Tympanic, supplies tympanum.

Arteria receptaculi, supplies walls of the sinuses, gasserian ganglion.

Anterior meningeal, supplies meninges, especially pia mater and arachnoid.

Ophthalmic, supplies eye proper and orbit of eye. Anterior cerebral, supplies anterior part of cerebrum. Middle cerebral, supplies brain and meninges. Posterior communicating (part of circle of Willis), supplies brain.

Anterior choroid, ends in choroid plexus of brain.

4. Describe the appendix vermiformis. Locate McBurney's point for performing appendectomy.

The vermiform appendix is a worm-like, tubular outgrowth which springs from the inner and posterior surface of the cecum, about an inch below the ileocecal orifice. It may point in any direction, but usually over the brim of the pelvis into the pelvis; upward behind the cecum; upward and inward toward the spleen. Its size varies. It is usually about 3 1-2 inches long and 1-4 inch thick. Its lumen varies with the age of the individual, being largest in the young, and smallest in the aged. It is covered with peritoneum, and has serous, muscular (longitudinal and circular), submucous, and mucous layers, and contains lymphoid nodules. McBurney's point is a point midway between the umbilicus and the anterior-superior spine of the ilium, and one-half inch above it.

5. What is the origin, action and nerve supply of the rectus femoris muscle?

The rectus femoris arises by two tendons: the straight, from the anterior inferior spine of the ilium; the reflected, from a groove above the brim of the acetabulum, and is inserted into the tubercle of the tibia, by way of the quadriceps extensor tendon. (Some authors give the insertion into the patella.) Action, to extend the leg. Nerve, anterior crural.

6. Give the boundaries of the thorax.

The thorax is formed by the sternum anteriorly, ribs and costal cartilages laterally, and the bodies of the dorsal vertebræ posteriorly. Superiorly, by the first rib, and inferiorly, by the diaphragm.

7. Describe the intestinal tract and name its divisions. The alimentary tract is a musculomembranous tube, about 30 feet in length, extending from the mouth to the anus, is

lined throughout with mucous membrane, furnished with several accessory organs, and performing the functions of ingestion, mastication, insalivation, deglutition, digestion, assimilation, and egestion. It is divided into mouth, pharynx, esophagus, stomach, small intestine (duodenum, jejunum, and ileum), and large intestine (cecum, colon, and rectum). The first three lie above the diaphragm, the rest below it.

8. Describe the sympathetic nerve.

The sympathetic nerve consists of a series of ganglia, connected together by intervening cords, one series on each side of the median line of the body, partly in front and partly on each side of the vertebral column, beginning in the ganglion of Ribes, on the anterior communicating artery and ending in the ganglion impar in front of the coccyx: three great gangliated plexuses situated in the thoracic, abdominal and pelvic cavities, smaller ganglia in relation with the abdominal viscera, and numerous communicating and distributing nerve-fibers.

9. Give a general description of the spinal cord.

The spinal cord is that part of the cerebrospinal axis which is situated in the spinal canal. Its length is about 16 to 18 inches, and it terminates at the lower border of the first lumbar vertebra, in the cauda equina, or filum terminale. It is cylindrical in form, with two enlargements, one in the cervical region and one in the lumbar. It is composed of gray and white matter, the gray being inside. Has three enveloping membranes, eight fissures, four columns, and a central canal.

10. What are the cranial nerves? What do they supply? Name function of each.

The cranial nerves arise from the brain direct, and supply organs situated in the cranium or emanate through fissures in the cranium.

1. Olfactory, supplies nerves of smell. Function, special

7. Facial, motor nerve of face, and nerve of facial expression. Function, motor.

8. Auditory, supplies apparatus of hearing. Function, special sense.

9. Glossopharyngeal, supplies posterior one-third of tongue and lateral part of palate, muscles of pharynx, and parotid gland, tonsils, anterior palatine arches, soft palate. Function, motor, sensory, and special sense.

10. Pneumogastric, or vagus, supplies meninges, external ear, pharynx, larynx, heart, lungs, esophagus, stomach, spleen, liver. Function, motor and sensory.

