J. H. Brown. 05. J. H. Brown. 05. [Graphic] Wheres Brown Bronchitis Acute 340. fibrinous 344  Diphtheria treatment 37. Diabetes Mellitis ther 45  Fever Typhoid, 28, Therapeutics of . Medicine 206. Typhus. Medicine 215 Maleria 200 Medicine of. Therapeutics of 32.-205. Cerebro Spinal fever Therapeutics 34. Small Pox Ther. 42. Yellow fever " " Whooping Cough. " " Erysipelis " 43 Surgery 246 Medicine 219 Scarlet fever " 39 Diphtheria " 37 Croupous Pneumonia " 36 Tetanus 43 ther. Surgery 247. Relapsing fever Medicine 216 Dengue " " " Cerebro Spinal " " 217 Grippe Treatment 35. Gout " 45 Gangrene Surgery 247.      Mumps Ther 44   Obesity Diet 45 Pneumonia Croupous- treatment- 36- " " Medicine- 244 quiz Therapeutics Friedman pg. 60. Rheumatism Acute Art. Ther. 44. " Chronic Mus. " 47. Lumbago. " 48. Stomach Medicines 280       Therapeutics (Prof. Friedman) Typhoid Fever. First thing put the patient to bed and keep him there constantly & get up under no circumstances, keep a nurse by him continually, who shall administer food, medicine etc. Keep him perfectly quiet only move him about & change his position occasionly to avoid bed sores. When first symptoms appear give him alcohol, always watching the pulse. This is given in form of Whisky, Brandy or wines making them plesant to take. Beer is to weak. Diet. The Diet should be absolutely fluid throughout the sickness & for ten days after the temperature has become normal. Milk is good, Bacteria Typhosus grow well in meat Broth, 'tho' it is recomended. Avoid any solids whatever in the Broth. Chocolate is good, in form of drops or otherwise, to satisfy the hungry Some give Soft Boiled Eggs. There is no remedy for curing the disease other than nursing. Some recipes recommened: Recipe (a) Dilute Hcl. & Phosphoric acid for antiseptic properties. (b) Acetagone. 15 gr. in pint of water & drink when wanted. (c) Salol = Salicylic acid & Carbolic acid, in 4 to 10 grs. every 4 hrs. (d) Salofine may be substituted for above as it does not affect the kidneys. Quinine should not be used only at first to help diagnose the case by eliminating Maleria if fever does not subside in a few days. Temp. During first week temperature ranges from 99 to 102 & 3 & second week is always highest being from 102 as high as 105°. Antipyretics should not be used Cold Bath is best treatment to be used when fever reaches 103° the water used from 68 to 95° Body & extremities should be rubed & cloth kept on head. In children opposed to the bath a pack may be used or a sponge bath given. In some cases Guaycol is used externally by rubbing 10 to 15 drops (dose) on the abdomen in using this watch heart affects. Acetanilid may be used where there has been no sleep for two or three nights as sleep is required in the disease. dose 1 to 3 grs for Children. If Heart Failure accompanies Strychnine 1/30 to 1/60 gr. may be used but don't use Digitalis. Diarrhea. Many cases begin with Diarrhea while beginning with constipation is not infrequent for Diarrhea we use opium in form of Tincture & may be used with Acetate of Pb. ꝶ Puto of Opium gr. X Pb. Acetate Sub. Mfr Pill no X One every 3 hrs. A Tablespoonful of Paragoric may be used. Tympanites Take hot water & add one teaspoonful turpentine dip in cloth & lay over abdomen covering with oiled silk to prevent evaporation. Beware of irritation. Turpentine taken internally 10 to 15 Drops. Syrup of Acacia with Tincture of Asafetida every 3 hrs. Extended Abdomen use Salacylate of Eserin 1/50 gr. every 2 hrs. Constipation. Calomel 1/4 gr. every hr. 3 gr. generally act within 8 hrs. Use mild Cathartic. Hæmorrhage of Bowels Use opium or combine with Pb. Acetate. Adrenalin Cloride is used. Ergot is used. ꝶ Gallic acid (sol in alc) ʒ II Alcohol q.s. mft. sol. add. Dilute Sul. acid ʒ I Aqua Cinamonni q.s. ℥ IV. Sig 1 tablespoonful every 3 hrs. Apply ice bag over hemorrhage. Headache & Insomnia. Alixir of Br. of Sodium 1/2 tablespoon Compound Acetanilid for sleep. Opium good for Delirium 1/4 gr. Hypodermic of Morphine. Perforation - Surgery- In Perforation have excessive pain, chill fever suddenly drops. Bed sores. Remove pressure, by water or an bag. Wash with alcohol. Iodiform powder with equal parts of Oxide of Zinc. Convalescent Never out of danger till 10 days after temperature has become normal. Dry Mouth, tongue & bad taste. Clense teeth every day and wash the mouth with an antiseptic solution Bromic Acid is good. Equal parts of glycerine & water plus a few drops of lemon juice relieves dryness & bad taste. Bronchitis is a complication the Bronchial rales may be heard over front & back Lungs. Pneumonia is a serious complication a form Hypostatic results from keeping the patient in one position Pneumonia should be treated just the same as if no Typhoid was present & where Typhoid complicated Pneumonia Vice Versa. Treatment should begin with stimulation from the start. A relapse in Typhoid is not a serious thing & should be treated the same as in the beginning. Relapse is due to improper diet. Malaria Where Quinine cannot be given any other way it may be made as a suppository giving 10 to 20 gr. per Rectum every 3, 4, or 5 hrs. given with Cocoa Butter. Arsenic is used as an adginant or when a tonic is wanted maximum dose is 1/20 gr. given as pill or powder & usually with Iron. ꝶ Adult Quinie Sulphate ʒi Arsenios acid gr. i Dry sulphate & Iron ʒi mft. Pill no XXX Fowlas solution given Children 3 or 4 drops which is 1/24 gr. arsenios ac. Malaria Fever. A specific treatment for Malaria is Quinine in form of Sulphate. Br. Sulphate more soluable Muriate still more soluable. It is given in Solution, Pill, Capsule, Powder, It is absorbed in the stomach & should be given that way & not in any form for it to pass thro'. Give in solution when possible Quinimil is good to disguise the taste ꝶ For Children Quinine Sulphate ℈i Comp. Acetanilid Powder gr. xv. quinimil q.s. ℥ ii mft. sig. Teaspoonful every 3 hrs. (shake well.) Dilute H2SO4 + Quinine may be given Calomel is used for a purgative. ꝶ To young Children.- Ointment Quinine Bi. Sulphate ʒ iss Lanaline Spts. Turpentine Sig. Rub under arms ℥ i The Quinine Sulphate & Bisulphate is very irritating when given Hypdermically & Carbonate of Quinine 1 to 3 gr. is injected in one dose ꝶ Children Ququinine gr. X. Lactopeptine gr. XX. mft powders No X. Sig One powder every 3 hours. (This has little taste). For grown people where taste doesn't bother. ꝶ Adults Quinine Sulphate ℈ ii Comp. Acetanilid Powder ℈ ii mft. Capsules no. xx. Sig. 2 Capsules every 4 hrs. In cases where the disease can't be cured a change to a high altitude is beneficial page 31. Cerebro Spinal fever. Epidemic in New York in '04 & success in treatment was poor. Extraction of fluid from lumbar region between two vertebral with a sharp needle & cover wound with an anteseptic bandage. Diphtheria Antitoxin may be tried was successful in one case by Friedman 6000 units being given to a child. There accompanies the disease, Delirium, restlessness, want of sleep etc. for this we give ꝶ Adult Chloral Hydrate ʒ ii Bromide of Potassium ʒ ii Syr. Lemonis ℥ ii Aqua Distil. q.s. ℥ iv Tablespoonful every 3 hrs. Cold applications to the head & spine are beneficial. One good man would shave the head & apply. Grippe. Introduced in 1889. May come on as a Catarrh. there is weakness of joints & patient feels very weak & extreme headache & sore throat which is of a characteristic red color. The patient should be put to bed immediately & apply cold bath to head. Cold tar preparations are used here & Acetanilid 4 gr. (grown person) every 4 hrs. ꝶ adult. Salol. Puto Aetanilid Comp. aa ℈ ii mft. puto no x one every 4 hrs. mft. Capsule. no xx two " " ". Dovers Powders are used by some but quinine is little used Accompaning grippe we have sore throat- Purplish red- & may have as membrane resembling Diphtheria. Benzoate of soda best treatment for throat, give large doses in solution It is more an antiseptic wash. ꝶ Benzoate of Soda ʒ ii Syr Tubul ℥ i Aqua. Dis. q.s. ℥ iv Tablespoonful every 4 hrs. Gargles are used H2O2 irritates if not dilute Diet- anything- For Bronchitis give a Cough mixture containing Benzoate of Soda ꝶ Benzoate of Soda ʒ iii Syr. White Pine Expectorant ℥ i Syr Tolul Glycerine aa ℥ i Aqua Dis q.s. ℥ vi. Give tonic containing Strychnine as he For Ear trouble consult a specialist for the Most cells may be involved & operation necessary. this is a slow process. Cardiac Weakness. Strychnine 3 times a day. Compound Syr. Hydrophosphite For Anemic use Iron & severe cases are sent South. Croupous Pneumonia. Bicarbonate of Soda in large doses & Tinct of Digatalis There is no specific treatment. Patient should have absolute rest. & Hot applications or cold action is same A glycerine Poultice made by taking a large piece of cotton & adding here & there a few drops of glycerine & cover with oiled silk & cloth make a jacket & keep on 4 or 5 days & remove wash with alcohol & Put Back. Many deaths are due to Heart failure so Stimulating treatment is recomended. Critical day is 5th or 6th day after Chill. & should be prepared for & after Crises patient is not out of danger. A Hypedermic injection is good for the excessive pain & will relieve the Dysponea. ꝶ Strychnine Sulphate gr. 1/2. Liq Ammion Anes atum ʒ i (Ger. Phar) Syr Tolul Aqua Dis q.s. ℥ vi mft. sub. sig. Teaspoonful every two hrs. given throughout disease. Dysponea is treated by inhalations of Oxygen. Don't give antipyretics for fever treat by cold applications. Insomnia treated in same way Cod Liver Oil is good in that it contains fat & small quantities of Iodine. Diphtheria. An exceedingly contageous Disease, & does not occur in children alone. Immediately Isolate the patient with nurse & other children should be sent away or minimized by 500 units of antitoxin. First the attack is localized to throat & Tonsils & Tr of Chloride of Iron is used. For ordinary sore throat: ꝶ Kali Chlorat- Disolve in H2O ℥ i Liq Ferrus Chlor ♏︎ xxx Glycerine Aqua Anisi " Fennel Aa ℥ i Teaspoonful every 3 hrs. Swabing throat & Spraying is recommended. ꝶ Hydrog Bi Chlor gr. i Hydrogen Peroxide ℥ ii Aqua. Distil ℥ vi mft. sol. teaspoonful every 4 hrs. Used as spray may be given internally. H2O2 May be used alone. Gargles do little good only to keep mouth clean. Antitoxin specific treatment & sooner the Better. Give immidiately 3000 units & wart 18 or 24 hrs. & if necessary repeat Inject in Right side of Back may form sore. Give plenty of Whiskey Laryngeal Diphtheria Laryngeal Diph.: Membraneous Croup Give 6000 Units watch closely give again if needed in 6 hrs. Incubation is used. Tracheotomy not used any more. Ertearia may follow antitoxin & will gradually disappear. Give Pilocarpin 1/36 to 1/16 gr. dose Paralysis may follow & patient [may] must be kept in bed quite a time to prevent this. Fever Stage of Scarlet Fever. No Antipyretics Use Cold Water. Itching of skin: Camphorated Oil Carbolated Vaseline with = parts Vas oline This also prevents Extension of contagion. in keeping these Bran like substance from flying around. All Books etc should be destroyed. Sore throat Complicates. Red throat, membrane may be Diphtheretic. Treated as ordinary Sore throat. Tr. of Muriate of Iron. 1 drop for each year ꝶ Sodii Bezoat. ʒ ii Syr. Simp. ℥ ii Aqua Dist q.s. ℥ iv mft sol. teaspoonful every 3 hrs. Glands may swell. Iodine may be used externally, mild,- Starch is antedote.- Ang Iodine Ung Petrolate aa ℥ ss. Sig. Externally When Pus occurs. open up. Acute Inflam. of middle Ear. Hot application or syringe. Open for Pus Inflamation of kidney at time of Desquamation face hands etc. swell Urine full of Albumin Child should be kept warm Diet no meat or eggs or nitrogenous food. In this case little urine is passed, give a [Dusotic?] plenty of water ꝶ Kali Citratix ʒ ii Syr. Lemonis ℥ iii Liq. amon. acetatis Aqua Dist. q.s. ℥ vi Spts Nitrosi Duler.. aa ℥i Sol sig teasp. every 3 hrs. ꝶ Child 5 yrs old. Syr. Ferri Iodid Telderis 10 drps. 5 drops in water every 4 hrs. 6 or 8 wks may take during Desquamation. Arthritis: Cold or hot application. Ictheol externally. ꝶ Sodii Salicyl. ʒ iii Syr. Lemonis Aqua Dist. q.s. ℥ vi mft. sol. teaspoonful every 4 hrs. Nov. 2. 05 Measles.- eruptive fever.- eruption accompanied by Catarrh. Cresentic eruption.- Cough accompanies.- Keep in dark room. Cough mixture which is good expectorant to relieve cough. Heroin new for cough Belladona where flem is coughed up. Bromides & Chlorides are good. Chloroform used as sedative in cough mixtures. Chnonia good stimulating cough mixture Amonia Muriate " " expectorant. Dry Irritating cough in Measles: ꝶ. Sodii Benzoat ʒ ii (Child) Syr. Sqellae Comp ℥ ss Syr. Toludl ℥ ii Aqua Dis. q.s. ℥ iv Teaspoonful 2 hrs. For sedative Cough. Brown mixture Comp. Syr. of Lochorice ꝶ Child Amonion Muriate ʒ ss Tr. Opii Camph. ℥ ss Syr of Senega ℥ i Aqua. Dis q.s. iv Teaspoon every 2 hrs 0 Syr of W Pine Expectorant Stimulation & sedative, Consumptives (Adult) ꝶ Carb. Ammonion ʒ i Morphin Sulp. gr. i Glycerine ℥ i Syr Prun Virg ℥ i Aqua Dis. ℥ vi Tablesp. 3 hrs. To hasten Expectoration ꝶ Heroin Muriat gr. i Kali Iodid. ʒ i Syr. Prunes Virg ℥ i Glycerine ℥ i Aqua Dis. q.s. ℥ vi Tablesp. every 2 hrs. Coden good in sedative Cough mixture. Diarrhea: Camp. Tr Opii.- Paragoric- ꝶ Child Bimuth Subnit. gr. xx Putd Dover gr. v Lactd peptin gr xx mft. putd no x 1 every 3 or 4 hrs. Chicken Pox- Not serious- Itching- Bath with hot water with Carbolic Acid. Morphia 1/4 gr. for Adult. outer part of arm not injurious. Be aseptic 1/200 gr. of atropia given along. Small Pox Vaccination- 1796- Jenner- Should be vaccinated at 3 months must be successful, & repeat every 6 or 7 years Pain in Back Loin severe head ache. No specific. Symptomatic. Hot application for Backache etc. Hot Water 100:, Carbolic acid for eruption. Yellow Fever. Sick, fever, slight jaundice, chills, Black Vomit. 4 day Black Vomit Death. No specific. Mosquito Carrier Immune after 1. Protect from Mosquito. Treat Indications. Champaign, Whooping Cough. Two stages to treat Catarrhal: cough mixture. Convulsive stage: Paroxym seem frequent. Do not cure lasts 6 weeks. Pertussein for external use Belladona large dose, Bromo form heavy liquid. 1 to 6 ♏︎. dose. Quinine has some action give large doses. Bromide of K. & Na. Alum may make vomiting Best {Chloral. at night. {Antipyrem in day. ꝶ Child during day Antipyrem ʒ ss Natrum Bromidi ʒ iiss Ex. Tr. Belladona ♏︎ vi Syr. Prum. Virg ℥ i Glycerine ℥ i Aqua Dist ℥ vi teaspoon every 3 hrs. ꝶ 5 yrs. old. Chlorose Hydrat. ʒ ii Natrun Bromid ʒ iiss Syr. [T???] ℥ ii Aq. Dis. ℥ iv Teaspoonful at Bed time repeat if necessary Erysipolis. Inflam. of skin. external injury subsides in about 12 days specific Muriated Tr. of Iron till interferes with indigestion give in water thro' tube. Don't us antipyretic, quinine may be used. Antistreptococcus toxin serum Hiccough: Creosote on sugar 1/4 gr Morphin. 8. (Trichloracetic acid for warts, place crystal on the warts, Vinagar for fat people) External application Ambulatory shifts position. Ictheol on account of sulphur. Fl. Ex. of Ergot Use Diluted Ictheol with vasoline. Cranberry poultice Internal No Specific 1/2 to dram Dose of Muriated Tr. of Iron with water thro' tube wash teeth with Bicarb Soda. Disease last 10 to 14 days. Cold aplications. for gangrenous skin use antiseptic washes. Tentanus Germ Disease, introduced thro minor wound. find injury enlarge in & clean out & give Tetanous antitoxin 6000 units in large dose repeat in 6 hrs. give rest, give chloral or opium to prevent convulsion Injection of Carbolic acid 1/2 to 1/3 gr. every hr. or 18 gr. in 24 hrs. Nov. 21.'05 Sherry wine with Iron- it contains no Tannic A. " " good in convalesence. Moselle wine has little sugar for Diabetes Tokay sweet for women. Cherry 30 Rum Distilation Molosses. Port. 22 Gin " Juniper Berries Rhine 12 Beer ferm. of Hops & Barley Champaign 12 Acute Articular Rheumatism Not certain about cause Intense inflam of joints accompanied by high fever Put joint at rest. by starch bandage. Ictheol may be used under bandage. Salacylic Acid is specific. administered in capsule or wafer. Salacylate of Na. Stonlum & am. " " " 15 grs. 3 or 4 hrs. If irritating to stomach change. Salicylic acid or Salicylats may cause Deafness Io. of K. or Na. for Chronic or tertiary Syphilis Rheu. Calcusum may cause Diarrhea. Poke root has been used. Give antipyretics for pain & for fever salicylates usually do. Application of heat for pain. Liniments no good. Asparien contains salicylic acid ꝶ Acidi Salicyl.- gr. 150 mft. Capsules no xx 2 Capsules after eating. ꝶ Sodii Salicyl. ʒ iv Tr. Phytolacal Virin Colchici Sig Amoniae Acet Spts Nitri. Deulc. aa ℥ i Syr Lemonis. Aqua Dis. q.s. ℥ viii tablespoonful every 3 hrs. 1 or 2 gr. of Morphia may be added to fore going will relieve pain & prevent bad action of Diarrhea. Strontium Sod. is less irritating. Iodide of Iron when Disease is drawn out. Nov.23.05 Mumps Mumps on one or both side swelling behind ears, contageous, fever is high. Secondary inflamation in Testis & should be treated as any arceatus. Apply lotion = pts subacetate of Pb. water fl. Ex. of Camphorated oil on cotton for Mumps. Disease runs course & gets well. Diabetes Mellitus Large amt. Sugar in urine of nervous people. Large amt. urine with high Sp. grov. Diet Exclude foods which are sugar or are transformed to grape sugar. Dietary List: allow Soups or Broth of Beef, Chicken, Oysters, Bacon, Mutton, Veil, Turtle, a Fish all kinds- no dressing containing flour Eggs in any way. Meats: fat beef, Mutton, free from flour, Bread, potatoes, flour. Farinacious foods exclude entirely Vegetables- String Beans, Spinach, lettuces, Cucumbers, Onions, Tomato, Asparagus, Celery, Pickles Olives, Beet top, chicken, Mushroom, Oyster plant, Dandelions, Radish Creses Deserts Custards- no sugar use saccharine or glycerine jellow, Creams, Walnuts, Cocoanuts, Pacans, Drinks Tea or Coffee, pure water, milk Avoid Liver, Sugars, sweat, starch Cornbread oatmeal, rice Barley Ryckead Macrond Tapeoca Vermicells Potatoes Parsnip, Beets, Turnips, Peas, Carrots, Melons, Fruits, pudding, Pastry Pies Sweet Sees no Honey jams wines, Cordial, Cider, Porter, Lager Beer Chestnuts or Peanuts, Potatoes. Wheaten Bread or Biscuits, Tapioca give Mosells Wine has less Sugar Obesity Cut out Breakfast for foods make fats. Eat Meat for Dinner barring fat. no bread or butter but some of vegetables before stated. take little water after meal sip one glass slowly. watch urine Diebetis Opium dose increased till man may take from 3 to 5 gr. a day usually in powder. give Saline Purgatives with opium. Codein 1/2 gr. 3 or 4 hrs not bad affects combine alkaline carbonates for thirst etc. " Bromides for sleep. Salicylic acid & preparations in gouty patients with Diabites Bromide of Arsenic 4 to 5 drps. 3 x day Ergot Ext. 1/2 teaspoonful doses. Constipation. Treat as treated alone. Itching & test urine. Diabetic Coma put on Milk diet & alkaline drinks. & Normal Salt Solution injection & Rectal injection. Gangreneous Diabites fatal. Cod liver Oil makes fat. Yeast cake divided in 6 pts. 1 pts in milk 3 times a day. Gout Inflamation of Joint usually Big toe- Rich people- " between Phlan. & Meta [illegible] Chronic Muscular Rheu. Colchium- Wine of Root- 10 to 15 drop. 3 times a d may give with Salicylate of Soda. ꝶ Sodii Salicyl. ʒ iv Sodii Iodidi ʒ ii Wine of Colchiu ℥ ss Syr of Sassaf. ℥ iv Aqua Dis. ℥ viii Tablesp. every 4 hrs. Colcheum may cause Diarrhea may give in this Perscript. 1 gr. Morphia. Celchiam sal Ictheol Salve Hot. Application etc. Diet Soup. Veg Broths, Fish Chowder Raw Oys. fresh fish meats: fat Bacon Ch. game all spareing farinaceous food Rice Sag Oat meal Rye grahm Bread Macaroni cracked Wheat, Hominy Biscuits Rolls, crackers toast. Vegetable, Potato Hash Green Pea St. Bean Squash Cabbage Colcum Cress lettuce Celery Desert: Plain malts pudding rice Sago & Milk Stewed fruit, Drinks: Weak tea milk butter toast water pure water must not use, Veal park goose Duck Turk, Salt. Digt potted preserved Meats eels mastera Crabs salmon Lobsters, gravies [illegible] [illegible] asparagus mushroom Rhubarb, spices pies cheese nuts Dried fruits tob. coffee cider malt liquors, champaign wines Chalk Deposits: grs. Piperazin 10 to 15 drop in water Salts of Lithia " " Hot. applications Blister Pleurodinice Chronic Rheu. Lumbago Strap patients. Use of Massage Electricity Hot an Bath Salol Com Acetanalid Pute Arsenic- Fowllers Sol. 1/20 gr. Pernicious Anemia Chorea Arsenic is a specific. Child bears best begin 4 drps Fowlers & increase till comp. arise. Diseases of skin not all. 1 1/2 to 2 will kill. excessive acts as its antedote. Severe Burning, cramps. Fe Cl. & Amonia will give Hydrated sesqui of Iron is antedote for arsenic. Most readily detected. add HCl to Sh. contents & add piece of copper & Metalic substance will form on copper. Arsenenous + Nitrate of Silver Dec.19.'05. Comp. Syr. of Squills Tartar Emetic 1/4 gr. in Squills for False Croup. ꝶ Sodii Benzoat. ℥ ii Syr. quillae comp ℥ i " Tolut. ℥ ii Aqua Dis. ℥ iv Teaspoonful. 3 hrs. Tannic Acid is Antimony Antidote. Glossitis { Antiseptic Wash. Pharyngitis. Remove cause Tonsilitis Acute { Falicular T. { Quingi Porbtons. Abess { Bicarb of Soda garble in hot water swallow ice Tr. of aconite internally. Chlorate of K. & Perchlorate of Iron Intenally Funicular Ton. Strepto. C. infection. normal areas beween follicles. Salicylates of Na. Benz. of Na. or use gargle. Runs a course of 5 days. Inflamation of Esophagus. Sweet Oil, acid drinks when burn by Costic Potash may leave Stricture of Esophagus. Jan.4.06 Indigestion is symptom to many diseases. Remove cause Hyper & po. acidity, atonic cond. Dilated stomach Give Alkali or acid for Hyper or Hypo. Nux Vom. for atonic Cored. Retention of food- wash out Acidity causes Pyroses. Heart Burn. give Subnitrate of Bismuth neutralizes acid & coats mucous membrane of Stomach give with Bicarbonate of Na, with Digestive. & with Papoid ꝶ Bismuth Subnitr. ʒ ii Papoid Sodii Bicarb. aa ʒ i. Codeine Sulph. ʒ iv mft. Pilo no xx before eating 3 times a day. ꝶ for Subacidity Acidi Hydroch. dil. ʒ i Tr. Nux Vomica ʒ i mft. sig. 15 to 20 drps after eating 3x Change Diet to relieve Constipation Have Regular Habits. Aloin, Strychnine, Belladona. Creosote 1/2 drp dose. Carbolic acid for Belching & gurgling in Stomach. fermentation. Acute Gastritis, over eating, Poison etc, Empty stomach by wash or emetic. Give Hypoderm of Morphia to grown people. Jan.9.'06 Flank steak good diet well Broiled & excercise. give no greasy food- baked potato, toasted Bread no Pastries, Lam chop, Roast Beef, Regulate Bowels Gastric Ulcer: Severe form of stomach trouble Blood from stomach is blackish increase HCl. Put to bed at rest Nitrate of Silver 1/4 gr dose. No Diet except per rectum. Milk 250 gms. { Yolk of 2 eggs { 2 grs of salt. { 15 cc Claret Wine { 15 grs Baked flour. { Enema Peptonized milk & Boiled Milk. Jan.11.'06 Cancre of Stomach. Excessive Vomiting. Pyloric End feed with food readily absorbed. fluid diet. Bismuth Sub Nitrate. Carbolic Acid or Creosote. Hydrocyanic Acid. Laurel Cherry Water. Chloroform in Water. Carbonated Wine- Champaign. Wash out Stomach. Muriate of Cocain 1/8 gr. Vomiting of Pregnancy. Oxalate of Syrum Hot application. Blister Bleeding. (Hemotonyses) Tr Cl. of Iron. absolute rest by Morphia. 10 drps Adrenalin 1-1000 Peroxide of Hydrogen. Fl. Ex of gyranium Condurango Syr. of. ꝶ Acide Murat Dil ℥ iii Ex Fl Conderango ℥ ss Essense Pepsin ℥ ii teaspoonful 3 hrs. Rectal suppository with Opium. ꝶ Puto Opiu xv mft suppo Rectal no x One every 3 hrs. Jan.16.'06 Acute Diarrhea get rid of irritating material. by laxative. Opium. ꝶ Bismuth Subnitr. ʒ ii Tr. Opii. ʒ ii Tr. Catichu ʒ [Aqua] Listerin ʒ ss Aqua Minth Pep. q.s. ℥ ii Teaspoonful. Boracic Acid Enema to wash out Bowel. Tanagin, Tanalbin. pass thro stomach Child ꝶ Salol gr x. Bismuth Subnit. ʒ i gr 20 Puto Doreri gr. 40 gr. i Lacto peptin gr. 30 gr. 10 mft. Puto no x one before each meal Milk diet. (Boiled). Bottle fed babies. (Summer Complaint) Milk of Cow best substitution. Sterile bottles & clean nipples. Clean out intestinal canal Calomel & Castor oil- withdraw food- give a little rice water. Children do not take opium well Wash out stomach for Vomiting. Give lime water with milk to neutralize acid Aeromatic Spt. amomia 3 drops Brandy 3 to 5 drops. Give frequently in water. Jan.18.'06 Dysentery Change of Cimate is good. Begin with Purge Castor Oil or Salts. Epicac treatment in Camps used with Morphia. Antitoxin used in Japan Small & repeated doses of Sulphate of Magnesium Magnesium Sulphat ℥ i Tr. Opii ʒ i Aqua [illegible] Pip ℥ iv Tablespoonful every 3 h. Enemas may be given 1 to 3000 Bichloride & follow with Water better is 2% Boracic Acid. 1 to 5000 of quinine injection for Amolbic Coli. 5 or 10 gr. doses of Thymol. Santarin 3 gr. Wash out with Antiseptic Sol. Diet same as in Diarrhea. Diarrhea of Liver Abcess remove Abcess & Diarrhea will Disappear. Dilute acid. Jan.30.06 Rectal Diseases.- Surgery Hemorrhoids (Piles) usually in male Wash clean. & place in proper place. Bleeding Piles. Come from Chronic Constipation. Ext. ap.p. goulards Sol. With Hages (Laudanum & Sub Ace. of Lead) ꝶ Ext. to Piles. Tannin gr. xx Puto Opii gr. xx Cocaine Muriat. gr. x Ung Stramona ℥ i May be put in Suppository Application of Hot Poultice or Hot Water. Feb.01.'06 Diseases Liver Relieve Constipation. Epsum Salts. Jaundice in Babies where frequently- usually disppears. Serious where Bleeding occurs. Billousness means constipation relieved by Calomel 12 triturates 1/4 gr. each every hr. followed by Purge. prevent Sour foods. If one dose 3 to 5 grs. at night 8 hrs. follow by Sulllph of Mag or Soda Feb.6.'06 Scerrosis of liver- caused by Syphilis. & by drinking whiskey Epsum Salts 1/4 gr. Eliterium in Capsule Don't tap early Cream of Tartar. Alternate Carthartic to Diuretics- Diuretine. Feb.8.'06. Treat of Gall Stones: Cannot be dissolved as yet. Colic- pain R. Hypoch. Region. Morphia Hypoderm. for pain. following Paroxysm have chill then high fevers & Jaundice usually follows- withdraw from fat. Starch. fats. sugars. Cold water injections. Sweet oil has been given. Hot applications. Removal. Tape worm. Milk diet. Herring. Begin with good Purgative. Chloroform 1 gr. grown person make emulsion or use Chloroform Pearls ꝶ Rad Granati (Bark) ʒ i Pumpkin Seed ℥ ii Crush in mortar skin & all. mft. Decoct. enough water to make ℥ vi add when cool Ether Ex & Felix Mass ʒ iss Ol Tiglii ggr. i mft. Sig. at. a dose. 15 min after taking Chloroform. For Chlor. poisoning Morphia antidote. Respiratory Tract. Spasmodic Croup, Laryngitis, Vomit patient. Child 2 or 3 ꝶ Hydrog Subsulph [fla?] gr xv. mft. puto no x. 1 every 15 min until Pat. Vomits. Give only 3 powders. Ext. & Int Heat. Comp Syr of Squills. Teaspoonful for emetic. ꝶ Sodii Benzoat.- ʒ ii Syr Scillae Comp.- ℥ ss Syr Tolal- ℥ ii Aqua Dis. ℥ iv. Teaspoonful every 3 hrs. Feb.15.'06. Asthma Bronchial. Mustard plaster vinagar exagerates action Hot application. Amyl Nitrite. inhale fumes of Pearl. Bromide & Chloroform Morphia. 1/100 Nitro glycerine. Potass ii Iodid 5 gr. to 20. 3x day. Pleursy Relieve pain by Heat or cold or Fly Blister. & adhesive rubber strap. Hypodermic 1/4 Morphia. May have an Exudate into Pleural Cavity. Paracentesis withdraw from between 6 & 7 Rib in Back. Comp jalap powder. Catharsis. Diuretics. Cream of Tatar. Empyema. Fever present. Mar.1.'06. Io. of Pot. for Pleursy. Tuberculosis: Propholaxis. Curable in early Insipient Stage. Send to Colorado. Adarondaes. N.C. Pine forest. S. Cal. Ariz. San Ant. Texas. Creosote capsule or Drop 1 drop 3x to begin in milk or whiskey. Special Symptoms. Cough. Codeine Mix Chloroform & Chloral. Morphin. Quinine. Bleeding. Keep quiet, Ice Bag. Hypo. Morph. to stop Cough. Ergot. Iron. Hydrastine, gallera. Night Sweats: Camphoric Acid, Atropine, Sage tea. Fever: Sponge. Diarrhea. Sub Nitrate Bismuth & Tr of Opium & Catichu. ꝶ Puto Opii gr. xx Plumbi Subnitrat. ʒ i mft Cap. no xx 1 every 3 hrs. give Boiled Milk. Enemas Starch Sol of Opium Edema: Nourish. Mar.6.'06. Disease of Heart. Pericarditis similar to Pleursy. follow case of Rheumatism Typhoid Rest. Blister for pain. Digitalis may be used Mar.13.'06. Tn. of Digitalis. best. Digitoxin { Stimulants insol in water .. Talin { sol in alc. .. tonin { sol. in water not alc. Depressant. Constrict Vaso Motor Digitonin. In accumulative action Patient becomes naseauted. Antidote Tanmin. Tn. of Aconite. Acute Endocarditis follow Rheumatism. Absolute rest. Sod. Sal. Digatalis. Chronic Endo. Sleeplessness Bromides Hoffmann Anodyne. Don't over eat. Tn. Digitalis. Palpitation Myocarditis. latter part of life. frequently associated with Angina Pectoris. Hypo. Morphine 1/2 gr. Nitro Glycerine 1/100 gr. Nitrite of Amygl. parts 3 to 5 gr. Aromatic Spts. of Amonia. Hoffman's Anodyne. Advise Patients not to go out in winter. & at night. light meal in evening. Neuheims Bath. Mar.20.'06. Acute Brights Disease Put to bed, keep warm. Absolute rest. Hot bath. Purgative. Pilocarpin. 1/4 gr. Eliterium. Diuretic. ꝶ. Kali Acetate. ʒ ii Liq Ammon Acet. ℥ i Spts. Nitri Dulc. ℥ i Syr. Lemones. ℥ iv Aqua Dis. q.s. ℥ viii. teaspoonful. every 3 or 4 hrs. Poultice over Kidneys Flax Seed & Mustard. Diuretine. 10 gr. Doses. Little water, no meat, 3 or 4 pints milk. Mountain Valey [illegible] is good Diuretic. Chronic Nephritis. Casts in Sediment of Urine indicative probably Climate: equitable Take away nitrogenous food Milk good diet. Spinach Muriated Tn. of Iron & Liq am. acetates ꝶ Mistural Basham. ℥ viii tablespoon in water 3 times a day 1 hr after Meal Strychnia Sulph. 1/30 gr. may be given with above. For Heart Complications. ꝶ (Diuretic Comb.) Kali Acet. ʒ ii Liq am. acet. Spts Nitr Dulc. aa ʒi Syr Lemonis ℥ ii Inf. Digatolis ℥ iv Aqua Dist. q.s. ℥ viii Kidney stone (gravel). pain. 1/4 gr. Morphia. Hot application Diuretics. Nervous Diseases. Cerebral Apoplexy bursting of Bld Vessel in Brain. forms clot. pressure, paralysis etc. Crotin Oil Calomel. Br. of Ka. Keep head up. feet warm. head cold. May clear up in a few weeks after 8 wks prognosis bad. May happen a second time Ka. Io, internally. Third attack severe. Results in Hemaphlegia. Electro. Therapeutics. Born. Oct.9.'06. Inherent power to return to health. Therapeutic Diagnosis 1. Eteologic Thera. Diag. 2. Pathologic " " . 3. Symptomatic " " . (a). " may have to be considered first as hemorrhage. (b) Pain or functional distress. When to intervene. Why. When. Where. how. First consider specifics. Oct.16.'06. Electricity peculiar state of matter. amplitude. [Illustration] Oct.23.'06. 1. Electro Physics 2. " Physiology. 3. " Therapeutics 1. Pressure. called Voltage. E.M.F. Potential. Unit of E.M.F. is Volt. Coulomb certain amt of Electricity. Ampere rate of flow of certain amt. per sec = unit of rate of flow. A current loses pressure by passing thro conductor. Variations in resistanse { 1. quality of cond. material. { 2. That of cross section of area. { 3. Length of Conductor. 106 cm { 41.73.° { 1 sq m. { Unit of Electrical resistance called Ohm. Nov. 13 '06. freezing pt. of water. Amperage. C=E./R. Current flow= E.M.F./Ohms. Character of Current flow. for body we want low amperage & high voltage. 1. Connecting in Series increases pressure not volumes. 2. " " Parallel " 1 volt & 2 amperes. good in use for body. Direct current.- galvanic current. [illustration] Interrupted direct current. [illustration] Direct Pulsating current [illustration] Alternating always interrupted [illustration] Nov.20.06. Ohm's law [illustration] increases Current strength C=E/R. Rheostat an instrument to increase resistance. Carbon. german wire. & Liquid Rheostats. Resistance increased throws current further thro' Body. Current Density. [current strength per unit of] [The unit of] Current strength per unit of cross section are of conductor Density varies directly with the current strength. Density varies universaly with area of Transverse section D= Density. C. Current Strength. A.- Cross Section Area. D=C/A. [illustration] 24 24m.a. D=24/24=1 Normal skin will stand 2 ma. Electrodes- are Terminals of Poles Battery-. 1. Protected Electrode. 2. Bare Metal. used mostly as cauterys. Felt avoids electrolytic action. Coverings are substances which will absorb fluid water & BiChloride warm sol work better Na.Cl. & Bicarb of Sodii. Nov.27.'06. Medical property of all currents alter in propero. to the their relation to their voltage & amperage. Amperage is predominating in galvanic current. Galvanic used in 2 forms only. Continuous & interrupted. Continuous possesses Polar properties which are at Poles. Interpolar goes on within body between Poles. Physiological action of Polar action continuous current are 4 in numbers: 1. Cataphoric is where chemicals are carried into body when placed between electrode & body. 2. Electrolytic is chemical changes which take place at pole. 3. Catalytic: Interpolar affect: changes within body. 4. Electrotonic: affect producing changes in nerves & muscles. Tendency is to carry fluids from + Poles. used in congestion + Pole is anti congestive & denutritive. - Pole is just opposite. Bare Metal applied to semi solid compound we get full phenomen of Polar Electrolysis. at + Pole O. Cl. C. S. & P are set free. & attracted to the + Pole we have the acids H2SO4 H2NO3 tissues become hard & acid makes it stick. At - Pole H is given off & Cations are attracted which are Na. K. Ca. NH2 tissues become soft & congested. Increase amperage with Bare metal & Cautery action may be brot on. slight amperage is a styptic. 3. Catalytic action is on Lymph. Blood? + Pole is soothing & sedative - Pole is irritating & stimulating Dec.12.06 Positive Polar action with Protected electrodes. Sedative nerve irritability tonic to nerve & muscle fiber. anticongestive. Osmotic pushes fluids to negative pole. Stronger current produces counter irritation, heal. pain. beneath electrode. & will finally vescicate. Negative Polar action with protected electrode: increases nerve irritability, relaxes fibrous tissue, attracts fluids from Positive pole congestive. General interpolar action Nutritional, electrotonic sedative. anodyne. alterative, warming, refreshing, vitalizing- Positive local polar action with nonattackable, bare metal electrode (Platinum). within soft tissue. with mild current. sedative. tonic, nutritional. anticongestion, astringent. hemostat ion, muscle contractive, mildly osmotic. catophore & electrolytic. With mediate current: styptic, coagulating. drying. shrinking of tissues. muscle contracting. anodyne. denutritive. antihaemorrhagic, antiseptic. osmotic. catophoric, electrolytic with strong current: Blanching. drying. denutritive, coagulating hardening. Muscle contracting. Antiseptic. Germicidal Cataphoric, Caustic, rapidly increasing to cauterization with gross destruction of tissue. sear contracts. (Page 67.) Quiz . Work. Nov.23.'05. Aloe given in form of Pill is a carthartic acts on lower bowels. Don't give to Pregnant or in Piles. given 1 to 10 gr. with Strychnia ꝶ Aenemic Women Quinine Sulph. Terri Sulph- exic- aa gr. xxx Aloes. (Soc) gr. xxx Ol Labini gtt x Mft. Capsule no xxx 1 three times a day. Given in Comp. Cascarra tablets. Aloin. Strychnine, Belladona, Cascara Aeromatic Spts. of Ammonia- Stimulant. Oil percipitate by water Am. Muriate expectorant. " water for fainting, irritant. Alum used as emetic & wash used injection Al2(SO4)3 for Peristalsis of Bowel. K2SO4 Apiol.- parsley- oily fluid Menagogue properties Don't use in pregnancy. 3 to 5 drops. Oxide of Arsenic. Arsenious Oxide As2O3 Doues Carminatives for Baby Colic is Asifidity for Nervous Ladies, for Tympanitis. Belladona Oint for Pain, Sore nipples & breasts. dries up secretion. milk etc. Sulph. Gatropia- dilates pupil. antidote to Opium poison Hypersecretion of Lung Bronchorea. Colic & Cramp 1/50 gr. Hypo. maximum Dose. Alloin. Stry. & Bella. (Lepactic Pill.) Bismuth Sub Nitrate.- Disorder of Stomach. 5 to 40 grs B" " " Gallate. Elexir of Bromide 1/2 to tablespoonful in water to grown person. good in nervous a sedative Br. of Strontium less irritating. Nervous people & congestion of Brain. Emissions at night Bromide of Camphor for Passionate etc. Whooping Cough. Bushu acts on Mucous Memb. of Bladder Fl. Ex Dose 30 nn. to gr. Canibus Indica powder drug. Nerv Mn Hay Fl. Ex. 10 to 20 m. Puto form. Hemp root Sedative Relieves pain Cough mixture for Tickling sensation does not constipate. Depressed patients. Melancholia people. ꝶ Canabis Indica (Powd Drug) gr. xv Papoid Soda Bicarb. aa ʒ ss. mft. Puto no x one before Meals. Salicylic A. in Alcohol. with Canabis Indica relieves. Cantharidis. (Spanish Fly). Used in Old to control water in form of cerate most irritating. in Pleursy Blister used only- Cantharadin- Collodion- for Blister. Feb.1.06. Capcicum Tn. & Puto. mostly used. used to increase absorbtive pus. of Stomach. Prescribed with quinine ꝶ Quinal Sulph. ℈ ii Puto Caplic. ℈ i mft. Cap. no xx 2 every 4 hrs. ꝶ Delirium Tremons. Tn. Nux Vomica. ʒ ii Copsici ʒ ii Sub Mit. Bismuth ʒ iv Elex Lactd Peptin ʒ iv Teaspoon every 4 hrs. Carbolic Acid- distil of Cold tar. deliquescent. Disinfectant. somewhat Poisonous. Used internally to prevent fermentation. 1 2, 3 drop doses- also for Tetanus & hypoderm for Tetanous. Linseed oil, Lime water. & a little Carbolic for Acute Burns. Is poisonus when given for any length of time. Poison regconized by odor by mark on Mucous Memb. raised & white. weak pulse. sweat. Paralytic affect on Rest. M. Alcohol diluted antidote 1 to 4 oz- give then Sulph of Soda. or Mag- Itching in Jaundice. apply 2% Alkaline solution. also itching in Piles. for quenzi. ꝶ Acidi Carbol. m x Kali Chloral. ʒ i Aqua Fennel. " Anisi aa ℥ i Tea 3 hrs. Cascara. Powdered. fl. Ex. Solid Ex. Pill. Lapactic. Castor Oil. applied to cracked nipples. Lead Shields for cracked nipples. for beginning Diarrhea. given with Lemon juice. Orange juice. Beer & best is with Whisky. Chloral Hydrate 15 gr. 10 gr. Antispasmotic. Strychnia Antidote. May be used Ext. with Camphor for facial neuralgia. (Pleuritis. Lanaline 30 to 40 gr. to [illegible]). Chloroform. Gastro Intestinal disturbances for tapeworm not given alone. Chlorate of Potash. mouth wash. 1 gm to 2 oz. water for Stomatitis. for sore throats. [Cocain] 1884 Cocain Hydrochlorate. dilates pupil (Midriatic) for Mucous Membrane. antidote for Opium. Poison treated symptomatic. Amonia Digatalis etc. for Relief of Preg. Vomiting 1/8 to 1/2 gr 3x day may be used for cough. Codine. ꝶ Codine Sullph. gr. iv Puto Acetanalid Comp. ℈ ii mft. Puto no. xii. one every 2 or 3 hrs. till relief. Cod liver Oil given with Whiskey. contains some Io. given for insipient T.B. Copaiba- Pleo Resin. Balsam. 10 to 20 drp. doses. Gonorrhea. Bronchitis. ꝶ ginci Sulph. Plumbi Ace Tas aa. gr. xxx. Tn. Kins ʒ ii. Aq Dist. ℥ vi. form of injection for gonerrhea after about 2 wks. Ergot. Fl Ex 30 m. to ʒ. Uterine Hemorrhage. Was used to paint Erysipalis before Ichthol was used. Contracts Uterus. Should not be used during labor. may be used after 1/2 teaspoonful. give for Hemorrhage in Fibroid tumors of Uterus. Ergot in ʒ i Hydrastinine HydroCl. gr. v mft. Caps. no xx 1 every 3 or 4 hrs. May be used for other Haemorrhages more especially Uterine Haemorrhages. Eliterium Hydrogogue Carthartic for robust people with Ascietes (is Debilitating) ꝶ. Eleterium gr. iii Jalap used when [prol?] mft. pill no xii. 1 every 4 hrs. till Acts. Europhine- prep. of Io. used instead of Iodoform good in Soft. Chancre. Formaldehyde. gas sol. in Water. Antiseptic. used as disinfectant. Sulphur good disinfectant. Chloride of Lime & Sulphuric Acid good. Eurotropin formed by treating Formaldehyde with Ammonia. ꝶ Urotropin 7 1/2 gr. { for Cystitis. Tablets or Capsule. { Mft. Cap. no xx. one every 3 hrs. Cystogen a form of Urotrophin. Dissolves Uric acid Hydrocyanic Acid (Brusic Acid) 2% in Drug Store. Ammonia Antidote. Used for tickling Cough. 1 ♏︎. dilute. ꝶ. Acidi Hydrocyanici. ♏︎. xvi Syr. Toluvl ℥ ii (not Prun Virg.) Teaspoon. every 2 hrs ꝶ Stomach trouble. Bismuth Subnitr. ʒ ii Acidi Hydrocyanici. ♏︎ xv Aqua Tlov Ansantii. Aquae ainisi aa ℥ i Teaspoonful before meals. Hydrogen Peroxide. Used in Surgery. good in Nose Bleed. don't use in Cavities. Rx for spray in Diphtheria. Hydra Bichlor. gr. i Hydrogen Peroxidi ℥ ii Aqua Dis. ℥ vi mft- Sol. use as a spray. 1 to 4 [gr?] internally for fermentation in Stomach. Apr.17.'06 Icthol distilation of fish fosil. 10% Sulphur. Chronic Bronchitis Pill 5 gr. 3x a day. Erysipalis. painting. Inflam swelling. equal Vasaline & Ictheol Iodide of Potassium. 1. Syphalis 2. Antidote or Metalic poisioning. 3. Bronchial Trouble. Chronic Rheumatism. Renders Mercury more soluable. 3 to 400 gr. 10 gr. 3x a day for Syphalis. ꝶ Hydrarg. Bi Chlor. gr. i Kali Iodidi. ʒ ii Syr. Sassar. Aqua Dist. q.s. ℥ viii. Tablespoonful. 3x daily. ꝶ Chronic Rheumatism. Sodii Salicyl. ʒ iv Kali Iodidi. ʒ iss [?ini] Colchic (Rad). ℥ ss Syr. Sassap. ℥ iv. Aqua Dist. ℥ viii. Tablespoonful every 4 hrs. Asthma 5 gr. Io K. stimulates Expectoration. ꝶ Asthma. Heroin Muriat. gr. i Kali Iodid. ʒ i Syr. Prunis Virg. ℥ i. " Senega. ℥ ii Aqua Dist. ℥ vi. Tablespoonful every 2 hrs. April.19.'06. Iodine sol. in alcohol. Iodoform- treat Io with [K. I] Caustic Potash & alcohol. obtained from seaweed. ash. Tn. Io. is counterirritant. Io Ointment " Iodoform. Stimulates granulations. good in burns. Io. Ointment 1 gm. to ounce Vasaline April.24.'06. Iron & its salts. tonic & foods. Introduced by foods. taken up in Duodenem. in Metalic & Non Met. Salts. Quevenges Iron fy Hydrogen (Pure). Carb of Iron. Ferus. more readily absorbed. FeO + H2SO4 = FeSO4 + H2O. Blauds Pill. FeSO4 + K2CO3 } In intestine FeSO4 } 1 to 3 every 4 hours. Wash teeth with K2CO3 Bicarb. Sodii. Muriated Tn. Fe. Sesqui Cl. of Iron. Tn. Chlor. of Iron. dram doses 20 to 30 drops in water 1 hr. after meals. ꝶ Sore throat. (adult). Kali Chloratis ʒ i Liq Ferri Chlor. m. xxx Glycernae. ℥ i Aqua Anisi " Fennel. aa ℥ i Teaspoonful every 3 hrs. Bushams Mix. (Liq Am. Acetatis Acid slight. Tn. Chlor. Iron) Tablspoonful mixture. for Nephritis Dialized Iron antedote for Arsenic Poision. q.Hydrated Sesquis Oxide of Iron. must be freshly prepared. Fe2Cl6 + NH4HO. Na Carb + Fe2CL6 Green Vitriol- FeSO4 Monselles Sol. as a Styptic. Iron Alum Iodide of Iron. Syr. Anemic Children. Phosphate of Iron. Lactates. Tartrates. Citrates. Valerianate of Iron for Histerical Women. May.1.'06 Mercury from Cal. Blue Mass for purge. Blue Ointment. Mercury & Chalk used as Antiphlogistic. Antiseptic. Syphalis. with Io of Potassium Prot Iodide of Mercury. Gray Oil Bichlor ) Calomel Salicylate of Mercury ) 4 Hypo. (Hydrag Prot iodid gr. xxv Mft. Pill. no 100 Pulv. Opium gr. xii One pill 3x after eating) Dec.13.'06. Born. Negative Polar action bare metal. with any metal in soft tissue. with mild currents, increases capillary circulation, nerve & muscle excitability. mildly electrolytic, alterative, relaxing, dilating nutritional, healing to ulceration. With medium current: more actively congestive, softening, nutritive, electrolytic. Strong Current: liquifying, haemorrhagic, exhorative soft. pink scar. Very high current: caustive affect. Positive polar action. with bare metal attacking electrode. zinc, copper, silver, nickel. Medium Current decomposes & deposits, Oxyclorides. of the metals within the tissues surrounding + pole. Antiseptic, germicidal. anti haemorrhagic. drying. styptic. astringent. tonic nutritional. alterative Curative of Catarrhal inflamation of muscous membranes. Dec.20.'06 Reaction of Degeneration: Electric Irritation causes altered irritability of Muscle & contraction. Gradual moderate application to nerve there is no contraction. Stronger causes contraction tetanic. Sudden Make or Break causes contraction. + Pole is Anode. - " " Cathode. (Electrotonus is Change in irritability of m. & Ir.) An electrotonus under anode. Cath " " Cath. 1. Testing at Anode irritability is diminished. 2. likewise testing Cathode after irritation the irritability is increased. {Anelectrotonis diminishes irritability. {Cath " increases " {Disppearing anelectrotonis increases " {" Cath " decreases " {Opening anode causes contraction. {Closed Cathode " " . (this is greater). {Anodic closure " no " {Cathodic opening " " " Tissue immediately under polvis Polar Region " around " " " " Peru. " " C-C-2 ma. Normal formulae. Jan.3.'07. Muscle contraction is manifest by rapid interruption or sudden change of Density. Polar zone charged with same as Pole Peripolae " " " unlike as ". Nerve being away will depend on its position. In testing Muscle with Galvanic dont have both electrodes on muscle. 1. m.a. gives no Contraction. 2. " C.C. get ". 3. Ma. AnC " " . 3.5 " A.O. " " . 15. " C.O. " " . Testing Muscle action is on Ceripheral Neuron A. Reaction of Deg. the Muscle no longer gives any action of Faradic or Static. B. 1. Contractions of Muscle are not so marked. 2. " Become equal of Dif. Poles. 3. Complete Reversal of Polarity. R.D of Erb. (AC. CC. CO. QO. R.D of Erb). Stimulus of less than 1/10 Sec. will not contract Deg. m. Jan.10.'07. Faradic Battery: current is an induced current. At make flows one way continued comes back to normal open flows opposite way. Change in position brings about a change also Primary secondary & Interrupted. [illustration] Rheostat. controls amb. of current. Galvanic Large amperage. low voltage. Faradic Smaller " larger ". " has no electrolytic action. Actions are on Striped & unstriped muscles. 60 to 125 Per m. will contract muscle & rest it sufficiently. No affect on unstriped muscle. 