Give in detail the anatomy and physiology of the pel- vic floor. 10. Name the different varieties of metritis; give causes, possible sequelae, and treatment. PATHOLOGY. 1. What is pathology? 2. Describe embolism and thrombosis. 3. Define and describe phagocytosis. 4. What is a neoplasm? Give some examples. 5. Describe sarcoma, fibroma, lipoma, myxoma, os- teoma, and glioma. 6. Describe a primary and a secondary anemia, and give examples. 7. Describe pernicious anemia, chlorosis, leukemia. 8. Describe phlebitis, varieties, common causes, and course. 9. Describe and differentiate between gastritis, ulcera- tion of the stomach, and cancer of the stomach. 10. Differentiate between arthritis deformans and acute polyarthritis. PRACTICE. i. Give symptoms of myxedema. Give treatment. 2. Name the acute infectious exanthemata, giving period of incubation and specific bacterium of each. 118 MEDICAL RECORD. " The most important and interesting items of the very atest medical news throughout the world." 3. Give diagnosis and treatment of acute eczema of the face in an infant. 4. Describe in detail the most common method used in the examination of stomachic conditions. Give diagnostic value of absence or presence of acids and juices, and sig- nificance of conditions found present. 5. Describe diagnostic significance of hematuria. Give etiological factors. How would you differentiate whether the kidneys or bladder were affected? 6. Give differential diagnosis of interstitial and pa- renchymatous nephritis. Give pathology of both diseases. 7. Give diagnosis, prognosis, and treatment of chronic pulmonary emphysema. 8. Give causes, diagnosis, and treatment of chorea. 9. Explain the diagnostic significance of the "knee jerk." 10. Give the abnormal heart sounds, and the point of greatest intensity of each. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Nebraska State Board of Health. May 29-31, 1906. physiology. 1. In the embryo, the red blood corpuscles are derived from cells in the vascular area of the mesoblast ; in the adult, they are derived chiefly from the red marrow of bones, also from the spleen. As to their fate, they are probably broken up in the liver and spleen. In form they are circular biconcave discs. Their size is about 1-3200 of an inch in diameter. In number they are about 5,000,000 to the cubic millimeter in males, and about 4,500,000 in females. Their function is to carry oxygen from the lungs to the tissues of the body; this is accomplished by the hemoglobin, which has a great affinity for oxygen. 2. By endocardiac pressure is meant the pressure of the blood within the heart. Pressure in the arteries and capillaries is caused by the contractions of the heart, by peripheral resistance, and by the elasticity of the vessel walls. In the veins pressure is caused by the elasticity of the vessel walls, by cardiac contraction, also by contraction of the skeletal muscles in general and particularly of the muscles of inspiration, and by the continuous traction of the lungs. MEDICAL RECORD. "Not a local Journal, but International In its scope. 3. The mechanism of the secretion is twofold. (1) By filtration, most, if not all, of the fluid is eliminated, and also inorganic salts ; this depends upon blood pressure, and takes place in the glomeruli. (2) By cell activity and selection, in the cells of the convoluted tubules, the urea and principal solids are eliminated. 8. Ameboid movement is a property common to all blood leucocytes. Some of the physiological uses of the leucocytes are : ( 1 ) They serve as a protection to the body from the incursions of pathogenic microorganisms; (2) they take some part in the coagulation of the blood; (3) they aid in the absorption of fats and peptones from the intestine; (4) they help to maintain the proper proteid content of the blood plasma. 9. It is generally held now that the glandular organs, chiefly the pancreas, liver, and the ductless glands, produce a secretion, peculiar in each case to the particular gland producing it, and which is supposed to be given off to the blood or lymph, and to have some peculiar value in the general metabolism of the body. Such secretions are called internal secretions, in contradistinction to the previously known secretions, which are carried off by a duct, and are known as external secretions. Very little is definitely known of these internal secretions, but much work is being done on the subject. 10. The difference between the corpus luteum of preg- nancy and that of menstruation is best shown in the follow- ing table from Dalton, which was reprinted in nearly all the text-books of ten or twenty years ago : Corpus Luteum of Corpus Luteum of Pregnancy At the end of three weeks . . One month . . . Menstruation Three-quarters of an inch in diameter; central clot red- dish; convoluted wall pale. Smaller ; convoluted wall bright yellow; clot still reddish. Reduced to the condi- tion of an insignifi- cant cicatrix. Absent. Pi Larger; convoluted wall bright yellow; clot still reddish. Seven-eighths of an inch in diam- eter; convoluted wall bright yellow; clot perfectly decol- orized. Still as large as at end of second month; clot fibrinous; convo- luted wall paler. One-half an inch in diameter; central clot converted into a radiating cicatrix, the external wall tolerably thick and con- voluted, but without any bright yellow color. CHEMISTRY. i. Organic chemistry is the chemistry of the compounds of carbon. An atom is the smallest part of an element that 120 MEDICAL RECORD. Keeps you strictly abreast of the times. can take part in a chemical reaction. An element is a sub- stance which cannot, by any known means, be split up into dissimilar substances. 2. By diluting cow's milk and adding lactose it can be made to approximate human milk. 3. To make hydrogen: Zn+H 2 S04=ZnS04+H 2 . To make laughing gas: (NH 4 )NOs+Heat=2H 2 0+N 2 0. 4. Chemical tests for strychnine. With concentrated H 2 SOi it forms a colorless solution; a crystal of potassium bichromate, if drawn through this solution, produces a track of color, which is in turn blue, violet, rose-colored, and yellow. For arsenic. Marsh's and Reinsch's are the two most commonly used tests. Reinsch's test is as follows : To the suspected fluid add a little pure HC1; suspend in the fluid a small strip of bright copper foil, and boil. If a deposit forms on the copper, remove the copper, wash it with pure water, dry on filter paper, but be careful not to rub off the deposit. Coil up the copper, and put it into a clean dry, glass tube, open at both ends, and apply heat at the part where the copper is. If arsenic is present there will appear in the cold part of the tube a mirror, which will be found on microscopical examination to consist of octa- hedral crystals of arsenic trioxide. 5. Both fermentation and putrefaction are forms of decomposition of organic matter under certain favorable conditions. When the organic matter is composed of car- bon, hydrogen, and oxygen only, the process is called fer- mentation ; when nitrogen and sulphur are also present, putrefaction is said to occur. 6. Heller's test for albumin is performed as follows : Pour into a clean test-tube a layer of HNO3 about half an inch deep ; then with a pipette carefully float on to the sur- face of this acid a layer of urine, taking care that the liquids do not mix. If albumin is present a cloudy ring, with sharply defined borders, will appear at the point of junction of the two layers. 8. The average amount of solids in the urine is about 850 to 950 grains in twenty-four hours. It can be estimated as follows : Take the specific gravity of the twenty- four hours' output; multiply the two last figures of this specific gravity by the numbers of ounces of urine passed in the twenty-four hours; multiply this product by 1.1 ; this repre- sents the total urinary solids in grains. 9. The common determinations in chemical examinations of the gastric juice are for total acidity, for free HC1, for combined HC1, for total HC1, for acid salts, for lactic and organic acids. MEDICAL RECORD. " Book reviews of foreign and American publications keep you thoroughly informed of the newest literature." io. Proteids consist of carbon, hydrogen, oxygen, nitro- gen, and sulphur, some also contain phosphorus, and a few iron. SURGERY. 2. In empyema we find limited motion on the affected side, edema and redness in the intercostal spaces, dullness on percussion, absence of breath sounds, diminished fre- mitus and resonance, chills, sweats, high fever, dyspnea, and expectoration of offensive sputum; exploratory puncture brings pus, and there is a high leucocytosis. In hemothorax there may be dullness on percussion, possible absence of breath sounds, diminished vocal fremitus, and if the quan- tity of blood is large there will be the usual symptoms of hemorrhage, shock, thirst, pallor, small thready pulse, and dyspnea. In bronchiectasis there are large quantities of sputum brought up at intervals ; it is sour or offensive, and on standing separates into two layers. 4. Intussusception : tenesmus, pain of sudden onset and continuous, diarrhea, normal or subnormal temperature, weak pulse, stercoraceous vomiting, and the intestine may protrude at the rectum. Floating kidney: kidney may be felt, generally on right side, heavy dragging pain in abdo- men, which is better on lying down, mental anxiety and sometimes hysterical symptoms, and general relief is af- forded by supporting the abdominal walls. Stricture of pylorus: the symptoms are those of dilated stomach; the stomach gets full and distended, and is relieved by very copious vomiting at long intervals. Bubonocele : tumor in the inguinal canal, with symptoms of hernia, can be re- duced, and gives impulse on coughing. Varicocele : feels like a bag of worms, does not transmit light, is dull on percussion, elastic, soft, and gives an impulse on coughing. Undescended testicle: scrotum on the affected side is empty, testis is in inguinal canal or in iliac fossa just above Pou- part's ligament, on pressure there is pain and the peculiar "testicular sensation." 7. The etiology of carcinoma of the breast is not defi- nitely known. Among the theories offered are: Cohn- heim's, of embryonic remains; injury or irritation, parasites or bacteria, and inherited tendencies have all been supposed to be causes, either predisposing or exciting. Further the breast is particularly liable to changes in functional activity, which may tend to formation of cancerous growth. It also follows Paget's disease (eczema) of the nipples. 9. Pain in the abdominal region, if diffuse may denote peritonitis or hysteria ; if localized it may indicate various MEDICAL RECORD. " Keeps you in closest touch with the weekly progress of medicine and surgery throughout the world." diseases or injuries, e.g. in the right iliac region, it denotes appendicitis ; acute pain generally implies acute inflamma- tion, or perforation or occlusion of a duct; paroxysmal pain generally means colic, either intestinal, hepatic, renal, vesical or uterine; persistent pain is often found in diseases of the abdominal viscera, aneurysms, and diseases of the vertebrae. OBSTETRICS AND GYNECOLOGY. 4. Ovarian cyst : absence of the chief signs of pregnancy ; there may be the characteristic facies; the tumor is soft, fluctuating, is more to one side, and does not show fetal signs. Ascites: absence of the signs of pregnancy; the abdomen is distended, but the shape varies with the position of the patient, on lying down there is bulging at the sides ; the tumor fluctuates, and percussion shows dullness in the flanks, with resonance in the median line, but the dullness varies with the position of the patient. Pregnancy : the tumor is hard and does not fluctuate, is situated in the median line, and may give fetal heart sounds and move- ments ; the cervix is soft, and the other signs of pregnancy are present. The rate of growth of the tumor, and the general condition of the patient's health, may also help in arriving at a diagnosis. 7. Symptoms of death of child in utero, are: cessation of the signs of pregnancy, the abdomen and uterus are both diminished in size, the fetal heart sounds and movements are absent, there is no pulsation in the cord, the mother's breasts become flaccid and occasionally screte milk. If the fetus has been dead for some time, crepitus of its cranial bones may be elicited. Treatment : Abortion or premature labor must be induced, and the contents of the uterus removed immediately. PATHOLOGY. 1. Pathology is that branch of science which treats of disease ; it includes the causes, nature, manifestations, struc- tural changes, and results. 3. Phagocytosis is the faculty of certain cells (notably the mononuclear and polynuclear leucocytes) to take up and destroy bacteria. 9. Gastritis : is generally caused by indiscretions in diet, or by mental worry; it may occur at any time of life, and is characterized by pain in the epigastric region which gen- erally comes on after eating; there is apt to be morning vomiting, the vomitus consisting of fluid with undigested particles of food; there is seldom hemorrhage; the stomach may be enlarged, and examination of the gastric contents 123 MEDICAL RECORD. " The only American medical journal that prints a detailed report of the British Medical Association." shows free HC1 diminished or absent. Ulcer of stomach : is generally caused by injury or bacteria, is most apt to occur between the ages of twenty and forty-five, after eating there is pain localized in the stomach, vomiting occurs soon after eating, hematemesis is common, there is localized tenderness over the stomach, and examination of the gastric contents shows an excess of free HC1. Cancer of stomach does not usually occur before forty years of age, is more common in males, the pain is localized ana while more or less continuous may be worse after eating; the vomitus contains "coffee ground" material; hemorrhages are common; a tumor may be palpated, and examination of the gastric contents shows absence of free HC1 and presence of lactic acid; severe anemia and ca- chexia are also present. PRACTICE. 5. Hematuria may be due to (1) conditions in which the blood is affected, as in the infectious diseases, in scurvy, pernicious anemia, and purpura; (2) to traumatisms or in- flammations in any part of the urinary tract; (3) to con- gestion of the kidneys secondary to disease of the lungs, heart, or liver. In renal hematuria the blood and urine are intimately mixed, tube casts are apt to be present, and there may be renal colic or pain in the lumbar region. In vesical hematuria the blood and urine are not so well mixed, and pure blood is apt to be passed at the end of urination. 9. The knee jerk is nearly always present in health, and denotes a healthy condition of the entire reflex arc (tendon, afferent or sensory nerve, posterior roots and anterior horn of the spinal cord, the efferent or motor nerve, and the muscle itself). It is absent when there is a lesion which affects any part of this reflex arc; such is the case in locomotor ataxia, poliomyelitis. Landry's para- lysis, neuritis, in apoplexy just after the shock, and in epilepsy following the convulsion, etc. It is exaggerated in increased irritability of the spinal cord, in organic diseases of the cerebrum, and in some incomplete lesions of the cord. MATERIA MEDICA AND THERAPEUTICS. 6. The non-medicinal treatment of cardiac insufficiency consists in rest, as complete as possible; light, nutritious. and easily assimilable food ; avoidance of all forms of excitement, and overexercise, also abstinence from alcohol and tobacco; good general hygienic conditions and avoid- ance of exposure and cold. Massage, medicated baths, and various forms of muscular, movements have also been recommended. 124 MEDICAL RECORD. " Choice and important abstracts from the leading medical periodicals of the world in a condensed and practical form." STATE BOARD EXAMINATION QUESTIONS. Board of Medical Examiners of the State of Nevada. August 7, 8, and 9, 1905. anatomy. 1. What valves guard the auriculoventricular opening in the left side of the heart? Those in the right? 2. Between the cartilages of what ribs would you locate' the apex of the normal heart? What is the average weight of the heart of an adult male? 3. What is the average weight of the brain in the adult male? In the adult female? 4. Name the three principal arteries of the forearm. 5. Of what artery is the nutrient of the tibia a branch? 6. Describe a sesamoid bone, its development, and func- tion. Name the largest in the body. 7. What muscles are attached, wholly or in part, to the trochanter major? 8. Name the nerve that supplies the tongue with the sense of taste ; of sensation ; of motion. 9. Name the three muscles of the tibiofibular region (superficial) that form the calf of the leg. 10. Name the ligament implanted near the center of the head of the femur. PHYSIOLOGY. 1. Describe a cardiac cycle, and give the phenomena attending it. 2. Describe the reflex centers. 3. Describe the phenomena of blood clot. 4. What is the function of bile? 5. What is the normal ratio of heart pulsations to res- piration in a healthy adult? 6. Give the physiological cause of sleep. 7. What is the function of the cerebellum? 8. Give a brief description of the portal circulation. 9. Give principal events in gastric digestion. 10. Define blood pressure. pathology. 1. Give the pathology of arteriosclerosis. 2. What diseases are attended with ulceration of the intestines? 3. What diseases are attended with cardiac hypertrophy? 4. Describe pus, and give its essential elements. 125 MEDICAL RECORD. " Surgical Suggestions that will appeal to the student and the general practitioner." 5. Differentiate fatty degeneration and fatty infiltration; give cause of each. 6. Describe briefly the pathological changes taking place in acute lobar pneumonia. 7. Describe lipoma, and give its most frequent locations. 8. State the most important sequel of diphtheria, and describe to what extent it may occur. 9. What is the significance of hyaline casts in urine? Of granular casts? 10. Give pathology of embolus; of thrombus. BACTERIOLOGY. 1. Give Koch's rules in regard to bacterial cause of diseases. 2. Describe the Klebs-Loffler bacillus. 3. Name four pathogenic bacteria that do not stain by Gram's method. 4. Describe the Widal serum reaction. 5. What is the commonest microorganism found in em- pyema? MATERIA MEDICA AND THERAPEUTICS. 1. Give the adult dose of three opium preparations. Name its principal alkaloids. 2. Name three mercurial preparations. Give dose and use of each. 3. Name five emetics with dose of each. 4. Name two drugs incompatible with tannic acid. Give reasons. 5. With what preparations should the iodides not be combined ? 6. Why should pepsin and pancreatin not be used to- gether ? fWhen is turpentine contraindicated? From where are the following alkaloids obtained? Quinine, strychnine, physostigmine, hydrastin, atropine. 9. Outline treatment of a case of acute pneumonia. 10. Outline treatment of a case of typhoid fever. CHEMISTRY AND TOXICOLOGY. 1. What is a mechanical mixture? A chemical com- pound? Give three examples of each. 2. Describe briefly the three acids most used in labora- tory. 3. State the occurrence and properties of oxygen, hy- drogen, and nitrogen. 4. State the occurrence and properties of arsenic, mer- cury, and iron. 126 MEDICAL RECORD. ; Its prestige attracts articles by the best known writers. 5. Describe respiration from a chemical point of view. 6. Describe the toxic effect of carbolic acid. Outline treatment for same. 7. Give symptoms of and antidote for arsenic poisoning. 8. Give symptoms of and outline treatment for a vege- table poison. 9. Name antidote for nitrate of silver, opium, phos- phorus, corrosive sublimate, wild parsnip. 10. Give inventory for contents of antidote bag. THEORY AND PRACTICE OF MEDICINE. 1. Give the symptoms of typhoid fever in first, second, third, and fourth weeks, and treatment of same. 2. Give diagnosis, pathological anatomy, symptoms, and treatment of chronic parenchymatous nephritis. 3. Give symptoms and treatment of cerebrospinal men- ingitis. 4. Give stages and symptoms of acute lobar pneumonia, and treatment. 5. What are the symptoms, complications, and differen- tial diagnosis of acute articular rheumatism and treatment? 6. What are the causes of, morbid anatomy, symptoms and treatment of rickets? 7. Give differential diagnosis of chronic gastric catarrh, gastric ulcer, and gastric cancer. 8. Give the forms of endocarditis, pathological anato- my, and physical signs. 9. Give definition, etiology, symptoms, complications, prognosis, and treatment of erysipelas. 10. Give the causes and symptoms of pneumothorax. OBSTETRICS. 1. What is tubal pregnancy? Differentiate it from nor- mal pregnancy. What are the three greatest dangers to the mother in tubal pregnancy? 2. What foramen unites the right and left auricles in the fetal heart? 3. In twin births how many placentas are there? 4. What membranes invest the fetus? Define their re- lations to it from within outward. 5. What veins carry arterial blood in the fetus? 6. What are the two most reliable diagnostic indications of abortion? How would you treat a case of threatened abortion? 7. What position does the uterus assume during the first three months of pregnancy? 8. What is the average period of pregnancy, computed 127 MEDICAL RECORD. " Therapeutic Hints contain many valuable formula? by the foremost medical men in the world." by days? What were the extremes that legitimized a child under the Code Napoleon? 9. Diagnose a placenta praevia. How would you treat such a case? 10. What are the most grave gynecological diseases to anticipate after delivery? GENITOURINARY DISEASES. 1. Give differential diagnosis of anterior and posterior urethritis, complications of each, and write six prescrip- tions for treatment, three internal and three local. 2. What are the causes of orchitis, and give treatment of same. 3. Give treatment for gleet. 4. Describe a case of gonorrheal rheumatism, give causes, treatment, and prognosis. 5. Give history and description of syphilitic dermatitis. 6. Make differential diagnosis of hard and soft chancre and treatment of each. 7. Give causes, symptoms, and treatment of organic urethral stricture. 8. What is syphilitic dactylitis, the varieties, and tissues involved in each variety? 9. Describe the general course of syphilis, giving stages, symptoms, and treatment of each stage. 10. Give causes, symptoms, prognosis, and treatment of pyosalpinx. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Board of Medical Examiners of the State of Nevada. August 7, 8, and 9, 1905. anatomy. 1. The mitral or bicuspid valve, on the left side; the tricuspid valve, on the right side. 2. Between the fifth and sixth, on the left side. Aver- age weight is ten to twelve ounces. 3. In the male, forty-nine ounces ; in the female, forty- four ounces. 4. The radial, the ulnar, and the posterior interosseous. 5. The posterior tibial. 6. Sesamoid bones are cartilaginous in early life, but later become osseous. They are developed in the tendons 128 MEDICAL RECORD. " Bulletins of Examinations of State Medical Licensing Boards published bi-weekly." of muscles at points where these latter are exposed to pressure upon the parts over which they glide. Their function is to increase the leverage of the muscles. The largest sesamoid bone in the body is the patella. /. Gluteus medius, gluteus minimus, pyriformis, obtura- tor externus, obturator internus, gemellus superior, gemel- lus inferior, and quadratus femoris. 8. The tongue is supplied with the sense of taste by the chorda tympani and the glossopharyngeal nerves ; of sensation, by the lingual branch of the inferior maxillary division of the fifth cranial nerve; of motion, by the hypo- glossal nerve. g. The gastrocnemius, soleus, and plantaris. 10. The ligamentum teres. PHYSIOLOGY. 3. When blood is withdrawn from the blood-vessels of the living body, it first becomes viscid, then sets, and is converted into a jelly-like mass. This is due to the forma- tion of fibrin. The jelly contracts forming the clot; and at the same time the serum is squeezed out from the clot. Various circumstances and conditions will hasten or delay the process of coagulation. In man, the blood generally becomes viscid in from two to three minutes ; it forms the jelly-like mass in from five to six minutes; a few min- utes later the serum begins to appear; and the whole process is completed in from twenty-four to thirty-six hours. The clot then floats on the serum. The process is thus summed up by Halliburton : In the plasma a proteid substance exists, called Fibrinogen. From the colorless corpuscles a nucleo-proteid is shed out, called Prothrombin. By the action of calcium salts prothrombin is converted into fibrin ferment, or Thrombin. Thrombin acts on fibrinogen in such a way that two new substances are formed : one of these is unimportant and remains in solution ; the other is important, viz., Fibrin, which entangles the corpuscles, and so forms the clot. 4. The functions of the bile are: (1) to assist in the emulsification and saponification of fats; (2) to aid in the absorption of fats; (3) to stimulate the cells of the intestine to increased secretory activity, and so promote peristalsis, and at the same time tend to keep the feces moist; (4) to eliminate waste products of metabolism, such as lecithin and cholesterin; (5) it has a slight action in converting starch into sugar; (6) it neutralizes the acid chyme from the stomach, and thus inhibits peptic digestion; (7) it has a very feeble antiseptic action. 129 MEDICAL RECORD. " The progressive physician must have his medical weekly just as the business man his newspaper." 5- About four or five heart pulsations to one respira- tion. 6. "There are several hypotheses as to the causation of sleep. It has been attributed to cerebral anemia; to chemical changes in the brain cells or neurons, such as an exhaustion of their intramolecular oxygen, or an accumu- lation of fatigue products ; to a contraction of the dendritic processes, and a consequent break in the transmission of nervous impulses; to an expansion of the neuroglial cell processes insulating the nerve cell processes, and pro- ducing the same effect ; and to a purely psychological con- dition, namely, loss of consciousness apart from any physical or chemical change. This last explanation is simply a cloak for our ignorance. The most probable hypothesis is that of an altered metabolism of the cerebral cells dependent upon exhaustion and diminished influx of stimuli." (Allbutt's System of Medicine.) Two new theories have recently been promulgated: One claims that sleep is due to an internal secretion of the pituitary gland, whereas the other makes it depend upon the phenomena of osmosis. 7. Coordination and equilibrium. 9. _ The principal events in gastric digestion are the con- version of the proteids into proteoses and peptones, which are more soluble and diffusible. Starches are unaffected, and fats are not altered chemically. 10. Blood pressure is the pressure on the blood due to the ventricular systole, the elasticity of the walls of the arteries, and the resistance of the capillaries. PATHOLOGY. 2. Typhoid fever, tuberculous enteritis, dysentery, chronic nephritis, extensive burns, syphilis, cancer, enteritis in children, actinomycosis, and anthrax. 3. Chronic nephritis, emphysema, fibroid phthisis, aortic stenosis, aortic regurgitation, mitral regurgitation, fibrous myocarditis, arteriosclerosis, gout, lithemia, pericardial ad- hesions, exophthalmic goiter, hysteria, lead poisoning, and syphilis. 4. Pus is a thick, creamy fluid, alkaline in reaction, with a specific gravity of about 1030, and containing from eighty to ninety per cent, of water. On standing it separates into two layers, the upper part being fluid, and consisting of serum, a little proteid matter and liquefied tissue; the lower, or solid part, contains dead and living pus cor- puscles, fatty and granular debris, and sometimes micro- organisms, and a few red blood cells. 130 MEDICAL RECORD. "European correspondents furnish medical news of special interest and reports of the principal foreign medical societies." 5. In fatty infiltration the tissues contain fat brought from without; there is no change in the cell protoplasm, and such damage as the tissue undergoes is due to the mechanical pressure caused by the fat. In fatty degeneration the cell protoplasm undergoes change ; the fat is in the cells, and not between them. Fatty infiltration may be due to obesity, lack of exercise, overeating or drinking, carcinoma, diabetes, chlorosis, frac- ture or disease of bones, or it may be hereditary. Fatty degeneration may be caused by poisoning (chiefly by phosphorus, lead, mercury, or arsenic), anemia, pro- longed fevers, diabetes. 7. A lipoma is a benign tumor composed of fatty tissue. It is roundish, soft, generally circumscribed and encapsu- lated, and tabulated. On section the fat is seen to be divided by septa of fibrous connective tissue. It is of slow growth, and generally appears in adult or middle life, but may also appear in childhood. The most frequent locations are the subcutaneous tissue of the shoulders, limbs, back, and buttocks, the mammary gland, and kidney. 8. Paralysis is the most important sequel of diphtheria. It is due to toxic neuritis, and is found as a rule during convalescence, and occurs in from about ten to fifteen per cent, of all cases. It may follow either a mild or a severe attack of diphtheria; and the pharynx, uvula, muscles of the eyes, face, one or both extremities, respiration, or heart may be affected. 9. '"Hyaline casts are common to all diseases and dis- turbances of the kidney, and are not pathognomonic of any one abnormal condition. They are, however, predominant in the sediment in cases of chronic interstitial nephritis, chronic diffuse nephritis, amyloid infiltration, and in passive hyperemia; while their relative proportion is much smaller in comparson with the other forms of casts present in active hyperemia, acute nephritis, and subacute glomerular nephritis." "Finely granular casts are found in every disease or disturbance of the kidney; they, therefore, cannot be con- sidered pathognomonic of any one disease or class of dis- eases." (Ogden, On the Urine.) BACTERIOLOGY. I. Koch's rules in regard to the bacterial cause of disease are: (1) the microorganism must be found in the tissues, blood, or secretions of a person or animal sick or dead of the disease; (2) the microorganism must be iso- I 3 1 MEDICAL RECORD. " Our reporters attend every convention of first-rate im- portance. The news is telegraphed or cabled exclusively to the MEDICAL RECORD." lated and cultivated from these same sources; it must also be grown for several generations in artificial culture media; (3) the pure cultures, when thus obtained, must, on inoculation into a healthy and susceptible animal, produce the diseases in question, and (4) the same microorganisms must again be found in the tissues, blood, or secretions of the inoculated animal. 2. The Klebs-Loeffler bacillus is a short rod, about three to six microns in length, and about a half to one micron in breadth ; the extremities may be rounded or clubbed. The bacilli are slightly curved, and may occur singly, in pairs, or in groups; they are non-motile, have no flagella, are aerobic, and contain granules which take on a deeper stain. The bacillus stains with the analine colors, by Gram's method, and with Loefner's alkaline methylene-blue. 3. Bacillus coli communis, Spirillum cholera asiatica. Friedlander's Bacillus pneumonia, and Obermeier's spiro- chete of relapsing fever. 4. The Widal serum reaction "depends upon the fact that serum from the blood of one ill with typhoid fever, mixed with a recent culture, will cause the typhoid bacilli to lose their motility and gather in groups, the whole called 'clumping.' Three drops of blood are taken from the well-washed aseptic finger tip or lobe of the ear, and each lies by itself on a sterile slide, passed through a flame and cooled just before use; this slide may be wrapped in cotton and transported for examination at the laboratory. Here one drop is mixed with a large drop of sterile water, to redissolve it. A drop from the summit of this is then mixed with six drops of fresh broth culture of the bacillus (not over twenty-four hours old) on a sterile slide. From this a small drop of mingled culture and blood is placed in the middle of a sterile cover-glass, and this is inverted over a sterile hollow-ground slide and examined. ... A positive reaction is obtained when all the bacilli present gather in one or two masses or clumps, and cease their rapid movement inside of twenty minutes." (From Thayer's Pathology.) 5. The microorganisms most commonly found in em- pyema are the Streptococcus pyogenes and the pneumo- coccus; others commonly found are the Staphylococcus pyogenes and the tubercle bacillus. MATERIA MEDICA AND THERAPEUTICS. i. Pulvis Ipecacuanha? et Opii, dose gr. vijss. Acetum Opii, dose TTEviij. Tinctura Opii, dose TTJ^viij . Vinum 132 MEDICAL RECORD. "We publish the proceedings of an association immediately after the meeting." Opii, dose TTJviij. The principal alkaloids are: Morphine, codeine, thebaine, narcotine, papaverine, pseudomorphine, and narceine. 2. Hydrargyri Chloridum Corrosivum, dose gr. 1/20; used chiefly, externally, as an antiseptic and parasiticide. Hydrargyrum cum Creta, dose gr. iv ; used chiefly as a mild laxative, an alterative, and antisyphilitic. Hydrargyri Subsulphas Flavus, dose gr. ij to iv; used as an emetic. 3. Apomorphina; hydrochloridum, dose gr. 1/16, hypo- dermatically ; or gr. 1/10, by mouth. Zinci Sulphas, dose gr. xv to xxx. Cupri Sulphas, dose gr. iv. Alumen, dose a teaspoonful. Antimonii et Potassii Tartras, dose gr. j to ij. 4. Ferric Salts and Alkaloids. With the former, ink is formed; with the latter, an insoluble precipitate. 5. With mineral acids, alkaloids and their salts, metallic salts, and ammonia. 6. Because pepsin requires an acid medium in which to exercise its powers, and pancreatin requires an alkaline medium. 7. In diseases of the kidneys, cardiac hypertrophy, hemorrhage, and plethora. 8. Quinine, from Cinchona. Strychnine, from Strychnos Nux Vomica, and Strychnos Ignatia. Physostigmine, from Physostigma (Calabar bean). Hydrastin, from Hydrastis (Golden Seal or Yellow Puccoon). Atropine, from Atropa Belladonna. CHEMISTRY AND TOXICOLOGY. 1. A chemical compound is a substance made of two or more elements, chemically united, in _ definite propor- tions. Examples : water, sulphuric acid, iodoform. A mechanical mixture is the product obtained by uniting into a more or less homogeneous whole two or more substances, whether elements or compounds, in any pro- portion, and without any chemical union. Examples : air, sugar adulterated with sand, salt in water. 2. Hydrochloric acid: when pure this is a colorless gas with a sharp, penerating, and irritating odor ; it is very soluble in water; it does not support combustion nor does it burn in air; it is very corrosive. The ordinary hydrochloric acid is a solution of this gas in water, and is found in three varieties : the commercial, the pure, and the dilute acids. Sulphuric acid is a colorless, thick, oily liquid, odorless, very corrosive; has a great tendency to unite with water; it chars organic matter. Nitric acid is a colorless or faintly yellow liquid, has 13.3 MEDICAL RECORD. The MEDICAL RECORD publishes no " Students' Number," for every issue is a students' number and a practitioners' number in one. a sour taste, a suffocating odor, and is very corrosive. It is a strong oxidizing agent, and stains animal tissues yellow. 3. Oxygen. Occurrence: free in the air and in com- bination in water, rocks, minerals, etc. It is more abun- dant than any other element, forming about forty per cent, of the total weight of the earth. Properties: It is a colorless, odorless, tasteless gas, heavier than air, slightly soluble in water, has an intense affinity for other elements, combining with almost all of them except fluorine. It is necessary to life, and is a supporter of combustion. Hydrogen. Occurrence: free in volcanic gases, in fire damp, and the gases of the intestines ; and in combination in water, all acids and in many organic compounds. Prop- erties: A colorless, odorless, tasteless gas, the lightest known substance ; it has a great affinity for oxygen ; it supports neither combustion nor respiration ; it is a neces- sary constituent of all acids ; the gas will burn with a pale blue flame, giving little light, but an intense heat. Nitrogen. Occurrence: free in the air, in combination in nitrates, ammonia, and in many organic substances. Properties: A colorless, odorless, tasteless gas, it neither burns nor supports combustion nor respiration, it has no tendency to unite with other elements. 4. Arsenic. Occurrence: free in very small quantities; chiefly in combination with sulphur as realgar, orpiment, and mispickel. Properties: It is a gray solid, is easily powdered, if pure it is odorless and tasteless; it is a good conductor of electricity, and is easily oxidized. There are four atoms to the molecule of arsenic. Mercury. Occurrence: Usually found in combination with sulphur, as cinnabar. Properties: It is liquid metal, is slightly volatile, the molecule contains only one atom ; it unites directly with chlorine, bromine, and iodine; it is a necessary constituent of amalgams. Iron. Occurrence: free, in small quantities only; in combination as oxides, carbonates, or sulphides, in hema- tite, magnetic iron, spathic iron, pyrites, etc. Properties: Pure iron is white and soft, and crystallizes in cubes or octahedra ; it is unaffected by dry air at ordinary tempera- ture ; in damp air it is converted into iron rust (a hydrate of iron); at red heat it is oxidized. It is dissolved by the strong mineral acids. 6. Symptoms: "Those portions of the skin and mucous membrane which have been in contact with the poison are whitened and hardened. There are burning pains in the 134 MEDICAL RECORD. "Range of subjects embraces every branch of medicine and surgery." mouth, esophagus, and stomach, and vomiting ; lowering of the pulse and temperature, contraction of the pupils, stupor, syncope, and collapse, terminating in death. The urine, clear and of the normal color when voided, becomes rapidly greenish, and finally dark olive-green or almost black." (Witthaus.) Treatment: White of egg should be administered; also sodium sulphate, and the stomach should be gently washed out. Alcohol is said to be antidotal. 7. Symptoms: "In acute cases the symptoms usually begin in from twenty to forty-five minutes. Nausea and faintness. Violent, burning pain in the stomach, which becomes more and more intense, and increases on press- ure. Persisting and distressing vomiting of matters, some- times brown or gray, or streaked with blood, or green (Paris green). Purging. More or less severe cramps in the lower extremities." In Chronic Cases: "Inflammation of the conjunctivae, with intolerance of light. Irritation of the skin, accom- panied by an eruption (eczema arsenicale). Local paralyses. Great weakness and emaciation. Exfoliation of the cuticle and falling out of the hair." (Witthaus.) The antidote is freshly prepared ferric hydroxide. 