ROCHESTER STERILIZING OUTFIT AN INSTRUMENT STERILIZER. A WATER STER- A DRESSING STERILIZER. The three great sterilizing necessities in one apparatus. Additional Water Sterilizer if desired. All fitted to a neat, strong, heavily enameled stand, pipe or angle iron. 9. Describe a septic tank, and explain the principles involved. 10. Describe the artificial feeding of an infant aged ten days. OBSTETRICS. I. Describe the difference in appearance of a foetus of three months and one of five months? 2. Name three of the most common causes of miscarriage up to the fourth month; the best means of preventing and the treatment of each. 3. What class or kind of substances, if any, pass unchanged from the blood of the mother to that of the child during pregnancy? 4. Name ten drugs which, if given to the mother during pregnancy, may have an injurious effect on the unborn child? 5. Under what circumstances is it advisable to convert a breech into a foot presentation? 6. What are the indications for the use of forceps during labor? 7. Name three pathological conditions which may simulate pregnancy before the end of the fourth month; give differential diagnosis of each from pregnancy and best treatment of each condition. 8. Give the symptoms of rupture of the uterus during labor; the most common causes, the best means of their prevention and the treatment if it occurs? 9. Name five indications for the termination of pregnancy before the eighth month? 10. Name three kinds of pathogenic bacteria which most commonly cause puerpural infection; the clinical and diagnostic symptoms of each and the best treatment of each. GYNAECOLOGY. Examination of December 3, 1907. 1. What is vaginitis and name six causes? 2. Define vaginismus and name three causes? 3. How would you treat chronic endocervicitis? 4. Describe briefly the treatment of complete laceration of the perineum? 5. Name five varieties of dysmenorrhoea from the standpoint of origin? 6. How would you distinguish between a case of prolapsus uteri and an hypertrophied cervix? 7. Give cause and treatment of pruritis vulvæ? 8. Name five diseased conditions found in the labia majora? 9. Give etiology and treatment of vesico-vaginal fistula? 10. Differentiate between: briefly hematometra, uterine fibroid, malignant growth, ovarian cyst and pregnancy? (Use parallel columns.) GENERAL DIAGNOSIS. I. On what signs and symptoms would you make an early diagnosis of pulmonary tuberculosis? 2. Describe leukæmia and mention the pathological changes occurring in this disease. 3. Give etiology and clinical findings in plague. SAL HEPATICA The original effervescing Saline Laxative and Uric Acid Solvent. A combination of the Tonic, Alterative and Laxative Salts similar to the celebrated Bitter Waters of Europe, fortified by addition of Lithia and Sodium Phosphate. It stimulates liver, tones intestinal glands, purifies alimentary tract, improves digestion, assimilation and metabolism. Especially valuable in rheumatism, gout, bilious attacks, constipation. Most efficient in eliminating toxic products from intestinal tract or blood, and correcting vicious or impaired functions. Write for free samples. BRISTOL-MYERS CO. Brooklyn New York. Patented March 17 and December 23rd, 1903. Price, Prepaid, 75 cents. Manufactured by F. C. WOODS & CO., IF you have used an "EXPERT" you will use no other; if not, you will eventually. Why not now? Several exclusive patented features Send for Catalog. Dept. M. Alliance, Ohio. The Medical Brief A Monthly Journal of Practical Medicine. VOL. XXXVI. ST. LOUIS, Mo., JUNE, 1908. No. 6. THE CLINICAL USE OF RADIANT ENERGY FROM THE HIGHPOWER INCANDESCENT LIGHT.* BY ALBERT C. GEYSER, M. D., New York City. Instructor in Radiography and Radiotherapy at Cornell University Medical College; Lecturer in Electrotherapy and Radiography at the New York Polyclinic; President of the New York Physical Therapeutic Society: Secretary of the American Electro-Therapeutic Association; Member of American Medical Association, Greater New York Association, Bronx Medical Association, gen Ray Society, etc. GENTLEMEN: Before beginning our clinical work, I must again call your attention to the oft-repeated statement, "It is not the agent, but the reaction of the body to the agent." Never, for a moment, lose sight of this dictum. The agent to be employed is always a secondary consideration; your first thought, as far as therapeutics are concerned, must always be, What is the reaction desired in this particular case? Your next consideration is, What agent is best calculated, therapeutically, to cause the desired reaction? Time and again have I demonstrated to you that there are only two pathological states possible in any organ, part of the body, or even the whole body. Either the part is in a state of over-activity or under-activity. No matter which of these two states is present, it is our endeavor to produce just enough of the opposite state to cause that activity to assume the normal. In the treatment of disease conditions, our first consideration is to remove the cause, if still active, or the effects of the cause, if the cause is not active or can not be removed. Again, unless our therapeutic measure is based upon a preceded diagnosis, we must expect failure in therapeutic results; not only that, having made a correct diagnosis, our therapeutic measure must be a logical sequence to the symptoms presented. We will begin our clinical work with a new patient: Case 1—Mr. S., how old are you? "Sixty-three years." How long have you suffered from your present ailment? "About six weeks." Tell * Stenographic report of a lecture on the use of radiant energy from high-power incandescent lamps, delivered to the students at the Electrotherapeutic Department of the New York Polyclinic, February 7, 1908. us all about it