20 to 30.000 per. m. does not affect striped but the unstriped muscles if viscera etc. fine coil for fast current. Contractions with course coil & slow currents contract muscle & are regenerating. fine Interruptions fine coil produces contraction to non strip applied in direction of Arterys in old flow increases + pole metal. old. supply serous fluid. relieves congestion High frequent current on Mucous Surfaces. Jan.17.'07 [illustration] voltage high amperage low. ground less irritating * first is breeze Direct spray spark. more irritating. Neg. insulation where P is charged negative by Pos. " . . . . . . . . Jan.31.'07 Morton Vave is a constant charge & discharge of Patient [illustration] Morton's induced current by Leyden's Jars. Physiologic action: No Electrolytic or Cataphoric action. A regulator of function. Regulates Temp. Pulse. Resp. Sleep. Perspiration Excretion. Secretion Increases Metabolism by stimulating to absorb more O. this is good in Gout. Rheu. Anaemia. Diabetes. Spark produces strong Musc. contraction gets rid of swelling about joints. Oedema etc. + spray is sedative. - Pole irritating on Ulcers etc. Feb.7.'07. Diabetes Mellitis. Sugar from Starch also some Proteids are converted. Restrict starch & sugar. Exercise. Codein. As. & Antipyrin. Electro-therapy. Static treatment is best. Regulates function. Counter irritating + spray along Vertebral Morton Vave. + Frictional spark with roller over abd. & lags. Local. + Counter Irr. Spray to base of Brain for headache. Gout: Sodium Biurate deposit. in Con. tissue Feb.28.'07. Endometritis Catarrhal. septic. gon. senile. memb. Dysmenorrhoea. Subinvolution. & Haemorrhages. Metrorhagia between Menses. Meno. " Haem. during Menses. Mar.7.'07. Tibromata. Electrode in uterus B.M. 0-50-150 every 3 or 4 days 5 min at a time. galvanic current. + Pole- stops Haemorrhage. Catarrhal Salpingitis. usually chrnonic. Exposure to cold. Excessive Menses. intercourse. constip. symptoms of Acute Peritonitis Local. Relieve Pain. use Bi Polar Vaginal Electrode. [illustration] disappears hyperemia oil with glycerine. start at 0 & increase. Use Ball electrode & cotton cover. April.4.'07. Xray tube: Geissers tube out of which some air has been pumped. Gas in tube becomes illuminated. [illustration] Plat. Mirror. Small Particles remain attached cause less heat. also focus rays. Copper back of Pl. to absorb heat. Some gas must be present & regulators are used to sustain presence of it. OsmoReg. = Pb. heated & N gas passes in. Automatic Reg. = add. tube also where Chem are put to generate gas.         Compound ethers or Esters. Prepared by union of acid + alcohol. Saponification. Fat is an ester of fatty acid & glycerine. CH3 OH + fatty acid. CH OH + CH2 OH + Ethyl Nitrite: Methyl Salicylate: oil of winter green. CH5OH + 2KNO3) + H2SO4 2(C2H5NO2) + K2SO4 + 2H2O Sweet Spts. Nitre is a mixture of ethyl nitrite in alcohol. 4%. Amyl. Nitrite C3H7OH. Aldehydes: Acid ald. C2H5OH + O which has passed over Heated Plat. Spuol. CH3(CHO) Formaldehyde. Dist Ca formate -> oxide & Pass air into methyl alcohol. formaline 40% sol. Paraldehyde. is Parimlized [illegible] & 3COH Trichlor [acetic acid] acetic aldehyde. CH3CHO. Cl3 -> Chloral. heavy oily liquid. acid ald. C2Cl3OH. H2O Chloral hydrate Ketone- Acetone CH3 CH3 > CO2 Mar.13.07. Hydro Carbons. Parafins C2H6 Saturated Comp. Olefinas. C2H4. un " ". Acetylene C2H2. Inflam. gas. prepared by CaC2 + H2O -> CaO + C2H2. Test for Chloroform: 1. Odor Phenyl isocynide CHCl3 + NaOH + C6H5NH2 -> C6H5- Reduces Cu Sol. 3. B. Naphthol + KOH + heat -> Prussian blue. Iodoform: CHO3. Ethyl Alc + Iodine + KOH. Ethyl Chloride Pass HCl into Alcohol. Mar.26.'07. Benzine a mixture of HydroCarbons from distil of Crude Petrol. Benzene C6H6 Colorless liquid Tolnol. C6H5CH3 = Methyl Benzene. Xylol C6H5C2H5 = Ethyl. ". All closed series hard to oxidize. Phenol C6H5OH Prep Cold tar { light oil. { middle " . -. 150-200° large quan. Phenol. { Hedge ". Phenol + KOH -> K Phenate + HCl -> C6H5OH + KCl. Cresol Resorcin-Hydroxy Benzene. C6H4 < OH OH. Pyrocatechen C6H4 < OH OH. Quiacol methyl Pyro- C6H4 < OH OCH3 Creosote- mixture of [Cre??] Ortha Meta Para. Lysol. 50% cresol + oil + KOH. saponify. Anilin C6H5NH2 or Amido Benzene. Benzoic acid (crystals). C6H5-COOH renders urine acid. Prep: toluene C6H5CH3 + heat -> C6H5-COOH. Salicylic Acid. 1. Oil winter green. 2. Synthetically. 3. Dest. Dist. Wood. C6H4 OH COOH. Heat C6H5 O Na in CO2. Salol. Acetic Acid: 1. Oxid of Alcohlo. 2. Vinegar Fermentation 3. Dest. Dist.                   Dec.5.'05. Test Meal. 1. Enald Breakfast 2. Boas B. 3. Riegel Dinner. gives 5-6 Lactic Acid Elmer. B. give 2 meals. Getting Meal- Hold breath & form Pressure on Stomach, Irritate Pharynx, Use Aspiriator & Bulb. Stomach Tube a Kind B technique. C. Obtaining meal. D. Expression sorry tube, suction, Boaz Bald, water suction after getting Contents, Inflate Stomach. Wash for Diagnostic, Therapeutic & to obtain Remainder of Contents. Next begin Examination. 1. Macroscopic. Stomach Anal. I. Macrosopic a. quantity. normal Break. 30 to 50 cc. " m. 40 to 80 ". Abnormal Increase Motor Insuf. Hypersecretion Decrease . Hyper Motility. B. Color. 1 Bile, with Bile may have Alkaline secretions which modify Acid test. 2 Blood coagulated Dark Brown Color. Coffee ground Vomit. Cancre Bright Red may be Ulcer. May Rupture Vessel of Esophagus. From Serosa of Liver we have varicosed veins along Esophagus. Erosion of Stomach, Streaks from Vomiting. C. Odor, normal has little odor. Rancid odor for Butleric acid Vinegar " " Acetic " Foetal " Poisonous " D. General appearance Solids, Liquids, Identify Solid give Motility E. Division or Dig Normal is like Corn Meal. F. Mucous signifies Catarrhal Gastritis Stringy appearance signifies Mucous amount. G. II Chemically. Acidity Test Acid or Alkaline. Litmus Diverticulum of Stomach Kind of Acid. Free HCl. D. A. Apo Benz. Congo. Red.  Jan.2.'06. 1. Urine. 1. Quanity. 1000 to 1500 C.C. 24 hrs. take evening urine. for examination. Path. Spec. keep 24 hr. in separate bottles. when Doubtful. Thymol. Boric Acid. chloroform. Salicylic Acid. Preservatives. 2. Specific Gravity. 1010-1020 & 5. Indicates amts. of total solids. Multiply last 2 figure by 2.3 3 (Halsers Coef). no. of gms. in 1000 CC. 3. Acidity or Alkalinity. Acidity due to acid Phosphates NaH2PO4 Alkalinity " " Carbonates NaHCO3 Carbonates formed from Vegetable food. q. * Transformation of Citrate etc into Carbonate. Salicylic & Benzoic Acid. * * " " + Amide Acetic A = Hypuric total aidity in "arms" of Oxyalic Acid. 4. Urea. Normal 72 gm. Solifd. 30 gm. Urea (2%). formed in liver mostly. q. * No. Hypo Bromide + Urea. Qualitative tests for Urea, Sulphides, Phosphide etc. Read to Sediments. Chemistry of Urine. Albumin. Albumin Test. {1. Acidulate with Acetic A. + NaCl. + Heat. {2. Hellers. Nitric Acid Contact Method. Acid Urate may make turbid. Heat when urates come down & they will dissolve. Notice for Indican Bile etc. Red. green. Mucin ring higher up & Nuclein Proteids. * Albuminoses. Dissapear on heat & reappear. 2. Potassium Ferocyanide & Acetic Acid. Serum Globulin. Sugar. {Dextrose {Hains Boil to see if there is any reducing body in Solutions. {Levulose {Lactose Uric Acid if too much will reduce. Don't boil too long may reduce uric acid & creatin may reduce with long boiling. Bismuth Subnitrate. does not reduce uric & Createnim Albumin contains sulphur which may cause a black p.p. Fermentation Urine & Yeast decant upper portion put in fermentation tube. Make a control of Yeast. *Acetone Deacetic, Beta Pref Beturic, Indrein, Bile *Ous, Mucus, Sedaments = outline. Jan.6.'06. Quan. tests for Sugar. & Alb. Phenol hetrozine T. ʒ. Blood {Blood Corpuscles {Haemoglobin. Haematin Test. Evaporate Salt. add urine add Acetic Glacial. Teichman's Crystals. Guayacum. Tr. quaic + Ozonized Turp. & add Blood (Suspected fluid) layer it on & at junction we get a blue color. Heller's Test: Urine + KOH. percip. Phosphat which are white & Blood colors. 4. Indican (Ka Indol Sulphate.). Proteids Urine + [Alkaline] + HCl + Fe.Cl2. = Blue Color. Obermeyer 10 CC Urine 10 CC Ober 5CC Chloroform shake. (FeCl3 2 grams [C?]. HCl. 1000 CC.) Indican. 5. Pus. - Cloudy. settles to bottom. don't disappear on heating, mucous like stringy. Heller's Nitric Acid test. Percipitate Add KOH to suspected fluid & there forms a gelatinous mass by breaking up pus cells. 6. Bile. from liver & absorbed from liver gemelin - fuming Acid Nitric. Hay's - flowers of Sulphur. Ruput's - CaCl + NaOH + NO3H greenish color. filter X 7. Acetone CH3 CO Dimethyl ketone. CH3 Distil & test Distilate Urine + NaOH + Lugol till sl. yellow warm slightly - odor Iodoform cool get Io. crystals- alcohol gives same. Use am OH instead Na & Tr. of Io. Diacetic acid. [Nitrous Prusside + alkali. NaOH.] FeCl3 drop by drop to PP. Phosphates. Red color. Gerhardts. filter & add few drops. Red color. Beto Oxy Butteric Acid. more β Oxy in urine more Am. Sedamentation. [Illustration] Macroscopic. Micro " . Microscop. {Bact {T.B. {Typh. {Gono. {Pus. {Blood. {Epith. Spermatozoa. Parasites. Fibers. Foreign Bodies Fungr. Casts: are moulds of Tubules of the Kidney. Pus looks like Leucocy to Casts {1. Hyalin Casts {1 Pure Hyalin. {2. Waxy {3. Tibronous {2. Granular Casts {1. fine {2. Course {3. Pigmented 3. Epithelial. 4. Fatty. 5. Blood. 6. Pus. 7. Bateria. 8. Crystaline. 9. False. Tot. Ac. 25 CC in Beaker + (10 gm. Ka Oxylate take out drop on filter paper No of CC of NaOH X.0063) NaOH + Urine test for pus. 1. Amount. 2. Color. 3. Odor. 4. Consistence. 5. Transparency {Bacteria {Phosphates. Urates. {Pus 6. Reaction. 7. Sp.g. Total Solids. 8. Total Acidity 9. Albumin. 10. Sugar 11. Pus. (125 Saxe) 12. Urea. Na Hypo Bromide. Acetone. Indican. Diabetis Jan.11.'06. Sugar- Haines Ulbumin- Hellers. Acetone- Am OH & Tr of Io. or Distil. Deacetic A. - B. Oxy Butyric Jan.13.06. Sedaments. Chloroform water 1-200 Preservative add 1/3 volume of water to Urine. Crystals Organic or Anatomical Sedament. Epithelial Cells. { Plain or squamous. { Bound cells. tubules of Kidney. { Elongated " . Pelvis of " Deep layers. [B?] Pus { Acid Urine- Clearly seen with granules. { + Acetic Acid on side of cover slip. see Nucleus. { Alkaline Urine- Breaks up quickly. NaOH. Casts { Hyaline {Pure { Evarry { Fibreous { Granular { fine { Course. { Pigmented. 1. For Hyaline shut if light are semitransparent, [Translus] Amorphous, cylindrical. Wavy edge. if not straight. from size of to 3 times size of R.B.C. drop of Acetic Acid will disolve Hyaline cast. 2. Waxy Hyaline more translucent, some larger. occur more often in Pyramids where tubules are larger. indented edge. Yellow with Iodine red with HCl. 3. Fibrinous Casts. 4. Epithelial Cast. may change & become course granular or further fine, may have fatty change & [nex?] Pigmented. 5. Granular round edge. Surface covered with granular 6. Blood cast. Bld cells on outside may be hyaline form. found mostly in Acute congestion. 7. Crystaline amorphous Urate or Phosphate or Waxy or hyaline. Cylindroid Cast more transparent than false bodies. Watch for foreign bodies. 8. False Cast Crystals Acid & Alkaline Acid Urine Uric Acid Crystals. lozenge or whetstone shape. reddish crystals. Star. rosette. Noncrystaline- Dumbell. Alkaline Urine. Triple Phosphate coffin lid- Am. acid Urate. Calcium Oxalate in either Acid or Alkaline. Jan.23.'06 Clinical Significance. Albumin- Serum Alb. & Serum. Glob. Does not always suggest Kd. lesion. may follow fevers. alimentary Albuminuria. Alcohol. Physiological:- Prolonged bath. excessive exercise. large quantities of Albumin in food. Alcohol. Pregnancy. Nervous. Lesion in g. u. Tract. Pus infections. Cystic Sluffing tumors of kd. Adelesence. Medicinal Cantharades. Turpentine Salicylate. Following Contageous Diseases. Heart incompeasated R. Heart. Passive Congestion. & Active Congestion. Nephritis inflamation of Kidney. general Kd affections from any cause. Acute Paren Neph Chronic " { Parenchymatous { Interstitial Amyloid Kd. Brights Disease is a Chronic Neph. Interstitialis. Acute Nephritis {quan.-Small. {Color. Dark- smoky. {Spec.g.- High {Blood. Leucocytes- Epithelium. Cuboidal- Albumin. Casts {Epi. Blood. {Granular, fibrinous Fatty & Waxy not gotten. Chronic Parenchymatous (alb. comes from Bld this degenerated cells) {quan. small {color- Dark {Sp. gran.- High. {Blood- not so often {Albumin {Leucocytes Epithelial. Casts {granular. Blood. Hyaline. fatty. Chronic Interstitial {quan- High. Color- light. {Sp. gr- low Blood - {Len.- Epi Not often. albumin [illegible] {Cast. Hyalene fatty? waxy- & Accentuated Second Ht. Lound. Enlarged Heart. Arterio Sclerosis. High Bld. Pressure. Sugar indicates Diabites tho does not mean it Diabites 1. alimentary glycosuria. 2. Brain Lesion. (not Phy). 2. Medicinal- Chloroform. 3. Pregnancy- Lactose. Pathological. 1. Lesion in Pancreas 2. " " Brain. 3. Diabites. Diabites Path Cond of Kd. & have Sugar in Urine. Ability to Oxidize & use up Sugar in Body is destroyed. 1. Source of Sugar- Carbohydrates. 2. Proteids 1. in food. 2. of Body. Diabites I Mild- Sug. comes from Carbohydrates. II. Middle Severe. comes from " & Proteids of Food. III. Severe " " " " & " " Body 1. Acetone 2. Diacetic Acid. {May be found in certain Cachectic 3 Beta Oxy [B?t??ic] {Conditions. Acidosis Acidosis. Determine Amt. of Amonia. Amonia 1 gm. Normal. Jan.25.06. Quanatative Calc. of Alb. Eshbach. tube. " Reagent = Citric & Picric Acid set aside corked & alb. will settle. graduated & grms are determined for 1000 CC. Sugar Quanitative. Haines or Fehling's. " Quan. test. Reagent 8.314 grms. pure CuSO4 dissolve in 400 C.C. Dist. water. add 40 CC C.P. [Gl?????] + 500 CC of Liquor Potassii (5%). Add water to 1000 C.C. Take flask + 10 CC Haines. + 30 C.C. Am. + Urine m Put Urine in Titrate. Boil solution & add urine drop by drop till Blue color disappear. Dilute 5 or 10 times if solution is strong. Am added to have atmosphere with no oxygen. & to keep Cuprous Ox. in solution. Get rid of Albumin first acidify boil & filter. 10 CC of Haines is reduced by 01 gm of dextrose It took 1.8 CC of Sug. Sol. to decolorize 10 CC Haines. 28 CC Sugar Sol corresponds to 01 gm Dex. in this case. Dr. Lewis. Oct.9.'06. Bladder: Serous. Muscular, Aerolar or con. tissue interstitial, mucous membrane. Size of fist to much larger. muscle Ex. Long. Int. Civ. Serous coat 2/3 Post. Sumib & 1/3 ant. Bladder has summit. body & base or fundus. Trigone in inferior part of Bladder not in folds or rugi. cause: it has no aerolar tissue. Here are openings of Ureters. Post. of Trigome is 'bas fond.' Interureteric fold an elevation from one Ureter to another. bas fond somewhat deeper. Testes secretes sperm. sent thro tab of Epid. thro Epid. Escretory organ. then thro' vas Deferens around bladder? to ampula of Henle. then into seminal vesicle (resevoir of semen). Urethra. Mucous. Muscular 80rq in. Open 3 min in 24 hrs. Prostatic portion. Membranous. (Compressor Urethra). Bulbous. Cavernous. Physiological Div. Ant. & Post. divided by cut off Muscle. Internal Sphincter at Base of Prostate Meatus smallest portion 24. Fossa Navicularis 32. Isthmus 28. Cavemous sin 30. Bullous 35. Membranous 28 Prostatic gradual increase 30-35 Oct.13.'06. Mucous Membrane of Urethra is same continuing to the Hilum of the Kidney. Mucous layer composed of 2 layers Epithelial & Subepithelial Base of Bladder Epithelial is pavement. Glands of Urethra are Littre and Morgagni Anterior of Urethra is Spongy. Post part muscular- erectile issue Prostate Gland funel shape {1. Muscular- Base. {2. Glandular- Apex. {3. Supportive Irritation of Prostatic urethra causes desire to urinate. Pudic Nerve supplies Anus Perinum. Urethra. Prostate. Sympathetic Base of Prostate. Dorsal vein empties into plexus around Prostate. also Inf. Hemorrhoidal veins. & veins from bladder. Blenorrhea. Tripper. Gonorrhea. Virulent. Contageous. Inflam of Mucous Memb. Specific disease. Gonococci develop by a process of segmentation in two parts. Stain by Gram & decolorized by after stains. Epithelia & Subepithelial (Contis) attack cement substance. Con tissue acts as a barrier 4 stages. 1. Incub. 2. Proliferation. 3. stationery. 4. decline. Dec.4.'06. Bullhedd Class. for skin swells & is caught back of Glans Penis.- Periphymosis.- lodged behind Glans-. Infection gets behind cut off muscles 90% of cases get back thro lymph. & continuity. Dec.10.06. Post. Urethral Infection. stationery & Decline stage. 1. frequent Micturation 2. Urgent " 1. Double glass test. 2. May be blood. Phosphates clear up with Acetic Acid. Urates " " " Heat. Treatment: Kill causation agents without harming tissues. Local & Internal. Silver Salts locally. Argyrol 2 to 10%. Permang of Potash 1/20 to 1/5 %. Protargol 1/2 to 1%. Argonin 1 to 5%. For Ant. injection use Penile syringe good year no 23. holds 1/2 of which fills Ant. Urethra. Moderately warm. inject 4 times a day. Relax Body & Mind. use Dec.17.'06. a little cocain to anaesthize urine is barometer. 2nd. glass clears first. Pallitinitis Inflam of Glans Penis. Jan.7.'07. Stricture {a. Congenital {B. Acquired. {organic {Traumatic. {Inflam. {Spasmodic. Inflam. {gonorrheal.. {Chancroidal. {Mastbra. {Chemical. 3. {Linear. {Anular. {tortious. Stricture is an abnormal lack of dilatability. Compressor Urethral seat of spasmodic stricture. Gon. Inflam. Organic Stricture most common. Urine tries to seep into con. tissue & there is deposition of White Cells & lymph cells. this may organize to tissue then to Cicatrical tissue. Bulbo Memb. site of 2/3 of cases. Gleat: Chronic deposition secretes mucoid discharge indicates stricture. Jan.21.07. Stricture may be caused reflexly by Sinegma under foreskin ant. Stricture. Remove cause for treatment Narrow twisted stream of urine-more force. Change in Char stream freq. of Urination. Gleat is subacute disc. from urethra mucous Pus. Corp. resistent. over supply of Mucus. is a symptom of Stricture. Must examine. Sound. Bulb. Deeper stricture the narrower. begin with large sound. Dont pass Bulb sound beyond Cut off muscle. Cut off Muscle does not obstruct steel sound. but if stricture is there it will stop large size. Per rectum absense of Prostate in Str there. Feb.4.07. Dont go below 18 French sound. Any size stopped by cut off muscle. Use steel sound to pass cut off muscle. next use soft silk Catheter then fill form boujie. (whalebone) Different strictures differently treated. Young stricture may be removed by massage. older are not. Location is considered in treatment. Meatus must be cut. Internal urethra stormy in well established stricture within 4 in of meatus. In forming stricture use massage, caustics, Dont cut deeper than 4 in. or protect with external urethrotomy. use cutting of meatus more than size wanted. on floor in isthmus & meatus. Internal urethratomy on [floor] roof with athrethrotome use anaesthesia local. solution of Cocain or Alyfein. in same strength 2-5%. or tablet by Depositer assistant holds Penis & instrument & Operator dilates urethra & when tense or to proper. Diameter. then incise once or twice use bulb sound to see if properly incised. Loosen slightly & withdraw at same time. Keep using bulb sound. Wash with hot water keep on using bulb sound. at first every 3 day- 4 days. 7- 1 mo. Mar.4.'07. 3rd. lobe of Prostate of Post Commesure usually is Pathological. 60 yrs Senile Hypertrophy Fibrous. Glandular & fibroglanular hypertrophy form of growth: lobes grow up & Bladder Laterally & makes a narrow slit of urethra Colarette form. [Bar???] of Post. Com. large not Projected stream. frequency of urination at night usually. Residual urine favors infection. 1. find out if gland is enlarged. 2. " " " there be [constriction] obstruction 3. form of obstruction. 4. Diag. with reference to other organs. 5. May be contraction without Hyper of P. Why. {1. sound out by palpation per rectum. {2. Urinate then pass Catheter & get residual urine. {3. Cystoscopic examination. restrospective view. {4. Exam. Urine. Catheter Urine.      Feb.1.'07. Dietetics is the science & arts of choice & preparation of food science includes 1. a knowledge of Metabolism 2. Hygiene sufficient to show effect on normal individual. 3. Therapeutics " " " " " diseased. 4. Physics & Phy. Chem. " " " digestability of food stuff. Metabolism: is the science which teaches us the the process by which food stuffs are built up into living tissue & protoplasm. or process by which we oxidize food stuff to give us heat & energy. Digestability is the process by which food stuffs are changed Chemically & mechanically that they may be absorbed. 1. Kind of food. 2. Preparation of food. 3. Condition of individual. Absorption: is process by which food is taken up by walls of canal & passed into blood. depends on. 1. Filtration. 2.. Dyalysis. 3. Hydrostatic Pressure. 4. Osmosis. 5.. Due to chemical changes. Food stuffs: Carbohydrates, fats, Proteids, Mineral salts. Digestion of Carbohydrates. 1. Starch, Destrin. gums are changed to Maltose by Saliva & Panc. 2. Dextrose, Levulose, Galactose. 3. Disacchrides 1. Maltose. 2. Cane sugar. Lactose. Carbohydrates: Absorption must be as normal Dextrose 0.1 Metabolism. 1. affected by liver so that excess of Dextrose is stored up as glycogen. 2. affected by pancreas 3. affected by nervous system. What becomes of Carbodydrates 1. changed to CO2 & Water {heat {Energy. 2. Part of Carbohydrates are laid down as fat. 3. Pathologically. Carbohydrates are not oxidized. Fats: stearin. Olean. [Palni?tin] Buturin {92% Burturic stearine Butter has 92% Vol. 8% nonvol. Oleo. M. Olean. Caproic. Capryllin. Caprie 98% Vol. Digest of fats 1. Mouth no changes 2. Stomach but little. 3. Digested in intestines split up into fatty acid & glycerine are absorbed. { glycerine {fatty acid as soap. reunites in passing this intest & exist as fat in blood. Feb.8.'07. Fats: Metabolism. 1. Heat generated. 2. Energy liberated. 3. Excess fat ingested stored up. Protins. I simple. II. Compound. III. Albuminoids. II. 1. Mucin. {Sug. {gly. Proteids. 2. Haemoglobin. 3. Nucleo Proteid. I. Albumin. 1. Serum. 2. Egg. 3. Lact. Globulins. 1. Serum. 2. Lact. Albuminates. {acid {alkali. Nucleo Albumin- Casein. Albumose Peptones. III. Supporting tissues of Body. 1. Gelatin. 2. Chondrin. 3. Keratin. 4. Reticulin. Digestion of Protins: Mouth- Masticated.- Mechanical. Stomach- 1. Native Proteid by acid gives acid alb. or Syntonin. then Albumoses then Peptones. Peptones are absorbed. others pass on. Intestional: Proteid to Alkali Alb.- Albumoses- Peptones. Amids Acids- Hexonebases. Absorption of Proteins: Mouth- None. Stomach- Peptones. Must be transformed is poisonous. Must change in Mucosa. Pep | Serum Alb. | Seun Glob. Intestine = Some Peptones is absosrbed as St. Absorpt. Amido Acids & Hexone Bases. Amido Acids { Hexone Bases { to Serum Alb. " Glob. Metabolism: 1. Some of Protein is built up to new tissue. Protoplasm. 2. Part of Protein is oxidized at once 1. Heat. 2. Energy. 3. Proteins some transform into carbohydrates. 4. Possible some may be stored up as fat. 5. [Part] Gelatin never built to Protoplasm. " oxidized at once. End products of Protein Metabolism. 1. Broken down cells. 2. Oxidized Proteins. Urea. Uric Acid. Creatinin. Creatin. Ammonia. Water. CO2. Sulphates. Indol. Skatol. tryptophan Leucin. Tyrosin. Amm. Carbonate. NH3 Lactate. Xanthin Bases. Many end products contain C6 & are converted into Carbohydrates. Nitrogenous Equilibrium: Body Equi. is state where ingested food & Excreted Products are the same. is that state of Met. in which ingested N. is the same as the Excreted N. Mar.1.'07. Income of Energy. 1. To determine energy must have amt. of intake. 2. Must know amt. of food which can be absorbed. 3. Must have certain unit to measure energy. Unit is calorie. amt. of Heat necessary to raise 1 gm. Dist. Water 1°. Small Cal. O° to 1° large. is 1 Kg. Heat value of food stuffs in Calories. 1. Proteins- Change to Urea 1 gm. Dry Protein = 4.1 Cal. 2. Carbohydrates. CO2 & Alcohol. " CarboHy = 4.1 " 3. Fat ... ... ... " = 9.3 " Isodynamic value of food stuffs. 100 gm. Proteins = 100 Carbohydrates. 100 gm. fat = 227 gm Prot or. Carbhy. Oatmeal: 7.6% Water 15.1% Protein. 7.1% fat. 410 Cal Calopheric value. 68.2 of CarboHy. 2% Salts. Mothers Milk. Water 87 Solids 12.6 Proteins 2.3%. 1 lb. give 319 Cal. Fat. 3.8%. 1 " Cows. 3.13 " . Milk Sug. 6.2 " . Ash .3 " . Calories required in 24 hrs. 701 kg. 2240 Cal. for starving man & ordinary work add 11 to 14 % = about 3200 Calories. 118 gm Pr.{ 37 " fat. { amt. for 24 hrs. 500 " CarboHy. { C.F. Mar.8.'07. 5.4 gm N. in 24 hrs. x 6.25 = 3.3.75 amt. of Protein. 40 gm. of Protein by Chitteden. in 18 gm o. instead of 118. In all he took 1500 C. For good nutrition. 1. Proper Diet-mixed-. 2. Proper number of Calories. 3. Regular periods of feeding. 4. Frequency. 5. Variety. 6. Appearance 7. Temperature 98°. 8. Highly Seasoned-. 9. Rest before a meal. 10. " after " . 11. Emotions. Mar.15.07. Milk. water 84-90. 87. Solids 13. organic & mineral Casein & Lact alb. org { cocos. 6 - 1 1 - 2 - Woman's. Fat. 4% Cow's & Woman's. Lactose. (Gal & Dext.) 3.8 or 4% Cow's. 6% Woman's. Mineral m. .7 Cow's .2 Mother's. Ca3(PO4)2, K2CO3, NaCl, Adulteration: 1. Add Water. Sp.g. 1030. 2. Removal of fat. Preservation: 1. Cold.- freezing. Denmark. 2. Heat- Boiling- sterilyzed.- Pasteurized. 3. Preservatives. Salicylic A. Boric. Formaldehyde- Alcohol. Digestion: 1. Curd. {Renin. {HCl.. 2. Casein is digested. Acid Alb. Albumoses & Peptones. Barley water P.P. Curd in fine flakes. Oatmeal " " - - - - - . Sodium Citrate 1-3 grs to pint. Predigested milk: Peptonized milk.- 1. Pepsinized. 2. Pancreatized. Carbonated water or fruit juice for taste. Fairchilds Tube 5 grs. Panc. Ext. 10-15 gms. Na2CO3, { for 1 pt. milk. Humanized milk: Condensed milk. sweet & unsweet. Normal Variations.- Mother's milk.- first wk. fats in excess. others small. 3 wk. is 6.7 C. 40 fats 2% P. 7 mo. Decrease Proteins & fats. Modify Mother's milk: 1. Increase fat- increase protein. 2. Decrease: - Reverse. other elements not changed by diet. 3. Increase Proteins- decrease exercise. 4. Decrease " - Exercise to point of fatigue. 5. Carbohydrates remain constant. 6. Increase quantity - increase liquid. 7. Decrease " - Cathartics & decreas liquid. Mar.22.07 Clinical method to determine fats & Proteids. 1. Carbohydrates remain constant. 2. Inc. fats. decrease Sphq. 3. " Proteids inc. " . Determine fats grad. t.t. 10 CC fresh milk set. in cool place 24 hrs. this graduate gives amount of cream the ratio of cream to fat is 5:3. Normal Spgr. & Norm fat. aug. constant milk is normal. Normal Sp.gr 1029-33. Scanty { Rich. modify by inc. liquids. beer. { Poor. Inc. liq. Inc. Proteids. Less Excercise. Baby feeding. 1. Breast fed. 2. Wet Nurse 3. Mixed feeding. Breast { alternate. Bottle { 4. Artificial or Modified. Reasons for modifying Cow's Milk. 1. Fats are same. 2. Sug. is low. 3. Proteins too high. 4. Casein to alb. 6 to 1. 1-2 in Mother's. 5. Casein Coag. large & compact. Ways of Modifying milk. 1. Diluting. 2. Peptonizing remove all or part of Casein. 3. Adding Oatmeal Water. Barley or Na Citrate. Nursing Periods: 1st. up to 3 or 4 Months. sug. 5% fat 2-3% Proteid 1.5% 2nd. up 4-9 Mo. Sug. 7% Prot. 2% fat. 4% 3rd. " 9-12-14 " . " 2 1/2 - 5% " 2 1/2 % " 4% April 5.07. Of 1000 children 430 more die than those fed on Mod. Milk. Requirements for Infant: 1-3 Mo: fats to Proteins 3 to 1. 3% fats. 1% Proteids. 3-6 " " " " 2 to 1. 4-5% " 2 - 2 1/2 " " . 6-12 " " " " 1 to 1. 4-5 " 4%-5 " " . Carbohydrates constant 4 to 5%. Baby 3 mo. old. fats 3%. Sugar 4-5% Proteins 5%. Lime water 5% total. 8 feedings. Amt. 4 oz. Jerseys: 1/4 water to milk. Hol. & Short hours: Poor add cream. Gravity Cream: 16 to 17 % fat Carbo & Proteids same. Centrifugal " 16 " 40 % " " " nearly " . Top Milk Cream. Method of removing Cream. 1. Pouring milk. | use upper 1/3 for 1 period. 2. Syphon. | " " 1/2 " 2 " . 3. Chapin cup. | use all " 3 " April.12.07. Home or Country Style: [illustration] a. first trimester. Syphon off with glass syphon. B. second " . C. Third " . Mix 20 ounces for 5 feedings. 1 oz of lime water. 6 oz 10% Milk. 1 ℥ Milk Sugar. water q.s. % of fat from 'a' = 1/2 no of oz. taken. 2 oz milk 10% fat 1% sug 5.5 Prot. 1/3 % 4 " " [2] " " 2 " " " " 1% . Barley water or oatmeal gruel may be exchanged for lime water or 1 gr. to oz of food of Na. Citrate. Sodii Bicarb has also been used.                    Physical Diagnosis Prof. Summa. Physical Diagnosis or Diagnostics is the application of our sense organs for detection of Disease when Patient enters things to be observed are: Inspection 1st. Gait comparing it with a healthy person, manner. position etc. 2nd. Condition of Nutrition under 3 heads. a. Skeleton. whether his make up is of a course or finer nature. B. Musculature. always examine when muscle is at work as have him contract his biceps etc. C. Adipose tissue under 3 heads determined by 1st. color of skin, the lighter & more beautiful the skin the more fat underlying. Most beautiful in children next in ladies always examine undisposed parts Abdomen etc. 2nd. By prominences of Bony parts and surface outline of muscles etc. 3rd. By Palpation skin should be smooth where subcutaneous tissue is present & where it feels ridgy it shows that the fat has been atrophied from the meshes. 3rd. Skin: color, dryness, moisture, roughness, smoothness, swellings, depressions etc. Inspection of general Build & Nutrition. of Gait influence of Nerve System on muscular system. Build: Heredity plays a great role more sickness of Parents show up on Individual. Phthisical Habitus & disproportion between Height & Bredth. Fat people have fat around heart & in abdomen & make examination very unsatisfactory Inspect skin surface & appendeges Eyes- Sclera Conjunct etc. Visible mucous membranes Eyes lips & Mouth. Lips teach extreme amount as to circulation as are pale or Blue & should be red. Pales - Pallor Blue - Cyanotic Pale-Blue - livor livid The redness of the lips is due to color of Blood seen thro the thin mucous membrane & in case of Cyanosis the Blood has changed color & the Capillaries are filled with venous Blood. This Cyanosis may be due to a sluggish circulation & is due almost entirely to Circulatory Disturbance. Picrotoxin causes a yellow discoloration Bile Pigment - Icterous - first in Urine Addison's Disease Brownish Discoloration. Cyanosis two headings. a. Circulatory Disturbance & B. Respiratory a.1. Congenital Heart Disease 1. Opening between Ven. & Auricle. Foramen Ovale. Aorta to R. Ventricle. Stenosis of Pulmon Ostium. Right Ventricle Dilates & tricuspid being insufficient blood regurgatates. Opening may exist between Pulmonary artery & Aorta: Ductus Botalli & this may cause a mixture to take place & when this obliterates a stenosis may form. This may be diagnosed by examining the femoral pulse which is weaker less filled impulse occurs latter. 2. Opening Between Pulus. Ducts. 3. Narrowing of Pul. Ostium. 2. Heart Disease Discompensated Valve Disturbance. 3. Local Blood Vessel Diseases B. Stenosis of Upper Air Passages. Disturbance within Lung. Heart Diseases.- Cardiopathies- 1. Myocarditic diseases - Cyanosis. 2. Valvular Diseases Valvular Disease is not serious only when complicated by Disease of Myocardium. May have Endocarditis without it being associated with valve murmurs this always involves a portion of the Myocardium. In Stenosis & Insufficiency of Mitral valve only leads to symptom of Cyanosis. Respiratory. 1. Croupous Pneumonia. Emphysema. Examination of Left Ventricle. 1. Pulse. 2. Strong first muscle sound of Heart Right Ventricle. Listen to 2nd. Pul. Sound. 2. Phthisis. General & Localized Cyanosis. a. A nervous Disorder. Local Vasomotor Paralysis. B. Interference Enternal or internal occlusion of large veins. Thrombosis. Paleness: Lack of Proper amt. of Bld. (Oligaemia) a. Real Oligaemia B. Spasm of Arteries. 2. Deficiencies in Proper constituents. Hypohaemoglobinaemia 3. Disturbance of Nutrition Temporary Paleness. Permanent " . Local Paleness. General " . Causes for Tempory Paleness. I. a. Temporay Circulatory Disterbance. B. " Blood Supply Deficiency A. Due to Spasm fin Arteries due to a stimulation of Vaso Constrictor Nerves. Atonia Cordia (Paralysis of Heart) Fainting Spell by temporary relaxation Per Acute Anemia of Brain. of Muscle of Ht. wall Day & weeks after Hemorrhage. II. Permanent Paleness. Diminished Blood Supply. a. Continued Hemorrhage. Intestine Paracite botriocephalas latus sucks blood. Ankylostomiasis Ankylostomia Doudenale affect people in Mts. tunneldiggers. Trichocephalies Dispar. B. Primary Blood Disease. (Chlorosis, Leucaemia, Progressive Pernicious Anemia) C. Diseases associated with loss of tissue juice (Nephritis) D Disease interfering with nutrition Jan.23.'06. Diminution of Sec. work. 1. Terminology (Hypochylic) a. Reduction of Entire Secretion (Achylia) b. Inspection of Chest. 1. 2. 3. 4. Surface Shape Cir. Mov. Resp. Mov. a. Vessel - Veins. large veins. - locality of. Venous radicles (Intercostal Veins (azy. nemyazy)) ziz zag veins at lower thoracic aperture. [illustratio] seen before U. Rad. seen. between Pect. Maj. & Rectus Ab. Brownish yellowish spots scales Petzriasis versicolor. expressive of weak constitution. (Later stages T.B.) 2. Shape 4/5 of Ch. walls are abnormal (Worlles) [illustration] Phy. Heteromorphionis. 1. Nipple. 2. Sternum. (Angulus Ludovici). zyphoid protruding St. Fissum. " Perforatum. 3. Lateral parts 4. Spine Upper & Middle Dorsal Part | deviates to Right Side Absent in Left Handed ususally. Abnormal Conditions. 1. Spinal Column first. Kyphosis Curvatura Circularis. " Angularis. due to Spondylitis suppurativa. " " gradual atrophy. Old Age. Senile Kyphosis. Children up to 10 yrs & Men use Diaphragm Women Intercostal & Scaleni M. reason of Gallstone. (Eccle's Respiratory Exercises as help in Therapeutics). 1 to 4 Normally. Changes in sickness when correspondingly increase of Both trouble is outside of Ht. & Lung. Points for Breathing. 1. Normal Chest wall, 2. Muscle & Nerve. 3. free excess & Normal respiratory surface. 4. Normal Cond. of Blood Tachy pnoea. fast Spano " . slow Change of time Different Inspir or Expir. Dysponea: Difficult breathing. Volumen Auctum pulmonis. loss of power to contrast. Increase Costal Breathing. New Born type one side then the others. Cheyne stockes - Cerebral Disturbance or acute Neuremia or Alcoholisms. Litten's Phen. is visible Diaphragm Breathing Disease of Oral Cavity. Thrush. Oidium Albicans. White Patches in Mucous Membrane of Mouth. Tr. remove with Curet. Wash Boric Acid etc. Warm, liquid oily foods. milk. Mucous acts against Bact. in mouth. Keep mouth clean 5% Alcohol sol of Thymol. 10 drops in warm W. Tr. Krameria (Rattrony) for gums apply with cotton. Disease of Esophagus. Symptoms Dysphagia Pain. Haem. regurgatation. Hem. to Varicose veins. or Aneurism. Ulcer of Stomach. Dysphagia due to paralysis of muscles, constriction or new formation which may be outside or inside Extra are mediastinal tumor large Bronchial lymph glands. Aneurisms. Pericardial exudates Pain mostly in ulcers. Regurgatition of foods absence of HCl. excessive admixture of Saliva. Bad oder from [stomach] food in Esoph. Look for Paralysis of Vocal Cord as to condition of Rech. Cachexia associated with Malignant growth Inspect neck for Cancres. Diverticulum Cancer may be felt near Xyphoid use Bousha for exam. dont oil avoid introducing finger. Height of Thyroid is impediment & then ask patient to swallow in introducing have patient breathe deeply. Don't tell patient before hand. Phthisical Habitus. Tuberculosis. Phthisis. 100° tem & Under. is Tuberculosis. Higher Temp. is Phthisis. Phthisis Mesaraica Tabes. consumation of Parts of Cord. Phthisical Habitus { Acquired. {Congenital. 1878 Cohnheim transmission of Cheesy material. 1882. Koch. Germ discovery. Phthisical habitus. {Bronchiectasia - {Chronic Pneunonia - {siderosis -(iron). chalicosis (stone). {Pneumoconioses - foreign B inhaled {Tuberculosis. Consumption. Upper Thoracic Aperture. T.B. carried to glands of neck from mouth to upper portion of Lung. Narrowing of Steno Vert. Diameter. & sunken down above Clavicle & below Clavicle. Tgrooves. Shoulders fall forwards from emaciation of Trapegius. Wing shape scapulas Chest wall becomes long. large spaces atrophy of Intercostal. (Paralytic Thorax) Disease of Esophagus. Rupture, Disturbance of Vessels lymph & veins. Inflamatory Cond. Acute & Chronic infections: Parasites. Neoplasms, Cancer chief one. Large doses of Bismuth Subnitrate.         Dec.6.'05. Pancreas- Compound Tubular gland. zymogen granules Clear, Watery Secretion 1.00075 S.g. Alkaline Na Carbonate. 500 to 800 CC a day. Trypsinogen Enzymes Lipase - Steapsin Amylosin Renin (?) Lactase Pancreatic juice cannot dissolve Proteids when it first comes out. but in intestines by action of Enterokinase Trypsinogen is converted into Trypsin. Proteid. Proteoses. Peptone {Amino acids glycocol lensen {Tissue {Proteid. {Hexone bases. Lysin. Peptoid = Nucleus Peptone cannot be found in Blood. Erepsin in Intestine attacks peptone {two reasons why Proteids are not absorbed as peptones. Amylopsin act on starch & splits into Sugar. Lipase fat splitting enzyme is reversible. Pancreatic juice helps Emulsify fats: splits into glycerine & fatty acid. before absorption. Lactase splits Lactose not present unless there is [Lactase] milk diet. Secretory Nerves. Secretin subustance formed in Intestine which when comes to Pancreas causes Secretion. formed by action of acid. Movements of Alimentary Canal. Deglutition - Raise & push back tongue pushes food into Pharynx. Soft palate closes opeing of Nares, Pharynx raises Muscles of Pharynx contract & force food into Esophagus. Reflex peristalsis of Osophagus force food down. first part is [cross out] striated fibers. Liquid goes fast. Cardia Recepticle Pyloric Churn after food enters peristaltic waves regularly over Pyloric causes churning. 19-38-18-19-59-20 3 per Minute. Occasionly Pyloris opens Esophagus similar to Intestine Constriction behind & relaxation infront Bayliss & Starling Lau) Divide in 8 sec. this Winne Vorst constriction mixes & aid absorption. No Antiperistalsis this peristalsis is local reflexion. Such sound heard in same spot for 1 1/2 hrs. by Cannon. Antiperistalsis in Large Intestines & by these means Enemas pass back to smal Intestines but not foetal m. Liver {External Secretion - Bile {Internal " poured back in blood a. Sugar glycogen function. B. Urea. Bile 500 to 800 CC per day. Bilirubin { Derived from Haemoglobin from Biliverdin { Decomposed R. B. Corpuscles. Urobilin. excretory products. Bile acids found as Bils salts. glycocohlic Accid Derived from Proteids Truocholic " Dissolve fats & help absorb some. Stimulants for liver itself (Chologogue). Secretin Stimulates liver. Destinction of R.B.C. causes increase in Bile. Glycogen C6H10O5 comes from or is formed from Sugar in Portal Vein. glucose levulose Galactose may form glycogen. .1 to .2% Sugar in Blood. Liver is governor Urea chief product of n. excretion Spleen may be taken out not absolutely vital During digestion increase in size Has Rhythmical Contraction evry minute. Spleen{1. Make R.B.C- foetal life after Hemorrhage. {2. Destroy " {3. Production of Lymphocytes. {4. " " Arric Acid {5. " " activating substance for Trypsic [?] Kidney Oct.9.06. Skin disease. Duncan. Skin contains Muscular fibers. both kinds. Smooth Muscle of most import. Sebacious glands. Sweat gland. Sweat glands assist in maintaining body heat nails & hairs appendiges. Function: Protection of deeper structures maintains normal contour & outline of body. Location of sensation of Skin. in papillary layer some of them. To some extent a sense of respiration. Power of Absorption. Property of Regulation of Temperature. Secreting & excreting organ. General Syptomatology: Subjective & Objective (Lesion sign) Lesion {Primary {Secondary or consecutive. Lesion is the breaking out or eruption Primary lesion is one representing the first manifestation or appearance. Secondary are those which come afterward. (blat.) 8. Primary L. Macule. Wheel, Papul, Tubercle, tumor, Pleb. Pustule. Vesicle. 7. Secondary. Crust. fissure. excoriation. scar. scale. [fissure]. pigmentation Oct.16.'06. Subjective & Objective. Symptoms. Itching most common. Primary are lesions which characterize the original eruption. (Pri.) Macule & Wheel Tubercle. Papule. Tumor Vesicle Bleb. Pustule. (Sec.) Crusts, excoriations, fissures pigmentation scar scales ulcer General Diagnosis occupation time Expose Body microscope. Gen. Treatment: Oct.30.'06. Gutta Percha & flex. Collodion for fixed dressings. Caustics. Irritants. Arsenious Acid. Electricity faradism of little value. Electrolysis is of value in destruction of growths. XRay. Classification of Diseases: 1.. Hyperemias. 2.. Inflamations or Exudation. 3.. Hemorrhage. 4.. Hypertrophies. 5.. Atrophies. 6.. New growth. Neoplasms. 7.. Neuroses. 8.. Diseases of Appendgies. 9.. Parasitic. 1.. Hyperemia increased flow of blood to apart without Path. cond. Produces a redness called Erythema. Simple is Intertrego are char. of this form. Simple form is 1. idiopathic or 2. symptomatic in Cause. 1. Cause is External. 2. Cause usually internal. In either form pressure Causes them to disappear. Abandon cause for treatment. Intertrego occurs on opposed surfaces. Nov.13.06. 2. Inflamations or Exudation. Multiform Erythema. inflam disease of Skin characterized. by various lesions. Papular chief form eruption. Papules are large & irregular. look like wheal but don't come & go suddenly. Location is back of hand & forearm. Dull red. No subjective symptoms. occurs with Rheumatism. Erythema Nodosum. characterized. by tumor like elevations or nodes. Confined to chins mostly looks like bruise. somewhat painful. various colors, looks like pus in it but dont open pus is not present. Urtycaria Nettle Rash. Hives. Char. by Wheals. which come & go suddenly. burning. tingling. itching. any part of body. internal & local causes Inquire of eating. Pruigo. Nov.20.'06. Lechen Planus. inflam. condition. like moss in later stages. char. by papules. intense itching. very chronic. lasts a few weeks occurs usually but once. Forearms & sides of Chests most common beginning. seldom on face. probably neurotic. Papules differ from all others in that they have a flat top. slight glazed over the top later may have an umbilication in some they are dark red. They may become diffuse & form patches which are somewhat glazed. Dry disease. Base of papues is irregular most common in adult not in extreme common more in women 7 of 10 lasts from 1 to 3 or more months. seldom returns. old treatment was arsenic. Mercury internally as in syphalis. Probiodide of Mercury 1/6 gr. 3 times a day. Use antipuretics Bichloride. Menthol & in water. Itching is worse at night. Psoriasis inflam condition characterized by scaly papules. It is a chronic disease. Papules are scaly from beginning: loosely attached. removing clothes scales may fall to floor. itching is slight. Comes in spring & fall mostly. Is not parasitic. Dry disease. May be found in Rheumatics. Prognosis good under proper treatment. Internal & Externally Arsenic internally Alkaline treatment after. Very little red meat. Psoriasis never ulcerates. Cannot bathe too often. Baking Soda in bath. Habra's Green Soap. then some stimulating Nov.27.06 Ointment. [Cresorobine] Chrysorobine most effective local application. mix this with Cocoa butter. Crisorobine pigment not so effective. Causes Dermitis so put on at one part of the body at a time. Dont use in hair or around eyes. Exzema. 33 1/3 % are a form of Exzema. Tettu, Saltroom. is a cutaneous Catarrh. Moisture present. May be acute or chronic. Chronic where skin is thick Acute may break out on this. Not contageous. Not inherited as a rule. Multiform disease. Come at all everything. Exzema in patches are ill defined shades off etc. intensely itching disease Four Cardinal Symptoms of any Exzema are 1. Redness. 2.. Moisture or weaping. 3. Infiltration & thickening 4., Itching. Principal varieties are four. 1. Erythemetous. 2.. Papillary. 3.. Vesicular. 4.. Pustular. Dec.4.06. Squamous & Exz Rubeum are secondary. Etiology may be local or internal. May have some predisposition Png: a curable disease. Diagnosis: Psoriasis is scattered over body healthy skin between not on face always dry always scaly. Exzema in axilla etc. Seborrhea squma removed in rolls others are brittle. Spots are anaemic. Scabies. usually on hands etc. Impetigo Contagiosa: mostly in children on hands face pustules are flacid & flat. Dec.13.'06 Duncan. Erysapelas. local or general erythema. differenciation. Eryspelas is infectious, increase pulse. fever. heat over inflamed part. swollen, tense, shining etc. Pruretus no eruption whatever. Papillary Exzema & Lichen Planus. see character of papules. no return in L.P. Papules are flat top glazed, pitted. dry. Papillary. Pustular Exzema & Acne. Acne no itching mostly on face. young people. Comedones between. Continually chronic. Ring worms (Trico Phytoses) Spores under microsope Sycosis: non Parasitic Pustular Exzema. occurs about hairy parts. " of upper lip intervening skin is healthy, thro every pustule is a hair. is Perifoliculitis. Ertycoria: lesions are wheals, come & go suddenly. Dec.20.06. Local Exzema: Anus quite favorable also External genetalia of Male & female. Principal causes are fistulae. fissure. thread worms. ulcers. Hemor. Examine Vag. & Uterus. Leucorrhoea & Diabetes. Hands another favorable place. back & palm. poor soap. lots of water not dried. Infantile Exzema. Vesicular & Pustular break down form crusts. yellowish. brownish. weaking. itching. Treatment. No Positive Cure. Acutely Inflamatory requires mild application.- soothing- In thickening & infiltration- medicines should be more stimulating- Do not use water in Acutely imflamed condition. Later green soap- Habra's in Chronic cases. Dont leave soap on & dry immediatly & apply ointment. Make applications Continuously. Treatment of Exzema Rubrum. An leg of old people especially.