and bark used. Dose of fluid extract 30 to 60 drops: specific medicin, 5 to 30 drops. Indications: Increast secretion from the mucous membranes, they being full and relaxt; imperfect circulation in the surfaces and in the extremities; catarrhal affections of long standing, characterized by a tenacious discharge, which is often offensiv and irritating. This remedy aids the process of digestion and blood making. Myrica Cerifera is stimulant, astringent, diuretic, alterativ and anti-spasmodic. This is all the information we can give. Perhaps some eclectic member of the family will write you direct.-ED.] Editor MEDICAL WORLD:-What is to be done in case of injury to soft palate at or in about 4 inch of posterior nares, left side-a puncture of about 1⁄2 inch diameter, rather ragged edged wound? I couldn't get at it, so just told patient that it would get well any how and let him go. It was done by falling on weed stub while skating. It just cut thru lower lip. Triplett, Mo. W. G. BROWN. [Such injuries are common among children, who carry pencils in their mouths while running and fall on them. It is very dangerous, of course, but the danger is immediate, and if the puncturing instrument miss the vessels and nerves, healing is usually prompt and uneventful. You were conservativ enuf, but you should have advised swabbing or "gargling" with some mild antiseptic; as peroxid of hydrogen, diluted; saturated solution of boric acid; potassium permanganate solution, enuf to color the water deeply, etc.--ED.] Editor MEDICAL WORLD:-People in this vicinity are claiming that "Roche's Embrocation" alleviates the paroxysms of whooping cough when rubbed over the throat once or twice daily. It is put up in a bottle lettered "W. Edwards & Son," and contains about 2% ounces of a reddish colored oil. About a teaspoonful of this is employed at a time. Can you tell me what it contains, or give a formula equally as good? Mansfield Pa. WENTWORTH D. Vedder, M.D. [The last clause is good: "or give a formula equally as good." We do wish the whole family would read that; then cut it out, and refer to it when writing to us about formulas of nostrums. You can make a preparation equally as good, or better; any doctor can. We quote from the Western Druggist: "Digest asafetida two and one-half parts, with oliv oil sixty parts, for some hours; decant, and mix the solution with oil caraway two parts, and oil turpentine two parts, and add a few drops of oil gaultheria."-ED.] Editor MEDICAL WORLD:-Girl of rheumatic tendency, aged 12 years, had her leg and foot lacerated by being stept upon by sharply shod horse. The wound was triangular in outline, starting at upper third of tibia, and extending downwards and outwards; it measured about four by six inches. Patient was anesthetized, and wound cleansed with bichlorid -1 to 2,000, and sutured neatly. Drest wound twice daily with bichlorid gauze. The temperature rose to 102 F., but disappeared at the end of three days. Appetite became normal, but the site of lesion sluft. Then I cleansed with peroxid of hydrogen. On ninth day child began vomiting, but it was checkt with subnitrate of bismuth. On tenth day the temperature still remained normal, and while she took nourishment sparingly, she was weaker. Called that night to find her dying; pulse ninety and weak; temperature normal. Wound lookt healthy; no redness; no pus; very little pain in wound, yet she complained of cramps in stomach for thirty-six hours previous to death. After the ninth day I used chloroform in lieu of gauze. (Did you not intend saying iodoform, Doctor? ED.) She had quinin and whiskey as tonic till the ninth day and afterwards as stimulant. Missouri. J. M. C. [The case, as reported, is very strange. does not correspond to anything we have ever seen, and it certainly does not indicate tetanus or septicemia. We can not make any intelligent comments. Have any of the family anything to say?-ED.] Editor MEDICAL WORLD:-Why should neither quinin nor iron be given when there is fever? Is not quinin antipyretic? I here reproduce from memory a poem which I read somewhere a few months ago. Possibly some of the "family" may have seen it before: "Lives of poor men oft remind us Honest toil stands little chance; Bigger patches on our pants; On our pants, once new and glossy, And don't pay us what is due. Then let us all be up and doing: Send in your mite, however small; [Quinin is a tonic in tonic doses, and an antipyretic in sedativ doses. There is no hard and fast rule as to what should or should not be given during fever. It all depends on the stage of the disease and the condition and needs of the patient. That poem was written by an unappreciated editor, and one who did not use his editorial quill to boom proprietary preparations owned by himself. One who can do the latter successfully can not only have "pants," but he can live in a palace in millionaire's row. WORLD for July, 1903, page 338.