11. Spinal accessory, supplies sternomastoid and trapezius muscles. Function, motor.

12. Hypoglossal, supplies meninges, neck-muscles, and intrinsic muscles of the tongue.

CHEMISTRY, ETIOLOGY, AND HYGIENE

CHEMISTRY

1. Define valence, acid, base. What is valence of Ca, Na, K, As, Ba?

An acid is composed of an electronegative element or radical with hydrogen, part or all of which hydrogen it can part with in exchange for an electropositive 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. 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. Arsenic is a triad; barium is a diad.

2. Give a test for arsenic.

Reinsch's test is as follows: To the suspected fluid add a little pure HCl; 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 octahedral crystals of arsenic trioxide.

3. Give a test for hydrocyanic acid.

Add ammonium sulphydrate and evaporate to dryness; then add solution of ferric chloride. A red color results from the reaction.

4. State the occurrence and properties of oxygen, of hydrogen' of nitrogen.

Oxygen. Occurrence: Free in the air and in combination in water, rocks, minerals, etc. It is more abundant than any other element, forming about 47 percent of the earth's crust and atmosphere. 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 except fluorine. It is necessary to life, and is a supporter of com

bustion.

Hydrogen. Occurrence: Free in volcanic gases, in fire damp, and the gases of the intestines. In combination: in water, all acids, in many organic compounds. Properties: A colorless, tasteless, odorless gas, the lightest known substance; it has a great affinity for oxygen; it supports neither combustion nor respiration; it is a necessary constituent of all acids; the gas will burn with a pale blue flame.

Nitrogen. Occurrence: Free in the air, in combination in nitrates, in ammonia, 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.

5. What is the formula for carbolic acid? Antidote? CH(OH) Alcohol, sodium sulphate, and vinegar are antidotes.

ETIOLOGY AND HYGIENE

1. Give etiology of pelvic peritonitis.

Due generally to sepsis or gonorrhea. May be due to salpingitis, ovarian inflammation, pelvic cellulitis, septic cystitis, metritis, perforation of uterus, perityphiitis, appendicitis.

2. Give the etiology of apoplexy.

Generally due to bursting of cerebral blood-vessel, most frequently the middle meningeal or some of its terminal branches, especially Charcot's artery; or the artery in the sylvian fissure, and sometimes the anterior cerebral artery is involved. The vessel is usually sclerotic, with miliary aneurisms, and on rupture the blood is poured out into the brain-substance, producing acute softening, which substance is later absorbed, and a cyst or a scar remains.

3. Give the etiology and means of prevention of typhoid fever. Typhoid fever is due to invasion of the small and large intestine by typhoid bacilli taken into the alimentary tract with food or water. The stools, urine, vomit and sputum of the typhoid patient should be thoroughly disinfected with an efficient agent; towels, napkins, bed-linen, and all clothing used by patients disinfected thoroughly before being laundered. Drinking water to be boiled All contamination from food by flies, etc, to be avoided.

4. What is the difference between a contagious and infectious disease?

An infectious disease is one which is due to a specific and pathological microorganism which grows and multiplies in the body, elaborating a biologic poison. A contagious disease is one which is communicable through the air or atmosphere, and does not necessarily require contact with infected patients

tion of the line of demarcation, amputate high up. In tran matic gangrene, if spreading, amputate at once, and high up without waiting for a line of demarcation.

2. What are the signals of danger in general anesthesia? 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.

3. Give the cause and treatment of painful cicatrix, adherent cicatrix, contracted cicatrix, and exuberant cicatrix.

Painful cicatrix is caused by the pressure of a contracting cicatrix upon the cut end 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.

4. Mention the most common sites of epitheliomata.

On the skin, mucous membranes, or at the junction of skin and mucous surfaces; lip, ala of nose, glans penis, cervix uteri, eyelid. The cylindrical-celled epithelioma is more likely to occur in the stomach, the rectum, and uterus.