- Examine carefully for Varicose Veins. Surgery or Rubber Bandage. Exzema does not ulcerate. Rubber stocking not so good. get Plain Rubber not Wet. For itching: Carbolic acid just to point of slight tingling sensations. Let Patient prepare it. Camphorated Chloral Ointment for localized Exzema. Gum Camphor. Hydrate of Chloral equal parts & rub down to semisolid. one dram of this to ounce of vehicle. Cold Cream or other Hot application may give temporary relief for a local application. Herpes Very common. (Herpi- to crawl.) Vesicular & nothing else. Herpes Simplex is an acute inflamatory disease of skin Char. by Vesicles. & these vesicles mostly clustered. They do not tend to rupture. No pronounced [tendency] Subjective symptoms. Favorite [conditions] location is on Lips & Prepuce or Vulva. History Previous attacks. Herpes of Penis should not be mistaken for either form of chancre. May have occured previously etc. pass away in a few days. May have begun in small Papules. Jan.10.'07. Vesicular acute no prounced subjective symptoms. Vesicles do not tend to break- are large as a rule. Causes: Often found under long foreskin. Cleanliness & Circumcision. Herpes zoster. Shingles or Zona. Char. by clustered Vesicles accompanied by pain in part. Along course of nerve. Intercostal. Sciatic & facial. Irritation of Post. Root gang. they become inflamed & nerve sheath becomes inflamed. It is a descending neuritis. Sudden change of Temperature usually unilateral. Dont break the vesicles Protect vesicles. Usually only one attack. Cheiropompholyx. Vescicular disease on Hands & feet. they are deep seated like scabes usually on sides of fingers. Outcome: entire outer skin exfoliated Itching buring. Pain. Tend to recur. Treatment: Sooth dont irritate. Immerse in hot water in aggregated cases. lexible Collodian in some cases. Pemphigus is acute or chronic char. by bleb. filled come out suddenly surrounding erythema. May prove fatal shortly. Impetigo inflam cond. char by flattened pustules. Rather superficially placed. Most common in childhood. about face. fingers. Not numerous lesions. Subj. Sym. not severe.. horrid looking sight. gets well of itself in a few wks. Keep clean. Seldom scars. Impetigo Contageosa. lesions are Vesico-Pustules. Cloudy milky contents. Jan.17.'07. Ecthyma. similar to above in old people is mildly. inflam. large pustules. superficially situated break down into scabs. lower extremities usually no subjective symptoms. Large Pustular Syphilide similate a hole under crust in Syphilis. Dermititis reneata. any artificial inflam. condition of skin. Poison Oak- ivy- (Toxicodendron) Summer or fall chiefly. lesions are vesicles bunches on swollen parts. foreskin oedematous Eyes swollen ears also. Prog. good. Predisposes. Treatment: Fl. Ex of [greendebra?] Robusta 2 dram to 4 ℥ each of lime water & water soak clothes & apply to parts. Dermitis Medicineata. Facticia - feigned - Jan.24.07. C. Haemorrhages: Diseases of Skin char. by Extrav. of Blood into Cutaneous skin. Pupura: an Extravasation of Bld. into skin. Not caused by Trauma. Must be a disease of Vessels themselves. Non Inflam: etc. Path. cond. walls of vessels. 3 forms; 1. Simple. 2. Rheumatica. 3. Haemorrhagica. Bright red spots becomes darker later. Pain in 2 & 3. No Subjective sysm. in symplex. 1. Most common is on extremities. Spots cannot be pressed out. Spots are Macules. Prog: is good. Purpura Haemorrhagica - Land Scurvy - Bad prognosis. Treatment: if in lower Extrem. Bandage the parts. Iron. Quinine. Salacy lates. Astringent n.q. 'D'. Diseases characterized by Hypertrophy. 1. Hyp. of Pigment freckles. Cause not known. Sunlight increases them. Dont treat them. 2. Chloasma - Liver spots- diffused Hypertrophy. Not due to Liver. May be associated with Uterine or ovarian trouble. Treatment: 16 gr. Corrosive Sub. to 4 oz each of alcohol & water. Gradually flakes off skin. Apply on Cloth till tingling sensation is felt apply during day [also asleep] dont let patient go to sleep. Shake it. This will relieve freckles temporarily. 3. Neves Pigmentosa. Mole. Circum Hyper. of Pig. also an Hypertrophy of skin tissue. May be hair on face from mole. favor Epithelioma. Destroy to get rid of. Electric Needle. Caustics. Knife. 4. Clavus - Corn.- Hypertrophy of Horny layer. Point presses on Nerve. Caused by pressure or friction. Remove pressure. Pare Corn. Use Corn plaster. Alcox. Brown flexibe plaster. Jan.31.07. Callosatas Hyper. Horny layer on hands & feet. may be extreme & extensive. Use [Liq.] Potash Caustic & mop it 25 to 50% Dil Acetic Acid to neutralize. then apply Salicylate or Sapo Viridis. Keratosis Pylaris. Hyper horny layer around a hair. itches & burns. shoulders & arm thighs in women mostly. Apply glycerine. Hypertrophy of Papilliary Varuga (Warb.) Electric needle. Caustic. Salicylic acid. Camabus dus. Sulph. of Mag. 3x a day. Hyper of upper skin is. Icthyosis like a fish skin not on parts exposed. scales like fish. more around joints. is Congenital & incurable frequent baths & greese body with oil will keep in good condition. 5. Atrophy: Abinism Vitiligo. atrophy of Pigment of skin. when congenital is albinism when acquired the Vitiligo. Leucoderma another name. most common in Brunettes. Nigers. when in spots make dark skin lighter. 6. New growth. Neoplasm. Keloid. means claw. con. tiss new growth appearing on scar. Do not remove it. returns more in tropics. XRay may cure it. No cure. Feb.5.'07. Molluskum Contageosum. pin head to plas. solid elevation. non inflam. a hole in center of wound. no subjective symptoms. Pinkish or color of skin. Opening is duct from Sebacious gland. Prog. good. Operate for treatment. resembles Mellium. Xanthoma: Benign. Con. tis. New growth of Skin with deposition or degeneration of fatty tissue in part fawn color. Usually on Eyelids. & face. may grow. Excise only when rapidly growing Xan. of Diabetes [?oseum?] Electric needle. Angioma: New growth of Bld. Vessels. Red color. Telangiectasis which comes on later. Vasc. Nevi. " " at birth. Incurable. small one may be removed slowly. Bld. Vis. in Mucous Memb may be involved. Can be deep. Semi Malignant: Tuberculosis. 1. T.B. Cutis 2. Scrofula Dum 3. Lupus Dulgaries. Feb.26.'07. Period of incubation important in differenciating Chancre. 1 wk to several days. Chancroid less time. 3 wks to 3 mo. Cutaneous manifestations occur. Cutaneous Manifestations lesions multiform rarely Vesicular in acquired. Vesicles & Blebs in babies. Early is more or less general configuration & color. Not inflamatory is infiltration Chemy like. tends to become cresentis. No Subjective Symptoms. Papilliary may itch. Course & duration: Early may get well. Concomitant Sym. Sore throat, mucous Patch. (Moist Papule). irritis at times. hair falls. generlly thins. headache. Ociput. rheumatism. anaemia. Nov.5.07. Tenia Vercicoli. from Macular Syphilide. Syphilis is in skin. T. Vercicola are on skin. Microscope [illustration] Tenea Vercicoli. may have had this for some time. comes only to colar line. Pieriasis Rosea Macule erptiondark color. ask about eruption or medicines taken. Exzema does not ulcerarate. Papilliary Syphilis from Keratites. Lichen Planus. flat top papules. Pustular S. Later end of first year. small may be early. Ecthyma similates large pustular syphilide. Ecthyma is a superficial inflamatory disease. S. is ulcerative destructive. Raise crust & in Ecthyma is just seton smooth skin. Ecthyma like Impetigo in young. Mar.12.'07. Some of scattered papules have ulcerated. Macular usually first then Papule. Pustular not early. Surface smooth under Impetigo. Boulous eruption rare in adult common in children. Late Syphilide not so contageous. Squamoas. Tubercular. & [gu????] Squamous Syphide. resembles Psoriasis both general. Psoriasis mot extensive on Extensors. rare on face- Syph at first pap. & become scaly. attacks Palms & soles- Infantile Syph. born healthy. few days like bad cold. hoarse. nose runs. loose apetite. looks old. Eruption of Buttox erythyma - Lwer color. Vesicles on palms etc. Prog: good. Treat: early Mercury - late. KI. Have teeth cleaned. Protorod. 1/6 gr. Mar.19.'07. KI. 5 grs. to begin. VII Neuroses: no eruption but functional derangement of nervous system. Pruritus: No lesions may be general or local. Himalis winter itching in fall. general & at night mostly. May have Senile form. Local form of anus & genitalia. Haemorrhoids. fistula thread worms. fissure ulcer. VIII Diseases of appendiges Hairs, nails, glands. Superfluous hairs: acne. allopecia, change in color & Prickly heat. Sweat too much too little. Sebaceous Inflam Mar.26.07 Soft downy hair cannot be removed. Destroy follicle of hair by electrolysis. bath parts in hot water & use cold Cr. use negative pole in hair. Platinum needle. Depilatory. XRay. Alopecia. baldness. Congenial. Senile. Premature. 52% of Premature are due to seborrhea of scalp. Tenia. Syphalis. fevers. Ring worms. April.2.'07. Tr. of Cong. unsatisfactorily. Dont have hair cut in women. Stimulating applications. Liquid best form. Resorcin. 2 drams to 4 ℥ each alc. & water. apply with sponge. turns gray hair yellow. every night for clear 3 wks. then once a wk. Allopecia Ariata in Areas bunches fall out Systemic & Parasitic form. Sycocis Vulgaris. inflam. around H folicle. Perifollicleitis. Nonparasitici. Pustule & Papule. upper lip mostly. Treatment: shave daily or not at all & make applications soothing Apr.9.'07. Barbars itch Lycosis parasitica freri falliculitis differs from sycosis vulgaris or nonparasitica. differentiated from exzema by area being all red in exzema. Prognosis good. Treatment is tedious shave every day or not at all. Diseases of the Sebaceous glands. Seborrhea is most common functional not an inflamatory. Seborrhea {sicca or dry, pitaris capitis {Oleosr or oily Oleara is probably only one existing at present is most common on head & breast. Milium an affect of sebaceous gld a sebaceous plug white or [papules] these never had a peripheral opening. Very common around eyes & face. Comedones or black heads Acne is [t] most frequent disease of the skin Acne is a simple inflamation of the sebaceous glds. caused by Bacillus Acne. Treatment both local & general Locally use germiciticides. General according to existing condition. Must treat from 6 mo to 1 yr.   Medicine - Prof Crandall. - Maleria Fever. Maleria Fever - Ague - Chills. An infectious disease due to Plasmodism Malerium carried by the Mosquito (Anopheles) being the only known means of transmission Charistics are attacks of fever & pain fever may be remittant or intermittant Maleria is found in all Tropical. semitropical & Temperate regions. Southern Europe, India, S. Africa. Northern S.A, Cent. A., S. U.S., most of Sea Islands. Prevails all year in Tropical countries is abundant in never bottoms. Most abundant in Summer & Fall. Sept. Oct. Nov. Mosquito is more abundant in fall a single female in 4 generations increases to 200,000,000. The intermidiate cycle of the organism takes place in the [mosquito] Man. Three Types of Maleria. Tertian, Quartan Aestivo Autumnal. 1 2 3 4 5 6 + - + - + - Tertiann + - + - + - } - + - + - + } Double Tertian. + - - + - - Quartan. + - - + - - } - + - - + - } - - + - - + } Triple Quartan. Pathology of Maleria. Organism develop in the Blood R.B.C. which when invaded are destroyed & produce a proportionate anemia. In sporulating & Maturing of organism takes place Paroxism occurs. Maturing of group in man occurs in a few hours. On severe cases the organisms invade the tissue cells mainly the Endothelial cells of the capillaries. Deposit of Pigment in the Liver & Spleen The Destruction of cells may be great producing rapid anemia depending on the number of organisms invading & the susceptability of the individual. Spleen & Liver become enlarged. Complications are: Hepatitis, Spleenitis Pneumonia, Nephritis, Haemoglobin-urea Nervous or Gastro intestinal Disease. Oct.18. Clinical forms of Malaria. Common, Intermittant {Tertian (common) {Quartian (rare) Incubation period is from 36 hrs to 2 weeks. Experimentally. In the individual it depends on on the intensity of inoculation & susceptibility of Patient. A Patient may become immune. Period of quartan is greater then Tertian. Prodroma symptoms + or - & not of much consequence as a rule. When Prodroma occur, headache, tired feeling, some Disturbance of appetite & constipation are common symptoms. Paroxysmal Disease Description of Cold, hot & sweating stage. Temperature begins to rise before chill chill develops varying from chily sensations to Destinct. Skin is Blue, Nauseau & Vomiting, headache pulse small, increase often urine increased. Chill lasts from 10 min to an hour & as chill subsides we have we have flushes of heat till hot stage appears & temp is from 103 to 106 a full bounding pulse. throbing headache frequently Delirium, some Vomiting occasionly Convulsions especially in Children Hot Stage lasts from 1/2 to 3 hrs. As this subsides the Patient Perspires freely. As Temp Declines other symptoms disappear & Patient goes to sleep, & afterward feel relieved but weakened. (Aching of Bones is a common Symptom) Patients feel comfortable between Paroxysms apetite is fair After few paroxysms Cachexia or a haemotogenous Jaundice may occur. Purpes develop on lips & sometimes we have a little Bronchitis. There is frequently an anticipation or retardation of the Paroxysm coming earlier or later on [same] due day If anticipated Malaria is becoming more internal, retarded less intense. Many patients recover spontaneously & majority would if not treated Some run a chronic course & these patients develop Malaria Cachexia. Tertian or Quartan may show double infection & we may have two chills in one day Irregular Type of Malaria Aestivo Autumnnal may be a distinct type or malignant type of tertian 1 2 3 4 5 [illustration] Presence of Cresents in this form in the blood is Characteristic, & Paroxysms are not so Noticable Patient looks sicker & of a more Cachectic appearance & resemble a Typhoid. condition & half are called Typhoid & treated so. This form does not respond so readily to treatment. Pernicious Malaria usually a form of Aestivo Auntumnal & is a severe type In susceptible persons this may develop in a short time & we have Congestive Chills of which no more than two is endured. Comotose forms affect the Brain & Meninges & here capillaries are extensively invaded by organisms. Character: high Temp. Delirium Coma. Algid Type. Temp. is low & may be subnormal, feeble pulse, vomiting & Diarrhea Organisms invade capillaries of gastro- intestinal tract. Severe pain in Stomach etc. Haemorrhagic Form (Black Fever). Haemoglobin passes thro' Kidneys & off thro' the Urine. Paroxysms may be moderate or severe. It occurs most frequently in the Tropics also in Temperate. Constipation, Kidneys not active high colored urine frequently some Stomach & Intestinal Disturbance latter not distressive. Neuralgic Pains may exist between attacks. Mental symptoms may develop & sometime symptoms of Paresis Pneumonia complicates & Nephritis quite common. Herpes. Duration: May terminate without treatment or may persist indefinitely a fact of persistence is repeated attacks of inoculation. Some have little power to expel. Children are more susceptible having only inherated immunity while adults have also the acquired. Prognosis very favorable if treated early Chronic not so favorable because of secondary symptoms; severe symptoms Anemia, Enlarged Liver, Spleen etc. More fatal in Children tho they respond more readily to treatment. Races alike are equal. Long residence in Malaria Country establishes immunity. Treatment: Calomel in small doses in Beginning total 1 to 2 grs. Quinine Muriate 4-5 grs every 3 hrs until severe cinchronism develop. then less frequently. Give total of 40 to 50 grs in 24 hrs or 50 to 60 of the Sulphate. This for 2 or 3 days has desired result. This acts best on organisms when they are free in the Blood. Some recomend a dose 10 to 15 grs just before Paroxysm. To relieve Cinhronism:- Bromide of Potash as much as of quinine 3 times a day Hydro Bromate of Quinine is recomended. If stomach wont retain give Hyperdermatically as quinine & urea Muriate or Quinine Bisulphate 15 grs Hypodermie 2 x day Inject well under skin to prevent a bad sore. If quinine cannot be taken at all on account of Nervousness give. Methyline Blue gr. 3 Mecks (Med. Pure) Pulv. Nutmeg gr. 2 give every 3 or 4 hrs. Acts not so rapid or accurate. & large doses produce toxic symptoms. For Chronic Malaria give Arsenic. & is good in Severe Secondary Anemics. ꝶ to be given after Malaria is getting Better Tr. Nux Vomica ʒ iii Essentia De Calisaya q.s. ℥ viii Tablespoonful every 3 or 4 times a day. This does not cinchronize & in time will check without quinine. To Prevent return while Individual is exposed give about 15 grs. 2 days of a week in 3 doses. Watch Bowels alway thro'. Diet: Anything. Treatment of Comotose Variety where patient is Dilerious & Unconsious Use Quinine Hypodermatically from 15 to 30 grs. every 2 or 3 hrs giving a daily quanity of 60 to 100 grs. till relief Coma disappears in about 24 hrs. & then use quinine by mouth. Aglid form - subnormal temperature. Quinine full doses Hypo. or mouth. use Stimulants Brandy or Strychnia & hot applications. Protection against Malaria - Little done here. 1. To Prevent Malaria Protect inhabitants against Mosquitos. 2. Use means to Destroy Mosquitos. 3. Use quinine when exposed. 1. Screening houses & various applications to keep mosquitos from biting. ꝶ Ol. Citronelle Wood Alcohol aa = parts. Apply to exposed surface as necessary. Smoking apartments before returning. 2. Preventing development as oil on water keeps them from Breathing. [illustration] anopheles Draining Country; avoid standing water. Typhoid Fever. An infectious disease caused by Typhoid Bacillus characterized by ulcerations & inflamation of Intestinal lymphatics. Changes in Parenchymotous organs. Typhoid B. related to Colon B. History first reported in 1829 Lewis - Paris. Etiology found in all Temperate Climates & warmer Climates. Presence of disease in a community is an index to sanitary proceedings. London freest from Typh. It is dependent on Carlessness of Sewage " in [H?] & Caring for same likewise green Veg. Overcrowding reduces Vitality Presence of flies 80% of continued fevers are Typhoid in Country as much as City. Spanish area 1/5 had Typhoid 1580 of 25,000 died Jap. Rus. few died English in Boer War lost over 8,000 Typhoid Bacillus. fulfills Koch's Laws. Variable in appearance Cultures are killed in 10 min when raised to 60°C. may live for 18 wks. at 5° below 0°. Killed in few hours by Sun's rays & are found in all secretions of infected patient. Have been found in milk, Butter & in soil, many infections take place after a rain following a long dry spell. as drainage is apt to take place toward wells. A contaminated well is never safe. Types of Typhoid fever. 1. Ordinary form usual intestional symptoms well marked. 2. Ordinary forms with slight intestional Symptoms. 3.. Infection without Intest. lesion. 4.. A mixed infection. 5. Para typhoid. Pathology of Typhoid. Catarrhal Condition of Small & large intestines. Involvment of Lymphoid structure. Hyperplasia of Lymph. tissue of Pyer's Patches. mesenteric glands which may result in resolution or Necrosis. If Necrosis is followed by ulceration & healing. 1/3 of Deaths are from perforation 1/20 from Hemorrhage. Mesenteric gland inflamed but resolution occurs more often than ulceration. Occasionly these break down & form local abcesses Bone Marrow may become Hyperaenemic & may result in necrosis & break out on surface as a sore Spleen is enlarged & sometimes infarcts occur & leave scar. Liver & Kidney undergo certain amount of granular degeneration & liver may be fatty. Resolution usually results. Respiratory some congestion & result in Bronchitis or Pneumonia ulceration of larynx & Pharynx In Protracted Patients if kept in one position is a tendency to hypostatic condition. Cir. System: All structures of the heart may be involved in granular Degeneration & muscular structure especially may have Myo. Endo & Pericarditis. Acute Inflamation not common. Inflamation of Arteries & Veins Plebitis [Complic?] Nervous System: some Hyperenemia of Meninges Meningitis rare Peripheral nerves may be involved. Granular degeneration of Skeletal muscles. Gall Bladder may be seat of inflamation. & may give symptoms years later. Sometimes have local infections & result in Abcess of muscles. Systitis rare. Nov.6.'05. First week Kerserling Sol.: to preserve tissue. Symptomatology & Typhoid. Prodromal sympt lasting 8 to 14 days. Headache, Backache, Malaise, Arexia, Epistaxis, Chilly sensations - on chills - with some afternoon temperature, Diarrhea or constipation, Tenderness & girgling in R. Iliac region. Headache & Paroxysmal coming in latte part of day - Backache same extend up to Neck, Malaise is Universal. Anorexia is the rule. Epistaxia common may at times occur throughout course of disease sometimes troublesome requiring tamponing of nose. Tendency to chill in all cases. Onset with Distinct chill is more severe. Temperature begins to rise at Prodroma period & at end may reach 102 03 Disturbance of Bowels always exist & [when] associated in R Iiliac Region Prodroma periods ends when patient takes to Bed is arbitrary. Prodroma symptoms continue except Epistaxis & Headaching. Temperature continues & rise during first week. Pulse 80-5 for first week. Tongue coated in center margins may be fairly clear. Malaria coated all over. Complection becomes sallow & tawny. nervous symptoms Develop. Delirious at night. Toward end of first wk spleen is enlarged. Rose spot appear on upper abdomen & lower Chest. Occasionly appear on trunk & Extremities usualy only a few 3 or 4 may be numerous. Disappear on pressure not elevated. Continue to reappear for about 10 days, at time of Rose spots we obtain Widal reaction, may be early & more constant. These occur less frequently in Children than Adults. No. of Rose spots indicative of lesions in Bowel? Bronchitis more or less at end of first week. Nov.8.'05. Second wk Second week same symptoms as first week Temperature some higher, nervous symptoms Delirium more tendency to Bronchitis. patient becoming more exhausted, tongue dry. During this week we may have any complication Third Week Roseola Disappears About same as second week patient becoming more exhausted. Toward end temperature inclines lower & [same] greater tendency to complications, Pulse my reach 100-110. During forth should begin Convalesing temp gradual return tongue clearing, return appetite Nervous sympt. disappear & steady improvement condition & Bowels return & normal with tendency to constipation. Convelense may begin in a few days or may be delayed for weeks. Complication: 1. Heart. marked cardiac weakness dependent on average height of temperature in gr. measure often have Diacrotec Pulse. A pulse above 110 should be watched carefully. Organ Ht trouble of Mitral Valve well compensated stand Typhoid very well Hemorrhage may arise during 2 week to end. most common in 3 & 4 wk. large percent show streaks in stools. More or less free Hemorrhage occurs in quite a percentage & a Degree of Tympanitis causes Hemorrhage Symptoms of Haem. Sudden fall in Temp. & rise in pulse rate. Severe Haem pulse 120 30 temp. below normal. Patient becomes pale & sense of of an hunger soon after pass a bloody stool. Haemorrhage occurs usually singly & may be succession of Haem. may occur every day or so. are rarely fatal. Perforation more common in severe cases Tympanitis Complain of sharp pain in R. Iliac Reg. Temp. falls pulse increases is not followed by haemorrhage from bowels is followed by symptoms of general Peritonitis Post Typhoid Complication: Nervous symptoms is Typhoid Spine is irritable condition of spinal partial Paralysis. Post Typhoid, Insanity Phlebitis of lower extremities - rarely fatal. make protracted convalesence. Inflamatory trouble of gall Bladder resulting in adhesion & bands which may obstruct flow of Bile. Nephritis not serious. most patients develop albuminuria, lasting till end of convalesence & good recovery. Essential fever. Idiopathic fever - Do not know cause - Nov.15.'05 Treatment of Typhoid When suspected put to Bed - absolute rest. insist on using bed pan - in difficulty give Cathartic. give plenty of water to drink & see that they take it 2 qts 24 hrs. not ice cold. Laxative Cathartic: Calomel triturates in large doses total of 2 or 3 grs. all at once or small doses at intervals. Oil may be used or salines but not effervesicent. During course of disease Cascara tablet in evening & sometimes oil or Calomel. An entima is good to move bowels give evening. Except in Hemorrhage. 12 or 14 no Catheter. soft. Rubber. Diet. Absolutely no solid food. or that which can become solid in Bowel.- no milk consequently objection to milk.- have to take good quanities. Casein forms hard curds irritating to Bowel when digestion is low. Broth & white of Egg have broth cool not to coagulate egg. Raw egg digests in 1:30 cooked twice as long. Strain broth after adding egg. Broth may be seasoned - salt & pepper. egg Egg water - white of egg in water strained- add a little orange juice. Every two to 3 hrs. when awake give diet. Total quanity 3 to 4 oz. at a time or cup full of Broth. Diet of Convalesence: when Temp has become normal for 2 or 3 days begin giving thoroughly Boiled rice in Broth.- continue Egg etc. After a week normal use peptonized milk or equal parts milk & water & soups. Soft Poached egg, toast etc. Chew Broiled Meat. Abundant water throughout favors elimination of toxins thro Bowels, kidneys & skin Black coffee or clear tea in Morning. guard against overeating. Nov.21.'05. Medicinal Treament Almost impossible to give medicine to reach Bowel & produce effects. Internal antisepsis not very satisfactory Best affect of Medicine on Bowel act thro their absorption thro circulation Salol some form of Salicylic Acid. Carbolic Acid & Camphor combined. Salicylate of Soda 10 gr. every 2 or 3 hrs. Salol 5 grs. every 3 hrs. Salol treatment may give Carbolic A. Poison effects on Kidd indicated by smoky Urine. Salicylate may be given for long time in full doses with a little Depressant affect on Circulation. If noticable decrease dose. Irritating effect on Stomach is due to 1. acid of Stomach spliling up & liberate Salicylic acid This may be overcome by giving with it an Alkali: Bicarbonate of Soda, Seltzer water & abundant water 1/2 glass each dose. Syrup of Chocolate to disguise taste. Plenty of water lessens liability of irritating Effect on kidney by keeping kidneys flush. ꝶ Sod. Bicarb. ʒ i Sod. Salicyl ʒ ii - (Merks Med. Pure) (Natural) mf. in powder. 12 Sig. 1 every 3 hrs. Dont stop Salicylate for Albumin in Urine It may not materially shorten Disease but it runs a milder course. Temperature To reduce temperature Cold water - Cold sponge baths - not tub baths - Start with cool & add till Ice Cold. Sponge Spine Especially. will reduce temperature from 1 to 3° in half hour as a rule. Wrap ice in towel & rub [towel]. Spine Use when dever is 103°, it also stimulates Do not reduce temperature below 100°. May continue to drop after Bath. & produce Collapse. Rectal temperature 1° higher. Nov.22.'05 Cold Pack in connection with Bath. Cover Cold sheet with flanel Blanket. Change sheet every 5 or 10 min. till Tem. reduced Fanning after putting on sheet. Injection enemas of cold water. 2 or 3 qts. Phenacitine least depressing given with Caffein may be used in early part of Disease first week. ꝶ 10 gr. Phenacitine & 3 gr. Caffein Cit. 1/2 to 1 powder every 3 hrs while temp is 103. give with Salicylate. Application of quaycol 10 drops painted. over abdomen use cautiously cover with Oiled silk. Application of cold to head. when Delirious. Alcohol sponge is good. Keep Mouth clean & clean teeth 2 or 3 times a day Gargle of Chlorate of Potash. Glycerine & Carbolic Dilute used in Clammy M. Sedatives indicative especially at Night. Trional & Bromide & Chloral ꝶ Trional gr. xv One at Bedtime. ꝶ Pot. Bromidi gr XX either is good Chloral Hydrate gr. X at Bedtime Don't wake patient except when stimulant is required Stimulants Whisky or Brandy smal quan in Beginning [gram] dram every 1 or 3 hrs to start. & increase Aeromatic Amonia is good 1/2 teaspoonful in wineglass of water is quick stimulant. Strychnia for Heart stimulant 1/40 gr. every 6 hrs to begin & increase no necessary till they take every 2 or 3 hrs. By mouth or Hyperdermatically. weak Heart in latter stage Digatalis may be used. Fat free Dig. has less action on Stomach Digitaloin PD.Co Hypodermically Digitaline varies Extreme Cases use Normal Saline Solution 0.9% Hyperdermatically using from 3 to 500 C.C. 2 daily Bed Sores Keep parts rubbed well with Alcohol & Alum W. Change position lessens posibility of Hypostatic Congestion of Lung. Retention Urine Save Water use soft Catheter can be told by percussion. Diurectic is good Potas. Citrate 10 to 15 gr. Spts. Nitrosi Duls. 30 drps If tongue is coated Dilute Muriatic Acid given 3 or 4 times a day 15 drops well diluted. Don't give with Salicylate Powder. Complication Pneumonia treated as Pneumonia alone. Hemorrhage keep quiet stop all food by mouth may use a little Morphine 1/6 or 1/8 Hyper-- If Profuce use Saline Hyper 500 to 1000 C.C. raise foot of Bed. use additional Stryclinia Put ice bag or Alc. Pack over R. Iliac Region Dont give food till 24 hrs but increase Brandy or Wh. Don't use enemeas good laxative Castor Oil Perforation give Opiate at once. Place patient on R. Side continuously all Secure surgical assistance give noting by mouth Use stim Hyper. fair result from Operation Ehlichs Diago A. Solutions required are [Sulphatrafis?] 10 grm. HCl 50 C.C. water upto 1000 (Permanent). B. 1/2 % Na Nitrite in Dist. water. Typhus Fever Jail or Ship fever, spotted fever an acute infection Disease Char by high temp Maculated eruption & Nervous symptoms Aetology specific Virus not known. crowding of people in unwholesome Surrounding is cause. A rare disease in this country & not common gen 1893 few cases in N Y & 1901 in last in Baltimore Very Contagious Disease when Numerous cases. Described as a plague in past few centuries. Isolated cases not so contageous. Nurses are attacked. Pathology Changes incident to High temperature Namely Parenchynateon Degeneration & Muscular tissue Symptoms Incubation 12 days Invasion by chills usually distinct Rigor Rapid rising temperature soon reaches 104-6 & continue day & night. Typhoid Expression. Some Bronchitis: disturbance of Stomach Delirium Eruption appears in 3 to 5 days. Chest & Shoulders usually Constipation. Prostration Extreme Rapid Pulse. Disease lasts from 1 to 3 wks. Kidneys show Albumin urea occasionlly Hemorrhagic type. Treatment Purely symptomatic. Essentially same as Typhoid fever. Prognosis Varies may be high as 25% or low as 5% 1. Part of B. Solution diluted to 50 with A. of this mixture equal parts of Urine in T.T. allow 1 CC Amonia run dow side of tube. ring when + is Bright red & shake foam is Bright Pink. & whole solution is red. Positive in over 80% get in first week. (Miliary T.B. gives same Reaction & Pneu. in Resolution stage. Relapsing fever A fever intermittent in character caused by Spirillum of Obermen temperature for 6 day then 6 days intermission. Mode of infection not known, Mosq or Bed Bug Life History of Org. is unknown. Incubation is 5 to 7 days, onset like Malaria. Pain & Aching of Limbs, sometimes sweats follow remissions Organism during height of Paroxysm & may be abundant. Enlarged Spleen more or less anarexia Constipation some delirium at height of fever May be several periods of fevers intermission 3 or More Tendency to loose virulence. Treatment No Specific. Quinine has no effect. Treatment resembling Typhoid, Sponging, light Diet during fever. Prevails throughout Tropics & Southern States. Prognosis Rarely fatal. Dendue Disease of Tropical & Sub trop Climate characterized by Paroxy of fever pains of joints & muscles & a polymorphous eruption. resembles exanthema very contageous virus unknown. Prevails thru trop of world common in Southern States last Epidemic 1897 30,000 cases in 2 months in Galveston Symptoms Incubation 3 to 5 days no Prodroma symptoms onset sudden, headache, chills, aching in joints more severe than any other diseases temperature rises to 105 to 7 Usual symptoms of an acute fever Some joints may become red & swollen as in Rheumatic fever. Hemorrhage from Mucous Membrane in severe case after 3 or 4 days of fever there is usually a remission or intermission patient feels sore & stif for day or two followed by 2 paroxysm of fever resembling first after which pat. convalesces & patient is sore & stif for week or so. Eruption may occur at any time during disease & is not uniform in Character may last for some weeks. Differential. Acute Rheu, Yellow fever, & Malaria. frequently called Rheumatism at beginning Treatment. No Specific. Quinine & Salicylate of Soda use of cold sponging for temperature Rarely fatal. Cerebro Spinal Fever. Causedes an infection caused by organism Diplococcus intracellulaus Meningitides found in leucocytes & pus cells probably same disease as found in cattle. Infects Cerebro Spinal Meninges probably thro' the nose. Corisa & Catarrah frequently precede disease. uaually only 1 or 2 cases occur in a family Occurs in epidemics with tendency to sporatic cases developing afterward, probably moderately infectious. Occurs in country & city more in Winter & Spring Most frequently in Young Children. 77 cases 60 under 2 yrs of age. 1000 deaths in N.Y. last year, more dreaded than any disease. Young Soldiers in Camp have suffered. single attack does not afford imunity. Pathology. A Meningitis invading Basilar Meninges. & Dorso & Lumbar Spine. a fibrins Pleuruo Exudate. Cranial nerves 2, 5, 7, 8 are involved Symptoms. Onset sudden. Chill Headache becomes persistent usually moderate fever may be high. great Depression & Somnelence pulse feeble & slow for febrile condition low as 50, 6, or 70 Very early Rash appears about Shoulders [tel?el] Eruption in first day or two. as for this reason been calld spotted fever. May be delirium or profound stupor tremor of Muscles with tonic or Clonic spasms may exist. Kernig sign consists of inability to keep knees legs straight with flexion of thighs [illustration] th. knee Babanski Sign tickling foot there is tendency to extension instead of flexion also a tendency to spread of toes. Whenever Babanski Sign is present something organic wrong of Brain usually Paralysis of Ocular Muscles appear Sensitiveness along spine with more or less hyperaesthesia. Herpes about Mouth common as in Pneumonia. Hyperleucocytosis 25 to 50,000 Constipation is Rule & some retraction of abdomen Vomiting common. Urine may contain Albumin sometimes Blood & occasionly Sugar. Irritation of floor of 4 ventricle produces Glycosuria. Death occurs in 3 to 5 days cases may show remission in symptoms & may become chronic. Complications Pleursy Pneumonia Peratiditis After results. Persistent headache or recurring Hydrocephalus a large % show paralysis of some Cranial nerves Blind Deaf or both. Prognosis as to recover death ratio is 25 to 75% & large % that recover show paralysis of some cranial nerves. Ear complications: Inflamatory condition of Labrynth Klebs says mucous lining was detached in vestibule & semicircular Canals. Liquid Diet Treatment Isolation of Patient, quiet, laxatives & Diuretics to assist in elimination. Spinal ice bag & ice cap. Stimulants. Sedative Bromide & Chloral. or separate. Severe Headache: opiate (Bromide & Chloral Per Rectum) Salicylate of Soda full doses. Lumbar Puncture introduce needle in Spinal Canal & withdraw fluid. on line or leve of Crests. 2 1/2 cm. Child 4 to 6 in adult. Platinum needle. Valuable as means of Diag. Pus cells contain Diplococcus 1/2 to 1 oz at a time. (Bromide relieve vomiting) Antiseptic fluids have been introduced Erysipalis Acute contageous infectious disease of the Skin caused by some variety of Streptococci Pyogenese. May gain entrance thro' abrasion & in some cases starts without apparant " especially about face. Nose most frequent site. frequent in Spring & Fall. Chronic Alcoholism Bright Disease & Debility from any cause are predisposing factors. Puerperal & Unhealed Naval in infants are favorable conditions. Should not attend confinement with Erysipalis. Pathology Simple inflamation rarely septic may have a Peri or Endocarditis. Incubation from 3 to 7 days. invasion distinct Rigor rapid rise of Temp. & a Typhoid state develops disturbance of St. & Bowels Sore spot itching, Burning, shining, swollen appears usually about face. skin thickened distinct line of Demarcation. feels like ridge gradually progresses, original site cleaning up in 2 or 3 days as Disease is progressing to other areas. Plebs may form containing serous or semipurulent fluid whole face may be involved in 2 or 3 days. may extend to neck scalp & any part of the Body occasionly Mucous Membrane May last for several days 5 to 10 days during most of this time Temp is 103-5 with little Remission. May have Delirium some prostration. if scalp is invaded extensively may have a Meningitis complicating. Pneumonia & Cardiac infection are Complications. tendency to migration of inflamation in Migrating cases original site may be healed while other is continuing. one attack does not protect Indiv but rather Predisposed Dec.16 Isolate. Tr. Clids of Iron full doses & quinine 1/2 teaspoonful 3 or 4 hrs well diluted 5 grs quin. Mur. " with above. Icthol painted on or Ic. Collodion. Injection of anti septics along margin 2% Carbolic Acid a little ahead of Disease. Cold Cloths local application. Cold relieves congestion & second inhibit growth of Mus Org. If abcesses form should be opened as elsewhere. Old or feeble stimulants are indicated. Prognosis favorable few fatalities. Treat Complications. Iodine blisters. Septiciemea Pyenemia Infection a morbid process induced by invasion & growth in body of Path. organism Local - a boil. general - anthrax Intoxication a morbid condition caused by absorption of toxins in large part derived from Path Organisms. {lecomains {Ptomains toxin. Septic Intox is sometimes cald Saperemia Agents of Infection are living organisms. toxin. those " Intox are Chemical. Types of Infection. 1. Local with production & absorption into the system of toxins Dip. Titanus. 2. Septicemia general invasion of Bld & tissue by organisms of suppration without metabolic free of suppration. first type may change to second as gonerrhea. Erysaphilas Symptoms: Chills, fever, & sweats, irregular in intervals & intensity. Pulse small & rapid gastro intestinal Disturbane. Tongue Charist Coated in center & red at margins - not Diffuse - Mental Hepitude resembles Typhoid. Delirium may be present more Char. of Staphlococcus Infection. Strep Infec. may show clear Mentality to end. Gen sep usually follows an acute infection or some acute or chronic disease may not always be able to locate point of entrance of organisms. 3. Septo - Pyemia - form of gen. Infection where who have Local Metastalic abcesses due to septic massess Emboli Dec.18.'05 External wounds of skin & subcutaneous may have secondary foci in the bones or in the lungs. Suppuration along Intestine tract may give secondary involvement of Liver. Endoo Inflamatory affections of Heart may result from infections of any part of the body. Infection about face, nose, ears may result in secondary infections of the Meninges. Treatment of general infection Eliminative By Bowels & Kidneys. Supportive treatment by easily digestive diet & stimulant if necessary Medicines: Salol, Salacylic Acid Comp. Merck new prep. griserin has general antiseptic property thro Cir. 5 grs. 4 hrs acts as laxative use frequent Infection: Salicylates 10 grs. every 2 hrs well diluted Rheumatism Acute Local application, moist pack, cold pack. at first Stropto. Antitoxin not accomplished much. but does not harm. Rheumatic fever: an infectious fever but not contageous. Etiology. Organism unknown believed to be cause. Predisposing or an associated condition Tonsilitis. Exposure is a cause, cold & wet. occurs in early adult life chiefly. One attack does not prevent subsequent attacks. Path. Hyperemia & swelling of synovial. membranes liq, tendons, & Sheaths. rarely resulting in suppuration. In this condition there is excess of fibre in Blood & leucocytosi of Modera to degree 10 to 12,000. Symptoms. Onset sudden. Pain in on joints occurs during night, slight fever Malaria, Temp 102 to 4, rapid pulse 100. Tongue coated, Perspiration (acid sweats). Joints painful, red, & swollen. smaller joints most involved. occasionly larger joints any or all joints. Urine - acid, High spef.g. High color urates increased, Chlorates diminished. Albumin present in small amounts. Tendency of Disease to migrate few joints in beginning course irregular from few days to several weeks give indefinite prog. as to duration. Prognosis. good. few die from Rheu. itself but complications less than Typoid 2 or 3% Dec.20.'05. Complications: most important. inflamatory conditions of Heart form & in mild or severe cases. evidence: by distress in region of Heart modifications of the sounds. possible disturbance of Rhythm & murmurs. Keep quiet for Heart trouble. Pneumonia & Pleursy. Hyperpyrexia rare. Skin eruption a form of Ertekaria, occasionly spots of Subcutaneous hemorrhage appearance of Bruised spots. Treatment Put to bed in flannel blankets. Diet. milk. gruels & plenty of water. Lemonade for acids. some Broths or Soups Fix joints to prevent irritation. Local application: Methyl Salicylate Lead Opium wash. use more opium than in official. Keep all joints wrapped. Internally. Salicylate Preparations full doses. Aspirin, Salicin or Salts. Oil of Wintergreen. Potassium Bicarbonate 1/2 dram every 3 hrs till Urine is thoroughly alkaline. K. Acetate for Kidneys. Add salts to diet. later K.I. moderate doses. for Hyperpyrexia use Cold. Keep patient quiet. Seldom have more than one attack. [Yellow Fever] Gonerrhal Rhem. Etiology. gonorrheal infection which becomes constitutional by absorption of Virus may occur at any time during attack. Eary symptoms are Rheumatic pains in Knees or Ankles, Elbow, or Wrist. Initial symptoms not so severe. temp 100-1. Joints swollen & red & gonococci have been found in the serous fluid about joint. Continue to be about. tho' may become severe. Quite a marked enemia. same true in Rheumatic fever loss in weight, disturbed apetite Constipation. Prognosis: good as regards recovery Doubtful as regards immediate recovery. May last for weeks & months. Protracted disease. Suppuration of joints very rare. Angiolosis partial or complete is quite common Treatment Systemic absorption from local infection reduce the Local infection, Medicines have very little affect as used before. Salicylate of Quinine. Some form of Mercury small doses. Iode Hydragerate of Potast pill. K I. 5gr. " 1/8 gr. Regulate Bowels & an Iron tonic works well throughout I.q.s. for pain: PhenoBromate 10 gr or Phenacitine 10 gr. with 3 grs. Caffein Citrate. Use little Morphin. In severe cases joint may have to be open. Subsequent stiffness of joint. Anesthetize & break up adhesion done 2 or 3 times will releave. wait till all acute Inflamation has disappeared. Do as well at home as at Springs, give plenty of Water. Heart trouble rare. Local applications same as in Acute. Yellow Fever Tropical & Subtropical manifested by febrile cond. jaundice & Toxemias. Jan.3.'06 Etiology. Sp. Org unknown. Means of Comunication known. Mosquito. (Stigomya Faciata). As Evidence of Mosq. Trans. non immune indiv. have slept, lived with & cared for yellow fever cases & no instance where Mosq. has been Eliminated has he acquired the disease. Clothing has been worn of sick patients. Experiments were on soldiers. In contrast with this it is easy to moculate by allowing Stigomya to Bite Patient after 10 or 11 days to bite Healthy individual. Mosquito cause was demostrated by Dr. Finley of Cerbo 25 yrs ago - 1881 - Recognizing Mos. as means of Com. for three yrs after clearing Cuba & Improving Sanitary condition there was no Fever except those coming from other ports. & Cuba had not been free for 100 yrs or more. Pathology: Degeneration of Parenchymatous organs as in any febrile Cond. Considerable free Haem. in Blood. this suspecious of R.B.C. Organism. Symptoms: Incubation 3 to 4 days, onset sudden, chilly sensation, pain in back & limbs, begin usually in morning. fever rapidly rise 102 or 3 - 4 - 5. may be some sore throat. Naseau, Vomiting Possibly, but is later Symptom, Constipation; flush face, Eyes injected, early signs of Jaundice. After 2 or 3 days symptoms abate & we have a period of remission, possibly Convalescence where Conval. does not occur symptoms reoccur more gastro Intes. disl. pulse high, greated Prostration. Delirium Vomiting Coffe ground. Black Vomit. May be fatal in from 1 to 3 days. or may recover by lysis Prognosis. Varies with Epidemics 15 to 85% fatalatic. Treatment: Symptomatic. Calomel early. Sponging to reduce Temperature. Abundant. Water, acid drinks, Alb. Water & Broths no solid foods. Stimulants. May have to give Med. Hypodermatically. Jan.8.'06 Tetanus infectious disease by T. Bacillus Char. by Tetanic convulsions, Etiology T. Bac. cause usually enters thro' punctured or incised wound. Colored race more susceptable. Is Anaerobic germ making Punctured wound more susceptable Path of Tetanous Resembles Diph. it is local disease producing toxin which are absorbed & affect nervous system Is very powerful Toxin Symptoms. About 9 to 10 days after wound symptoms appear. onset depend on location of In. usually a stiffness about seat of infection Stiffness of muscles of neck. Ridigity of masseter muscles. (Trismus) Chilliness, rigor may occur. later envolvement of general muscular system until condition of opus Thotmus Temp. rather high 100,3,4,5 - 10 death. Cannot take requisite food. condition of Hyperaesthesia Noise of air etc may produce convulsive attack when not in convulsions no pain. Diagnosis: Strychnia Poison. we have patient relaxed between Convulsions not in Tetanus. Cannot bend head forward in Tentanus. Tentany disease ridigity of muscle due to auto intoxication extrematies develop ridigity. accompanies gastro Intest. disease. In tetanus look for primary lesion. Prognosis. 80% or proport. of Traumatic cases die if not treated until signs of Tetanus begin about 50% of Idiopathic cases die. (when origin cannot be detected) If treated in propholactic way the treatment is as satisfactory as in Diphtheria. Treatment. A punctured wound should be treated as an open wound which may be done by packing with guaze & reach bottom with Pure Carbolic A. & pack afterward. Dress every day untill period of danger is past (8 or 9 days) as a local dressing Campho Phenic (Camphor & Carbolic Acid equal parts). Tetanus Antitoxin if in dangerous wound. give one buld (10 CC) at time of injury & in body. It is advised to use dry Tet. Antitoxin in the wound itself if Disease develops. Keep patient quiet avoid excitement. Early [illegible] Tet. Antitoxin give 20 or 30 CC every 3 hrs. for days if necessary. use laxatives. ꝶ For Kidneys action Diuretic Mixture (S.A. Matheus) Sod. Chl. 15.00 Sod. Sulph. 12.00 Sod. Citrate. 