—ED.] See [An over-modest brother sends with his subscription an excellent letter, but requests that it be thrown into the waste basket after being read, as he does not wish it to crowd out any of the generously good things from my own pen. It is not my own effusions, but the sentiment of the profession, that I wish these pages to present. Therefore I cannot resist presenting at least a part of the letter.] I wish I could so express myself as to make you realize just how much I appreciate your efforts in our behalf, and how I admire what I believe to be your honor and sincerity of purpose. Continue your exposure of the Medical Brief, and its class and kind. The last eight issues of my regular subscription to that journal, and the almost monthly "sample copies" since received, have all gone into the stove with [I do not like to expose nor oppose, but I must work for the profession. That is my chosen task, and I must do it. It requires both conscience and courage. I trust that I have both. Evils of certain kinds have been entrencht for years, and their strength has defied attack-none seemed to have steel worthy of the cause and contest. I have drawn attention a time or two to these evils, but no other medical journalist has ventured to come with me up to the "firing line." I have now determined to make the fight alone. It is not a journalist's fight as much as it is the fight of the profession; the members of the profession will follow if they are led aright.-ED.] Spread on thickly, cover with cotton, and bandage lightly. If properly made, this paste should remain moist for thirty-six to forty-eight hours. If it has a tendency to dry too quickly, cover with moistened cotton under bandage. Another treatment frequently advocated is prolonged counter-irritation by tincture iodin, with the hand on a splint so as to insure absolute rest. As the inflammation subsides, gentle motion is practised, to prevent adhesions forming in the later stages of resolution. If the disease has progrest to a ganglion, there is noth ing to do but cut down cautiously and express the contents, and dress antiseptically; beginning motion as soon as soreness permits. We prefer the term teno synovitis, to the term thecitis. We are not familiar with any preparation that will enable a traveling quack, or any other person, "to immediately lift the corn out." Any strong caustic, carefully watcht, would destroy enuf of the tissues to permit of one holding them up for exhibition, and declaring the corn was out." The following preparation is the best we know; it will enable you to take the corn out, in fact, in about a week. It will take out the soreness and pain in one day : Ꭱ Up-to-Date Ethics for Physicians. If called by night to attend a stranger at a great distance, dress quickly and go, never stopping to ask who wants you or if the bill will ever be paid, lest you be counted inhuman. Never ask how many physicians are in attendance in a case or how many kinds of patent medicins the patient is taking. Such curiosity on the part of the physician is vulgar. Never insult a stranger by asking for credentials, nor a patient by asking for moneydollars and cents is the vernacular of bankers, tradesmen and laborers. Never send in a "statement;" patients will think you are hard up. Pay your bills promptly. Send a check; it looks better. In writing a prescription, invoke Jove and cultivate mystery; a splash of ink and wiggle of the pen is sufficient. The druggist will put in "something just as good." Be sure to taste of the medicin left by the other physician, and "wonder if it will kill you." you." The remark is strictly original with you and impresses the patient and nurse with the brilliancy of your humor. Be sure to mention the fact of your being overworkt. Neurasthenia," " ovariotomy," "operativ work" and "uric acid diathesis" are words that impress the laity. Use them often. When going by a patient's house, stop in socially and tell her of some interesting case, and incidentally mention how busy you are. Never be friendly with any other physician. It's unethical. If you think another physician makes five dollars more a month than you do, cut him dead. If another physician's name is mentioned in your presence, bite your tongue and compress your lips, and the patient will understand that your hypertrophied good principle keeps you from "telling the truth, the whole truth," and a few other things about him. If called in after another physician has been treating a case of meningitis, make your diagnosis "inflammation of the brain" and be sure to say if you had been called in