9. The antidote for nitrate of silver is salt and water; for opium, there is no one substance which is a complete antidote, washing out the stomach with a dilute solution of potassium permanganate is the best treatment ; for phos- phorus, old French oil of turpentine; for corrosive sub- limate, white of egg; for zvild parsnip, emetics, lavage, and purgatives. 10. The following is mentioned in Potter's Materia Medico, etc. : Dialyzed iron, syrup of chloral, chloroform, spirits of chloroform, calcined magnesia, aromatic spirits of ammonia, oil of turpentine, acetic acid, tincture of digi- talis, tannic acid, amyl nitrite, zinc sulphate, ipecacuanha, potassium bromide, potassium permanganate. Also a hypo- dermic syringe and solutions or pellets therefor of: mor- phine sulphate, atropine sulphate, apomorphine hydro- chlorate, pilocarpine nitrate, strychnine nitrate. To the above should be added a stomach tube and a soft rubber catheter. THEORY AND PRACTICE OF MEDICINE. 7. Chronic gastric catarrh is generally caused by indis- cretions in diet, or by mental worry, it may occur at any time of life, and is characterized by pain in the epigastric region which generally comes on after eating; there is apt to be morning vomiting, the vomitus consisting of 135 MEDICAL RECORD. " The most important contributions to the literature of medicine and surgery have been published first in the MEDI- CAL, RECORD." mucus with undigested particles of food; there is seldom hemorrhage ; the stomach may he enlarged, and examination of the gastric contents shows free HC1 diminished or absent, and the digestive ferments diminished. Gastric ulcer is generally caused by injur}' or bacteria, is most apt to occur between the ages of twenty and forty- five ; after eating there is pain localized in the stomach, vomiting occurs soon after eating, hematemesis is common, there is localized tenderness over the stomach, and examin- ation of the gastric contents shows an excess of free HC1. Gastric cancer does r.ot usually occur before forty years of age, is more common in males, the pain is localized and constant, vomiting is copious and occurs some time after eating; the vomitus contains ''coffee ground" material; hemorrhages are common ; a tumor may be palpated, and examination of the gastric contents shows absence of free HC1 and presence of lactic acid; severe anemia and ca- chexia are also present. OBSTETRICS. i. Tubal pregnancy is a pregnancy in which the ovum is arrested in the Fallopian tube and develops there in- stead of in the uterine cavity. In differentiating this condition from a normal pregnancy the following signs and symptoms are of most reliance. "When extrauterine pregnancy exists, there are: (i) The general and reflex symptoms of pregnancy ; they have often come on after an uncertain period of sterility. Nausea and vomiting appear aggravated. (2) Then comes a dis- ordered menstruation, especially metrorrhagia, accom- panied with gushes of blood, and with pelvic pain coinci- dent with the above symptoms of pregnancy. Pains are often very severe, with marked tenderness within the pelvis. Such symptoms are highly suggestive. (3) There is the presence of a pelvic tumor characterized as a tense cyst, sensitive to the touch, actively pulsating. This tumor has a steady and progressive growth. In the first two months it has the size of a pigeon's egg; in the third month it has the size of a hen's egg; in the fourth month it has the size of two fists. (4) The os uteri is patulous; the uterus is displaced, but is slightly enlarged and empty. (5) Symptoms No. 2 may be absent until the end of the third month, when suddenly they become severe, with spasmodic pains, followed by the general svmptoms of collapse. (6) Expulsion of the decidua, in part or whole. Nos. 1 and 2 are presumptive signs; Nos. 3 and 4 are 136 MEDICAL RECORD. " European correspondents furnish medical news of special interest and reports of the principal foreign medical societies." probable signs; Nos. 5 and 6 are positive signs." {American Text-Book of Obstetrics.) The three greatest dangers to the mother are: hemor- rhage, peritonitis, and death. 2. The foramen ovale. 3. If the twins are from two ova from separate Graafian follicles there will be two placentse; if from two ovules from one Graafian follicle, there will be one placenta; if from a single ovule with two nuclei, there will be one placenta. 4. The membranes investing the fetus are, from within outwards, the amnion, the chorion, and the decidua. 5. The umbilical veins. 6. Hemorrhage and a dilated os. Absolute quiet and rest in bed, with the head lowered, and in a darkened room. Nerve sedatives should be ad- ministered in large doses ; opium is indicated, either lauda- num in fifteen or twenty minim doses, or the extract of opium in suppository. After the cessation of the hemor- rhage the patient should be kept in bed for one or two weeks. 7. Increased anteflexion and descent. 8. About 278 to 280 days. The extremes that legitimatized a child under the Code Napoleon were 180 and 300 days. 10. "Tears of the perineum destroy the integrity of the pelvic floor and result eventually in rectocele, cystocele, hemorrhoids, and displacements of the pelvic organs. If the tear involves the sphincter ani, incontinence also results. Lacerations of the cervix retard or check involution of the uterus and predispose to endometritis, menorrhagia, dis- placements, eversion of the cervical mucous membrane, cys- tic degeneration, and malignant disease. Deep lacerations of the vaginal vault may open into the base of the broad ligaments, and in the majority of instances genitourinary fistulas are caused by traumatisms of labor. All lacerations are immediately dangerous on account of the increased liability _ to sepsis, while the remote results are generally due to interference with involution or the pelvic circula- tion and to the destruction of the normal supports of the pelvis." (Ashton's Gynecology.) GENITOURINARY DISEASES i. "The symptoms of acute anterior urethritis are: An in- cubation period of twenty-four hours, a tickling or an itching sensation at the meatus, which is red, glazed, and often colored with grayish, opaline mucus; the discharge is MEDICAL RECORD. " Keeps you In closest touch with the weekly progress of medicine and surgery throughout the world." scanty at first, but gradualy increases. At the end of three or four days the redness and congestion about the meatus increase and may cause edema, phimosis, and para- phimosis. Lymphangitis is present. The discharge becomes thick and purulent. Ardor urinse, chordee, and frequent urination are now present. At this stage, when the urine is passed into two glasses, in the first glass the urine will be cloudy; in the second, clear. The symptoms just men- tioned usually last for about four weeks, when they grad- ually abate. "The complications of acute anterior urethritis are phimosis, paraphimosis, chordee, painful erections, penitis, lymphangitis, adenitis, balanitis, periurethral abscess, Cow- peritis, hemorrhage, and preputial folliculitis. "Symptoms of acute posterior urethritis. — The discharge decreases ; the frequency of urination increases ; vesical te- nesmus may be present ; there is considerable pain ; he- maturia, albuminuria, and retention of urine are also symptoms. When the urine is passed into two glasses, both specimens will be cloudy. "Complications of posterior urethritis are prostatitis, seminal vesiculitis, inflammation of the cord, epididymitis, orchitis, cystitis, nephritis, pyelitis, abscess of the prostate, abscess of the kidney, peritonitis, uremia, retention of urine, gonorrheal rheumatism. The sequels are hyypochon- driasis, sexual neurasthenia, stricture, impotence, sterility, hyperesthesia, spermatorrhea, and melancholia." (Gould and Pyle's Cyclopedia of Medicine and Surgery.) 2. Causes of orchitis: — Traumatism, inflammation of the urethra, epididymitis, rheumatism, mumps. Treatment: — Rest in bed, elevation of the parts, hot or cold applications, pain is to be relieved by opiates or leeches, lead water and laudanum should be applied, salines or cathartics are to be administered. Sometimes strapping the testicle is of service; so too, is the application of ichthyol and lanolin. 6. HARD CHANCRE. First lesion of a constitu- tional disease, viz., syphi- lis. Due to syphilitic infection. SOFT CHANCRE. A local disease. Due to contact with secre- tion from chancroid. 1,38 MEDICAL RECORD. " Original Articles are of the highest scientific value and most practical character, by the foremost men of the world." HARD CHANCRE. Generally a venereal infec- tion. May occur anywhere on the body. Period of incubation never as short as ten days. Generally single. Not autoinoculable. Secretion slight. Slightly or not at all painful. As a rule only occurs once in any patient. Buboe-s are painless and sel- dom suppurate. SOFT CHANCRE. Always a venereal infection. Nearly always on genitals. Period of incubation always less than ten days (gen- erallv about three). Generally multiple. Autoinoculable. Secretion profuse and puru- lent. Generally painful. May reoccur in same pa- tient. Buboes are painful, and usually suppurate. 8. Syphilitic dactylitis is a specific gummatous infiltration of the tissues of the digits, occurring in the tertiary stage of syphilis. It tends to undergo necrosis and ulceration, or inflammation and subsequent pyogenic infection. There are two varieties: (i) In which the subcutaneous fibrous tissues and the ligaments are involved; and (2) in which the periosteum and bone are specially affected. STATE BOARD EXAMINATION QUESTIONS. University of the State of New York. January 2Q-February 1, 1907. The candidate is required to answer any 10 of the ques- tions on each paper, but no more. ANATOMY. 1. Locate and define (a) odontoblasts, (b) the ductus venosus, (c) the vesiculae seminales. 2. Describe the arrangement of the bones of the ear. 3. Mention and describe the various forms of epithelial cells. 4. Describe microscopically (a) bone, (b) cartilage. 5. What is unstriped muscular fiber and where in the body is it found? 6. Describe the popliteal artery and give its branche?. 7. What are ductless glands? Name the important ductless glands. 139 MEDICAL RECORD. Keeps you strictly abreast of the times. 8. Describe a spinal nerve. g. Give the minute anatomy of the skin. io. Describe the appendix vermiformis and give its topography. 11. Give the origin, insertion, action and nerve supply of one of the following muscles: pectoralis major, levator ani, internal oblique. 12. Describe the superior petrosal sinus. 13. Give the gross anatomy of the tongue. 14. Describe the ovaries and give their relations. 15. What anatomic parts are normally found in the left hypochondriac region? PHYSIOLOGY AND HYGIENE. 1. Describe bones as to varieties and functions. Give the general structure of bone. 2. What constitutes the lymphatic system and what forces are concerned in the circulation of the lymph? 3. Describe the controlling forces that regulate the circulation of the blood in (a) the arteries, (b) the capil- laries, (c) the veins. 4. State the functions of the medulla oblongata. 5. Give the physiological mechanism of the valves of the heart. 6. Compare expired air with inspired air. What is (a) external respiration, (b) internal respiration? 7. Describe micturition. What mechanism serves to keep the urine in the bladder until it is voluntarily voided? 8. State where in the body each of the following sub- stances is found and mention the special purpose served by each: (a) ptyalin, (b) pepsin, (c) glycogen, (d) trypsin. 9. Give all the causes of (a) contraction of the pupil, (b) dilatation of the pupil. 10. Mention the functions of the facial nerve and state the effects of its complete paralysis. 11. What kinds of contamination does the presence of each of the following substances in drinking water indicate : (a) nitrites and nitrates, (b) excess of chlorin? Give the causes of hardness of water. 12. Describe the best method of constructing a house drain. 13. What special measures of prophylaxis may be best employed against (a) typhoid fever, (b) yellow fever, (c) malarial fevers, (d) rabies? 14. Describe the best method of heating and ventilating a hospital ward. 15. How may milk be adulterated and how may it be contaminated with infectious elements? 140 MEDICAL RECORD. Its prestige attracts articles by the best known writers.' CHEMISTRY. 1. Define destructive distillation, smelting, normal salts. 2. Name two monads, two dyads and two triads. Illus- trate each in a graphic formula. 3. Describe the metric system of weights and meas- ures and give the practical equivalent of each unit in Troy weight. 4. Give the uses and the chemical properties of phos- phorus and mention any peculiarity of phosphorus in its relation to oxygen. 5. What constitutes hard water? How may the pres- ence of albuminoid matter in water be recognized? 6. Give the chemical properties of ozone. 7. Name 10 principal elements chiefly concerned in the chemical changes taking place in life and describe the preparation of one of them. 8. Describe the preparation and give the properties of chlorin. On what important chemical feature does the useful application of chlorin depend ? 9. Give the percentage composition of normal urine as to water, urea, uric acid, organic matter, and sodium chlorid. 10. What is electrolysis? State the ionic theory. 11. Give the chemical features of disinfection. 12. Mention the general properties of organic com- pounds. 13. What are hydrocarbons? Give the name and the formula of one important hydrocarbon. 14. Describe a method (laboratory or otherwise) of making alcohol (ethyl). What is the percentage of alcohol in (a) porter, (b) port wine, (c) champagne? 15. Describe the preparation and state the uses of cyan- ogen. SURGERY. 1. Give the symptoms and the treatment of actinomy- cosis. 2. Mention the most common sites of epitheliomata. 3. Mention three operations on the stomach. Describe one oFlhese operations and give the indications for its performance. 4. Give a classification of complete fracture according to (a) line of separation, (b) mode of production, (c) number of fractures present. 5. What are the immediate and the remote effects of a fracture-dislocation in the lower dorsal region? 6. What tumors occur in bone? 7. Give the treatment of hip joint disease in children. 141 MEDICAL RECORD. " Choice and important abstracts from the leading medical periodicals of the world in a condensed and practical form." 8. Give the predisposing and the exciting causes of aneurysm. 9. What operative measures are applicable in the treat- ment of stone in the female bladder? 10. What is meant by secondary suppurative inflamma- tion? Give the most frequent sources of secondary sup- purative inflammation of the abdominal wall. 11. Give the treatment of an injury of the rectum in- volving the peritoneum. 12. What are the specific diseases of the vulva? De- scribe one of these diseases and give treatment. 13. Describe convergent strabismus and give its sur- gical treatment. 14- Give the symptoms of syphilitic rhinitis in the new- born. 15. Describe the pediculus pubis and mention the symp- toms to which it gives rise. Give treatment. OBSTETRICS. 1. Give a brief description of the physiology of reproduc- tion. 2. Describe the liquor amnii raid state its functions. 3. What pathological conditions of the internal organs of generation are liable to cause abortion? Give reasons. 4. Give the causes and the treatment of umbilical hemor- rhage in the newborn. 5. Give the prognosis and the management of a face presentation. 6. Describe the effects of syphilitic infection on child- bearing. 7. Mention the factors that affirmatively determine pregnancy between the third and the fourth month. 8. What is understood bv premature artificial delivery? Mention the conditions that justify this procedure. 9. Give the treatment of retrodeviation of the uterus when it complicates pregnancy. 10. Give the technique of catheterization of the female. 11. Make a diagnosis of tubal pregnancy. State the dangers of tubal pregnancy. 12. Describe phlegmasia alba dolens and give the treat- ment. 13. Give the symptoms of pelvic abscess. Through what channels may pelvic abscesses drain? 14. Define vaginismus. Give the etiology and the treat- ment of vaginismus. 15. Give a technical description of the operation of craniotomy. 142 MEDICAL RECORD. " Book reviews of foreign and American publications keep you thoroughly informed of the newest literature." PATHOLOGY AND DIAGNOSIS. 1. What pathological changes occur in (a) tumefaction, (b) hypertrophy, (c) induration, (d) calcification? 2. Describe the bacillus of tuberculosis and give a method of demonstrating the same. 3. Mention some of the structural tissue changes caused by pyrexia. 4. What changes occur in the red blood corpuscles in progressive pernicious anemia? 5. Describe a method of making a bacteriological diag- nosis in diphtheritis. 6. Under what pathological conditions may casts be found in the urine? Describe two varieties of casts. 7. Give the macroscopic and the microscopic appear- ance of pus. 8. Describe the skin lesions occurring in psoriasis. 9. Mention the pathological conditions that may arise from the presence of calculi in the gall-bladder. 10. Mention the changes that may occur in the nervous system as a result of syphilis. 11. What muscles are involved in the paralysis follow- ing lesions of the musculospiral nerve? 12. Describe a test meal and give the method of its use. 13. Describe the onset and the course of ophthalmia neonatorum. 14. Give the incubation period of (a) scarlatina, (b) measles, (c) variola, (d) varicella, (e) rotheln. Give the clinical history of one of these diseases. 15. Mention three pathological conditions the (local symptoms of which are manifested in the epigastric region. THERAPEUTICS, PRACTICE, AND MATERIA MEDICA. Questions prepared by the Board of Examiners repre- senting the Medical Society of the State of Netv York: 1. Give the therapeutic uses of lobelia. <2l Give the physical signs of aortic obstructive lesions of the heart. 3. Give the physiological action of digitalis on the heart and on the kidneys. 4.' Define and describe iodism. 5. Give the treatment of acute lobar pneumonitis. 6. Mention the official preparation of strophantus. State the dose of this preparation and describe its physio- logical effects. 7. Give the therapeutic uses of sanguinaria. MEDICAL RECORD. The MEDICAL, RECORD publishes no " Students' Number," for every issue is a students' number and a practitioners' number in one. 8. Give the diagnosis and the treatment of gonorrheal rheumatism. 9. Mention five official preparations of senna and state the dose of each. 10. Describe the therapeutic uses of sulphur. 11. State the period of incubation in hydrophobia. De- scribe the prophylaxis in hydrophobia. 12. What preparation of apomorphin is used medicin- ally"? Mention the doses of this preparation and state for what it is employed. Q 4 Mention the class of acids administered to acidify alkaline urine. 14. Give the signs and the symptoms of intestinal per- foration in typhoid fever. 15. State the dose of (a) liquor potassii arsenitis, (b) liquor sodii arsenatis. ANSWERS TO STATE BOARD EXAMINING QUES- TIONS. University of the State of New York. January 29 to February 1, 1907. PHYSIOLOGY AND HYGIENE. 1. Bones are described as: (1) Long bones, consisting of a shaft (which is hollow), and two extremities; exam- ples, humerus, tibia, metacarpals. (2) Short bones, which are compressed, short and spongy in structure, except on their surfaces ; examples, the bones of the carpus and tarsus. (3) Flat bones, consisting of broad, flat plates of bone in- closing some cancellous tissue; examples, parietal, scapula. (4) Irregular bones, consisting of compact tissue externally, and cancellous tissue internally, are such as cannot be grouped under one of the preceding divisions; examples, vertebrae, ethmoid. The functions of bones are: (1) for protection (chiefly the flat bones) ; (2) for muscular attachments (chiefly the long bones) ; (3) for support of the body (chiefly the long bones) ; (4) for locomotion and motion (chiefly the long bones) ; (5) for strength (chiefly the short bones) ; (6) to maintain the shape and outline of the body. 2. The lymphatic system consists of : lymphatic glands, lymph vessels, perivascular lymph spaces, the lymph canal- icular system, the pericardial, pleural, peritoneal, and syno- vial cavities, and the lacteals. MEDICAL RECORD. " Therapeutic Hints contain many valuable formulae by the foremost medical men in the world." The forces concerned in the circulation ©f the lymph are: (i) The pressure of the blood in the blood-vessels; (2) thoracic aspiration; (3) muscular contractions of the vol- untary muscles; (4) contractions of the intestine; (5) the action of the valves in the lacteals and lymphatics. 3. The circulation of the blood is regulated in (a) the arteries, by: (1) the elasticity and tone of the arteries, (2) the force and frequency of the cardiac contractions, (3) the resistance in the capillaries ; (b) in the capillaries it is reg- ulated by: (1) the action of the heart, (2) the action of the arteries; (c) in the veins it is regulated by: (1) the action of the heart, (2) aspiration of the thorax, (3) the contraction of the muscles, and (4) slightly by the valves in the veins. 4. The functions of the medulla oblongata are: (1) It is a conductor of nervous impulses or impressions from the cord to the cerebrum, from the brain to the spinal cord, also of coordinating impulses from the cerebellum to the cord; (2) it contains collections of gray matter which serve as special nerve centers for the following functions or ac- tions : respiration, salivary secretion, mastication, sucking, deglutition, speech production, facial expression; it also contains the cardiac and vasomotor centers. 6. Oxygen Nitrogen Carbon dioxide Other gases. ... Watery vapor. . Temperature. .. Volume Bacteria , Dust Expired Air. 16.6 per cent. 79 per cent. 4.4 per cent Often present. Saturated. That of body. Diminished. None. None. Inspired Air. 21 per cent. 79 per cent. 0.04 per cent. Rare. Variable. Variable. Varies. Always present. Always present. (a) External respiration is the interchange that takes place between the blood and the gases in the lungs; (b) internal respiration is the interchange that takes place between the blood and the tissues of the body. 7. The urine is kept in the bladder by the sphincter vesicse and by the muscular and elastic fibers of the urethra. 8. (a) Ptyalin is found in the saliva; it changes starch into dextrin and sugar; (b) pepsin is found in the gastric juice; it changes proteids into proteoses and peptones in an 145 MEDICAL RECORD. Save and bind your numbers; it will give you two great ledical encyclopedias .every; year. acid medium ; (c) glycogen is found chiefly in the liver and the muscles, also in the white blood corpuscles, and in the placenta; (d) trypsin is found in the pancreatic juice; it changes proteids into proteoses and peptones, and after- wards decomposes them into leucin and tyrosin; it acts in an alkaline medium. o. (a) The pupil contracts: (i) when stimulated by light; (2) on stimulation of the third nerve; (3) on paraly- sis of the cervical sympathetic; (4) when the eye is accom- modated for near objects; (5) during sleep; (6) through the action of certain drugs, called myotics, such as opium, and the local influence of physostigmine ; (7) when the eye- ball is turned inwards, (b) The pupil dilates: (1) on re- moval of the stimulus of light; (2) on paralysis of the third nerve; (3) on stimulation of the cervical sympathetic; (4) when the eye accommodates for distant objects; (5) in deep chloroform narcosis; (6) in dyspnea; (7) under the influence of certain drugs, called mydriatics, as atro- pine ; (8) under the influence of pain, or fear. 10. The facial nerve is the motor nerve of the muscles of expression, also of the platysma and the buccinator; it also supplies the muscles of the external ear, the stylohyoid, and the posterior belly of the digastric. Through the chorda tympani it is a nerve of taste and a vasodilator of the ves- sels of the submaxillary and sublingual glands. "When it is paralyzed, the muscles of the face being all powerless, the countenance acquires on the par- alyzed side a characteristic, vacant look, from the ab- sence of all expression; the angle of the mouth is lower, and the paralyzed half of the mouth looks longer than that on the other side; the eye has an unmeaning stare, owing to the paralysis of the orbicularis palpebrarum. All these peculiarities increase the longer the paralysis lasts, and their appearance is exaggerated when at any time the muscles of the opposite side of the face are made active in any expression, or in any of their ordinary functions. In an attempt to blow or whistle, one side of the mouth and cheeks acts properly, but the other side is motionless, or flaps loosely at the impulse of the expired air; so, in trying to suck, one side only of the mouth acts ; in feeding, the lips and cheek are powerless, and, on account of paralysis of the buccinator muscle, food lodges between the cheek and gums." (Kirkes' Physiology.) 11. (a) The presence of nitrates and nitrites denotes contamination from nitrogenous organic matter of animal origin; (b) the presence of excess of chlorin denotes organic impurity of animal origin. 146 MEDICAL RECORD. " Since 1890 the Medical RECORD has had a cabled report of every International Medical Congress." Hardness of water is caused by the salts of calcium and magnesium ; usually the bicarbonate or sulphate, but some- times the chloride, phosphate, or nitrate. 15. Milk may be adulterated by the addition of water (clean or dirty), by skimming, by the addition of coloring matters or preservatives, and by the addition of solid sub- stances, such as sugar, flour, etc. Milk may be contaminated with infectious elements by being obtained from infected cows, by being diluted with water containing disease germs, by the cans, containers, vessels, etc., being contaminated with dirty water; through carelessness in handling by persons who are infected. CHEMISTRY. 1. Destructive distillation is a process of decomposition of nonvolatile organic matter by the agency of heat, and with exclusion of air. Smelting is a method of obtaining a metal from its ore by the process of fusion. Normal salts are salts in which all of the replaceable hydrogen of the acid has been replaced. 2. Two monads: hydrogen and sodium; two dyads: oxygen and sulphur; two triads: nitrogen and boron. H-Cl ; Na-Cl ; H-O-H ; Hydrochloric acid; Sodium chloride; Water; u O— H H / / / S< B— O— H N— H. n O— H H Sulphuretted hydrogen; Boric acid; Ammonia. 4. The chief uses of phosphorus are in making matches, rat paste, and phosphor bronze. It is also used in medicine in cases of osteomalacia, rickets, and as a nerve tonic. The chemical properties of phosphorus are: chiefly its readiness to enter into combination with oxygen; it is a re- ducing agent; it is not acted on by HC1 or by cold H 2 SO«; it is oxidized by hot H 2 S0 1; and by HNO*. 5. Hard water is a water containing an excess of cal- careous salt. (See above, Physiology, 11.) 6. Ozone is a strong oxidizing agent; it oxidizes nearly all metals in the presence of moisture; it decolorizes indigo and other pigments of organic nature; it is but slightly sol- uble in water. 7. Carbon, hydrogen, nitrogen, oxygen, iron, chlorine, sodium, potassium, calcium, sulphur. 147 MEDICAL RECORD. " Our reporters attend every convention of first-rate im- portance. The news is telegraphed or cabled exclusively to the MEDICAL RECORD." Hydrogen is prepared by the action of zinc on dilute sul- phuric acid: Zn+H 2 S0 4 =ZnS04+H 2 8. Chlorine is prepared by the action of hydrochloric acid on manganese dioxide: 4 HCl+Mn0 2 =MnCl 2 +2H 2 0+Cl 2 It is an active disinfecting and bleaching agent in the presence of moisture. It acts by decomposing the water, the nascent oxygen thus liberated attacks the odorous or coloring substance. Chlorine will not bleach a dry sub- stance. 9. Water, 95.00 per cent. ; urea, 2.80 per cent. ; uric acid, 0.06 per cent.; organic matter, 3.75 per cent.; sodium chloride, 0.80 per cent. 10. Electrolysis is the process of electrical conduction accompanied by the separation of the constituents of the electrolyte; or the decomposition of a chemical compound by passing an electric current through it. The primary products of electrolysis are called ions; those which sep- arate at the positive electrode or anode are called anions; those which separate at the negative electrode or cathode are called cations. A solution of sodium chloride contains NaCl, but it also contains the cation Na and the anion CI; and the action of the electric current is to separate these ions (which are already liberated) at the respective elec- trodes. It is supposed that the hydrogen and metallic ions are charged with positive electricity, and the hydroxyl and acid-residue ions are charged with negative electricity; hence the former are attracted to the cathode and the latter to the anode. 11. Chemical disinfectants act in virtue of their power to form definite chemical compounds with the bacteria which are responsible for the infection. The bacteria are thus rendered harmless. In order to accomplish this the disinfectant must come in direct contact with the bacteria, and in the combination thus effected both bacteria and dis- infectant change their chemical properties. 12. Organic compounds may be either gases, liquids, or solids (either crystalline or amorphous) ; may be either vol- atile or nonvolatile ; may be either colorless, tasteless, odor- less, or have any variety of these qualities; thev are changed by heat and chemical reagents with a readiness which is directly proportionate to their complexity. 13. Hydrocarbons are chemical compounds consisting of carbon and hydrogen only. Example, Methane, CH 4 . 14. Ethyl alcohol can be formed synthetically from cal- 148 MEDICAL RECORD. " The medical profession have been presented with the re- sults of great discoveries by the MEDICAX, RECORD in ad- vance of any other publication. cium carbide, water, and hydrogen. Thus (i) calcium car- bide and water form acetylene: CaC 2 +2H 2 0=CaH 2 2 +C 2 H 2 (2) Acetylene vapor and water form aldehyde : C 2 H 2 +H 2 = CH 3 .CHO. (3) Aldehyde and nascent hydrogen form alcohol : CH 3 .CHO+H 2 =CH 3 .CH 2 OH (a) Porter, 4 to 6 per cent. ; (b) port wine, 19 to 25 per cent.; (c) champagne, 8 to 12 per cent. 15. Cyanogen is prepared by heating mercuric cyanid : 2 Hg (CN). = 2 Hg + 2 (CN) 2 SURGERY. 2. On the skin, mucous membranes, or at the junction of skin and mucous surfaces ; lip, ala of nose, glans penis, cer- vix uteri, eyelid. The cylindrical celled epithelioma is more likely to occur in the stomach, the rectum, and uterus. 3. Gastrotomy, gastrostomy, gastrorrhaphy. The indications for gastrotomy are: In the removal of foreign bodies from the stomach, for exploration, for the treatment of various conditions existing in the stomach, pylorus, or lower end of the esophagus (such as ulcer, stricture, etc.). 4. (a) Transverse, oblique, spiral, longitudinal, dentate, T-shaped, V-shaped, and comminuted, (b) By external violence, either direct or indirect ; by muscular contrac- tion ; spontaneous, (c) Single and multiple; this latter may be double, triple, or quadruple, etc. 5. "Paraplegia below the part injured is present in most cases, and with it some amount of general shock. When the cord is disintegrated or divided, symptoms of spinal myelitis rapidly follow, and a fatal issue often occurs at an early date from toxemia following septic cystitis or sloughing of the nates. The spechl phenomena of paraple- gia in the region referred to are : — complete paralysis of the muscles of both limbs, including those passing to them from the trunk; total anesthesia of the legs, gluteal and perineal regions, and possibly the lower part of the abdo- men; whilst, if the vesical centers are destroyed, there is total paralysis of the bladder, with relaxation of the sphinc- ter, dribbling of urine, which early becomes ammoniacal, and cystitis, due to trophic changes; if the centers escape, retention with overflow is the usual result; the rectum and sphincter ani arc paralyzed, causing incontinence of feces, the passage of which is unrecognized from the anesthetic condition of the anus." — (Rose and Carless' Manual of Surgery.) 149 MEDICAL RECORD. " Statistics of the health boards and many articles of scien- tific interest and items of general information." 6. Sarcomata, chondromata, osteomata, carcinomata, fibromata, myxomata, angiomata, myelomata. 8. Predisposing causes: atheroma, syphilis, old age, intemperance, undue exertion, embolism. Exciting causes: injury to an artery, increased blood pressure (either from increased heart action or from obstruction beyond the aneurysm), blows, strains, sudden exertion. 9. Litholapaxy, suprapubic lithomy, vaginal lithotomy, lithotrity (and extraction with forceps or by mere manipu- lation). 11. Laparotomy should be performed at once, the ab- dominal cavity must be thoroughly cleansed out, and par- ticular attention be paid to asepsis, disinfection, and drainage. 14. Coryza or "snuffles," with a thin, watery discharge which does not readily respond to treatment, and which causes excoriation ; fissured lips, "rhagades," and a hoarse cry. 15. The pediculi pubis are the shortest of the pediculi, but are broader and flatter than the pediculi capitis. The head is fiddle-shaped, and they bear a general resemblance to a miniature tortoise or crab. They have six legs ; the two front pairs are used for walking, and with the claspers on the hinder legs they stick tight to the pubic hair, and generally have the head buried in the follicular orifice. The nits are situated quite near the base of the hairs. The symptoms are : itching in the pubic and perineal re- gions, excoriations from scratching, hemorrhagic puncta or papules. Treatment: The pubic region should be shaved, washed with soap and water twice a day, either mercurial ointment should be rubbed in, or lotion of corrosive sublimate should be applied. 2. The liquor amnii is the fluid contained in the amniotic sac; it is alkaline in rea tion, has a specific gravity of about OBSTETRICS. 1.001 to 1.008, its quantity is variable, but is generally about two pints. It consists chiefly of water, but contains small amounts of albumin, epithelial cells, urea, phosphates, chlorides, etc. Its source is unsettled. Functions: (a) During Pregnancy: (1) As a protection to the fetus against pressure and shocks from without. (2) As a protection to the uterus from excessive fetal movements. (3) It distends the uterus, and thus allows for the growth and movements of the fetus. (4) It re- ceives the excretions of the fetus. (5) It surrounds the fetus with a medium of equable temperature, and serves 150 MEDICAL RECORD. "Bulletins of Examinations of State Medical Licensing Boards published bi-weekly." to prevent loss of heat. (6) It prevents the formation of adhesions between the fetus and the walls of the amniotic sac. (7) It has been supposed, by some, to afford some slight nutrition to the fetus. (b) During Labor : It acts as a fluid wedge, and dilates the os uteri and the cervix; it also slightly lubricates the parts. 3. Malformations, and displacements of the uterus (chiefly retroversion, and prolapse) ; inflammations of the uterus or appendages (metritis, endometritis, salpingitis, ovaritis),; adherent uterus with perimetritis ; undue rigidity of the uterine muscles; extreme laceration, erosion, or ulceration of the cervix; tumors of the uterus; pelvic congestion, acute or chronic. 4. If primary, it is due to slipping of the ligature or injury to the cord; and the cord should be re-ligated in a proper manner. Secondary hemorrhage is due to either: hemorrhagic diathesis, deficient coagulability of the blood, or loosening or tearing of the normal coagulum from the hypogastric arteries. Treatment: compression with hare- lip pins, and application around these of a figure-of-eight ligature. 9. The patient (the bowels and bladder having been emptied) should be placed in the knee-chest position, and the uterus replaced by manual pressure. If this proves un- successful, a repositor may be used ; and the procedure may be facilitated by drawing down the cervix with a volsellum forceps. If the uterus is bound down by adhesions, tam- pons soaked in ichthyol and glycerin should be placed in the posterior cul-de-sac. After reposition, the uterus should be kept in place by a pessary or tampons. In case the uterus becomes incarcerated, in addition to the above procedures, anesthesia may be necessary; and if reposition is not possible, the advisability of inducing abor- tion or of performing a hysterectomy may have to be con- sidered. 13. Fever, chills, pulse weak and rapid, pain in lower abdomen and thighs, anorexia, pelvic tenderness, prostra- tion; there may be painful urination and defecation. Drainage may take place through the vagina, or through the abdominal wall. 14. Vaginismus is a condition of painful and spasmodic contraction of the vaginal orifice, which renders coitus either painful or altogether impossible. Its causes are irri- table hymen, ulcer, or fissure anywhere in the immediate vicinity, urethral caruncle, raruncuke myrtiformes, a long perineum with vaginal orifice placed too anteriorly. The 151 MEDICAL RECORD. " Special reporters in England, France, Germany, Austria, Turkey, Denmark, the Philippines, and the leading cities of the United States and Canada." treatment consists in removing the cause when possible, tonics and general constitutional treatment; dilatation of the vaginal orifice may be necesary; local application of a 5 per cent, solution of cocaine will relieve the hyperesthesia and allow of coitus. PATHOLOGY. 3. Cloudy swelling, fatty degeneration, coagulation necrosis; these occur principally in the muscles, the liver, kidneys, and the heart. 9. Impaction in the gall duct, causing biliary colic; dilatation and inflammation of the gall-bladder; hypertrophy and cirrhosis of the liver; carcinoma of the gall-bladder. 10. Formation of gummata; meningitis, myelitis, and degenerative changes in the nerve tissues; hemorrhages; encephalitis. As a result there may follow : mania, melan- cholia, paretic dementia, pseudoparesis, myelitis, paraplegia, hemiplegia, locomotor ataxia, general paresis, neurasthenia, hysteria, epilepsy, and neuralgia. 11. Triceps, anconeus, supinator longus, extensor carpi radialis longior, brachialis anticus, supinator brevis, ex- tensor carpi radialis brevior, extensor carpi ulnaris, exten- sor communis digitorum, extensor indicis, extensor minimi digiti, extensor pollicis longus, extensor pollicis brevis, abductor pollicis. 12. Ewald's test breakfast consists of one or two dry rolls, or one or two slices of dry bread ; and about two- thirds of a pint of water or weak tea. This is taken in the morning, no food having been taken since the previous evening. The contents of the stomach are withdrawn about an hour to an hour and a half after the test meal, and examined. 15. Cancer of the stomach, cancer of the pancreas, aneurysm. THERAPEUTICS, PRACTICE, AND MATERIA MEDICA. i. It is used internally in asthma, bronchitis, and con- stipation; locally for the, eruption in poisoning by rhus toxicodendron. 3. It slows the heart, increases the force of the systole, and prolongs the diastole. It also causes a rise in blood pressure. On the kidneys it exerts more or less of a diuretic action. 