20.00 Calc. Chl. .05 Aqua Dist. 4000.00 500 CC. 3 or 4 times a day by mouth or Hyperdermatically. Bromide & Chloral to Control Convulsions Morphin & Chloroform if necessary. Never give Strychnia. Avoid Nerve Stimulant. & outside stimulation Jan.10.06 Hydrophobia or Rabies. Acute Disease of warm blooded animals due to some specific unknown Virus Negri has found bodies in cells of C. Nervous Sep Ameboid in Character which may be cause [illustration] Negri Bodies. Conveyed to man by inoculation. dogs wolves & most domestic animals are susceptable. Bites of Rabid animals or those infected with Rabies are very dangerous on exposed parts of the body. Only a minority of those bitten contract the disease. Practiclly all die if not treated. Incubation period 2 wks to 3 months. Symptoms. Premonitory Symptoms some little irritation about site of infection & numbness patient becomes anxious & sleepless general hyperaesthesia to impulses. larynx becomes injected accompanied by hoarseness. slight elevation of temperature. May have difficulty in swallowing water stimulates this spasm more than solids. Excited period. All exagerated any attempt to take food produces laryngeal spasm. Tem. 100-03. & remains thro exciting stage. this stage lasts from one to three days Paralytic stage six to Eighteen hrs. condition of syncomy dies of exhaustion Diagnosis. Mistake usually made to kill suspected animal. but preserve . if it is killed. A small piece of spinal cord of animal moculated into a rabit will produce Rabies in 15 days Inoculate under Dura. Treatment: Send away for treatment. Cauterize around thoroughly & keep wound open for 5 or 6 weeks. treats by attenuated Virus. Rabits are Inse. Virus Fixe. highly active. at height of disease glycerine Extract of Some of Cord is made & kept at ages from 1 to 30 days old. Small quan of 30 day Virus is incoculated & kept up till strong Virus can be used. Result of this specific there is very rare a fatal case. Keep patient in Dark room avoid Excitement. Bromide, Morphin, Chloral,: Sedatives Laxatives, & Diuretic Solution. To relieve Spasm. Spray throat with Cocain Solution or allow patient to swallow a little. Warn family against injuries from patient. Jan.15.'06 Anthrax or Malignant Pustule, Wool sorters Disease B. Anthrax cause. gains entrance thro inoculation by some abrasion of face or hand among stock people & handler of Wool Hides or Hair. implies an infection of animal or hide etc. Anthrax B. is of moderate Vitality spore is of great Vitality stand for time 5% Carbolic & Boiling water. Symptoms: Mild & Severe. Painful swelling at site of [illegible] abrasion becomes vesicular & Pustular. fever rises rapidly for first few days fever may abate or continue to fatal termination. Some involvement of Lym. about site. organism found in Blood just before Death. Found in liver & Spleen. Edema about face. feeling of anxiety, fear. Gastro Intest. May develop anthrax by eating infected meat Char. by chill Vomiting & Diahera colicy pain rise in Temp - Dysponea & Cyanosis. usually short Duration may recover from any infection usually severe internal Mild cases slow recovery - If first few days are favorable. Patient is becoming immune Treatment to far for cauterizing Infection about swelling of Carbolic 10% is beneficial 18 grs large dose. Beside local injection. Stimulation & [????ment] Watch elimination. Glanders is a Tubercular Disease manifests itself by formation of tubercles Visceral & Superficial or External. Sup. resemble Tubercular Nodules of skin in Horses is called Farcy Etiotogy due to B. Mallei or Glanders short rod. infection obtained usually from horses affects Mucus Membrane of Horse usually catarrhal Condition of Nose. & Individual contract glanders from this secretion. Mucuous Memb. of Nose of Horse & Man are favorable ground. few day sufficient for development of acute form. Symptoms Beginning resemble grippe. Catarrhal Inflam of Nose & Throat Pain & aching in different parts of body & rise in Temperature. Acute glanders may be intense & patient may die in 8 or 10 days. on other hand they develop slowly & exist in a Chronic form. lasting for months Chronic Cases are dangerous. Have in Man a glanders Pneumonia due to inhaling. Superficial obtained thro' abrasions in skin Like Lupus is very persistent & difficult to eliminate. Diagnosis examine Secretion for organism or using a toxin Mallein same as use of Tuberculein. Treatment: No specific. Antitoxin not satisfactory Symptomatic treatment. If accessable use antiseptics irrigation of membranes. Local glanders treated as Anthrax by use of Carbolic Acid. Attention to Bowel & Kidneys. Stimulant if necessary Main feature is Propholaxis. Jan.22.'06 Actinimycosis chronic infections disease Actinomycosis. Tubercular in nature due to Ray fungus streptothrix actinomycis common in cattle acquire it from eating grain or other feed usually found about jaw thought to enter down by teeth may develop same way in man may affect any part of the body. a growth resembling a sarcoma develops from which it cannot be told except by Microscopical exam. of tissue. swelling gradually. ultimately breaks down with advent of suppuration with pus we find coming small granular bodies sald Sulphur bodies size of Head of pin on crushing them they are made up of Ray fungus are characteristic of this disease. After suppuration there is some fever less fever in free discharge. serious disease. There infection is local & removable should be removed by Surgeon. Pot 20. 60 gr. a day. Xray some results. Propholaxis important be careful of infecting hands. Bubonic Plague. Specific infectious disease due to B. Pestis disorder by Kinsatto found in disease tissue & later stages in Blood. in last 5 yrs 3,000,000 have beed killed. has existed in all civilized countries in Cal. & N.Y. Etiology. A filth disease due to poor & unsanitary Cond. Rats, Mice, Dogs flies ticks carry disease. Rats worst May be taken this digestive canal prevails especially during hot season. all classes Symptoms mild form Pestis Minor lasting for a few days little glandular meeting slight systemic symptoms. Headache Backache, stiffness, soreness gradual rise in temperature anxiety restlessness. with considerable depression. Temp 103 or 4 in first four days. then a remission of temperature of glands which have begun to swell become sore showing signs of suppuration with which we have another rise in Temperature. from this on the symptoms are characteristic of a severe septe condition. Gastro Inte symptom mobility to digest their food & constipation or Diarrhea. These Sym - may last a few day with death or for a few weeks with death or [rett??rate] Recovery This was Black Plague of London 1665 - 70,000 complications. gland Oxalliary & Inquiral Pulmonary type lungs are affected. Gastro Intes. Pneumonia may complicate any case. 96% of all cases in which Pneu. occurs are fatal Propholaxis are great danger in handling patients if care is taken. essential thing is Pollusion of food or drink by rats & bites of these various insects. Treatment. Haffkinis Lymph. promises most in a specific way apart from this treatment is symtomatic Essential or Idiopathic fevers or fevers about which we know no cause Febricula Ephimeral. fevers lasting a day or two with evident local affection. Aborted types of infectious diseases symptoms of which are not [sufficient] manifest enough to determine exact nature. Gastro Intestinal especially Autointoxication inhaling odors from decaying Organic Matter or other poisonous gasses Treatment: Purely symptomatic withhold or restrict diet, attend to Bowel & Kidneys. Infectious Jaundice (Weil's Disease) a jaundice appears sometimes as an epidemic begins with Gastro Intestinal dist lasts a few days some fever 102-3 jaundice & Albuminuria. Liver & Spleen are enlarged, complains of Headache lassitude, Anorexia & has a coated tongue sick for 1 to 3 wks symptoms grad disappearing. usually recover. Treatment. Symptomatic. Laxatives, restricted diet easily digested. Broths, Orange juice white of egg some milk. Glandular Fever. Rare infectious disease involving Lymphatic Glands. Symptoms, Usually begins with Slight Sore throat. Fever headache Malaize swelling of glands especially those of Neck & Sub maxilliary lymphatics. neck may be much swollen resembling swollen glands in Diphtheria. Tendency to suppuration may also be involvement in other superficial glands. & in fatal cases Visceral glands are involved liver & spleen somewhat enlarged Nephritis to some extent as complication Recovery is the Rule Symptomatic treatment. Salicylates warm moist Pack with Laudinum. if suppuration sets in open glands. Liquid food can only be taken Jan.29.'06.. Disease of Thyroid Animal Extracts used for ages Brown Lecord & Bernard Elixor of life Prolong life. Extracts. Stimulate for weeks etc & is reaction & condition is worse than before. Chief Ex over Test. & Or. B.S. stim work along this line in studing secretion with archetic Ex Thyroid. Pituitary. Adrenal. Thymus. Lyme Since that time most organs producing secretion have bee studied Parenchymatous organs. Para Thyroid. Test. Ovaries. Internal secretions of Or. & Test is positive necessary for existence in Normal life. Reserve all possible when surgery is used. Thymus value to young Indiv. well developed at Birth. atrophies gradually till 14 yrs. Pituitary Body. has some relation on Cerebral Circulation & nutrition of Brain. of other Spleen differs in that its function can be assumed Liver Essential Parotid, Prostate, Lym, may be removed without bad results. Adrenal cannot be removed. Thyroid gland has been most studied Tendency to develop goiter. Removal of Thy & Para Thy in man is invariably fatal. If all is removed Symptoms of Myxodema. develop. & continue to fatal result unless Thyroid Ex is given. It seems that the Iodine Element is most essential part of Int Secretion Combined in Mucoid substance. During first 3 months no Iodine is present in gland there is considerable Iodine in Mother Milk. In gland of Calf first Months Io is present but in Cows Milk there is little Io. There is often enlargement in Thyroid at time of Menstru & during Pregnancy. Usually some enlargement & increase Activity when it does not enlarge there is usually Kd. Dist. Alb in Urine & this is that to have relation of Elampsia 20 of 24 with no Enlarg where was Alb in Urine. Jan.31.'06 Exp. tests have shown that Thyroid Ex increases amount of Oxy absorbed & elimination of CO2 also increases amt. of Nitrogen Eliminated especially thro' Urine Increases Temperature in normal Indiv. Gland seems to have some relation therefore to Respiratory gaseous change of Blood & tissues (Metabolism). Some believe that it produces an Anti toxin which neutralizes Metabolic toxins (Leuco main Goiter - Struma - described in 13th.. Century by Marco Polo. as a disease in Central Asia & Certain valleys supplied by water from mountains. prevailed to some extent in Animals. Paracelsus in 15 C. Wrote on it as existing in Alps. & spoke of its relation to Cretinism. Disease occurs epidemically & sporatically. Epidemics occur in schools, prisons, Barracks, community around these centers may be unaffected something in locality or of Building seems to have bearing on cause. Afflicted Indiv. when removed often recover readily. Rare in Animals here. Etiology: Virchow. Cocher think the disease is due to water but element therein not decided prob. Metalic. Some think Bacterial origin Symptoms: Cary greatly a large Goiter may cause no trouble other than inconvenience while small cause a great deal. usually occurs soon after Puberty rarely after 40. More common in female. have Acute & Chronic form. Acute is usually vascular & Chronic Parenchymatous Chronic form may be mixed. Differenciation Simplest form: is a simple Hyperemia. Coincident with menstruation or stim of sexual organs as pregnancy throat enlarged, rounded, smooth round neck consistency soft or normal Parenchymatous form: glands enlarged somewhat nodular or symetrical border sharp or defined. may reach size of a Hen's egg. Consistency: rather soft but outline distinct Vascular form: Moderate enlargement spongy consistency. Readily compressed & Vascular murmurs heard on auscultation Colloidal form symetrical enlargement not very large skin usually rather tight Jug. Veins dilated Hyperthyroid symptoms Atrophy present. Consistency: rather firm Fibroid form Hard, nodular, firm consistency size of Pea to egg are nodules. tendency in some cases to cacification. accompanied by myx edematous symptoms. Mixed form may partake of any of above forms It is mixed form that usually hang down. Symptoms incident to simple types. Unless there is some inc. or diminution in gland secretion there are no constitutional symptoms. May produce local symptoms thro' its mechanical relation to adjacent parts & studying resulting symptoms the two Classes of Sym should be considered Most goiters do not produce symptoms of consequence many do not know they have goitre when it exists even when symptoms can be associated Feb.5.'06 with Goitre. Sporatic cases not due to Goiter develops at beginning Menstruation. Symptoms of Goitre not seen. When [Iotle????] does not exist the Goitre does not protrude as when present. does not rise & fall with Larynx also greater tendency to growth into Thorax. Symptoms: Suffocation especially at night pressure in upper part of Thorax on sinking the head. evidences of nerve pressure: recurrent Laryngeus " by disturbance of voice, Phrenic, disturbance of Resp. Vagus dist. of Heart. some cases Diag Proflamatic. Dif. Diag. Visible of Palpable tumor in neck in region of Thyroid, Symetrical?, Is a goitre in majority of cases. Hodgkins involves lymphatics enlargements are irregular & in other locations then Thyroid. Aneurisms will show circulatory symptoms change in pulse. usually appear lower down & give peculiar sound or murmur but may have also in goitre pressing on aorta .. Thymus only in young children Enlarged lymphatics from other causes for ex T.B. Syphilis, Malignant growth. Sacculated or diverticulum of Esophagus regurgication of food etc. Treatment Simple Goitre. (Rocker) Propholactic treatment change climate usually to sea coast. Med. Iodine is Specific. proper used Io & their Comp. 90% of Simple Goitre can be cured or so far improved & that they will not require operation. Pure Io or some of Salts K.I. usually Internally & Externally almost eternally Internal Pure Io 1 drop 3 time a day best form K.I. 5 to 10 grs. 3x well dilute. Locally apply at night wet pack with 10 to 20 % Solution of K.I. or [illegible] Io. ointment. or Tr of Io may be painted over surface every 2 days If Color Io is used tell how to take out with Dilute Am. Water. Desiccated Thyroid in 2 to 5 gr. dose 3x a day fortifying with Strychnia if Heart is disturbed give after meals. 10 gr. Soda Bicarb { half hr. before eating , in glass water 5 gr. Sulph. Soda { before giving 4 hrs Not Beneficial in Colloidal or fibrinous. Does not Treat rapid. May reoccur after removal. This Treatment acts best in young & in Early disease. Feb.7.06 Thy. Complications in infectious Dis. quite often becomes congested & some change in Parenchyma & some of glandular spaces do not contain secretion but in their space disintegrated cells. other evidence of change is that colloidal material changes in character & shows different reaction. Suppuration of Thyroid may occur due to invasion of Micro org. Strep. or Staph. When suppuration occurs gland usually breaks Externally may break into Trachea or Esophagus. Evidences of Sup. are Swelling. Pain. Temp. & general symptoms. May have Acute Inflam. alone. (Thyroiditis) When gland breaks down usually heals rather quickly. occasionly a sinus will remain indefinately. Following Infectious dis. may have a sclerosis or fibroid change. Come on gradually resulting sometimes in Myxodema & impaired mental development Thyroiditis sometimes Complicates Rheumatism also Typhoid, (T.B. & in most cases there is some sclerosis. Io. tends to disappear) Cancre may occur Syphalis is quite common more especially in Heredity. Cretinism - Hypothyroidism are in congenital & Infancy. From Infancy to Puberty Infantilism ? " Puberty on Myxedema. These three diseases are characterized by changes in the skin a Pseudo Edematous condition on thickening of skin. a cachexia & non development of Mental faculties in the adult impairment of Mental " In young individual skeleton does not develop normally. in adult not apparent Treatment of all these conditions is Desecated Thyroid indefinitely. Feb.12.'06. Graves or Basedow's Disease or Exoph. Gorter. In contract with Myxedema it is a Hyperthyroidation or increase or perverted function. Shock has thot to be a cause & anxiety any severe nervous strain is probably are exciting causes frequently evidences of unstable nervous system auto intoxication may be factor. Disturbances of Sym. Nervous system are always observed some believe that Goiterous condition is secondary to nervous sympt & result of changes in Sym. N. System. Symtomotology. Increased action of Heart. Tacacardia ranging from 90 to 140. enlargement of Thyroid. may be slight or moderate not usually every great. Exopthalmus, more or less notable in most cases general nervousness, irritable cond. of N. Sys Patients otherwise calm are irritated at trifling noises. Emotional. fine rhthymical tremor, in extended fingers Digestive organs periodical diarrhea worse when patient is very nervous Anorexia or irregular appetite. Nausea. Vomiting. Abnormal thirst & Jaundice latter not constant. Respiratory organs: some atrophy of Pectoral muscles interferes with respiration. Expansion between 2 & 3 in. Consequent increase in frequency of Respiration. Nervous symptoms inability to converge eyes. lag opthalmus headache Neuralgia & pains resembling Precordial distress. mental disturbance. Hallucinations. depression Conditions of Skin. Increase perspiration. flushing & sensation of Heat. occasional rise in temperature. diminished Electrical [reaction] resistance. tendency to loss of Hair. dry and brittle. some atrophy of nails. Condition of Kidneys. Polyuria. albuminuria. increased uric acid. Generative System. Menstrual disturbed loss of Sexual desire even to impotense debility. loss of weight enemia, Cachexia. & often Odema especially of lower extremities. Treatment. Surgical or nonsurgical. try latter first. Treat may be Medicinal & Hygienic should be protected from all nervous & mental irritation. Keep them quiet. Takacardia diminishes sleep better. ꝶ Pot. brom ʒ VI. Tr. Strophanthus ℥ SS. Elixir Simp qs. ℥ III. mft. Sig Teaspoonful in water 3 times a day. Intestinal antiseptic. Salicylate of Soda. 15 or 20 grs. 3xday. Hygrag Bichlor gr. 1/30 Sod. gly cocholate gr. V Pill or Capsule 3xday (Transfered to 253.) Surgical Pathology - Prof. Lutz -. The cell is not a simple substance has a life is nourished lives & dies. Life of all organisms is limited. Functioning means waste. Characteristics of cells: Ameboid movement. changes in exterior of cell brot about by changes within & change in form. Cell takes on nourishment & has power of reproduction, the reproduction of cell is the formation of new tissue. called Embryonal tissue. & a conglomerate of new tissue is granulation Cells posess irritability characteristic in wound healing Wound is anything which concerns continuity An incised wound is one clean cut with a sharp instrument Lacerated wound concerns a larger area. In an incised wound we notice a gapping & a watery substance - lymph made up of Plasma & cells forms or comes to the surface also does blood These undergo chemical changes the blood coagulates & glues together the surface of the wound later on Nature unites them permentantly. New cells are formed, grow & take the place of ones destroyed, this is a reproductive process. An Inflamatory process follows infected part. Cell healing is the result of new tissue formation. These new cells come from the fixed or permenant cells of the wounded locality. All new cells are formed from cells of a like nature or the fixed cells produce cells of their own respective types. A Trauma acts as an inpregnation of the cells. These new cells form granulation tissue which is developed into permenant tissue. These new formed cells require nourishment & therefore blood & spaces are formed within the new tissue & from an existing blood vessel projections are thrown out This wound healing is result of new formed tissue & not by direct union Oct.19.'05 Vascularization. Granulation tissue made & requires nourishment brought about by formation of New Vessels made up of new cells formed from old vessels & project in a Budding manner from vessels that have been ruptured or lacerated. These Bld. Vessels form rapidly & project thro different parts & give to the granulation tissue its rough appearance. These Blood Vessels are quite numerous at first [& as] there is a large anastimoses of Branches. When the Embryonal tissue is becoming more of the fixed type the tissue is contracting & in this manner closes many of the Bld. Vessels & they become obliterated - most of them while only a few just necessary to nourish remain. A tumor is hardly distinguishble from granulation tissue & a Malignant tumor is always Embryonal. Cicatrization is the process by which Embryonal cells are converted into permenant tissue. In development cells approach the likeness of the mother cell & not till the permenent stage is reached is it a like- All granulation tissue is alike. These new cells have various shapes contain a large amount of protoplasm & a fimbriated edge or Pseudopodia like process which enable it to combine with other cells to form the tissue. As the cells become more perfect the protoplasm becomes less in amount. The Epidermis is formed from the epithelium of the adjorning skin at the margin of the wound. These Epithelial cell wander & become attached away from the original place of formation. There may remain a hair follicle or a small bit of skin in the wound & from the epithelium of this new tissue from. On this is based the process of grafting Grafting is done where large areas of skin have been destroyed & as the granulation tissue forms & having such power of contraction as to deform the neighboring part so portions of skin are taken from another healthy part & laid on the injured which by mechanical means is attached for a short period till process of new formation begins. The greater gap in a wound the more granulation tissue is required to repair & if these various cut tissue be brot in apposition with their like tissue there will be less scar a better & quicker union. If muscle & fascia are brot together a connective tissue unites them & here the scar will be less firm may yield & be source of a Hernia. Thus all tissue should be brot together separately & sooner better & in doing this dont rely on touch alone but use sense of sight by pushing apart the gap & seeing the actual condition The granulation tissue of bone is called Callus. & is divided into Temporary & permanent. Source of Granulation tissue: It is formed by any material which will produce Osteoblasts & is chiefly by Periosteum & Medullary layer. These cells cannot be formed till the hemorrhage is stopped & Blood gotten rid of. This is easily done in this position as the Blood lies internal & is not infected & is absorbed very readily. As the Bone is Broken the same force usually tears the periosteum & the result of Trauma causes Proliferation of Cells. In first place the Periosteum acts & the Dense part is last. as this has to become softened before union will take place & sometimes mechanical force has to be applied & soften up the parts before they act & in rare instances to cut down & cut away the dry dead material. As the Periosteum is torn away the internal if its cells become active & form the External Callus next the Cells of Endocardium form the internal Callus & last from Broken End of Bone & is most important Callus. As these Cali form the serve as a splint in supporting the Bone & the final scar resulting is derived from the Callus which formed between the Bone Substance. [illustration] Oct.31.'05 Disturbed Repair - Inflamation. Disturbed wound extends to entire economy - Begins as Local Disturbance. Inflamation means infection for surgeon. Bacteria grow on Devitalized tissue. Vitality destroys Bacteria. Normal Blood good germecide. Bacteria to infect must appear in great enough numbers. Extent of Inflam. depends on virulence & number of Bacteria. Disease is disturbance of function of Organs Pus producing Bacteria. Bacteria do not create Disturbance but change in tissue & wound secretion & Embry Cells. First disturbance is local. 2nd. in circulatory Disturbance in surrounding. g. Hyperenemia & Blood slowed first affect. 2. Disturb. of Capillary walls by products brot. about by Bact. affects cells & cement substance which hold together. Cells become thick sticky. Cement substance is broken down holes are formed cold stigmata Nov.3.'05 Stagnation of Blood & Change in Blood Constitutients. Solid flow near center In stagnation solids flow near Periphery Mural implantation Corpuscles attach to wall of Blood vessels Emmigration of Leucocytes thro stigmata Leucocytes. Nov.7.'05. Albuminous substance formed serve as food & Antiseptics act mainly on Albumin. Bacteria are removed by Leucocytes property of Phagocytosis. Nov.10.'05 Local infection: q Act on devital tissue & extract albumin... Cell is composite structure & furnish culture Media for Bacteria. Growth depends on food Oxygen Carbohydrate etc Toxins are results of Bact. on such structures. Macroscopic symptoms: Heat- increased Blood supply- augmented function where there is infection the Blood furnishes material & may serve to carry away. Normal secretion have Bacteriocidal action. May not be increased injury. Redness: Dilatation of Blood Vessels & the stasis Reprodative & Inflamatory may occur together Nov.16.'05 Coagulation necrosis is superficial affection. Causes an exudate & area for growth. This should be removed by scraping, incision, Bacteriocidal material etc. Wound should not be closed till it is able to unite. Influence of Local Dis on general condition Influence on & Nerve 2 Blood designated *as sepsis: a disturbance in blood as result of infection & results in a fever ? Resultant of Putrefactive organisms. Danger of Loca Dis is in sepsis. Sepsis continues as long as Local Dis. Elevated temperature is index of sepsis. Local infection should be treated to check sepsis. Record of Temperature & pulse should be kept. as an index of sepsis also an examination of the general system. Examination of Blood aids in determination as Leucocytosis is generally present & especially indicative of Deep seated supuration. Nov.22.'05 Blood changes Leucocytosis W. Bld. Cov increased & increase fibrin ferment. In local Disturb Leucocytosis is Physiological. as attempt on part of nature to serve a purpose W.B.C. contain Paraglobulin. W.B.C. are of low vitality & lose constituents & Coagulates readily. Acute Supprative Process. Dif. of Sepsis & Leucocytosis. Thyphoid Fever gives rise to Sepsis. Thrombosis is coag in Bld. Ves. of Inflam part. due to leucocytosis & stasis. This Thrombus may result in Cardiac Thromboses or Metastatic inflamation by vertue of it being able to carry Organisms. R.B.C. are increased & thus decrease Oxygen capacity. Nov.24.'05. Erysapolis infectious. organism enters thro' wound which may not be recognized. Infection readily conveyed. Bad Prognosis when Mucus Mem. is attacked. attacks outter & inner skin Odema may cause closure of Larynx by tendency of inflamation to spread. Limites itself to Lymphatic of Skin. Bacillus similar to Streptococcus Glands are often involved at beginning Inflamation may not result in Pus. Pus is incidant of one kind of infection Ev. Is self limmited Disease. Ev. furnish predisposition to same disease. Iodine destroys the skin. Self limited disease treat symptoms. Internal medicine do little good. Antistreptococcus serum should be used. s. Extreme Contagion of Disease & carried readily Tetanus Microbe is Anaerobic - non pus producer. Best surrounding is in Deep seated & poorly drained. It is an Omnipresent Bacillus Bacillus is present in Intestine of Horse. Results in transformation of Toxins. & Toxins travel along nerve to Brain & Toxins act on Brain & Sp. C directly. tonic contraction of Masseter & Temporal. " " Flexor Muscles of Trunk. 1. Symptom stiff neck. 2. Cannot open mouth very far. Erector Muscle of Back. Board like Abdomen. At first are Clonic- relaxed. *Apistatis. Unusally High Temperature. Visible wound is supperating. should be cleaned. Higher temperature from Muscle Contraction. Desire for water warm water should be injected into Bowel. Disturbance increase secretion & where secretion cannot escape Bacillus more [act] liable to act as wound in hand & foot below fascia in such wound it should be well opened & cleaned. & wound should be opened, cleaned, & packed never sew up till perfectly clean. Drug treatment is Symptomatic. Morphia, Chloral, Bromides, Hyocyanus, Fowler's Solutions. Antitetanis Syrum. Where Tetanus occurs almost simultaneous it is most virulent. Longer Existence better the chance for recovery. Dec.5.05. Inflamation action disturbance in cell formation. T.B. properly planted causes cell formation. & Toxins modify growth Dec..8.'05. Gangrene death of a part medical & Surgical Condition Diabetes next to injuries produces most gangrene. Dry where part remains dry mouldy & do not furnish soil for Putrefactive Bact. also Pyogenic Bacteria. Line of Demarcation may be infected but does not act on dry part as Bld supply is poor Arterial may be destroyed Moist gang. as result of Venous circulation good ground for action of Bacteria Odor of Putrefaction & Better Soil for Absorption. Causes of Gangrene are as a rule noticed before gangrene. Trauma by interference of Bld Supply or injury to all parts. Such limb should be elevated surrounded to prevent evaporation, application of Heat Cleanliness Line of Demarcation limit of circulation on skin Dec.12.'05. Shock generic including many changes. Anemia of Brain & Spinal Cord Disturbance of Central Nervous Sys. not known. Exhaustion of Central Nervous System. Relation of Hemorrhage to Shock. Affects depend on quan of Bld & on Individual. Smal Rapid pulse when large amt. of Bld is lost. due to less stimulation of Heart may increase & cause exhaustion. By without nutrition of Bld to Cord & Brain we have shock much augmented. Harm cause shock. Treatment stop Bleeding. Use of Saline solution, warm application. No Alcohol. Dec.15.'05. Shock profound disturbance of Nervous system. Delirium disturbance of ordinary thinking & surrounding relations. Sudden withdrawal of Alcohol causes symptoms same as crisis Alcohol abused is followed by degeneration of Excretory Organs. Gives poor foundation for reproductive process. Use strychnia. Opium for sleep. Care of injury examine Habits, don't withdraw Bleeding from small Blood vessels. 'Bleeders' Hard to stop. Elbow. knee. ankle joint. Due to absence of fibrin ferment. or walls may be thin, may be degenerative changes where there is a thickening Use pack. Dec.19.05. Anesthesia - Ether & Chloroform.- for producing sleep & relieving pain. 1. If anesthesia should be general or local. 2. Condition of Patient if fit for ether or Chloroform. Amount of each determined on [O?] in each " " " " by Physiology action Phy action begin on higher centers. At first delerious. Reflexes abolished last at Perineum, Voluntary muscles first to relax. Jan.2.'06. Surgical Pathology deals principally with three things 1. Repair of wounds, Inflamation, Neoplasms or New growths. Tumor: A swelling & is inadequate to cover meaning of new growths such as neoplasms. Tumor should mean a new growth a new growth which has no physiological function, a permanent growth. New growth occurs internally & Externally Internal medicine has preformed its best diagnosis in discovery of internal growths. All new tissue formed must be from like tissue Lipoma must have been developed from fat-cells. Carcinoma from Embryonal epithelial cells. New growths must start from Embryonic tissue. Embryonic tissue retains its characteristerics in the new growth & the more of this Embryonal Characteristic it is the more malignant the new growth. Rapid growth & Embryonic Characterstic of tissue are the two important features of Malignant growth Sarcoma, in young, are most malignant of new growths. Jan.5.'06. New growth goes on independently or at expense of Body. Neoplasm not interfering with gen Body Lipoma resembles fatty tissues Heart acumilates fat.. When tumor grows into tissue called tissue infiltration Malignant. or may grow between organs or parts. Benign. Fat passes from sub serous parts to inter tissue Symetrical tumor due to Nervous disturbance Jan.9.'06 Malignant tumor have tendency to enter tissue from matrix. New growth results from cell proliferation result of Embryonic tissue may be congenital or post. May have growth on granulation tissue. New growth not due to bacteria. Erysapolis used to destroy new growth. New growth posesses life of its own. tho' not separate. " " Does not disappear spontaneously. as a rule. Infiltration causes malignancy. returns in loco or metastase. Benign is usually encapsuled or limited by border of organs - pushes away.. may press on Trachea etc. [Remove] advise early removal. may disturb internally Danger in removal of suppuration. In removal think of making part useful. Jan.16.'06. Bones are separate & become united are developed from numerous centers. Function of Epiphasis is cartilagenous. Bone tumors are more [malignant] Benign. grow slowly. Exostosis is an outgrowth of Bone. Covered with Carb. which may be converted into bone. Covered with Bursae to protect muscles etc. occur in Neighborhood of Epiphasis. When on Skull must be differentiation from Syphalis. Nasal process of Sup Max Exos are Symetrical. Bone tumor are injurious by influence excited on surrounding tissue. Should be removed when interfering with neighboring structures or when in themselves are undergoing changes & containing other elements may become malignant. Fibroid small hard smooth grows by pushing away parts. is rare form. Keloid a form of fibroid grow ordinarily [apon????] " Dont operate on Keloid. New growth causes pain in sciatic nerve Neuroma fibroid growth within sheath separating Nerve Bundles. Myomata are prone to take on growth which interferes with their life Jan.23.'06. Malignant is clinical term which expresses behavior & its clinical characteristics Recurrence after removal. fast growth require large Bld Supply. involve body thro lymph channels while Sarcoma thro' Bld. Phosphoric acid do not use Thyroid Extract Serums with questionable results. Vegetables & fruits small amt. Meat, Eggs & fish used Removal of part of gland few may recover without treatment most recover after treatment may remain well indefinate period. tendency to return when under nervous strain. Creatinism Infantile Myxedema. common in Sevitz & occurs Sporadically in most countries. Cause unknown. except frequently a nervous disease in family & not perfect development. May not be recognized at birth of child. but after first few months will no develop mentally. learns to talk slowly Skeleton does not grow right physically dwarfed in every respect. skin more or less shriveled. dry. very little perspiration. (in contrast to Exopthalmic Goiter where skin is [illegible]). Child never attains untreated a normal degree of development. border on imbecility. can imitate have nothing original. no evidences of paralysis as in children who cease to develop from central nerve lesion. Some Creatins may have increase in size & function but never attains a perfect condition. Treatment: Begin at once with Dessicated Thyroid start with small dose 1/4 to 1/2 gr. two or 3 times after meals. Watching affect, specially condition of circulation. may increase dose. must be continued for months before results are noticable & continue it for years possibly for life. As they grow & develop fewer doses may be used but continued. Infantalism: develops later in life not congenital becomes especially apparent after puberty may be result in many cases of infectious diseases. Path: same as Creatinism deficient action of Thyroid Loraine Type is believed to be due to imperfect development of Arterial system. General symptoms which Char. Creatinism, tho' in a lesser degree. Treatment same as Creatinism. Senility developing in early period. tissue atrophy Myxedema same etiology develops later. in individuals who have been perfectly well previous. General Symptoms Etiology (some acute disease probably) dulling of mental faculties. tendency to melancholia. Hypochondria, Pseudo edema Thickening of skin without pitting as in ordinary edematous conditions a dull expression. Vague pains thro' body paresthesia Headaches a tendency to some local hemorrhage of Mucous Mem. cessation of sexual function, & Menstruation. Treatment: in general the same. 2 gr. in adult 3xday increasing gradually to 5 gr. if patients stand well. symptoms usually clear up largely but treatment should be continued. In Senilism Thyroid + Strychnia & Arsenic often tend to delay the process. In Brights Disease with evidence of Arteries Scleroses Hypert. Heart High tension pulse is beneficial. Menstrual Disturbance in developing girls it is good (2 grs. 3x). Tetany has been benefited. Nervous Diseases acts as an Alterative & in functional neurosis Paralysis Adjutans. also Hemorrhage; combine with Calcium Chloride 10 to 15 grs. in water. Feb.21.'06. Chronic Rheumatism. occurs usually as a primary condition or secondary to Acute. Constitutional condition. not infectious. not caused as is acute rheumatism Exposure to cold & wet in those who are predisposed may excite attacks. probably also a defect in Metabolisms resembles in this way gout. Path. Pain & stiffness about joints single or multiple. often several involved. indicates some irritation at this point & ligaments & capsule are thickened. some injection of synovial membrane. rarely active inflamation or necrosis of membrane Severity of these symptoms are no indication of change taken place about the joint. In protracted cases there is a certain amount of atrophy of Muscles controling the joint involved. nearly always occurs after middle life. many case give Heredity History. Symptoms. Pain & stiffness in joints changing with weather tending to reoccur & resisting to treatment usually involving larger joint. Hip. Shoulder. etc. usually no swelling or redness. if smaller joints are involved after long period there is some Deformity Symptoms occur at intervals for many years most troublesome during winter season. do not stand cold very well. Prog As a rule does not shorten Life. Treatment Hygienic. should be clothed in flannel the year around. Flannel blankets. Restrict heavier Meats plenty of Liquids. except Alcoholic. warm baths everything to promote free action of skin. Massage. Potassium Io. in small doses 5 grs. 3x a day for some time. Solisylate prep benefit to some extent relieve pain. tend to intefere with Antitoxins Muscular Rheumatism. Myalgia. Painful affection of Voluntary muscles or their attachment. Lumbago. of same nature. Etiology: Cool draught most important other Exposure. Rheumatism & Gout are predisposing factors Symptoms. Pain usually severe on movement of the muscles. dull aching. Local. Confined to 1. muscle is acute usually lasts but a few days. may be able to get about or confined to bed. Feb.26.'06. Treatment: Rest. Turkish bath followed by vigorous massage of muscles of back. strapping of affected part especially pleuridinae. Acupuncture leave 10 minutes. Morphine in bad cases 1/8 gr. follow with massage. Small doses Pot. Io. full doses Strychnia. tend to relieve protracted attacks & prevent reoccupies KI 5gr. 3x Stry 1/30.. 3x as patients stands (twitching of fingers) Salicylates in some form. relieve pain & tend to prevent attacks. ꝶ Sodii Benzoate. Lithia Benzoate. Sodii Salicylate. Pot. Citrate aa ʒ ii Glycerine ℥ ii Aqua Cinamon qs. ℥ vi. Teaspoonful in glass of water every 3 hrs. Gout. Etiology: constitutional disease usually history of Heredity. presence of Excess of Uric Acid in Blood or tendency to Percipitation of Uric Acid Salt from fluids. cause acute symptoms. Constitutional sympt. are due to disturbed metabolism. this salt deposits as Buirate of Soda. found to some extent in acute & Chronic Cases. Occurs at any age more manifest after middle life. Alcohol as taken in malt Liquors favor it especially Ale & Beer. Overeating without sufficient exercise. Lead intoxication. Chronic Lead Poisoning diminishing Metabolism of Body. Disease of Rich & Poor. Exciting Nervous Strain. Exhaustion. an unusual period rest. Feb.28.'06 Metabolic Causes: excessive eating. diminished exercise. chief cause of Impaired metabolism. Imperfect oxidation results in percipitation of Uric Acid salts. & posibly to an excess of these salts in body fluids. Pathology: May be deposits of Uric Acid salts & Lime S. specially about joints & in the Cartilages. Cartilage of ear good place called in ear Tophi. Urteris Sclerosis accompanies. Contracted Kidney in later stages. Neuritis, Path. changes in lungs Characteristic of Chronic Bronchitis. Mind unusually clear. Symptoms: Acute Gout. a person with favorable History awaken after Midnight with pain in great Toe. Tarso Ph. joint Sharp pain. Paroxysmal. joint becomes red. swollen & feverish. resembling joint of acute Rheumatism, Tongue becomes coated, Stomach disturbed. bowels Constipated. Temp. 100 to 102. Symptoms abate during day to recur at same time at night. continues for several days symptoms gradually disappear. frequently patients will give History of Previous attacks. bear in mind exciting causes. Chronic Gout: joints become permanently involved & any joints of body may show affects. Sp.C. & large joints most exempt. Thickening about Capsule & Sheath of Tendon & deposits about any of these joints. associatiated with Ch. Gout is Lathemic Diathesis. Other symptoms are. skin eruption Exam. Billiousness common. Symp Arteric Sclerosis. Headaches. Neuralgias Paresthesias. Hot. itching feet at night spoken of Lispings of Gout, Cramps of Muscles, Periodic excesses of Uric Acid in Urine. (Uric Acid Showers) Oxaluria. Minute quanaties of Albumin are common Transient of continuous for years. Hyaline Casts. Chronic Bronchitis troublesome in Winter, Intis. Glocoma, Apoplexy. Diagnosis: Acute Gout by its solitary involvement of joints. Chronic Gout by joint symptoms accompanied with Constitutional symptoms. Treatment: Acute: Rest, elevation, Heat as Hot as Can bear, follow with Opium Application made by Hot Compresses surface wet with Tr. of Opium Internal: ꝶ Tr. Colchici seed ℥ i Liq 10 drops in water every 6 hrs watching constitutional affects & depressing. Laxatives: Calomel, Salicylates, Asparin. Phanacetin 10grs. & 3 gr. Caffein Citrate. for pain. Mar.5.'06. Chronic Gout Treatment constitutional required often a change in mode of life of individual. General Hygiene. Open Air, to improve Oxidation this stimulates circulation & elimination. Gouty Indiv. Complaint of Cold. wear flannels. frequent baths. Cold if can be tolerated. Cold path in morning good rubbing. If reaction is poor stop Cold B. Warm Bath at night Alcohol rub to stimulate reaction. Diet Lots of water. Pay no attention to Lythia Water. Saline Water is best: Food Excess in Uric Acid Restrict Nitrogenous foods. Game or foul Meat Bar Beef. Eggs Moderate. Milk, Vegetables & fruits. Bananas ng. Orange. apples etc. Don't eat to much. Fats are good. Moderate amt. Coffee & Tea. No Malt. liquors at all. Whiskey is best, not between Meals Rest after Meals. Regular. Right meals when under strain sm. doses 3 to 5 gr. 3x day Salicylates indicated. Potass ii Iodidii for elimination. Lithia. Citrate, 5 grs. 3x in Water coffee or Tea. don't go beyond 3 5gr. tabletes. tendency to Vertigo. Benz. of Lithia ꝶ Mag. Sulph. ʒ ii Pot Bicarb gr. xv Tr. Colch seed. m x Inf. Buchu ℥ i Sig. Every 6 hrs. in water. Mar.7.'06. Scurvy: Etiology: Poor Hygiene & errors in diet. Lack of green vegetables & fresh meat. why? not known. probably. Veg. acids 1. absence. & organic salts. 2. toxic elements in food or 3. infection occupation: sailors, miners, & soldiers are more sesceptable to disease. more apt to be deprived of food. poorly fed prisoners & patients. Miners in Alaska Path: not knowing Etiology Enemic. tendency to Haem under Mucous membranes & skin. gum swell. erosion & loosening of teeth. Leucocytosis. gradual deg. of Parenchymatous organs. onset slow. looses in weight becomes weak, pale, after a time spongy gums tendency to bleed on slight irrit teeth may become very loose as in salivation & even necrosis of jaw. tongue coated, mouth foul & not much secretion. Skin dry & rough tendency to subcutaneous hemorrhage. haem into deeper tissue, Edema of limbs due partly to cond. of kidneys & feeble circulation pains in limbs & joints, constipation always. fever irregular not characteristic. may be sub periosteal hemorrhage. & some necrosis of bone. Dif. Diag. Rheumatism. History & general symptoms. a Rheumatic patient would have more fever. purpura exists on surface comes on suddenly. without previous symptoms. & with some other constitutional disease. Prog. good except in late cases. Fruit juices & fresh meats. tonics. Baths etc. Fresh meats prevent it. Broad of trade require foods to prevent. Infantile Scurvy: Imperfect food often associated with Rickets. Art. feeding, may develop in Nursing children. milk may not be suitable Condensed & prepared milks more apt to cause it. Symptoms are much the same. lower limbs & joints most affected likewise gums. Cry out when moved one of first indications. deformities may occur of limbs & sternum. separation of Opiphases of Bones. Paralytic symptoms. Temp. eratic. Treatment: Proph. Art. feeding use some fruit juice. yolk of soft Poached egg. once or twice a day. Orange juice. Mar.14.'06 Sun Stroke. or Heat Stroke caused by exposure to excessive heat especially to the Sun may occur in enclosures. Soldiers suffer in summer more common in Cities, Teamster coal driver. occasionly in country. Alcohol exciting cause. Pathology: Congestion of all tissues. Parenchy degeneration Rigor Mortis develops quickly after Cholera similar. Symptoms: An Indiv. normally should perspire. perspiration ceases, Dizziness. fullnes in head face read. skin injected. sense of oppresion, colored vision, naseau & vomiting may or may not. may gradually lapse into unconsciousness. may be partial of profound Coma. may last for a short time to several days. breathing labored. stertorius breathing. Rapid rise in temperature. 