twentyfour hours earlier you could have saved the case. Never (or rarely) tell the truth; patients won't stand it. They will have you charge them up with one dollar and pay a liar $75 in advance. "The Lord loveth a cheerful liar; so do the laity. It is understood that you would not interfere with gestation-no, not for the whole worldbut it is well to prove it by telling of the vast sums of money that have been offered and failed to tempt you. If you cannot be " Great Mogul," don't play. This will give you a chance to be Chief Growler. If the other fellow doesn't think as you do, it proves his inferior intellect. Jealousy and envy are the tributes paid to superiority. Do not expect the "glad hand" when you give the "cold shoulder."' We haven't enuf "skin specialists" in the profession to offset the dead-beats in laity. "Physician, heel thyself," lest in old age the world say: "Well done, good and faithful servant; enter thou into the-poor-house." -Dr. Ella H. Dearborn in Pacific Coast Journal of Homeopathy. Patent Medicins. Robert Hutchinson (Lancet, November 28, 1903), gives a list of popular patent medicins with their approximate ingredients. While most of them are more generally employed in England, many of them are used in this country. Some of them are: Beecham's Pills.-Aloes, ginger, and soap. Bile Beans.-Cascara, rhubarb, licorice, and oil of peppermint, coated with gelatin. Carter's Little Liver Pills.-Podophyllin (one-eighth grain), and aloes soc. (one-third grain) in each pill. Dixon's Pills.-Taraxacum, podophyllin, jalap, and soap. Holloway's Pills.-Aloes, rhubarb, saffron, Glauber's salts, and pepper. Page-Woodcock's Wind Pills.-Aloes, oleum carui, and soap. Scott's Pills.-Aloin and cascara with a soap basis. Whelpton's Pills.-Rhubarb, aloes, ginger, pulv. ipecac, and soap. Eno's Fruit Salt.-Bicarb. soda, tartaric acid, and citric acid. Abbey's Salt.-Tartaric acid with bicarbonate of sodium, sulfate of magnesium, and sugar. Balsam of Aniseed.-Contains aniseed and other ingredients, with one-tenth of a grain of morphia in every ounce. Mrs. Frost's Anti-Obesity Remedy.-The activ ingredient is extract of fucus vesiculosus. Russell's Anti Corpulent Cure.-Citric acid. (20 grains to half an ounce), glycerin, and water. The Pink Tablet-saccharin. Buer's Piles Cure.-Ointment: Gall and hamamelis with lanolin basis. Powder: Precipitated sulfur and carbonate of magnesium. California Syrup of Figs.-Senna (activ constituent), syrup of figs, and cinnamon. Doane's (Backache) Pills.-1. White-coated aperient (dinner pills): Podophyllin, aloin, rhubarb, and peppermint. 2. Brown-coated (backache pills): Oil of juniper and a resinous constituent (? benzoin). Guy's Tonic.-Phosphoric acid, tinct. cochineal, inf. of gentian and chloroform water. Dalby's Carminativ.-Pulv. rhei, magnes. carb., glycerin, sugar, ol. menth. pip. and ol. anethi, and a small quantity of laudanum. Chlorodyne.-Chloroform, ether, hydrocyanic acid, morphin, cannabis indica, capsicum, peppermint, and treacle. Clarke's Blood Mixture.-The activ constituent is iodid of potassium (about six grains to the ounce). Pink Pills. -Sulfate of iron, an alkalin carbonate, and licorice, thickly coated with sugar and colored with carmine. Phosferine.-Quinin, phosphates, and hypo tem of Physiologic Therapeutics possesses value for all our readers, we give it space. Indications for the diet to be prescribed for those suffering from typhoid fever are afforded, first, by the existence of acute inflammation in the intestins. Such a lesion anywhere in the gastro-intestinal tract indicates a liquid diet. Second, by the enfeebled digestion, which makes it necessary to use only food that can be directly absorbed or easily digested. Third, by malassimilation, which is so considerable in all severe cases as to make it impossible during the period of pyrexia to restore strength and flesh. Food must be given, however, to lessen or retard this loss of strength and flesh. In mild cases, during the first days of illness, appetite is diminisht and capricious. At this time it is necessary to often vary the foods so as to tempt the patient to eat. The variety must be chosen from liquids. Milk should form the main staple, but beef juice, chicken broth, clam broth, oyster broth, custard, weak tea or coffee, and gruels may also be given. In severe cases, after the first few days, the mental sluggishness or indifference that the disease produces makes it possible to adopt a monotonous but nutritious diet. Patients are more inclined to complain because they are disturbed too frequently by the offer of nourishment than because of the kind of nourishment they are given. As convalescence approaches and is finally establisht, hunger demands quantity of food, and solid food, more