OBSTETRICS AND GYNECOLOGY.

1. Describe the preparation of the woman and bed in a case of labor. 2. Differentiate true from false labor pains, and give symptoms that show labor has commenced.

3. What do you understand by retained placenta, and how would you treat it?

4. What is the cause of ophthalmia neonatorum? Give preventative and curative treatment.

6. Give symptoms of retroversion of the uterus and its treatment. 7. Describe the preparation of a patient for a laparotomy.

8. Pyosalpinx-give definition, symptoms, and operative treatment. BACTERIOLOGY.

1. Describe a coccus and name the divisions according to arrangements. What is a spore?

2.

3. Name conditions necessary for bacterial growth. Mention inhibiting

or destructive agencies.

4. What are the effects of bacteria upon the tissue?

5. Define a toxin. Define an antitoxin.

1. Define hygiene.

HYGIENE.

2. Tell how you would manage a case of typhoid fever to prevent spread of infection.

3. What lower animals are carriers of diphtheritic poison? How manage cases of diphtheria to prevent spread of contagion?

4. How stamp out typhoid fever?

5. How prevent spread of scarlet fever? Of measles?

6. How prevent infection from tuberculosis, especially if there were cavities in the lungs?

7. How manage infants during hot weather to prevent the fearful ravages of the summer diseases to which they are liable?

8. Can the State diminish or eradicate tuberculosis? How?

9.

What simple means will prevent ophthalmia neonatorum?

10. Give best method of disinfecting bedding, clothing, etc., after diphtheria, scarlet fever, small-pox? How soon should children return to school after each?

SETON HOSPITAL REPORTS.

PROF. L. E. RUSSELL, SURGEON.

CASE 62.-Mr. H., age 50 years, carpenter bv occupation, alighting from a street car in the evening accidentally fell through a trestle to the ground below, a distance of forty feet, sustaining many injuries to the body, including a backward dislocation of forearm. There was rupture of the anterior ligaments, and the coronoid process was driven backward, resting in the olecrnon fossa. The lesion of the arm was not detected by the surgeon who was called in to the case at the time. nor for several weeks afterwards; and the case finally passed out of the care of the surgeou first called, and one of our men was employed, who immediately discovered a backwaad dislocation of the elbow. But inasmuch as some eight months had elapsed between the time of the injury and the placing of the case into the hands of an Eclectic surgeon, nature had done much towards a permanent obstruction to any attempted reduction; and inasmuch as the case was therefore sent to

the hospital clinic, before attempting any surgical proceeding we took an X-ray, which is herewith produced, showing the gravity of the injury to the elbow joint.

By careful observation it will be noted that the coronoid process rests in the olecranon fossa, and that an osseous plastic exudate has formed in the proximal end of the radius, making complete bony anchylosis of the elbow joint.

There is a diagnostic feature in dislocations of the elbow so plain that it seems almost inexcusable for a surgeon to allow this dislocation to go unnoticed. The arm is generally semiflexed, and there is an inability on the part of the patient or of the surgeon to forcibly flex the arm to its normal position. The condyles of the humerus resting on the dislocated ulna and radius act as a fulcrum, and when you take into consideration the pronounced appearance of the olecranon fossa and the heavy tendon, it seems that the lesion should be readily understood.

In this case, on account of the extreme anchylosis, the patient was anesthetized, and an incision at the posterior part of the elbow joint, extending in a half elliptical shape, brought the flap downward to and into the elbow joint proper. We were then compelled to chisel loose the osseous material that had joined the injured and dislocated bones. The olecranon fossa was now cleared of its bony debris, and by careful

manipulation the reduction was easily accomplished, and the arm flexed and dressed in plaster-Paris dressing, allowing a fenestra for the caring of the incised wound.

Within ten days time the patient left the hospital for his home in West Virginia, bearing instructions to his surgeon to remove the fixed dressing in a few days, and commence forced extension and flexion so as to secure a useful joint.

CASE 63.-Infant three weeks old, presented by Prof. Watkins on account of a deformity of the left knee joint, which, from the history of the case, must have been dislocated in utero, one month prior to confinement.

Dislocations are classified as traumatic, congenital, and pathological. Traumatic dislocations result from direct or indirect violence, or from muscular activity in which the position of the bone may be bound as a fulcrum. Pathological dislocations, on the other hand, are usually of an insidious type, resulting from lesions of the joints, such, for instance, as tuberculosis; while congenital dislocations are due to some violence which the mother has sustained, producing severe muscular uterine contractions. In speaking of dislocations, the distal bone is discussed as being the one dislocated; and if there is no solution of continuity of the soft parts, the dislocation is termed a simple dislocation, while if there is a solution of the continuity of the soft parts, it is spoken of as a compound dislocation; and where the bones are greatly crushed, it is called a comminuted dislocation.