4. Iodism is the name applied to the condition resulting from the prolonged use of iodin or the iodides. The symptoms of iodism are : Severe coryza, sore throat, MEDICAL RECORD. " The most important and interesting items of the very latest medical news throughout the world." conjunctivitis, headache, nausea, anorexia, metallic taste in the mouth, increased flow of saliva, eruption on the skin which may go on to suppuration. 6. Tinctura strophanthi. Dose TTJJviii. It paralyzes the muscles, first causing stiffness, and later, loss of voluntary movement; the heart is particularly influenced. In small doses it has the same effect as digitalis, increasing the force of the systole, prolonging the diastole, stimulating the cardiac contractions, and causing increased blood pressure. It is also a diuretic. 7. It is used as an expectorant in bronchitis, and as a gastric and hepatic stimulant. 9. (1) Confectio sennse; dose, 5j. (2) Fluidextractum sennae; dose, fl£xxx. (3) Infusum sennse compositum; dose, 3iv. (4) Syrupus sennas; dose, 3j. (5) Pulvis glycyrrhizas compositus ; dose, 5j. 12. The hydrochloride. As an expectorant, gr. 1/30; as an emetic, gr. 1/10. 13. Benzoic acid. 14. Severe, sudden, abdominal pain; collapse; small, rapid pulse; the abdomen is distended and tender; the legs are drawn up and the thighs flexed; there may be nausea and vomiting ; blood examination shows the presence of leucocytosis. 15. (a) Liquor potassii arsenitis, Trgiij. (b) Liquor sodii arsenatis, TTgiij. STATE BOARD EXAMINATION QUESTIONS. North Carolina Board of Medical Examiners. Morehead City, June 5-8, 1907. chemistry and diseases of children. 1. Define an atom, (a) How always found? (b) What is taken as the standard? 2. Define a symbol, (a) Also a coefficient, (b) What does each represent? 3. Define a metal, (a) How many are known? (b) Name the noted exception. 4. What is a thermometer? (a) How is it made? (b) Name standard brands. 5. What is a blood corpuscle? (a) How many kinds? (b) To what is the color due? 6. Define dentition, (a) At what age does it appear? (fr) Name some of its disturbances. 7. What is ophthalmia neonatorum? (a) Whence de- rived? (b) Give treatment. 153 MEDICAL RECORD. "The only American medical journal that prints a detailed report of the British Medical Association." 8. Define exanthematous fever, (a) Name three. (&) What ages are exempt? , . g. What is diarrhea? (a) Acute inflammatory. (&) Treatment. , . t ..-, /, \ 10. Define rachitis, (a) Who is most subject to it? (&) How long do the effects last? PHYSIOLOGY AND HYGIENE. i. Describe a complete physiological revolution of the heart; fetal and adult. . 2. Give origin of salivary and gastric secretions and function of each. ... 3 Give function of pancreatic and intestinal secretions. 4. Through what media is the blood relieved of ettete material and provided with new? 5. How is the blood current maintained and what arteries carry venous blood? 6 What is the function of the cerebellum ? 7 If seventh cranial nerve were incised at its exit from the stylomastoid foramen, state briefly the result. 8. Give function of pneumogastnc nerve as related to respiration. , , , 0. Detail uses of the largest gland in the body. io. What occupations cause a predisposition to pul- monary diseases? ANATOMY. 1. Describe the pubic or pectineal bone. 2. Name the ligaments of the elbow joint (humerus with ulna and radius). 3 Give the relations of the deep palmar arch. 4 Name the divisions of fifth (trigeminus) pair of cra- nial nerves and mention in a general way the parts sup- plied by each (motor, sensory, etc.). ■ 5. Give the boundaries of the inguinal canal. 6. Describe the cecum. . 7. Name the contents of the submaxillary triangle and eive its boundaries. , ' 8. Mention the hepatic fissures, name the structures found in each and the lobes separated by each. g. Describe the prostate gland (do not give its relations or its histology). . io. Name the structures cut in performing a tracheotomy above the isthmus of the thyroid. N. B.— Answer only eight questions. OBSTETRICS AND GYNECOLOGY. i Given: Primapara at end of eighth month of preg- nancy, considerable edema of the face, feet, and legs, urine 154 MEDICAL RECORD. "The most important contributions to the literature of medicine and surgery have been published first in the MEDI- CAL RECORD." scant in quantity, slight cephalalgia, dimness of vision, anemic, weak, short of breath upon slight exertion; (a) give diagnosis; (b) what grave symptom might be ex- pected to follow if patient is not properly treated; (c) briefly outline treatment. 2. During normal labor (a) how and by means of what action is the dilatation of the cervix brought about? "(6) What forces are employed in the stage of expulsion? 3. Give diagnostic symptoms of placenta prsevia. 4. How would you treat a case of adherent placenta? 5. Prescribe for a case of pruritus vulva?. 6. Name three causes for which you would curette the uterus, and state in which you would use the dull and in which the sharp curette. 7. In ventral fixation, (a) what organ is fixed, (b) for what purpose is it fixed, (c) to what (anatomically) is it fixed, (d) what kind of sutures should be used? 8. How would you treat a case of congenital atresia of the cervix ? MATERIA MEDICA. 1. Name and describe the methods of introducing medi- cine into the circulation. 2. Name an example of: (a) An alterative, (&) anti- periodic, (c) antispasmodic, (d) diaphoretic, (e) diuretic. 3. Name the alkaloids of hyoscyamus — doses. <&j What are the uses of the bromides? fName the preparations and doses of arsenic. What is the dose of (a) ol. terebinthinse, (b) tinct. veratrum viride, (c) Basham's mixture, (d) tincture of aconite, ( vapor has an odor of garlic; it is insoluble in water; it unites with nascent hydrogen; it burns in oxygen; on being heated in air it is converted into arsenic trioxide, As.CX. It is used in MEDICAL RECORD. " Choice and important abstracts from the leading medical periodicals of the world in a condensed and practical form." the manufacture of shot, flypapers, fireworks, and pigments. Its chief compounds are : Hydrogen arsenide, arsenic tri- chloride, arsenic trioxide, arsenic pentoxide, arsenous acid, arsenic acid, arsenic bisulphide, arsenic trisulphide, arsenic pentasulphide. 10. Four normal constituents of urine : Water, urea, uric acid, and sodium chloride. Test for (i) Albumin: The urine must be perfectly clear. If not so, it is to be filtered, and if this does not render it transparent it is to be treated with a few drops of magnesia mixture, and again filtered. The reaction is then observed. If it be acid, the urine is simply heated to near the boiling point. If the urine be neutral, or alkaline, it is rendered faintly acid by the addition of dilute acetic acid, and heated. If albumin be present, a coagulum is formed, varying in quantity from a faint cloudiness to entire solidi- fication, according to the quantity of albumin present. The coagulum is not redissolved upon the addition of HNOs. Test for (2) Sugar: Render the urine strongly alkaline by addition of Na 2 C0 3 . Divide about 6 cc. of the alkaline liquid in two test tubes. To one test tube add a very minute quantity of powdered subnitrate of bismuth, to the other as much powdered litharge. Boil the contents of both tubes. The presence of glucose is indicated by a dark or black color of the bismuth powder, the litharge retaining its natural color. Test for (3) Acetone : Add a few drops of a freshly pre- pared solution of sodium nitroprussid, and then KHO or NaHO solution, when, in the presence of acetone, the liquid is colored ruby red, and on supersaturation with acetic acid changes to purple. Test for (4) Indican : The urine is mixed with one-fifth its volume of 20 per cent, solution of lead acetate and fil- tered. The filtrate is mixed with an equal volume of fuming hydrochloric acid containing 3:1000 of ferric chlorid, a few drops of chloroform are added, and the mixture strongly shaken one to two minutes. With normal urine the chloro- form remains colorless, or almost so; but if an excess of indoxyl compounds be present the chloroform is colored blue, and the depth of the color is a rough indication of the degree of the excess. — (From Witthaus' Essentials of Chemistry.) PHYSICAL DIAGNOSIS AND PATHOLOGY. i. The topographic lines of the thorax are vertical lines and horizontal lines, as follows: 180 MEDICAL RECORD. Save and bind your numbers; it will give you two great medical encyclopedias every year. "The vertical lines are from front to back: (i) The midsternal line and its prolongation upward. (2) The sternal line, corresponding to the lateral border of the sternum. (3) The parasternal line, midway between (2), and (4) The mamillary or nipple line, which, even in the male thorax, does not always pass through the nipple, but may be more exactly defined as a vertical line dropped from the center of the clavicle. (5) The anterior axillary line, drawn through the point at which the great pectoral muscle cleaves the chest when the arm is raised sidewise to a horizontal line. (6) The middle axillary line, drawn through midway between (5) and (7) The posterior axil- lary line, which is drawn through the point at which the latissimus dorsi leaves the chest, the arm being raised as in (5). (8) The scapular line, drawn through the inferior angle of the scapula. (9) The midspinal line. "The horizontal lines are, in front and at the side, from above downward: (1) A line running from the cricoid cartilage to the outer end of the clavicle. (2) The line of the clavicles. (3) A line through the third chondro- sternal articulation. (4) A line through the sixth chondro- sternal articulation. Posteriorly they are: (5) A line through the spines of the scapulae. (6) A line through the inferior angles of the scapulae. (7) A line through the spine of the twelfth dorsal vertebra."— (Butler's Diagnos- tics of Internal Medicine.) 3. A physiological leucocytosis is found: In the new- born, after parturition, after exertion, after a cold bath or massage, during pregnancy, and during digestion. A polymorphonuclear leucocytosis is found in all acute inflammatory diseases, in certain of the acute infectious diseases, and accompanying the cachexia of malignant dis- ease. A lymphocytosis is found in lymphatic leukemia, and sometimes in sarcoma, and whooping cough. 4. In locomotor ataxia the posterior columns of the spinal cord and the posterior nerve roots are involved. The process is destructive and progressive; it is not a simple wasting, although the nerve fibers are atrophied, but it is characterized by irritation, changes in the axis cylinders, overgrowth of the connective tissue, and some- times congestion. The spinal ganglia may be affected ; the membranes over the affected parts are adherent and opaque. 6. Septicemia begins with a rigor, followed by a rise of temperature up to about 104 F., which remains constant. IQO MEDICAL RECORD. " Statistics of the health boards and many articles of scien- tific interest and items of general information." The pulse is weak and progressively rapid; there is an- orexia and constipation, which is followed by diarrhea; the urine contains albumin; the temperature may become sub- normal. There are no repeated rigors and no secondary (metastatic) abscesses. Pyemia begins with a rigor, which may last for half an hour, and is repeated every one or two days. The temper- ature rises as in septicemia, but rapidly falls, and at the same time the patient suffers a profuse perspiration. The pulse is weak and rapid ; there is anorexia ; and there may be delirium, with jaundice and signs of abscesses in the lungs, joints, etc. In pyemia there are repeated rigors and secondary abscesses. 7. In mitral regurgitation there is a systolic murmur, heard loudest at the apex, transmitted toward the left axilla, and often heard at the angle of the left scapula. The heart is enlarged. In aortic regurgitation there is a diastolic murmur, heard loudest at the second interspace, transmitted down the sternum. The left ventricle is hypertrophied. There will also be present Corrigan's pulse, and pulsating arteries in the neck. 8. In erysipelas the rash is local ; it is not punctate ; the surface of the skin is smooth and edematous ; bullae are often present, and have a well-defined margin; the skin of the affected part is burning, tender, tense, and painful. 9. Phlebitis is apt to begin in a varicose vein; the vein is felt as a hard cord ; edema is present, and the skin has a dusky hue. Lymphangitis generally begins in a sore, the neighboring lymph glands are involved, it tends to spread in a spiral line, and the skin has a rosy tint, which appears before the edema. 10. (1) Very young children are attacked with vari- cella, whereas variola usually shows itself in adults. (2) Vaccinated children readily take varicella; not so variola, even in the modified form. (3) Children who have had varicella may contract variola, even soon afterwards ; or the two diseases may co-exist. (4) Varicella is non-inoc- ulable, whereas variola is notoriously so. (5) The erup- tion of varicella appears in twenty-four hours; that of variola not till the third day. (6) The febrile symptoms continue after the eruption appears in varicella; those of variola subside. (7) In varicella the spots come out in successive crops; this is never seen in variola. (8) The 191 MEDICAL RECORD. " Special reporters in England, France, Germany, Austria, Turkey, Denmark, the Philippines, and the leading cities of the United States and Canada." spots in varicella are unilocular, and collapse on being punc- tured; the spots in variola are multilocular, and do not collapse on being punctured. (9) In varicella the erup- tion is very irregular, and appears over the body generally ; in variola it appears in groups of threes and fives, and is always seen on the limbs. (10) The papule in varicella is soft, and disappears on stretching the skin; in variola it is hard and shotty, and does not disappear on stretching the skin. (From J. W. Moore's work on Variola and Varicella.) PRACTICE OF MEDICINE. 2. In Bell's paralysis "the muscles of the face being all powerless, the countenance acquires on the paralyzed side a characteristic, vacant look, from the absence of all expression; the angle of the mouth is lower, and the par- alyzed half of the mouth looks longer than that on the other side; the eye has an unmeaning stare, owing to the paralysis of the orbicularis palpebrarum. All these pecu- liarities increase the longer the paralysis lasts, and their appearance is exaggerated when at any time the muscles of the opposite side of the face are made active in any ex- pression, or in any of their ordinary functions. In an at- tempt to blow or whistle, one side of the mouth and cheeks acts properly, but the other side is motionless, or flaps loosely at the impulse of the expired air; so, in trying to suck, one side only of the mouth acts ; in feeding, the lips and cheek are powerless, and, on account of paralysis of the buccinator muscle, food lodges between the cheek and the gums." — (Kirkes' Phvsiology.) In Cheyne-Stokes respiration the respirations gradually increase in volume and rapidity until they reach a climax, when they gradually subside, and finally cease for from ten to forty seconds, when the same cycle begins again. 3. The early manifestations of pulmonary tuberculosis are: (1) Physical signs: Deficient chest expansion, the phthisical chest, slight dullness or impaired resonance oyer one apex, fine moist rales at end of inspiration, expiration prolonged or high pitched, breathing interrupted. (2) Symptoms: General weakness, lassitude, dyspnea on ex- ertion, pallor, anorexia, loss of weight, slight fever, and night sweats, hemoptysis. OBSTETRICS AND GYNECOLOGY. 2. The pelvic diameters are easily remembered from the following table : 192 MEDICAL RECORD. " The medical profession have been presented with the results of great discoveries by the MEDICAL RECORD in advance of any other publication." Antero-posterior Oblique Transverse 4i inches . . . 4* " 4* " Mid-plane Outlet 4i " 5 " 4 The fetal head has the following diameters: Occipito- frontal, occipito-mental, bitemporal, biparietal, suboccipito- bregmatic, trachelo-bregmatic, and mento-bregmatic. Of the,se the occipito-frontal is 4^2 inches, the occipito-mental is sVi inches, and all the others are approximately 3J/2 inches. MEDICAL JURISPRUDENCE. I. Any statement made by a dying person who believes that he cannot recover and that he is, at that very time, in actual danger of death. The statement need not be sworn to; it should be voluntary and sincere; and it is admissible as evidence in a court if the individual dies. An official or someone else should take down the deposition in the exact words of the patient, who should, if possible, sign the declaration. 3. Symptoms of poisoning by corrosive sublimate are: A burning pain in the mouth, pharynx, and stomach; the mouth and tongue are white; the vomitus is white, with shreds of mucous membrane, and tinged with blood; there may be bloody stools, also salivation. Treatment: The antidote is white of egg, but too much must not be given at one time; this should be followed by an emetic. 4. "The time at which the bodies of the drowned will float varies with the temperature of the air, the water, the age, sex, and corpulence. As the human body is slightly heavier than water, it must remain submerged until it be- comes lighter through the development of gases of putre- faction. Hence, in summer the body may rise within twenty-four hours. In salt water it will float sooner than in fresh; very fat bodies float sooner than lean ones; the bodies of women and those of young children sooner than those of men. Hence, in infanticide by drowning, the in- fant's body speedily rises to the surface." — (Reese's Medi- cal Jurisprudence.) 5. "The postmortem appearances are neither certain nor characteristic. There is usually some fullness of the ves- sels of the brain ; occasionally, extravasation of serum into the ventricles, very rarely of blood. Sometimes there is congestion of the lungs and other vascular organs. The blood is apt to be fluid. The stomach and bowels may be T0.1 MEDICAL RECORD. " The progressive physician must have his medical weekly just as the business man his newspaper." perfectly natural in appearance. The odor of opium may be observed in opening the body. It is hence impossible to diagnosticate a case of opium poisoning from the post- mortem appearance exclusively." — (Reese's Medical Juris- prudence.) 6. Malpractice is a failure on the part of a medical practitioner to use such skill, care, and judgment in the treatment of a patient as the law requires ; and thereby the patient suffers damage. If due to negligence only, it is civil malpractice. But if done deliberately, or wrongfully, or if^gross carelessness or neglect have been shown, or if some illegal operation (such as criminal abortion) be per- formed, it is criminal malpractice. 7. The patient should be removed to pure air; inject normal saline solution ; the patient should be bled ; arti- ficial respiration may be necessary; inhalations of oxygen under pressure have been recommended. The body temper- ature should be maintained by external heat. 8. The symptoms are: Vomiting, purging, collapse; the secretions (including the urine) are suppressed, and the pupils may be dilated. Treatment: Emetics, lavage, and mucilaginous drinks, with opium to relieve pain. Lethal dose: Three beans have proved fatal. 9. Symptoms: Headache, vertigo, blindness, weakness, and neuritis. Treatment: Lavage, and strychnine hypodermically. 10. Symptoms: Contracted pupils, odor of turpentine on the breath, stertorous breathing, collapse, convulsions, odor of violets to the urine. Treatment: Lavage, Epsom salts, and mucilaginous drinks, with opium. STATE BOARD EXAMINATION QUESTIONS. Medical Board of Examiners of the State of Penn- sylvania. December 4 to 7, 1906. ANATOMY. 1. Name the arteries through which blood would pass from the heart to the thumb and the veins through which it would return from the thumb to the heart. 2. Describe the formation of the palmar arterial arches, and give anatomical landmarks for location of the same. 3. Describe the bony relationships and landmarks of the elbow joint. 194 MEDICAL RECORD. " Th# most important and Interesting items of the very latest medical news throughout the world." 4. Describe the anatomical structure of the female perineum. 5. Describe the structure and anatomical relationships of the female mammary gland. 6. Describe the anatomical structures entering into the formation of (a) the internal and (b) the external abdomi- nal rings. 7. What muscles are attached to the great trochanter of the femur? 8. Describe the appendix vermiformis ; give its relations and the external landmarks of its location. 9. Describe the superior maxillary bone. 10. Describe the uterus and give its relations and nerve supply. PHYSIOLOGY. 1. Define metabolism. Cite an example. 2. Enumerate four conditions to be observed in taking the pulse, and describe what each signifies. 3. Over what functions of the body does the cerebellum preside? 4. Describe the thermal and chemical changes in muscle, as the result of exercise. 5. How is respiration influenced by the nervous system? CHEMISTRY. 1. What is hemoglobin; name some of its properties and give a chemical test for it. 2. What chemical reaction takes place when hydrogen dioxid is applied to sloughing wounds? 3. Describe a reliable test for the detection of free hydrochloric acid in gastric contents. 4. When testing for albumin in urine, how do you determine between it and other coagulable proteids? 5. When testing for glycosuria with Fehling's solution, how do you determine whether the reaction is that of sugar or some other reducing agent? MATERIA MEDICA. i. Classify electricity as a remedial agent, (£>) and name the different forms useful in the. treatment of morbid conditions, (c) describe how they are applied. 2. Name five vegetable and three mineral astringents, describing method of administration and dose in each instance. 3. Name and describe three antiseptics useful in internal medication. 4. Describe and classify the important active principle 195 MEDICAL RECORD. Its prestige attracts articles by the best known writers.' of each of the following drugs : Hydrastis canadensis, veratrum viride, and humulus. 5. Write a complete prescription for a child of three years suffering with pertussis, (or) Discuss ergota, stat- ing to what alkaloid or active principle it owes its thera- peutic activity. PATHOLOGY. 1. Describe the cardiac changes that occur in mitral stenosis. 2. Describe the alterations that occur in the respective coats of an artery which is the seat of endarteritis ob- literans. 3. Describe two methods of wound repair. 4. Describe the pathological changes occurring in dry gangrene. 5. Describe the various forms of acute salpingitis. DIAGNOSIS. 1. Give a practical method of differentiating gas- troptosis and gastrectasis. 2. Differentiate chronic parenchymatous nephritis and chronic interstitial nephritis. 3. Describe a case of tabes dorsalis and differentiate the condition from multiple sclerosis. 4. State the diagnostic symptoms of progressive per- nicious anemia, and what changes in the blood aid in the diagnosis. 5. Differentiate acute synovitis and acute articular rheu- matism. THERAPEUTICS AND PRACTICE OF MEDICINE. 1. What are the symptoms of exophthalmic goiter, and what are some of the measures employed in its treatment? 2. What are the symptoms of abscess of the lung? 3. Describe the treatment of a case of sunstroke. 4. What are the symptoms of a typical case of acute lobar pneumonia? 5. Describe the treatment of a case of diphtheria. 6. Describe the symptoms and treatment of a case of acute tonsillitis. 7. Describe the symptoms of a case of chronic lead poisoning and outline a method of treatment. 8. What are the symptoms of poisoning by belladonna, and how would von treat such a case? 0. Name some of the indications and contraindications of ergot. 10. Name some of the most important uses of the prepa- rations of opium. 196 MEDICAL RECORD. "Not a local Journal, but International in its scope." OBSTETRICS. i. Give the maternal causes of dystocia, and methods of treatment. 2. Give the most frequent causes of puerperal mammary inflammation and give treatment. 3. How would you deliver a child when face is present- ing with chin posterior? 4. Describe the various methods of preventing infection during childbirth. 5. Give symptoms and treatment of placenta praevia. 6. Give the indications for version, and detail the opera- tion. 7. Give the methods of resuscitation in the apparently still-born. 8. What symptoms would lead you to suspect threatened miscarriage? 9. Name the cause and give the diagnosis of pelvic hematocele. 10. To prevent laceration of the perineum, describe the proper method of delivering the head. SURGERY. i. Give the diagnosis and treatment of transverse frac- ture of the patella. 2. Describe the symptoms and give the treatment of the several forms of gangrene. 3. Define surgical shock and give treatment. 4. What are the symptoms of "Colles' fracture," and give treatment. 5. Describe a backward dislocation of the hip joint, and give treatment. 6. Describe the objective and subjective symptoms of strangulated inguinal hernia, and an operation for the relief of the same. 7. Give the symptoms and treatment of fracture of the vertebral column with compression of the spinal cord. 8. Enumerate the recognized degrees of burns, and de- scribe the treatment for the second degree. 9. Describe surgical methods for treatment of stricture of the male urethra, with respective indications. 10. Give a minute description for the proper adminis- tration of ether for general anesthesia. HYGIENE. 1. Name three diseases due to animal parasites, and tell how their introduction into the human system may be prevented. 107 MEDICAL RECORD. « Editorials on subject* of timely interest and of vital im- portance dealt with in a masterly and scholarly style." 2. What are the relative effects on health of altitude, sea air, humidity and sunshine. , , 3 What diseases are communicated by stools ana sputum, and what are the best methods of prevention oi communication? ., 4 Name three exanthematous fevers and describe a rational effective method of quarantine, giving the proper duration thereof. ,. ^ M „ m 5. Give the disadvantages and dangers of cold storage foods. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Medical Board of Examiners of the State of Penn- sylvania. December 4 to 7, 1906. ANATOMY. 1 The arteries through which blood would pass from the' heart to the thumb, are:— Aorta, innominate (on right side onlvV subclavian, axillary, brachial, radial, and princeps pollicis or dorsalis pollicis. The veins through which it would return to the heart are arranged in two sets-— (1) Superficial veins:— venous plexuses, supernciai radial, cephalic, axillary, subclavian, innominate and su- perior vena cava. And (2) Deep veins:— The vense comites of the radial or deep radial, brachial, axillary, subclavian, innominate, and superior vena cava. ■ S If the forearm is extended, the internal condyle oi the humerus, the tip of the olecranon, and the external condyle will all be found on the same transverse line. In extreme extension the tip of the olecranon is slightly above the level of the condyles. If the forearm is flexed to a right angle, the tip of the olecranon is immediately below the condyles. PHYSIOLOGY. 1 Metabolism is a name given to the entire series of changes that occur in a cell or organism during the processes of nutrition. It is of two kinds:— (i). anabolic, or constructive, and (2) catabolic, or destructive. The changes produced in the cells by the oxygen or nutrition conveyed by the blood, come under the class of anabolic changes. 108 MEDICAL RECORD. "New instruments are portrayed and their use thoroughly explained." 2. (i) Its frequency, this gives the rate of the heart beats. (2) its compressibility: this denotes the force with which the heart is beating. (3) Its tension : this denotes the peripheral resistance, and also the state of the arterial walls. (4) Its regularity or rhythm : this denotes the reg- ularity (or otherwise) of the heart's action in force or rhythm. 3. Muscular coordination, and equilibrium. 4. There is an increase in heat production, and conse- quently a rise of temperature. The muscle becomes acid in reaction, due to the development of sarcolactic acid; at the same time there is an increased consumption of oxygen, and more carbon dioxide is set free. CHEMISTRY. 1. Hemoglobin is the coloring matter of the blood. It exists in the blood in two forms, as hemoglobin and as oxyhemoglobin. Chemically it is a protein ; its molecule is very complex, and consists of the elements carbon, hydro- gen, oxygen, nitrogen, iron, and sulnhur. It is a crystalline solid, and is not diffusible. Hemoglobin is the means by which the oxygen is carried by the blood to the tissues. It readily enters into combination with other gases such as carbon monoxide, nitrogen dioxide, and hydrocyanic acid. It is soluble in water, insoluble in alcohol and ether. Test. Mix some of the suspected liquid with a few drops of a saturated solution of sodium chloride, evaporate to dryness on a microscopic slide, add a drop or two of glacial acetic acid and gently warm ; crystals or hemin or hematin will form on cooling, and may be seen under the micro- scope. 2. Oxygen is liberated and effervescence occurs. It acts as an antiseptic. 3. The phloroglucin-vanillin test : — The reagent is made by dissolving two grams of phloroglucin and one gram of vanillin in 100 cc. of alcohol. The test is made by taking a few drops of the filtered gastric contents and an equal quantity of the freshly-prepared reagent; these are then mixed in a porcelain dish, and evaporated over a water bath ; in the presence of free hydrochloric acid a brilliant red color is produced, beginning at the upper border. 4. By using the four tests, as mentioned in the follow- ing table (compiled from Croftan) : 199 MEDICAL RECORD. "Range of subjects embraces every branch of medicine and surgery." The The The Potassium The Boiling Nitric Acid Ferrocyanide Biuret Test Test Test Reaction Serum Albumin. .. Positive. . Positive Positive Positive Serum Globulin. .. Positive. . Positive Positive. On the addi- tion of acetic acid there is a preci pitate which is re- dissolved on the addition of more acid. Positive Nucleo-albumin . . Negative . Positive Positive On the addi- tion of acetic acid there is preci pitate which does not ' re-dis- solve on the addition o f more acid. Positive Positive. The precipi- Positive. The precipi- tates formed tates formed in the cold in the cold disappear on disappear on heating, but heating, but re-appear on re-appear on cooling. cooling. Peptones Negative . negative Negative Positive 5. On getting a positive result with Fehling's solution, a further examination should be made by the fermentation test. If fermentation occurs, it indicates the presence of sugar. The phenylhydrazine test may also be applied; it does not react with reducing agents other than sugar. MATERIA MEDICA. 1. Bartholow classifies electricity among the agents used to excite the functional activity of the spinal cord and the sympathetic. (b) Static or frictional, magnetism, galvanism, faradism. 2. Five vegetable astringents: — Hammamelis, dose of the fluid extract, T™xxx. Gambir, dose, gr. xv. Kino, dose, gr. vijss. _ Hematoxylon, dose of the extract, gr. xv. Tannic acid, dose, gr. vijss. Three mineral astringents: — Alum, dose, gr. vijss. Cop- per sulphate, dose, gr. 1/5. Silver nitrate, dose, gr. 1/5. Of the above silver nitrate is only applied locally as an as- tringent; all the others can be used internally or locally. 3. Phenol, creosote, and phenyl salicylate (salol). 200 MEDICAL RECORD. " Since 1890 the MEDICAL RECORD has had a cabled re« port of every International Medical Congress." 4. Hydrastis canadensis: berberine and hvdrastine, both alkaloids. Veratrum viride: jervine and veratrine, both alkaloids. Hamulus :lupuline, an alkaloid. 5. I£ Tincturse belladonnas 3j Extracti cannabis indicae gr. jss Glycerini 3J Tincturae aurantii amari 3ijss Aquse destillatse q. s. ad $iv. Misce. Signa : — Two teaspoonfuls every four hours. The composition of ergot is indefinite; the chief con- stituents are : — Ergotine, ergotinine, ecboline, sphacelic acid, ergotinic acid, cornutine, tannic acid, and other sub- stances. Most of these ingredients contract the blood ves- sels ; the cornutine, in addition, is credited with the chief part in contracting the uterus. DIAGNOSIS. 1. The stomach should be inflated; the diagnosis is then made by outlining the stomach. In both conditions the lower border of the stomach is depressed below the umbili- cus. But in Gastroptosis, the upper border and pyloric end are also depressed, and the stomach assumes a vertical position; whereas in Gastrectasis, the upper border and pyloric end are but slightly depressed. 2. The following table is from Millard's work on Bright 's Disease : CHRONIC PARENCHYMATOUS NEPHRITIS. The urine is always albu- minous. Urine usually scanty. Dropsy and edema almost always occur. Hypertrophy of the heart seldom exists. Specific gravity of urine usually higher than the nor- mal. Urine darker and with less of a soapy appearance. Uremic symptoms less frequent. CHRONIC INTERSTITIAL NE- PHRITIS. Urine not constantly al- buminous. Urine usually abundant. Dropsy seldom or never present; sometimes slight edema. Some hypertrophy of heart, with increased arte- rial tension, almost always present. Urine generally of a light color and low specific grav- ity. Uremic symptoms are met with in their most pro- nounced form, and in severe cases usually occur. MEDICAL RECORD. . " Original Articles are of the highest scientific value and niGst practical character, by the foremost men of the world." CHRONIC PARENCHYMATOUS NEPHRITIS. Epistaxis and cerebral hemorrhages rare. Occurs most frequently before the age of forty. Blood corpuscles and con- nective tissue shreds more frequently found. Casts more numerous and in greater variety ; waxy, granular, fatty, and hyaline casts occurring. Epithelia from the kidney and pus corpuscles more nu- merous. Urates and phosphates predominate ; oxalates rare. Albuminous retinitis rare. Gangrenous erysipelas and phlegmonous swellings more common ; also dyspepsia and anemia. Visceral complications not uncommon. Atheroma of arteries rare. CHRONIC INTERSTITIAL NE- PHRITIS. Epistaxis and cerebral hemorrhages frequent. Occurs most frequently after forty. Absent. Development more grad- ual, the health of patient often less impaired, and duration longer. Casts rare, the hyaline variety being most frequent- ly met with. Kidney epithelia and pus corpuscles scantv. and oc- casionally absent. Oxalate of lime almost always occurs. Albuminous retinitis com- mon. Visceral complications rare. Atheroma common. 3. In multiple sclerosis there will be found increased reflexes, a greater loss of muscular power, volitional tre- mor, nystagmus. In locomotor ataxia, there are: lightning pains, loss of knee jerk, ataxia, but not much loss of muscular power, Argyll-Robertson pupil. 4. Pallor, indisposition to exertion, palpitation of heart, flabbiness of muscles, poor appetite, languor, edema, de- bility, hemic murmurs, water-hammer pulse, dyspepsia, diarrhea. The blood changes are : — great diminution in the number of red corpuscles, hemoglobin is relatively in- creased, the red cells vary considerably in size and shape, and there are present nucleated red corpuscles of all sizes MEDICAL RECORD. "The only American medical journal that print* report of the British Medical Association." and in varying numbers. The white corpuscles are either unchanged or slightly diminished in number. THERAPEUTICS AND PRACTICE OF MEDICINE. 1. Tachycardia, enlargement of the thyroid gland, ex- ophthalmos, and tremor are the cardinal symptoms. Other symptoms are : — pigmentation of the skin, edema and mois ture of the skin, impaired nutrition, anemia, and mental irritability and depression. Among the measures employed in its treatment are : — iron, digitalis, ergot, the bromides, rest in bed with appli- cation of ice bag over the heart or thyroid gland, electricity, thyroid or thymus extract, iodine, opium, section of the cervical sympathetic nerve, and partial thyroidectomy. 2. Chills, high fever, signs of a cavity or of general pyemia; the sputum is offensive and yellowish or greenish in color, and contains elastic fibers or fragments of lung tissue. 3. The first thing is to lower the body temperature. The patient should be put into a cold bath, rubbed with ice, and given a hypodermic of some active antipyretic; he should be wrapped in a wet sheet, and if necessary may re- ceive ice water enemata. Further symptoms may be treated as they arise; for heart failure, digitalis and strychnine may be given hypodermatically ; for convulsions, chloral or chloroform. 7. Symptoms : — colic, chiefly round the umbilicus ; cramps in the flexor muscles, muscular paralysis (wrist drop) ; pain in some of the joints; blue line on the gums at the border of contact with the teeth; anemia; consti- pation ; eclampsia and nervous symptoms may also be present. Treatment: — The patient should be removed from the source of harm, personal cleanliness in every way must be enforced, a hypodermic of morphine (gr. %) may be given for the pain, then hot baths, Epsom salts, diuretics, electricity, iron, and strychnine are all useful. 8. Symptoms of belladonna poisoning: — In the first stage, that of delirium, there are dryness of the throat, thirst, difficulty of deglutition and spasms upon swallowing liquids, face at first pale., afterwards highly reddened, pulse extremely rapid, eyes prominent, brilliant, with widely- dilated pupils, complete paralysis of accommodation, dis- turbances of vision, attacks of giddiness and vertigo, with severe headache, followed by delirium, occasionally silent or muttering, but usually violent, noisy, and destructive, accompanied by the most fantastic delusions and hallucina- 203 MEDICAL RECORD. Keeps you strictly abreast of the timet." tions. Usually the urine is retained, and the body tem- perature is above the normal. The delirium gradually subsides, and the second stage, that of coma, is established, with slow, stertorous respiration, and gradually failing pulse, until death occurs from respiratory or cardiac paralysis, or sometimes in an attack of syncope during apparent amelioration. (Witthaus.) Treatment: — The stomach should be washed out; pilo- carpi may be given hypodermatically ; mornhine may be given cautiously during the period of violent excitement ; cold applications to the head and artificial respiration are useful. There is no chemical antidote. g. Indications: — To promote uterine contractions dur- ing third stage of labor; fibroids, menorrhagia, post-partum hemorrhage. Some forms of amenorrhea and dysmenorrhea, dysentery, arterial hemorrhage, congestive headaches, laxity of sphincters of bladder or rectum, hemorrhoids, aneurysm, diabetes, urinary incontinence, direct paralysis of the sphincter vesicae, atonic spermatorrhea. Contraindications:— In labor if the birth canal is not free, and the os uteri is not dilated. 