than variety, altho a varied diet is fully appreciated. During the febril stage patients must be fed and given drink at specified times and in prescribed amounts, because they are mentally so indifferent or somnolent that they rarely ask for either food or drink. While not to be overcrowded with food, and, as a rule, not to be disturbed during sleep, their appetite must not be considered by nurses as a guide to the frequency with which food is to be given them. On the other hand, when convalescence is first establisht, the extreme hunger of typhoid patients must not tempt physicians or nurses to give solid food too quickly or too plentifully. In uncomplicated cases a milk diet should be adhered to until a normal temperature has been maintained for four or five days. During the next four or five days food should be liquid, but can be varied. When the temperature has been normal for a week, soft or semisolid food may be given. A few days later, finely divided meats may be given, and slowly the patient may be allowed to return to a mixt diet such as is usual in health. Milk is the best food for those having typhoid fever, as it contains in liquid form the ingredients essential for the maintenance of bodily temperature, strength, and repair of waste. Milk sugar and the fat of cream are easily prepared for absorption, and the proteid of milk is, as a rule, easily digested. These ingredients do not commonly undergo fermentation in the gastrointestinal tract. The salts of milk are almost identical with those of blood. Milk is an efficient diuretic and stimulates elimination by the kidneys, which is also important in lessening typhoid intoxication. All these qualities of milk make it a particularly good food in typhoid fever. From two to three pints of it should be given a patient daily. It is best to give a glass or half glass at a time. It is also well, when possible, to give it ten or twenty minutes after a Brand bath. Occasionally milk is found to disagree with typhoid patients. This is sometimes due to giving too much of it. Friends will now and again crowd two quarts or more a day upon the sick. With impaired powers of digestion, this may be more than the stomach can tolerate, and it may be vomited as a sour and curdled mass. At other times it disagrees with them because it clots with abnormal rapidity. Excessivly rapid curdling and consequent vomiting can frequently be prevented by adding lime water or barley water to the milk, or by thickening it with wheat flour. Better than any of these additions is a modification of milk, so that the proportion of the proteid in it will be 1.5 percent or 2 percent instead of 4 percent. This can be accomplisht by mixing one part of cream with three of boiled water, and three and one-half parts in 100 of milk sugar. It is often helpful to "pancreatize" the milk given to patients having typhoid fever. In the ordinary case, two grains of pancreatin and six grains of sodium bicarbonate dissolved in one ounce of cold water are stirred into four ounces of lukewarm milk, and this is at once given to the patient, who drinks it slowly and is usually unaware that anything has been added to the milk. This quantity is given every two hours. In rarer cases the milk must be peptonized or partly digested before it is given. This, however, is necessary only in exceptional cases. Patients who suffer from proteid indigestion are often much helpt by the administration of hydrochloric acid and pepsin. Typhoid patients who are mentally dull rarely object to any food that is given to them, but a few of those who are not, have so intense a dislike for milk that enuf nourishment cannot be administered to them if milk alone is used. In such cases it is necessary to find some substitute for it. Malted milk and similar products may be used, or gruels of wheat or barley; these last should be strained to remove solid particles. Patients will frequently take koumiss and buttermilk when they refuse sweet milk. Many others will take custards, or milk with a raw egg beaten up in it, when they will take neither of the other preparations. It must not be forgotten that many persons who have a prejudice against milk can be taught to take it if it is fed to them from a spoon at first, in doses of two or three teaspoonfuls at a time. Those who cannot tolerate milk in any form must depend upon bouillon. It is not sufficiently nutritious of itself. It can, however, be fortified by adding to it an egg or by giving an egg lemonade in its stead. A little soft boiled rice may sometimes be added to bouillon with benefit. The bouillon is absorbed directly, almost without digestion; the egg and rice require digestion. Bouillon, however, stimulates strongly the peptic glands and excites an increast flow