104 to 112 Temp. Twitching of muscles. later relaxation. pupils dilate at first later they contract. pulse full & bounding. Body red & dry. Symptoms develop quickly full Bld Indiv suffer more than spue. After symptoms: Indiv who has had one attack cannot stand heat afterward. may last for rest of life. Heat Exhaustion: weakness, exhausted feeling. Cramps in muscles. gastro. Intes. irritation may be delirious or some mental confusion temp. subnormal. low as 96. surface is cold. come on more in enclosures. Dif. Diag. espec. between Thermic fever. Alcoholicism. Mephitis. (ureamia) Apoplexy. Alc. two may be assoc with Th. fever high temp assists in dif. Ureamic Coma odor of breath. exam of Urine. & Temp. Apoplexy sym. of paralysis espec. of Ocular muscles. Temp. Treatment of Thermic fever. Application of Cold Cold on head first thing. Take Temp const. per Rectum. do not reduce temp too low. Inject ice water. watch pulse. if weak use strychnia, Phlethoric patients bleed early 1 pt. dont give any thing to eat, cool water first 24 hrs. Hypoderm Saline for Kidneys. Watch Pot. & give stim as indicated. When concious are out of danger as a rule. Tr. Heat Ex. Opposite measure. Stim from beginning, Hypo. Saline. injection. opiate for pain. Light diet. when delir clears up out of danger. Both Conditions may be 2 or 3 wks convalescing Mar..19.'06. Diabetes. Insipideus. Char by passage of large quan. of urine for a considerable time. Etiology. found in young people, children, infants, more common in Males. 23 of 91 members of a family had Dia Insip & all were well. Idiopathic & Secondary. Idio. Cases occur without apparent cause. large quan. water often after drinking excessive quan. Secondary injury to nervous system Head, Br. & Spinal injuries especially Brain or Sp [Syp???] Injuries most freq found near bas & in Meninges. Irritation of Medulla thot to be cause. Tumors of abdom. espec. T.B. Disease of abdomin. Fright & Shock may be a cause. Path: Not. Constant. Some cases Kds large & congested. Bladder dilated & Hypertrophied. Increase function of Kd. Symptoms. Gradual onset may be sudden. increase elimination of water & increase thirst Pain in Lumbar region radiating down thighs. Quanity from 10 to 56 pints. Specific gravity 1001 to 1005. Solids normal. Traces of Sugar may be found. Apetite excessive. patients look well & if not ill appearance due to primary disease rather than Diabetes. Able to carry on usual work chief inconvenience is thirst & passing water. Skin becomes dry & hard. mouth becomes dry. Tolerate large amts. of Alcohol. Prog: Idio. form not serious as regards life. Sec. Form depends on primary disease. is Symtomatic disease. Dif. Diag. Dia. Mellitus told by specific grav. & pres. or ab. of sugar. Mel. 1030-40. In 1001-05 Polyuria: not constant. associated with functional nervous disturbance. Bright's disease water is increased, 5 pts. Hysteria may periodically pass large quan. but not constant & associated with Nerv. Sys. Polyuria at close of Disease. Treatment: Not very satisfactory. If Secondary treat Primary condition. Nerve Sedatives used. Powd Valerin Root 20 gr. to 2 ʒ a day. or Valerinate of zinc 45 to 120 gr. per day. Bromides. persist in Med for some time, restrict water somewhat. Liquors should not be taken. Little possibility of it becoming Dia Mellatis. Mar.21.'06. Diabetes Mellitus. Disorder in metabolism where sugar is found in blood, eliminated in urine. condition must exist for some time Etiology: In all people all countries, gradually increasing more in well to do class, heredity little affect. Diet important causative factor Males in Excess. most common between 30 & 60. may occur at any age. Hebrews suffer more. Negro least. Obesity favors development. likewise Gout. Nervous shock or strain exciting cause Disease of Spinal Cord. Medulla at floor of 4th.. Ventricle is a cause. Pathology not known definitely. do not know Metabolism of Starches. glycogen supposed to be found & stored up in liver & muscles to be reconverted into glucose as required by tissues as glucose may find .1 to .2% in blood. if in excess is eliminated by Kidneys. & sometimes found high as .4% in Diab. Excess of Glucose 150 to 250 grams will produce glycosuria. feeding starches in any amount will not produce glycosuria. because starches are not transformed so rapidly & can be taken care of. We find changes in liver & Pancreas & of Pancreas Osle. of Langerhans are affected. may show hyaline degeneration or otherwise. Change of Kd & liver is more of Hyperenenic nature. True Nephritis may develop. Blood shows some changes P.N. Leuc. contain Glycogen. Neuritis may develop. T.B. is prone to develop in Diabetes. Symptoms Dietetic. Dia. due to errors in Diet more or less Transient usually relieved by correction Diet. Fatty Dia: in Excessive fat. usually associated also in errors in diet relieved by correction of same above show tendency to reoccur tho' not serious Such cases may prove to be Pancreatic Diabetes & is possible that a change may occur to same Pancreatic Dia: onset gradual. thirst & hunger develop as in Dia. Insep. but with greater appetite excessive amt. of Urine with thirst. mouth dry. skin dry. no perspiration. gradual emaciate probably. Cond. of Urine. Sp. g. high 1025-45. Pale, sweetish odor. sugar 1 to 10%. total of 1 to 2 lbs. in 24 hrs. Acetone usually present in severe cases, at any time & indicates the presence in the circulation of β Oxybutyric Acid which is cause of Diabetic Coma. Alb. fat. & casts are common, increase in bld. cells. leucocytes increase with advent of Coma. Complications: boils & Carbuncles, Eczema, Gangrene, T.B. Arterio Sclerosis, Neuritis, & Coma. Coma usually fatal. Prog. Diet. & fatty usually recover. Pancreatic rarely recover. may live for many years. Treatment: Hygiene: Kept warm care for skin occasional warm baths & massage. Diet: Restriction of starchy foods. Gluten bread & Oatmeal are best sort for cereal food. Green Vegetables, meats & eggs, Liver not good some fats, olive Oil, fruit if not too sweet. soups. coffee & tea & whisky. Saccarhine. no pasty Custard puddings with no sugar. Laxatives, Medicinal: Arsenic, Codeine, Salicylates, Codeine lessens amount of Sugar 1 to 10 gr. dose a day. Avoid excessive exercise. Coma best treated by withdrawing blood & introduce 1 pint Saline Sol. large dose Bicarb. Soda. 2 teaspoonfuls. Blood. Normoblast. Earthoblast. Microblast. Megaloblast. Porkilocytosis. Crenated. Red cells assume Basophilic granulation. Mar.28.'06. Aenemia: Secondary types. Implies deficiency in substance of Corpuscles in their number or in the plasma of Blood itself. applies especially to red cells. Color of skin is not always an indication of the degree of aenemia. Color of mucous membranes more reliable. Changes taking places: in beginning No of Corpuscles not much changed, change begins in the substance of Corp. Corp. average smaller as Anemia develop. color of indiv. corp. diminish Lowered specific gravity. Changes in shape of Corpuscles great variation in size. Endoglobular changes, vacuolization, & granular changes may occur peculiar staining reaction. No. of Cells gradually diminish. Anemia from Hemorrhage. lose 2 to 4 lbs blood & recover. loss of Corps. & Plasma, immediately after Hemorrhage shows dim. in Red Corp. few Nucleated red cells & slight increase in leucocytes. If severe Hem. some time after some degree of Anemia may exist but blood is quite rapidly restored, first water & salts. & albumin of plasma, next increase in corpuscles averaging smaller than normal. Color gradually returns, New Corp. show dim in Hemoglobin also. Rapidity of Recovery depends on degree of Hem. & cond. of individual, Norm. Indiv. recovers quite rapidly. Chronic Disease more slowly. Second. Anemias due to April.4.06. Chronic Diseases. Any Exhausting disease Neph. T.B. Sepsis etc. Chronic infection. Blood has usual characteristics. Toxines produce same thing Mineral workers. miners Lead. Zinc Mercury. Intestional parasites, Ankylostoma. No treatment for secondary anemia. Chlorosis, Green sickness, Etiology chiefly in girls 14 to 17. bearing some relation to sexual development & Establishment of Men. function. In retarded development. Heredity. Poor Hygiene. Constipation, Symptoms. Yellowish green color. pigmentation about joints, blood looks pale when drawn. Hemoglobin 40% total amt. about 4.000.000 May increase to 2.000.000. Corpuscles irregular in size, shape. Micro & Macro. may have a few normoblasts. slight Leucocytosis. General symptoms. Apetite: variable & capricious desire for strange articles of food. coffee. Hyper acidity. tendency to gastroptosis. Kidney displacement. disturbance of heart. Palp. on Excitement, murmurs at apex & base Hernia or functional murmurs due to relaxed cond. of muscle wall. Murmur in R. fug. Vein. pulse soft. rather weak may lead to formation of Thrombosis. especially femoral vein. (Milk Leg) Most cases are Hysterical. Menstrual disorder cold hands & feet. Headaches quite common Constipation is rule. Dif. Diag. T.B. Readily susceptible to T.B. Examine Lungs. & watch for symptoms. Sl. irregular. Temp. in T.B. signs of irritation in R. Apex changes in Resp. sound. cough. Nephritis: Examine Urine. Syphalis. unusual at this age. Treatment: Long time. Iron. Tr. Chloride of Iron. 15 m in egg water 3 times a day. Bland's Mass. plenty of milk. eggs. nourishing foods. Spinach. Laxatives. Cascara. Phenothalin favorable hygiene. April.9.'06. Pernicious Anemia a progressive anaemia which develops to extreme degree. Etiology: Idiopathic type cause not known. Parasitic. Intestinal Parasites. condition in which blood is rapidly formed & exhausted. Pregnancy, sever hemorrhage, Atrophy of Stomach. Path: Not much loss in weight fair amt. of subcal. fat skin & fatty tissue are lemon yellow color Muscular tissue flabby & weak. voluntary & invol alike blood making organs not characteristic change Spleen normal in size, lymph glands & Bone marrow not specially different than in any other. Symptoms: Gastro intestinal early disturb of Gas intest tract. some loss of appetite imperfect. symptoms come slow. shock or worry. early signs are pale mucous membranes & lemon skin. pulse large & soft fatigue on slight exercise. dysponea. vertigo. As disease progress exhaustion becomes extreme Bld. falls to 1/4 or 1/5. Haemoglobin relatively increased. Change in shape & size. & a few large nucleated Red cells. Blood serum same. as bld. diminishes Circulatory symptoms appear. Haemic murmurs. & weakened heart. Extreme degree may have retinal hemorrhages & other mucous membranes. Diarrhea. Urine pale. Sp. G. low. Post. Lat. Sclerosis of Cord. Dif. Diag. Addison's disease. Brown skin not light but Browned yellow. Bright's Disease. Examine Urine. T.B. General History. Bld. count not so low. Cancer. usually pain Prog. Idio path very unfavorable. may partially recover with tendency to relapse. Secondary type may recover. Rest in bed fresh air & easily digested food of most importance Medicine. Arsenic & Iron. Bone Marrow Moderate doses Arsenic & increase well tolerated. 1 or 2 drops increase per wk till 20 or 30 drops- after meals. Bone marrow in Sandwiches. April.11.'06. Lukaemia disease of Bld. making organs char. by increase of Leucocytes. & changes in Parenchymatous organs Liver Kidneys. Etiology: Not definitely known. anti intoxication considered. Metalic poisons Pb. Zn. Hg...etc. infection processes some believe Specific infection. related to Mal. growth. Mal dis. of blood Path: Enlargement of Lymphatic Structure certain ones more than others depending on Variety of Leu. Splens Myelogenous. Spleen & Bone Marrow are Hypertrophied. Lym. Variety Lym Glands especially Enlarged Liver. due to infiltration into liver by leucocytes. Same in Kidneys may have some fatty Deg. may have deposits of Leucocytes in any of the tissues of body. analogous to Metatastic growths. Great dim. in R.B.C. & marked increase in Leucocytes from 50,000 to 1/2 million. in Blood of Sepsis cells are normal but increased Bld. of Leu. Cells are Changed. frequently N.R.B.C. WBC in splens Myelog. Leu. consist of Lymphocytes P.M. Cells & Myelocytes. P.M. & Myelocytes in excess Lym. Type. Lymphocytes in Excess. Tendency to Hemorrhages. Metabolism disturbed resulting in formation in Bld. Urine of Tyrosin. & Leucin & Uric Acid Compounds. Gravel not infrequent. Oxygenation imperfect. Dysponea. Circulation weak from fatty deg of Heart. Symptoms: develops slowly. become weak. appetite Capricious, a little irregular temperature. Early spleen & Liver begins to enlarge & Lym. Glands Spleen becomes very large resembling Malaria S. Liver 2 or 3 fingers below Costal margin. Patients tire very easily. Dysponea On drawing Bld. it is pale like puss. as dis. progresses skin is Anemic & patient becomes emaciated. Increase Sexual excitement. Peritonitis common Complication or Inflam. of other serous Memb. Apoplexy may result. Headache. more at night. Bowels constipated. Urine increased. show Renal irritation due to infiltration there, Duration: Malaria, Spleenic Anemia. Pernicious Anemia. T.B. Cyphalis Hodgkins. & Lymphaedemia. Prog. grave. Splens Medullary most frequent Lymph type occurs. in children Spl. Med. longest duration. few M. to few years. Lym. Type few (2) weeks to a year Treatment: Arsenic in increasing doses & for long periods Easily digested food. Attention to bowels & Kidneys Out door Air. Not much exercise. April.18.'06. Leucocytosis increase in number of leucocytes in peripheral blood over number normal. increase never involves a diminution of P.N. Cells. but always an absolute & relative gain Certain conditions change leucocyte count normally. Apparently normal individuals may show a variation from 3 to 10,000. Spare indiv. 4. Strong. 10,0000. Physiological Leucocytosis. New form leucocytosis 10 to 13,000. During period of Digestion increases to double 13,000. Pregnancy doubtful. following confinement average 15,000. Exercise. vigorous increase to double. 15 to 20,000. may last only a few hours. Massage increases. cold baths & prolonged hot Baths Time of day lowest in morning. highest in evening After violent exercise accompanied by falls myelocytes may be found. injuries to bone same affect 1. May be apparent increase not absolute or there may be an actual increase. Cause may be elimination of toxins increase in metabolic processes. fate of leucocytes is dissloution. disintegrated & eliminated when demand ceases. April.23.06. Path. Leucocytosis. follows usually come Inflam. or Toxic condition, may result from loss of Blood. under Toxic varieties may be any element that is toxic to tissues from outside or formed inside. from Disturb Metabolism or suppuration. Must consider individual reaction to disease in estimating value of leucocytosis. Mild infection with good resistance low Leucocytosis Milder " " less " Moderate " Severe infection " poor " No " " " " good " High " Scarlet fever & Diphtheria, Erysapalis. Pneumonia Supurative Small Pox Septic Condition, Articular Rheumatism. Gonorrhea if systemic. Boils, appendicitis Throat infection, Psoas Abcess. not purely T.B. Liver abcess. Pelvic Abcess. Malignant Dis may or may not Certain Medicines produces Leu K.I. Sodium Salicylate. Salt solution Hypo Leucocytosis Ergot SulphoNol. Trional Atropine & [Tamine?] Acid. Quality of Leucocyte is of value. P.N. offer greatest resistance. may changen in qual under different diseases. Leucopoenia or Hypoleucocytosis Grippe: Measles. Mumps, Typhoid fever. pure T.B. Cystitis, Malaria may or not. Presence of Eosin in excess is Characteristic of Brochial Asthma, in Blood & secretion. acute skin diseases. Infections (Intestinal parasites Trichina, Tape worm. uricinaria, Eosinophilia) April 24.'06. [illustration] {Lateral Chain {Chem Differ for different food stuffs & in different kinds of cells. {Side " {Terms. {Receptor of cell. {Haptophore {Binding group. [illustration] May lose its toxic property while the Haptophore retains its uniting powers. Toxophore can exert its action only when its Haptophore finds affinity with a cell Haptophore. Haptophore resembling the Haptophore of some food stuff. with affinity for Haptophore of some cell more stable than toxophore. Inject Toxic element into imune animal animal remains uninjured either because the animal has no available Haptophore which may form an affinity with Hap. of Toxoid or because Torophore of Toxoid may have lost its toxic element. If inject in non imune Indiv the Toxin Haptophore combines with available cell Haptophore enabling Toxophore or Toxic element of Toxoid to act upon the cell causing symptoms of the disease. If cell function is too greatly disturbed the animal dies. If not the toxoid or toxin is only anchored to the cell Haptophore which cell not being able to assimilate or utilize the toxoid Haptophore with its attached toxophore the whole is cast off as waste. By Vergert's law the cell restores this lost Haptophore by producing several instead of one. one only being required the others are cast off which cast off Haptophores have same affinity as the original thus is formed antibodies, antitoxin, or amboceptors. If an animal be inject with inoc of Bact. in doses less than fatal the serum of animal aquires several new properties. first: a few drops of animal serum adopted to a few drops suspended Bacilli of same variety injected they lose their motility & chump. due to formation of agglutinins 2. same combination may result in a percipitate being thrown down in solution of suspended Bacilli due to formation of Percipitance 3. By same combination. Bact. in susp. Sol. may be dissolved due to formation of Lysins. Same phenomena may result by injectionn of Blood or tissue cells of one species animals into body of another. Causing Cyto Lysins. Clinical Notes Dr. Crandall Compliment is an unstable normal element which may exist in the inoculated animal assisting immune body in producing lysis. Dr. Crandall. Oct.5.06. Clinical Notes Compliment & Alexin same thing P. age 51 F.N. neg. P. well till 4 yrs ago. then had sl. Enlarg. under arms no pain. Fell 3 yr. ago struck in back. 1 yr. ago P. began feeling weak in legs, glands under arms became swollen lost 40lbs. with do decrease in Girdle Slight gastro Intest. symptoms. a feeling of fullness of Abdomen. Bld. fiding R.B.C. 2,900,000 Normal Dif. Count. Small Lymph 500 - 80 % 20 - 25 % Large " 25 - 47 % 1 - 4 " Poly Neuc. 125 - 1.4 % 60 - 70 " Eosinophiles 0 - 0 " 1 - 3 " Mast. 0 - 0 " .3 - 1 " Transitional 5 - 1 % 0 " Urine 1020. yellow cleas. alb. sug-. few Hyaline Casts. Cachectic. Lungs - Spleen extended 1 finger below Umb. & to Median line. Case II Woman . 45. Hemorrhage from Mucous Memb. loss of wght. marked dyspnea, Cachectic, limbs swollen, no pain at all. increasing weakness. Bld. Ex. Diag. I Lymphatic Leukaemia Small Lymph. 3 % " II Myelogeous " Large " 4 " Myelocytes 40 " Poly Nuclear. 45 " Eosinophiles 4 " Mast. 2 " Transitional 2 " Prog. Progressive form of either very bad 1-3 yrs. Lymph. rarer more severe. Cause unknown. Nervous strain. shock. syphilis. infectious diseases. Treatment: Arsenic full doses 5 to 30 m 3x a day An abundance of Nitrogenous food required much is eliminated by Urine. support digestion. fresh air. lots of water. Tr. Iron. & Tr. Nuxvomica equal parts. 850.000 RBC 3400 WBC 20% Halm Copes: Colored. 1 sister dead cause unknown. Brother killed by accident P. Had Pneumonia. usual Children's disease. Complains of Dysponea. for two Mo. Marked Edema of lower Ex. Scrotum tapped. Urine normal. Pulse 128 Nutral Murmur Some Bronchitis. Has had rheumatism. 10 Tab. a day Infus. of Digatalis. Potassi Citrate. Comp Jalap [??der] Dry Diet. Oct.19.'06. Dyspepsia. Starches of fruits favor Hyper acidity. Dyspepsia Tr. Bicarb of Soda. Mag. Sul. Sug of Milk. Diet Cooked fruit more broiled Milk. restrict Sugar. Examine Eyes for Headache. Drink water between meals.       Medicine. - Prof. Summa -. Stomach In Diagnosis 1st.. we determine the seat of the organ 2nd.. the Pathological anatomy 3rd.. Aetiology Disease may be caused by Heredity, Infection Intoxication. Physical factors & Diseases of other organs. By Heredity is being born with a weak stomach etc plays quite a part. Infection. By infection the stomach is almost wholly immune on account of the free HCl. & Its onward motility aids & next to acid is its inability to absorb. The presence of Mucous acids in destroying action of Bacteria. Intoxication Intoxication is the chief cause of disease by Ectogenic from outside invasion or endogenic from inside. Intoxication Means of Protection Physical factors 1. Vomiting especially more in children depending on position of stomach. 1. Emetics. Stomach tube used mostly Stomach secretes watery substance to dilute sharp substances, peper, mustard etc. for alcohol the secretion is 10 to 1. 2. Internal secretion 3. Action of Mucous on Chemicals. Physical factors. Internal & External Internally. a. Mechanical 1. foreign Body 2. Abnormal amt. of food. Megalogaster (primary dilation. 3. Course material most common cause. B. Thermal. Substances temp. too low or too high. A low temp as ice water takes half hour to bring to Normal Too high Temperature may cause erosion. Taking of cold of stomach Externally Trauma - abnormal pressure from without due to bad corset, wrong tied skirt etc. Abnormal pressure by wrong position probably Book keepers etc. 5. Causes by Other Diseases Secondary function, healthy condition of glands a. Blood disease B. Nerve Disease c. Amt. of Blood - Circulatory disturbance passive Hyperaenemia. Heart Disease. Lung " . Portal Vein " Nearly all nervous Diseases affect Stomach. Infectious & Constitutional diseases affect the Stomach. causing Vomiting etc. Physiology general Symptomatology gen. Theraphy 1. To prepare food for Digestion. 1.. Temperature regulation. 2.. Dilution of too irritative or too concentrated 3.. Disinfection of Food. HCl. 4.. Mechanical Diminution. 5.. Chemical " Solution of Substances. 2. Digestion (fat emulsified) split up. Albuminous Substance of Plant. Absorbtion of Stomach 1. Traces of Dextrin, Salts. 2. Moderate Amt of Sugar 3. Alcohol No water. How to examine Stomach. a. Physical Diagnostic means. (Pathologic Anatom. Cond.) b.. Biological Ex. (Stomach Contents) (Physiological Pathological Cond). General Symptomatology. Motor Activity Secretory Activity. a. Increase Motility (Super) (Hyperkinesis) b.. Decrease " (Sub) (Hypo ") Secretory a. Increase [Mohlin] (Super Acidity) Hyper Chlohedra B. Decrease (Sub Acidity) (Hypo Chlorhydrae) Anacidity = no Acid. Nov.21.'05 Vomitus Vomiting dont think of Stomach Disease Coughing, Sneezing etc. is Pathologic. Vomiting Organs Participate as Brain Pharynx. Vomiting is sucking of St. Contents into Esoph. there is Voilent Contraction of Ab. Muscles Center of Vomiting in Medulla. near center of Vagus. & Resp. Deep respiration when Naseau is present may overcome Vomiting Increase. Vomiting induced by Psyhical effects. Vom. is associated with disease of all organs supplied by Vagus nerve. Dura Mater etc. sup by recurrent Branch Affections of Esophagus & when this symptom occurs all organs from above down should be examined which are supplied by Vagus. When Due to Stomach must be regular & at time of Digestion Consequence Vom. Severe Vom may [to do] lead to Hem of Ulcer if such is present. & such Hem occurs when Vom. Danger to Pregnant woman causing Abortion. Anything interfering greatly with Cir. may lead to Miscarriage. Salicylate Comp. overdose cause Miscarriage Bad affect of Heart Habitual Vomiting come symptoms of Starvation. Increase motility Hyperkenesis. 1., While Pyloris open 2., Pyloris Closed. great hunger (bulimia) Acoria due to Anaesthesia. Bulinia we have poor nutrition on account of being forced into Intest umprepared. Hyperacidity Anorexia loss of appetite. Acoria - Hunger not satisfied. Bouleminia - Large apetite. Pararexid - Preverted apetite. Symptomatology of Stomach Disease Pain, Vomiting, anorexia,, pyrosis, thirst, Naseau, Rumination, Rictus. Hyperorexia in Hypermotility, Dilation of Pyloris, Hypersecretion. Thirst - Nervous disorder. Pyrosis - Hypersensibility. Stomach Cramps nearly all due to gallstones. Disease of Mouth. Salivary glands - New formation. Inflamation. Epidemic Mumps. Secondary affections of lips Innervation insufficient [Ano????] of former shape Foetor Exora. Disturbance of sensibility. taste . 4. Motility " " Tongue gum. teeth. hard or soft Palate. Paraosmia (objective odor) Physiological odor. Amonia. Hy. Sulphide; garlic, onions, etc. Path. Odors. Sweet odor. Diabetes Mellitus. Septicemia & Pyemia. Menstruation Specific odor. Chronic & acute Intoxications Bitter Almond odor. Chloroform, Ether, Bromide Ac. Camphor Opium Carbolic Acid Ectogenic. Endogenic. Urinous Odor from Chronic Neph. Cider odor in Diabetic Coma. Bad odor from Morbid condition of Oral [tract] Cavity, Morbid codition of Resp. tract. Stomach. Gingivitis - gum. Chronic Lacunar Toncilitis Broncho Ecthasis. Retention of food in Esophagus Decomposing factors of gastric ulcer Tongue changes. Inspective. Grayish tongue due to Keratosis. Coated tong. Normal to heavy smokers. excessive milk diet, By certain drugs. Iron Bismuth, Arsenic Sulphur Path Whitish Color tongue. Catarrhal glossitis. Diseases of Oral Cavity " " Stomach Sub acidity, gastric atonia. Acute & sub acute Catarrhal condition Passive dilatation of stomach cancre with fermentative processes in stomach. Center of tongue caoated whitish due to acute febrile condition. Strawberry tongue in Scarlet. fever Ichthyosis. Longer fever lasts more coated Brown tongue Motility & Dryness Cramping, jerking movements. unilateal protrusion, inability to protrude. Dryness of tongue due to Mouth bleeding drugs. atropin. Morphia. Adenoids. profuse diarrhea, perspiration. Dia. Mellitis. Insip. Ch. Inter. Neph. Dry glazed tongue in Phthisis " Brown " Acute wasting diseases. Xerostomia - dry mouth - nervous females. due to supression of gland secretion. Extensive to pint 2 oz. injection per rectum Jan.17.'06. Topography. of Chest Wall. Median. Right & left. Sternal line. Papilary. Para Sternal. Axilliary. Ant. & Post. Axilliary Linia Costa Articularis line from Eterno Slav. to eleventh rib. Lung 1 1/2 in. above clavicle. back reaches plane of VII Cervical vertical. Papilary line upper border of VII Rib. Mid Axilliary lower margin 7 rib. Scapula. reaches 9 rib. Median dorsal " 11 rib. Sternal line 6 rib. Kyphosis. Hump on Back. Curve to front is Lordosis. Skoliosis curvature to either side. Cause of Kyphosis is senile or premature Senile change or muscles lying about Spine Chronic Infectious disease may lead to cause of Vert. Corresponding Kordosis with Kyphosis is T.B. Habitual Skoliosis 2nd.. Rachitis. Nodules on Cartalage of Ribs daag of Rickets. Permanent changes Infraction from 2 to 10 ribs in Rachitis. Infraction due to method of lifting child. Projecting sternum. Chicken Breast. Pectus Carvinatum Jan..23.'06. Gastric Decomposition. " Chemical question. 1. Fermentation take place amoung Carbo Hydrates. 2. Putrefaction " " " Albuminous. 1..a.. lactic acid fermentation B. Butyric Acid " c.. yeast fermentation transformation of Sugar into Ethyl Alcohol & CO2 C6H12O6 = 2C2H6O + 2CO2 Saccharonyces Cerevisiae. Sugar germ Beer End products of fermentation is Acid " " " putrifaction " Alkaline NH3, H2S a. Comes from ferm. of Milk Sugar. C12H22O11 + H2O = Lactic Acid 4C3H6O3 B. Comes from a. Gas CH4 March gas inflamable. II. Causes. 1. Bacteria get in Stomach {1. Incompletely disinfected food. {2. Saliva. Steralize food & Mouth. 2. Secretory disturbances. 3.. Motor disturbances. 4.. Introduction of an already decomposed food. III. Clinical feature Sequelae. 1.. Anorexia 2.. Eructation of gases. 3.. Naseau. 4.. Vomiting. 5.. Pain {due to gas formation {Spasm Pyloris (Pylorismus) Anti intoxication Hydrothronaemia. intoxication of Blood. by. Hydro. Sulphat. Vertigo. Headache. Pulsations visible on chest wall. 1.. Apex Beat of Heart 2.. Visable Ht. Movements. 3.. Pulsa. of large Ht. Vessels. 2 & 4 intercostal space on each side. 4.. Epigastric Pulsations. to left of m. line between zypt. P & L.B. of Ribs Aortic Pulsations Liver " R. Heart Pulsations due to low position of Diaphran, due to Emyphsem Protrusion of Med. Exudate in Pleural cavity or 2.. enlargement of R. Ventricle. Aortic Pulsations are Parallel with m. line Liver Pulsations in insufficient Tricuspid. Apex Beat 5 inter Spac 1/2 way between Para St. & Mam. L. Under 14 yrs in 4 space & to left Position has been seen from 2 to 9 R. & on R.S. to 4 to 8. between L. Ax & Papillary. May be due to change in Diaphragm as Tympanils Ascites, tumors. also enlargement of Heart. Normally covers not more than tip of 2 fingers Fermentation dist only Motor dist. Disturbance of gastric Secretion. 1. Physiological Remarks. 1. Stimulus for secretion. 1.. Phychical St. most important. 2.. Nerve Stimulus (Vagus.). 3.. No Mechanical Stim. Chemical stim. - broth Raw Meat. Water Milk. Gelatine. Amylacrous food has no influence Fat is inhibitory. Gastric Secretion Acid most important. Appears as Comb with Alb. Sub. " " free. 2 ‰. 2., Increase seretory work. 1. Terminology: Supersecretion (Disease of Reichmann). gastro leucorrhea continue Hyperchylia. Super acidity (HyperChlorhydria) Increase Ferments. (Hyperenzymia) Causes (for Hyperchlorhydra) Abnormal stimule of Vagus. a., Abnormal condition of Vagus. B,, As a Part of Nervous System. Neurasthaenia. c., Gastric Ulcer. d. Sour Catarrh. 2 Symptomatology & Sequelae. a.. Subjective Sym Prevailing Pain greatest in Climax of stomach work. clong. of highly acid [Su?] in St. Spasm of Pylorus. diminished digestion. Acid eructation. Vomiting Objective (Sequelae). Dilatation. Inflamation. Gastric Ulcer Catarrh - surface affection of Mucous Memb. Mucus, serum, pus thrown on surface. In stomach Mucous is only product. Pus & Serum is digested. Sub acidity Mucous is clear glassy. Mucous in flakes sour Catarrh. Diminution of Secretory work 1. Terminology. a. Reduction of Entire Secretion (Achylia B.. " " Normal ferments (Anenzymic) C.. " " Secretion HCl. Subacidity - Hypochlorydria. Anacidity - Achlorhydria. 2 Causes Hypochlorhydria. a. upon Hereditory basis. A " a. " Nervous disturbance. Hypchlor: B.. general diseases Acholic Stools (no Bile) Without fever. Blood diseases. Constitutional D C.. Feverish diseases. (infectious Dis) Ant - intoxication. D. Catarrhal Diseases (except Sour). Achlor. B Destruction of gland. tissue. Toxic influences. Chronic Catarrh. 3. Clinical Symptoms. 1. None at all 2. if assoc with HyperKinesis. when cir. Dis is slight Intestinal affection. Particular in no motal Dist. 3. assoc with Hypokinesis. ferm. & Putrif. 292 Chest wall. small protrusion. Area is half side or whole of chest wall is distentions & retraction 1., Protrusion: Abnormal condition of covering of chest wall. Lipoma, Tumor of Mama, tumor of Clavicle {gumata {Sarcomatous. any abcess formation. May have disturbances from within may be between ribs or come thro' the ribs. Between ribs Hernia & Exudate in pleural cavity. Projection may be physiological. (Phy Heteromorphism) failure to develop etc. Empyema most important. Morbid cond within rib: Carcinoma primary in Bronchi, Adenoma or Sarcoma. Aneurism by continuous pressure. Differential Diag: first by Resp. & 2nd. Circ. Movements. Tumor pulsate in only one direction while aneurism in all direction. On deep inspir. all tumors seemingly disappear. & you may feel bony outline of ribs. by pressing on tumor you may get Circ. Disturbances. Dysponea & Cyanosis. Projections are possible in region. of heart from 3 to 7 left Ribs R Para St. to Left Pap. line are then called Voussure may be abnormal Curvature or Enlarged Heart or Pericardial exudate. Dif. between Eul. Ht. Exudate. If to Heart it is to the left & you have increase heart impulse (ictus Cardis) & if no heart impulse & reaches to right due to Voussure & no impulses think of Exudate. Protrusion in R. 2 & 3 intercostal space are chiefly aneurisms of ascend Inom. artery & ascending Aorta Prot in left. think of [Ascend] arch. Aorta A sunken in due to morbid cond. of Integument or to Physiological or to morbid cond. below first Pleura by heal up Pleur. Ex or to old dry Pleursy. or to liquid pleursy lasting a long time & power of Expansion lost. May be due to Lung (Acteletasis). " " " Pneumonic. Bronchia Esthysis. or T.B. on acct of Pleuritic effusions Most lower down are due to Distentions., due to Pneumo Thorax Pleuro Exudates. Loss of Lung Elasticity or Emphysema fascicular Submotility Term, Clinical Sym, Causes. Cause 1.. With Impediment in Pyloric. 2. Without impediment Perichole, cystitis consequence of gall stones. 2.. A.. Congenital Weakness. (glenards Disease) 1884 France B.. Anomalies in position. Enteroptosis displaced organs C.. Chronical Infections. Gastroptosis Anti tonic Diseases Hepato " D.. Chronic Catarrh's. Nephro " E.. Unknown degenerative changes Colo " in musculature. Clinical sym. A.. Decomposition B. Dilatation I General Clinical features. II General Therapeutics. I A.. gastric symptoms. B.. Intestinal " C.. Disturbance in nutrition. D.. " " Nervous System. E.. " " Blood formation. F.. " " respiration. II. 1.. Prophlaxis 2.. Dicto Therapy a.. general measures b.. secretory Disturb. c.. Motor " (Decomposition). d.. ExtraBuccal Alimentation 3. Pharmakotherapy. a.. Acids & Alkalies. B.. Medicines against fermentative processes. C " " Special affection. D " improving secret & Motor functions. 4. Physical Therapy. 1.. Lavage. 2.. Hydro pathic procedures. 3.. Electricity. 4.. Massage. 5.. Operative indications Therapeutics of Stomach Diseases. Prophylaxis. Diatetics: Mech. Chem. Thermic. Diminution in Amt. avoid hot & cold. proper quality. Chem: Dietetic proper. 30 grams Whut B. 1 cup water. 30 gr. (℥ i) 1 t 1 1/2 ‰. free HCl. Albumin increases acid. give rest. For Hyper. give fat. decreases acid secretion For Hypo. Dim again of Funct. Activity. 1. Alkali. Acid. Dilute Hychlor. Acid 10 drps. in water ever half hr. till 4 doses are taken. 1/2 lb meat 120 dip. HCl are necessary. Alkali. Magnesia usta. Bismuth Sub nitrate. 15 gr. 1.. May form gases. 2.. acts as stimulus Secretions increasing & decreasing. Atropia Sulp. inhibits for time [short] Pilocarpin Hydroch. increases secretion 1/8 to 1/20. Hyosinum Hydrobromatum gr. 1/100 to 1/200. increases HCl. for Nervous troubles. Disinfecting Drugs. Cleanliless of Mouth. Many patients of Acute Febrile Diseases die from secondary infection thro' mouth. Salicylic Acid. ꝶ. Acid Carbol liquid gr. vx aq Chloroform.. ℥ v. May add Casc. Safrod [illegible] for Constipation. Stomach Tube. to wash Stomach. Drugs for special purposes. Nitrate of Silver. Subnitrate of Bismuth. introduced 1/2 to 2 % Nitrate Silver, 1 pt. warm. leave 1. 2. to 5 min & draw out. ꝶ Argent Nitric grs. iv. Aq. Dist. ℥ iii. Glycerin ℥ i. m Da ad vitreum caeruleum. (luteum) Sig. Tablespoonful before each meal given from glass. ꝶ Argent Nitric grs. xv i ae Bolus Alba qs. Pills no. 100 Bismuth Subnitrate covers ulcers & allows food pass over without pain. in 30 gr. dose. 1 powder suspended in water before meals. Physical Methods 1.. Stomach Tube. 2.. External Hydropath Treatment. 1. Cold packs. 3.. Massage. Left to Right. 4.. Electricity. 5.. Operative Treatment. 1. Stomach Tube. Counter indications: Affections (certain) of esophagus. Acute Esophagitis & Venous Dilatation. from Serosis of Liver thro' Disturbance of Portal Cir. Affections of Heart & Pericard. Cardiac end 7 rib juntion L. Sternal line Pyloris level of end of Ensiform on a level with Parasternal line. fundus may go to 4 intercostal space. 4/5 of major curv. on L. Side when collapsed cannot reach. Give no water before examination. Mouth. dryness moisture. tong. teeth. Below ribs depression then protrusion. Protrusion may be due to liver below Umb. but usually by stomach distended with gases. Sunken in may be due to shrinkage of stomach or misplaced stomach. Gastroectasia: disturbed motility. Gastrodiaphania lighting the stomach. Fill stomach with Bismuth Sub Nit. & use Xray. Palpation: sensitiveness & resistance 2 in from spine in Mid Axiliary Para sternal line Neuralgic Pain. Localized may be cancer. Diffuse in gastric. Resistance. Preperiteonal lipomatus pain on pressure. Epigastric Hernia. Pain. Percussion. Drink water or inflate. Presence or absence of seccussion. Presence without giving water is motor disturbance. Gastric succorrhea: Chemistry. Alkaloid. 1. Strychine. [Bic] K2crO4 + H2SO4. Crystal. HNO3 -> yellow (Marguis Reog.) [cross out] 2. Caffein - alk. not typical. Purin Ring [illustration] to Kanthin. Cof + HNO3 = yellow + am. = orange. (Nantho Proteic.). Xanthin decomposition products of Protieds. Caff sol. in water. Theobromin not. Theobromin - Sod. Sal. (Diuretin). 3. Prepotoxin - Nitral Principle 4. Morphin - Alk. - Codein, Narcein. Narcotin. papridin, Thebain. from Opium. 1 2 3 Morphin Artificial Alk. Heroin - Dionin - 1. Diacethyl 2. Ethyl. Benzol. Tests: for Meconic acid. Marguis (20 CC H2SO4 1 CC Formalin 40%) play of color (HNO3 & Heat orange color). purple red to violet Blue. 5. cocain. Alk. decomposed on heating. Eucain. Synthetic. Stovain. Amypline. Holcain. Heat + Alc + HeS)4 -> [??sity] odor of [illegible] Organic. Functional Diseases. 1. Catarrh {Merch. {Poison. Acute Toxic Gastritis. Pain. Vomiting. 1. Stomach Tube. 2.. Emetic (ApMorp) 3.. Physics. (Calomel). (Hypo 1/10 gr.) Cardia. 2.. Cancer: Fundus. 72% Pain. Smaller Cum. 22% Vomiting. Pyloric end. a. Tumor belonging to Stomach B. Cachexia. = C. Abscence of HCl. Cardia: Gastrostomy. Albuminous food restricted & increase fats & Car. H 6. Atropin: Hyocyamin. isomeric. Scopolamin & Atroscin isomeres. Hyosicin. Nervous Dyspepsia. 1.. Sensitive Neurosis. 2.. Motor Neurosis. {Anesthesia {Hyperaethesia {Ahypo- Kynosis {Hyper. " 3.. Secretory Neurosis. {Achlohydria {Hypochlorhydria {Hyperchlohydria Anaethesia - (Boulimia). Akinesis (following Operation) Acute Dilatation 1 Nervous Diseases most common. 2. Following diseases (secondary). 3. Organic " Neurosis where symptom is present or conflicting symptoms Treatment. Anaesthesin. 4 to 8 grs. Suggestion. Liver. [cross out] Chronic Inter. Hepatitis. Cirrhoses. Due to alcohol. Liver notched. yellow May.3.06. Function of Liver. 1.. Bile 2.. Disposal of food Material. a.. Carbohydrates. {Portal V. B.. Peptone C.. Fats Hepatic Artery. Carbohydrates changed to glycogen then back to sugar. Petones - NH3 to Urea Protects against Automtor. 1. Stores up fat & 2. forms fat. 3. Attracts fat from others organs. General Diag. of Liver Diseases. 1. Liver itself. percussion & Palpation inspection auscultation 2.. Disturbance in Bile system Icterus. 3.. Disturbance in Portal Circulation 1. Distention of veins on Ab. [Su?] 2. Ascites. 4.. Spleen 5.. Examination of foeces & Urine. General Symtomatology of Liver Diseases. 1.. Changes in Organ itself 1. Size, consistency, shape, surface. Pain. 2.. Icterous 3.. Ascietes. 4. Hepatargia. (Dilated Veins) Biliousness. Lionel Biale Oct.8.06 Struma. Goiter. Parenchymatosa. Struma mostly Bilateral. Thyroiditis is painful. Carcinoma is Hard resistance Cyst is smooth soft. fluctuating. Surgical for Cyst. Tr. of Io. gastrodemia Nov.12.06. Alb in Urine & Dropsical Cond. 1827 Brights Disease Passive Hyperemia. Cyanotic Kidney. Acute Paren. of Secreting cells. Chronic " Amyloid Kidney.  Treatment (of any infectious disease.) a Prophylactics. 1. Quarntine a. National: Immigration- Coast: Inspection of Steamships etc. [Inspection of all products of food] B. Civic: Inspection of all immigration trains boats etc C. Certain Ty of infection 2. Isolation: until not transmissable 3. Personal Disinfection all excretion & everything in contact with Pt Room: furnishings washed with Bichloride walls calcimined fumigation 1 pint 4% formalin { 1000 gtt. for 24 hrs. 4 ℥ Potassium permang. sulphur formalin. ammonia will clear this up Body: wrap in Bichloride sheats. Sealed [illegible] Private [f?????] 4. Civic: Legal. special laws & requirements. Report of all infectious to Board of Health individual inspection investigation of all infectious diseases Free clinics Sanitories General Sanitation: water food supply. sewage [w???] mosquito. rainbarrels cisterns 5. State: Inspection of food stuffs. Sanitorium T.B.C. 6. National: Inspection of food & immigration. B. Specific Drug. Serum Vaccination C. Active Hygiene Proper Ventilation light sun. remove all unnecessary furniture Proper Bed. Mattress Covered by rubber sheat. Clean sheats Personal: clean night shirts clean bed dress daily split femals daily bath alcohol rub mouth head etc & convalescence wheel chair etc. B Diet. C. Medicinal: 1. Specifics... 2. General. 3. Local 4. Symptomatic. A Parasite is a small organism which has habitation on stronger " & feeds on such. Animals Entozoa 1. Temporary - leech - 2. Permanent - tapeworm. Ecto parasite. Cling to surface - leech - Ento parasite. Internal. - Malaria - Tapeworm - Leech fastens on by sucker at each end of Body. recognizes host when in water by sensation of waves. gets food from smaller creatures. Tapeworm is true Parasite, poor sense, no eyes, ears. has no Alimentary Canals. Gets Nourishment by Absorption. Has habitat in Chyle, must have head & suckers. to enable it to maintain position. must have continuous production of cells or segments. & these Segments produce eggs. these eggs are produced to spread disease as action is Passive. These eggs are taken by Hogs & in hogs they pass thro Intestine wall & arrives in Muscles & gets back to man. Hosts. Temporary Definitive Groups of Animal King Protozoa 1 celled animals. Malaria - Metozoa tissue producing animals Porifera Coelenterates Ectimodermus Vermes { are parasites reason: low organization. Arthropods. { Mollusca. Protochordates. Chordates Verterbrates. Protozoa Amoeba. [illustration] Pseudopodia Naked Protoplasma fluid like, process of movement. 1. Rhizopods Amoeba. 2. Flagellata. [illustration] move tail first Trypanosoma mouth rare. 3. Sporozoa most important includes Malaria Absorb nourishment Animal Dis. Texas fever Division By breaking within Microgametes Sexual generation in Macro " Egg. Mosquitos. 4. Infusoria round or oval covered with cilia [illustration] Large cilia around mouth to take food no permenant anus Paramecium food remains in vacuoles till digested. Rhizopods. Amoeba Coli - Loesch 1875. Produces a form of Dysentery. [illustration] Ectosarc Endosarc. Divides Nucleus first. When outside thick capsule forms Encystment [illustration] Highly resistive gets in plants & Digestive juices soften capsule liberating Spores. 1. Amoeba harmless 2. Intensify or alter lesion already present. 3. Different kinds Pathogenic & Non pathogenic. 4. All amoeba are or may become Pathogenic. Cannot get pure culture on a gar. To get Multiplication another Bacteria must be present Period of Inoculation Tropic Dysentery produced by Amoeba. Cultivating Amoeba increases virulence. Abcess in Liver Doesn't spread in Monkeys. Flagellates very numerous & important. Trichomonas Vaginalis young & old past Menopause [illustration] nucleus mouth not important 10 to 15 η 7 to 10 broad. form varies Lamblia found in intestine Intestinalis [illustration] Cup shape body fits on epithelial cells. transmitted thro' foeces. I. Trypanosomidae. a. Trypanosoma [illustration] Blepharoplast, divides first flagella is vibrating body. b. Spirochaeta. [illustration] free living Trypanosoma, parasite in Blood of variety of Animals. B. Spirochaeta Pallida - Syphilis " Obermerei - Relapsing fever. May have long axial nucleus a. Trypanosoma. Division Longitudinally New membrane formed produces flagella In Rat my be 1 μ - 60 μ. 1. Trypanosoma leuvisi found in Blood of Rat about 25 % rare in white rats & tame rats. Observed 1845. Lewis 1879. Morphology length 8 to 30 μ width 2 to 3 μ. Protoplasm granular granules related to division. flagellum single long as body, large oval Nucleus Rapidly motile. Keep alive longer in cold. require oxygen & show affects of Septic conditions. Nucleus Reticular. Blood free from infection will inoculate Rat. Serum will produce active & passive Immunity Agglutinate in Rosette form when in Serum. Serum produces great activity of Leucocytes & liter of agar they act. Grow on Agar + 10 CC Normal Na Carbonate Sol. cool to 50° add 2 volumes Rabbits Blood. Dec.13.'05. Trypanosomes. - Divide rapidly. Binary - one becomes two. Rosette - multiple division Agglutinate in Rosette form. [illustration] Disease in Domestic Animals in southern tropics S.A. etc. Surra - Horse Disease in India & Philippines Tr. Evansi. Nagina - S. Africa - Tr. Brucei. not sheep or goats. {Dourine N. " Europe Tr. Equiperdum. {Mal de Coit Mal de Caderas. S.A. Tr. Equinum. Brucei 15 to 77 μ Surra - general similarity in all cases. variable incubation period. rise of Temp. stupid, watery discharge nose & mouth. Hair falls out. marked emaciation, Aedema of parts genital, gait staggering. Skin Eruption, Parasites found not always in blood Autopsy Enlarg Spleen, gelatinous material in Adipose Serious Exudate Aedmatous condition Don't know of Recovery in Horse & Mules. No toxin has been found. No evidence of Tr. getting into mouth. Must be conveyed by blood suckers. Quite a number of flies contain Trypanosomes. Tse tse fly which affects. Glossina morsitans. Rats get it thro fleas or lice Tr. does not change or develop while in flies Tr. live for about 48 hrs. on the flies. Dogs & cats when inoculated are susceptible. for culture 2/3 fibrinated Bld. & they lose virulence on cultivation. Treatment not suscessful. Trypanosomyses in Man. Nep view found Tr. in 6 out of 200. Malaria also found. 1901. Dutton Relapsing fever, wasting Enlarg. Sp. increas pulse & respir. fatal 18nn. fatal in Monkeys 2 months. Tr. is Distinct Species. Trypanosoma Gambiense. Human Tr. sleeping sickness. Castelliani - sleeping sickness amoung poor. in Marshy regions. 10,000 have died in 4 yrs glossina palpalis fly which carries disease. Symptoms Tr in Blood yrs. & enters Cerebro Sp. fluid which is second stage. fevers hectic. pulse increase neuralgic pains, trembling of muscles, weakness, Emaciation Death due to obstruction of cells of Brain by Tr & prevent Bld supply Congestion of Meninges, increase quan. of Cul Sp fluid. to Examine 10 CC Blood from vein + 1 CC Citrate of Na Centrifuge 10 min Exam Hang drop & Spear. then try inoculation. Can be examined from Cebro Sp fluid. Phropoloxis. Animal must be quarantined. Protection of Carcus from flies. Destruction of flies. No cure for Disease Dec.18.'05. Spirochaeta [illustration] flexible undulating membrane some have of flagellum at each end. Sp. refringe has flagella. 