1. (1) Malaria, (2) Trichinosis, and (3) Tapeworms. (1) In the case of Malaria: — the destruction of all mosquitoes, or the prevention of inoculation. (2) In the case of Trichinosis : — the meat (of the pig) should be thoroughly cooked ; mere curing or smoking will not do. Further, there should be systematic inspection of the meat sold, and the animals should not be fed with the refuse of slaughter-houses. (3) In the case of Tapeworms: — all meat should be thoroughly cooked, and vegetables should be thoroughly cleansed. 3. Diseases communicated by the Stools: — Typhoid fe- ver, dysentery, cholera, intestinal tuberculosis. To pre- vent communication of these diseases, the stools should be received in vessels containing a disinfectant solution in greater quantity than the expected discharge. The whole should be thoroughly mixed and allowed to stand for at least one hour before final disposition. Diseases communicated by the Sputum: — Pulmonary tu- berculosis and pneumonia. To prevent communication of these diseases, the sputum should be received in vessels containing disinfectant solution, and kept covered when not in use. The contents of the vessel should be burnt, and the vessel washed with disinfectant solution. The patient should not wear either beard or mustache. 304 MEDICAL RECORD. '•Acknowledged to be the leading independent medical weekly." STATE BOARD EXAMINATION QUESTIONS. Board of Medical Examiners, South Dakota. January g and 10, 1907. CHEMISTRY. 1. Define an atom, a molecule, chemical affinity, chemical action, atomic weight. 2. Phosphorus — state its source, enumerate its proper- ties, and name some solvents. 3. What is the difference between a salt, an acid, and an acid salt? Give an example of each. 4. What is the ordinary source of glycerine? Give its formula. Write an equation showing the process of its preparation. 5. Give in detail your method of examination of urine for three abnormal constitutents, and state the clinical significance of each. EYE, EAR, NOSE, AND THROAT. 1. Give symptoms and treatment in detail of lachrymal stricture. 2. Define mydriasis, myosis. Name some drugs which produce each condition. What is the Argyll-Robertson pupil? In what diseased condition is it found? 3. What are the diseases of the middle ear? Outline your treatment of any one disease. What complications are liable to occur? 4. Give symptoms and treatment of abscess of frontal sinus. 5. Define dysphagia, aphonia, dysphonia. JURISPRUDENCE AND TOXICOLOGY. 1. How could you determine whether death was due to freezing or that the freezing had occurred after death, in a body found frozen? 2. Describe one or more chemical tests for blood that may be used in investigating suspected blood stains. 3. What is a "live birth," medicolegal^? How would you determine whether a dead infant had lived or was "dead-born"? 4. What post-mortem appearances would indicate poi- soning by phosphorus, arsenic, strychnine? 5. Give the symptoms, treatment, and post-mortem appearances of poisoning by carbolic acid. PRACTICE AND THERAPEUTICS. I. Differentiate toxic effects of strychnine and tetanui poison. 30.S MEDICAL RECORD. "We publish the proceedings of an association immediately after the meeting." 2. Diagnose bronchopneumonia. 3. Inform me on rheumatoid arthritis. 4. How can you make early diagnosis of tuberculous infection ? 5. Mention two remedies which are used to check the secretion of milk. 6. Give symptoms and treatment of migraine. 7. Differentiate organic and functional heart murmur. 8. Give diagnosis, prognosis and management of aneurysm of the thoracic aorta. 9. Mention diseases in which the patellar reflex is exaggerated. 10. Differentiate scarlet fever and measles and suggest treatment for both. PATHOLOGY. 1. Mention a few symptoms caused by toxins produced within the body. 2. Describe gliomata. 3. What do you understand "Wallerian degeneration" to signify? 4. What pathological conditions increase the elimination of urea? 5. Define hyperinosis, hydremia, melanemia, and hemo- globinemia. 6. Name some of the causes of active hyperemia. 7. What conditions give immunity from the pathogenic action of bacteria? 8. Amyloid degeneration — what do you know about it? 9. Give the pathology of locomotor ataxia. 10. What is embolism, a thrombus, an infarct? PHYSIOLOGY. 1. Describe the functions of the kidneys, and name the products excreted. 2. Tell what you know about osmosis, and give exam- ples of some. 3. What is color blindness, and what colors are usually indistinguishable to a person so affected? 4. What is the variation of temperature, in health, be- tween childhood and old age, and how is the normal tem- perature of the body maintained? 5. Describe the normal heart sounds, and explain cause of same. 6. What is the cause of stammering and stuttering? 7. What diseases are usually quarantined, and for what length of time? 8. How many different kinds of blood corpuscles in the 206 MEDICAL RECORD. "European correspondents furnish medical news of special interest and reports of the principal foreign medical societies." human body, and what are their relative numbers in health? 9. Name the active principles of the digestive secretions, and explain how each affects the food. 10. Name and describe the normal respiratory sounds of the lungs. ANATOMY. 1. How many bones in the human body? 2. Describe the meibomian glands. 3. What muscles are attached to the great trochanter of the femur? 4. Describe the tibia, and state what bones it articulates with. 5. How many bones in the hand? Name them. 6. Name and describe the salivary glands. 7. Describe the mammary gland, and give nerve and blood supply. 8. Where is the popliteal space, and what structures are contained therein? 9. What cavities may require tapping, and for what diseases, and at what points should the punctures be made? 10. What structures would be severed in an amputation at the middle of the humerus? OBSTETRICS. 1. Describe the indications of pregnancy at the begin- ning of the third, sixth, and ninth months. 2. Name the principal diseases and conditions during pregnancy said to be caused by that condition. 3. Give causes, diagnosis, dangers, and treatment of antepartum hemorrhage. Also of postpartum hemorrhage. 4. In vertex presentation, after dilatation, how would you tell the position from internal examination alone? Describe a given case. 5. When during delivery would you use an anesthetic, and how? When is it contraindicated? Name your choice of anesthetic, with reason therefor. 6. What do you do to prevent laceration of the per- ineum? 7. Describe a well-marked case of puerperal sepsis, giving time of invasion, symptoms, course, and treatment. 8. How would you treat a shoulder presentation with arm down? 9. What is involution, and how long does it normally continue? 10. How, and how long would yon treat a babe appar- ently dead when born? 207 MEDICAL RECORD. " Our reporters attend every convention of first-rate Im- portance. The news is telegraphed or cabled exclusively to the MEDICAL RECORD." DISEASES OF WOMEN. 1. Describe the preparation for, and the manner of opening and closing the abdominal wall in a laparotomy. 2. Describe a uterine curettement and its dangers. When should it be employed? 3. Differentiate simple from gonorrheal vaginitis, and give treatment for each. 4. Describe pruritus vulvae, giving causes and treatment. 5. Describe a case of endometritis, and give treatment BACTERIOLOGY. 1. Define immunity. Explain (a) how acquired, (6) how destroyed. 2. Name the three most important culture media. 3. Give method of staining gonococci. 4. Give the cultural and microscopic points of difference between the Bacillus coli communis. 5. Explain the Widal reaction. 1. Classify burns. Give methods of treatment. 2. What is shock? _ How would you treat the shock accompanying a severe injury of an extremity? State con- ditions under which amputation would or would not be justifiable. 3. In what manner may operative work be affected by (a) alcoholism, (b) leucocythemia, (c) diabetes, (i) atheroma, and (e) good health? 4. Mention the characteristic symptoms of fracture of the clavicle, and give a method of treatment. 5. Differentiate elbow joint injuries, and describe method of reduction and after-treatment of backward dis- location of this joint. 6. What are the causes of abscess of the frontal sinus? Outline its symptoms, treatment, and prognosis. 8. What is osteomyelitis? Mention the different vari- eties. Describe a case of acute infective osteomyelitis, giving briefly its causes, diagnosis, treatment, and prog- nosis. 9. What is an aneurysm? What are its predisposing and exciting causes, and the usual locations? 10. Give symptoms, diagnosis, and treatment of gastric ulcer. 306 MEDICAL RECORD. The MEDICAL RECORD publishes no " Students' Number," for every Issue Is a student's number and a practitioners' number In one. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Board of Medical Examiners, South Dakota. January g and 10, 1907. CHEMISTRY. 1. An atom is the smallest quantity of an element that can enter into chemical action, or that can enter into the com- position of a molecule. A molecule is the smallest quantity of any substance (element or compound) that can exist in a free state. Chemical affinity is the attraction that exists between atoms, whereby they are united to form molecules. Chemical action is the action of one substance upon an- other whereby chemical change is produced. Atomic weight is the weight of an atom of an element as compared with the weight of an atom of hydrogen. 2. Phosphorus. — Source : From the phosphates. Prop- erties and solvents: It is a solid, with a valence of three or five, an atomic weight of 31. The molecule consists of four atoms ; it combines readily with oxygen and is an actiye reducing agent. It exists in four allotropic conditions — the yellow, red, black, and white varieties ; the two former are the most frequently met with and have different physical properties, as follows: The yellow "when freshly prepared, and at ordinary temperatures, forms a yellowish, trans- lucent solid, which, on exposure to light, becomes more darkly colored and opaque. It has the consistence of wax. When exposed to the air it gives off white fumes and an odor of garlic. At 32° F. it becomes brittle; at 11 1° F. it melts to a yellowish liquid, and at 554° F, in the absence of air, is converted into a colorless vapor. In air, at 140 F., it ignites, burning with a bright flame and giving off dense white fumes and producing ozone. In the dark this form of phosphorus gives off a peculiar pale light. It is insoluble in water, sparingly soluble in alcohol, ether, and the fatty and ethereal oils; very soluble in carbon disulfid, from which solution it separates in the form of crystals. This variety is exceedingly poisonous. "The red variety is red, brown, or dark yellow in color. It may be heated to 482 F. without melting, but at that temperature it is suddenly converted into the yellow va- rietv. which ignites with an explosion. It fires much less r<*adily than yellow phosphorus, and may be kept dry, whil« 200 MEDICAL RECORD. "Surgical Suggestions that will appeal to the student and the general practitioner." the yellow must be preserved under water. It has no odor or taste, and is insoluble in those substances which dissolve the other form. It is not luminous at ordinary tempera- tures." — (Witthaus' Essentials of Chemistry.) 3. A salt is a substance formed by the substitution of an electro-positive element for part or all of the replaceable hydrogen of an acid. An acid is a compound of an electro-negative element or radical with hydrogen, part or all of which hydrogen it can part with in exchange for an electro-positive element with- out the formation of a base. An acid salt is a salt in which only part of the replace- able hydrogen of an acid has been replaced. Examples: H2SO4 in an acid; Na 2 S0 4 and NaHSO* are both salts; but NaHSC>4 is an acid salt. 4. Glycerin is obtained as a by-product in the manu- facture of soap. CH 2 OH I Its formula is C s H«(OH)», or CHOH CH.OH. (C,H 5 )'" 1 Q , K \ Q _ (C S H 6 )'" \ Q ,(C 18 H S5 0) 1 Tristearin, Potassium Glycerol, Potassium hydroxid, stearate, 5. To examine for albumin: "The urine must be per- fectly clear. If not so, it is to be filtered, and, if this does not render it transparent, it is to be treated with a few drops of magnesia mixture, and again filtered. "The reaction is then observed. If it be acid, the urine is simply heated to near the boiling point. If the urine be neutral or alkaline, it is rendered faintly acid by the addition of dilute acetic acid, and heated. If albumin be present, a coagulum is formed, varying in quantity from a faint cloudiness to entire solidification, according to the quantity of albumin present. The coagulum is not redis- solved upon the addition of nitric acid." To examine for sugar: First remove any albumin that may be present, then "render the liquid strongly alkaline by addition of sodium carbonate. Divide about 6 c.c. of the alkaline liquid in two test-tubes. To one test-tube add a very minute quantity of powdered subnitrate of bismuth, to the other as much powdered litharge. Boil the contents of both tubes. The presence of glucose is indicated by a 210 MEDICAL RECORD. " Keeps you in closest touch with the weekly progress of medicine and surgery throughout the world." dark or black color of the bismuth powder, the litharge retaining its natural color." To examine for indicannria : "The urine is mixed with one-fifth of its volume of 20 per cent, solution of lead acetate and filtered. The filtrate is mixed with an equal volume of fuming hydrochloric acid containing 3 : 1000 of ferric chloride, a few drops of chloroform are added, and the mixture strongly shaken one to two minutes. With normal urine the chloroform remains colorless or almost so; but if an excess of indoxyl compounds be present the chloroform is colored blue, and the depth of the color is a rough indication of the degree of the excess." Albumin is found in the urine: "(1) In fevers, as typhoid and pneumonia. (2) In valvular heart lesions, degeneration of the heart muscles, diseases of the coronary arteries, im- peded pulmonary circulation, in pregnancy by pressure upon the renal veins, in intestinal catarrh and in Asiatic cholera. (3) In purpura, scurvy, leukemia, pernicious anemia, jaun- dice, diabetes and syphilis. (4) After taking Pb, Hg, I, P, As, Sb, chloroform, cantharides, oxalic, carbolic, salicylic or the mineral acids, turpentine and nitrates. (5) In large amounts in acute nephritis, and chronic parenchy- matous nephritis ; in small amount in chronic interstitial nephritis and amyloid kidney." Sugar is found in urine as "transitory glycosuria," "(1) in certain hepatic derangements, congestion, cirrhosis and amyloid degeneration; (2) in many diseases of the central nervous system, with tumors or hemorrhages at the base of the brain, in meningitis, concussion, fracture of cer- vical vertebrae, railway injuries, in epileptic and apoplectic seizures, and also in certain diseases of the peripheral nervous system, as in sciatica and in tetanus; (3) in acute febrile diseases, pneumonia, typhoid, acute articular rheu- matism, scarlatina, etc., particularly during convalescence; (4) under the influence of many poisons, such as curare, chloral, carbon monoxide, morphine, arsenic, and the anes- thetics. As 'permanent glycosuria' (1) in lesions of the brain involving the floor of the fourth ventricle; and (2) in diabetes mellitus." Indicanuria is found "in hypochlorhydria; in hyperchlor- hydria of gastric ulcer; in conditions in which there is diminished peristalsis of the small intestines, as in ileus and peritonitis, not in simple constipation; also in conditions in which putrefactive changes occur in the body elsewhere than in the intestine, as in empyema, putrid bronchitis, gangrene of the lungs, etc." (From Witthaus' Essentials of Chemistry.) MEDICAL RECORD. " Choice and Important abstracts from the leading medical periodicals of the world in a condensed and practical form. • EYE, EAR, NOSE, AND THROAT. 2. Mydriasis is the condition of extreme dilatation of the pupil of the eye. . . Myosis is the condition of extreme contraction of the PU Mydria mm .^Atropine, homatropine, daturine, duboisine, hyoscyamine, cocaine. Myotics: Eserine, pilocarpine, opium. Argyll-Robertson pupil is the condition of the pupil in which it responds to accommodation, but not to light. It is found in locomotor ataxia, general paralysis ot tne insane, and sometimes in cerebral syphilis. 4 Abscess of frontal sinus— Symptoms : Intense iron- tal headache, which may become worse on lying down ; pus may be discharged from the nose, chiefly on rising .in the morning; pain on blowing the nose; the upper eyelid may be swollen ; the mucous membrane of the middle turbinated bone will be found swollen and hyperemic. Treatment: Establish free drainage; a spray of supra- renal extract will reduce the swollen and hyperemic mucous membrane; the anterior end of the middle turbinated bone may require removal, the frontal sinus may require to be opened and curetted. (And see below, surgery, Question 5. Dysphagia is painful or difficult swallowing. Aphonia is loss of voice due to some peripheral lesion. Dysphonia is an impairment of voice; or pain or diftv culty in speaking. jurisprudence and toxicology. 1. The post-mortem changes in death from freezing are not sufficiently characteristic to justify a positive opinion on the subject. But if the body were found putrefied, it would be evidence that death was not due to freezing, for intense cold hinders putrefaction. So, too, the posture of the body might afford some aid; if the body is found in a crouching posture, death was probably due to freezing, as that attitude is characteristic. 2. Let some of the stained material soak thoroughly in a very small quantity of saturated solution of sodium chloride. Put a few drops of the fluid on a slide, cover with a cover-glass, let evaporation occur, allow a drop of glacial acetic acid to enter from the side, and gently warm. On cooling, hsemin crystals form, and can be seen under the microscope. 3. To constitute a "live birth," there must be (I) com- plete extrusion of the child from its mother's body, and (2) MEDICAL RECORD. "The most important contributions to the literature ot medicine and surgery have been published first in the MEDI- CAL BECORD." some certain sign of life. The latter would be established by one or more of the following: pulsation of the cord, beating of the child's heart, motions of the limbs, twitch- ings of the muscles, wrinkling of the brows, puckering of the face, opening of the eyes, even if respiration does not take place. (From Witthaus and Becker's Medical Juris- prudence, etc.) PRACTICE AND THERAPEUTICS. I. In strychnine poisoning there is a history of taking strychnine; the symptoms develop rapidly; the spasms occur early; muscular symptoms commence in the extremi- ties, and the muscles of the jaw become involved late, if at all; there is muscular relaxation between the con- vulsions. In tetanus stiffness of the neck and muscles of the jaw with tonic spasm of the masseters soon develop ; risus sar- donicus is present; the body is thrown into a condition of opisthotonos or emprosthotonos ; the muscular rigidity is persistent; the paroxysms are very painful. 4. The early manifestations of pulmonary tuberculosis are: (i) Physical signs: Deficient chest expansion, the phthisical chest, slight dullness or impaired resonance over one apex, fine moist rales at end of inspiration, expiration prolonged or high pitched, breathing interrupted. (2) Symptoms: General weakness, lassitude, dyspnea on ex- ertion, pallor, anorexia, loss of weight, slight fever, and night sweats, hemoptysis. 5. Two remedies to check the secretion of milk: bella- donna, and potassium iodide. 7. Organic murmurs are due to stenosis or incom- petency of one or more of the valves of the heart. Functional murmurs are not due to valvular disease. Organic murmurs may be systolic or diastolic; may be accompanied by marked dilatation or hypertrophy, and there will probably be a history of rheumatism or of soma other disease capable of producing endocarditis. Whereas a murmur, usually systolic, soft, and blowing, heard best over the pulmonic area, associated with evidences of chlorosis or anemia, and affected by the position of the patient, is a hemic or functional murmur, and denotes as a rule an impoverished condition of the blood. 9. The patellar reflex is exaggerated in : hemiplegia, lateral sclerosis, general paresis, transverse myelitis, in- juries to the spinal cord, hysteria, neurasthenia, tetanus, and strychnine poisoning. 213 MEDICAL RECORD. "Therapeutic Hints contain many valuable formulae bj the foremost medical men in the world." PATHOLOGY. I. Chills, malaise, fever, vomiting, and symptoms of general poisoning. 3. "Suppose a nerve is cut across, the piece of the nerve left in connection with the brain or spinal cord remains healthy both in structure and functions; but the peripheral piece of the nerve loses its functions and undergoes what is generally called after the discoverer of the process, Wal- lerian degeneration. A nerve is made up of nerve fibers, and each nerve fiber is essentially a branch of a nerve cell; when the nerve is cut the axis cylinders in the peripheral portion are separated from the cells of which they are branches and from which they have grown. These separated portions of the axis cylinders die, and the medul- lary sheath of each undergoes a gradual process of disin- tegration into droplets of myelin, which are ultimately, absorbed and removed by the lymphatics. At the same time there is a multiplication of the nuclei of the primi- tive sheath. This degenerative process begins two or three days after the section has been made. In the case of the non-medullated fibers there is no medullary sheath to exhibit the disintegration changes just alluded to, and the nuclei of the sheath do not multiply; there is simply death of the axis cylinder. The degeneration occurs simul- taneously throughout the whole extent of the nerve ; it does not start from the section and travel to the periphery." (Kirkes' Physiology.) 4. The elimination of urea may be increased in : acute fevers and inflammations, diabetes, severe leukemia, paraly- sis agitans, pernicious anemia. 5. Hyperinosis means an excess of fibrin in the blood, Hydremia means an excess of the fluid constituents of the blood. Melanemia means the presence of a black pigment in the blood. Hcmoglobinemia means the abnormal presence of hemo- globin in the plasma of the blood. 6. Active hyperemia may be caused by: stimulation of the vasomotor nerves, injury to the walls of the blood- vessels, sudden removal of support, the action of certain drugs. 7. See below, bacteriology, Question 1. PHYSIOLOGY. 3. Color-blindness is the inability to distinguish clearly differences of color. Red and green are the colors usually indistinguishable by a person so affected. 214 MEDICAL RECORD. "Range of subjects embraces every branch of medicine and surgery." 4. The variation of body temperature, in health, is very slight; it is maintained between 98 and 99° F. The normal temperature of the body is maintained by the thermotactic centres in the brain and cord keeping an equilibrium between the heat gained or produced in the body and the heat lost. Heat is gained to the body by (1) the muscles, during contraction; (2) the secreting glands; (3) the brain, during mental activity; and (4) by the ingestion of food and hot liquids. Heat is lost to the body by (1) the skin, through evapo- ration, radiation, and conduction; (2) the lungs; and (3) the excretions (feces and urine). 5. The causes producing the first sound of the heart are not definitely ascertained; the following are supposed to be causatory factors: (1) The vibration and closure of the auriculo-ventricular valves, (2) the muscular sound produced by the contraction of the ventricles, and (3) the cardiac impulse against the chest wall. The second sound is caused by the vibration due to the closure of the semilunar valves. 6. Stammering and stuttering are due to a want of co- ordination between the various groups of muscles con- cerned in the different actions that go to the make up of articulate speech. Imitation, adenoids, and fright are some- times supposed to be contributing factors. 9- DIGESTIVE SECRE- ACTIVE PRIN- ACTION. TION. CIPLE. Saliva Ptyalin. Changes starches into dextrin and sugar. f Pepsin. Changes proteids into proteoses and peptones Gastric juice in an acid medium. A curdling Curdles the casein of ferment. milk. ' Trypsin. Changes proteids into proteoses and peptones, and afterwards decom- poses them into leucin and tyrosin; in an al- Pancreatic juice. . . Amylopsin. kaline medium. Converts starches into maltose. Steapsin. 1 Emulsifies and saponifies fats. A curdling Curdles the casein of ferment. milk. 215 MEDICAL RECORD. " Bulletins ol Examinations ol State Medical Licensing Boards published bi-weekly." ANATOMY. 9. (i) The pleural cavity; in the sixth or seventh inter- costal space, midway between the axillary lines; or in the eighth intercostal space, near the angle of the scapula. (2) The peritoneal cavity; on the semilunar line, or on the linea alba. . .„,.,,. . i (3) The pericardial cavity; in the fifth left intercostal space, one inch from the sternum; or in the sixth left intercostal space, immediately to the edge of the sternum. (4) The subarachnoid space of the spinal cord; in the middle line, between the fourth and fifth lumbar ver- tebrae. . .,.,,, (5) Joints; and (6) the tunica vaginalis of the testis. 10. Skin: fascia; muscles, biceps, coraco-brachialis, bra- chialis anticus, triceps; arteries, brachial, superior pro- funda, inferior profunda; veins, basilic, cephalic, brachial, superior profunda, inferior profunda ; nerves, median, ulnar, musculo-spiral, internal cutaneous, musculo-cutaneous ; bone, humerus. OBSTETRICS. 9. By involution is meant the contraction and return of the uterus to its normal size after labor. It generally takes from six to eight weeks. DISEASES OF WOMEN. 4. Pruritus vulvas is a condition characterized by in- tense itching of the vulva and neighboring parts. Pruritus vulvae may be caused by :— -parasites ; diseases of the vulva, as inflammation, edema, vegetations, con- gestion, irritating discharges, lack of cleanliness, diabetic urine; it may also be of nervous origin, or idiopathic. Treatment consists in removing the cause, if possible; cleanliness, fresh air, tonics, and general attention to hy- giene; local applications of solution of bichloride of mer- cury, 1:2,000; or carbolic caid, 1:100; or lead and opium; dusting powders of bismuth subnitrate, calomel, or zinc oxide are also useful. BACTERIOLOGY. I. Immunity is the power of resistance of cells and tissues to the action of pathogenic bacteria. (a) The conditions which give immunity from the pathogenic action of bacteria are:— (1) a previous attack of the disease; (2) inoculation, with small quantities of bacteria, so as to produce a mild attack of the disease; (3) vaccination; (4) the introduction of antitoxins; (5) the introduction of the toxins of the bacteria. 216 MEDICAL RECORD. " Book reviews of foreign and American publications keep you thoroughly informed of the newest literature." (b) Immunity can be destroyed by any condition which lowers the vitality of the tissues and thus causes lessened resistance to the action of the bacteria. Such are: — bad hygienic surroundings, exhaustion, exposure to cold, the action of poisons, diseases, injuries, etc. 2. Bouillon, gelatin, and blood serum. 3. Ihe gonococcus stains with gentian-violet, and other basic aniline dyes; but it does not stain by the Gram method. 4. The cultural and microscopic points of difference between the Bacillus coli communis and the Bacillus ty- phosus (.of Eberth) are: "(1) Ihe motility of the colon bacillus is, as a rule, not very pronounced, sometimes absent; that of the typhoid bacillus is usually very active. '"(,2) On gelatine plates the colon bacillus develops more rapidly and luxuriantly than the typhoid bacillus, and on potato it grows more abundantly, being almost always visible. "(3) The colon bacillus coagulates milk with acid reac- tion within twenty-four to forty-eight hours; the typhoid bacillus does not coagulate milk. "(4) The colon bacillus causes fermentation with pro- duction of gas in media containing sugar; the typhoid bacillus does not. "(5) In nutrient agar or gelatine containing lactose and litmus tincture and of a slightly alkaline reaction, the color of the colonies of colon bacillus is pink and the sur- rounding medium red; while the colonies of typhoid bacil- lus are blue and there is little or no reddening of the medi- um. "(6) The colon bacillus produces indol in cultures of bouillon or peptone; the typhoid bacillus does not. "(7) When a twenty-four-hour-old bouillon culture of the colon bacillus is mixed with the blood or serum of a patient suffering from genuine typhoid fever, in a dilu- tion of one to ten or more, after the first week of the dis- ease, the Widal reaction is negative; cultures of the typhoid bacillus treated in the same manner and ex- amined in the hanging drop give the characteristic ag- glutination and clumping of the bacilli." (Reference Hand- book of the Medical Sciences.) 5. The Widal serum reaction "depends upon the fact that scrum from the blood of one ill with typhoid fever, mixed with a recent culture, will cause the typhoid bacilli to lose their motility and gather in groups, the whole called 'clumping.' Three drops of blood are taken from 217 MEDICAL RECORD. "Statistics of the health boards and many articles of sclen title interest and items of general information." the well-washed aseptic finger tip or lobe of the ear, and each lies by itself on a sterile slide, passed through a flame and cooled just before use; this slide may be wrapped in cotton and transported for examination at the laboratory. Here one drop is mixed with a large drop of sterile water, to redissolve it. A drop from the summit of this is then mixed with six drops of fresh broth culture of the bacillus (not over twenty-four hours old) on a sterile slide. From this a small drop of mingled culture and blood is placed in the middle of a sterile cover-glass, and this is inverted over a sterile hollow-ground slide and examined. ... A positive reaction is obtained when all the bacilli present gather in one or two masses or clumps, and cease their rapid movement inside of twenty minutes." (From Thayer's Pathology.) SURGERY. 2. Shock is the name given to a sudden and general depression of the vital powers due to some strong stimu- lation (such as injury or emotion) acting on the vital centers in the medulla, and producing vasomotor paralysis. Treatment of shock: — place the patient in the recum- bent position, with the head low. apply warmth to the body, administer a stimulant, and give a hot saline in- fwsion; morphine, hypodermatically. may be necessary for the relief of pain. Amputation may be done if it is necessary to save the patient's life, or if the damaged limb is adding to or prolong- ing the condition of shock. Some surgeons (e.g. Da Costa) think that it is never wise to amputate during shock; others (e.g. Roswell Park) oppose this view. 6. Abscess of Frontal Sinus. — "The usual cause is an injury which may long antedate the symptoms. This in- jury causes or leads to blocking of the infundibulum ; se- cretion accumulates and distends the sinus; and in some cases pus forms. In many cases the fluid slowly accumu- lates, and it requires years to produce marked symptoms. In other cases infection takes place, and the symptoms are positive and violent. If the outlet into the nose is not permanently blocked the fluid may discharge itself from time to time. In the chronic cases there is rarely much pain. The chief sign is a swelling of the inner or upper part of the orbit, which swelling progressively increases in size and displaces the eye. If at any time acute symptoms supervene, there will be pulsatile pain, discolor- ation, and tenderness. "Treatment: In some cases it is possible to pass a trocar 218 MEDICAL RECORD. "New instruments are portrayed and their use thoroughly explained." upward from the nose into the sinus, and so drain and irrigate. In most cases an incision should be made through the soft parts, and the sinus opened by a trephine or chisel. After the sinus has been opened it must be curetted, the opening into the meatus should be restored and enlarged, and a drainage tube is to be passed from the forehead in- cision into the nostril. Some surgeons open the sinus by making an osteoplastic flap." (Da Costa's Surgery.) Prognosis is generally good; some cases get well spon- taneously, and most cases recover when the obstruction is removed and drainage is reestablished. 7. The lymphatic glands along Poupart's ligament are enlarged in syphilis ; in malignant disease of the external genitals; in boils or other sources of irritation around the anus and perineum. 8. Osteomyelitis is an inflammation of the medullary canal of a bone, including both bone and marrow. Varieties: Simple acute osteomyelitis; acute infectious osteomyelitis; chronic osteomyelitis. 9. An aneurysm is a pulsating sac containing blood and communicating with the lumen of an artery. Predisposing causes: — atheroma, syphilis, old age, ar- teritis, alcoholism, male sex. Exciting causes: — increased blood pressure (which may be due to severe labor, sudden strains, violent exercise, chronic interstitial nephritis) ; injury to the artery, and embolus. Usual locations: — Thoracic aorta, abdominal aorta, pop- liteal, femoral, carotid, subclavian, innominate, axillary, and iliac arteries. STATE BOARD EXAMINATION QUESTIONS. Board of Medical Examiners for the State of Texas. October 16, 17, and 18, 1906. (The applicant will answer ten questions of his own se- lection in each of the following papers.) ANATOMY. 1. Describe a dorsal vertebra. 2. Give origin, insertion, and action of the pectoralis major muscle. 3. Name the nerves that supply the tongue and give their function. 4. Give the relations of the radial artery, and name its branches. 219 MEDICAL RECORD. "Since 1890 the MEDICAL RECORD has had a cabled report of every International 3Iedical Congress." 5. Describe the spleen. , 6. Name the points of special interest of the popliteal SP 7 Ce 'Name the ligaments which suspend the uterus. 8. What area is drained by the right lymphatic duct.' q. Describe the elbow joints. io. Describe the artificial divisions of the abdomen, ana name the contents of each subdivision. 11. Describe the great sciatic nerve. 12. Describe the rectum. PHYSIOLOGY. I Explain what is meant by "blood pressure" and "WfthSSS'ln the circulatory system does the blood flow most rapidly? , 3. Which travels with greater rapidity, the pulse or the blood stream? ... , ,, 4 . In what organ is lymph most rapidly formed? 5. How is digestion modified by the absence of hydro- chloric acid from the gastric juice? _ 6. To what kind of diet is the addition of sodium chlo- ride of most importance? 7. What are the limitations to the use of milk as the sole article of diet? . 8 What is meant by "internal secretion i o. What is the chief source of urea • io What are the functions of the red blood corpuscles? II Why does the injection of a large quantity of nor- mal saline solution into the vessels cause diuresis? 12. What are the functions of the pancreatic juicer' CHEMISTRY. 1 Define molecular weight. 2 Define potable, hard, and temporary hard water. V How is H 2 S prepared? Write formula. 4 . Describe the bismuth test for sugar in the urine. What is the objection to this test? 5 Mention chemical and physical properties of arsenic. 6. Upon what reaction does the cooper test for sugar in the urine depend? ,,..-■ t 7 7 What do you understand by diffusion of gases.-' 8. What is the chemical antidote for bichloride of mer- cury? 9 What are the chemical incompatibilities of iron and antipyrine ? . , io. What are fats, what are soaps? MEDICAL RECORD. "The only American medical journal that prints a detailed report of the British Medical Association." 11. Give atomic weight and valence of hydrogen, lead, sulphur, and mercury. 12. What is the relation between albumin and the spe- cific gravity, and sugar and the specific gravity of the urine? HISTOLOGY. 1. To what part of the anatomy does histology apply? 2. What relation does a knowledge of histology bear to physiology? 3. Describe in a brief way the histology of the kidney. 4. Give the minute anatomy of the liver. 5. Name the minute endings of the bronchi. 6. What are Haversian canals and where found? 7. Mention the communication between the great sys- tem of blood-vessels. 8. Mention the three great groups into which the tissues of the body are divided. 9. What are the principal forms of fibrous tissue? 10. Mention principal difference between cartilage and bone. 11. What structures compose secreting glands? 12. What are lymphatic glands, and where are they found? PATHOLOGY. 1. Describe in a brief way the pathology of yellow fever. 2. In what part of the system would you expect to find primarily the infectious element in yellow fever? 3. From results of recent investigations, what, in your opinion, is the infectious element in yellow fever, and how is it conveyed? 4. What other infectious disease, common in the coun- try, the morbid appearances of which sometimes so much resemble those of yellow fcrver? 5. What, in your opinion, is the source of infection in malarial diseases? 6. In malarial cachexia, or chronic malarial poisoning, what morbid conditions 'are usually found? 7. A case — age 26. Recurring hematemesis. profuse — enormously enlarged spleen. Anemia — lemon-tinted skin — moderate general dropsy. Sclera bluish white; digestion poor, with inclination to costiveness. History: Two or three terms of chills in boyhood, each lasting one year or more. Diaenosis "made without microscope. Gave him quinine in acid solution for six or eight weeks — nearly MEDICAL RECORD. " Range of subjects embraces every branch of medicine and surgery." 400 grains in all. Spleen reduced like magic to almost normal size, no more hemorrhage, dropsy disappeared, skin resumed more natural tint, when he passed from under my care. What, in your opinion, was the morbidity causing the hemorrhage; and what caused this morbidity? 8. Where would you expect to find pathological lesions in hydrophobia, and mention some of the most pronounced. 9. What pathological lesions to be found in simple acute endocarditis? 10. How does endocarditis differ from acute plastic pericarditis pathologically? 11. Which of these will likely affect most seriously the circulation of the blood, and why? 12. Mention some disease which ismost commonly the cause of either or both of these morbid conditions. PRACTICE. 1. What is intestinal obstruction and its pathological anatomy ? 2. In acute indigestion resulting in cholera morbus, what would be your first plan of treatment? 3. What are biliary calculi, their cause and treatment? 4. How would you diagnose and treat a case of gastric cancer? 5. What is sciatica, symptoms, and treatment? 6. What are the symptoms and treatment of acute ca- tarrhal laryngitis? 7. How would you diagnose and treat a case of diph- theria ? 8. What are the methods employed in making an ex- amination of the heart? Describe the same in normal con- dition. 9. What is epilepsy, its cause, and varieties? 10. What is interstitial nephritis? 11. What is anemia, its causes, and pathological anatomy? 12. How would you diagnose a case of croupous pneu- monia? SURGERY. 