and how it began. "About six weeks ago I was suddenly taken sick, became unconscious, and remained so for several hours. Upon recovering consciousness, I found that I had lost the use of my right arm and leg; I remained in bed for ten days. Since then there has been no change in my condition to the present." (Mr. S., now walk up and down the room). Gentlemen, do you notice that the patient drags his right foot and makes a scraping noise by the contact of the sole of his shoe upon the floor? Notice, again, that since the patient's attention was directed to the noise, he now walks without the noise, but, instead, tilts his pelvis to the left, and brings his right leg forward with a swinging motion, showing, as he has correctly stated, that he has lost the free use of his leg. Upon attempting to flex the arm or extend it, we find a spastic condition upon the right side, while the left arm is quite free and lax. The grip of his right hand is quite feeble as that compared with his left. (Mr. S., remove your clothing down to the waist.) There is no atrophy. In making an electrical examination, always begin with the faradic current. We place the indifferent electrode over the spinal origin of the to-be-tested nerve, and with the active electrode touch the motor points of all the affected muscles. You notice they all respond in a normal manner. We know, therefore, that we are not dealing with a reaction of degeneration. Upon testing the patellar reflex, we find increased tone and exaggerated movements. We have, then, besides the patient's history, five cardinal points. They are: A paralysis extending over a large area, no atrophy in any of the muscle groups, a spastic condition upon the affected side, exaggerated patellar reflexes, and normal electrical response to the faradic current. Upon this information we make the diagnosis of hemiplegia, with a central lesion located below the division of the motor branches of the face. What, then, is the indicated treatment? The text-books inform you that potassium iodide is the only drug indicated, with perhaps strychnin for a tonic. The potassium iodide is given for the purpose of assisting the absorption of the clot. Its manner of action has been pointed out to you so many times that you are thoroughly conversant with its good, but especially its baneful, effects upon the system. We have a much surer and better agent for the purpose of absorbing the blood clot. Our aim is to heat, and, at the same time, increase the speed of the circulatory cycle. We expose the bare back of the patient to the action of radiant light and heat, as furnished by this high-power incandescent lamp. The lamp is kept in constant motion all over the back, at a distance of about two feet from the parts to be treated. During the first few minutes, the patient may be very suscep tible to the heat. Always treat the patient first, the condition secondarily. I mean thereby, consult the feelings of the patient. After a few minutes, the patient is not so susceptible to the heat, and is able to stand a close application very much better. The system has reacted to the intense local light and the heat, the heated blood is removed quicker, and cooler blood substituted; the patient breaks out in a more or less profuse perspiration, showing that the whole system is brought into play for the purpose of cooling the locally-heated area. The capillary circulation over the back has, by this time, become enormously distended, favoring the blood-flow to the periphery, and so lessening the central pressure. The heated blood now bathes and gradually softens the periphery of the blood clot in the motor cortical zone, and tends to absorb it. By causing these muscles to perform their physiological function, we accomplish that for which the strychnin is given, without subjecting the entire body, and all its organs, to the influence of so potent a drug. The entire procedure should be repeated at least every other day, and extended over a long time, or until the normal at least has been re-established. Case 2-Miss O., telephone operator. Complains of acne vulgaris of some years' standing. This patient presented herself at this clinic four weeks ago. The patient was treated with the X-ray for the purpose of inhibiting the over-activity of the sebaceous glands; this was accomplished two weeks ago. For the past two weeks she has been exposed to the action of this radiant energy, at each treatment with the lamp as close to the face as she could bear it. The result, as you can see, has been most satisfactory. The enormously-increased circulation has removed all the detritus, which had become softened, and, therefore, easily removed. Many of these patients get well in the summer, when the face can be exposed to the action of sunlight, without any other treatment; but in the winter, or in cases of patients who are obliged to work, and can not devote the necessary time for an outdoor life, something of a substitute must be had. The combined effect of the X-ray, and, later, the high-candle-power incandescent lamp, will cure most cases subjected to treatment. Case 3-Mr. M., age twenty-two years, clothing cutter. For the past six months complained of pain in his right shoulder and arm. There was no history of trauma; it came on gradually and spread from the forearm. to the shoulder. Before coming to this clinic, he was treated for rheumatism of the shoulder. The word "rheumatism" covers much ignorance. Upon physical and electrical examination, it was discovered that only the nerve seemed to be more tender than normal. The pain and weakness is due to a peripheral neuritis-an occupation neuritis. This patient came here one month ago, and was treated every other day as now, by subjecting the shoulder and arm to the action of radiant light and heat, |