1873 Relapsing fever - Spirochaeta [?berimeiri] swim rapidly in Blood 17 to 40 μ by .1 μ. Does not stain by gram's 3 motions in movement Nucleus may be along axis. Short Period of incubation. Increase as fever increases dissappear at time of crisis. Spirochaeta Pallida Schaudium Apr.4.05. found in Primary & Second. Hoffman. --- but not yet in Tertiary. (giemoa stain) 4 to 10 μ. long found in chancre. lymph glands. Sp. Refringe found External lesion. & non Syphalitic lesions. Class III Sporozoa. spore producing animals. all parasitic. intracellular parasites. at some stage, some altime. Order I. gregarinida - not Human. Parasites. " 2. Coccidiida - Rarely " " . * " 3. Haemosporida - Often " " " 4. Sacosporida - Rarely " " " 5. Myxosporida - None " " fishes Coccidium Cuniduli in Rabbits. [illustration] sporozoite Merozoite Macrogametocyte Microgametocyte Dec.20.'05. Coccidium Hominis about same as in rabbit. Haemosporidia: Blood Parasite of all Vertebrates except fishes. Always in R.B.C. in Vertebrate. [Illustration] sporozoite. asexual (Human) Melanin Merozoite Macrogamete tocyte. Micro " tocyte microgamete. Malaria: Tertian. quotidian Lavenania Malarae Quartian - " Malaral. Aestivo Autumnal - " Praecox. Paroxysm when Merozoite are released. Ross - Mosquito cycle. [illustration] Cysts filld with Sporozoite break out & get into salivary glands of Mosquito Aokinet, Pigment collected, enters Epithelum of Stomach Anopheles Mosquito. Culex Birds. Intermediate host. has asexual stage of Parisite Infinitive " " sexual " " " Mosquito is Infinitive host for Malaria. Tertian 12-20 Quartian 9-12 Astivo Autumnal 10-12 pigment scant & heaped in one spot. Tertian - sexual differenciation after 3 Paroxysm. Anopheles stands on head [illustration] Culex Anoph. Maculipennis punctipennis. mottled wings Stegomyia fasciata Cuba Anopheles & Culex in all parts of world. Malaria absent account of Cold Mosquito not ever being infected [illustration] Palp. Antennae male anopheles. female pointed Palp. female culex short palp. male culex. Propholactic. 1. Destroy Mosquito. 2. Destroy disease in man. 3. Drainage of sloughs. 4. Oil on water to prevent breeding. Duckweed (Lemna). few mosquitoes are found. Piroplasma. Bovine piroplasmosis. (Texas Fever). Ovine " sheep. Canine " Dogs. Europe Equine " Horse, africa. Human " Rocky Mts. Bovine high continuous fever. 108° Dim. in Bld.C. [illustration] Begeminum 7,000,000 to 2,000,000. Cattle. Ameboid Human. Western Mont. 126 cases to '03. 70 to 80% fatal. Organism in Blood In Wood stick time. one side of stream. Hypoderm. Quinine. Vermes. Infusoria - appear in infusion. Jan..8.'06. 1. Balantidium Coli [illustration] Peristome Nucleus Micro N. Vacuoles contain some food. Cilia all over large at mouth Reproduce by constriction in middle Appears in swine intestine & sometimes in man 117 cases in Manila 35 fatal ulcers in Intestines. Chronic disease characterized by diarrhea. Come from Northern Europe. Mode of infection direct as using intestines of Hogs. May in cyst itself. 2. Plat helminth = Flat worms. Solid mass parenchyma. Class a. Tubellaria - in water damp places not Imp. " B. Trematode - Flukes " C. Cestodes - Fluke Liver of sheep. Liver Rot. Distonum Hepaticum Tasciola [illustration] Organism has both Males & Female genitals. Eggs pass from sheep may fall in water & the egg shell ruptures & Miracidium escapes & swim about in water & gets into breathing apparatus of snail & then forms a cyst Spiro cyst contains germ Ball. Redia forms & multiplies & snail becomes infected Orcaria have tail to swim makes its way out of snail & gets on grass Blade & sheep eat grass. it is protected by cyst wall in stomach & gets to Bile Duct. Occur in nearly all herbivorous animals occasionly in man. Path. P likes obstruct B. Duct & cause L. Rot. [illustration] Sporocyst Redia Redia Divide. Cercaria Jan.10.'06. Chistosomum Haemotobium. Bilharzia - 1852. Disease in Africa lives in Portal Vein. Bladder affected Catarrh Kd. Inten Nephritis. Native of Lower Egypt. 30% affected. Eggs cause most trouble cause stone in bladder. Has wide distribution Nabia to Cape Colony. 15 m.m. [wide] long 2 suckers. body covered with warts & prickles female more slender. 20 m.m. long. 2 Alimentary canals which come together behind suckers. female has ovaries & yolk. Eggs pass out in urine & get in water [illustration] Cestodes. Bothriocephalus latus. 1 in wide 30 ft. long. two suckers on head. segmented animal. compound. Nurse portion which get into system. Six hooked Larvae gets into muscle of animal from intestines. [illustration] Bladder worm. with which pork is infected Alternation of generations. Hydalid form fert. Egg Proglottis discharged by foeces Taenia Solium. & gets into Hog. Each joint is independant. Scolex - (head) has hooks or suckers. Uterus cavity in Parenchyma [illustration] Eggs fertalize & pass to Uterus & other sex organs atrophy Tena Soleus is Slender [illustration] Both Latus retains segments gets in Hog & throws out eggs. may get into water & in fish Jan.14.'06 Taenia Saginata - Beef has no hooks Proglattides are very active Uterine branches are numerous. Taenia Soleus 7-10 Uterine branches, No hooks. Flesh of Hogs contains Bladder worms (Cyst cercus Cellulosae) Ox is (Cyst cercus Bovis) in Hog is inter muscular 20-30 mm. long 1/2 wide [illegible] In stomach Head & part of neck remain [illustration] Cys. Bovis from muscle of jaw mostly Proglotlides active & from excrement get on Blades of grass & back into animals. Dipylidium canum. Dogs & cat sometimes in Children get on Dog louse & louse is infected & gets back in dogs by their eating [illustration] in small intestine of Dogs (T.Echinococcus Ech stage in Domestic animals & not uncommon in people Brood sacs may be large as an orange mostly in Herbiverous. [illustration] Dipylidium Jan.17.'06. Nematodes Trichnae Filiaris. Uncinariasis - worm in intestine sucks blood in Poor whites of South. Ascaris lumbicoides small intestines of man & mostly children. Common in Finland Holland. Sexes mostly distinct in Nematodes. Not so large in man 20 to 40 c.m. Specules sharp hook shaped on tale end this tale hooks around female. [illustration] Pass out with foeces 70 to 50 μ 50 to 40 μ. Must be kept in moist place 2 or 3 months & can then be inoculated. Form long & cylindrical. genatel opening on ventral side mouth is Terminal [illustration] Straight Alimentary Canal. Triangular hunen Body covered with thick cuticula Excretory system opens near mouth. Nerve ring surrounds Esophagus near front. and four nerve bands run back connected by commisures Oxyaris Vermicularis limited to children. female 10m.m. Male 3 to 5 m.m. [illustration] mouth terminal simple alimentary canal live in large intestine. Produce irritation. Crawl out of anus at night may get in vulva. Egg may get on finger & into mouth. May occur in large numbers. Family 1. Ascaridae Genus ascaris 250 species. " Oxyuris. 2. Filariidae - Trichinella - Filaria - 3. Strongylidae - Uncinaria. Feb.12.'06. Starfish ovum: Holoblastic seg - equal Div Meroblastic seg. Discoidal Development of Chick. 1.. Shell two parts 2.. Membrane two layers. air chamber between. 3.. Transparent part. Chalaza from ends to y. 4.. Yolk in membrane [illstration] Somatopleurae. Sphlanopleura. Amnion formed from Somatoplura folding over Embryo Cytomorphosis. 1. Undifferentiated Cells 2. Progressive Differentiation. 3. Regressive " 4. Dest. Death. " Law of Unequal growth. Histogenesis formation of tissue Organo " " & origin of organs. Epidermis & apendages nervous system. S first sp. n. 2nd.. Div. of Brain 2 sense organs [illustration] muscle plate outer layer somite [illegible] my stome duct area Pellucida zona sclerotome Bodies of Vertebrae. Endoderm & Meso. Sphlan & layer. Bld. Ves. formed. Ductus Cuvieri. Mesenchyme. Endoderm less developed. Epi. of Digestion tube: Lung, Liver, glands etc. Notocord Mesoderm: Supporting tissue of Bone. Blood & Vascular System & g.u. System. [illustration] Beef tea. = [illegible] comp. from proteids C5N4O2H2(CH3)2 { Theatovum { Theaphylliv { Puraxanthen Dr Nicholson Oct.15.'06 Wounds of Abdomen: { Non penetrating. { Penetrating. Non penetrating diag easily made. inspection & touch. Small wound should be enlarged. Large clean it Close large wound. Penetrating wound. do not insert finger or probe. Normal Saline Sol. Punctured. gunshot. & Stab. Ascertain condition of Viscera Prog. depends on this. Existance of air not dependent. Explore wound by careful dissection. Incise above & below. 1.. General 2 Local symptoms of Dif. in Pen & Nonpen. 1.. Vomiting may be result of injury blood indicative of Stomach 2.. Palor. may come from shock. 3.. Pain not important in differenciating. 4.. Pulse 5.. Hemorrhage. large amts. in Abd. usually an Ozing. Weak. fast pulse Air Hunger when much hemorrhage takes place. Operate in Hemorrhage & where contents of Bowel escape. Lembert Perotring Holstead Sutures 4 or 5 to inch. Examine viscera in line of Injury. Murphy's Button. Compress Ab. [Injury] Aorta to find place of hemorrhage. Handling intestine causes shock. Oct.22.'06. Ulcer of Stomach. & Doudenum Necrosis of wall probably cause of local origin funnel shape. terminal but most often in Lesser Cure & Pyloric orifice young women. Sum. Pain. Cir area of tendencies & vomiting & Aid Vomit blood without Cer diag positive. Ant wall may perforate. Post Wall. Catatria. Previous of Supposed Dyspepsia for months. Surgery advisable after more than one hemorrhage of considerable amt. & recurring. If in Post wall open ant. wall. Lembert Sutures on Post Wall. Mortality may havve stenosis. Cicatrical not common result of destruction of Mucuous Memb. Oct.29.'06. Abdominal covered or partially by Peritoneum. Dec.17.06 gallstones usually preceded by inflammation & infection Long jaundice may have haemorrhage on operation lack of coagulation. Test coaguability prior. More than 5 min. countraindicated. Chloride of Calcium 1 gr. to 30. feed gelatin. Chlcocystotomy indicated small incision parallel to ribs. 100 or 110 day catgut stones in duct more serious. Stomach; foreign bodies may cause symptoms resembling gastric Crises of Locomator Atasia. Use Xray. Give food which form a bolus. potatoes etc. dont give purgatives. Jan.7.'07. Ulcers: Anaemia. Syph. Alc. Embolism. Acidity Burns Skin. causes. Excess HCl. Blood Brighter red. Anemia some loss of flesh. Naseau. Pain. Vomiting. Keep Patient in bed & use Rectal feeding. Large doses of Bismuth 60 to 120. Nitrate of Silver is good. Carbolic Acid 2 drops 5x a day Lapastomy. Gastropexy. attach center of ant Body of Stomach to body wall. For dilated stomach attach Post & ant. wall & push in Lesser curvature. Double stomach. may remove one or fold one upon other & make opening between. Cancer stomach of Cardia produces atrophy of S & dilatation of Esophagus. food retained in Esophagus may become enormous. should be recognized early. Dispepic sym. Vom. Pain over 40 yrs. is suspicious. 1.. age after 40. 2.. Pain. 3.. Anemia loss flesh. 4.. Haemor. Vomiting. Tumor not so important. Decreased Mobility. HCl free is absent. If Lymphatics are involved dont bother stomach May grow away from Lumen. Radical early before Cachexia & other parts involved. Next to Uterus most frequent for Primary. 1. Cylindric Cell. 2 Encephaloid 3 scirrheas 4 Colloid. 2. Rapidly destructive. substance like Brain substance. Jan.14.07. Hernia 90% irreducilbe contain omentum. Inflam trouble. Heat. swelling, tender may becaused by escape of contents from Bowels Incarcirated, obstructive, obstruction of Bowel may not be complete. Causes digestive disturbance strangulated also affects circulation may perforate. toxaemia causes death. General sym. Pain. Prostiation. High temp. Vomiting. Higher up earlier vomiting: may have gas & frequent small stools. Reversed Peristalsis. Inguinal 80% of Hernias. Oblique 93% Direct is mostly Bubonicele. Infantile 60% cured by operation. Soft Pad is better. Richters [illustration] Litters Hernia [illustration] is a diverticulum   Fibronous Bronchitis It have Bronchioles covered with fibrin & when lose are balled up & expectorated. found in people of Tubercular Tendency. found with some skin Diseases. Between ages 20 & 40 Most frequent in Spring & fall Symptoms: Commence with Chill temp runs up. Compressed feeling in Chest. interferes with Resp. Bronchial cast are distributed quite general. Treatment: is to try to remove casts. Inhale - warm steam give Pilocarpin may cause flaw in mucous. Io. of Soda good for Permenant treatment. Congestion of Lung - Active & Passive.- Active Congestion congestion of Alveoli, air vesicles & increase in Temperature. Preceeded by Chill Sudden exposure to intense cold. Passive congestion - Weakening of Heart. Mitral Insufficiency mechanical form Pulmonary Hemorrhage. May be Capillary small & ozing from a number. or bursting of large. Pul. apoplexy due to infarct. & breaking into substance of lung. is rare. Spitting of blood is indicative of T.B. May be in Health person. T.B. is frequent. Blood is Veid when vomited. " " alkaline vom Mose. Pharynx Cling etc. " from aneurism expectoration continues for several days - serious - Broncho Rag is indication of pneumonia. Cancer of lung may cause breaking Broncho Ectiches Dilation of Bronchial tube may cause small article to give way. Hemorrhage may take place from abcess. Heart Disease - most frequent is Mitral Disease. Viterious Hemorrhage. where disturbance of Menstrual flow. Japan & China due to worm in Bronch. tubes. Distom Lungara When due to T.B. usually takes place at night. Diapedese keep Bowels open use opium keep quiet Ergot Adrenalin. Ergot + Opium. Pneumonia. Infectious Disease Lobar. Croupous Firbrous Pneumonitis United five Runs a course termination in lysis. Urinates when enough antitoxin is formed to counteract Disease. Serum does little good. Due to Deplococcus Pneumonia of FRankel found in 20% of Hattly people. Vitatility should be lowered. Wide spread. Sudden changes favorable. fall & Spring best time. most frequent of acute Dis 20 to 30 in 1000. Violent Exposure. Males more frequently. fatal after 50 yrs. Debility & is secondary to Brights etc. Once had is more likely to develop. immune for about 6 months. Epidemic in certain localities. or in houses. Affects other organs. may be a cause of Pericarditis. When apex Pneu. may have a Meningitis More frequent is Endocarditis. more or less Pleuritis. 3 stages Stage of Red Hepatization 1st.. Engorgement. " " gray " May have violent Hemorrhage in Engorgement. Tension of Pulmonary circulation increased lasts 24 to 36 hrs. this Precedes. Engorgement. Crepitation in Engorgement Stage. Capillaries swollen. fibrin in air cells is semiliquid Red Hep. fibrin fills air vesicles, Bronchial tubes has granular appearance. Certain cells are slower to be involved & here is where there is crepitation & when lung becomes solid we have Bronch. Breathing Alveolar walls are infiltrated leucocytes are found in interlobular tissue & there is approaching of Gray Hep comes after crisis. fever has subsided. leucocytes & gradual softening Leucocytes aid in clearing up. & looks like Purulent Secretion this is calld Resolution. When this process is retarded small abcesses form or another termination is interstitial development of fibrous tissue & this destroy function of these cells R. Lung is more frequent involved than left. 51% 32% 16% Symptoms Ushered in by chill lasting 20 min to hr. comes on abrubtly. fever rises rapidly to 104 - 4 1/2. after chill cough commences. dry cough. Pain on side where pain is located usually [nip??] may be refered to abdominal region. Grunting with cough. Cheeks red, Eye Bright.. Respiration increased & is an effort. may hear Crepitant Rales. Broncho Vescicular Murmur over inflamed part. 16 - 72 . 45 - 100 favorable Prog. 60 - 110 unfavorable Prog. Expectorate Mucous tinged with Blood. later Rusty color Sputum Pathognomonic. Old people & insane do not always have these signs. Second stage - early we have Crepitant Rales made by Inflam. products thrown into Air Vesicles. later material has filld an vesicle & such Rales is not heard then late stage is consolidation & Dull percussion & Bronchial Respiration. If extensive Bronch or Chest Voice is heard As Dis progresses Symptoms increases Delerim. Leucocytosis, high colored Urine, Increase Uric Acid. Pseudo Crises temp drops & Patients seems to be improved & after symptoms are more serious 7 or 8 days have true crisis antitoxin has been developed which counteracts the toxins of Organ Heart should be examined frequently. Second Pul. sound is index to lesser Cured later R. Side is dilated & interferes with " " Cyanosis appears. Sound is Muffled. Prognosis grave in old people. Not bad in Children & Healthy adults. Do not rely to much on treatment, most time is over. medicated. Pneumonia with Meningitis fatal. Meningitis most apt when upper lobes are involved. Endocarditis interferes with recovery Peri not so serious Pleura nearly always involved. Great deal depends on the heart. When Pulmonary second sound is dull there is increase in Beat & may lead to Muffle sound. Brackacardia. Prognosis bad strain on R. Ventricle. Toxins bad effect on Heart & Muscle cause of Delirium Treatment Self limited Quinine not large dose 3 grs. every 3 hrs. Reserve Digitalis for Extreme Measure. Strychnine acts as tonic without increasing contraction a valuable remedy where heart shows weakness. Alcohol - Whisky Brandy are Best. Don't use Opium. Sulphonol. Bromide of Soda to allay Nervous Debility. Fibroid Phthsis Interstitial Pneumonia: Phthsis means wasting or contraction Unilateral disease, condition where fibrous tissue takes place of the normal. are brot about by various conditions. Septa & Alveolar walls, & Pleural extensions. & Interlobular tissue. Local & Diffuse form. Tubercular invasion have some local. fibroid tissue in walling in foci. Abcess of Lung, Gumata etc have same local condition that is substitution of Normal by fibroid tissue. Diffuse variety cause is a sequence 1. Of Acute fibrinous Pneumonia when there is failure of normal course to undergo Resolution or partially after organization there is contraction. 2. Chronic Broncho Pneumonia result of Tubercular condition, lung becomes absolutely dull. 3. Pleuridigeous form originate in dry pleura & fibrinous material extend to lung - air ves. Bronchioles etc except. Large. 4. Miller's Coal miner's Phthisis etc. at apex of lung. due to a form of Dust. Temperature is Normal & an increase in T.B. is a Chronic Disease for it is a sequence of some acute disturbance. Physical Exam. There is Bronchial Resp. as no air enter lung. there is also Broncho Pectises, [Ca???ous] Resp. & surrounding tissue is Hard Dullness on percussion more than ordinary also a woody dullness or flatness. will extend to point of substitution there is also a contraction & the healthy lung is enlarged & presses on the mediastium causing displacement. Heart may be pushed out of position may be on right side. Treatment. Prevent T.B. infection support strength, give tonic, small doses of Bichloride of Mercury. Jan.2.'06 Broncho. Pneumonia Common in Old people frequent in young. Secondary in majority or sequel. Typhoid Measeles, Whooping Cough etc. Affects those suffering from Ht. & Kd trouble. Bilateral disease originally (Capillary Bronchitis) frequently Cop Bron. Different. Terminal Bronchi are first affected. then extends to air of Vesicles Lobular Pneumonia from extent from Bronchi. to air Vesicles. Extends to air Vesicles in spot. Areas of cells devoid of air. May have Peri bronchial thickening. Aspiration Pneumonia. due to inhalation of food presence of Blood which passes down to small part form a localized Pn. T.B. Broncho Pneumonia. spreads as tubercle spreads. Splenazation is areas inflamed & becomes harder & may be entire occlusion. Termination is by resolution suppuration. may terminate in gangrene (serious). " " " fibrosis small fibrotic spots remain & contract becoming useless & normal cells dilate & compensate. Jan.9.06. Usually secondary may be primary Diagnosis: Help when disease precedes. When patient seems to be recovering a rise of temp may come. resp. increased general uncomfortable condition.- examine lungs - Is Bilateral exists in identical parts. Preceded by Bronchitis which extends. Has been called suffocative Disease. Lobar comes on in Healthy person from 3 to 15 more likely to be Lobar. Death rate from 30 to 50 %. Prog. depends on preexisting disease. Treatment: see that excretions are good. Dose of Calomel. Have a moist atmosphere a temp of 68-9°. favors breathing. If Dysponea is great give emetic. Epicac. Sy don't keep them nauseated. 1 teaspoonful " " Cough Mixture Carb Am - 1 gr. every 2 hrs. Sy Squills Aqua Dist. Do not use Opium Use stimulants when needed. Whiskey Jan.16.'06. Emphysema of Lung. Nourishment Predigested milk Liquid Peptanoid Two forms Hypertrophic & Atrophic (Senile Emphysema). Development of Hypertrophic Emphy. may be decreased or stopped. Distension of air cells & atrophy of cell walls. may break together. Heredity of weak lungs a great factor may be due to defective development of alveolar tissue. Cause may be due to increase function by long retaining air as glass blowers. Musician In suspected patients advise Hygienic measure. Increase of elveoler pressure encroaches on Blood vessels cause a rise in Bld pressure & Hypertrophy of R. Ventricle also there may be an Edema of lung from same causes Tendency of Heart is to grow to the right. Lividity after full extent of development & on extra exertion are cyanotic. Dysponea in early stages. Prolonged Expiratory effort. Treatment: little to be done. Hygiene Measure Intercurrent attacks of Bronchitis Pleursy Inflam. of Pleura. Jan.30.06. 1 Dry & Adhesive Primary & Sec. 2 Effusion Acute & Chronic. Dry may be Primary or most frequently complicating or secondary. More or less lymph on surface of Pleura. Have changes which bind down Pleursy Independent dry Pleursy is rare in healthy people usually complicates T.B. Secondary Process most frequent cause of Dry Pleursy is T.B. infection. Pleursy of Effusion is brot. about by sudden change in temperature. Most likely caused by Micro organisms. Onset sudden lancinating pain. With effusion from T.B. infection onset is slow. pain not so intense. Pain may not be over affection occasionly. Pain first 24-36 hrs is intense dry stage Pleursy are rubbing against each other when effusion come on pain subsides. May have large amt. of Pleural effusion. May compress one lung but other will compensate but when rapid Dysponea comes on. If Dysponea is great fluid should be drawn but not all of it. Golden yellow color. this causes drain of blood. & causes weakening. Albuminous & has property of Bld. Serum. Chlosterin, Uric A. & some sugar may be found Feb.6.'06. Friction reducts when fluid is absorbed. may mislead to diagnosis of Pneumonia sound is finer soft. sound is double on Inspir. & Expir. Aspirate in six weeks not completely. Some pressure is on Heart, also may be misplaced. Physical signs: Inspection: Tendency to guard & favor diseased side. lancinating pain at point usually, may be referred. above almost same as in Pneumonia. Pain on Inspir. & Expir. in " usually on Inspir. Auscultating in Pleursy there is a double friction sound. no friction sound in Pneumonia, after 24 hrs on inspir there may be Crep. Rales. After 36 to 48 hrs. cessation of Pain. due to effusion In Pneumonia Pain is increasing. Flatness more than dullness due to lack of air some air in Pneumonia Vocal resonance defective due to air not getting into lung. Bronchial voice in Pneumonia. Empyemia abscent of Breath sounds. (Bacillus Sign) fever runs different course. Chills, rigor, fever irregular. more emaciation more systemic disturbance. Feb.20.'06. Hydro Thorax. is secondary condition & is Bilateral. secondary Dropsy. may be due to Cardiac Broken compensation or Kidney & Liver trouble. Pneumo Thorax. Hydro. Pyo. Bursting of Cavity of Lung into Pleura Cavity may come from Wound. Hernia of Diaphragm. Symptoms of Pneumo Thorax Tympanitic resonance chest is bulging. Vocal Phrematous diminished & also Breath sounds. Corn test. Mediastinum Tumor in Whooping cough. Measels etc. may have T.B. infection of these enlarged glands. Mar.13.'06. Tuberculosis. First walling off for protection May have cassation & formation of cavities & in this way spreading. T.B. in Air cells may cause Bronchi Pneumonia. Heredity is very rare in this Disease. Mar.20.'06. Fresh air prevents Spread Jewish most nearly immune. 3 to 8 yrs. less apt. to occur. after 15 is Resp. or Intestinal. Women slightly more than men. Typhoid form of T.B. Acute. Irregular Temp. in Acute T.B. Mar..27.'06. Pneumonic type. alveoli filled & a consolidation at that point. both apices affected, does not terminate by crisis (fever). course of fever. fever varies more in T.B. Pneumonia. Runs a short course. many terminate in 3 weeks in death. Rusty sputum becomes 'Prune juice'. Broncho Pneumonia. Temp. not so high. irregular " " resulting from acute diseases spreads. Sclerosis may develop. Chronic form. slow form. Conferata. Disperata Modern. 1, 2, & 3 stage. 1st.. Insipient. of greatest importance. April.3.'06. Chronic T.B. Symptoms. Slight variation in temperature, take every 2 or 3 hrs. for a week. Subnormal in early morning hrs. height at same hour each day. Stomach disturbed. Some expectoration in morning. Loss of flesh. Examine Heart. Pulse 90 to 100. Percuss with fingers some resistance felt. dullness. Auscultation. Prolong Expiration, roughened. jerky. Mucus click on deep breath. increase Vocal resonance. then have them whisper. (increase resonance). Treatment. Hygienic. Anti tubercular Serum. Presystolic murmur generally heard before first sound of heart usually called mitral direct or stenosis. generally a contraction of Mitral valve. may be tricuspid generally heard anteriorly at apex. Systolic murmur heard with first sound generally heard due to Mitral regurgitation. caused by blood flowing back to auricle heard plainly near apex like distinct blowing also heard posteriorly below scapula. Systolic murmur heard aortic notch heard during first sound due to Aortic stenosis. or constriction of Aortic Valve. more roughened murmur. Dystolic after murmur second sound caused by regurgitation from Aorta to L. Vent. defective valve. April.9.'06. Pericarditis: follow infective disease. Idiopathic in Children. Extention of another disease. Acute Plastic Pericarditis (Butter Bread) May have fluid. T.B. Cancerous Chronic Pericarditis Tonsilitis & Rheumatism may precede. Septic & Purulent Pericard. is very painful. Friction in rhythm of Heart Effusion impedes action of Heart. may have bulging Symptoms not so pronounced. Inspiration presses Pericard & there is cessation of Pulse Pulsus Paradoxes. Cardio Hepatic Space should be normal. Keep Patient quiet. may have to use aspirator. Watch Bowels. Blister over Heart. Nourished. Io of Sodium. 2 gr. to begin to 10 gr. April.17.'06. Endocarditis. Inflam. cond. of Endocard. Acute & Chronic. Benign & Malignant or ulcerative. Rheumatism most prob. cause. Simple Inflam. valves mostly affected. Vegatations on TendCerda. may cause Embolis trouble. found mostly in children & young adult. Poisons of infectious diseases also cause. Mitral Valve most frequent affected Auricular side. Aortic vent surface next. Bld. current has to due to these process. R. Side in foetus affected. After birth L. side mostly affected. Endo. does not always follow Rheu. but there may be a history of Sore throat Tonsilitis etc. May complicate pregnant woman. Pulse rapid & weak. Malignant or Ulcerative due to various kinds of germs. more pronounced destruction. is a septic few Patients become reduced. Eruptions similar to Typhoid Prognosis: bad. Strict attention to Diatetics. Ice bag Digitalis not indicated. Salicylates when Rheu. probably a cause. Keep quiet. April.23.06. Result of Endocarditis. Affects Mitral valves (incompetency) most common. may bring about a stenosis. & Dilatation of Heart causing insufficiency of Valve in such Discompensated Hearts. Auscultation reveals murmur. May 1.06 Aortic Insufficiency 1/3 of cases. Comes from EndoCard. from Rheu. Cusps are distorted & ulcerated. Arteris Sclerosis accompanies found to people edicted to alcohol. Typical Ox heart. develops Rare as congenital. Water hammer pulse. Early Manifestation Dizyness. Dysponea. Liver Lung. etc. Murmur after second sound in region of aorta [???mal] tension 135mm. may drop to 110. [Uis?] afrontae [illegible] Aortic [?????enosis]. little leaking [illegible] Nov.7.'06. Delirium Cortis extended for few days shows organic change. Sodii Io. 2 1/2 gm. Tr Dig. P.D. 4gm.          [illustration] * Trophoblast. has power of Dissolving. Desudua. & will destroy Blood ves. wa.. & maternal blood will enter trophoblast. Primary Intervillous space where this blood enters. At this stage Mesoderm sends out projections & this vascularizes the Projecting Villi Trophoblast & now is known as Chorion Villi. Syncytium layer formed superficial in trophoblast due to Maternal blood in contact & Lower layer into Langerhans Cell. first has no cell wall or division Langerhans is more distinct cell No mixing of Different Blood. Fetal Blood takes oxy & give of CO2 by means of osmosis. Chronic Villi Excretion, Nutrition Respiration. " " begin in latter stage to atrophy & Hypertrophy as to Bld supply as next to Reflexa Bld. Sup. is Poor this is Cald Chrcon laeve & other Chrcon from dosium [illustration] Decudua Reflexa & Vera join together. Albumin area some sugar amniotic fluid 800 to 1000 CC. sg. 1007. Fetus may secrete Urine or may be secreted by Amnion Protects fetus, may Nourishment Aligohydramios = Small amt. of amniotic fluid. 1. Amnion may aglutinate with fetus. Polyohydramios = excessive fluid. Umblica Cord 50 to 60 cm Warthon jelly - Embryonic Con. tissue. Lysol [illustration] Placenta Membranacea large thin as below [illustration] [illustration] May overlap Cervix (Pl. Previa) is dangerous condition. Part is detached when Cervix opens & causes a hemorrhage in early part. [illustration] Auto intoxication of Pregnancy. Vomit first 5 or 6 months. Change in Parenchyma of kidney. End product of Metab. have toxic product Eleminated by foeces. Urine. perspiration. Chemical obstruction is another means of Elemination. Pregnant woman eats more indigestable more toxic end products from fetus etc. Cincitium thrown into material parts. may be disolved & get into blood. Placenta a toxic tissue Cincitium fetal tissue making it toxic. Heterogeneous is fetus. Fetal metabolism may be cause when dead symptoms stop. Constipation natural interferes with toxic elimination also respiration interfered with compressed kd. Arteries Ureter etc interferes with kidney of kd affected causes some albumin. Liver organ of Chem. Destruction. Jan.12.'06. ath. Toxemia when Equilibrium disturbed. Fetal Metabolism. Cincitium. Organs of Defense unable to keep functioning perfectly. Insufficient at time of Pregnancy is bad. May be congenitally deformed 2. Diseased condition. Undeveloped Thyroid cause of toxemia. Prediseased & diseased caused by Pregnancy. By twins accumulate in Kd & form toxic sub for Blood & by same again affect Kd. Symptomatology Naseau. Vomiting. Headache. convulsions. Increased irritability of Nervous system. These diseases which occur in Pregnancy are due to these toxins [cross out] by these increase in severity & any other causes given for this only aggravate the condition. such as Hysteria etc. & the different diseases such as Eclamcia & Severe Vomiting are caused by different kinds of toxins (Ehrenfest Theory of Bases) Treatment: Decrease as much as possible the introduction of toxins which is very limited. Interruption of Pregnancy in severe cases. Increase Illimination & action of Defense Organs. Jan.18.'06. Placenta Vein 1. 2 arteries. Arterial Bld in Vein Ductus Arantius between Am. V. & Suf. Ven. Case. Other part goes in liver & to Inf. V. Liver & Some from Vena Ceva Proper. Carried to R. Auricle & strilles foramen Ovale con. to [?] auricle this Eustachian well reflects bld to L. Aur. then into L Vena leaves thro Aorta branches to [illegible] & Dec Aorta to Hypogastric arteries which. Com. with P.A. One part from R.A. to R.V. & into Pulmonary Ateries. & Lungs not Developed but goes thro Ductus Botalli to Aorta. Dec. V.C. also enter R.A. & this goes to R.Ven. Cannot go thro' For. Oval. Obstetrics. Dorsett. Natural Labor Unnatural labor is where distotia is present. what is cause of Labor : Fetus. Mem & Placenta become foreign bodies at a certain time & Nature attempts to expel it. Expulsion of after Birth {amnion. Chorion. {Placenta. Clot. [illustration] Placenta Uterus active Plac. Passive & is detached by uterus. Muscle of Cervix dilates the rest contracts. Fluid is dilator of uterus. evenly around Cervix. Dynamic contraction is in Cervix by introduction of finger. when Bag breaks only a certain part of water escapes. the rest shut off by fetus forming valve. Feb.9.'06. 9 Lunar Months. 280 Days. count back 3 months & add 7 days. from beginning of last menstrual period. does not hold good with irregular menstruation. Presentation refers to part of presenting body position relates to presenting part & relation to canal. position determined by Heart beat. L. O. A. L. O. P. R. O. A. R. O. P. Three stages for convenience. First " from begin of Pain till Presenting Part passes thro cervix of Uterus. 2 - 3 stage Prominence of Sacrum higher level than Pubis. Egg Plant Blue of Cervix & Vagina. [illustration] Feb.16.'06 Movement of Child's Head. Head is passive fixation of Body uterine neck dilates. flexion makes long diameter shorter. Extension flexion & rotation Ex. means elevation of chin Fl. " dropping " " first flexion, rotation then extension then external rotation. Bladder or bowels may be full. Cord may be round neck [illustration] Mar.2.'06. Patient lies on back knees flexed on right side of Bed. Give enema for bowel. pass water. Douche before labor is Lysol preferably Vasaline put up in tubes. Examine cond of Rectum & Bladder thro' vagina next. condition of Cervix. to see how far case is advanced next size of Pelvis. & to find out if patient is Pregnant or not. Condition, thickness & elasticity of Cervix. Straighten legs to relieve cramps. After Chin drops over Perineum there is rotation & lower arm is born. then child is born clense eyes see to respiration If cyanotic let Baby bleed some. If asphixiated place child in hot water Mar.16.'06. Perineum wound closed immediately. Cervix repaired to stop bleeding. Sepsis may come on immediately initiated by chill, rise in Temp. may be rigor sweats. Examine Placenta. May have organisms entering Ab. Cavity & Peritonitis comes on Lymphatis may take up material & have general sepsis without peritonitis. Engorgement of Breasts may cause high fever on 3rd.. day not serious. Use Placenta forceps & Sims speculum. follow with irrigation then curet & wash again. 20 gr. Iodsform suppository. Sterile in neck of Uterus & pack carefully with Io. gauge. Mechanism of Labor we understand the operation of the mechanical forces & the exception of the mechanical movements necessary to secure the passage of the child thro & its Prov Hypes. Oct.3.'06 1.. exit from the Parturient canal. Obstetrics means caring for woman (& child) during pregnancy. labor & puerpral state. Medicine art of healing. 2.. Synonyms: Midwifery. Tocology. Parturition. Accouchment. Marientics. 3.. Obstetrical Science means. The classified knowledge of the laws of human reproduction. 4.. Obstetrical art means - The rules drawn from those laws which are to be observed in Practice. Oct.5.'06 English school dates from Royal College of Phycians at 1815. Dr. Linacre. Peter Chamberlain reinvented the Obstetrical forceps early in 17th Century Sir Fielding Auld of Dublin described mechanism of Labor 1741. Dr Deman 18 & 19 Centuries wrote of contalousness of Puerpial fever thro unclean Drs.& medicine French school dates frome time & work of Pari 1510 great surgeon & Obstetrion called by Smellie The discovery of Restorer of medwifery 17 century first hospital for instruction to men. Andre Leoret 1747-1758 improved forceps Naurecian 1718 described Phenonan of Labor. German school 1777, 1815 most accurately described Mech of Labor. His classic phamplet. (1818) called Euclid of Obstetrics. (F.C. Naegele) Greek History. Hyppocrites was born in Cresculapian temple where father was Priest & Phycian 450 B.C. mother a Midwife. called father of Medicine 1.. First scientific writer on Medicine including Obstetrics 2.. Separated Priestdom from Medicine 3. Introduced clinical study kept records. Plato 400 B.C. Aristotle 330 B.C. founded Alexdrian Library Celcus 25 B.C. Cicero of Medicine Soranus 98 AD. first book on Obstetrics. Actious 502 A.D. Compiler of Med Knowlege. described version craniotomy use of forceps, speculum, crotchet. Arabian school Rhazes. A.D. 850 described use of fillet & Obstetrical instrument used by Egyptians. Oct.17.'06. Hygiene of Pregnancy { relates to. { {Diet {Clothing {Exercise (a) fresh air & Sunshine. {Rest & Bathing {Elimination {Kidneys {{Bowels {Vaginal douche. {Sexual intercourse. {Care of {teeth {{Nipples. {Mental Condition. Physician should give { special attention to. { {Examination of Urine. {Pelvemetry. {Physical & Vaginal Ex. {at (7) Mo. of Pregnancy. Pregnant women should be warned of & consult Physician for: Danger signal. A. Abdominal Pain. B.. Vaginal Hemorrhage. C.. Persistant headache & dizziness D.. Epigastric pain. E.. Nausea & Vomiting late in Preg. F..Edema {local Onset of Puerpral Eclampsia {general Should avoid {Lifting, stretching & reaching. {Coition & overexertion {Blow upon abdomen {Riding over rough roads. {Long railroad journeys. Diet: Drink water & milk. Milk increases size of child. avoid strong tea & coffee & alcohol. Exercise: with care & judgment. Moderation. Vaginal Douche. May irritate. Hot douche 4 times a day causes Abortion. Never use Hot. Warm. teped one to two pints with no force. Sexual intercourse: Avoid first 2 or 3 Mo. not near the time of Menstruation period. & latter stages. Care of teeth & Nipples keep mouth clean more apt to suffer from bad teeth. Neuralgia common. Deficiency of Lime Salts or Acid eructations may be cause. mouth abonds with Lactic Acid. Milk of Mag for teeth Last 2 Mo. Raise Niples moderately every day in poorly developed cases. Keep clean & soft. Oct.24.06. A. [Ergot]. Dr. Hypes. Obstetrical Medication. 1.. During Pregnancy. B.. Strychnine. Syr. Lacti - Phos of Lime Uterine Tonics & Abortifacients {Vibrunum {Cemisfuga Fl Ex 1/2 [D???] {Avoid Ergot. & large dose of Quinine. Aletris Aletris During Labor: Anesthetics: Ether & Chloroform. Chloral Hydrate. Morphine & Cocain. Spinal anesthesia & Morphine & Ergot. During pureprium: Ergot: Strychnia. Persistent headache. Dizziness pressure back of eye points toward uremic poisoning. Anaesthics. Advantages of A. Diminishes Pain. Relaxes uterine spasms & assists in dilating as Uteri. Lessens danger to Perineum. Disadvantages: lessens uterine contractions. predisposes to post partum hemorrhage. when excessively used, to blood change. to sub-involution, sepsis & dangerous to child. Fl Ext. aseptic preferred given after 3rd.. stage of Labor. Hypodermic most reliable in dose of m 15 to ʒ i. Especially indicated after chloroform. Benefits. Lessens danger of Haemorrhage & Sepsis. Lessens after pains & promote involution Uncontrollable Vomiting connected with Uremic condition may be of septic origion. Edema indicated with Kidneys. Oct.26.'06. Unesthics - partial Chloroform & Ether Sooths pain. quiets nerves. relaxes Cervix. Pressure from 80 to 30 lbs. sg. in. Excess causes changes in blood cells & Fatty Deg of Heart etc. Induces Post Partum Haem. Oct.31.'06 Fluid extract of Ergot. (aseptic prefered) Give after 3 stage of Labor. Hypodermatic administration most reliable. Dose 15mm to ʒ i. Chloral Hydrate for spasmodic contraction of Os. 15 grs by mouth every 15 min for 3 doses. or 20 grs by rectum [?] Morphia for highly irritable patients. Sulpt Morphia gr. 1 ʒ Chloral Hy in Pep water 1 ʒ i teaspoonful every 15 min for doses.. Cocain for local application to Os. Uteri. for great pain. Spinal Anesthesia inject Cocain & Eucain into Cord. not used much. Ergot especially indicative after chloroform. Benefits: It lessens danger of Hemorrhage & sepsis. Lessens after pains & promotes involution. Ergot of Rye most important Solid. powder & fluid extract. Tl. Ex. contains 1. Ergot uric Acid 2. Cornution 3. Sphlanalythic [Ac???] contracts Involuntary muscles. Aseptic form devoid of acid. Ergot uric [P.?] first contractions are Peristaltic then tetanic contraction. tonic [illegible] Strychnia - give strength & vitality & tones uterus. Nov.8.'06. Indications { for { induction of { abortion. { Mothers life { threatened by Path { state of herself or { foetus as from { {foetal {A. Cystic degeneration of chorion. {B. Acute hydromusos {C. Foetal death. {Maternal {1. Nephritis. {2. Uncontrolable vomiting of pregnancy. {3. Irreducible retroversion graved [illegible] {4. Marked contraction of Pelvic Canal below 2. {5. Pernicious Anemia. {6. Chorea & Insanity. {7. Chronic Heart Disease. {8. Placenta Previa (some cases). {9. Albuminric retinitis. 10. Accidental Hemorrhage. 11. Eclampsia. 12. Disease of growtles affecting Pelvic organs. I. Labor 1. Natural 2. Artificial 3. Postponed. {Child {alive. 4. Missed. {Child {Dead. Abortion. I. Date. 1. Ovular 1st.. wk-3.. wks 2. Embryomic 1-3 mo. 3. Foetal after 3 mo. Classification Spontaneous. Artificial Artificial {Therapeutics. {Criminal. Incompleted. Missed. Drugs used to induce abortion. Ergot, Quinine, Pilocarpin, Ustilago. Oils of Tansy, Pennyroyal, Savine, Parsley. Act by causing congestion of Pelvic viscera. All are unreliable. Nov.14.'06. Indication for induction of Premature Labor. Generally for life { of Mother or fetus. { Threatened by some { Patholigical Cond. as. { {Fetal {Premature ossification. {Habitual death late in Pregnancy. {Maternal A Pelvis 2 1/2 - 3 3/4 C.U. B. Placenta Previa C Extreme debility D. Eclampsea E. Accidental hemorrhage. Premature labor indicated with. Pelvis 2 1/2 in at 28th.. wk. " 3 "" 32 " " 3 1/3 "" 36 " " 3 3/4 " " 38 ". Reliable methods for induction: first 3 mo. A. Tampon cervix with Iodoform. repeat in 12 hrs. B. Dilate instrumentally os uterus remove foetus by finger or curet. 2nd.. after 3 mo. Same as Premature. 3rd.. To induce premature labor. a. Catheterization of Uterus (Krause's) b. Tamponade of Cervix - Vagina still better of Uterus. C. Dilitation of Cervix (Manual or water bag.) D. Rupture of membrane. Duhrssen's incision of Cervix When indicated terminate labor by forceps or Version To induce premature Labor. Methods: Catheterization of Uterus (Krause's) Dec.5.'06. Dec.7.'06. { see kitchen Dec.21.06. Indication for Symphysiotomy 1. Flat pelvis & Contracted. 2. Conjugate Vera 7 to 9 cm 2.6 to 3.1 in. 3. Impacted Brou Face & post. Position. Contraindications { Pelvis less than 3 3/4 in. { Tumors cancer or other obstruction. { Ankyloses of Sacroiliac joints. Dangers { Sepsis. { Fistulae - Ves Urethra - Interference of Locomotion { Haemorrhage & Injury to soft parts. Symphysiotomy lengthens all diameters. with separation of 2 3/4 in. C.V. increases 1/2 in. Obliquely 1 1/2 in. Transversely 1 1/5 in. Jan.4.'07. Indications for Casarian Section A. Contracted Pelvis. Ant. Post. Diameter below 2 3/4 in. B. Mechanical Obstruction of Pelvis by soft or bony tumors & Cicatrics. C. Impaction - irreducable - of child in transverse presentation. D. Obstetrical accidents or Anomalies { { 1604 first successful operation { Rupture of Uterus { Eclampsia. { Placenta Previa Porro Operation 1st.. Labor prolonged. bag of water ruptured. Extensive Manipulation. making sepsis probably. 1876 Remove whole uterus. 40% Miller raised uterus out. 2nd.. Diseased Uterus requiring second operation. 3rd.. Growths etc obstructing passage. Saenger 1882 new method of suturing save 90% Advantages: A. No Haemorrhage from Uterine [illegible] B. No Uterine wound to suture. C. Wound is Extraperitoneal hence less chance for sepsis. D. No subsequent Pregnancy. Embryotomy; Embryulsomy. generally cutting below head. Crainotomy upon head. {Crainotomy {Evisceration {Eviseration {Exerceteration. {Decapitation - decollation. {Amputation of Extremities. Instruments for Crainotomy {Perforation. {Blat's. {Smellies. {Crainoclast. {Cepholotribe. {Baseotribe {Forceps. Indications for Embryotomy.. 1. Malproportion between Child & Pelvis. Hydrocephalus. 2. Monstrosities & other mechanical obstacles to deliver such as impacted shoulder Presentations. 3. Post. Rotation of Chin in hollow of sacrum locked twins. 4. Child dead or a monster. in. cm. Female Pelvis. { Living. { Internal { Diameter. { {Brim {Ant Post 4 - 10.1 {Trans. 4 - 101 {Oblique {R. 5 -12.7. {L. 4 1/2 - 11.4. {Cavity {Ant. Post. {5 - 12.7. {Transverse. { {Oblique { Outlet {Ant Post. 4 1/2 - 5. {Trans - 4 {Ob. - 4. Ext. Diameters { by Pelvimetry. { of living { {Intercristal 10 1/2 - 26.6 {Interspinous. 9 1/2 - 24.1 {Ant. Post. 7 1/2 - 19. {Oblique 9 - 22.8. Dia. of Child { Head { {Occip frontal 4 1/2 11.4 {" Mental 5 1/2 14. {SubOccip Bregma. 3 3/4 95 {Frontd Mental 3 1/2 - 8.8 {Bi Parcetal 3 1/2 8.8 {Bi temp 3 1/4 8.2 {Bi Mastow 3 7.6 Distocia arises from anomalies of 1. Torces: A. Excess = Percipitated Labor. B. Deficiency = Delayed labor inertia Uteri C. Spasm & irregularity, rigid os & Cervix Uterus [Tetan?] 2. Passage: A. Hard Parts Pelvic deformities. B. Soft Parts 1. Atresia of Cervix. 2. Rigidity " " . 3. Impaction " " . 4. Malposition " Uterus. 5. New growths " " . 6. Stenosis & rigity of Vulva. 7. Haematuria of Vulva. 8. Labial Abcess & Cyst. 9. Condition of Bladder. 10. Tumors. swelling of various tissues 11. 12. 3. Passagenger: A. Malposition of Head. Occip. Post. Cases. B. Malpresentation. 1. Face. 2. Brow. 3. Breech. 4. Transverse. C. Prolapse of limbs. D. Abnormal foetal development. 1. Shortness of Cord. 2. Unduly Ossified skull. 3. Large size of Fetus 4. Death of Foetus. 5. Disease " " . 6. Pleural Births. 7. Monstrosities. Causes of Inertia Uteri. 1. Emotional Disturbances. 2. Full Bladder & Rectum. 3. Imperfect development of Uterine muscle 4. Fibroids 5. Disease of Uterus. 6. Excessive uterine distention. 7. Abnormal adhesions of membranes. 8. Dry Labor. 9. Displaced Uterus. 10. Frequent Labor. 