1. Give the principal methods of abdominal drainage with which you are familiar. What method do you con- sider best? 2. How would you treat a case of ingrown toe-nail? 3. Mention the most important symptoms of an acute synovitis involving the hip-joint. 4. Give vour treatment of a large varicose ulcer of the leg. 222 MEDICAL RECORD. " Keeps you in closest touch with the weekly progress of medicine and surgery throughout the world." 5. What are the principal signs of a simple fracture involving the femur? 6. What important tissues may be accidentally wounded during an operation for femoral hernia? 7. What are the symptoms of acute intestinal obstruc- ^ tion? 8. How should an aneurysm of the femoral artery be treated ? 9. How would you treat a large varicocele? 10. Describe in detail how you would correct the de- formity and dress a case of Colles' fracture. 11. Describe in detail how you would proceed to control hemorrhage during an amputation of the hip-joint. 12. How would you treat a carbuncle? EYE, EAR, NOSE, AND THROAT. (Four questions to be answered.) 1. What are the dangers of otitis media? 2. How would you make a differential diagnosis be- tween a case of diphtheria and a bad case of follicular tonsillitis? 3. Upon what would you base a diagnosis of suppu- rating disease in the antrum of Highmore? 4. Describe in detail how you would proceed to remove a small foreign body embedded in the cornea. 5. Upon what symptoms would you make a diagnosis of mastoiditis? OBSTETRICS. 1. (a) What is the connection between ovulation and menstruation? (b) What is the average duration of men- struation? (c) What is the interval between the men- strual periods? (d) Give the average age at which men- struation first occurs. 2. Describe tl£ axis of the inlet and the outlet of the pelvis and the aYis of the cavity. 3. How are rne organs of generation divided, external and internal? 4. Describe the changes which occur in the ovum after impregnation. 5. (a) What are the uses of the liquor amnii during pregnancy? Cb) During labor? 6. (a) What is puberty? (b) Describe the changes that take place in the female at puberty. 7- (a) What comprises the puerperal state? (b) De- scribe the maternal changes during that period. 223 MEDICAL RECORD. " Therapeutic Hints contain many valuable formulae by the foremost medical men in the world." 8. Describe the lochia and the conditions that change its composition and quantity. 9. Give the diagnosis and treatment of trunk presenta- tions. 10. In what way may delivery be arrested in twin births? Describe the management of the same. 11. Give the causes, diagnosis, and treatment of puru- lent ophthalmia neonatorum. 12. Give causes, pathology, and treatment of thrush. HYGIENE. 1. What is the difference between a contagious and an infectious disease? 2. Describe two of the best methods of fumigation to prevent the spread of contagious diseases. 3. What steps are essential to prevent the spread of typhoid fever from a patient to other members of the household? 4. Describe a good plan for ventilating a sleeping-room in a temperate climate during winter. 5. What are the normal constituents of atmospheric air? 6. What are the deleterious ingredients of exhaled air? 7. What is meant by absolute and relative humidity? 8. What symptoms are produced in some persons by sudden changes from low to high altitudes? 9. Why should the principles of hygiene be observed in construction of dwellings? 10. In the selection of a building site, what things are to be sought and what avoided? 11. How would you guard against the bowel disturb- ances of infants during their first and second summers? 12. From what foods does ptomain poisoning arise? MEDICAL JURISPRUDENCE. 1. Define forensic medicine. 2. Briefly enumerate the difference between an ordi- nary and a medical expert witness. 3. Enumerate the general rules to be observed in testi- fying as an expert witness. 4. Define criminal and civil malpractice. 5. Briefly enumerate what you would do if called to view the body of a person found dead. 6. What do you understand by personal identity? 7. Give a practical and reliable test for human blood. 8. State what is considered a live birth by law and 224 MEDICAL RECORD. "Surgical Suggestions that will appeal to the student and the general practitioner." what manifestations of life would establish it medico- legally. 9. If called to see a person before death suspected of having been poisoned, state what steps you would take to determine this fact both before and after death. 10. What do you understand by a dying declaration, and what is its value in court? 11. Give a differential diagnosis between opium poison- ing, acute alcoholism, and apoplexy. 12. If called to view a person found dead from gunshot wound, state how you would determine as to whether it was probably suicide or murder. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Board of Medical Examiners for the State of Texas, October 16, 17, and 18, 1906. physiology. 1. Blood pressure is the pressure on the blood due to the ventricular systole, the elasticity of the walls of the arteries, and the resistance in the capillaries. This latter is called peripheral resistance. 2. At the beginning of the aorta. 3. The pulse travels at the rate of about fifteen to thirty feet per second in the arteries; the blood stream travels at the rate of about one foot per second in the arteries. 4. There are two theories as to the formation of lymph : — (1) That it is formed from the blood plasma by the processes of filtration, diffusion, and osmosis. (2) That in addition to these, the endothelial cells of the capillaries exercise some influence. 5. Proleid digestion may be slightly delayed. 6. Vegetable foods. 7. During the earliest months of life milk is a perfect food. Later on it will not suffice, as it contains too little iron ; further, tremendous quantities of it would have to be ingested in order to ensure an adequate supply of carbon and nitrogen. 8. It is generally held now that the glandular organs, chiefly the pancreas, liver, and the ductless glands, produce a secretion, peculiar in each case to the particular gland producing it, and which is supposed to be given off to the blood or lymph, and to have some peculiar value in the general metabolism of the body. Such secretions are called MEDICAL RECORD. Its prestige attracts articles by the best known writers." internal secretions, in contradistinction to the previously known secretions, which are carried off by a duct, and are known as external secretions. Very little is definitely known of these internal secretions, but much work is being done on the subject. 9. Urea is produced from the proteids of the food and tissues. It is chiefly formed in the liver. 10. To carry oxygen from the lungs to the tissues. 11. The normal salt solution abstracts water from the tissues of the body and causes a condition of hydremic plethora; the capillaries of the kidneys thus contain a greater quantity of blood, and capillary pressure is in- creased. The result is: — (1) more rapid filtration, and (2) an increased amount of urine. 12. (1) It changes proteids into proteoses and peptones, and afterwards decomposes them into leucin and tyrosin; (2) it converts starch into maltose; (3) it emulsifies and saponifies fats; and (4) it causes milk to curdle. CHEMISTRY. 1. Molecular weight is the weight of a molecule of a substance as compared with the weight of an atom of hydrogen. It may also be said to be the sum of the weights of the atoms composing its molecule. 2. A potable water is one that is apparently fit to drink. A hard water is one that forms a curdy deposit with soap. In a temporary hard water the hardness is due to the bicarbonates of magnesium and calcium, and can be removed by boiling and filtering. 3. H 2 S may be prepared by treating ferrous sulphid with dilute sulphuric acid. Thus :— FeS + HsSO, = FeSO« + H a S. 4. Albumin, if present, must be removed. Add to the urine enough Na 2 C0 3 to render it strongly alkaline. Put about three cubic centimeters of the urine into a test tube, add a very small quantity of powdered bismuth subnitrate, and boil. If sugar is present the bismuth powder be- comes black. The test is not reliable, for other substances than sugar will produce the reaction. 5. Arsenic is a brittle gray solid with a metallic lustre, or a black amorphous powder. It is insoluble in water, and is either odorless or has the odor of garlic. It is tarnished by moisture; in dry air it is not altered; heated in air it becomes arsenic trioxide. It combines with most metals, also with chlorine, bromine, iodine, sulphur, and with nas- cent hydrogen. 6. The boiling alkaline solution converts glucose into substances which are very easily oxidized, and are there- 226 MEDICAL RECORD. Not a local Journal, but International in Its scope. fore good reducing agents. If cupric sulphate is present it is converted into cuprous sulphate, which latter is decom- posed and cuprous oxide is deposited. 7. When two gases are placed side by side, or are sep- arated from each other by a porous substance, the gases will pass into one another, and a homogeneous mixture is the result. 8. White of egg, in moderation, and followed by an emetic. 9. The chief incompatibles of Iron are : acids, acid salts, vegetable astringents, alkalies, and their carbonates. Of Antipyrine: nitrous compounds, ferric salts (in solu- tion), nitrites (in solution), chloral hydrate, tincture of iodine, mercuric chloride, and tinctures containing iron or tannin. 10. Fats are mixtures of the glycerol esters of stearic, palmitic, and oleic acids. Soaps are the sodium or potas- sium salts of stearic, palmitic, and oleic acids. 11. Hydrogen: atomic weight, 1; valence, I. Lead: atomic weight, 207; valence, 2 or 4. Sulphur: atomic weight, 32; valence, 2 or 6. Mercury: atomic weight, 200; valence, 2. 12. (1) The presence of Albumin may have no material effect upon the specific gravity of the urine, but (2) a specific gravity lower than normal has been held to denote the presence of albumin. Sugar in the urine causes a higher specific gravity. HISTOLOGY. 1. Microscopically, to all parts. 2. Histology treats of the minute or microscopical struc- ture of the various tissues and organs of the body; physiol- ogy is concerned with the functions of the same. Hence, a knowledge of the former is supposed to be an aid to the proper understanding of the latter. 5. The alveoli. 7. The capillaries. 8. Epiblastic, mesoblastic, and hypoblastic. _ 9. White fibrous, yellow elastic fibrous, mixed fibrous, mucous, and retiform; areolar and adipose tissues also con- tain some fibrous tissue. 10. Bone tissue is impregnated with lime salts. 11. A basement membrane, epithelial cells, vascular tis- sue with lymphatics, nerves, and capillaries, secreting cells which are capable of elaborating the elements proper to the particular secretion. PATHOLOGY. 1. Rigor mortis is well marked/and appears early; the muscles are dark and dry; the skin is yellow or very dark, 227 MEDICAL RECORD. Save and bind your numbers; it will give you two great medical encyclopedias every year. yellow green; subserous hemorrhages are found in the lungs and heart, and the blood may be thm and fluid The gastric mucosa is strongly congested and swollen, and hem- orrhages into the membrane and in the cavity are common, the blood is dark and thick; in the upper part of the smaU intestine similar lesions may be found and .m th co Ion there mav be dysenteric necrosis. The liver is swollen or moderately decreased, soft and of a ~lor varying from dark red to light yellow, with bile staining; he gall-bladder contains a small amount of dark, thick bile The spleen may be small. The kidneys show acute nephritis, often hemorrhagic. (Thayer's Pathology.) 2. In the blood. _ _ . 3 Probably Bacillus tcteroides of Sanarelh. It is conveyed by the Stegomyia fasciata mosquito. 4 Severe bilious or remittent malarial fever. 5. The Plasmodium or hematozoon malaria;, conveyed by the anopheles mosquito. 6 Secondary anemia ; diminished number of white blood corpuscles; spleen enlarged, hard and pigmented; liver enlarged ; kidneys pigmented ; skin, dirty yellow color, and sometimes paraplegia and orchitis may be present. 7. Chronic malarial poisoning or malarial cachexia. Caused by the Plasmodium malaria. 8 The upper part of the spinal cord, pons medulla, and cortex of the cerebrum. Hemorrhages, and dilated and congested blood-vessels. . o Vegetations occur on the valves or on the lining mem- brane of the cavities of the heart. These vegetations con- sist at first, of fibrin and leucocytes, later of connective tissue Microorganisms are also generally present. ii "The endocarditis; because the vegetations present may' become broken off and carried by the circulation to distant parts of the body, thus causing embolism or infarc- ^i"'. Both of these diseases may be caused by acute artic- ular rheumatism. PRACTICE. 2 Remove any irritant or offending matter ; give calomel in fractional doses, and, to allay the pain, a hypodermic of morphine (grain %) and atropine (gram ™) * The predispos ng causes are : age, sedentary habits, and obstruction of the bile ducts. The exciting cause is microbic infection of the gall-bladder. The treatment dur- m. an attack: inhalation of chloroform, a hypodermic of morphine and atropine (as in question 2. above) .application of heat, and diffusible stimulants if shock is present Prophy- 228 MEDICAL RECORD. "The most important and interesting items of the very latest medical news throughout the world." laxis includes : plain and easily digested food, the ingestion of plenty of good drinking water between meals, sufficient outdoor exercise, salines, and the avoidance of indigestion. 7. For diagnosis, see below, Eye, Ear, Nose, and Throat, question 2. SURGERY. 1. Gauze; rubber tubing; glass tubing; strands of gut, or horsehair, or silk. There is no one method that is uni- versally best. For blood or serum, capillary drainage along a strip of gauze is best; for pus, the tubes are better em- ployed. 3. Pain ; limited movement of the joint ; the limb is flexed, abducted, and everted ; there may be tenderness and fullness in Scarpa's triangle and in the gluteal region; the muscles controlling the movements of the joint may undergo tonic contraction or become atrophied. 6. The obturator artery, if abnormal; the deep epigas- tric artery; the spermatic cord, in the male; the round ligament in the female. This latter is not of much conse- quence, but, if the spermatic cord is cut, the vas deferens and spermatic artery are also severed. 8. It may be treated by (1) extirpation, or (2) ligature of the common femoral or superficial femoral artery, or (3) by compression in the groin. EYE, EAR, NOSE, AND THROAT. 1. Deafness or impairment of hearing; necrosis of the ossicles; caries or necrosis of the temporal bone; polypi; inflammation of the mastoid cells and antrum; choleste- atoma ; facial paralysis ; subcranial abscess ; cerebral com- pression ; meningitis; thrombosis of the lateral sinus; abscess in the cerebrum or cerebellum ; death. 2. In diphtheria the onset is more gradual ; the temper- ature rises to about 101 to 103° F. ; the tonsils are not much enlarged ; there is an exudate of a thick grayish mem- brane which is very adherent, is removed only with diffi- culty, and leaves a bleeding surface; this membrane soon re-forms and may be found on the fauces and pharynx as well as on the tonsils; in the exudate the Klebs-Loffler bacilli may be found. In follicular toisillitis the onset is more sudden; the tem- perature may be a little higher than that of diphtheria; there is no membrane, but the tonsils are red and swollen, and in the crypts are seen white cheesy spots or plugs, which consist of broken-down epithelium, and are easily brushed away; Klebs-Loffler bacilli are never found. 229 MEDICAL RECORD. •* The medical profession have been presented with the re- sults of great discoveries by the MEDICAL RECORD In ad- vance of any other publication." 3. Pain; a periodic purulent discharge from the nose; the presence of pus on puncturing the antrum; and, some- times, transillumination will be of service. 4. "The eye is cocainized; the patient is seated facing a good light, with the surgeon standing behind and support- ing the head; the lids are separated and the eyeball is steadied by the fingers of the left hand, the index finger is applied to the margin of the upper lid, and the middle finger to the lower lid, and the two fingers are separated, at the same time gently pressing backward. The instru- ments used are either the blunt spud, the gouge, or the foreign-body needle. When the foreign body is super- ficial, the blunt spud will answer. When it has penetrated into the corneal substance, it must be picked or dug out with the gouge, or the needle; in such cases, the instru- ment is passed behind the foreign body. The wound which results must be kept clean by frequent irrigation with solu- tion of boric acid; frequently a protective bandage is indi- cated. If a ring of rust is present, this also should be removed. Care must be taken to inflict as little injury as possible, and when the foreign body is deep, not to per- forate the cornea." (From May's "Diseases of the Eye.") 5. Intense pain of a boring character in the ear or mas- toid process; a depression and tumefaction of the postero- superior wall of the auditory canal ; great tenderness on pressure over the mastoid region ; swelling, redness, and edema over the mastoid process. OBSTETRICS. 1. (a) The connection between ovulation and menstrua- tion is not yet definitely settled, but the two functions seem to be closely associated. It has been held that ovulation is dependent upon menstruation ; also that menstruation is de- pendent upon ovulation; it has also been proved that each may occur without the other, and it is possible that they are both dependent upon some common (and as yet unknown) cause. (b) About three or four days. (c) About twenty-eight days, from the beginning of one period to the beginning of the next. (d) In this country, about fourteen years; in warmer climates it occurs earlier. 5. (a) (1) As a protection to the fetus against pressure and shocks from without. (2) As a protection to the uterus from excessive fetal movements. (3) It distends the uterus, and thus allows for the growth and movements of the fetus. (4) It receives the excretions of the fetus. 230 MEDICAL RECORD. " Special reporters in England, France, Germany, Austria, Turkey, Denmark, the Philippines, and the leading cities Of the United States and Canada." (5) It surrounds the fetus with a medium of equable tem- perature, and serves to prevent loss of heat. (6) It pre- vents the formation of adhesions between the fetus and the walls of the amniotic sac. (7) It has been supposed, by some, to afford some slight nutrition to the fetus. (b) It acts as a fluid wedge, and dilates the os uteri and the cervix; it also slightly lubricates the parts. HYGIENE. i. An infectious disease is one that is caused by bacteria. A contagious disease is one that can be communicated to a healthy person by contact with one who is infected. 5. Oxygen, nitrogen, carbon dioxide, water vapor, argon, ammoniacal compounds, hydrocarbons, ozone, oxides of nitrogen, and solid particles. 6. Carbon dioxide, crowd poison, organic matter given off from the skin and lungs, fatty acids, and pathogenic bacjeria. 7. Absolute humidity is the amount of watery vapor contained in the atmosphere, irrespective of the temper- ature. Relative humidity is the proportion of watery vapor in the atmosphere at a certain temperature, as compared with air completely saturated (which is expressed by 100). 8. Any of the following : giddiness, dyspnea, palpitation of the heart, headache, gasping for breath, dryness of the throat, intense thirst, general malaise, fatigue, loss of appe- tite, nausea, vomiting, tinnitus aurium, slight elevation of body temperature, and occasionally epistaxis, bleeding from the gums, bloodshot eyes, and hemoptysis. MEDICAL JURISPRUDENCE. 1. Forensic Medicine has been denned as the application of medical, surgical, or obstetrical knowledge to the pur- poses of legal trials. 2. The ordinary witness testifies only to facts. An expert witness, in addition, gives his opinion on facts or supposed facts as noted by himself or asserted by others. 3. The following, which admirably answers this ques- tion, is from Witthaus and Becker's "Medical Jurispru- dence" : (1) A physician should refuse to testify as an expert unless he is conscious that he is really qualified as an ex- pert. (2) After accepting the responsibility, his first duty should be to make a diligent examination and preparation for his testimony, unless it be upon a subject with which he is familiar, and which he is satisfied that he has already 231 MEDICAL RECORD. " The progressive physician must have his medical weekly just as the business man his newspaper." exhausted, by reading the best authorities that he can find, and by careful reflection upon particular questions as to which his opinion will be asked. (3) Where he is to make an examination of facts, such as the post-mortem examination of a body, a chemcial analysis, or an examination of an alleged insane person, he should insist upon having plenty of time and full op- portunity for doing his work thoroughly. He should take particular pains to make his examination open and fair, and, if possible, should invite opposing experts to cooperate with him in it. , , . ^ . . (4) He should be honest with his client before the trial in advising him and giving him opinions, and upon the trial should observe an absolutely impartial attitude, con- cealing nothing, perverting nothing, exaggerating nothing. (5) On the preliminary examination as to his qualifica- tions as a witness, he should be frank and open in answer- ing questions. He should state fully the extent and the limits of his personal experience and of his reading upon the subject, without shrinking from responsibility, yet with- out self-glorification. . (6) He should be simple, plain, and clear in his state- ment of scientific facts and principles, avoiding the use of technical language, and trying to put his ideas in such form that they will be grasped and comprehended by men 01 ordinary education and intelligence. . . (7) He should avoid stating any conclusions or princi- ples of which he is not certain, but having an assurance that he is right he should be firm and positive He should admit the limitations of his knowledge and ability. Where a question is asked that he cannot answer, he should not hesitate to say so, but he should refuse to be led outside the subject of inquiry, and should confine his testimony to those scientific questions which are really involved in the case, or in his examination of the case. (8) He should always bear in mind that at the close 01 his testimony an opportunity is usually given to him to explain anything which he may be conscious of having said which requires explanation, and partial statements which need a qualification to make them a truth I his is the physician's opportunity to set himself right with the court and with the jury. If the course of the examination has been unsatisfactory to him, he can then by a brief and plain statement of the general points which he has intended to convey by his testimony, sweep away all the contusion and uncertainty arising from the long examination and cross-examination, and can often succeed in producing for 212 MEDICAL RECORD. "Editorials on subjects of timely interest and of vital im- portance dealt with in a masterly and scholarly style." the first time the impression which he desires to produce, and can present the scientific aspects of the case briefly and correctly. 8. To constitute a "live birth," there must be (i) com- plete extrusion of the child from its mother's body, and (2) some certain sign of life. The latter would be established by one or more of the following: pulsation of the cord, beating of the child's heart, motions of the limbs, twitchings of the muscles, wrinkling of the brows, puckering of the face, opening of the eyes, even if respiration does not take place. (From Witthaus and Becker's "Medical Jurispru- dence, etc.") 10. By a "dying declaration" is understood any state- ment made by a dying person who believes that he cannot recover, and that he is, at that very time, in actual danger of death. The statement need not be sworn to; it should be voluntary and sincere, and it is admissible as evidence in a court if the individual making it dies. STATE BOARD EXAMINATION QUESTIONS. Vermont State Board of Medical Registration. January, 1907. chemistry. 1. (a) Discuss the chemical characteristics of a good drinking water, (b) State the most important fact about hydrogen. 2. Name two gases that have not been liquified. 3. (a) How is H 2 2 made? State strength. (&) Name four alkali metals and give symbol of each. 4. (a) Mention the principal proteids of nerve tissue. (b) What is saccharin? 5. (a) Define urobilin, urochrome, uroerythrin. (b) What leaves the body mainly through urea? (c) Give test for urea and state number of grains normally excreted in twenty-four hours. MATERIA MEDICA. ffj (a) State dose and strength of dilute hydrocyanic acTd. (b) What preparations used in medicine contain it? @) Give the composition, uses, and dose of the following preparations: (a) Spirits of Mindererus, (b) compound syrup of squills, (c) Pearson's solution, (d) Griffith's mix- ture, (e) brown mixture. @) Name the alkaloids, preparations, and doses of ipe- cac. 233 MEDICAL RECORD. " Acknowledged to be the leading independent medical weekly." 4. (a) Give the source, dose, and action, of the follow- ing alkaloids: sparteine, berberine, atropine, narceine. (6) Give the strength of the following: tincture of capsicum, tincture of rhubarb, tincture of colchicum seeds, tincture of digitalis, tincture of aconite, tincture of hyoscamus, tincture of veratrum viride, tincture of belladonna. 5. Discuss the composition and physiological action of ergot. THERAPY. 1. Briefly explain : — natural therapeutics, empirical thera- peutics, rational therapeutics. 2. Write a formula for each of the following: acne rosacea, hysteria, angina pectoris, bronchiectasis, chronic nasal catarrh, enuresis, diabetes insipidus, hepatic cirrhosis, hiccough, influenza. 3. How would you treat and manage a case (a) of infantile convulsions? (b) of renal and vesical calculi? 4. Mention the indications for the following drugs: potassium chlorate, salicylic acid, phosphorus, chloral, can- tharides, carbonate of ammonia, potassium bromide, ela- terium, guaiacol carbonate, stramonium. 5. Give your drug and dietetic treatment of typhoid fever. ANATOMY. 1. Describe the bones of the foot, giving their divisions and articulations. 2. Describe the occipitoatloid articulation. 3. Name the superficial muscles of the neck and scalp, and give the origin, insertion, and nerve supply of any one of them. 4. Describe the portal system of veins. 5. Give the origin, course, and termination of the tho- racic duct. 6. State the origin, course, and distribution of the sixth pair of cranial nerves. 7. Describe the special organs of taste, and give their nerve supply. 8. Name the coverings of femoral hernia from without inward. 9. Describe the prostate gland and give its relations. 10. Give the normal position, size, form, ligaments, blood, and nerve supply of the uterus. PHYSIOLOGY. 1. Give the classification of nerves. 2. Of what does the cerebrospinal axis consist? 3. Name the coverings of the brain, and describe them. 234 MEDICAL RECORD. Keeps ycu strictly abreast of the times. 4. Describe and give location of the corpora quadri- gemina, also give function. 5 Describe healthy urine, and give constituents. 6. What are enzymes? State the special functions of each enzyme concerned in digestion. 7. Describe the proteid digestion, and name the ferments concerned therein. 8. Into how many classes are food stuffs divided? Name them. 9. What is meant by the automatic action of the spinal cord? Give three examples. 10. Name some of the kinds of cells found in man. What is epithelium? What are its varieties? HYGIENE. 1. What is meant by personal, domestic, and public hygiene ? 2. What is the distinction between sewer air and sewer gas? What gives sewer gas its peculiar odor? 3. Give the hygiene of the secretory organs. 4. How do disease germs produce their characteristic effect on the system? 5. What constitutes a thorough inspection of milk as to food value and purity? BACTERIOLOGY. 1. Classify bacteria, and state the difference between a saprophyte and a parasite. 2. State the difference between a toxin and a ptomain. Give five sources of ptomain poisoning. 3. Describe the gonococcus, and give method of stain- ing the same. 4. State microscopical appearance, and staining peculiar- ities of the tubercle bacillus. 5. What evidences of contamination of drinking water may be obtained by bacteriological analysis? Compare the value of chemical analysis with that of bacteriological analysis. PATHOLOGY. 1. Give the pathological difference between moist and dry gangrene. 2. Give the pathological anatomy of lobar pneumonia. 3. Give the pathology of carcinoma. 4. Give the pathology of typhoid fever. 5. Give the pathology of chronic arteriosclerosis. PRACTICE. I. Give the treatment, including preventive treatment, of typhoid fever, also that for the more common complica- tions of this disease. 235 MEDICAL RECORD. " European correspondents furnish medical news of special interest and reports of the principal foreign medical societies." 2. Give the etiology of, and describe the different types of influenza. 3. Give the differential diagnosis (a) between rubeola and rubella, (b) between rubeola and scarlatina. 4. Give differential diagnosis between variola and vari- cella. 5. Give the period of incubation of the diseases men- tioned in questions 3 and 4, also the proper period for quarantine in each. 6. (a) Mention the different types of pneumonia; (6) give its treatment. 7. Differentiate betwixt cardiac hypertrophy, cardiac dilatation, and pericarditis with effusion. 8. Write a short article on hemophilia. 9. How would you manage a case of chronic interstitial nephritis? 10. Give the symptomatology of tabes dorsalis. 1. What are toxins, antitoxins, and phagocytes? 2. Describe four methods of reducing dislocation of the shoulder. . . 3. How would you treat a fracture of the elbow joint? 4. What is septicemia and pyemia? Give causes. 5. Differentiate between acute ovaritis of the right side and appendicitis. 6. Describe the mastoid operation for suppuration. 7. Name and describe four forms of talipes. 8. Describe fistula in ano, and give treatment. 9. Give symptoms of acute cystitis, and write a pre- scription for same. 10. Describe in detail Bassini's operation for inguinal hernia. OBSTETRICS. 1. Enumerate signs of pregnancy and indicate relative importance. 2. Describe the management of a case of R. O. P. pres- entation. 3. Give symptoms, diagnosis, and treatment of placenta praevia. 4. Give causes and treatment of mastitis. 5. What, how often, and how much would you feed a baby one week old? 6. Name at least six of the most common conditions calling for the use of forceps. 7. Give management of a case of miscarriage. 236 MEDICAL RECORD. "The most important contributions to the literature of medicine and surgery have been published first in the MEDI- CAL RECORD." 8. Give prophylactic treatment of postpartum hemor- rhage. 9. Give treatment of puerperal sepsis. 10. Give diagnosis and treatment of extrauterine preg- nancy after rupture. GYNECOLOGY. 1. Describe the uterus. 2. Give causes and treatment of ovaritis, acute and chronic. 3. Give symptoms and treatment of retroversion of uterus. 4. Give contraindications for use of uterine sound. 5. Give symptoms and treatment of acute vaginitis. LEGAL MEDICINE. 1. Give a definition of a medicine, also of a poison. 2. Give examples of mania, monomania, dementia, and idiocy. 3. What is the difference between civil and criminal malpractice? 4. Give your reasons that a child had been bom alive. 5. Describe a bullet wound, entrance and exit. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Vermont State Board of Medical Registration. January, 1907. CHEMISTRY. 1. (a) It should be colorless, odorless, cool, limpid, soft; it should have an agreeable taste, neither sweet nor salty nor flat; it should dissolve soap readily without for- mation of a curdy precipitate; it should contain not more than twenty-five to thirty grains of harmless solids per gallon, and should not be contaminated with sewage, lead, or other poisons, or pathogenic bacteria. (£>) There is no most important fact about hydrogen; the following are all of them facts, the relative importance of which must be decided by the examiner for himself: Hydrogen is a necessary element in the composition of all acids, also of water; the weight of its atom is the unit by which all atomic weights and molecular weights are meas- ured ; it is the lightest known substance. 2. There arc none 3. (a) HiOs is made bv adding barium dioxide to a »37 MEDICAL RECORD. The MEDICAL RECORD publishes no " Students' Number," for every issue is a students' number and a practitioners' number in one. solution of dilute hydrofluoric acid. The strength is a ten to twelve volume solution. (b) Lithium, Li.; Sodium, Na. ; Potassium, K. ; Rubi- dium, Rb. 4. (a) Albumin, globulin, nucleoproteid, and neurokera- tin. (b) Saccharin is benzoyl sulphonic imid, or anhydro- ortho-sulphamine-benzoic acid. 5. (a) Urobilin is a brownish pigment found in the urine, the feces, and sometimes in the blood. Urochrome is a yellow pigment of the urine. Uroerythrin is a reddish pigment sometimes found in the urine. (b) Nitrogen. (c) A comparatively easy test is that of Fowler, based upon the loss of the specific gravity of the urine after the decomposition of the urea by hypochlorite. "To apply this method the specific gravity of the urine is carefully determined, as well as that of the liquor sodae chlorinate (Squibb's). One volume of the urine is then mixed with exactly seven volumes of the liquor sodse chlorinatse, and, after the first violence of the reaction has subsided, the mixture is shaken from time to time during an hour, when the decomposition is complete; the specific gravity of the mixture is then determined. As the reaction begins instantaneously when the urine and reagent are mixed, the specific gravity of the mixture must be calculated by add- ing together once the specific gravity of the urine and seven times the specific gravity of the liquor sodas chlor- inatse, and dividing the sum by eight. From the quotient so obtained the specific gravity of the mixture after decomposition is subtracted ; every degree of loss in specific gravity indicates 0.7791 gram of urea in 100 cc. of urine. The specific gravity determinations must all be made at the same temperature; and that of the mixture only when the evolution of gas has ceased entirely." (Witthaus' Manual of Chemistry.) MATERIA MEDICA. i. (a) Dose is one and a half minims; strength is two per cent, by weight. (&) Cherry-laurel water, Scheele's dilute hydrocyanic acid, oil of bitter almond, and Prunus Virginiana. 2. (a) Spirits of Mindererus, an aqueous solution of ammonium acetate, containing not less than seven per cent, of the salt, and also a little acetic and carbonic acids. Dose, two to four drams. 238 MEDICAL RECORD. " Our reporters attend every convention of first-rate im- portance. The news is telegraphed or cabled exclusively to the MEDICAL RECORD." (b) Compound syrup of squills contains fluid extract of squill and of senega, tartar emetic, sugar, calcium phos- phate, and water. Dose, half a dram. (c) Pearson's Solution, solution of sodium arsenate, consists of that salt and water. Dose, three minims. (d) Griffith's mixture is compound iron mixture, and contains ferrous sulphate, potassium carbonate, myrrh, sugar, spirit of lavender, and rose water. Dose, four drams. (e) Brown mixture, is compound mixture of glycyrrhiza, and contains extract of glycyrrhiza, syrup, acacia, wine of antimony, spirit of nitrous ether, camphorated tincture of opium, and water. Dose, two drams. 3. Alkaloids: Emetine, cephaeline, and a third, unnamed alkaloid. Preparations and Doses: Fluid extract, TTgxv; powder of ipecac and opium, gr. viiss; syrup of ipecac, Ttyxv, as an expectorant, 5iv as an emetic; wine of ipecac, TT#xv; tincture of ipecac and opium, TTgviij. 4. (a) Sparteine, from scoparius, sparteine sulphate, gr. 1/5 ; berberine, from hydrastis, calumba, berberis, and other plants, berberine sulphate, gr. ss. to gr. jss; atropine, from atropa belladonna, gr. 1/160; narceine, from opium. (b) The tinctures of capsicum, colchicum seeds, digitalis, aconite, hyoscyamus, veratrum viride, and belladonna are ten per cent, strength; tincture of rhubarb is twenty per cent, strength. 5. The composition of ergot is indefinite; the chief con- stituents are : Ergotine, ergotinine, ecboline, sphacelic acid, ergotinic acid, cornutine, tannic acid, and other substances. Most of these ingredients contract the blood-vessels; the cornutine, in addition, is credited with the chief part in contracting the uterus. I. Natural therapeutics comprises the processes which may be included under the general heading of the healing or recuperative powers of the organism itself, independently of any outside aid. Rest and sleep are examples. Empirical therapeutics is a term applied to such reme- dies as are used simply because they have been found beneficial in similar cases. Rational therapeutics means the use of remedies based on a combined knowledge of their physiological action and of the pathological condition present in the patient. 239 MEDICAL RECORD. " Original Articles are of the highest scientific value and most practical character, by the foremost men of the world." 2. For acne rosacea: — r£ Zinci sulphatis Potassii iodidi aa. 5ss Aquae rosae, q. s. ad 3iv. Misce Sig: Use as a lotion. For hysteria: — $ Tincturae asafoetidae Tincturae Valerianae ammoniatae aa 3j Aquae camphorae, q. s. ad 3iij. Misce Sig: One tablespoonful every hour. For angina pectoris: — r£ Pearls of nitrite of amyl, Tljfiij. No. x. Sig: Crush one and inhale when required. For bronchiectasis: — $ Potassii iodidi 3j Glycerin 3iij Syrupi senegae 3j Aquae destillatae q. s. ad 3i>j- Misce. Sig: A dessertspoonful one hour after meals. For chronic nasal catarrh: — fy Sodii boratis Sodii bicarbonatis aa 3ss Phenol gr. xv Glycerini 3ss Aquae destillatae O. j. Misce. Sig: Use as a spray. For enuresis: — rj Potassii citratis 3ss Spiritus etheris nitrosi 3vj Aquae destillatae q. s. ad 3ij- Misce Sig: A dessertspoonful every four hours. For diabetes insipidus:— J£ Fluidextracti ergotae 3iss Aquae destillatae q. s. ad Siv. Misce Sig: One teaspoonful, three times a day. For hepatic cirrhosis: — ]£ Potassii iodidi 3ijss Aquae destillatae 3u*. Misce Sig: One teaspoonful in a tumbler of water one hour before meals. For hiccough: — I£ Spiritus etheris compositi 5j Sig: One teaspoonful in a glass of ice-water. For influenza: — 5 Quininae hydrobromatis Sodii benzoatis Caffeinaeaa gr. xx. Misce, et fiat massa in pilulas No. xx. dividenda Sig: Take one three times a day. ANATOMY. 8. Skin, superficial fascia, cribriform fascia, crural sheath, septum crurale, subserous areolar tissue, and peritoneum. 