of gastric juice. It restores the mineral salts of the blood, which are rapidly eliminated during the period of fever. So considerable is this elimination that a mineral inanition is sometimes threatened. In such cases bouillon must be given in quantities of from one to one and a half pints daily. It is so useful as a stomachic and a restorer of mineral matter that it is well to give it in small amounts to all typhoid patients. Patients also need to be given an occasional drink of water. Unless specially instructed, nurses frequently neglect this. They wait for the patient to ask for a drink, and he is frequently too dull to do this. Lemonade is craved by many, and is harmless. (We always order it strained. Ed.). Tea and coffee may be permitted in small amounts when they are desired. Coffee is decidedly useful in extreme cases when the heart is weak or failing. It should then be given as a strong decoction. A half pint may be allowed daily. The simpler diet of milk, or milk and bouillon, is to be preferred, however, except in those rare cases where a variety seems necessary to satisfy a patient's crayings or caprice. Fruit juices, such as orange and grape juice, and jellies are relishes that are not only harmless, but mildly nutritious, and are much enjoyed by fever patients. Drinking copiously of liquids increases tissue oxidation, but does not increase disintegration; therefore elimination of waste products becomes more perfect. By introducing much fluid into the circulation, waste matters are washt from the tissues and rapidly carried to the organ of excretion. It also lessens the concentration of the blood, which is considerable during the first half of the course of typhoid fever, and therefore prevents exosmosis from the tissues. Elimination by the kidneys is increast because blood tension is greater. The noxious matters in the blood and lymph are diluted and become less irritating to the nervous system and emunctories. The typhoid state is consequently less pronounced when fluids are drunk freely, and the kidneys, liver, and muscles are less likely to disintegrate. If instruments were always cleaned as soon as used, or as soon as one gets back to the office from a trip, there would be no trouble with dirty or missing instruments when wanted in a hurry. Gratitude. Thank God for the doctor," the layman cried, To him who has saved us this life to-day; The doctor's hand that was thin and cold, What a lovely thing is this gratitude! For the labor we do for the sick and weak; What a wealth we have for our daily work How sweet to the ear is the grateful word— Oh, wise was the man who of Old Nick wrote: But gaining his health-what a truth it was- -GEO. THOS. PALMER, in Indian Med. Rec. State of New York Medical Examination, January, 1904. ANATOMY. Answer any ten of the questions on this paper but no more. Check the number (V) of each one of the questions you have answered. 1. Give the gross anatomy of the human skull. 2. Describe the sternoclavicular articulation. 3 What muscles control the movements of the tongue? 4. Give the boundaries of (a) the popliteal space, (6) Scarpa's triangle. 5. Give the origin, course, and branches of one of the following arteries: (a) femoral, (b) ulnar, (c) internal iliac. 6. What vessels unite to form the superior vena cava? Describe the course and termination of the superior vena cava. 7. How and where does the thoracic duct terminate? 8 Mention the branches of distribution of the seventh nerve. 9. Describe the ileocecal valve. 10. Give the anatomy of the eyeball. 11. Describe the right ventricle of the heart, mentioning its open. ings and its valves. 12. Describe the pleural membrane. 13. Give the usual position and the relations of the appendix vermiformis. 14. Mention the varieties of tissue and describe three varieties. 15. Mention the various regions of the abdomen and indicate the contents of one of these regions. PHYSIOLOGY AND HYGIENE. Answer any ten of the questions on this paper but no more. Check the number (V) of each one of the questions you have answered. 1. Enumerate the ultimate chemical elements that are physiolog ically present in the tissues of the human body. 2. Mention and illustrate the varieties of epithelium and indicate their functions. 3. Give in regard to bone (a) structure, (b) method of nourish. ment, (c) physical and chemical properties, (d) functions. 4. Mention the digestiv glands and state the particular function of each. 5. Describe (a) serous membranes, (b) synovial membranes. State the functions of each. Enumerate the serous mem. branes of the body. 6. Define and describe (a) lymphatics, (b) chyme, (c) chyle. 7. Where and how is urea formed in the body? In what quantity is urea excreted by the adult in twenty-four hours? 