11. Precocious or advanced age. Labor may be rendered difficult by: 1. Abnormality of involuntary forces. " " Voluntary " abd. muscles etc. " " resisting forces of inertia uteri Jan.30.'07 Delayed Labor may be defined as occuring whenever at any stage of parturation a considerable period relapses without satisfactorary progress or when signs of Exhaustion of mother or child appear. Uterine inertia is that condition in which the uterine contraction by weakness or irregularity are insufficient to dilate the Os. 1st.. stage or exposed fetus 2nd.. stage. Explanation of certain expressions indicating character of labor: Primary inertia: sluggish action of uterus from lowered muscular or nervous tone. as extreme age invalids. Cases of twins. weak pains occuring at long intervals. Secondary inertia: generally slight obstruction but contractions feeble or strong at beginning of case. Uterus exhausted flabby no tenderness. no constitutional reaction save fatigue 2nd.. stage. Tetanoid cont. of Uterus develops with obstruction. Tonic contractions uterus hard, tenderness marked constitutional symptoms develop rapid pulse. sighing respiration. face anxious fever. restlessness. vomiting dry & coated tongue. Coma. Convulsion. Death. treat cause. Nervous weak women should have strychnia for 20 days before labor. Quinine good. When Os is dilatable may rupture waters not otherwise Page. 392. Jan.3.'06. Pavement Epithelium covering of Uterus. some Ciliated form to carry ovum. Basement membrane & muscular part. Mucus sacs, glands, in Epithelium dipping in mucous structure. Muciperous gland involved when Cervix is inflamed caused by some organism. Acute & Chronic. Endometritis. No organism beyond External Os. thus a laceration may admit such. find cause for treatment. Acute: Symptoms of Early Inflamation. Treatment: Rest. Carthartic. Anodine* Pro. depends on cause & treatment (Radical). Curetment. Irrigation mild antiseptics. Cotton - glycerine for 12 hrs. day time. Beware of Curet when inflamation is deep seated. Jan.10.06. Displacement of Uterus: 35° tilted forward. freedom of movement before & Back. limated to sides. Power of itself. its weight concern disp. weighs 2 - 1/2 - 3 oz. Lack of Proper tone of ligament etc. Upward dislocation tumor association. Downward " (prolapse) 1, 2, 3 degree. Laceration of Cervix Jan.17.'06. 2 1/2 times as often cancre in female as male. 60% of female Cancre are found in Uterus Must be due to injuries or physiological disturbances. injuries at Child birth common acid secretion to irritate & Micro organisms introduced Primarily in Neck of uterus. rarely in Body Age of Child Bearing period. After Menopause is not so frequent. Symptoms. General History. age. Mucous membrane bleeds readily when touched. hard circumscribed Microscope. Radical treatment. Jan.21.'06. Uterine Fibroma may occur at any period in life more Early than Carcinoma location Post. May be sub mucous. Sub Peritoneal. At. is Hypertrophy of Non Striated Muscle fiber. & Connective tissue. grows slowly. Develops from Capsule has few bld. vessels. but surrounded by large vessels. usually [Intersti????] May be cast out. Pain a symptoms Prognosis favorable. Remove early. Hemorrhage prominent symptom. Differenciate from Pregnancy & Carcinoma. Feb.21.'06. Menorrhagia. Amenorrhea. Dismenorrhea Amenorrhea Dis. difficulties attended with pain. Men. Flow during period. Amenorrhea due prob to organic change. Misplaced Uterus. Menorrhagia caused Nervous strain. Laceration of Cervix. Endometritis. Retention of some portion of Fecundines Anemia Feb.28.'06. Fallopian tubes. 4 in. long. Isthmus 1 in. Ampula. 3/4. Fimbriated 2 in. Covered outside by Peritoneum Muscle fibers similar to those of Uterus. above & to one side of Broad Lig. Lined with Ciliated Epithelium. Glands of Rose Mueller. *Pyoceffsix. *Hydrocalpinx. Curetment indicated. Ectopic Pregnancy. Ovaries almond size 1 1/3 in. Trans. 1/2 in perpendicular 1/4 Ant. & Post. borders. located in Infundibulum of Lig. held in position by covering of Peritoneum. Covered by Columnar Epithelium. Infundibulo Ovarian lig from Fimbriated fold of tube. Covered with dull Columnar Nucleated Epithelium. Graffian follicles 40 to 70,000. Tunica Membrane & fibrosa. Memb granulosa. Liquor funicula, ovum 1/100 in. Ext. Envelope. Yolk. Germ. Vesicle. spot. 1/3000 in. Cystic Ovary. Most frequent in middle life. Use Anesthetic to examine. Neoplasm of Ovaries. Pearly hue. Faciaes Ovariana. thining of Muscles of Abdomen. Draw down uterus if tumor does not move it is not attached. Post operative suppurative Peritonitis. Peritoneum. Lym. gl. absorptive power Micro organism may exist within body at time of operation. {Glycerine {1 oz powd Alumn. {Water {Sulph. Mag. {Spts. Turp. for accumulation of gases. {Water Oct.8.'06. Born. Examination at Patient's home 1.. Lying lengthwise on a bed. 2.. Lying crosswise on a bed. 3.. Lying on kitchen table. Anesthetics. Antiseptics. Boil gloves 5 min in 1% Sol of BiCarb of Soda. Preparation of P. for examination. Empty Rectum by enema or Cathartic evening before. empty bladder by Patient herself. dont Catheterize Give douche if instruments are to be used. Lubricant Liquid soap sterilized white vasaline for instruments. glycerine Dr. Dorsett. Oct.9.'06 Born. Oct.15.'06. 1. Index finger & thumb extended other fingers on Perineum 2. All fingers & thumb extended. Gynecologic postures of Patient. 1.. Dorsal. Elevated. 2. Dorso Social. 3.. Erect Positions. 4.. Knee Chest: Elevated. 5.. Lateral Prone or Sims 6.. Horizontal Recumbant. Microscopic Examinations. {tissues. {Discharges. Tissues. obtained 1.. Curetment. 2.. Excision. 3.. Removal of Entire growth. Discharges. 1.. Slides. Oct.14.'06. Dorsett. Uterus movable. Fibroid tumor 1. Intra Mural 2.. Subperitoneal. 3.. Submucous. 1. growth in wall of uterus. All originate in wall of Uterus. Oct.22.'06. Born. Vulva Vaginal Glands are between Hymen & Labia. Examination of Abdomen: R. Upper quad. gall Bladder Liver L. " " Stomach. Spleen. Part of Kidney. R. Lou q. ap. see. R. Ovary. L. " " Rectum L. Ovary. Inspection. Palpation. Percussion. Mensuration. Auscultation. Inspection: Contour. Movements of Ab. wall. Appearance of skin. Oct.23.'06. Dorsett. History: Name...[age] address. Date of first visit. Age. Physical signs. Number of Children. Number of Miscarriages. Married or Single. Age of first menstruation. How long ill. Principal Symptoms. Diagnosis. [Menstruation]. Supposed cause. Present condition. Date of last confinement. Menstruation {Regularity. {Amount " " " Miscarriage. {Duration " " " Catamenia. {Symptoms By whom refered. Discharge {1 Character. By whom referred. {2 Amount. Cond. of Bowels. {3 Consistency. " " Bladder. Pain along Crual Nerve means inflam of Pelvis. Pain {Locality {Degree. {Character. Pain in top of Head Chronic Pelvic Uterus trouble. Physical signs: (Case seen at Baptist [Sa?ta?]) Nov.13.'06. Patient. 44yrs. hemorrhage 3 yrs ago. bleeding for 2 yrs. Later History of Bleeding & bad odor. ulcerated spot at Cervix. Odor come on when endometrium beyond Os is involved. Nov.20.'06. Dec.17.'06. Classification of Wounds Subcutaneous injuries of Vulva. Open - Incised. lacerated. punctured. Ecchymosis... Hematoma is circumscribed. septic or aseptic. shock may accompany Lacerated W. Secondary haemorrhage severe at times sluffing may take place: Hot fomentations. H2O2. Punctured wound may be infected. Diseases of Vulvas: Haematoma circumscribed swelling due to infusion of blood into connective tissue. Cause: Varicose Veins Pregnancy. Direct. Labor. Traumatism, musc. efforts. result of forceps. straining at stool. cough. vomit etc. Large Haematoma. Pain. fullness disturbs Bladder & Rect May become infected. May become absorbed or encapsuled. Open. close or pack. Deep sutures. enucleate capsule. Due not suture during Labor. Jan.7.'07. Gonorrheal Vulvitis specific infection. Gonococcus. Most frequent cause & violent. Urethra becomes involved early. Bartholins glands may be affected. Occasionly inguinal glands. Violent character & History, other glands involved. Prog: guarded. Latent form of disease. Treatment destroy cause. Bichlorid 1 to 5000. 3xday. 25% aquous sol. of argyro on Tampon. Compress on Vulva. 30 grs. to Oz of Nitrate of Silver to swab parts. dust then with mild powder. Vulva Vag. Bartholin glands are affected. Gon. most frequent cause of Abcess. Discharges. Extension. Traumatism may cause it. Puerperal sepsis may cause abcess. Glands may become cystic. Abcess usually unilateral. Pain itching. puritis. Dorsal position most comfort swelling & Oedema. some fever. opening of duct like flea bite (Gon. Macula). fluctuation may be felt. Contents are infectious pus. [?] Paliative before suppuration. place in bed use hot flaxseed poultice. Open bowels Morphia for pain. Tor Suppuration. free incision curette wash out 1 to 5000 Bichloride & Carbolic. then open up duct & curette it & dicire feel it. Dont suture opening but pack & use compress. May have relapse. Varicose Veins of Labia Permanently involved etc. usually in L. Majorca. 2 Causes. 1. Pregnancy. 2. Other interference of Venous Cir. Pelvic Exudate. adhesions tumors disp Uter. Consti. heavy lifting. Vom. Straining. When large symptoms itching burning. pulling down. aggravated by walking Coitus. Dark blue colored veins. Bogy sensation pressure empties & fills. may be very large. During Preg. partly disappear after gestation. May rupture under skin Hematoma may become adherent. & form Ext. Haem. May become infected. Exzema & Ulceration may occur. 1. Paliative 2 Surgery. 1. In Preg. Lint Compress. T Bandage. regulate bowels. dont strain or lift. Lie down. Hot or cold compresses. Lead or laudinum water may relieve. Direct pressure on opening for Haemorrhage. 2. Operation Incis 1 1/2 in use Catgut & legate & descect out & close. Antiseptic compress Jan.8.'07. Jan.14.'07. Venereal Ulcer. Rupture of Perineum: Trauma. Occur on forchette. labia. Vulva Vaginal orifice on Cervix Chancroids. Vestibule. Rarely found on walls of Vagina. Thighs Urethra. Abd. Anus. Virus can be carried. Prostitutes mostly affected. Anatomic relation causes a worse prognosis. Secretions also irritate. Urine also. friction during walking. Differenciate from Herpes. Chancre. Cancer. Exzema. History. Chancroids appear within first 5 days to 12 days. there is rapid development. multiple Involvement of Lymphatics. may break down & form buboes. Characteristic appearance looks punched out edges undermined. painful to touch. inflame. profuse discharge. Treatment: Destroy local infection cautery. cocainize then burn. or acids. +Pole Mercuric catophorises: Cleanse with H2O2 Place guaze between labia. use dusting powder. Stimulating ointment. zinc. Oxide. Chancre initial lesion of Constitutional trouble. Not so characteristic in female. Location is opposite on female to male. less frequent about Vulva & parts 1. Labia Majorca. 2 forchette 3 Nimple. 4. Clitoris 5. Mons Veneris. 6 groin. rarely on cervix Not on walls of Vagina. Diag: Herpes. Chancroid Cancer 3 wks. after inoculation. indurated mass may similate Chancroid when irritated etc. Jan.21.'07. Born. Mercuric Catophorises for Chancre. Secondary Syphilider. Constitutional tr. first May discharge use Bichlorid of Mercury. Vag. tampon 2 daily. Silver Nitrate stick. Venereal Warts produced by Heat. irritation. moisture. Remove them. Remove cause. Keep dry. Tertiary lesion. Gumma. - Labia Maj. round tumor, become soft Bluish discharge. [suppura??] Adhesion of Clitoris similar to Prepuce. Examine Child at 3 months. this sets up neuroses [??health]. Masterbation. Remove adhesions. Cover parts with Carbolized Vasaline. Vagina. Diseases mostly in lower 1/3. Cystocele. {to see rectocele etc. ask P. to bear docv Rectocele. { Neoplasm. { Cysts. { Jan.29.'07. Dorsett. Feb.7.'07. A.. Malformation of Vagina. 1. Persistent Chloachna. Common opening. 2. Absence of Vagina failure of Mahleis D. to unite. 3. Double Vag. imperfect coalaesence of Mukleis Ducts. Stenosis of Vag. contraction of Mukleis ducts. B.. Wounds of Vag. 1. Associated with other structures. 2. Labor. Coitus. Sym. not much Pain or Haemorrhage. impaired function. Retraction of edges. not longitudional. May have fistulae. May have shock. Results depends on extent there of. Cellulitis. Peritonitis. fistulae etc. Treatment: check blood. dont use styptics. look for shock. pack Uterine secretion trim edges. stitch - catgut. Pack with antiseptic gauze. rest. dress every 24 hrs. Feb.25.07. Cystocele. Tear of Ant. Vag wall. Relaxation. Laceration. Prolapse Uterus. Sensation of Distention when standing. deoging in Pelvis Ant. Colparrhaphy. operation for Cystocele. Mar.3.'07. Rectocele symptoms of distension etc. difficult defecation etc. bulges on straining. Operate to repair. Post. [Colpoperinoirha???] Mar.11.07. Uterus: Malformations double - duplex. tubes have not come together. Septate. & two horned. & one horned. Rudimentary: no organs. Fetal Uterus: arrested at time of birth. greater part of U. is C, Canal. Infantile uterus. up to Puberty. Absence of Uterus. Injuries of Uterus: rare. 1. Parturition: rupture. 2. External violence. 3. Internal " . Operations. Curetment. Crim. Abortion. Treatment for puncture: Rest. keep bowels open. No Douche. No enemeta. If septic open up abdomen & sew up hole if aseptic or removal if septic. Mar.18.'07. Lacerations of Cervix from labor. forceps. ergot. premature ruptue. Malignent infiltration. abortion. complete & incomplete. Symptoms: Subinvolution. Salpingitis etc. bearing down pain in pelvis. Headache, backache. leucorrhea. sterility constipation. May lead to cancer later on. Vag. touch. indirect inspection. Ulceration in Carcinoma. May have eversion of Mucous M. Radical treatment in about 3 months. April.1.07. Version - flexion. - Inversion:- Tumors, weak wall etc. Torsion. Causes of displacements: Those which interfere with strength of uterine ligaments. " " destroy supporting power of pelvic floor. " " impair sustaining action of Pelvic Organ " " weaken retentive power of abdomen.    Feb.6.'07. Anomalies of Pelvis in {size {Inclination. causes: Diseases of Pelvis: Rachitis. New growths. Osteomalacia. Anomalies of form: Fracture. Caries. Firm union of joints. Loose " " ". Disease of Spine. Disease of Bones of Limbs. Forms of contracted Pelvis: More common Varieties. Rachitis - Flat. Justo Minoris. Oblique Contraction from hip joint Less common: Kyphotic. Scoliotic. Osteomalacia. Male shaped. Spondylolisthetic. Roberts transeversely contracted. Naegeles Obliquely. " . Narrow of Brim. Simple Flat. Rachitic pelvis. Narrow at Outlet Justo Minor, Male. Roberts & Naegeles Brochounicles Diet: To lessen size of fetus. Morning small cup of coffee. + ʒ vi noon any kind of meat. eggs. fish. sauce. green vegetables. & fat. salad. cheese. Evening as for noon + 1 1/2 ℥ Bread. + Butter. fluid per day limited to 12-13 ℥. Red or Moselle wine avoided. Water. Soups. Potatoes. Sugar. Creams & beer. A flat Pelvis is where the Pubic bone is higher & lies nearer the Promentory. Feb.27.'07. Face - 1 -250. Brwo. 1 - 1800. Assist. Delivery by. {Breech Presentation- {1-50-60. {In Dorse ant. Position {Express fetus. {Strong Vol. efforts of mother. {Givin assistant {Emillie Diet method. {Wagand Martin " . {Forceps. {Dorse Post Postion {Above with rotation. {of trunk. Breech Delivery Method. Wigands: Child rests on one arm finger in mouth making traction with other hand press over Pubis. Morccans: Child rests on one hand & arm & other on childs back fingers over Clavical. Supro. Pubic. Pressure by Assest. Prague: Left hand to back of Child the other holding legs near ankles. traction downward then upward. Deventers In last manner make traction backward & downward. Mar.8.'07. Multiple Pregnancies. 13.000.000. twins 1 - 89. Triples. 1 - 7910. Quad - 1 - 371126. 150.000 twin. Boys 50.000. Girls 46.000. B & G. 54.000. Twin Preg. Presen. April.3.'07. Uterine Mole (true & false) fleshy mass formed in & expelled from Uterine Cavity. True - Origin in & presents with Comp. parts of Products of Conception. False is one which has no connection with [Cova?] Hydatidiform Pregnancy is a form where there is degeneration of Chrion. like wine wirst. 1 - 2.000 Preg. 1. Haemorrhage. slight continuous. 2. Rapid growth of contents of Uterus. Child dies 3. Passage of Cyst from Uterus. Dangers: Sepsis Haemorrhage. apply Tr. Iodine. Cure Post Partum Haem. have at hand. Hot water. ice. Brandy. ether ergot. Hypderm. Syringe. Medicine. Gauze. fountain Syringe. Treatment. Prevenative. Remedial. Danger: Hae. previous. high pulse. - 100 per. imperfect retractions. Other signs of blood. Sym Outfow of blood. No uterine globe. Sym. & signs of severe haemorrhage. 1. Manipulation of uterus - pressure. 2. Ergot. 3. Irrigation hot sterile H2O. 120° 4. Tampon with gauze. compresses & bandage keep bladder & Rectum empty. Remedies of acute anaemia due to severe Haem. May become Malignant. may be passed1 1/ yrs. Other organs involve. 2ʒ to pint normally. Placenta site Preved mostly. Preph. Tr: slow delivery of child. Pressure on Uterus during & after delivery Uterus failing to retracted rub ice over Hypogast. Empty bladder. Ergot after deliver of child or Plac {Primary during first 6 hrs. of Puer prium. {Secondary - after 6 hrs. Plac. site. Causes: 1. Inertia of Uterus. 2. Retained Placenta. 3. Full Bl. & Rect. prevent contractions. 4. Weak. Constitution. 5. Anaesthesia Plac Prev. Exertion etc. April 12.07. Eclampsia: occurs: before. after & during labor. 1-200-500 Cases. Earlier severer. Like Epileptic Convulsions & similates several conditions. Cause not well defined: is a Toxaemia most likely arising from Metabolism of Mother & foetus. May be Creatin or other toxic products. Toxaemia acts on Nervous system. Pathology like infection. Affects many organs Liver and Kidneys mostly. Kd. 90%. In death Liver & Kidney always affected. They contain Haemorrhagic spots & necrotic tissue. similar to ac. yell. atrophy. & Hyperemesis. Premonitory signs & symptoms. Urine: Albuminuria. Tube casts. Lessened urea. Blood corpuscles. Edema. Debility frontal Headache. Naseau and vomiting late in Pregnancy. Contracted Pupils Visual disturbance & Epigastric pain. Spasm follows, eyes fixed. Stupid Dull Epileptic status. first signs twitchings of face arms twitch, bites tongue. Spit blood. coma. stupidity follows. Spasms repeat & may be frequent. Pulse 140. Respiration labored. fever 104 Prognosis depends on severity. Die after 15 Conv. or fever 105. Primpera over 40 die. Prim & Prev. nephritis die unless premature labor.    Lids. Lachrymal. conjunctiva. Lower lid pulling down & have them look up upper... by eversion. " " " " down. Sup Rectus & Levetor of Upper lid act together. Conjunctive of Eye ball next. Inflam most pronounced at margin of Cornea Para Corneal injection is indicative of Inflam within the eye ball Reddish around edge of Cornea mostly. Next Cornea Normal of transparency interfered with. Focal illumination [b??] use of BiConvex Lens 2 in focas for examining. Anterior Chamber: if normally deep. foreign sub in Aquous & these are conspicuous by their color.. Pus. Blood. etc are heavier & settle down. Iris & Pupil. Iris if inflam color is darker. Size & Motility of Pupul. light most important factor size varies average 2. to 4. m. young larger. Movement of Iris. Shade one eye for 1/2 min take off cover & watch contraction which is quick. Cald direct reaction to eye. indirect action is of fellow eye. [illustration] Crystaline lens. May be loss of transparency seen in form of opaqueness examine by Oblique Ilum. & Opthalmoscope (Helmholtz 185 Concave mirror with perforation. Direct Examination Indirect " is interposing Biconvex lens Yellow Spot Macula Lutea Feb..7.06. Tension of Eye Ball. examined by touch. T = + 1 + 2 + 3. = - 1 - 2 - 3 Motility of Eye. all movements are rotary. 1. each eye alone. then both together. can be rotated about 50° in all directions. " " " laterally till cornea touches Ext. Canthus. Internally " " " Caruncula. Near point of convergence. in young is 10-11 c.m. Subjective Examination. 1. Exam. 2. " of Field of Vision 3. " Periphery of Retina is 1/50 of yellow spot. V = 6/6 - 6/9 - 6/36. Test near vision & accommodation. at. 10 yrs = 14 dioptics. near point 10 c.m. 20-20 c.m. 40-36 cm. Presbyopia - weakness of accommodation comes on between 40 & 45. at 70 lost. testing take age into consideration. Vision depends on state of refraction. General condition of whole eye. Field of vision tested with Perimeter white objects used. Scotoma places in field where spot is dark. White Black, Red Green, Blue Yellow, Complementary get same grey in each. Maxwell mixing is rapid rotation Color blindness acquired or congenital. Red green Congenital most frequent. Yellow Blue. Feb.14.'06. Lachrymal gland under outer border of Orbital [Ru?] may have inflamation or abcess formation. Treated as all " & abcesses. Tumors Carcinomata, or Sarcoma fibrinous composition. swelling pushing eyeball out of place causes double vision. Incision along outer half arch dont injure tendon of Levator. Tumors usually encapsuled when removed Prog. good. Lach. Duct. Canaliculi. Excretory Apparatus Puncta may be closed mechanically by foreign bodies. cilia. dust. may be congenitally closed. Treat. is to open it. Lach. Sac. & Nasal Duct. Chronic Inflam & Suppuration & Chronic Dacryo Cystitis. Swelling of mucous membrane & close lumen & there is a contraction of sub mucous lining causing stricture. most frequently at Beginning & ending of duct. may be more than one. tears accumulate in Lach. Sac. causing extension can be seen. is usually in a state of inflamation may be mucous to Pus. upon pressure fluid escapes thro Puncta & diag made there from. Gets in Cony. Sac & is inflam when in lower & inner is indic to Lach Sac. Constant tearing. Do not operate when Chronic Inflam. of Lach appar exists. Treatment. 1. to reestablish lumen & reduce any stricture 2. to get rid of any inflam. Probes are used 1 to no 10 Lach or Bowman's always used flexible probes. to Probe slit usually upper Canaliculus Make use of gradual dilitation Let probe remain 15-20 or half hour. Largest duct size of Bowman no. 10. Probe. When using anesthetics follow one probe with another. Anel syringe used to inject fluid & will come out of nose or be swallowed when flows out over check canal is closed. To reduce inflam in Nasal duct & Lach Sac Use antiseptic solution with Anel syringe. Prognosis only fair. Entire Lach. Sac. may have to be removed. Feb.21.'06. Affections of Tarsus. free edges. Muscles. Free Edge. Chronic Inflam. process (Blepharitis) disease of Childhood. similar to Exema. Squamous form number of gray caps around Cilia. Ulcerous. Abcesses small under these caps & around cilia. Ulcers may become large. in Children not well kept. Diseases of skin may complicate Treatment: Cleanliness. Boric Acid Solution Warm Crusts soften with Glycerine ect. Nitrate of Silver best application 1% Sol. Ointment 2% Yellow Oxide of Mercury applied in evening. May be advisable to remove some of cilia & cleans deep part of Ulcers. Madarosis where cilia fall out. Sty acute abcess formed around a cilia Tarsus. Chalasion. (Retention Cyst) near sharp border of lid. may have pus & pain Remove small may recede. open from inside & vertile Lupus. Epithelioma from free edge of lower lid usually. Trichiasis any condition where cilia are going in wrong direction. may affect the eye ball. Wild hair where gets to Eye Ball Trichiasis accompanies abnormally curved tarsus. Causes of Trichiasis. diseases of Conjunctiva. Granular Conjunctivitis long standing Blepharitis Treatment: Extract. destroy roots by use of Needle electrode. H. free cauterizes Feb.28.'06. Ectropium lids standing away from eye ball. lid becomes dry & becomes inflamed chronic. most frequent on lower lid. Senile Ect. due to relaxation. & want of fat. caused also by disease of Conjunctiva (Cicatrical tissue. & Turus make it secondary & Diseases of Skin; Excema & Lupus. Treatment: Different according to Cause. Slit Canuliculus. Snellen Operation. Stitch thro' Conjunctiva & thro skin on Cheek tightening every day. forms cicatrix which contracts lids back to place. If elongated excise triangle of Mucous Cory. & Tarsus. When caused from cicatrix. transplant skin. after cause has been remedied. Transplanted flap must be 1/3 size & best to have pedicle Blepharophimosis. narrowing of Palpebral fissure. Caused from Granular Conjunctivitus Blepharob slit external Canthus 4 to 6 m.m. Unite skin to Edge of Conjunctiva to prevent healing Wounds of Lids. Perforating sew up Conjunctiva first. then unite well free edge of will. Affection of Muscles of Lids. Orbicularis: Spasms Tonic & Clonic twitchings require into habits. Paralyzed cause tearing cannot be closed Eye may be injured treat. same as facial paralysis. Ptosis affection of Levator muscle Paralysis. consequence of Paralysis of III Nerve Congenital Ptosis due to want of development most frequent Unilateral Treated by Surgical procedure. stitch tendon down to skin drawing it downward may substitute Corrugator for Levator. Conjunction diseases. 45% of Diseases of Eye. Inflamatory processes. 6 forms. 1. Simple 2 Purulent. 3 Granular or trachoma 4. Croupous, 5. Diphtheritic. 6.. Phlyctaenular. Mar.7.'06. Hyperenemia Lach. Conj. Misuse of Alc. Tob. Dust. interocular affections. dryness of lids. unpleasant when closing. No undue discharge in Hyperemia. Mucous discharge & Purulent. mucopurulent etc. Simple Conjunctivitis by irritation by dust etc. most freq due to infection. Staphlo. Pneumo. Diplo. more or less contageous Catarrhal Conj. may be in epidemics. In mild forms is mucous secretion, sticks cilia together. most pron. on Palp. Conj. of lower lid. as a rule cornea is not affected. Treatment: Cleanliness. remove discharge regularly Boric Acid 3%. Liq Plumbi Sub Acet. Bichlor of Hg. 1 to 5,000. Clean 2x a day or more often according to severity. To restore Conj. to norm. we use Caustic or astringent. Caustic may produce Necrosis of Upper layer. Astringen Alumin Weakest. Sulph of zinc 1% sol. Tarmic acid. 1% sol. Sulph of Copper. 1% " (Caustics) " " " stick. Blue stone Silver salt Nitrate 1/2 to 2% Sol. Neutralize Nitrate of Silver by [Silver] Salt Sol. Protrarg ol { 5 to 20% Produce less pain. Arg y rol { Catarrhal Conj. Astringants sufficient Purulant & Where weet Bac is found Caustics are used. Chronic Conj. Caustic are used. Purulent due to gonorrheal infection. Blenorrhea of New Born takes place infection at birth. first stage is red etc & in a few days thick yellow purulent discharge. Upper lids swells found also in Diphtheria Usually last 4 to 8 weeks. Dangerous disease. lies in fact that cornea becomes implicated with ulcers. grayish disclor in beginning & enlarge rapidly. may destroy entire cornea & perforate cornea & Vit H. may escape. ulcer never passes into sclera. upper lid is hard in Diphtheritic Conj. Treat. Cleaning of entire sac. by irrigator. with Bichlor. or Permang. of Pot. (fresh) 1 gr. in pint of water. Rest & careful dressing Caustics stronger. Nitrate of silver. 2% Sol Application to Conj. of upper lid first. Once a day as a rule not oftner. wait till previous escar has passed off. If ulcers form don't cauterize. give some [Mid??atics]. Blenorrhea neonatorum due to infection of gonoccus. in infant. appears 3 . 4 or 5 day after birth. Prophalaxis: be careful for yourself Wash eyes with antiseptic sol. & drop in Sil. N. Close well eye with transparent. shield. watch [glas?] Granular Conjunctivitis (Trachoma) found in low altitudes. more severe in lower states. Path. 1. Enlarged follicles roundish whitish bodies.[illustration] conj. becomes rough & granulated. Conj swells becomes thicker. clears up & is transformed into cicatrical tissue. later stages there is atrophy. Chronic Disease. Acute Tr. discharge after a few days & becomes mucopurulent. upper lid swells not large Conj. red. swollen. Hyperenemic. then the granules appear. Chronic Trachoma. Symptoms in upper lid. Swelling. irregular outline. enlarge. lymph follicles (Sago grain) feeling of Uneasiness. No impairment of sight when Cornea unaffected uni fallicular Conj. Imbeded Lymph. follicles. Mucous Character of discharge. Trachoma treated early subsides in 7 to 8 weeks. very Chronic disease. 10-20 yrs. May affect Cornea & lids. 1. panus (superficial opacity over Cornea & formation of Bld Vessels from edge of Cornea. between Bowman's Caps. & Epithelium. Panus found in other diseases. mostly from Trachoma grows from above downward. a reaction to irritation of lid or an infection similar to Tr. 2. Ulcer may be formed on Cornea not so progressive On lids Cause of Entropium. Tarsus become affected & may cause turning in of Tarsus. Trichiases also present. fissure become smaller (Blepharophimosis). Treatment: Remove content of follicles with forceps Use Cocain. Caustic etc. Sulph. of Copper. (stick form) or Blue stone. have edge smooth. apply to upper fold of Transmission, evert upper lid make application from below upward. once in 24 hrs. Cold application to counteract Pain. Nitrate of Silver 1% sol. Bichloride Mercury 1 to 500 makes a Caustic. 1 in 24 hrs. also... where discharge is Purulent Nate. Silver & Bich. are best. Change remidies occasionly. where ulcers are present Nitrate irritates. Panus Complication. when small no treatment necessary will clear up with disease. Excision of part of Cornea Ulcer. proper clensing. Scraping if necessary Dilate pupil to prevent Iritis Lids bring lids to proper shape. Blepharophimosis widen fissue by previous described operation. Croupous Conj. Croupous discharge lies as secondary covering over conj. affects lower lids. after a week Membrane becomes loose & is cast off. duration two or 3 weeks. after membrane leaves muco purulent discharge. Benign diseas. Cleanliness, & antiseptics. Don't remove Membrane too soon. 2 % to 1 % sulph. zinc. 1/2 % Nitrate of Silver. April.4.'06. Diphtheritic Conj. is exudate in mucous membrane. usually on lower swollen lid is very hard. first stage watery discharge later stage of Purulency. Increase Temp. Glands in neck swell. Cleanliness. Antitoxin. Phlyctaeneous Conj: Vessicles on conj usually at edge of Cornea. Contents of Ves. is clear fluid found in poorly nourished children. Scrofulosis etc. no mucous discharge. Mercury Prep. Yellow Oxide in form of Ointment. put into Conj with probe. Calomel for severe cases. Tumors. Cysts. angioma. Epitheliomata. Pterygium. grows Horizontally. apex toward Cornea usually goes from Nasal side Cornea when diseased power of reflection lost. Curvature change. Superficial & interstitial Ulcus serpens. no. conj. disease present. due to 1. injury. 2 infection. Pneumo coccus & Strepto. Ulcer of Cornea is typical. may grow to pierce Ant Chamber. & Aquous humor escapes. Ulcer deceiving is pressed outward. Hypopyn accumulation of Puss in Ant Chamber accumulate in lower part. Cicatricial tissue found in healing Ulcer. Grayish color. thicker whiter Tr. Check progress. by Steralizing ulcers use cautery Cocain 4% solution 1 drop in eye & close follow in 2 or 3 min. & will anestheze. the Cornea Cocain is not efficient more than 2 weeks. Conj not affected as is Cornea. Cocain dilates pupil. Io. Powders have been used. Paracentesis of Cornea for Hypopyon treatment Ulcer stops when perforation forms. Luke warm applications. Herpes Soster. Warm applications. Dentritic Keratritis, Opacities like trees. Tr. apply antiseptic remedies. Scars are tatooed black. Staphyloma bulging of Cornea due to previous ulcer. Remove Dondas Dec.11.'06. Emetropic Parallel rays focus on Retina. Hyper-opic. " " " Behind. My-opic. " " " in front. Subjective: Objective : 10 May3.06. Acquired Cataract. {Sof. cortical 40 to 60 {Hard. - 60 Soft. [illustration] soft mass takes 2 yrs. to grow opaque Hard begins at center to be opaque takes 5 to 10 yrs to mature. In soft. Ant. Chamber becomes shallow. Both eyes affected usually Frequently follows Diabetes Mellitis Naphthalene Treatment is surgical. Decision. incise ant. capsule Practiced up to 15 yrs. [illustration] Extraction Cong. & soft. Decision. Ant. & Post. Cataract no operation needed. 90% recover. Aphahca loss of lens of up Eyes need lens 23d By [illegible] Trauma lens may leek into ant chamber Glaucoma disease Eye Ball Increase intraocular tension 1, 2, 3 degree. cause unknown. in later stages of eys. Ant Chamber is shallow, Dilated pupil. Inflamation this is only disease where pupil is dilated with inflamation. Excavation of Optic n. due to intraocular pressure 1.. Simple has no inflam. loss of sight 2.. Inflam symptoms of Inflamation. Iridectomy for treatment allows fluids to flow out at normal place. Pterygium horizontal growth over cornea is Triangular in shape. More frequent to exposed people. Nasal form most common. Many times no subjective symptoms. grow slowly. Treatment: Surgical. Dionin used in absorbing clot from sub conjunctiva. Keratitis. 1. Interstitial 2. Parenchymatous. Phlychtercular. Cause inherited or acquired syphilis         Ry. Surgery.. Mar.1.'06. Treatment of Fractures. Reduction & Retention. Use anesthetic to overcome Muscle contraction & Nervous Irritation. follow with Morphin. Plaster Paris. To reduce carefully manipulate to proper place. by following course of its act in dislocation. Oct.8.'06. Advantages of Ry. Surgery 1. To the injured 2.. To the Ry. Co. 3.. To the Public. 4. To the Profession. 5.. To the Ry Surgeon. Distinctive features of Ry Surgery. 1. The emergency character of the cell. 2. The great force producing Injury. 3.. Infrequent litigation 4.. Social status of Ry Employ. 5.. Collateral duties of Ry Surgeon. (a). Making reports. (b). Economical management of Cases. (c).. Physical Examinations etc. etc. Description of Injuries. Contusions. Bruise. Mash. Crushing. Degree. Mild. severe. Effecst: Hyperemia, swelling Ecchinosis. Extravasated Gangrene. Lacerations. Tears smooth ragged Incisions cuts. by edged tools. Fractures: Partial, simple, compound, comminuted. Sprain Mild. severe. wrench. Disorginazation of joint. Dislocation Partial. Complete. Compound. Internal injuries. Effects, Contusions, Ruptures. hemorrhages. Concussion. Compression. Contused & lacerated wounds. Punctured wound. stab wound gun shoot wounds. Oct.22.'06 Report of Injuries Age. Color. Res. Occupation. Date & Place. Person calling surgeon Insurance Injury Description. How occured - statement. Probably time of recovery. Any Blame attached. Services. Examination Employe. Eyes Distance & Color. Ear. Power of Hearing. General. forms of Disability. Nov.5.'06. Fees of I.C.R.R. Patient within limits of city or town where Physcian resides. (Two Dollars) first visit if only {Medical Treatm {Introduction of Catheter. {Sunstroke. Contain Minor Cut etc. Five Dollars {Minor Surgical Op. {1. Amp of one or more fingers. {2. Fracture of Ribs. {3. Dislocation of Bones of Hand & foot. {4. Ligation of Artery below elbow or Knee. Ten Dollars {Dislocation of Ankle wirst or jaw. {Fracture of {Scapula. {Clavicle. {Arm {Forearm. Fifteen Dollars {Amp at or below Wrist. {Dislocation of Shoulder Elbow or knee. {Fracture of Patella - Femur. Thirty Dollars {Amp at Knee {Thru leg. foot. arm. {Excision of any of the larger joints except Hip. {Severe Cpd fract of skull. Fifty Dollars {Amp of Hip {Amp " Shoulder. One dollar for each subsequent visit in all of above enumerated cases. 1. One dollar minimum fee. a. Office Consultation one or more prescription. b. Minor surgical treatment. c. After dressing of injuries. d. Opening of small abcesses. e. Removal of foreign bodies from Cornea. f. Vaccination. g. Introduction of Catheter Ordinary treatment of Eye & Ear. Cauterizing wounds. After treatment of Uterus or Rectum. Small Burns or scalds. Physical examination for lodges without Urinalysis Tongue tied. Certificates of Disability. Hypodermic Injection. Chemical Urinalysis. Two Dollar list: Ordinary visit outside one per mile. Treatment of Urethra: Rectum. Opening deeper Abcesses. Irrigation of Bladder. Removing Embeded foreign bodies requiring cocain. Insised or lacerated wounds not more than 2 sutures Exam for lodges with Chem. Urinalysis. Ordinary Sprains. Skin grafting. First adjustment of truss. Antiseptic clensing of punctured wounds. Three Dollars. Minimum fee for night visits. Life insurance with urinalysis. Antitoxin infection. High enema. Phlebotmy. Microscopically Examination. Five Dollars. Reducing fracture of fingers toes. Minor dislocations Treating wounds of five stiches. Treating severe Burns. Removing foreign bodies Nose throat. Small growths. Deeper Abcesses. Difficult Cathelengator. Professional [illegible]. Removing Cinders or powder stains. Chem & Micro Urinalysis. Night visits unusual detention Operation for ingrown toenail. Insanity cases. In court as witness Reducing Hernia. Tapping Hydrocele. Exam in Syph. & gorr. Severe spraines of larger joints Removal foreign bodies. sphincter etc. Gun shot - wounds. Anesthesis. Irrigation of Bladder. Cerdeminoir Cutting stricture. Removal tapeworm. Chem & Micro of stomach Cout Dislocation of Patella. Ten Dollar. Amputation of fing & toes with cares Deep extensive Incesed wound. Reducing fract forearm [illegible] Dislocated jaw wrist. Removal plac. Cellener Miscarriage. Tapping. Small growth remove with [illegible] Recent laceration of [permi???] Rescetion of rib. Expert testimonies in court. Ureter [illegible] Tonselotone Wound labor 3 vessil fract leg patlla [a??] Disloc. shoulder or knee. Polts. Reloca Bones fract. fract of skull not depressed Removal of Pile Curetage Rewix lacerated. $25 forceps delivery Dificult labor col complete lacerater Track colur Post morten $30 Hene joint ampl. for arm etc. Comp fract of [illegible] Disloc of Hip Wound of Bone $50 Amp Hugle should hip sever comp skul fract $100 Appen dis st . kid gall [bla??] 1/3 added for assistant. above are minimum fees. Emergency Bag: Splint - Plain - tressed. Cotton 1/4 lb. Bandages - 1/2 Doz. Gauze 5 yds. Rubber tissue. Towel- soap- brush. Tourneguet. Adhesive Plaster. Court Plaster Bottle antiseptic, 50% sal. ac.cart. alcohol. Iodine Turp.  As + H -> AsH3 or arsine. Prep of arsine: 1. Arsenides + Nascen H. 2. Whenever reducible comp. of arsenic is brot in presence of Nascent H. 3. By water on Arsenedes of alkali metals. Phy. prop. 1. Colorless. gas. 2. Sol in 5 parts water free from air. 3. Easily inhaled & most poisonous of As. Comp. Chem Prop of AsH3 1. Neutralin reaction. 2. In air its H is reduced by oxygen. 3. In O. it is reduced to Metalic As. 4. Buns with bluish flame -> As2O3 5. Cl decomposed As H3 violently -> HCl + As or As2O3 6.. Oxidizing agents decomposes readily. As + Halogens: Forms Comp with all. Donovan's solution. Liquor asenic et Hydrarg Io. As + O -> As2O3 & As2O5 or Arsenic trioxide & Arsenic Pentoxide. As2O3 1. By roasting native Sulphides of Arsenic with charcoal in current of air. 2. By burning As in O. or in air. Phy [Chem] Prop: (glossy) 1. 3 forms. Crystaline. Vitrious. Porcelain. 2. Heavier than water yedd it floats due to fact that particles of air are attached to surface. 3. It is called white As. in Commerce. 4. Impure form is Ron Rats. 5. Sweetish taste. Chem. Prop: 1. Sol. in water is acid -> H3AsO3 2. Neutralize by bases -> Arsenites. 3. NaOH dissolves it forming Na Arsenite. 4. Readily reduced -> metalic arsenic 5. Oxidyzing agents convert it into As2O3. AS2O5 - Arsenic Pentoxide: Prep. 1. Heat as to redness in O or air. 2. Oxidizing As2O3. 3. Burning As3H3 in excess of O. Prop: Phy: 1. Amorphous Powder. 2. Colorless - white 3. Dissolves in NaOH -> Arsenate. Chem: 1. As2O5 + 3H2O -> 2H3AsO4 (Arsenic Acid) 2. Can be reduced giving Metalic As or AS2O3 3. It is Anhydride of Arsenic Acid. Arsenious Acid. 1. formed by dissolving As2O3 + H2O. 2. Liquor Arsenious Acid = 1% sol of As2O3 in HCl. 3. Fowler's Sol = 1% Sol. of Pot. Arsenite. use As2O3 + KCO4 -> [?] 3. Scherle's Green -> Cu Arsenide. 4. Paris " -> Comp of Arsenite of [Cu] & Acetate of Cu Arsenic Acid. or H3AsO4 Prep: As2O3 + Oxidezing by Mix of HNO3 & H2O. Prop. 1. Colorless. Syrupy liquid. 2. May become semisolid. 3. May Crystalize. Crystals are delequete 4. In presence of Nas.H. -> AsH3 & H2O. Compounds of As & S. same as Native forms. Poisoning by Arsenic: 1. Usually taken by mouth. 2. Metalic or elementary As is not Poisonous. 3. AsH3 is most poisonous of all Comp. 4. As2O3 is form most frequently used. crystal may be seen on lining stomach. 5. K. Arsenite often used in Poisoning. 6. Na " used to clean vessels food or water taken from such vessels may cause poisoning 7. Arsenious & Arsenic. 8. Sulphides especially may cause poisoning. 9. Schiele's Green 10. R. on R. - Paris Green. - 11. Pigment from green wall poper. 12. Some green colored candies Test spot. Jan.24.07. 1. Volitilization Sb. 440° As 100°. 2. Sol. As. sol in Na. Hypochloride. 3. Place deposit in tube & make mirror test. See Arsenic Tests2. Feb.6.07. Carbonic Acid H2CO3 unstable. 2 salts. Na2CO3 NaHCO3 Bicarb. Na2CO3 + H2O + CO2 -> [Na2CO] H2CO3 + 2H2O? Leblanc's & Holuays method of prep of Na.Carb. NaCl + H2SO4 -> Na2SO4 + 2HCl. drive off HCl. mix remainder with C. -> CaCO3 Na2SO4 + 2C-> Na2S + 2CO2 Na2S + CaCO3 -> Na2CO3 + CaS. CaS + O -> CaSO4 & is insol & raked out into water & CO2 absorbed. Soluay. NH4HCO3 + NaCl -> NaHCO3 + NH3Cl. (2) NaHCO3 + NaCO3 -> H2CO3 + H2O + CO2. NaHCO3 -> Na2CO3 + H2CO3 -> H2O + CO2 treat NH4CL + CaOH -> CaCl2 + 2NH4OH NaCl + NH4OH -> NaOH + NaCl. NaOH + H2O + CO2 -> Na2CO3 + 2H2O. Carbon Bisulphed CS2 heat C + S -> CS2 Prop. Liq. heavy. peculiar Odor. best solvent for S + P. Poison to inhale. C + N -> Cyanides or CN2 1. gas Pungent odor. Poisonous. can liq. burns. with blue flame gives HCN. (Prussic Acid) Prep. KCN + H2SO4 -> K2SO4 + 2HCN. Prop: colorless liq. taste oil of Bit. alm. Poison Prep of KCN. KOH + HCN -> KCN + H2O. Toxic. Most poison. Sym. falls at once. dizzy. naseau. Resp slow. ht. weak stops suddenly. antidotes. no time. art Resp. affects tiss so they cant take up O. Silicon Si. 28. few comp. SiO2 Imp. constituent of glass. CaF2 + H2SO4 + glass or SiO2 -> CaSO4 + 2HF. SiO2 + 2HF -> H2SiF2 very Vol. Not ordinary. Feb.5.07. Antimony. Sb. 120. Occurrence as sulphide. Prep. roasting with Carbon Prop. a metal. Stibium SbH3 Prop. that of a gas. Prep. same as antimony. Tartar Emetic or Pot. antimony tartrate Prep. Boil 3 parts of antimony trioxide with 4 parts of Cream of Tartar. KSb. OC4 H4O6 Dose as Emetic + 2 gr. Expect. 1/8 - 1/6 Poisonous sympt. or overdose & long Cont. dose. At.W. Bismuth. Bi 207 - occurrence as Sulphides. roast with Carbon. Prop. Metalic. -Most important Bi. Subnitrate. Bi Subcarbonate. Bi Subgallate = Dermital. Carbon: C. At.W. 12. occurrence - Diamond. Graffite. Hard & Soft Coal. allotropic forms. 1. Diamond - no ash. 2.. graphite 5% ash. 3.. Amorphous & coal. Anthracite Coal 98% Bituminous 70-80. Peat small % . Lamp Black pure. from incomplete oxidation Animal Charcoal. Coal gas is made by destructive distillation of Coal. Illuminates: Ethylene C2H4 Propylene. Butylene. Antylene. also n.CO2.H2O. Water gas prep. by passing jets of steam over carbon. in form of Coal heated to Redness C + 2H2O > CO2 + 4 H. Constituents 1.. H. 2.. Carbon.. 3.. CO2. Water gas. Carbon Monoxide Prep. 1. burning incomplete oxidation 2. Oxide + H2SO4 + Heat. Phy. Prop. Colorless. odorless. tasteless. Burn with blue flame. Nearly insol in water Reduces Phys effects. Narcotic. Dizziness. Headache. naseau. Mental Dullness. Coma & Death. treatment Art. Resp. Remove source of Poison. Supportive. Ht. & Resp. Stimulant. Inject of Saline Solution. Mar.11.07. Paraffins: Saturated Comp. Stable. CH4 Methane. Marsh gas Illuminating gas from decomp. of Organic Matter. Fire damp is Mixture of O & CH4. CH4. Methane. C2H6 Ethane. C3H8 Propane. C4H10 Butane. Petroleum: crude oil Kerosene: from .. .. is that part which distils between 150 & 220°C. treated with 2% Sulphuric Acid. takes out unsaturated HydroCarbons. add NaOH to neutralize acid. Redistil. Benzene mixture of Paraffins C5H10 C6H12 etc. cleanser. rubber etc. passes off first gasoline next. Petrolatum Liq is heavier Alboline. Vasaline. remains. Paraffin. Subtitution product of Methane. trichlor Methane. - chloroform. Prep. Commer. treat Acetone CH3COCH3 2 Acetone + Chloride of lime. Chloral CCl3CH6 + NaOH -> CHCl3 + NaHCO2 Mar.18.07. Alcohol. water where 1. H is replaced by hydro Carbon. Monatonic - C2H5OH Diatonic C2H4(OH)2 glycol. Triatonic. CH2 OH. CH " CH2 " Glycernil. I. CH3CH2OH II. OH attached to carbon which in turn attached in 2 C. [illustration] III. OH to C. which in turn to 3 or more C atoms. [illustration] isobutyl alcohol. Primary alc. when O. yield aldehydes. Secondary " " " " Ketones with same C. Tertiary " " " " Ketones with less C. Distilled {Brandy {Whisky. {Rum. Malt. Beer. 3.5 dark 4-5 Ferment. wine. 15-20- Champagne - Carbonated wine. Compounds obtained from alcohols by dehydration.--- Ethers 1. Simple. - when Radicals are same. 2. Mixed " " " different. 3. Compound or Ester: alcoholic radical & acid radical. CH3COOH + NaOH -> NaCH3COO Ethyl Ether. Labarraque. Sol. Page 80. Mar.1.06. Proencephalon. Mes " . Rhomb " . [illustration] Axilary Neuron to Post. C. Col Gal. Burd to Dendrites to Per) Medulla & thence to parts of Brain. Motor [illustration] afferent or sensory {Pain {Thermic Special Sensation {tactile - contanct etc {muscular & articular sense. {smell, sight, Heart & taste. Excito Reflex. Efferent Motor to Vol. Strip Mus. Vaso Con. Secretory. Inhibatory Cirbro Sp. Mech. 1 Psychic. 2 3 Sensory 4 Voluntary Motor. 5 Reflex. Visceral Mech. 1 Secretory. 2 3 Troph. 4 Vaso Motor. Ant. Lat Post. Col. Post {gual {Burd. fibers entering cord Post divide into asc & Desc. ends some pass to ant Hons [illustration] " " " Clarks Col. most pass to Nucleus of gaul & Bird in Md. from Clark to Direct Cerebellar tr. " " some go to gowers (Heat tract) [illustration] Rolandic centers of Motor. Precentral for extremities & Cran. N. Lowest Opertulum. Hypoglos. facial Hand wrist sh. Feet to Mescal Uper Neuron has inhibitory action Sensory ending in ant Horn. exciting Precentral Conv. center of Motion for oposite side. lower part. face, tong. larynx, Mast. Mid " arm. fin. hands upper " Lower extremities. Lower part. 3rd. frontal Conv. muscle of speach. Candal end 2nd. " " center causes. when irritated to move head & eyes to opposite side. Prefrontal area higher Psychical functions. Primary center for Optic is Con. of Optic Thalamus & corpora quadrogen & Ext. geniculate body. end in Cuneus of Occipital lobe cause partial Hemeop. Bl. Post central conv. center for sensory impulses. [illustration] [illegible] Angularis affected cause Olexia. Cerebellum Loss of Control of Muscles. two Lateral lobes & a middle. No nervous symptoms from Lat. Lobes. Cerebellar Ataxia from middle lobe staggering gait. Connected to other parts by Peduncles. Restiform body Inf Ped. [?io] Psychical function but Equilibrium. Symptoms of Nervous Dis. Neurosis morbid nervous state Phsycosis " mental. " Motor & Sensory. Exaggerated, lessened, perverted. function Hyper, Hypo. A, pava. Objective & Subjective " Sym can be seen directly. Sub. " felt by patient. 