240 MEDICAL RECORD. " Choice and important abstracts from the leading medical periodicals of the world in a condensed and practical form." PHYSIOLOGY. I. Nerves are classified as: — I. Efferent nerves, or centrifugal nerves, which may be motor, accelerator, in- hibitory, secretory, or trophic nerves. II. Afferent nerves, or centripetal nerves, which include nerves of general sen- sation, special sense and of pain. III. Intercentral nerve fibers, which connect different parts of the nervous sys- tem. 4. The corpora quadrigemina are four small rounded eminences situated over the aqueduct of Sylvius. They are arranged two on each side behind the pineal body, and are separated from each other by a crucial depression. They are white on the surface, but contain gray matter in the interior. As to their function, they contain centers for the contraction of the pupils and for the coordination of the movements of the eyeballs. 6. Enzymes are unorganized ferments which are the result of the activity of special cells of the animal body. Saliva Gastric juice. .. Pancreatic juice. Ptyalin. Pepsin. A curdling ferment. Trypsin Amylopsin Steapsin. A curdling ferment. Changes starches into dextrin and sugar. Changes proteids into proteoses and peptones in an acid medium. Curdles the casein of milk. Changes proteids into proteoses and peptones, and afterwards decom- poses them into leucin and tyrosin ; in an al- kaline medium. Converts starches into maltose. Emulsifies and saponifies fats. Curdles the casein of milk. 8. Food stuffs are divided as follows: — I. Inorganic Water. Salts. 241 MEDICAL RECORD. " Bulletins of Examinations of State Medical Licensing Boards published bi-weekly." I Non-nitrogenous \ Carbohydrates. II. Organic \ ' Fats. ( Nitrogenous — Proteids. 9. By automatic action of the spinal cord is meant that property of the nerve cells of the cord by virtue of which they become active as the result of changes within the cord, and without any external stimulus. Some of the centers in the cord may act automatically, but as a rule they act as reflexes in response to external stimuli. Examples are parturition, defecation, and micturition. HYGIENE. 2. Sewer air is atmospheric air with its oxygen dimin- ished and its carbon dioxide increased from 0.04 per cent, to 0.4 per cent., and contaminated with more or less marsh gas, sulphuretted hydrogen, ammonium sulphide, etc. Sewer gas "is but a mixture of a number of gases, such as carbonic acid, carburetted hydrogen, ammonium and hydrogen sulphide, nitrogen, etc., together with a consid- erable amount of fetid organic matters, the volatile or semi- volatile products of animal and vegetable decomposition, varying according to the condition of the sewer, the kind of matter received therein, the amount of surplus water, etc." (Egbert's Hygiene and Sanitation.) 4. Disease germs must first effect an entrance into the body; they then grow, multiply, and produce toxic sub- stances which are absorbed and distributed throughout the system. Sometimes ourelv local effects are produced, such as the plugging up of small vessels or causing changes in the cells and tissues. Occasionally, as in anthrax, the disease germs invade the various tissues, and cause dis- turbances more bv their presence and multiplication than by their toxic products. 5. The inspection should include: — the color, reaction, specific gravity, sediment, taste, odor, total quantity of solids and of water; the percentage of cream, fats, lactose, casein, and ash; the presence or absence of preservatives, coloring matter, added solids, and dilution. There should also be thorough investigation as to its source, the cows and their environment, the method employed in caring for, milking, storing and transporting the milk. BACTERIOLOGY. 1. Bacteria are classified as: — 1. Cocci; 2. Bacilli; and 3. Spirilla. Saprophytes are bacteria that derive their nutriment from 242 MEDICAL RECORD. "We publish the proceedings of an association immediately after the meeting." dead organic substances; Parasites derive their nutriment from living tissues. 2. "A ptomain is a basic substance, contains nitrogen, is found in putrefaction of proteid matter, and resembles alkaloids in its action, combining with acids to form salts ; at one time considered the essential element in bacterial intoxication. Toxins are formed by most all pathogenic bacteria, both by analysis and synthesis, in the living organ- ism; do not act like basic bodies, cause symptoms like animal and plant alkaloids (snake venom, abrin, strychnin), and vary with the source, each kind of bacteria having its own specific toxin ; their effect on the human organism is immense in minutest dosage, not only constitutionally but also locally to less degree" (Thayer's Pathology). Common sources of ptomain poisoning are : — putrid fish, meat, sausages, cheese, milk, and ice-cream. 5. The presence of Bacillus coli communis indicates the possibility of any organic contamination. Therefore the finding of this one bacillus, with or without any pathogenic bacteria is evidence of the contamination of the water. It is difficult to make an accurate estimate of the relative values of a chemical and a bacteriological analysis of water. Both methods are necessary, neither method is infallible, and each may help the other. Water may be pure from a bacteriological standpoint and yet the chemical analysis may show that it should be condemned. The chemical analysis is probably the more valuable to decide as to the quality of a drinking mater. SURGERY. I. Toxins are poisonous products of bacteria (See an- swer to No. 2 in Bacteriology, above). Antitoxins are substances elaborated in a living body to counteract the poisonous effects of toxins. Phagocytes are cells that devour and destroy microorgan- isms. 5. Both conditions are characterized by sudden onset, pain, tenderness, rise of temperature, and rapid pulse. But appendicitis will be accompanied by history of intestinal disorders, rigidity of abdominal muscles, chiefly the right rectus, possibly vomiting and constipation, the right iliac fossa is the site of the pain and tenderness ; in acute ovaritis there will probably be some menstrual disorder, the ovary will be tender on pressure, and unless there are adhesions it is mobile, the tenderness and pain are nearer the median line, there is generally either salpingitis, endometritis, gon- orrhea, or septic infection. In case of doubt an explora- tory incision will clear up the difficulty. 243 MEDICAL RECORD. "Book reviews of foreign and American publications keep you thoroughly informed of the newest literature." 7. (i) Talipes varus, in which the inner edge of the foot is drawn up, the anterior two-thirds is twisted in- wards, and the outer edge rests on the ground. (2) Talipes valgus, in which the outer edge of the foot is drawn upwards, and the inner side of the foot and ankle rest on the ground. This condition is the reverse of talipes varus. (3) Talipes equinus, in which the heel is raised and cannot be brought to the ground, and the patient walks on the toes and on the distal ends of the metatarsal bones. (4) Talipes calcaneus, in which the toes are raised and the heel depressed, so that the patient walks on the latter. This condition is the reverse of talipes equinus. OBSTETRICS. 5. A baby one week old should be nursed at the mother's breast regularly every two hours between the hours of 5 a.m. and 11 p.m. It should receive about an ounce or an ounce and a half at each nursing. 6. Uterine inertia, pelvic deformity, persistent posterior position of the occiput, eclampsia, face presentations, arrest of the after-coming head in breech cases, hemorrhage. 8. During pregnancy the patient should be put in as good a physical condition as possible; the uterus should not be emptied too rapidly; the patient should not be allowed to become exhausted; after the birth of the child the fundus of the uterus should be grasped and held till the placenta is expelled; after the expulsion of the placenta the patient should receive a dram of the fluid extract of ergot, and an abdominal binder should be applied. The physician should not leave till at least an hour after the conclusion of the labor, and not even then if the patient's pulse is 100 or over. GYNECOLOGY. 4. (1) The least suspicion of even the possibility of pregnancy; (2) menstruation; (3) acute endometritis; (4) malignant disease of the uterus or vagina; (5) acute pelvic inflammation. LEGAL MEDICINE. I. A medicine is anything that possesses or is supposed to possess remedial properties. A poison is any substance which, on being in solution in the blood, may produce death or serious bodily harm. 3. Malpractice is a failure on the part of a medical practitioner to use such skill, care and judgment in the 244 MEDICAL RECORD. " Original Articles are of the highest scientific value and most practical character, hy the foremost men of the world." treatment of a patient as the law requires ; and thereby the patient suffers damage. If due to negligence only, it is civil malpractice. But if done deliberately, or wrongfully, or if gross carelessness or neglect has been shown, or if some illegal operation (such as criminal abortion) be per- formed, it is criminal malpractice. STATE BOARD EXAMINATION QUESTIONS. Medical Examining Board of Virginia. June 19, 20, 21, and 22, 1906. CHEMISTRY. 1. Define valence, base, a salt, dialysis, alloy. 2. Describe the chemistry of alcohols and ethers. 3. Give formula of ammonia. The sources and uses of ammonia in medicine and the arts. 4. Give chemistry of respiration, showing what is inhaled, what is exhaled, and how the gases enter and leave the blood. 5. Show by equation how nitric acid is formed by the action of sulphuric acid on potassium nitrate. 6. Complete the following equations : AgNOs + NaCl. = 4 HF + SiO,= TOXICOLOGY. 1. Give symptoms and treatment for carbolic acid poi- soning. 2. State symptoms of chronic arsenic poisoning with treatment for same. 3. Describe the difference between alcoholic, uremic and opium coma. MEDICAL JURISPRUDENCE. 1. Define medical jurisprudence. 2. Give the reliable signs of death. 3. How would you distinguish between insanity and idiocy. OBSTETRICS, GYNECOLOGY, AND PEDIATRICS. 1. What signs are brought out by abdominal palpation in the last stages of pregnancy, and their relative value? 2. Detail briefly the hygienic measures necessary for the successful issue of pregnancy? 3. Define pelvimetry; what measurements obtained thereby should determine interference? 245 MEDICAL RECORD. " Range of subjects embraces every branch of medicine and surgery." 4. What circumstances, other than pelvic contractions, may cause dystocia? 5. Describe the management of delivery in breech pres- entations. 6. Describe briefly an operation for relaxed pelvic out- let. 7. Detail the symptoms and possible terminations of pelvic peritonitis. 8. Treatment of rectovaginal fistula. 9. What therapeutic agents should be cautiously exhib- ited in infancy, and mention some that they bear propor- tionately better than adults. 10. Mention the most important diseases of the larynx in children, giving the causes for their greater danger. SURGERY. 1. Give the diagnosis and treatment of acute osteo- myelitis. 2. Give the cause and treatment of varicose ulcers. 3. Name the surgical diseases common to man and the domestic animals. 4. Give the differential diagnosis between (a) concus- sion of the brain so-called, (b) fracture of the skull, and (c) rupture of the middle meningeal artery. 5. Give briefly Cohnheim's hypothesis as to the origin of tumors. 6. What is hydrocele? Give diagnosis and treatment. 7. Give the nature and treatment of Pott's fracture. 8. Name the dangers and give the treatment of car- buncle. 9. Give the causes and treatment of cystoureteropyelitis. 10. Name the dislocations of the elbow. Give the symptoms and treatment of the backward dislocation. ANATOMY. 1. Describe the upper extremity of the tibia. 2. Describe the ligaments of the hip joint. 3. Describe the external oblique muscle, including a de- scription of the superficial abdominal ring. 4. Give the commencement, termination, relations, and branches of the brachial artery. 5. Give the commencement, termination, and relations of the internal jugular vein. 6. Describe the duodenum. 7. Give origin, course, and distribution of the median nerve. 8. Name the muscles, nerves, and arteries severed by a cross section of the thigh at the junction of the middle with the lower third. 246 MEDICAL RECORD. " European correspondents furnish medical news oi special interest and reports of the principal foreign medical societies." EMBRYOLOGY. i. At what stage of embryonic life does the develop- ment of the alimentary canal commence, and from what layer of the blastoderm is it formed? 2. What changes occur in the vascular system of the fetus at birth? PRACTICE, ETIOLOGY, AND DIAGNOSIS. 1. To what disorders are persons of a lithemic diathesis most prone? Outline dietary and treatment of the lithemic state. 2. State early symptoms and causes of tuberculosis. 3. State physical symptoms and diagnosis of asthma. 4. In what conditions is severe pain a prominent symp- tom, and to what extent does localized pain aid recogni- tion 5. State cause and management of acute milk infec- tion. 6. Describe the stools of acute enteritis, typhoid, ob- structive jaundice. 7. Differentiate between scabies and pustular eczema. 8. What is aphasia? Give cause, and differentiate be- tween the ataxic and aphasic forms. 9. Give symptoms and treatment of chorea. 10. What drugs influence character of stools? 11. What clinical significance attaches to cardiac aryth- mia 12. Cause and treatment of stomatitis. PATHOLOGY. 1. Name the phenomena comprised (changes which occur) in an inflammatory process. 2. State the systems through which, and how necrosis is produced by disordered nutrition. 3. What is leucopenia, and in what important disease does it occur? 4. What is an exudate, and what is the character of the exudate in lobar pneumonia, bronchopneumonia, and acute peritonitis? 5. Name the histological elements to be found in a fibro- osteochondromyxo sarcoma. By what route do the metas- tases of sarcoma generally occur? 6. Give the morbid anatomy of acute articular rheuma- tism (rheumatic fever), and name the possible complica- tions of this disease. BACTERIOLOGY. I. Define and illustrate the terms, aerobic, obligate, ple- 247 MEDICAL RECORD. Its prestige attracts articles by the best known writers. omorphous, and sporogenous, and name and explain the two varieties of chemotaxis. 2. Describe the microorganism of anthrax, and give its pathogenicity. 3. What special culture medium is required for the growth of the gonococcus? Give the pathogenicity of the gonococcus. NEUROLOGY. 1. Give the etiology of locomotor ataxia. 2. Give the symptoms of cerebral apoplexy, and name the conditions the coma of which may be simulated by an apoplectic stroke. 3. Give the prognosis in tubercular meningitis and in epidemic cerebrospinal meningitis, and the general indica- tions of treatment in the latter. MATERIA MEDICA. i. Name, with dose of each, the preparations of sali- cylic acid; give its physiological action, and state in what form it is to be administered. 2. Give the preparations of belladonna; describe the toxic effects and give antidotes. 3. Give the chief alkaloid of cinchona, its dose, and its physiological action. 4. Name the preparations of the chlorides of mercury; give dose and differentiate the physiological action of each. 5. Name the mineral acids and mention the special prop- erties of each. 6. Give the physiological action of opium ; name its most important alkaloids and give dose of each. THERAPEUTICS. i. Into what two classes are bitters divided? Give therapeutic uses. Contraindications. Time of administra- tion. 2. How may the two chlorides of mercury be admin- istered? Give their therapeutic uses. In bilious attacks, when you give calomel, what remedy often used to allay nausea would you be particular not to give? 3. Why would you use a strong solution of arsenic when applied over large surfaces? In giving Fowler's solu- tion in increasing doses what untoward symptoms would . indicate that the dose should not be further increased? 4. (a) Give the therapeutic application of drugs in the different stages of pneumonia; (b) give the comparative value of chloroform and ether as an anesthetic. 5. (a) Describe the therapeutics of iodine and its salts; (b) what are the therapeutic uses of diuretics? 6. Prescribe a local application for erysipelas, for rhus- 248 MEDICAL RECORD. Not a local Journal, but International In Its scope." toxicodendron poisoning. Name some remedies used for epistaxis, croup, singultus, ptyalism. Write a prescription for night-sweats of phthisis, for ascites. PHYSIOLOGY. 1. What are the uses of the blood, and what is the dif- ference between arterial and venous blood? 2. What is the effect of the pneumogastric nerve upon the heart? 3. What is meant by the term vesicular murmur? 4. What are the characteristics of peptones? 5. Name the pancreatic ferments, and describe the ac- tion of each. HYGIENE. i. Name the qualities desirable in water for drinking and domestic purposes. 2. Give best methods for disinfecting a house in which there has been a case of smallpox. 3. What precautions should be taken by a physician attending a case of diphtheria. HISTOLOGY. 1. What is meant by endochondral formation of bone, and describe process briefly. 2. Describe formation of an artery, giving coats. LARYNGOLOGY. 1. What are the symptoms, course, and treatment of acute laryngitis? 2. Give the diagnosis and treatment, both general and special, of laryngismus stridulus. 3. Give the symptoms, course, some common complica- tions, and treatment of acute follicular tonsillitis. RHINOLOGY. 1. What anatomical arrangements within the nares ren- der the treatment of chronic rhinitis difficult? 2. Give the most generally accepted theory of predis- posing and exciting causes of hay fever, and describe its symptoms. OPHTHALMOLOGY. i. What are the macroscopical appearances of the most common forms of keratitis, and the appropriate treatment? 2. Give the causes, symptoms, and general and local treatment of trachoma. 3. Give cause, symptoms, and treatment, both prophy- lactic and remedial, of ophthalmia neonatorum. OTOLOGY. 1. Define tinnitus aurium and give the causes of it. 2. Give briefly the diagnosis and treatment of acute otitis media. 249 MEDICAL RECORD. " Therapeutic Hints contain many valuable formulae by the foremost medical men in the world." ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. Medical Examining Board of Virginia. June 19, 20, 21, and 22, 1906. CHEMISTRY. 1. Valence is the combining power of an atom of an element as compared with that of an atom of hydrogen. A Base is a compound which on entering into double decomposition with an acid produces a salt and water. A Salt is a substance derived from an acid when the hydrogen of the latter has been partially or completely replaced by an electropositive element or elements (a metal or metals). Dialysis is the process of separating colloids from crys- talloids. An Alloy is a substance composed of two or more metals. 2. An Alcohol is the hydroxide of a hydrocarbon radi- cal. Alcohols are monoatomic, diatomic, and triatomic, according to the saturating power of the radical. They are also classified as primary, secondary, and tertiary. The primary alcohols are characterized by the group CH s OH, and yield on oxidation, first an aldehyde, and then an acid. Secondary alcohols contain the group CHOH, and on oxi- dation yield a ketone. The tertiary alcohols contain the group COH, and when oxidized two acids or ketones are produced, each with fewer carbon atoms than the original alcohol. Ethyl alcohol, CH 3 .CHoOH is a primary alcohol; isopropyl alcohol, CH 3 CHOH.CH< is a secondary alcohol; tertiary butyl alcohol, (CH 3 ) 3 .COH is a tertiary alcohol. Ethene glycol, CH 2 0H.CH 2 0H is a diatomic alcohol, and glycerol, CH,OH.CHOH.CH,OH is a triatomic alcohol. An Ether is the oxide of a hydrocarbon radical. In sim- ple ethers the radicals are the same, as (C2HO2O, ethyl ether; in mixed ethers the radicals are different, as CH 3 . GH5.O, methyl ethyl ether. A compound ether is a sub- stance derived from an acid by replacing the hydrogen of the acid by a hydrocarbon radical, thus C 2 H 5 .N0 2 .0, ethyl nitrate or nitric ether; compound ethers are now generally called esters. 3. Ammonia ; formula is NH 3 ; sources, in nature from the decomposition of animal or vegetable matter containing nitrogen and hydrogen ; it is manufactured from ammonium chloride and calcium hydroxide according to the equation: 2NH«Cl+Ca(OH) a =2NH,+CaCl,+2H.O. It is used as a respiratory stimulant, a circulatory stimulant, a counter- 250 MEDICAL RECORD. " Keeps you in closest touch with the weekly progress of medicine and surgery throughout the world." irritant; it neutralizes acids, making definite salts known as ammonium salts, which are formed by the direct com- bination of the ammonia with the acid. It is also used in the artificial preparation of ice. 5. KNO,+H,S04=KHS04+HNOs. 6. AgNO,+NaCl = AgCl+NaNO«. 4 HF+Si0 2 =SiF<-f2H 2 0. TOXICOLOGY. 1. Symptoms: — buccal mucous membrane is whitened and hardened; vomiting; burning pain in mouth, esopha- gus, and stomach; pulse and body temperature are lowered; the pupils are contracted; collapse, and finally death. The urine may become dark. Treatment: — emetics, white of egg, stimulants. Alcohol is said to be antidotal. 2. Symptoms: — malaise, anorexia, drowsiness, photo- phobia, conjunctivitis, eczema, weakness, emaciation, local paralysis, stripping off of the skin and dropping of the hair. Treatment: — remove the causes, give freshly prepared ferric hydroxide, castor oil, diuretics. 3. In alcoholic coma there may be an odor of alcohol on the breath, the patient can generally be aroused by shouting in his ear, there is no paralysis, the pupils are normal or dilated, respiration is practically normal, the pulse is first rapid and later feeble, and the skin cool. In uremic coma there may be a urinous odor to the breath, the urine is scanty and contains albumin, there is slow pulse with high arterial tension, the pupils are usually small and equal, respiration is deep and may be quickened, the body temperature may be above normal or subnormal. In opium coma the pupils are contracted, respiration is slow, pulse slow and full, body temperature is normal or subnormal, there may be the odor of laudanum on the breath. MEDICAL JURISPRUDENCE. 1. Medical jurisprudence is the application of the knowledge of any of the branches of medicine to the prob- lems and requirements of the law. 2. The complete and permanent cessation of circulation and respiration, rigor mortis, loss of body heat, pallor of the body, putrefaction. 3. Idiocy is congenital. OBSTETRICS. GYNECOLOGY, AND PEDIATRICS. 9. The following should be cautiously exhibited in infancy: — cocaine, opium, apomorphine, jaborandi, the coal- tar derivatives, acids, and some of the preparations of iron. The following are relatively well tolerated : — arsenic, 251 MEDICAL RECORD. The MEDICAL KECOKD publishes no " Students' Number," for every issue is a students' number and a practitioners' number in one. belladonna, chloral, calomel, bromides, iodides, quinine, and alcohol. SURGERY. 3. Tuberculosis, hydrophobia, actinomycosis, glanders, anthrax, septicemia, pyemia, cancer and other tumors, cleft palate and hare-lip. 4. (a) Concussion of the brain is characterized by sud- den onset, the patient is unconscious but can be aroused, the muscles are relaxed and flaccid, the pulse weak and slow, respirations faint and irregular, the skin pale and cold, the sphincters relaxed, the pupils are equal and react, the temperature is subnormal but is the same on both sides of the body. (b) In fracture of the skull (at the base) there will be hemorrhage and escape of the cerebrospinal fluid either from the nose, into the orbit, from the ear, or into the loose cellular tissue of the mastoid or occipital region ; there will be indications of injury to one or more of the cranial nerves, such as loss of smell, blindness, ptosis, strabismus, facial paralysis, internal deafness. (c) In rupture of the middle meningeal artery there will be first a concussion with its accompanying unconsciousness; this will be followed by a temporary return to conscious- ness, lasting from a few minutes to an hour or more; this is succeeded by a gradually increasing drowsiness, ending in coma. 5. Cohnheim suggested that, owing to some slight devel- opmental errors, small portions of embryonic tissue become misplaced and surrounded by cells belonging to a different blastodermic layer. These misplaced cells lie dormant, but are still alive; and later some blow or other irritant acts as a stimulus and starts them growing, and the result is a tumor. 8. The dangers of carbuncle are :— hemorrhage, septic phlebitis, septic clots or emboli, septic meningitis, exhaus- tion, septicemia, or pyemia. ANATOMY. 8. Muscles: — Vastus externus, vastus internus, crureus, rectus femoris, sartorius, gracilis, adductor longus, adductor magnus, biceps, semimembranosus, semitendinosus. Arteries: — Femoral, profunda femoris, external circum- flex, comes nervi ischiadici. Nerves: — Anterior crural, middle cutaneous, internal cu- taneous, long saphenous, external cutaneous, obturator, great sciatic, lesser sciatic. 252 MEDICAL RECORD. " Our reporters attend every convention of first-rate im- portance. The news is telegraphed or cabled exclusively to the MEDICAL KECORD." EMBRYOLOGY. 1. The development of the alimentary canal begins at a very early period of embryonic life, the enlargement which later becomes the stomach being noticeable as early as the fourth week. The alimentary canal is derived from all three layers of the blastoderm, but particularly from the hypoblast and the mesoblast. 2. The hypogastric arteries shrink and become imper- vious, the foramen ovale closes, the eustachian valve atro- phies, the ductus arteriosus closes, the ductus venosus becomes obliterated, the umbilical vein becomes obliterated. PRACTICE, ETIOLOGY, AND DIAGNOSIS. I. They are most prone to gout, arteriosclerosis, chronic interstitial nephritis, aneurysm, angina pectoris, acute in- flammations, apoplexy, and certain skin diseases, such as urticaria, eczema. 4. Severe pain is a prominent symptom in : — passage of calculi, burns, aneurysms, angina pectoris, colic, gout, whit- lows, otitis media, tic doloureux, and acute inflammations. Localized pain is of some value as an aid to diagnosis, but an indication of the different conditions in which such pains are found would take up too much space; it should, however, be remembered that pain is sometimes wrongly referred, as pain in the knee in hip joint disease, or the pain of herpes zoster, which is referred to the skin. 6. In acute enteritis, the stools are fluid or semifluid, and contain particles of undigested food, bile, and tiny specks of mucus. In typhoid, the stools are thin, yellowish ("peasoup"), and vary in number from one or two up to ten or twelve in twenty-four hours. In obstructive jaundice, the stools are clay-colored, pasty, and offensive. 7. In scabies, there will be the presence of burrows and of the itch-mite, the eruption will generally be found on the anterior surface of the wrists, about the umbilicus, in the mammary region in females, or around the genitals in males; there is intense itching; it is communicable, and is readily amenable to treatment. In. pustular eczema, there are no burrows and no itch- mites ; as a rule, poorly nourished or delicate children are attacked, and the eruption is found on the face and the scalp; after the pustules rupture, yellowish or greenish crusts form ; the itching is variable. 8. Aphasia is the inability to express ideas by either 253 MEDICAL RECORD. " Choice and important abstracts from the leading medical periodicals of the world in a condensed and practical form." speech or writing. It is caused by lesions of the cortical centers, and is not due to lesions of the peripheral nerves or of the organs concerned in speech or writing. In ataxic aphasia, there is loss of speech, owing to lack of coordination of the muscles concerned in voice pro- duction. In sensory or amnesic aphasia there is loss of word memory, which may or may not exist in connection with ataxic aphasia. There are several varieties of aphasia. io. Calomel and colchicum may color the stools green; rhubarb, senna, and santonin may cause a yellow color; iron, bismuth, and manganese may give a black color ; log- wood may cause a red color; and sulphur may cause a very offensive odor. II. Cardiac arrhythmia has no particular clinical sig- nificance, unless it accompanies some disease. According to Butler (Diagnostics of Internal Medicine), search should be made for one or more of the following: — (i) Valvular cardiac disease, especially mitral lesions, in _ which it is usually, but not always, a sign of beginning failure of com- pensation, passing in many instances into delirium cordis; simple dilatation, chronic myocarditis, sclerosis of the coronary arteries, and fatty degeneration; possibly obscure changes in the cardiac ganglia, and overstrain or impaired nutrition in wasting diseases or long-continued fevers. (2) Poisons circulating in the blood, such as alcohol, coffee, tea, tobacco, digitalis, aconite, and belladonna, or the toxines of the infectious diseases, especially of typhoid fever and pneumonia. (3) Diseases of the intracranial contents, meningitis, hemorrhage, abscess, softening, concussion, and not infrequently mental excitement. (4) Neurasthenic conditions resulting from excesses or overstrain. Brief attacks of moderate arrhythmia are not uncommon in neurotic individuals, following even a slight departure from their usual habits in food, drink, or exertion. (5) Diges- tive disturbances, acute or chronic, and jaundice or consti- pation, particularly if associated with an unusually hypo- chondriacal frame of mind. (6) More rarely arthritis deformans, exophthalmic goiter, and renal disease. PATHOLOGY. 2. Necrosis is produced by disordered nutrition through two systems: — (1) the circulatory, by means of anemia and of stasis of blood and lymph; and (2) the nervous, by means of both vasomotor impulses and the reflexes. 3. Leucopenia is the condition in which the number of white blood cells is diminished: sometimes the term is 254 MEDICAL RECORD. " The most important contributions to the literature of medicine and surgery have been published first in the MEDI- CAL RECORD." used to denote merely absence of leucocytosis. It occurs in: — typhoid, tuberculosis, pernicious anemia, pneumonia, cachexia, inanition, measles, influenza, malaria. 4. An exudate is the material that has passed through the walls of the vessels into the surrounding tissues, as the result of inflammation. In lobar pneumonia, the exudate consists of fibrin, red blood cells, epithelial cells, polynu- clear leucocytes, and diplococci, in the stage of red hepati- zation; in the stage of gray hepatization the fibrin and red bood cells have disappeared, and the exudate now consists mainly of leucocytes and some pus cells. In bronchopneumonia the exudate consists of serum, leu- cocytes and endothelial cells ; occasionally there may be a few red blood cells and a trace of fibrin. In acute peritonitis the exudate is serous or purulent, and is generally fibrinous. 5. Fibrous tissue, bone, cartilage, mucous tissue, and connective tissue of embryonic type. The metastasis is by way of the blood-vessels. 6. The synovial membrane and ligaments are swollen and congested ; the synovial fluid is increased in amount, is turbid, and may contain lymph; the cartilages are roughened and may become ulcerated or eroded; the joint may suppurate or there may be a false ankylosis; in the blood there is a diminution in the number of the red cells, and an excess of fibrin. The possible complications in- clude: — endocarditis, pericarditis, occasionally myocarditis, pleurisy, chorea, tonsillitis, pneumonia, cerebral disturbances such as convulsions or delirium, and certain skin eruptions as urticaria. BACTERIOLOGY. I. Aerobic bacteria are such as require the presence of oxygen in order to live and grow. Most bacteria are aerobic. Obligate means necessary ; and the term is used in op- position to facultative. Obligate aerobic bacteria are such bacteria as cannot exist without oxygen; whereas fac- ultative aerobic bacteria are such as thrive better in the presence of oxygen, but still can manage to exist with- out it. Pleomorphous bacteria are such as assume more than one form. Sporogcn-ous bacteria are bacteria in which reproduction takes place by sporulation instead of by the more usual method of fission. Chemotaxis is the property by virtue of which certain 255 MEDICAL RECORD. "We publish the proceedings of an association immediately after the meeting." ) living cells approach (positive chemotaxis) or move away from (negative chemotaxis) certain other cells or sub- stances. 3. The special culture medium required for the growth of the gonococcus is human blood serum. NEUROLOGY. I. Locomotor ataxia is a disease of adult life; is more common in men than in women; is more common in cities than in the country; syphilis is believed to be the most frequent direct cause; alcoholism, injury, exposure to cold and wet, have all been urged as causes, but they are not now assigned so important a place as etiological factors as was formerly the case. MATERIA MEDICA. 1. Preparations of salicylic acid are : — sodium salicylate, dose gr. xv; lithium salicylate, dose gr. xv; ammonium salicylate, dose gr. iv; strontium salicylate, dose gr. xv; phenyl salicylate (salol), dose gr. vijss; bismuth_ subsalicy- late, dose gr. iv. Physiological action: — antiseptic, irritant, diaphoretic, diuretic, antipyretic, and cholagogue. It is best administered in the form of one of the salts, preferably sodium salicylate. 2. Preparations of belladonna : — the extract, the fluid extract, tincture, ointment, the plaster, and the liniment. Atropine, with its oleate and sulphate, and homatropine hydrobromide. Toxic effects: — dryness of the mouth and throat, thirst, drowsiness, dysphagia, face flushed, pupils much dilated, eyes prominent, numbness and partial paralysis of the extremities, and there may be delirium and coma. Antidotes:— There is no antidote; pilocarpine is the best physiological antagonist and opium will counteract the effect on the pupils. 4. The only preparation of corrosive sublimate or mer- curic chloride is the lotio hydrargyri flava, or yellow wash. The preparations of calomel or mercurous chloride, are compound cathartic pills, dose two pills; lotio hydrargyri nigra, or black wash ; and compound pills of antimony, or Plummer's pills, dose one to three pills. 5. The mineral acids are: — hydrochloric, sulphuric, nitric, nitrohydrochloric, and phosphoric acids. THERAPEUTICS. i. The two classes into which bitters are divided, are: — (1) simple bitters, and (2) aromatic bitters. Their thera- peutic uses are: — to promote appetite, to increase gastric 256 MEDICAL RECORD. Save and bind your numbers; it will give you two great medical encyclopedias every year. secretion, to act as tonics to the mucous membrane of the alimentary tract, in atonic dyspepsia, in chronic gastritis, in sea-sickness, and as vehicles for the administration of other drugs and preparations. Contraindications: — acute gastritis and gastric ulcer. Bitters should be administered shortly before meals. 5. (b) The therapeutic uses of diuretics : — to remove liquid from the body tissues or cavities, to increase the elimination of waste products and of poisons, to dilute the urine, and to maintain the excretory action of the kidneys. 6. For erysipelas, equal parts of ichthyol, ether, and col- lodion. For rhus toxicodendron poisoning, grindelia ro- busta, four drams to a pint of water. For epistaxis, acon- ite, adrenalin, witchhazel, vinegar, tincture of the chloride of iron, plugging the nares. For croup, ipecac, apomor- phine, lactic acid, hydrogen dioxide, potassium citrate. For singultus, morphine, chloroform, ether, strychnine, ice. For ptyalism, acids, astringents, potassium iodide, borax, belladonna. For night sweats of phthisis: — I£ Acidi camphorici 3ij Alcoholis 5j Mucilaginis acacise Siss Syrupi aurantii corticis q.s. ad. 3 n J Misce. Signa : — One dessertspoonful one hour before the sweat is expected. For Ascites: — 5. Pulveris digitalis^ Pulveris scillse aa gr. xxx Misce. Fiat in pillulas no. xxx Signa : — One every four hours. PHYSIOLOGY. 1. The uses of the blood are to supply nourishment to, and to take away waste matters from, all parts of the body. The red corpuscles supply the tissues with hemoglobin; the white corpuscles serve as a protection to the body from the incursions of pathogenic microorganisms, they take some part in the process of the coagulation of the blood, they aid in the absorption of fats and peptones from the intestine, and they help to maintain the proper proteid content of the blood plasma. Arterial blood is bright red in color, contains more oxy- gen, less carbon dioxide, more water, and is slightly warmer; venous blood is purple in color, contains less oxygen, more carbon dioxide, less water, and is slightly cooler (except in the hepatic vein). -'57 MEDICAL RECORD. "Acknowledged to be the leading independent medical weekly." 2. The pneumogastric nerve conveys inhibitory im- pulses from the medulla to the heart. 3. By the term vesicular murmur is meant the peculiar breathing sound which is heard when listening over the vesicular tissue of the lungs. 4. Peptones are characterized by being very soluble in water, hygroscopic, easily dialyzed, and they respond to none of the ordinary proteid reactions with the exception of the biuret reaction, with which they give a red color. _ 5. The pancreatic ferments are (1) trypsin, which changes proteids into proteoses and peptones, and after- wards decomposes them into leucin and tyrosin ; (2) amy- lopsin, which converts starch into maltose; (3) steapsin, which emulsifies and saponifies fats; and (4) a milk-curd- ling ferment. All of these act in an alkaline medium only. HYGIENE. 1. It should be colorless, odorless, cool, limpid, soft; it should have an agreeable taste, neither salty nor sweet nor flat; it should dissolve soap readily without formation of a curdy precipitate, it should contain not more than about twenty-five to thirty grains of solids per gallon, and should not be polluted with sewage. OTOLOGY. 1. Tinnitus aurium is the name given to any subjective sounds heard in the ear. The chief causes are : — neuras- thenia, impacted cerumen, otitis, and other ear diseases; Meniere's disease, obstruction of the Eustachian tube, anemia, leukemia, cerebral hyperemia and anemia, arterio- sclerosis, gout, digestive disorders, excessive use of alcohol or tobacco, and the use of certain drugs such as quinine or salicylic acid. STATE BOARD EXAMINATION QUESTIONS. State Medical Examining Board of Washington. Spokane. January 2, 3, and 4, 1907. SURGERY. 1. Give the differential diagnosis between dislocation of the head of the femur and a fracture of the neck. Describe the treatment of the latter. 2. Give a summary of the treatment of fracture of the patella by the non-operative method. 3. Give the treatment of delayed union in ununited frac- ture. 258 MEDICAL RECORD. Keeps you strictly abreast of the times.' 4. Describe the different varieties of hernia, and describe one operation for inguinal hernia. 5. Name the different varieties of aneurysm, and the method of treatment of aneurysm in general. 