8. How is the heat of the body (a) produced, (b) dissipated. Mention the functions of the skin. 9. State the effect on respiration of section of (a) one phrenic nerve, (b) both phrenic nerves. 10. Mention the forces that produce and maintain the circulation of the blood in the arteries, capillaries, and veins. 11. Give the ordinary composition of atmospheric air. State the permissible limit of CO in air. 12. Describe the hygienic construction of a bedchamber for two adult persons, touching on size, shape, air inlets and outlets, heating, and lighting. Give reasons. 13. What appliances are commonly employed for the heating of houses? What is their comparativ value? Give reasons for conclusion. 14. State in detail the means that may be employed to prevent the spread of epidemics of (a) Asiatic cholera, (b) bubonic plague, (c) small-pox. 15. Give an analysis (parts per 10,000) of a proper drinking water. State parts per 10,000 of the following which render a water non-potable: Free ammonia, albuminoid ammonia, nitrogen as nitrates, nitrogen as nitrites, chlorin, volatile residue, fixed residue. CHEMISTRY. Answer any ten of the questions on this paper but no more. Check the number (V) of each one of the questions you have answered. 1. Define reaction, reagent, water of crystallization, atomic weight, specific gravity. 2. Cite the laws in conformity with which chemical combination invariably takes place. 3. Mention the five compounds of oxygen with nitrogen. Give the formula of each. 4. Describe nitrogen as to (a) occurrence, (b) preparation, (c) properties. 5. Give the formula and properties of (a) chlorate of potassium, (b) sulfuric acid, (c) ammonia gas, (d) tartaric acid. 6. Give the symbol, atomic weight, and physical properties of bismuth. 7. How is anilin obtained? State how anilin dyes are manufactured from anilin. 8. Describe the preparation and use of guncotton (pyroxylin). 9. Mention two reactions by which hydrocyanic acid is formed. Give the properties of hydrocyanic acid. 10. What is vinegar chemically? Describe the chemical changes in the manufacture of vinegar. 11. Give the symptoms and diagnostic features of oxalic acid poisoning. Mention the antidotes for this poison. With what commonly used salt is oxalic acid likely to be confused? 12. Give a detailed test for ascertaining the presence of albumin in the urin. 13. What are aldehydes? Mention the properties and principles derivativs of aldehydes. 14. How are soaps made? What constitutes (a) hard soap, (b) soft soap, (c) castile soap? 15. Complete the equations: 4CuO+2NaCl + H2O= KeCr2O 4H&SO4= SURGERY. Answer any 10 of the questions on this paper but no more. Check the number of each (V) one of the questions you have answered. 1. Give a classification of wounds. 2. Mention three of the most commonly observed tumors of the scalp. 3. Give the technic of thoracotomy for empyema. What are the indications and contraindications relating to the use of an anesthetic in this class of cases? 4. Describe the postoperative dressing for fracture of the patella. 5. Give the symptoms, diagnosis, prognosis and treatment of a compound (open) dislocation. 6. Differentiate symptomatically traumatic compression of the brain, apoplexy and extreme inebriety. 7. Give the etiology, diagnosis and treatment of rachitis. 3. Describe air embolism. Give treatment. 9. Make a diagnosis of renal calculus by exclusion. 11. Differentiate acute and chronic ischiorectal abscess. Give the symptoms and treatment of one form of ischiorectal abscess. 12. Give the causes, symptoms and treatment of hematoma of the vulva. 13. Describe cataract. Give an operation for the cure of cataract. 14. Describe nasal polypi and give operativ procedure for their removal. 15. Describe keloid. Give treatment, OBSTETRICS. Answer any 10 of the questions on this paper but no more. Check the number (V) of each one of the questions you have answered. 1. Describe the important diameters and measurements of (a) the female pelvis, (b) the fetal head. 2. Give a physiologic description of the impregnation of the human ovum. 3. Define menstruation and describe its phenomena. Mention the abnormal varieties of menstruation. 4. Give the management of a pregnancy and labor complicated by a fibroid tumor of the uterus. 5. Give the causes and management of delay in the second stage of labor. 6. Define multiple pregnancy and state how it may be recognized. 7. Describe the causes and management of a "head-last" labor. 8. State the causes and management of puerperal phlebitis. 9. To what diseases is the puerperal breast liable? What care should be given to prevent and to relieve infection of the mammae? 10. Under what conditions are anesthetics desirable in labor? How should anesthetics be administered in labor? |