5. Give classification of asphyxia. Livida, blue; pallida, pale.

6 Classify aneurism. What is its predisposing and exciting causes and the usual locations?

An aneurism is a sac formed by the walls of an artery and filled with blood. The predisposing causes are: arteriosclerosis, violent muscular exertion, straining, increased arterial tension, sudden emotion. The aorta is most commonly affected, especially the transverse aorta. Aneurisms are classified into circoid, sacculated, dissecting, splindle-form.

7. Give the principal methods of abdominal drainage with which you are familiar, also what method you consider best.

Gauze, rubber tubing, glass tubing, strands of gut, horsehair or silk. For blood and serum, capillary drainage along a strip of gauze is considered best. For pus, the tubes are considered better. Surgeons have different methods preferred but most surgeons prefer the vaginal if it is a pelvic disorder, otherwise the lowest point and gauze drain.

8.

What important tissues may be wounded accidentally during an operation for femoral hernia?

The obturator artery, if abnormal. The deep epigastric artery. The spermatic cord, in the male, the round ligament in the female. The round ligament in the female is not of so much surgical importance, but if the spermatic cord is cut the vas deferens and spermatic artery are also severed. (The iliohypogastric nerve may be severed. The femoral artery, vein, and anterior crural nerve are of greatest importance.

9. Name and describe four forms of talipes.

Talipes varus, in which the inner edge of the foot is drawn up, the anterior two-thirds twisted inwards, and outer edge rests on the ground.

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 opposite of talipes varus

Talipes equinus, in which the heel is raised and cannot be brought to the ground. Patient walks on his toes and distal ends of the metatarsal bones.

Talipes calcareous, in which the toes are raised, heel is depressed, patient walks on his heel, toes cannot be brought to the ground. There are many variations of these deformities.

10. Give briefly Cohnheim's theory as to the origin of tumors,

Cohnheim's theory, that of embryonic remains, was that, owing to some slight developmental errors, small portions of embryonic tissue become misplaced and surrounded by cells belonging to a different blastodermic layer. These misplaced cells lie dormant but still alive. Later, traumatism or some other form of irritation acts as a stimulus and starts them proliferate, and the result is a tumor.

and of life generally, broadened my mind, and, I firmly believe, helped me in my profession.

In taking charge of this department, I shall try to follow the plan followed for so many years in the "Therapeutic Club." I shall yield to my moods, writing to you just as the spirit moves, just as I would talk to you were we smoking our pipes and chatting together in the seclusion of our home, after the day's work was done. You, Doctor, know what comfort and satisfaction there is in sitting down for an evening's chat with a brother doctor, who has been your life-long friend, giving your experiences, your confidences-baring your soul if need be. Now that is what I am going to do in these columns, and we'll say a few words at first about some practical therapeutic points that I have learned by experience, matters that occur to me as I write.

One of the chief causes of diseases in my opinion, is the clogging of the avenues of the body by the wear and tear of the human machinery and the retention, mechanically or otherwise, of some material that should be cast off. The wear and tear of the human machinery furnishes a fit medium for the cultivation of different species of germ life. The longer it is allowed to clog the various avenues the more will these minute beings multiply and produce a still further clogging of the system. The more the system is clogged the more impure the blood current becomes, and the more the circulation is burdened with waste matter; the greater the efforts put forth by the vital force to control the general interests of the body, the more rapid will be the circulation and the higher the temperature. The process of cure is the opposite. Cleanse all the avenues, tone the organs into the formance of their various functions. As Abbott says, "Clean out, clean up and keep clean" and then "take up the slack." Of one thing there can be little doubt, and that is that there are some germs which produce disease but not without favorable existing conditions for propagation. Germs only interfere with those persons who are

per

in the proper condition to receive them, or to place themselves in proper relation to become infected. Keep well by keeping all the emunctories free from waste matter. In this connection don't forget the laxative saline, calomel and podophyllin.