6. Give the symptoms, diagnosis, and treatment of in- testinal obstruction. 7. Give the symptoms, diagnosis, and treatment of chronic tuberculosis of the kidney. 8. Give the treatment of shock resulting from hemor- rhage. 9. Give the contraindications for the employment of ether and chloroform. 10. Describe and give treatment of an infection under the palmar fascia. PREVENTIVE MEDICINE AND MEDICAL JURISPRUDENCE. 1. Differentiate between idiocy and lunacy. 2. How would you determine that a full-term dead babe was born alive or still-born? 3. Give a detail account for an examination of a body from the standpoint of the coroner in charge. 4. How do you determine that an incised wound was in- flicted by a blunt or a sharp instrument? 5. What constitutes expert testimony? 6. How long after recovery would you keep in quaran- tine a case of (a) diphtheria, (b) scarlet fever, (c) small- pox? 7. Name the portals of entry of tubercular infection. 8. State the best means of disinfecting sputum. 9. Describe the difference between contagion and infec- tion. 10. (a) What are the effects o- breathing impure air? (b) How many cubic feet per person should be allowed in a room for continued occupancy, and in a sleeping-room. PRACTICE OF MEDICINE AND DISEASES OF CHILDREN. 1. How would you differentiate between chronic gastritis and carcinoma of the stomach? 2. Define constipation and give its causes, symptoms, effects, and non-medicinal treatment. 3. What is vertigo and its different varieties? Give the diagnosis and treatment of one. 4- Give the etiology, symptoms, and treatment of hydro- thorax. 5. Give causes, symptoms, diagnosis, and treatment of myxedema. 6. Describe an attack of angina pectoris. Give its eti- ology, diagnosis, and prognosis. 259 MEDICAL RECORD. " Book reviews ol foreign and American publication! keep you thorougyly informed of the newest literature." 7. What is asthma? Give its causes and symptoms. 8. Differentiate between hypertrophy and dilatation of the heart, and outline treatment for each. 9. What are the causes, symptoms, and effects of ade- noids? 10. Describe an attack of enterocolitis in a child. Uive its etiology and dietetics. 11. What are the etiology and symptoms of alopecia areata? How is it distinguished from ringworm? 12. Describe an attack of pertussis. Give its etiology, pathology, complications, and sequelae. 13. What are the etiology, symptoms, and treatment of stomatomycosis? 14. Contrast ordinary dairy milk with human milk, and give a brief description of the essentials for the production of pure dairy milk. , 15 Give symptoms and course, with differentiation, prognosis, and treatment of tubercular meningitis in a child. OBSTETRICS AND DISEASES OF WOMEN. i Define presentation and position. Give three examples of each. Which of the latter is the most common? _ 2 Which is the greatest diameter of the female pelvis, also that of the fetal head? Give the mechanism of rota- tion of the latter during parturition in the first position. 3 At what time of gestation is the placenta formed r How would you treat an inevitable abortion subsequent to its formation? , , . 4 In a difficult labor, upon what would you base your decision as to whether Cesarean section or the application of forceps would be the proper procedure? 5 What is placenta praevia? Name the different attach- ments of the placenta in the same. Give the method of management. . . . 6 Give the symptoms and diagnosis of ectopic gestation. 7. Give the common causes of subinvolution of the uterus and the treatment of each. 8 Define metrorrhagia. Name two of its most common causes prior to the menopause. What would you suspect should it occur subsequent to the same? How would you verify your suspicion? 9. Give your treatment of a recent attack of specific vaginitis. Name two of its most common sequelae 10. Give two indications for hysterectomy. Which do you prefer, vaginal or abdominal? State upon what ground you would base your preference. 260 MEDICAL RECORD. " Statistics of the health hoards and many articles of scien- tific interest and items of general Information." CHEMISTRY AND TOXICOLOGY. 1. What is an antidote to arsenic? What effect lias arsenic on the gastrointestinal canal? What effect has it on the nervous system? In arsenic workers, what local condition may be found upon the hands? 2. What is an antidote to carbolic acid? What combina- tion is formed by its administration? How would you make a diagnosis of carbolic-acid poisoning before death? 3. Enumerate the symptoms of chronic lead-poisoning and give the treatment. 4. Give the treatment of phosphorus poisoning. 5. What are the symptoms of nitrate of silver poisoning and what are the antidotes? 6. Complete the following formulae: Zn+H 2 SO«=? and Ba0 a +2HC1=? 7. What is an atom and what is a molecule? 8. What are isomeric compounds? 9. Describe the method of detecting uric acid by HNOa. 10. Describe in detail a method of the quantitative esti- mation of sugar in urine. ANATOMY AND PHYSIOLOGY. i. Name in order the branches of the arch of the aorta. 2. Give the origin, course, and termination of the thor- acic duct. 3. Describe the occipital bone and name the structures passing through the foramen magnum. 4. (a) What tendons form the inner hamstring? (&) The outer hamstring? 5. Describe a lumbar vertebra. In what points does it differ from a dorsal vertebra? 6. Describe the diaphragm. Mention the openings formed by it, and tell what structures pass through each. Give its nerve supply. 7. Describe the circle of Willis, and name the arteries forming it. 8. What arc attachments of Poupart's ligament? How is it formed? Give its surgical significance. 9. How is the venous blood current maintained? What arteries carry venous blood? 10. Describe tbe normal heart sounds. Give causes which produce each. 11. Give the daily amount, composition, and functions of the bile. 12. What part does saliva take in digestion? What is 261 MEDICAL RECORD. « Since 1890 the Medical RECORD has had a cabled report of every International Medical Congress." its ferment? Name and give the physiology of the nerve SU i3. Y Name and give the function of the various glands of the small intestines. . 14. Give the physiology of visual accommodation to light and distance. 15. What is the physiology of blood formation i HISTOLOGY, PATHOLOGY, AND BACTERIOLOGY. i. Describe a sebaceous gland. 2. Name the layers of the mucous membrane, and give the locations where it is found. 3. Describe the cross-section of an artery. 4. Describe the iris. e, Describe a peptic ulcer of the stomach. 6 Give the pathology of the blood in pernicious anemia. 7. Name the chief differential points between carcinoma and sarcoma. . . , , .„• 8 Describe a method for staining tubercle bacilli. 9. Describe methods of culture of the diphtheria bacillus. 10. What is the Widal's reaction? NERVOUS DISEASES AND DISEASES OF THE EYE AND EAR, 1 Give diagnosis and treatment of migraine. 2 What is tic douloureux? Outline treatment 3. Mention etiology, symptoms and treatment of sciatica, 4. Describe a case of progresive bulbar paralysis. S Briefly describe a case of general paresis. 6. Define: hordeolum, chalazion, ectropion, entropion, ptosis, astigmatism and myopia. 7. Give symptoms and treatment of purulent conjunc- tivitis. , .... 8 Give diagnosis and treatment of mastoiditis. 9. Describe and give the treatment of pterygium. 10. Give the three most common causes of otitis media. MATERIA MEDICA AND THERAPEUTICS. 1. Define narcotics, anesthetics and sedatives. Give an example of each. _ 2. Define diuretics and diaphoretics. Give three ex- amples of each. 3. Give the therapy of phosphorus. 4. Give the physiological action of opium and name its . alkaloids. 5. Name the drugs you would exhibit in pneumonia, acute interstitial nephritis, and rheumatism. 262 MEDICAL RECORD. "The only American medical journal that prints report of the British Medical Association." 6. Mention three heart stimulants. Give the adult dose of each. 7. Write a prescription for acute bronchitis, chronic constipation and acute cystitis. 8. Classify the following drugs : aconite, atropia, pilo- carpine, ergot, elaterium and manganese. 9. Name four hypnotics and give the adult dose of each. Name four emetics and give the dose of each. 10. Define an alkaloid and give an example of the same. Define serum therapy. Mention three serums, the indica- tions for their use and state the dose of each. ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. State Medical Examining Board of Washington. Spokane. January 2, 3, and 4, 1907. SURGERY. 1. In fracture of the neck of the femur, the head of the femur will be found in the acetabulum ; in dislocation, the acetabulum will be empty, and the head of the femur will be found elsewhere, e.g. on the dorsum of the ilium. In the fracture, crepitus may be elicited; in the dislocation, never. In the dislocation, there is inversion and a fixed position of the limb, both of which are absent in fracture. 2. The knee is disinfected, then covered with antiseptic gauze, and firmly bandaged. The leg is extended on the thigh, the thigh flexed on the abdomen, a posterior splint i3 applied, and the foot is supported. In two or three days the bandages may be reapplied if the parts are in good con- dition, and a plaster-of-Paris dressing put on. The patient is then allowed to walk about ; the plaster-of-Paris dressing remains on for about three weeks. 3. "When delayed union exists, seek for a cause and re- move it, treating constitutionally if required, and thoroughly immobilizing the parts by plaster. Orthopedic splints may be of value. Use of the limb while splinted, percussion over the fracture, and rubbing the fragments together, thus In each case producing irritation, have all been recommended. Blistering the skin with iodine or firing it has been em- ployed. If the case be very long delayed, forcibly separate the fragments and put up in plaster as a fresh break. If these means fail, irritate by subcutaneous drilling or scrap- 263 MEDICAL RECORD. " The medical profession have been presented with the results of great discoveries by the MEDICAL RECORD in advance of any other publication." ing, or, better, by laying open the parts and then drilling and scraping at many places." (Da Costa's Surgery.) 5. The different varieties of aneurysm are: True; false; fusiform; sacculated; dissecting; arteriovenous, of which there are two varieties, varicose aneurysm and aneurysmal varix; cirsoid, and aneurysm by anastomosis. 9. The following contraindications for ether and chlo- roform are from Hare's Practical Therapeutics: "Ether should not be used by inhalation in bronchitis or acute nephritis, because of its irritant properties; in peritonitis or gastritis, because it is apt to induce vomiting; in aneur- ysm or in the presence of marked vascular atheroma, be- cause it may rupture a blood-vessel by raising arterial pressure; nor in diabetes, lest it produce diabetic, coma; and if anemia is present and an examination of the blood shows that the hemoglobin is below 50 per cent., the use of the drug should be avoided if possible. "Chloroform is not to be used in cases of fatty heart or dilatation of the heart, in those with a known idiosyncrasy, nor in the so-called lymphatic persons with overgrowth of lymphoid tissues, as, for example, adenoids. In the latter case it is particularly apt to cause sudden death. In valvu- lar disease of the heart chloroform may be used with caution, although ether is preferable. Given a case of valvular disease that must be subjected to operation, the chances are bettered with an anesthetic than without it, as the pain and mental shock are worse for the heart than is the anesthetic." PREVENTIVE MEDICINE AND MEDICAL JURISPRUDENCE. I. "Idiocy differs from other states of insanity in the fact that it is marked by a congenital deficiency of the men- tal faculties. There is not here a perversion or a loss of what has once been acquired, but a state in which, from defective structure of the brain, the individual has never been able to acquire any degree of intellectual power to fit him for his social position. It commences with life and continues through it." (Taylor's Medical Jurisprudence.) 4. A wound inflicted by a blunt instrument will have somewhat of the appearance of a contused wound; the edges will not be so clean cut, and the surrounding tissues will be more or less bruised. 5. In expert testimony the witness may give his opinion on facts or supposed facts as noted by himself or asserted by others. Theoretically, this can only be done by those perfectly familiar with the subject in question; but prac- 264 MEDICAL RECORD. " Special reporters in England, France, Germany, Austrian Turkey, Denmark, the Philippines, and the leading cities of the United States and Canada." tically any (or almost any) physician with a license to practice is accepted as an expert witness. 6. (a) Diphtheria: till the patient is free from all signs of congestion or rhinitis, and continued bacteriological ex- amination is persistently negative. (b) Scarlet fever: till the patient is quite free from sore throat or discharges of any kind, and the desquamation has entirely disappeared; generally six to eight weeks. (c) Smallpox: till all crusts or scabs have entirely dis- appeared. 7. The portals of entry of tubercular infection are: the respiratory tract, the alimentary tract, the skin, the mucous surfaces. It may be hereditary. 8. "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 uncertain. By reason of its consistency and adhesive properties, sputum is one of the most difficult materials to sterilize." (Har- rington's Practical Hygiene.) 9. Infectious diseases are such as are due to the pres- ence of bacteria. Contagious diseases are such as can be communicated by contact from a person who is infected to a healthy person. 10. (a) The skin becomes pale, there are gastric dis- turbances, general muscular weakness, mental impairment, and lowered vitality, resulting in the taking of various dis- eases. (b) In a room for continued occupancy each person should be allowed 3,000 cubic feet of fresh air per hour, or at least 1,000 cubic feet of space with ample and adequate facilities for ventilation. In a sleeping room occupied by several people each person should have at least 750 cubic feet of space, with proper ventilation. A sleeping room occupied by one person only should have from 1,200 to 1,800 cubic feet of space. PRACTICE OF MEDICINE AND DISEASES OF CHILDREN. I. Chronic gastritis is generally caused by indiscretions in diet, or by mental worry; it may occur at any time of life, and is characterized by pain in the epigastric region which generally comes on after eating; there is apt to be 265 MEDICAL RECORD. " The most important contributions to the literature of medicine and surgery have been published first in the MEDI- CAL KECOBD." morning vomiting, the vomitus consisting of mucus with undigested particles of food; there is seldom hemorrhage; the stomach may be enlarged, and examination of the gas- tric contents shows free HC1 diminished or absent, and the digestive ferments diminished. Carcinoma of the stomach does not usually occur before forty years of age, is more common in males, the pain is localized and constant, vomiting is copious and occurs some time after eating; the vomitus contains "coffee ground" material; hemorrhages are common; a tumor may be pal- pated, and examination of the gastric contents shows ab- sence of free HC1 and presence of lactic acid; severe anemia and cachexia are also present. 3. Vertigo is a disturbance of the sense of equilibrium, a condition in which the patient or objects surrounding him appear to be in a state of rotation or oscillation. It is not a disease; but is a symptom of many pathological condi- tions. The chief varieties are: (1) auditory, or labyrinthine, also called Meniere's disease; (2) cerebral; (3) gastric; (4) toxic; (5) senile; (6) hysterical; (7) essential. 9. Adenoids a. Causes: The real cause is unknown, but the condition is generally observed in childhood; heredity is also supposed to be a factor ; males are more frequently affected than females ; malnutrition and scrofula seem to be causative factors ; the condition is often associated with en- larged tonsils, enlarged cervical glands, hypertrophy of the nasal mucous membrane, deviations of the septum, spurs; it often follows some of the acute infectious diseases. Symptoms: Mouth-breathing; snoring; open-mouth; a vacant, dull expression of the face; modification of the voice (nasal twang), with inability to pronounce certain letters. Effects: Earache and other ear affections ; mental de- ficiency; frequent attacks of coryza; nose-bleed; stunted growth ; convulsions, laryngismus stridulus, and various other neuroses may also be noticed. 11. Alopecia areata. Etiology: The real cause is un- known ; it has been regarded as a neurosis ; as due to para- sites ; or as the result of malnutrition of the hair. Symptoms: There are circumscribed round or oval patches of baldness, which may appear suddenly or gradu- ally, generally in early adult life; the scalp appears un- changed or may be pale or hyperemic ; there are no scales ; occasionally the eyebrows or beard are involved. 266 MEDICAL RECORD*. " Surgical Suggestions that will appeal to the student and the general practitioner." It is distinguished from Ringworm, in that the latter is rare in adults, is characterized by scales in which are broken off stumps of hairs with split ends, and a micro- scopical examination shows the presence of the tricophyton fungus in ringworm. 13. Stomatomycosis is caused by a vegetable parasite, the oldium albicans. The symptoms are redness, either general or in patches; swelling of lips, gums, cheek, and tongue; fetid breath ; dribbling of saliva, or the mouth is dry ; ten- derness, and difficulty in eating. Treatment consists in cleanliness, antiseptic mouth washes, tonics, stimulants, and good general hygiene. OBSTETRICS AND DISEASES OF WOMEN. 1. By Presentation is meant the part of the fetus which presents at the pelvic brim ; examples — vertex, breech, face, By Position is meant the relation between a point on the fetus and a point on the maternal pelvis; examples, in a vertex presentation the positions may be (1) left occipito- anterior, (2) right occipito-posterior, (3) right occipito- anterior, (4) left occipito-posterior. The left occipito- anterior position of the vertex presentation is the most common. 2. The greatest diameters of the female pelvis are the transverse at the brim and the antero-posterior at the out- let; each of which is five inches. The greatest diameter of the fetal head is the occipito- mental, which is five and a half inches. 3. "The placenta is formed by the union of the chorion frondosum and the decidua serotina, and therefore is com- posed of fetal and maternal tissues. In the third or fourth month of pregnancy it constitutes a distinct struc- ture, although its site is indicated at a much earlier period by the increased thickness of the chorion at that point." (Williams' Obstetrics.) 6. "When extrauterine pregnancy exists there are: (1) The general and reflex symptoms of pregnancy ; they have often come on after an uncertain period of sterility. Nau- sea and vomiting appear aggravated. (2) Then comes a disordered menstruation, especially metrorrhagia, accom- panied with gushes of blood, and with pelvic pain coinci- dent with the above symptoms of pregnancy. Pains are often very severe, with marked tenderness within the pel- vis. Such symptoms are highly suggestive. (3) There is the presence of a pelvic tumor characterized as a tense cyst, sensitive to the touch, actively pulsating. This tumor has a steady and progressive growth. In the first two months 267 MEDICAL RECORD. "Editorials on subjects of timely interest and of vital Im- portance dealt with in a masterly and scholarly style." it has the size of a pigeon's egg; in the third month it has the size of a hen's egg; in the fourth month it has the size of two fists. (4) The os uteri is patulous; the uterus is displaced, but is slightly enlarged and empty. (5) Symp- toms No. 2 may be absent until the end of the third month, when suddenly they become severe, with spasmodic pains, followed by the general symptoms of collapse. (6) Expul- sion of the decidua, in part or whole. Nos. 1 and 2 are presumptive signs; Nos. 3 and 4 are probable signs; Nos. 5 and 6 are positive signs." {American Text-Book of Ob- stetrics. ) 7. Subinvolution of the uterus is commonly caused by: Lacerations of the cervix; absorption of septic products; mismanagement of the convalescent stage of the puer- perium, chiefly too early rising; tedious labors; misplace- ment, of the uterus; retained clots or membranes; tumors of the uterus. 8. Metrorrhagia is a uterine hemorrhage independent of menstruation. Two of its most common causes prior to the menopause are uterine displacements and tumors (chiefly fibroids and polypi). Occurring subsequent to the menopause, cancer would be suspected. This_ suspicion would be verified by a microscopic ex- amination of a piece of tissue excised from the cervix. 10. Two indications for hysterectomy: Carcinoma and fibroids. As to preference between the vaginal and abdominal routes, the following is taken from Garrigues' Gyne- cology: "If the vaginal route is available, it should be preferred, because it entails much less shock, requires a simple after-treatment, does not leave any visible cicatrix, predisposes less to hernia, and allows the patient to re- sume work in shorter time. On the other hand, the vag- inal route is more difficult on account of the limited space. Hemorrhage is more troublesome to check, adhesions are harder to separate, and the bladder and intestine more ex- posed to injury and less accessible for repair. The pelvic cavity cannot be seen so well and the abdominal not at all. If tissue is left to mortify, it emits an offensive odor." CHEMISTRY AND TOXICOLOGY. I. Antidote for arsenic is freshly prepared ferric hy- droxide. Arsenic acts as an irritant on the gastrointestinal canal and then causes inflammation. 268 MEDICAL RECORD. "The progressive physician must have his medical weekly just as the business man his newspaper." On the nervous system it probably acts as a stimulant, if given in medicinal doses; in toxic doses it may cause par- alysis. The local condition that may be found upon the hands of arsenic workers is as follows : If the epidermis is unbroken an eruption may appear, if the epidermis is broken the arsenic has a caustic and destructive effect; ulceration around the nails and shedding of the nails may also occur. 2. The chemical antidotes to carbolic acid are the soluble sulphates, such as magnesium or sodium sulphate. With the carbolic acid these salts form insoluble sulpho- carbolates. Before death carbolic acid poisoning can be diagnosed by the hoarseness of the voice, in addition to all the other signs of corrosion, such as eschars on mucous membrane of mouth, vomiting, purging, abdominal pain, cold, perspiration, pinched and anxious face, collapse, etc. 3. The symptoms of chronic lead poisoning are: Wrist drop, severe colic around the umbilicus, constipation, feces clay colored, blue line on the gums at the junction with the teeth. The treatment is first to remove the cause; then admin- ister a purge of jalap and calomel combined witn opium; iodide of potassium should also be given to help in the elimination of the lead. 4. The treatment of phosphorus poisoning is to ad- minister first an emetic, then old French oil of turpentine, or solution of potassium permanganate, and avoid giving any oils or fat with the food. 5. The symptoms of nitrate of silver poisoning are: "Almost immediately after the ingestion of a poisonous dose of nitrate of silver violent pain in the belly, with vomiting and purging, comes on. At the same time evi- dences of widespread gastroenteritis develop. The ab- dominal walls are knotted and hard, and perhaps scaphoid. The face is anxious and livid and covered with a sweat When the vomiting occurs the ejecta are seen to be brown or blackish, or even white and curdy. The lips are stained white, but they rapidly become brown, then black. In some cases the nervous symptoms are severe and con- vulsions with rlelirium may occur. The convulsions are epileptiform. Death ensues either from gastroenteritis or from centric respiratory failure, accompanied by a profuse exudation of liquid mucus into the bronchial tubes. "The treatment consists in the use of common salt, which is the chemical antidote, the employment of opium and oils to allay irritation, and in the ingestion of large draughts of milk and of soap and water for the purpose of diluting 260. MEDICAL RECORD. "Bulletins of Examinations of State Medical Licensing Boards published bi-weekly." the poison and protecting the mucous membranes of the esophagus and stomach from the action of the irritant. The bodily heat mus be maintaned." (Hare's Therapeutics.) 6. Zn+H 8 SO«=ZnSO*-fH,. Ba0 2 +2HCl=BaCl+H 2 0,. 7. An atom is the smallest portion of an element that can enter into a chemical reaction, or that can enter into the composition of a molecule. A molecule is the smallest quantity of any substance that can exist in a free state. 8. Isomeric compounds are compounds which, while differing in properties, possess the same percentage com- position. 9. Moisten the substance with HN0 3 and evaporate; then let it cool, and add a little NHJIO ; a brilliant red color is produced. 10. Method for the quantitative estimation of sugar in urine: "Fehling's method. — The solution is made as fol- lows: I. Dissolve cupric sulphate 51.98 gm. in water to 500.00 c.c. II. Dissolve Rochelle salt 259.9 gm. in sodium hydroxide soln. sp. gr. 1.12 to 1,000 c.c. (Piffard). When required for use, one volume of I. is to be mixed with two volumes of II. The copper contained in 10 c.c. of this mixture is precipitated completely, as cuprous oxid, by 0.05 gm. of glucose. "To determine the quantity of sugar, place 10 c.c. of the mixed soln. in a flask of about 250 c.c. capacity, dilute with H 2 to about 30 c.c, and heat to boiling. On the other hand, the urine to be tested is diluted and thoroughly mixed with four volumes of H 2 if it be poor in sugar, or with nine volumes of H 2 if highly saccharine, and a burette filled with the mixture. When the Fehling soln. boils, add a few gtt. NH 4 HO and then 5 c.c. of the urine from the burette, boil again, and continue the alternate addition of diluted urine and boiling of the mixture until the blue color is quite faint. Now add the diluted urine in quantities of 1 c.c. at a time, boiling after each addition until the blue color just disappears. Have ready a small filter, and, having filtered through it a few gtt. of the hot mixture, acidulate the filtrate with acetic acid, and add to it I gtt. soln. of potassium ferrocyanide. If a brownish tinge be produced, add another Yi c.c. of dil. urine to the flask, boil, and test with ferrocyanide as before. Continue this MEDICAL RECORD. "New instruments are portrayed and their use thoroughly explained." proceeding until no brown tinge is produced. The burette reading, taken at this point, gives the number of c.c. of dilute urine containing 0.05 gm. glucose, and this divided by S or 10, according as the urine was diluted with 4 or 9 volumes of H 2 0, gives the number of c.c. of urine contain- ing 0.05 gm. sugar. The number of c.c. urine passed in twenty-four hours divided by 20 times the number of c.c. containing 0.05 gm. glucose, gives the elimination of glu- cose in twenty-four hours in grams. Example. Urine in 24 hours = 2,436 c.c. Fehling's soln. used = 10 c.c. Urine diluted with 4 vols. H 2 0. Burette reading = 18.5 c.c, l8 -s = 3.7 = c.c. urine containing 0.05 gm. glucose. 5 2,436 = 32.92 — grams glucose eliminated in 24 hours." 3.7X20 (Witthaus' Urinalysis.) ANATOMY AND PHYSIOLOGY. 9. The venous blood current is maintained by (1) the action of the heart, (2) muscular contraction, and (3) as- piration of the thorax. The pulmonary arteries carry venous blood. 10. The causes producing the first sound of the heart are not definitely ascertained ; the following are supposed to be causatory factors: (1) The vibration and closure of the auriculo-ventricular valves, (2) the muscular sound produced by the contraction of the ventricles, and (3) the cardiac impulse against the chest wall. The second sound is caused by the vibration due to the closure of the semilunar valves. 11. The amount of bile secreted in twenty-four hours varies from about 500 c.c. to 900 c.c. The composition of the bile may be shown in the fol- lowing table, which presents the averages of three analyses given by Hammarsten ; the results are given in parts per thousand : Water 971.380 Solids 28.620 Mucin and pigments 4.910 Bile salts 12. 197 Taurocholate 2.431 Glycocholate 9.766 Fatty acids from soaps 1.200 Cholesterin 1.243 271 MEDICAL RECORD. "The only American medical Journal that prints a detailed report of the British Medical Association." Lecithin and fats 0.970 Soluble salts 7-3<5o Insoluble salts 0.317 The functions of the bile are: (1) to assist in the emul- sification and saponification of fats; (2) to aid in the ab- sorption of fats; (3) to stimulate the cells of the intestine to increased secretory activity, and so promote peristalsis, and at the same time tend to keep the feces moist; (4) to eliminate waste products of metabolism, such as lecithin and cholesterin; (5) it has a slight action in converting starch into sugar; (6) it neutralizes the acid chyme from the stomach, and thus inhibits peptic digestion; (7) it has a very feeble antiseptic action. 13. The glands of the small intestine are: (1) Glands of Lieberkuhn, (2) glands of Brunner, (3) Peyer's patches. The function of these glands is to contribute towards the composition of the succus entericus. 14. Mechanism of Accommodation. — The lens is an elastic structure, and when released from the flattening influence of its suspensory ligament tends to assume a spherical shape. During accommodation the ciliary mus- cle (especially the circular fibers) contracts, drawing for- ward the chorioid and relaxing the suspensory ligament; this diminishes the tension of the lens capsule and allows the inherent elasticity of the lens to increase its convexity. The change in curvature affects chiefly the anterior sur- face of the lens. This is Helmholtz's theory and the one usually accepted. Lately Tscherning has advanced a dif- ferent theory; he maintains that the ciliary muscle in- creases the tension of the suspensory ligament during con- traction and that this causes peripheral flattening of the lens with bulging anteriorly at its center. The act of ac- commodation is accompanied by contraction of the pupil, and (in binocular vision) by convergence of the visual lines." (May's Diseases of the Eye.) HISTOLOGY, PATHOLOGY, AND BACTERIOLOGY. 2. The layers of mucous membrane are: (1) Epi- thelium, (2) basement membrane, (3) fibrous and elastic connective tissue, (4) sometimes involuntary muscular tis- sue. Mucous membranes are found lining all passages which connect the interior of the body with the surface. The principal ones are the gastrointestinal tract, the pulmonary tract, and the genitourinary tract. 5. Peptic ulcer of the stomach is usually situated on the posterior wall and lesser curvature, near the pyloric 272 MEDICAL RECORD. " Original Articles are of the highest scientific value and most practical character, hy the foremost men of the world." orifice; it is generally small and round or oval; clean punched out, and with sloping edges, giving a funnel shaped appearance with the apex outward; the edges and floor are generally pale and smooth. These ulcers may be single or multiple, and are liable to terminate in hemor- rhage and perforation. 6. In pernicious anemia the blood would show: (i) A diminution in the number of red corpuscles; (2) a rela- tive increase in the amount of hemoglobin; (3) poikilo- cytosis ; (4) the presence of nucleated red cells ; (5) varia- tion in the size of the red cells; (6) the leucocytes may be diminished. 7. Carcinoma is apt to occur at a later age; is found in structures derived from the epiblast or hypoblast; pos- sesses a fibrous stroma, in which are found both blood- vessels and lymphatics; metastasis is by the lymphatics. Sarcoma is apt to occur earlier; is found in structures derived from the mesoblast; there is no stroma between the cells ; the blood-vessels are in direct contact with the tumor cells; there are no lymphatics; metastasis is by the blood-vessels. 8. The sputum must be recent, free from particles of food or other foreign matter; select a cheesy-looking nodule and smear it on a slide, making the smear as thin as possible. Then cover it with some carbolfuchsin, and let it steam over a small flame for about two minutes, care being taken that it does not boil. Wash it thoroughly in water and then decolorize by immersing it in a solution of any dilute mineral acid for about a minute. Then make a contrast stain with solution of Loeffler's methylene blue for about a minute ; wash it again and examine with oil immer- sion lens. The tubercle bacilli will appear as thin red rods, while all other bacteria will appear blue. 10. The Widal serum reaction "depends upon the fact that serum from the blood of one ill with typhoid fever, mixed with a recent culture, will cause the typhoid bacilli to lose their motility and gather in groups, the whole called "clumping." Three drops of blood are taken from the well-washed aseptic finger tip or lobe of the ear, and each lies by itself on a sterile slide, passed through a flame and cooled just before use; this slide may be wrapped in cotton and transported for examination at the laboratory. Here one drop is mixed with a large drop of sterile water, to redissolve it. A drop from the summit of this is then mixed with six drops of fresh broth culture of the bacillus (not over twenty- four hours old) on a sterile slide. From this a small drop of mingled culture and blood is placed 273 MEDICAL RECORD. " European correspondents furnish medical news of special interest and reports of the principal foreign medical societies. " in the middle of a sterile cover-glass, and this is inverted over a sterile hollow-ground slide and examined. A posi- tive reaction is obtained when all the bacilli present gather in one or two masses or clumps, and cease their rapid movement inside of twenty minutes." (From Thayer's Pathology.) NERVOUS DISEASES AND DISEASES OF THE EYE AND EAR. 6. Hordeolum is an abscess or inflammation in the tis- sues about the follicle of an eyelash. Chalazion is a tumor in the eyelids due to obstruction of the duct in a Meibomian gland. Ectropion is an eversion of the eyelid with exposure of conjunctival surface. Entropion is an inversion of the margin of the eyelid and eyelashes. Ptosis is a drooping of the upper eyelid, generally due to paralysis. Astigmatism is a condition in which owing to a greater curvature of the eye in one meridian than in others, the refractive power of the eye varies. Myopia is a condition in which the antero-posterior axis of the eye is abnormally long, and parallel rays are focused in front of the retina. 10. (i) Catarrhal conditions of the nose and throat, (2) infection from the external ear, Eustachian tube, or else- where, (3) traumatism. MATERIA MEDICA AND THERAUPETICS. 1. Narcotics are agents that produce sleep or stupor and allay pain. Example — opium. _ Anesthetics are agents which destroy sensation for a pe- riod of time. Example — chloroform. Sedatives are agents which allay excitement and func- tional activity, and sometimes tend to diminish pain. Ex- ample — potassium bromide. 2. Diuretics are agents which promote the secretion of urine. Examples — water, alcohol, potassium acetate Diaphoretics are agents which promote the secretion of sweat and increase the activity of the skin. Examples- alcohol. Dover's powder, Turkish bath. 6. Three heart stimulants: (1) Alcohol, dose 3j to 3ij of spiritus frumenti diluted; (2) ammonia, dose of aqua ammonise, TTgxv to xx, well diluted; (3) sparteine sulphate, dose gr. 1/16 to %. 2/4 MEDICAL RECORD. " Keeps you in closest touch with the weekly progress of medicine and surgery throughout the world." 7. For acute bronchitis: I£. Vini ipecacuanhae 3ij Liquoris potassii citratis 3iv Tincturae opii camphoratae Syrupi acacias aa 3J Misce. Sig : — One tablespoonful three times a day. For chronic constipation: P*. Aloin gr. vj Atropinae sulphatis gr. % Strychninae sulphatis gr. j. Misce. Fiat massa in pilulas no. xxx dividenda. Sig: — One pill two or three times a day. For acute cystitis: IjL Potassii acetatis Potassii citratis aa 3i j Aqua destillatae q.s. and %vj Misce. Sig: — One tablespoonful three times a day. 9. Four hypnotics: — (1) chloral hydrate; dose, gr. xv to xx. (2) Sulphonal; dose, gr. xv to xxv. (3) Trio- nal ; dose, gr. xv to xxv. (4) Paraldehyde ; dose, Tljjxxx to 3i. Four emetics: — (1) Apomorphine hydrochloride; dose, gr. 1/10 hypodermically. (2) Copper sulphate; dose, gr. iv to vj in water. (3) Zinc sulphate; dose, gr. x to xv in water. (4) Turpeth mineral ; dose, gr. iij to v. 10. Alkaloids are active nitrogenous principles, alkaline in reaction, and capable of uniting with acids to form salts in the same way that ammonia does. Example — strych- nine. "Serum therapy proper is the prophylactic and curative treatment of certain infectious diseases by the subcu- taneous or intravenous administration of a blood-serum containing an antibody which is specific to the particular disease." (Potter's Materia Mcdica.) Examples: — (1) Diphtheria antitoxin; dose, 3,000 units; immunizing dose, 500 units ; indicated in diphtheria. (2) Antitctanic serum; dose 3ijss to y; indicated in tetanus. (3) Antivenomous serum; dose, 3ijss to viij ; indicated in snake bite. 27S MEDICAL RECORD. "Acknowledged to be the leading independent medical weekly." STATE BOARD EXAMINATION QUESTIONS. West Virginia State Board of Health. November 13, 1906. BACTERIOLOGY AND HISTOLOGY. i. Mention three diseases of microorganismal origin and describe the organism of each. 2. Give three pus-producing organisms. 3. Which of the above in questions 1 and 2 is most widely distributed? Which is the most virulent, and why? 4. Through what channels do the organisms of tuber- culosis, tetanus, anthrax, diphtheria, and typhoid fever enter the body? 5. What becomes of pathogenic bacteria in a dead body? 6. Where in the body is adipose tissue never found normally? 7. Name structural elements of nerve tissue. 8. Of what is a tooth composed? 9. What is a Peyer's patch? 10. What is periosteum, and how many layers? HYGIENE. 1. What hygienic guards would you throw around a bottle-fed infant? 2. Why were the disabilities and deaths from disease so much less in the Japanese armies than in the American in the recent wars? 3. How would you prevent ophthalmia neonatorum ? 4. What influence has the purity of water upon its power of dissolving lead? 5. Name five of the best disinfectants and explain their action and method of use. 6. Tell how you would prevent the spread of the fol- lowing: Typhoid fever, diphtheria, scarlet fever, and smallpox. 7. What instructions would you give in a case of tuber- culosis to prevent other members of the family from con- tracting the disease? 8. Describe your ideal for a sleeping-room from a sani- tary standpoint. 9. What instructions would you give as to the toilet of mother and child in the first week after confinement? 