In the case of the little clinic just spoken of above, we found a forward dislocation of the tibia and fibula; the condyles of the femur resting in the popliteal space. The three weeks infant was chloroformed and remained under the impress of the anesthetic for fully one half hour, as it required much time to get sufficient extension of the muscles and tendons to allow of replacement of the dislocated knee. The foot would bend forward so as to touch the body of the child, yet in any attempt at its flexion, the condyles of the femur immediately pressed against the lower bones, locking the joint. The age of the child, and the fragile condition of the bones, made it imperative that very little violence should be exerted in the attempted reduction. The tibia and fibula were grasped in the right hand through the upper third, and the left hand surrounded the condyles; and then by gently pulling and manipulating some freedom was obtained, and after several minutes we were enabled to place either thumb against the condyle of the femur; and with the relaxed condition attained, give promise of a restoration of the bones to their normal position, by pulling with the palm of the hand and fingers against the posterior part of the lower limb, and the thumbs pressed upward and backward

on the condyles of the femur. At last the bones were placed in their normal position, the leg semiflexed and immobilized in plaster dressing, which will be removed every ten days or two weeks to change from the flexed to the extended position until nature asserts her rights.

EYE, EAR, NOSE AND THROAT.

CONDUCTED BY KENT O. FOLTZ, M. D.

ACUTE RHINOPHARYNGITIS.

Symptoms.-Acute catarrh of the naso-pharynx; acute post-nasal catarrh ; acute naso-pharyngitis; acute retro-nasal catarrh.

This is an acute catarrhal inflammation of the naso-pharyngeal mucous membrane.

Etiology. Predisposing causes: The most active cause is climatic changes, especially in the spring and fall. The patient's powers of resistance to these changes are also factors. A hypersensitive condition of these tissues is not infrequently found in neurasthenic patients. The disease is infrequently seen in children; but a scrofulous diathesis is a predisposing condition.

Exciting Causes.-It may accompany either an acute pharyngitis or rhinitis, or may be an exacerbation of a chronic catarrhal inflammation of this region. It may also result from extension of an inflammatory process in either the nose or pharynx through continuity of tissue. Local irritation caused by the inhalation of dust or chemical fumes may be a cause. Any of the conditions which might provoke an acute rhinitis, may involve the naso-pharynx. Among the infectious diseases, scarlet fever, diphtheria and measles are quite likely to be followed or complicated by acute pharyngitis.

Pathology.-Practically the same as in acute catarrhal inflammamation of any mucous membrane.

Symptons. These vary according to the severity of the case. When the disease accompanies an acute rhinitis or pharyngitis, it may not be recognized. When occurring independently, however, the symptoms are quite well defined. The attack is sudden, usually with a slight rise in temperature, not often reaching 101° F., malaise, disturbance of the stomach and bowels, and tongue coated. A dryness of the post-nasal space is present, which is very uncomfortable, as well as a sensation of tightness, which is increased on swallowing.

A neuralgic pain is usually complained of, and is referred to the pharyngeal vault, roof of the mouth, angles of the jaws or the vertex, and is generally persistent during the attack. Slight hemorrhages may occur. The dryness continues for one or two days, or until secre

tion commences. The secretion at first is quite clear, but thick and tenacious; then it changes to a white color, and finally becomes purulent. The secretion is very adherent to the mucous membrane, and on account of the irritation produced, a more or less constant "hawking” and spitting result. Sometimes the secretion is expelled through the nose, but as a rule through the mouth. Some of the secretion is unavoidably swallowed, and this increases the gastric disturbance.

The secretion may produce an acute rhinitis through irritation. If an aggravated case, catarrhal ulcers may form, the hearing may be impaired, and the voice become hoarse through impeded circulation. Cough is not often present. After ten days or two weeks the symptoms gradually disappear and the tissues regain approximately their normal condition. Very infrequently is there bronchial or tracheal involvement.

Inspection of the naso-pharynx during the early stage reveals a reddened, swollen condition, with dry, glazed surface, and tortuous, congested vessels. In the later stages, the secretion will be seen cling. ing to or hanging from the walls, filling the crypts of Luschka's tonsil, as well as Rosenmuller's fossæ.

Diagnosis.-The history of the case, but especially by posterior rhinoscopic examination.

Prognosis.-Favorable.

Treatment.-Local treatment is of no especial value, excepting to cleanse the surfaces, and for this purpose any of the alkaline washes will do. Internally, during the initial stages, sp. jaborandi in doses of gtt. ij. to iij. every hour until secretion is established. If there is much burning, as sometimes occurs, sp. rhus tox. should be added. For the pain, aggravated on swallowing, sp. bryonia. When the mucous follicles are engorged, sp. phytolacca. The remedy which will be most generally indicated after secretion is established is potassium bichromate, 1.100 gr., giving it every three houre. When the secretion becomes purulent, lime, either as lime water or the sulphide of lime. After the subsidence of the disease sp. hydrastis and sp. phytolacca should be administered for several weeks, or until the tis sues regain their normal activity.

BORIC ACID IN EAR DISEASES.

The use of boric acid in suppurative diseases of the middle ear forms the basis of local treatment, but discrimination is necessary in order to obtain satisfactory results. The powder should be lightly dusted over the mucous surface after thoroughly cleansing with cotton on a cotton applicator. I very seldom use any fluid in the ear in suppurative cases. The following are the combinations I have been in the habit of using. The names employed are for the most part of my own coining, more for the sake of convenience than for their appropriateness.