The majority of doctors find the treatment of chronic diseases a stumbling block in the way of reputation and financial success. The reason is that they follow a routine method or some fad, instead of going about their work systematically, picking out and applying correct principles, making a definite plan and adhering to it persistently. The three cardinal factors in the treatment of chronic diseases are: rest, fasting, and appropriate drug treatment. Of course these must be applied with judgment. Rest for instance does not mean that a man should drop his work, go home, pull off his shoes climb into bed and remain on his back indefinitely. He may need rest in bed or in a hammock with cool breezes playing about. He may need rest from whisky, heavy dinners, mental excitement, rest for the overworked stomach, the paralyzed bowels, rest for the nervous heart and strained nerves. The brain may become tired in a variety of ways. Lying down perfectly still and for very short intervals is a very good way to rest the heart, brain and nerves, and will pull one together in an astonishing way, and as a daily practice undoubtedly prolongs one's life.

In chronic diseases nutrition is abnormal, waste is not promptly and properly eliminated; it accumulates, the system does not reduce its products to their lowest terms, causing friction and making the work of elimination all the harder. It is a great mistake to add further to the difficulty by giving more and more food to patients in whom the process of nutrition stagnates. Food will not be transformed into nourishing red blood unless the system needs it and there is appetite for it. Fasting rests the heart, making its work easier; rests the stomach and bowels, enabling them to store up secretory and peristaltic power; lowers blood pressure, flushing the area of

elimination; increases the consumption of water, softens and relaxes the entire body so that the work of "cleaning up" can proceed with greater rapidity and the least expenditure of vital force. Fasting may be absolute for one day or for several days; it may be partial, from abstaining from one meal or two meals, or by using a very light diet. We should always avoid extremes and hobbies, making successful experience the sole judge of the value of our methods, and be prepared to discard them for others if unfavorable symptoms develop.

In regard to the choice of drugs, eliminants such as I have mentioned, and sometimes alteratives are indicated in all chronic diseases, and the preparations used must be reliable. Bad drugs and a want of perseverance in their use are responsible for many failures in treatment. You must have good medicines and make the patient understand he will have to take them faithfully and for a long time in order to get well. The alternation of remedies is important in the treatment of chronic diseases. Any one drug, no matter how good a remedy it is, will wear out. It is a good plan to alternate the eliminant and the alterative, the one increasing nutrition and therefore waste, the other increasing the system's ability to dispose of this waste. Hence renovation and reconstruction go hand in hand.

Often distressing or excessive palpitation of the heart can be arrested by bending double, the head down and hands hanging so as to produce a temporary congestion of the upper portion of the body. In nearly every instance of nervous anemic palpitattion the heart immediately resumes its normal function by this exercise. Do not forget, however, in palpitation of the heart to examine the urine and see that proper elimination is going on; and by all means remember that cactin is of value in functional derangements of the heart.

Hot physiological salt solution is one of the best applications to ulcers of the leg. Hot salt solution has a physiologic effect on the tissues, exciting phagocytosis and at,

say, 58° C. is fatal to some bacteria, though not to their spores. The ulcer is best irrigated with a hot solution for a quarter of an hour and a sterilized dressing (gauze or cotton-wool) and a bandage is then applied. This is done daily until the ulcer cleans, then as often as necessary. Healing proceeds rapidly and this is especially suitable for patients who cannot afford the time to lie in bed. But don't forget the internal treatment-keeping the bowels open and the system clean.

How much trouble doctors have with their cases of dysmenorrhea! Preparations of viburnum and helonias, as well as gin and other "remedies," often fail to relieve many of these cases. When you get a case of dysmenorrhea which cannot be relieved by the employment of all rational means, apply a 4-percent solution of cocaine to the mucous membrane of the nose and notice how quickly your patient will be relieved.

Here is another therapeutic trick, this time for incontinence of urine in women, dependent upon relaxation of the sphincter urethræ? Massage! This is applied by introducing into the urethra a mediumsized metallic urethral sound and rapidly but gently stretching the urethra by a series of rotary movements. This should be done for a minute or two each day. A few weeks of this treatment will often accomplish the desired results.