10. Name some of the diseases whose germs are carried by water, and those carried by air. How may they be de- stroyed ? 276 MEDICAL RECORD. ' Xot a local Journal, but International In its scope." PRACTICE OF MEDICINE. 1. Practice of medicine. Define it. Is the use of pat- ent medicines legitimate? 2. Differentiate between true croup and laryngismus stridulus; treat the latter. 3. Name four of the eruptive diseases and give period of incubation of each. 4. Hiccough : causes, symptoms, and treatment. 5. Differentiate between diabetes mellitus and diabetes insipidus ; give urinary analysis of the former and some of the things found in it. 6. Differentiate between cancer and ulcer of the stomach. 7. Describe the clinical thermometer; give three methods of using it and variations. 8. Scabies : describe and treat. 9. Biliousness: give causes, symptoms, and treatment 10. Warts and corns: describe and treat — nonsurgical. PHYSIOLOGY. 1. Describe lymphatic circulation. What does it do and how does it do it? 2. Give function and description of various blood cor- puscles. What regulates blood pressure and how meas- ure it? 3. How does bone grow ? Purpose of Haversian canals? Function of marrow and periosteum? 4. Describe development, construction, and use of teeth. What glands are affected by mastication? 5. What is function of the vagus nerve? 6. Locate and give function of thymus, thyroid, and suprarenal glands. 7. Describe the portal circulation. 8. Describe prostate gland and detail its functions. How does ovum get to uterus? 9. Detail minute anatomy of skin and function of each part. 10. Describe the process and purpose of respiration. Why an involuntary act? ANATOMY. 1. Locate and describe the ileocecal valves. 2. With what bones does the malar articulate? 3. What muscles form the tendo Achillis, and where is the tendon inserted? 4. Name the branches of the abdominal aorta. 5. How is the eye supplied with blood? 6. What constitutes the brachial plexus? MEDICAL RECORD. " The most important contributions to the literature of medicine and surgery have been published first in the MEDI- CAL RECORD." 7. How are the saphenous veins formed, and where do they empty? 8. Give the anatomy of the bladder. 9. Describe the ankle joint. 10. Name the arteries and veins passing to and from the kidneys. CHEMISTRY. 1. What is a molecule? 2. Define an acid, a base, a salt. 3. What is the most common element in nature? 4. What is uric acid? Tell all you know about it. 5. Name five acids used in medicine, and give their formulae. 6. Name five preparations of mercury used in medicine. 7. Define distillation and sublimation and give exam- ples. 8. What is the therapeutic value of alcohol? 9. Give color, reaction, and weight of normal urine. 10. Give a reliable test for albumin, bile, blood, and sugar in the urine. OBSTETRICS AND GYNECOLOGY. 1. Give the diameters of the true pelvis. 2. What is the perineum ? How should it be protected ? 3. How is the semen carried to the ovum? 4. Give various changes which take place in ovum after impregnation. 5. Name the different presentations of the fetus at the end of gestation. Which are normal, which abnormal? 6. What are the indications for instrumental delivery? Would you call help? 7. How long would you remain with patient after de- livery? What symptoms would cause you to delay your going? 8. Give symptoms, diagnosis, and treatment for chronic endometritis. 9. Give symptoms, diagnosis, and treatment of a small fibroid of uterus growing from margin of internal os ex- tending upward in wall of uterus. 10. Diagnose and treat a case of placenta praevia — cen- tral, marginal. SURGERY. 1. What is hemorrhage? Divide anatomically and clini- cally; treat mechanically and therapeutically. 2. Describe, differentiate, and treat furuncle and car- buncle. 278 MEDICAL RECORD. "Choice and important abstracts froni the leading medical periodicals of the world in a condensed and practical form." 3. Describe, give symptomatology, and treatment of dis- location of inferior maxillary bone. 4. Exarticulate humerus, give steps, and tell all you know. 5. Trephining, give indications, precautions, and compli- cations. 6. Define gonorrheal urethritis, give complications, sequels, and treatment. 7. Mention the dangers of anesthesia, and treat case of chloroform, ether, and cocaine poisoning. 8. Give form of historical examination. 9. Differentiate piles, fistula, and fissure; treat each. 10. Differentiate phimosis, paraphimosis; treatment. MATERIA MEDICA, AND THERAPEUTICS. i. What per cent, are the two classes of tinctures in the new pharmacopoeia? 2. Give the official preparations of mercury, and the diseases in which its use is most indicated. 3. Name the three best teniacides and the dose of each. What is meant by coaltar derivatives, and what is their action in general? 5. Mention the ingredients of citrine ointment; what is its official name? 6. State the effects of the bromides on the respiration Mnd on the action of the heart; what effect is the long- continued use of the bromides liable to produce on the mental functions? 7. Write a prescription for a four-ounce mixture con- taining an expectorant, a sedative, and a tonic of which the dose is a tcaspoonful every two or three hours. S. Give the composition of the compound cathartic pill; state the dose. . 9. Define hemostatics; their mode of action, the best local hemostatic; therapeutics. (fa What are counterirritants? Explain their action and the rationale of their use in diseases; enumerate four in the order of efficiency. 279 MEDICAL RECORD. " Therapeutic Hints contain many valuable formulae by th« foremost medical men In the world." ANSWERS TO STATE BOARD EXAMINATION QUESTIONS. West Virginia State Board of Health. November 13, 1906. BACTERIOLOGY AND HISTOLOGY. 1. (1) Typhoid fever, caused by the Bacillus typhosus of Eberth; (2) tuberculosis, caused by the Bacillus tuber- culosis of Koch; (3) diphtheria, caused by the Bacillus diphtheria (Klebs-Loeffier bacillus). 2. (1) Staphylococcus pyogenes albus; (2) Staphylococ- cus pyogenes aureus; (3) Streptococcus pyogenes. 3. The Staphylococcus pyogenes aureus is the most widely distributed; the Streptococcus pyogenes is the most virulent, because it is the most active in the production of soluble toxins. 4- Organisms of: Enter the Body by the Following Channels: Tuberculosis. Tetanus. Anthrax. Diphtheria Typhoid fever. Respiratory tract, alimentary tract, skin, and mu- cous membranes. Wounds of skin and mucous membranes. Wounds of skin and mucous membranes, mouth, and respiratory tract. Mouth, nose; wounds. Mouth. 5. Most of them die ; some, because they can hardly exist at any other than the temperature of the living body ; others, because they cannot obtain suitable nutriment from dead tissues. Others, again, are rapidly killed by other organisms with which they come in contact and against whom they are powerless to compete. Some may eventually enter another host. 6. Adipose tissue is never found normally in the penis, scrotum, eyelids, nymphae, cranial cavity, and the lungs (except near the root). 7. The structural elements of nerve tissue are: — (1) The nerve cells (consisting of protoplasm, nucleus, nucleo- lus, axis cylinder process, and dendrites) ; (2) the nerve fibers, (a) medullated, consisting of axis cylinder, medul- lary substance, and neurilemma or sheath of S'chwann; (fc) non-medullated; (3) the supporting tissues and neu- roglia. MEDICAL RECORD. "Bange of subjects embraces every branch of medicine and surgery." 8. A tooth is composed of dentine, enamel, cementum, and pulp. Q. Peyer's patches are oval groups of lymph follicles, packed closely together, and held in place by diffuse adenoid tissue ; they are situated chiefly in the ileum, and are found in the mucous and submucous layers. 10. Periosteum is a tough fibrous membrane surrounding a bone. It consists of two layers. 2. Because : — The Japanese expected war and were pre- pared for it; they knew that disease was more fatal than bullets, and had their medical department thoroughly well prepared and organized and under the absolute control of well equipped medical officers; the soldiers had suitable rations, which were purchased, inspected, and transported without political or civil interference; all the medical (and military) appointments were made on the basis of skill and experience, and whatever the health and sanitary condition of the soldiers required was promptly provided, without being dependent on the vanity, ignorance, or political as- pirations of the military officers; in a word, politics was absent. 3. Ophthalmia neonatorum can be prevented by: — (i) Taking the utmost precaution to prevent sepsis during and after labor, and (2) instilling into the eyes of every new- born infant one drop of a one or two per cent, solution of nitrate of silver. 4. As a rule, the purer the water the more liable it is to dissolve lead. 10. Diseases whose germs are carried by water: — Ty- phoid, cholera, dysentery; sometimes also diphtheria. The germs may be destroyed by boiling the water used either for drinking or for washing vessels, etc., used in con- nection with food or cooking. Diseases whose germs are carried by air: — Tuberculosis, scarlet fever, smallpox, measles, pneumonia, influenza, diph theria, and erysipelas. The germs may be destroyed by the proper use of anlL septic solutions. PRACTICE OF MEDICINE. i. Practice of medicine may be defined as all that ap- pertains to the knowledge, prevention, and cure of disease. The use of patent medicines is legitimate. 2. True croup is either laryngeal diphtheria or a strep- tococcus infection. In either case there is a prior stage of 281 MEDICAL RECORD. Keeps you strictly abreast of the times.' malaise, accompanied by chills, fever, and sore throat. The fever may become high. A membrane forms, in which are found the Klebs-LoefHer bacillus or streptococci. The child is hoarse, suffers from dyspnea, and may expec- torate shreds of false membrane; there is prominence of the suprasternal notch and of the sternomastoid muscles. In laryngismus stridulus the child holds his breath, the face becomes congested and cyanotic, the glottis is closed, inspiration is suddenly arrested, and ends in a shrill crowing sound ; there may be spasms or convulsions ; the attack is sudden, and may be repeated ; there is no fever, coryza, or cough. Treatment of laryngismus stridulus: — Cold water should be dashed on the face and chest; ammonia may be applied to the nostrils ; an emetic may be administered, bromides or chloral should be given ; attention must be paid to the diet and general hygiene of the child. 3. Typhoid fever, incubation period two to three weeks ; measles, ten to fourteen days; scarlet fever, one to ten days ; erysipelas, one to five days. 4. The cause of hiccough is: — Sudden clonic spasm of the diaphragm, with closure of the glottis. This may be due to: — (1) Irritation of the stomach or lower end of esophagus by food, or indigestion ; (2) irritation of the phrenic nerve by pressure of a tumor or aneurysm; (3) hysteria or various neuroses; (4) diseases of the gastro- intestinal tract; (5) various constitutional diseases. Symptoms: — Hiccough is itself a symptom. Treatment: — Cold drinks, ice, brandy, pressure or cold on the epigastrium, emetics, the induction of sneezing, in- halations of chloroform or nitrite of amyl, hypodermic injection of morphine, pressure or- galvanism over the phrenic nerve have all been tried with and without success. 5. In diabetes mellitus the urine has a high specific gravity and contains glucose; complications are many and frequent. In diabetes insipidus the urine has a low specific gravity and does not contain glucose; complications are rare. Urinary analysis of diabetes mellitus shows : — Great in- crease in the amount voided, high specific gravity, pale color, sweetish or aromatic odor, sweetish taste, increase in the amount of urea. Glucose is present ; acetone, dia- cetic acid, and beta oxybutyric acid may be present. 6. Cancer of stomach does not usually occur before forty years of age, is more common in males, the pain is localized and constant, vomiting is copious and occurs sometime after eating; the vomitus contains "coffee ground" material ; hemorrhages are common ; a tumor may 282 MEDICAL RECORD. Its prestige attracts articles by the best known writers." be palpated, and examination of the gastric contents shows absence of free HC1 and presence of lactic acid; there is progressive emaciation; severe anemia and cachexia are also present. Ulcer of stomach is generally caused by injury or bac- teria, is most apt to occur between the ages of twenty and forty-five; after eating there is pain localized in the stom- ach, vomiting occurs soon after eating, hematemesis is common, there is localized tenderness over the stomach, and examination of the gastric contents shows an excess of free HC1. 7. Three methods of using the clinical thermometer: — (1) In the mouth: The thermometer should be placed under the tongue and to one side, and the patient should keep his lips closed. It should be kept in the mouth for about three minutes, and the patient should not have taken a very hot or a very cold drink for some time before the taking of the temperature. (2) In the axilla: The axilla should be dry, and the bulb of the thermometer be placed in the hollow; the elbow should be placed against the thorax, and the forearm brought across the chest. No clothing should be in the axilla or in contact with the ther- mometer. Five minutes is required to take the tempera- ture. (3) In the rectum: The rectum must be empty; the thermometer is oiled and inserted two inches; it should remain in five minutes. The temperature will vary according to the place where it is taken. Thus, if the temperature is 98.6 F. in the mouth, it will be about 98.2 F. in the axilla or groin; about 100.2 F. in the rectum, and a little higher in the vagina. 8. "Scabies is a contagious, animal, parasitic disease due to the Sarcoptes scabiei, characterized by burrows and a multiform eruption, and attended by severe itching. The eruption usually occupies certain areas where the skin is thin ; these are the interdigital spaces, the flexor surface of the wrist and arm, the anterior and posterior axillary folds, the mamma: and nipples (in women), the umbilicus, the buttocks, the penis, the inner side of the thighs and legs, and the toes. The face is exempt except occasionally in infants. The itching is intense and worse at night. The affection is curable, but dermatitis may result from over- treatment. "The treatment consists in a protracted bath with soap and hot water, followed by the application of sulphur oint- ment (3 1 to BO or other parasiticide every night for one week. In the meantime, the bed linen and underclothing should be sterilized by heat. At the end of a week an- 283 MEDICAL RECORD. " Book reviews of foreign and American publications keep you thoroughly informed of the newest literature." other bath should be taken and some sedative ointment or lotion should be prescribed. Sulphur may be substituted by beta-naphthol, balsam of Peru, styrax, tar, staphisagria, etc." (Gould's and Pyle's Cyclopedia of Medicine and Sur- gery.) PHYSIOLOGY. I. The lymphatic circulation is, strictly speaking, not a circulation at all; since the lymph flows only in one direc- tion, namely, toward the heart. The lymph capillaries take up any excess of the blood plasma which is not required for the nutrition of the tissues. These capillaries consist of a single layer of epithelium, and empty themselves into vessels very like the veins. The lymph vessels are well provided with valves, which are so closely approximated as to give the vessels a beaded appearance. All the lymphatic vessels, except those of the right upper half of the body, empty into the thoracic duct, which terminates in the left subclavian vein, where the left internal jugular vein also enters. Those from the right upper half of the body dis- charge into the right lymphatic duct, which, in turn, empties into the right subclavian vein at its junction with the right internal jugular vein. The forces concerned in the circulation of the lymph are : (i) The pressure of the blood in the blood-vessels; (2) thoracic aspiration; (3) muscular contractions of the vol- untary muscles; (4) contractions of the intestine; (5) the action of the valves in the lacteals and lymphatics. 2. The red corpuscles supply the tissues with hemo- globin; the white corpuscles serve as a protection to the body from the incursions of pathogenic microorganisms, they take some part in the process of the coagulation of the blood, they aid in the absorption of fats and peptones from the intestine, and they help to maintain the proper proteid content of the blood plasma. The red corpuscles are biconcave discs, about 1/3200 of an inch in diameter; they are non-nucleated, and there are about 4,500,000 or 5,000,000 of them in each cubic milli- meter of blood. They contain hemoglobin. _ The white corpuscles are spheroidal masses, varying in size, having no cell wall, and containing one or more nuclei; there are about 7,000 to 10,000 of them in each cubic millimeter of blood. They differ much in appear- ance, and are divided into (1) small mononuclear leu- cocytes, or lymphocytes, (2) large mononuclear, (3) tran- sitional, (4) polynuclear, or polymorphonuclear, or neu- trophile, and (5) eosinophile. They are all more or less granular, particularly the last two varieties named. MEDICAL RECORD. "Bulletins of Examinations of State Medical Licensing Boards published bi-weekly." There are also platelets, which are very small, colorless, irregular shaped bodies; they are about one-fourth the diameter of a red corpuscle. Their function is not deter- mined ; it is possible that they take some part in the coagu- lation of the blood. In number they vary from about 200,000 to more than 500,000 in each cubic millimeter of blood. Blood pressure is regulated by: — (1) The force and fre- quency of the ventricular systole, (2) the quantity of blood contained in the vessels, (3) the elasticity of the walls of the arteries, and (4) the resistance in the capillaries. Blood pressure is measured by the aid of a manometer or U-shaped tube containing mercury, one limb of which is attached to a lateral branch of the blood-vessel in which the blood pressure is to be measured. This attachment is made by means of a non-elastic tube and canula filled with a watery solution of sodium carbonate or magnesium sul- phate. The blood, through this solution, forces the mer- cury up in the distal tube of the manometer. The blood pressure is the difference in the height of the mercury in the two limbs of the manometer. 3. Bones grow in length at the two ends of the shaft; this is due to the process of ossification in the cartilage situated between the epiphysis and diaphysis. Bones grow in thickness by the development of successive layers be- neath the periosteum. The Haversian canals contain the blood-vessels, lym- phatics, and nerves of the bone. The function of marrow is: — The formation of the red blood corpuscles. The function of periosteum is: — (1) The nutrition of the bone, (2) the growth of bone, and (3) the regenera- tion of bone. 4. The glands affected by mastication are: — The sali- vary glands (parotid, submaxillary, and sublingual) and the gastric glands. 5. Functions of the vagus: — "Throughout its whole course the vagus contains both sensory and motor fibers. To summarize the many functions of this nerve .... it may be said that it supplies (1) motor influence to the pharynx and esophagus, stomach and intestines, to the larynx, trachea, bronchi, and lungs; (2) sensory and, in part, (3) vasomotor influence, to the same regions: (4) inhibitory influence to the heart; (5) inhibitory afferent impulses to the vasomotor center; (6) excito-secretory to the salivary glands; (7) excito-motor in coughing, vomit- ing, etc." (Kirkes' Physiology.) MEDICAL RECORD. "Since 1890 the MEDICAL, RECORD lias had a cabled re- port of every International Medical Congress." 6. The thymus gland is found only in infancy and child- hood; it is situated in the lower part of the neck and in the anterior mediastinum, behind the sternum, and rest- ing upon the pericardium. The function of the thymus is not settled ; it is said : — (i) to be a blood forming organ; (2) to have influence on growth and nutrition; (3) in hibernating animals it is supposed to store up materials which can be utilized dur- ing the period of inactivity. The thyroid gland is situated on the anterior and lateral surfaces of the upper part of the trachea. The function of the thyroid is not definitely settled; (1) it has some trophic function ; (2) it is supposed to antago- nize toxic substances ; (3) it produces an internal secre- tion. The suprarenal glands are situated in the back part of the abdominal cavity, behind the peritoneum, and above and slightly to the front of the upper part of each kidney. The function of the suprarenals is not definitely settled; they produce an internal secretion which is probably neces- sary to life; it is supposed that they are able to destroy or remove some toxic substance produced elsewhere in the body. 8. The functions of the prostate gland are: — (1) The secretion of the prostatic fluid ; (2) to act as an involun- tary sphincter to the bladder; (3) its muscular fibers are also involved in the contraction that expels the semen during ejaculation. The following theories have been held to account for the conveyance of the ovum to the tubes and uterus: — (1) That the fimbriated extremity of the tube becomes erec- tile and, aided by muscular contraction, grasps the ovary; (2) that the ova are ejaculated from the follicle into the tube; (3) that the ova are carried along in the serum by currents generated by the ciliated epithelium which covers the fimbriae of the tubes ; (4) in a certain number of cases there is a migration of ova, which pass across the abdominal cavity and come down the opposite tube. (From Edgar's Obstetrics.) CHEMISTRY. 1. A molecule is the smallest quantity of a substance (either element or compound) that can exist in a free state. 2. An acid is a compound of an electro-negative element or radical with hydrogen, part or all of which hydrogen it 286 MEDICAL RECORD. " Statistics of the health boards and many articles of scien- tific interest and items of general information." can part with in exchange for an electro-positive element, without the formation of a base. A base is a ternary compound capable of entering into double decomposition with an acid to produce a salt and water. A salt is a substance formed by the substitution of an electro-positive element for part or all of the replaceable hydrogen of an acid. 3. Oxygen. 4. Uric acid, also known as lithic acid, is a dibasic acid, and has the formula QH4N4O3. It occurs in the urine, and in smaller amounts in the blood and tissues. It is not found free, but as sodium urate ; it is derived from the purin bases of the nucleoproteids. About 6 to 9 grains are voided in the urine daily. Pure uric acid is odorless, tasteless, and very slightly soluble in water; it crystallizes in small colorless rectangular or hexagonal plates or in rectangular prisms ; crystals from the urine are lozenge- shaped and are colored. 5. Sulphuric acid: H2SO4; nitric acid: HN0 3 ; hydro- chloric acid: HC1; acetic acid: CH3.COOH ; phosphoric acid: H 3 PO*. 6. Mercurous chloride; mercuric chloride; mercurous oxide; mercuric oxide; mercuric iodide. 7. Distillation is the conversion of a liquid into a gas, followed by the reconversion of the gas into a liquid. Ex- ample: — The distillation of water. Sublimation is the conversion of a solid into a gas (with- out passing through the liquid state) and the reconversion of the gas into a solid. Example : — Sulphur can be sub- limed by heating in a suitable apparatus. 8. "Though decidedly injurious in health, in disease al- cohol is a most valuable remedy in appropriate cases. In vomiting of yellow fever, seasickness, etc., iced champagne is useful. Atonic indigestion of nervous and depressed subjects, cautiously. Phthisis, it does good if it prdmotes digestion and assimilation; otherwise it is very injurious. Cholera infantum, diarrhea, etc.. Cognac brandy in full doses. Cardiac failure, brandy in small doses repeated as fast as oxidized. Chloroform anesthesia, 3 j-ij of whiskey beforehand, to sustain the heart, and prolong the chloro- form narcosis. Poisoning by cardiac depressants and snake venom, alcohol freely, to sustain the heart. In snake poi- soning it is given ad libitum. Diphtheria, whiskey or brandy in small doses frequently from the commencement, and dilute alcohol sprayed into the throat, is very efficient 287 MEDICAL RECORD. "The progressive physician must have his medical weekly just as the business man his newspaper." treatment. Adynamic fevers, small doses frequently are often of great value. Gonorrhea, Niemeyer is said to have done a lucrative business by treating this affection with in- jections of tannic acid in port wine. Insomnia from cere- bral anemia may be prevented by small doses of some alcoholic stimulant at bedtime. Wounds, no better dress- ing than strong alcohol, to prevent putrefaction and pro- tect the surface by coating it with a coagulum of its own albumen. Bed sores if threatening, alcohol locally, to harden the tissue. Cold from exposure, may be prevented by a moderate dose of alcohol, to restore the balance of the circulation and prevent internal congestion, by relaxing the vessels of the periphery." (Potter's Materia Medica.) g. Normal urine varies in color from a very pale yellow to a brownish orange; the reaction is acid; the quantity voided in twenty-four hours is about fifty ounces. 10. Test for Albumin. — The urine must be perfectly clear. If not so, it is to be filtered, and, if this does not render it transparent, it is to be treated with a few drops of magnesia mixture, and again filtered. The reaction is then observed. If it be acid, the urine is simply heated to near the boiling point. If the urine be neutral or alkaline, it is rendered faintly acid by the addition of dilute acetic acid, and heated. If albumin be present, a coagulum is formed, varying in quantity from a faint cloudiness to entire solidification, according to the quantity of albumin present. The coagulum is not redissolved upon the addi- tion of HN0 3 . Test for Bile.— Put 3 c.c. HN0 3 in a test tube, add a piece of wood, and heat until the acid is yellow ; cool. When cold, float some of the urine to be tested upon the surface of the acid. A green band is formed at the junc- tion of the liquids, which gradually rises, and is succeeded from below by blue, reddish-violet, and yellow. Test for Blood. — To the urine add a solution of potas- sium hydroxide to distinct alkaline reaction ; heat nearly to boiling (do not boil). A red precipitate is produced. Test for Sugar. — Render the urine strongly alkaline by addition of Na 2 C0 3 . Divide about 6 c.c. of the alkaline liquid in two test tubes. To one test tube add a very minute quantity of powdered subnitrate of bismuth, to the other as much powdered litharge. Boil the contents of both tubes. The presence of glucose is indicated by a dark or black color of the bismuth powder, the litharge retaining its natu- ral color. (Witthaus' Essentials of Chemistry.) MEDICAL RECORD. " Original Articles are of the highest scientific value and most practical character by the foremost men of the world." OBSTETRICS AND GYNECOLOGY. i. The pelvic diameters are easily remembered from the following table : Antero-posterior Oblique Transverse Brim 4^ inches. . 4* " ■ • 4* " •• 5 inches. 4 3. Immediately after coitus, the cervix of the uterus is normally immersed in a pool of seminal fluid. Some of this passes up into the uterus, and it may or may not be assisted by the suction or aspiration power of the uterus. The spermatozoa travel by virtue of the vibratory motion of the tail or flagellum. 5. The different presentations are : — 1. Head : including vertex, brow, and face. 2. Breech : which may be breech, knee, or foot. 3. Transverse : including shoulder, arm, and head. Of these, the vertex (when the occiput is anterior) is the normal presentation; the others are abnormal. 6. Indications for the use of forceps are: 1. Forces at fault: Inertia uteri in the presence of conditions likely to jeopardize the interests of mother or child, (a) Impend- ing exhaustion; (b) arrest of head, from feeble pains. 2 Passages at fault: Moderate narrowing, 3% to 2>Va inches, true conjugate; moderate obstruction in the soft parts. 3. Passenger at fault: A. Dystocia due to (a) occipito-pos- terior, (b) mento-anterior face, (c) breech arrested in cavity. B. Evidence of fetal exhaustion (pulse above 160 or below 100 per minute). 4. Accidental complications: Hemorrhage ; prolapsus funis ; eclampsia. All acute or chronic diseases or complications in which immediate de- livery is required in the interest of mother or child, or both. (From Jewett's Practice of Obstetrics.) I should certainly seek assistance. 7. The physician should remain with his patient, or at least be within call for an hour or more after the com- pletion of labor. A pulse near or over 100, or inadequate uterine contractions, should cause the physician to delay his departure. SURGERY. i. Hemorrhage is loss of blood from some part of the arterio-venous system. 289 MEDICAL RECORD. "We publish the proceedings of an association immediately after the meeting." The anatomical varieties are : — Arterial, venous, and capillary. The clinical varieties are : — Primary, intermediate or re- current, and secondary. Mechanical treatment includes : — Elevation, pressure, tor- sion, ligation, compression, acupressure, and forced flexion of limb. Therapeutic treatment includes the use of: — Heat, cold, styptics, and the cautery. The constitutional symptoms must also be treated: — lower the head, inject normal salt solution, administer alcohol, strychnine, digitalis, morphine. MATERIA MEDICA AND THERAPEUTICS. I. In the new pharmacopoeia the official tinctures vary in strength from 0.4 per cent, to 50 per cent. By far the greater number fall into two classes : — 10 per cent, for the more powerful substances and 20 per cent, for the others. 2. Official Preparations of Mercury Ammoniated mercury Bichloride of mercury Calomel Red oxide of mercury Yellow oxide of mercury Red iodide of mercury Yellow iodide of mercury Solution of mercuric nitrate . . Ointment of mercuric nitrate.. Chiefly Indicated in: Ozcena, psoriasis, tinea, and other skin affections. Syphilis, anemia, summer diarrhea. Syphilis, biliousness, dropsy, dysentery. Syphilitic sores, chronic skin diseases. Indigestion, syphilitic sores, chronic skin Syphilis, acute tonsilitis. Chronic Bright's disease, syphilis. Epitheliomata, warts, lupus. Chronic skin diseases. 3. Aspidium, dose of the oleoresin gr. xxx ; granatum, dose of the fluid extract, TTgxxx ; kousso, dose 3iv. 4. Coal tar derivatives are substances derived from the aromatic or closed-chain series ; they are synthetic prod- ucts. Their action in general may be said to be: — (1) Anti- pyretic; (2) stimulating to. the nervous system, but later on causing paralysis; (3) antiseptic; (4) irritant and toxic to the cells and tissues of the body; (5) they also tend to produce methemoglobin and to disintegrate the red blood corpuscles. 5. The ingredients of citrine ointment are : — A hot so- lution of mercury, nitric acid, and lard. Its official name is Unguentum Hydrargyri Nitratis. 290 MEDICAL RECORD. " European correspondents furnish medical news of special interest and reports of the principal foreign medical societies." 6. The bromides cause a slowing of the respiration, and a weakening of both the force and frequency of the heart. Their long-continued use causes an impairment of the mental functions, with melancholia or hallucinations, and sometimes a suicidal tendency. 7. 5c Strychninae sulphatis gr. ss. Codeinae sulphatis gr. viij. Syrupi scillae 3Jss. Glycerini Bss. Aquae destillatae q. s. ad 3'v. Misce. Sig: Take one teaspoonful every three hours. 8. The compound cathartic pill consists of: — Calomel, about one grain; compound extract of colocynth, about one and a quarter grains; resin of jalap, about half a grain; and gamboge, about one-quarter of a grain. The dose is two pills. 9. Hemostatics are agents which, on being administered internally, arrest hemorrhage. Agents which act in this manner on being applied locally are called styptics. The former act by causing the vessels to contract; the latter sometimes in the same way and sometimes by promoting clot formation in the mouths of the wounded and bleeding vessels. Ergot, gallic acid, digitalis, hamamelis, and ipecac are hemostatics. As styptics may be named the actual cautery, acids, nitrate of silver, alum, collodion, and vege- table astringents. 10. Counterirritants are substances which, on being ap- plied to the skin, produce more or less vascular excite- ment, and exert some beneficial reflex influence on a part remote from the site of application. "The entire basis for the employment of counter irrita- tion rests upon reflex action, or the conduction of a nervous impulse to a center, which, when so stimulated, sends out an impulse to the part of the body which is diseased. "The use of counterirritation may be divided into four parts or purposes: The first is for affecting inflammations or congestions ; the second for causing the absorption or removal of inflammatory deposits after true inflammation has ceased; while the third purpose is for the relief of pain ; and the fourth for the effect which can be exercised upon the general system by blisters in systemic disease." (Hare's Practical Therapeutics.) Four counterirritants : — Cantharides, capsicum, mustard, ammonia. MEDICAL RECORD. " The progressive physician must have his medical weekly just as the business man his newspaper." REQUIREMENTS FOR MEDICAL LICENSURE. In the following table the State requiring of the can- didate both a diploma from a recognized college and an examination are printed in roman ; those requiring either a diploma or an examination, in italics; those requiring an examination only, in small capitals. State Fee Alabama $10.00 Arizona 10 . 00 Arkansas 10 . 00 California 25 .00 Colorado 25 . 00 Connecticut 15 -°o Delaware 10 . 00 District of Columbia 10.00 Florida 15.00 Georgia 10 . 00 Idaho 25.00 Illinois 10.00 Indiana 25.00 Iowa 10 . 00 Kansas 15.00 Kentucky 10 . 00 Louisiana 10 . 00 Maine 10.00 Maryland 1 5 . 00 Massachusetts 20.00 Michigan 25 . 00 Minnesota 10 . 00 Mississippi 10.00 Missouri 15-00 Montana 25 . 00 State Feb Nebraska $25 .00 Nevada 25 .00 New Hampshire 10.00 New Jersey 25.00 New Mexico 25 . 00 New York 25 . 00 North Carolina 10 . 00 North Dakota 20 . 00 Ohio 25 . 00 Oklahoma 5 . 00 Oregon 10.00 Pennsylvania 25 . 00 Rhode Island 10.00 South Carolina 10 . 00 South Dakota 20 .00 Tennessee 10.00 Texas 15 -°° Utah 15.0° Vermont 15- 00 Virginia 10 . 00 Washington 25 . 00 West Virginia 10.00 Wisconsin 10 . 00 Wyoming 25 . 00 State fSfebtral HJtottBUtg Soarfo. BULLETIN OF APPROACHING EXAMINATIONSt STATE NAME AND ADDRESS OF SECRETARY Alabama* W. H. Sanders, Montgomery. Arizona* Ancil Martin, Phoenix Arkansas* F. T. Murphy, Brinkley. tPLACE AND DATE OP NEXT EXAMINATION . Montgomery . . . .Phoenix Jan. .Little Rock. . . Jan. California* Chas. L. Tisdale, 1879 Sutter Street, San Francisco Los Angeles. . . .Dec. Colorado S. D. Van Meter, 1723 Tre- mont Street, Denver Denver Jan. Connecticut*. . .Chas. A. Tuttle, New Haven. . .New Haven. . . .Nov. Delaware J. H. Wilson, Dover Dover Dec. Dist. of Col'bia. W. C. Woodward, Washington. Washington.. . .Jan. . D. Fernandez, Jacksonville. .Jacksonville.. . .Nov. Florida*. Georgia. . Idaho . . . Illinois. . . Indiana.. R. Anthony, Griffin Atlanta. .J. L. Conant, Jr., Genesee Boise April J. A. Egan, Springfield Chicago Oct. .W. T. Gott, 120 State House, Indianapolis Indianapolis Oct. 292 MEDICAL RECORD. " Range of subjects embraces every branch of medicint and surgery." STATE. NAME AND ADDRESS OF PLACE AND DATE OF SECRETARY. NEXT EXAMINATION. Iowa Louis A. Thomas, Des Moines. .Des Moines Dec. — Kansas T. E. Raines, Concordia Topeka Feb. n Kentucky-* J. N. McCormack, Bowling Green Louisville Oct. 22 Louisiana F. A. LaRue, 211 Camp Street, New Orleans New Orleans. . .Oct. 15 Maine Wm. J. Maybury, Saco Portland Nov. 12 .Maryland J. McP. Scott, Hagerstown Baltimore Dec. 3 Massachusetts*. E. B. Harvey, State House, Boston Boston Nov. 12 Michigan B. D. Harison, 205 Whitney Building, Detroit Ann Arbor June 9 Minnesota W. S. Fullerton, St. Paul St. Paul Jan. 7 Mississippi J. F. Hunter, Jackson Jackson May 13 Missouri J. A. B. Adcock, Warrensburg.St. Louis Nov. 19 Montana* Wm. C. Riddell, Helena Helena April 7 Nebraska Geo. H. Brash, Beatrice Lincoln .Nevada S. L. Lee, Carson City Carson City. . . .Nov. 4 X. Hampshire* . Henry C. Morrison, State Li- brary, Concord Concord Jan. 14 New Jersey J.W.Bennett, Long Branch.. .Trenton Oct. 22 N'ew Mexico.. . .B. D. Black, Las Vegas Santa Fe Dec. a !New York . Albany ( w , . Syracuse J* en. 4 Buffalo ) N. Carolina*.. . .G. T. Sikes, Grissom Winston, Salem May — N. Dakota H. M. Wheeler, Grand Forks. . .Grand Forks. . Jan. 7 Ohio Geo. H. Matson, Columbus Columbus Dec. 10 Oklahoma* J.W.Baker, Enid Guthrie Oregon B. E. Miller, Portland Portland... . . . Jan. 8 Pennsylvania. . . N. C. Schaeffer, Harrisburg. . j £•$ ^burg*"*' " ' ) Dec- Rhode Island.. .G. T. Swartz, Providence Providence Jan. 2 S. Carolina W. M. Lester, Columbia Columbia June o S. Dakota H. E. McNutt, Aberdeen Mitchell Jan. 8 f Memphis "I Tennessee* T. J. Happel, Trenton { Nashville f May — [ Knoxville.. . . J Texas G. B. Foscue, Waco Fort Worth Oct. 21 Utah* R. W. Fisher, Salt Lake City... Salt Lake City. Jan. 6 Vermont W. Scott Nay, Underhill Montpelier Jan. 14 Virginia R S. Martin, Stuart Staunton Dec. 10 Washington*. . .C. W. Sharpies, Seattle Spokane Jan. 7 W.Virginia H. A. Barbee, Point Pleasant. . .Clarksburg Nov. 12 Wisconsin J. V. Stevens, Jefferson Milwaukee Jan. 14 Wyoming S. B. Miller, Laramie Laramie * No Reciprocity recognized by these States. t Applicants should in every case write to the secretary for latest details regarding the examination in any particular State. JSee latest issue of Medical Record for up-to-date changes in "Plac« and Date of Next Examination." 293 The American Journal of Obstetrics and Diseases of Women and Children Price, $5.00 a Year (Issued Monthly) The recognized leading journal in Gynecology, Abdominal Surgery, Obstetrics, and Pediatrics The history of medical journalism shows no more striking example of success than "The Journal's' present popularity and wide circulation, and the changes and improvements that have been made in it since the date of its first issue, May, 1868. The first volume contained 448 pages; now each issue contains over 160 pages, or a total of about 2,000 pages for the twelve numbers in the year. The Original Articles which have appeared in its pages include the most important contributions to medical literature in the departments concerned, by the most celebrated physicians in the world. The American Journal of Obstetrics is printed and illustrated in a style of typographical excellence superior to that of any other medical journal, con- taining many plates, in black, tint, and colors, con- forming with absolute fidelity to the original subject. WILLIAM WOOD & COMPANY Medical Publishers 51 FIFTH AVENUE NEW YORK 9