1 Mental & Cerebral 1 3 Sensory Asthesial Neurosis 4 Trophic " 5 Vaso motor & Thermic " 6 Secretory " Mental irritability, depression, emotional, morbid fears, lack of self control, fixed ideas, weak memory & concentration. Cerebral Sym. Vertigo, disorder Equi. insomia, somulence, stupor Cornea, Headache, Motor Sym: Exagerated Motility, Tremov. {1 {2 1 Fibriclary. &2 Tnemor Proper. {1. Intentional Tremor, 2 Passive, 3 Constant, 4 Tonic, 5 clonic. 6 Coordinate. Movements Coeric Mov. Athytosis. Muscular tension. Associated movement. Reflexes. Lessen Mot. Paralysis, Parases. loss of Reflexes Hypotonia [Tribraliary] Convulsion 1. Clonic. 2. Tonic. Epilepsy both are present. When painful is Cramp 3. Coordinate. Convulsive seizure associated with unconsciousness. Coeric Mov. are sudden jerking twitching mov. of certain muscle. are purposeless not under control are incoordinated. at times only indiv muscles twitch. Tie Movement. (Habit Spasm) is a form of Coeric movement confined to group of M. which work together is coordinated movement more or less under control of individual. In ties movement are of more definate character. Ties of muscles of Expression. Resp. Speach. Athetosis. peculiar form Char by slow successive extention, flexion, promotion & supination of fing. Hand. Arm or analogous of toes & feet. rarely ceases in waking except for short time. Contracture. 1. functional - unable to contrast arm 2. Organic - in tracts - Associated Mov. are those which occur unvoluntary when opposite side moved. Hemaphlegia. Half body paralyzed Para " two lower limbs. Paresis partial paralysis. Reflexes. a motor response to sensory impression Is involuntary & 4. kinds reflex 1. superficial. 2.. tendon (deep.) 3.. visceral 4.. Idiopathic or direct. Sensory functions belong to nerve of special & general sensation. may be depression or loss increase or preversion of sens funct. Ansthesia lost of tactile Unalgesia loss of Pain Therm " " " temp. Muscles sense to Pain & Sense. Antaxia loss of sense of muscles. Disturbance of Muscle sense is Low motor Ataxia. Definite & Coordinated movements are made possible. Static Ataxia loss of Equilibrium. disturbance in sense muscles. Coordination is perfected by repetition Deep sense interfered with is incoordination Cerebellar Ataxia. Ustereognosis - loss of sense of form Hyper asthesia increase sense of touch. Hypo " decrease " " " Analgesia loss of pain sense. Hyper " Hypo " Parasthesia loss of all morbid general sensation except pain. Delayed sensation 1 or more second elapses 1/0 sec is normal. Refered sensation Allochina transfered sensation. reffered to opposite side. Arthropathies affected joint. Acromegaly disturbance of Petruratary. Angio Neurosis Simple pereted gait Hemophlegic " Spastic gait both sides affected. Stepage raising leg to raise toe. Rhombergism. Argyl. Roberts Pupil does not respond to light. Testing reflexes have patient relaxed move leg & feel contraction in quadraceps . Ex. Difference in tendon reflexes important tap with same intensity. Gen drassiak method to withdraw attention Ankle Clomus Patellar " Reflex. motor response to sensory impulse Lesion of Pyramidal above center of Reflex Arc Causes exag. relex. in Hemphleg also Sl. irritation in Sensory tract increase reflexes Certain drugs Strychnia. Diffuse disease above Reflex Arc. Lesion complete transverse absence of Reflex. Oct.5.'06. Dr.Schwab. Oppenheim. Day ner. Progressive Bulbar Paresis. slow progressive degeneration of 12.10.7. Motor nuclei of Medula. degenerated nuclei. Appoplectic - very fast rare [?ag] Pseudo. not in med. rare. Mysthenia gravis no change in Post Mort. [illegible] very emotional. first complaint. speech nascent. get tired speaking could not swallow well especially liquids. which came thro nose. Phy. Ex Tremor of Tongue. no dist. sensation. Tr. supportive little can be done. Prog 1 to 5 yrs. Path. Degeneration of Nuclei of 12.10.7. in floor of IV Ventricle & Celerosis of Neuralema with gray discoloration & atrophy of nerves as they come from Medulla. there is an atrophy finally of muscles of Lips & tongue. Oct.9.'06. Mental Diseases. Mind is experience. sensitiveness. choice. & movement. Intelligence. Spoken Language Sup. Temp. Look Conv. Written " Angular Gyrus. Inferior Frontal for muscles of speech. Sensation underlying element of mentality. Intellect - think feeling - of [motion] emotion Well - regulates actions. Insanity is that state of Mind in which the subject is no longer able either Temp. or Perm. to draw logical conclusions in accordence with age. race. education etc. Illusions & Halucinations. delusions are preverted in Insanity. Delusions is an error of judgment out of which p. can not be reasoned. Illusions are falty interpretations of senses with Physical foundation. Halucination is a Preverted misinterpretation without Physical foundation Oct.11.'06 Schwab: Inorganic or functional no chance in Post Morta Tic. general movement purposeless in character. in groups of Muscles or single. Bilateral Tic Chorea differenciate. Treatment of Tic is Physical treatment. Bell's Palsy. Reaction of Degeneration present in Periphery. 7 only in Peri. 3 Branches " " Tabes Dorsalis. Oct.16.'06. Chaddock. Insanity {functional {Organic. 1. No path. Cesions. no signs of inheritance or organic. follow shock. accumulation of Poisons. Uremia. Melancholia & Mania: Simple Insanity. 2.. Anatomical changes in Brain substances. Syphalytic causes. Alcohol. Lead. Deposits in Meninges - tumor. Uremia. Diabetes. Thyroid Diseases. 3. Due to Mental instability inherited. May be due to defective conformation of Skull. Change in convolution or arteries. In this type there is recurrence. Periodicity. Remissions with relapses. Prodroma state, delusions. Absence of Cause except. degeneracy. form Periodic. recurrent 3rd.. Neurotic. 4. Due to arrested development. Glandular deficiency. Cerebral hemorrhage. Treatment of Melancholia: Intubition of Mental & Physical activity out of all proper to cause. Symptom. Depression & inhibition of Mental activity. Cause: emotional & Physical: Phy. Disturbed Nutrition of Brain. Stomach is secondary. Depression always present & monotonous. simple. & mel with delusions. Del may be Moral & Hypocondria Active or Passive. Symptoms: Mental distress & depression uneasiness & expression of grief. Sluggish liver, defective Stomach Constipation. Urine excess of Phosphate & Indican sleep disturbed. speech slow & monotonous. Headaches Neuralgia great Agony. Prodromal symptoms of apoplexy. Oct.19.'06. Schwab. One sided Paresis loss of good use of Muscles. T.B. 3 yrs. ago. Numbness of fingers. Make careful Physical Examination Careful History. Must be some lesion of Heart. Hemorrhage. Embolus or Thrombosis cause apoplectic stroke Valvular disease may cause it by Embolism. Softening from Enfaret. Hemorrhage from arterodcluosis into Brain (syphele) Thrombosis from slowed current. Nephritis may exist with arteric sclerosis. Treatment Nitro glycerine & K.I. Second Aortic slightly accentuated. Examine Urine. Oct.25.'06. Paresis. general Paralysis of Insane. Dementia Paralytical Unequal pupil. fixed Pup. Double Vision. Opthal - Slight paralysis of Ont Rectus. Tabes. Syph cerbral Parasis, posible.. Optimism. Nov.2.06. Chorea Chorea {acute infectious disease. Chorea {Chronic. Symptoms may follow Hemph. Hysteria. Adult Choreas. Huntington type in family degeneration Mental symptoms incurable. incordiration, purposeless, dif in time. frequently one sided. Relation Closely to Acute Rheu. Tonal. Endocarditis. Treatment: Rest. Bath salt warm. Aspirin 5 grs. 3x a day. Post Diph. Neuritis: Paralysis depending on Diph is curable. Nov.9.'06. Paranoia? Nov.13.'06 Neuritis. Inflam. more particularly degenerative, structure of N altered Post Column. & Peripheral Nerve same substance. Nov 15.'06. Cerebellar Symptoms: Ataxia. may be caused by tumor. Friedreich's Ataxia. is an Hereditary Ataxia Alcoholic Neuritis most common. Complains of abnormal sensations in lower Extremities. Cotton pads. feet hurt in walking, Hypersensitiveness. lancinating character. Pain slight or severe. increased on pressure or movement. Weak in legs. Calf Muscle extremely sensitive. Anaesthesis of Touch. Muscles are flabby & soft. wasting of limbs. May be masked by oedema. fat may obscure foot drop ant. muscles of [thigh] shin involved. Reflexes are reduced or absent at knee & ankle. Paralysis is rarely complete. muscles are unequally paralyzed. Reaction of Degeneration present. indicates nerve is undergoing degeneration. Muscles of forearm & hands Ex of wrist. R. & Muscular Sp. N. muscles mostly affected. May begin in Hands first. As a rule Neuritis develops symetrically Upper < lover. toe touches first - Tabes Heel. Distal >. Bladder & Rectum rarely involved when so there is more than a Pure neuritis. Cord must be involved. sometimes Optic Neuritis. Hearts action may be involved. develops slowly. in regression some muscles may contract forming deformities. (the Calf muscles etc). Some delirium. dullness. loss of Memory to certain date. Recovery slow. Women more susceptible. Treatment: get rid of alcohol. protect affected limbs Keep warm. keep feet in proper positions. Massage & Elect. Nourish patient. Relieve pain. Watch heart. Application of strong current facadic no pain noticed in Tabes. Bladder involved in Tabes also girdle pain - argyle [Rof???] also. Areas on surface correspond to Root centers in Tabes Atrophy is a final result. Nov.27.'06. Lead common cause of degeneration of Nerve. Degeneration Neuritis Preceeded by other symptoms. May be first. Usually begin in upper extremities the one most employed usually. both alike fre. development is slow. Weakness in extensors of fingers to hands causing wrist drop fingers are flexed at same time. Supinator Longus escapes. May go further & involve flexors. Triceps escapes. Atypycal type may involve Biceps & Deltoid. Muscles involved shore twitching . later may be reaction of Degeneration. No disturbance of sensibility. No paraphlegia. Lower ex. may be involved giving foot deg Prognosis: If P. is removed from Lead is good. Treatment; get rid of Poision use K.I. Mg.SO4 Open Bowels. Use Diaphoretics & treat symptom Arsenical Paralysis May come on slowly after acute poisioning Premonitory sym. Pain & peculiar sensation in hand feet at same time. Weakness followed by atrophy Parts affected by preference are Perenei of Legs & Extensors but flexors more freq than in other two diseases. Sensitiveness of muscular moves to pressure Anaesthesia. Ataxia freq. Reaction of Degeneration. may resemble Tabes dif. early indication of Atrophy Reaction of Deg. Prog. good. recovery in Mild cases in a few weeks. otherwise long. Diphtheria is a paralysis depending on action on Periph nerves. 2 varieties: Local & general. May follow mild or severe case of Diphtheria. Paralysis occur a few weeks after convalescence. Common location is in soft Palate which becomes motionless may be involvement of Ciliary Muscle. but no loss of reflex to light. Abducens may be involved. swallowing may be interfered with. Recurrent Laryngeal may be involved. Cardia nerves may be involved. Involvement of Extremities comes later others may have disappeared. May be limited to loss of Deep reflexes. This may go further & give rise to deg. change in nerves. History good in differenciate. Bladder & rectum not involved. Prog very good as a rule. may be slow. Prog of general Neuritis depends on extent & involvement of Brain & Cord. No sensory involvement in Infantile Paralysis except in beginning. Treatment of Neuritis in general is to sustain vitality support to prevent deformities. anodynes. use of electricity Better of Massage where patient can stand this. Dec.4.06. Tabes Dorsalis - Post Spinal Sclerosis. - Loco motor Ataxia. wasting of Post Cord. disturbs motor & sensory systems. Causes is Syphalis. In children Hereditary. Dementia Paralytica. about same only affects Cortex of Brain. Time 1 to 35 yrs after infection 5 or 6 as a rule. 10 times as frequent in Men. same as syphalis. Affects nearly all parts of Nervous system. Sensory especially. Sensory symptoms first appear. 1. Pains in legs - lightening - come & go. occur in Paroxysms. 2. girdle pain. 3 Crises are pains. in various Organs as named gatric etc. very common. 4. Pads under feet. 5. Sensation of Creeping over skin. 6. Diminution of Pain sense. This analgesia may affect skin & deeper structures. 7. May be hyperalgesia. 8. frequently show retardation of sensation. 9. May be dissociation. 10. Inability to locate impression on surface. 11. Sensibility in Muscles & joints is lost & Patient cannot locate position. 12. Loss of Reflexes. Achilles may go first. This is a slow process. Interruption of Reflex are causes loss. Post Roots mostly affected. Loss of tonicity of muscular tone. 13. Transitory ocular palsies quite common. Ptosis also common. Pupilliary symptoms are early & quite common. (Argyll Robertson) At first sluggish. Myosis. small pupil due to involvement of Cord in upper Dorsal region. that is sympathetic does not oppose the Motor Oculi. Jan.4.'07 Chaddock. Deg. Peripheral Sens. Gang. Optic Atrophy is frequent. May be involvement. atrophy of Cells of Ant. Horn. Also lateral tracts are at times involves. Bell of Hip anesthesia at nipple line May extend alway round or part may be wider on one side. this has a sort distribution. this point is practically diagnostic. Rhombergism May be unilateral. Paralysis of one or both Vocal cords. Tabetic or Shares joint. rapid swelling with no indication for it. limb may be swollen joint may be very loose. Dont open joint. Perforating ulcer usually on feet where theres pressure. Herpes foster do to lesion of spinal roots. Muscles may be affected by involvement of ant. Horn. which fibullary twitchings go to show. Multiple Sclerosis may similate.. Cerebellar Tumor " " . Jan.11.'07. Injections of Calomel treatment of Babansky. No treatment only to check trouble. Sit patients on table & bend body for nourishment of Cord. Reeducation. Loss of Muscle tone cause Contrued - Pain - dont give Morphin. 2 1/2 gr aa Antifpyrin Phenacetin 1/100 nitrogly. 1/16 fr. Op. mixed with Comp. Licorice Powder. 3 doses - 15 min apart & long rest of few hrs. 4 or 5. Morphia hypo. for gastric crises. Electricity not very good. good Hygiene etc. may not go very fast. Keep up hopes of P. 3/4 to 1 gr. once a week suspended in Olive oil in Buttox. give only 3 wks. Begin large dose of Iodides. Combined Post & Lateral Sclerosis. Ataxic Paraphlegia in a person with weakness & ataxic. Inflam. of cord diffuse may produce this. May occur from Vascular interference. Caused by invaded elements which dont belong there. Friedrichs. Heredity Ataxia. Involves Post & Lat Pyr. Cerebellar & Gowers tracks. Poor Embryonal development. Reflexes may be exaggerated. Symptoms not so severe as in Tabes. Tr. may use actual Cautery along spine in P. L. Sc. Freidrichs affects member of one family. Comes on early. is developed in Mother. Mostly Males. Undersized cord & Cerebellum mostly. Atrophy of Cerebellum alone not cord in some cases.- Maries Disease - Jan.18.'07. Staggering stumbling gait. Not a true Rhombergism. Constant moving. Very few sensory symptoms. Deep reflexes are lost early. Exaggerated in Cerebellar form. Sphincters not interfered with. Nystagmus jerking of Eyes. Difficultly of speech. Atrophy Optic common in Cerebellar type.anomalies of Pupils in this form. Face blank. Two deformities lateral Scoliosis. Club foot: increase of Planter arch & hyperextension of toes chiefly big toe. Disease progresses slowly. Similates Multiple Sclerosis. Reflexes exaggerated. Amiotrophic lateral sclerosis. (Sharko's) Involve Motor cells of ant-horns. Disease begins in Cew. & goes down & upward. Lateral tracts first. Exag. reflexes. [sp?ticity]. Atrophy. Hands chiefly involved progresses rapidly. 1-3 yrs. Syringe Myrelia. Infantile Paralysis. Acute ant. Polio. Myelitis. Young children. P.M. Intense Cong. in all case. gray columns. later foci of destroyed gray matter scattered about. Begins as fever. may become paralyzed suddenly all extremities or 1 or 2. May be hemiphlegic. Likely to be pain - joints - after a day or two there are no sensory symptoms atrophy develops slowly. Cong. recedes. Response to Faradic current usually lost in 10 days others may recover. There is Reaction of Degeneration Jan.25.'07. Infections in Character. Sphincters escape. Inc. galvanic response in Muscle. Reflexes are lost in those connection of at. muscle Motor & trophic affection. Regression after some time. Muscles of R. of D. doomed. Affects all structures. affected limb smaller etc Lower limbs mostly affected. Extensors mostly. Hand extensosrs & Deltoid mostly. Sup Long & Bie. escape Nuclei in Medulla are involved. Cerebral Palsy so Hemiphlegia. spastic. Reflex Ex False Syphilitic paralysis: lack of union of Ephysis & Diathesis of long bones. Birth Palsy: Deltoid. Bie. Brach. Caracu. Inf. Spina Root Inf. Pos Prog: good if Med. is not involved. Massage & Electricity. Prevent deformities. Duchenne - Aran: Atrophy. Vasc. supply of ant Cord. involving Motor Seg of ant Horn. May be due to syphilis. Hereditary in Cases. Involvement of Upper extremities. Disturbance of finer movements of Hands first. Habitual Movements. Feb.7.'07. Prog. Sp. Musc. Atrophy Small Thenar Em. then interosser Limb. & others. Peculiar cond of thumb. Claw hand Hollow space between bones. affects other hand then Deltoid. forearm etc. May progress slowly. Usually Lower Cervical. Sphincters escape. No sensory disturbance. Weakness proportion to Atrophy. Feburally Contraction - affection of Cells of Cords. Reflexes are diminished K. jerks & Muscles easily fatigued. Too tight bandaging caused cange in Muscles. Charcots [exog?] Reflexes. Syr. My. Sensory symptoms Rest. Massage. No treatment. Else N.q. Strych. Syringe Myelia. Abnorm. Cavity in Sp. Cord. symptoms depend on location not process. Lesion in gray matter Post to Lat. invading Post Horn & Ant H. & by pressure involves w. matter. this Comb. of sensory & Motor & Spastic. Low Cew. & Up. Dorsal. Dist of Sens of Pain & Temp. Retention of touch. Dissociation of Sen. Neurons. May be exag. of Deep Ref. of Low. Ex. Morvan's? Feb.28.'07. 1. Emotional insanity Depression. Exaltation. 2. Intellectual " Mania or Delusion is rapid change of thot. Melancholy monotonous one line of predominate thot. 3. Primary Delusional insanity. 4. Delirium in coordinate dreamy hallucinations not aware of surroundings etc. this prolonged is Hallucinatory or confusional insanity. 5. Dementia Acute. Primary acute eleberation of all thot. Funcutional insanity Physic degeneracy a cond. of development Ment. & Phy which leaves the individual short. in comparison to his race. Degenerative vary from simple in form. cause etc. Paranoiae - Delusional insanity -. Mar.7.'07. Dementia Precox. early & rapid failure of mental faculties. 14-23 yrs. (Hebephrenia) (Insanity of Puberty). Cataleptic resist all movements. & retain certain attitudes. delusions are not systematized. few eases recover. Cause defective nervous state. Alcoholic Insanity. organic. general Bld change in brain no cure. Moral & Intel. symptoms. outbursts of rage on emotional side. frequent depression & suicide. weak memory progresses to dementia. leads to abuse. delusion of persecution tremor etc. Cramps in Calves - Muscular weakness. [illegible] Chronic Melancholia due to alcohol. short duration. Hall. of sight & Hearing. Opium is useful in treatment. Alc. Mania is grave. Temporary insanity Hall. of hearing may commit murder Sym: Use History Anesthesia of lower Ex. Pains. grand Delusions. etc. general Paralytics Lym. of Cord. Alc. Epilepsy. Mar.14.'07. Myelitis. Inflam. of Cord. cross destruction. May have laceration from Haemorrhage. from affected parts we have a an ascending & descending degeneration. may have pains darting down limbs. girdle pains. numbness below lesion. disease progresses & patient becomes paraphlegic. loses control of bladder & rectum. Hypersensitive at line of demarcation. complete lesion loss of reflexes. Babansky's indicates organic lesion of Motor track & early. tendency to bed sores. Best prognosis when Dorsal region is affected. Tr. Mercury in large doses. Ice over spine. add one [crossed out] spine in Cervical for segment. 1 to 6 Dorsal add two " " 6 " 11 " " 3. " " Level of Nipple - 5 Dorsal segment. " " Naval - 9 - 10 Perineum & Coccyx to lowest part of cord. Mar.28. 07. Multiple Sclerosis. Insular. Disseminated Sclerosis en Plagues. May follow infectious fevers. - age - 18 - 30. May occur in young. Rather diffuse plagues may be large or small or irregular, found mostly in the White Matter. May affect the optic nerve by several plaques or large ones intruding. Spastic gait; stiff & staggering. Intention tremor may affect whole body. pure Cerebellar gait staggering not spastic. Apoplectiform & Epilectiform seizures. Reflexes exaggerated. foot clonus. Babansky Sensory losses common. May be interference of higher [centers] senses. Slight atrophy of Optic disc Extrarnal or temporal segment Ext. Ocular muscles are weak. May have irregular myosis. Nystagmus common. May have gastric Crises trophic disturbance rare may have vivid muscular atrophy but is usually late. Glycosuria probable from irritation around 4th. Ventricle & in region of Medulla. Vertigo. Disturbance of speach slow scanning way. explosive & monotonous similates hysteria. May begin sudden or progresses slowly or in remission form. May live a long time. Prog not bad. May reach a certain degree & recede. Treatment: French use actual cautery along spine. April 4.'07. Brain Haemorrhage. Apoplexy is simply a state of sudden stroke etc not nec. Haem. tho'. frequent Causes; Arterial disease. deg. of walls. gen. involvement. of advancing years. Milliary aneurisms. & bursting. Bld. tension plays important role. At first apoplexy later symptoms of Center affected. Lenticular Stride - Mid. Cerebral - Op. Tr. Int. Cap. Anq. Gyrus. Int Cap = Motor tracts & Optic nerve. Predis: Alc. Syph. Rheu. Gout. Lead etc. & accident cause Haemorrhage. Strains etc. P. falls. coma. Pallor passes to Congestion Conjugate deviation of eyes. & head. tells side of lesion. in Perebrum P. looks toward lesion. In Pons look away. if irritating looks from it & in Paralyzing looks toward it. in Isthmus & Pons Vice Versa. Immediate after Reflexes are increased & soon absent later increased. Babansky occurs within one hr. Rectal Temp. lower rises in a day or two if high is fatal. Paralyzed side temp. higher Unilateral sweating. lower face more involved. face drawn away from Paralyzed side. tongue deviates toward paralyzed side. Paralysis of Hand & arm is greater. Lesion in Cap. Speach little affected. Dif. articulation if in Hemisphere. Post Part of Cass. Hemi anaesthesia. Hemiblurdners if Optic Thal. involved. Some involvement of sensation thro' Capsule Int. Some trophic disturbance with state of Coma. Todd. English - desc. 'Mowing Gait" foot clonus. Skin Reflexes lost. Deep. Reflex. exag. jaw jerk reduced to Clonus. Pupils normal. Smooth Platysma weakness on that side.    Oct.2.'06. History taking: Mother's Complaint. {fits {cough {chill. Past History: measles. Scarlet fever. whooping cough. Family History: (Syph.) Tub. C. Rheumatism. Miscarriage. Present History: How to approached: undress baby. (1).. Inspection: Type of Respiration. Position of Head. etc (2).. Palpation. Glands. Rickits etc. knee jerks. (3).. Auscultation: 1. Back base, then in front. (4).. Percussion.. Rickits. Holt. text Oct.3.'06. atk: Normal child. 17 to 20 inch. 280 days. old 50 CC. Female 7 lb. Male. 7 1/2 lb. Sudden & continued decrease of wght. means malnutrition. mal assimulation. or onset of some Path. Condition. Average doubles initial wght at 5 or 6 mo. " Treble. " " " 15 mo. At 7 yr. wght. should be double that of 1st.. yr. " 14 " " " " " " " 7 yr. Increase in wght & length is in direct proportion of amt. of Proteids & salts of Mother's milk. 1st.. yr. increases 4 or 5 in. in L. 2 six mo. increase 3 to 4. 3 yr. 3 to 5 in. 3 yr. 2 to 3 1/2 in. 4 " 2 to 3 " thence 1 2/3 to 2 in every yr. slow or arrested growth due to Malnutrition or Syph. rickits. creatinism Proportion. Thorax at nipples 1/2 length + 10 CC Cir of skull around frontal & Occ. Pr. is measurement of thorax + 2cm This meas. falls below 32 c.m. child is apt to be premature. when exceeds greatly 37. Path. Cond. Rickets or Hydro [illegible] Observe quality of Pulse. rate 120 to 140 at birth. 2 yr. 100-15. then to 80 or 90. wght of Heart is 20.5 gm. 2/3 ounce. RBC. 6 million to c.m Both diminish for first 10 days W.BC 18 thous. " " Spg. 1060. Ductus Art & Ven. For. Ov. Umb. require some also except Ov. Resp. first abdominal. Upper portions of Lung not always filled (Atelectasis), Child should breathe with mouth closed. Rate of Resp. 30 to 45 Min. Oct.8.'06. atk. Temp. at birth 99.5 to 100° in 1 hr. falls to 97. then rises & in a week comes to normal. Premature child normally temp is below normal. Stomach lies almost vertically slightly expanded a cylindrical shape. At birth 5/6 to 1 oz at Birth when normally full. at 2 wks. 2 1/2 fl oz. 2 mo. 4 1/2 mo. oz. 6 mo. 6 oz. - at 12 mo. 9 oz. Liver is 2/3 larger relatively at Birth than an adults. Smal. intestines average length 9 1/2 ft. large. 10 in. 1/2 of this is Sigmoid flexure. Intes. discharge at birth are dark greenish sticks together consists of Epr. Hair. Contents of Bowel lasts 3 days. first secretion of Mother's gland not milk but serves to drive out Meconium. After 3 days stools are lemon yellow color. slight odor. slightly acid 85% water. Starchy food reaction more acid to brown. In disease there may be false membranes, pus. blood. mucus. parasites. & foreign bodies. Stools 2 to 5 a day normally. amt. 1 to 2 ozs. Albuminous food gives putrid odor to stools. Color change in disease. Intes. inflam. - green stool. Clay color due to disturb of Liver. Weak & feeble' children have large stools & watery lack of capicity also Cholera Infantum. colorless. like rice water. musty odor. Inflam of smal Intes. stools are liquid & large Inflam of Large. liquid. small & frequent & coated with diseased mucous. Head at 1 1/2 yr. is 1/3 larger than at birth in next 5 yr. 2 in & next 10 yr. 1 in. Ant. & Post fontenelles. Ant 1 1/2 Ant & Post Trans 1 in remains open 1 1/2 to 2 yrs. Post closes soon Oct.10.'06. Atk. Symptoms: Posture: healthy child sleeps most of time. on back limbs slightly flexed or on side. Babe should sleep sound Disturbed sleep due to Hunger or indigestion. do not dream Colic a form of indigestion smile in sleep due to contract of lips associated with Intest tract. Syphilitis & Rachitic child. sleep badly. 3 Classes of diseases have typical positions & Expressions 1. Affections of gastro Intestinal track. 2. Diseases of Respiratory Apparatus. 3. " of Brain. (1). Does not sleep quietly. tosses & tumble & sleeps with more comfort on Belly provided there is no ulceration or Peritonites. Child cries nearly all time when awake except before & right after eating. General expression of waste in general Ex. of face. Winl. form. muscles flabby. Depression of Ant. fontinelles. Hatchet face. (sunken cheek & eyes. pointed mose & chin) Expression is that of care & discontent & disgust. skin becomes clay lose of elasticity. (type) (2). Broncho. Pneumonia: face flushed. eyes bright. anxious continues & expressive of pain in early stages. later dull. Nurses for short time & drops nipple. attemp & to cry & cease suddenly. Cough short also, suppressed ending with grunt. Breathing rapid superficial lacking rhythm. dilattion of alae Nose where there is obstructive dyspnea. Cyanosis when dyspnea is increased. In great obstruction. depression of unsupported parts of thorax. supia clan. Intercostal spaces. etc. Skin hot & dry. sleep disturbed. 3. Acute Inflam of Brain body is [flea???] [illegible] retracted. Opus Thotimus. Eyes usually closed. pupils dilated 2 irregular, brows corrugated. muscles of jaw contracted. fontenelles full & bulging . Skin Hiperasthetic. Cry nocturnal. sharp & shreiking, Meningitus & bone disease produce this sort of crying. contraction of eye brom means headache pain in head or irritation of eye in turning head away from light. Carying hand to head suggest Otalgia. Constantly rubbing nose may suffer from intest. parasites. Cough loud & sonorous (bark of old dog) in Spasmodic Croup. Coarse & harsh in true croup. Cough clear & distinct in Bronchitis early is dry later moist. Painful & suppressed in Pneumonia & Pleursy] Convulsive more [efforts] inspiratory then Ex in Pertuesus irritated Dry & Painless from intest parasites. Also dry & spasmodic char in Typhoid. Malaria remittant. In Diffused deulaton may be spasmodic irritated cough. Cry shrill loud at night from sleep or in a child well in day means disturbed digestion. Cry lasting from 5 to 10 min several times daily no fever or Brain trouble means spasm of Bladder. Cry in passing urine acid. Sharp cry during defecation fissure of anus. Sharp loud cry at night to awake. brain inflamation. Hygiene. Do not bathe except Eyes. mouth etc. for first 24 hrs. grease with lard or vaseline. Bath daily in 100° last bath a short time as older bath colder. Reduce temp 1° per Month. At two yrs give sponge bath in water 90 to 95°. for feet. & water used 20° lower 1 min. follow by friction. Chilliness of Nose. lips etc water too cold. Clothing should be loose. warm. light no constrictions. Oct 15.'06. atk. first 6 weeks. 21 his sleep out of 24 normally. not well without it. After 8 wks requires less sleep. End of 1st yr. 14 hrs in 24. at 2 1/2 to 3 10 hrs of 24. some in day time. Well ventilated rooms. temp. 68. Continual wakeness. give Br of Na or K. 3 grs. at 6 mo to 1 yr. delucted. After 1 yr. 1 gr. each yr.. Asphixia Neonatorium two forms 1. Antepartum. Causes of 1. Partial or complete separatism of placenta. Interference of Cir by pressure of Cord. Around Chest or neck. Pressure of Cord between head or breech & Plevis of mother. Inspiration of Amniotic fluid. Post Partum results from immmaturity cannot respire causes atelectiases. long continued pressure on Head or cord. Improper application of forceps pressure cause hemorrhage into 4th.. Ventricle or Ventricle. 3 grades. 1 degree. spank. cold water. clean [crossed out]. Blue. 2. Lived or apoplectic in more robust. Tonicity in Muscles. Eye balls bulge. Contiva nyested. 3. Asthenic form occurs in weak children. surface pale. loss of tone of muscles. Lips blue loss of cutaneous reflexes. relaxation of sphincter ani. Meconium may pass during labor. In Breech presentation Meconium passes. Diagnose Antipartum by auscultation before birth Pulse rapid. weak intermittant. Symptoms of Post Partum above Pro 1 & 2 good 3 bad. Heart ceases to beat in 5 min after birth apt to die. Sylvester Method. raise arm with something uner arms. [illegible] " them in index & swing. Hot Bath & Cold water. Whisky bath. Caput succidamin infil of Bld & serum on Presenting part of Child's head. Cephal Hematoma under Pericranium elastic touch. elevated. ova. never open may have bony film covering. sorter crackles at times. or bony formation around tumor on skull. Meningeocele: tumors which are hernias. may be membranes or fluid in membranes or membranes & brain substance. Oct.16.'06. Clements Nervous Manifestations of Rickets. 1.. general convulsion. 2.. Tentany. 3.. Laryngismus Stridulu Chloroform. Ether. Chloral. Morphia for Convulsions. Chloral 6 mo. 4 gr. 1 yr. 6 gr. 2 yr. 8 gr. ℥t warm mills. Morphia 1/48 " " 1 1/24 " " 1/16 "h Chloral hydrate per Rectum. Bromides. Antipyrin.. 2.. Tetany. suddenly stiffen. Head extended.. does not lose conciousness. Elbow & shoulder. Knee & Hip movable. [Chvosteks?] top facial Trousseau press on vessels & nerves of Elbow causes attacks of rigidity of arms etc. Laryngesmus ... suddenly stops breathing. cyanotic. Prog. bad. cold water. antipyrin Barlow's Disease (Scurvy Rickets). 6 & 18 mo. Screams on touching, Paralysis, Bruised. [illustration] Blood under Periosteum. Ecchimoses. Blue Ecchimoses around teeth. Discard Rheumatism Paralysis excluded by reflexes. Treatment: Raw milk. Orange juice. Raw meats juice Potatoes. Dosage. Under 6 mo. & under 1 yr. Uner 6 mo. 1/3 old dose. age/age+12 of Mean Dose. over 6 mo. 2/3 " " " Oct.22.'06. Atkinson Icturus Neanatorum. (jaundice of New Bord). 3 to 5 day after birth some show yellowish discoloration in conjunctiva first extends. continuous 5 or 6 days & normal color comes on. All secretion affected. Urine Brilliant Orange blue (excess of Bile Pigment). this is Phy. form of Icthurus. Probably due to destruction of R.B. globules. May be portal blood entering Cir thro' Duct. Venosis ? Occur in 60% New Born. More prevalent in Hospitals. 1/16 gr. Calomel & 1/12 gr. Porid Epicac. 1/16 gr. Bicarb Soda. Malignant Jaundice. due to retention of various Element of Bile results from stricture of Duct of Gall Bladder Catarrah of Gall Bl. Duodenal Catarrh. Defective Hepatic Circulation Asphyxia, Malena. Syphalis, Long continued exposure & cold & dampness. Symptoms are prolonged from previous. Drowsiness subnormal Temperature. Refusal to Nurse. Stools black & tarry. If due to stricture. Stool are Clay Color. Treat cause. Phosphate of Sodium Calomel. Keep skin active. Breast Milk. Stim. Kidneys Minkles Disease or Acute Hemoglobin Urea Swelling of glands in Pyer Patches. Mesenteric gl. inlarg. Liver & other ab viscera undergo fatty deg. Harm. charged to Beleruber Urine Redbrow contain cast Haem. & varied forms of Micrococci amt. small. Passed with straining effort. Bluish tint of Contenance Cyanotic changes into deep yellow. Sym. begin 4 day progress rapidly then comes Diarrhea. Vomit. Child dies of Conv. or Coma. 19 of 23 died Tetanus Neanatorum (Nine days fits). Cause Infection with Tetanus B. Entrance wound of Umb. due to filth. Comes on about 9th. day. More common in Blacks apt to occur in tropical countries. As late as 15th. day & early as 2 or 3 day. 1st. sym is Trysmus (fixed cond of muscles of Jaw & face) inability to nurse. frothy con around lips. Spasm causes (Sodinic [illegible]) whining cry. jaws unlock on day of death. Climax is reached in 12 hrs. frequently go into consious muscular spasms. tonic & Clonic Comb. Die in spasm or Coma. Convulsions are broken by current of air or sudden noise. generally last about 2 day. sometimes get well. Prog good comp. to length of time disease lasts. Treatment: Chloral per Mouth or Rectum. Chloroform for Spasms. Hot Bottles ? Inspiration Pneumonia: occurs from inspiration of septic Material. general in women of Gons. a. Endrudo of lobular. disease dangerous. Stimulate: Alcohol May inspire in Utero. Clean Mouth. Oct.23.'06. Clements. Rheumatism attacks Heart. No two Physical signs occur together. F.H. strong family History. M. complains growing pains . (3) Torticolles ". - (2) Tonsillitus. (7) rheumatic rash. walks on its toes. stiff Hamstrings. (4) Chorea. Chr. (5) Endocarditis. These nerve occur together. 6 Pericarditis. 7. Peliosis Rheumatica. {Rheumatism {Rash. Purpura Articava. Erythema Nodosum on Tibia. 8. Synovitis of joints. Treatment. put to bed milk diet. Alkaline drinks. ꝶ Salicin. Liq Ammon acetates Aq. Cinnamonii Occurs in children not under 3 or 4 yrs. old. Rheumatism usually follows precedes. Chorea. Weak Permang of Potash. weak Sol for mouth good as deodorizer Oct.24.'06. Atkinson. Disease of Digestive tract. common up to first Dentition. Stomatitis 1. Simple Catarrhal, 2 Apthous 4. Ulcerative. 3. Mycosa, (Parasitic form). Gangrenous, Syphalytic. Diphtheritic. Mercurial. 1., Simple Hyperenemic mucous Mend of Buccal cavity. Alteration of secretion in character & amt. causes. Trainatism. Gastro intestinal disease. eruptive fevers. dentition most frequent cause, Result of Pertusis. Symptoms: Slight temp. 100°. Child irritable. indisposition to take food. takes water, rejects nipples or spoon. may be vomiting. constipation generally occurs early. Pain on contact. Mucous Memb. first dry then red. swollen. lip swollen. enlarged lymphatics. later there is increase of saliva. Disagreeable odor. tong. may be coated & swollen. Muciperous glds enlarg to assimulate a papillary appearance. Treatment: 2 to 3% Sol. of Boracic Acid in Cold water on soft mop. (abs. cotton). Salycylate of soda for application 1% Nitrate of Silver 1 1/2 % Sol. foods cold liquid. kep bowels open. 2. Hyperemia of Mucous Memb. of Mouth. small superficial ulcers on tongue. gum & interior of lips & cheeks. 10 to 13 Mo. may occur at any age. freq. folows gastro Intest. Dis. acute fevers. common in convalescence of Pneumonia. Symptoms: High fever excessive irritability increase salivation. sometimes vomiting. constipation common. lymphatics enlarge more or less. Oval outlines inward dentition of Ulcers. these ulcers are superficial gray or yellow around ulcer is zone of Red. (enlarg. Cap.). Appear in successive crops. tendency to coclere. Treatment: Regulate Bowels. Keep mouth clean. Liq. diet. Chlorate of K. 20 to 25 gr. to oz of water for wash. Nitrate of Silver. Iron internally. Nutritive Enema. Boxax & water for wash. 3. Stomatitis or Mycosa (Parasitic form) [illustration] Thrush. [illegible] albicans yellowish white film can be wipfe off leaves red surface. Bomes from use of dirty nipple & spoons. sugar tit. observed in wasting diseases of children. found in court. from acute diseases. in [cross out] [??yrasmus]. children Treatment: Borad of Soda. Boracic acid aa 1 dram glycerine 2 ʒ water qs ii ℥. as a wash. Rhubarb & Soda internally, Carbolic Acid 2 gr. Saly of Soda Boracic acid 1/2 ʒ glycerine. 2 ʒ Rosewater qs. ℥ii. 4, Ulcerative: destructive in Broken down condition begins around teeth. spreads rapidly & extensive. Rarely found in children under 5 yrs. of ages. Non contagious. becomes offensive, Treatment: chlorate of Potash. dil HCl. Syrup water, 58 grs KClO3 Dil HCl 1 ʒ Syr. 1/2 ʒ water qs iii ℥. Iron Tr Cl. [illegible] 5 to 20 dut. Oct.30.'06. Clements. Malaria Malaria disease (other 2 are Lobar Pneumonia & Scarlet fever). accompanied by Tonsilitis no malaise clean moist tongue. older children complain 1. Myalgia: intermittent torticollis. Pseudo appendicitis, gastric form. Rheumatic form. Headache or Hemicrania. 2.. Typhoid with intermittent temperature. young babies often turn blue or pale without a chill. Physical Ex. Skin jaundice with dash stools. Mucus surfaces: Spleen cant palpate in small children; signs of enlargement are rigidity of L. Rectus Temp. may be high yet child may feel well. Chill indicates second infection. Pigment granules of white cells always present. Treatment: Use hydroBromide or Chloride Quinine Sulph gr i dilute Sulphuric Acid gr. iii reduces solvability from 1-400 8 1-8. Never give Calomel with hydroBromide or Chloride. 3 forms of quinine best are Hydrochloride. Hydro bromide. Bisulphate. Milk diet give large amount at day & let sleep at night. Oct.31.'06. Atkinson [Physi] Cyclic Vom. in Nervous children. Vom is severe at intervals. 1st.. is contents. 2nd.. Mucous. frothy serum sometimes blood stained. not due to errors of digestion. Material is acid (uric). Severe prostration follows there attacks. gen. preceeded by 12 to 24 hrs prodroma: child is weary. drowsy may be constipation always dull & languid. no appetite. sense of discomfort in abdomen or stomach. Temp. slightly elevated. pulse fast. vomiting almost constant. Temp falls during an attack of Vomiting. pulse may be weaks & irregular. Dif. Diag: Apt to be history of vomiting previously. not preceeded by irregularity of diet. By persistence of vomiting. lack of tenderness over stomach. self limited disease. Treatment: Calomel. AlkaLithia. Acute Gastritis Acute Inflam. of glandular tissue of stomach. interferes with digestion. Symptoms may come suddenly. pain in epigastrium. annoying. cry continuous after taking food. Bluish tint around mouth. look of disgust. Temp. 103-104. Vomiting a great deal till stomach is empty. & longer vom. comes early. deficient in HCl. Tongue is coated heavy white brown tinge. edge & tip of tongue is red & dry. Always Anorexia. diarrhea. Contains altered mucous. attack may begin with convulsions. extreme Epigastro tenderness. Abdominal tenderness sometimes a Pharyngitis. Prognosis: good if properly treated. & in strong children. sometimes Nephritis complicate Acute cases: Avoid food for 24 to 48 hrs. avoid Cow's Milk. ... give all. (Egg water) Boil water. bits of ice ꝶ NildChlor Mer gr iii Pulv Epicac gr iii Sod Bromt ℥ ii Powd. one every 9hrs till stools claus color [illegible] Then give Cathartic. teaspoonful of Castor Oil. for vomiting give 1/10 gr Cal. with 1/300 to 1/200 Arsenite of copper. for continued vom. Tr of Nux Vomica 1 or 2 drops before eating. When Bowels are involved Castor Oil & inject Cold steralized antiseptic sol high enema. Sub Nitrate & gallate of Bismuth. Salol. Sodii Bicarb. 5 grs to amt. of injection. 1 to 3 times a day of 1 to 2% salt solution. Regulate diet. cold steralized water to drink. give few drops of Brandy with water. during convalescence. fresh air. exercise. sufficient ventilation keep body clean & warm. Nov.7.'06. Chronic Gastritis. chronic inflam of lining memb of stomach attended with thickening which result in decrease in quanity & alteration of quality of gastric juice. Mucous coated with glary tough tenacious mucous alkaline in character. digestive powers become emfebled. digestion slow & incomplete ingested is returned gas forms & distension results. result in irritation. tenderness. prolonged & excessive use of fats may cause this. improper food. & persistent acute form. mucous memb is grayish with spot of injection red. Rylorus rougheness. Cells sometimes destroyed. fatty deg. takes place. this destruction is scattered. Mucoid deg. prededes. after comes atrophy. Symptoms: Continuous of acute less violent. Vomiting. food. mucous, bile fluid. immediately after eating. Child lies on back. legs drawn. Apothetic look. blue line around eyes. Abdomen enlarged & tender to touch. eructation of ags sometimes acid. Bowels usually constipated. attacks of Mucous Diarrhea. Tongue coated in Base & center Brownish gray. edges red & glazed. Papilae enlarged. face old look. muscles flabby. Skin dry. tendency to eruptions. Stomatitis of Parasitic forms. Apetite feeble. eager desire for water. Sleep irregular & disturbed. Hands & feet cold. wasting. temperature at times. Outlook in healthy children not bad. Treatment: regulate diet. cow's milk is acid women's neutral. rich in fat & salt is domans. Cow's rich in protieds food not appropriate is in stool mainly casean of Protieds. Barley gruel & water used to prevent coag of casean. Change starch first. little saliva in mouth (Destringed) Oatmeal water in Constipation. Citrate of Soda to alkalinize Cow's milk. Warmly clothed Dry rub in morning. with salt bath cool with feet in warm. Avoid irritating diet plenty of sleep. Massage belly gently. Electricity is used. Lavage with warm alkaline Sol. Calomel & Soda in minute doses. Phosphate of soda well diluted 3x a day. Diluted HCl where Bismuth Sub gallate & sub nitrate for excessive vomiting. open air gentle exercise. Bitter tonics Nov.12.'06. Atkinson. Disease of intestional Canal. Acute Enterites: simple Diarrhea. Acute Catarrh. begins with increase frequency of stools. pain in abdomen. stools increase from 5 to 20 in 24 hrs. loose. greenish yellow. later are streaked with blood. more or less mucous. pain just before stool around Anus Loss of fullness of face. Abd. not tender at first. later tender. vomiting not usual May begin with convulsions. Pulse & Temp. not increased. Prg. good. with good treat Tr. 1 Dram. Castor Oil. 1/16 gr. Calomel with Bismuch & Salol. Sub galate of Bismuth 3 gr. Subnitrate 10 grs. Cinamon. water. Chalk mixture. Lime water every 2 hrs. Don't use Astringents till evacuation has taken place. stop milk food. Steralized water for 8 hrs. with 15 to 20 drps Brandy every 3 hrs. Egg water. 1 dram. every 2 hrs. Beef extract. 24 hrs after normal stools return to milk. Tr. Need Nomica for stomach tonic. Bismuth & Oxalate of [crossed out] Cereum. For Vomiting: Liquid Calcis ℥ i Aqua Cinamon. " " Chloroform. " 1 dram every 15 min. Nov.13.'06. Clements. Chronic Enteritis. Bedwetting 1. Age of Child. 2. wets bed only. 3 wets bed & clothes. during day. 4. wets cloths during day. I. Wets Bed only occasionly {cold in head. {Nocturnal epilepsy. " " " always. {Adenoids. Treatment. Cold: ordinary treatment. Dont let Epileptic sleep by self Adenoids remove. II. Incontinence by day & night {Urinary reaction {Hyperacidity. {Alkaline. {Abnomal Constituents {Alb. {Sug. {Idiopathic {Short Bladders. {Diabetes insepidis. Anemia. Acid. Treatment: stop meat. lemonade in plenty of water. Liq Ammonia Acetatis & Pot. Citrate. Alkaline: Render urine acid by Sod Phosphate will acidify in 12 hrs. cut off fruits, give meats albumin Sugars.. first look to diet, Diabetes abnormal amt of urine Anemia: Use tonic to improve blood. III. Diurnal incontinence. Vesical Calculus caused by irritation of Mucous Membrane. Belladona questionable Purulent discharges from genito Urinary tract is gonorrhea in 90% Treatment. Pot. Permang. Protargol 2% to 10% Children under 2 may be Masturbators. Nov.14.'06. Chronic Enteritis: Chronic intestional indigestion. Chronic. entero Colitis. result of continuation of acute form or return of acute at short intervals. may follow any acute injectious disease. May be result of a bad cold. results from bad Hygiene. Type of Hoth months more severe than cold.. Rare in breast fed babies unless constitutional troubles complicate 3rd.. Mote 3 yrs. Occurs about 17 Mo. at time of Dentition. Tainted Cow's Milk most common cause. Symptoms: Stools liquid as a rule. vary sometimes semifluid. contain grayish white mases like putty. Offensive & putrid odor. contain bacteria contain mucous. undigested food. sometimes blood stain some Pus. Stools are green at beginning of each return. stools 4 to 10. Pain with stools child cries first before. Tenesmis accompany frequently. Moderate loss of flesh. progressive form may end in Marasmus. Child is Pale. tongue is coated with brownish yellow fur. clear ata edges & tip. slight temp. & pulse rate. gastric complications are unusual. glands large. Prognosis depends on treatment. tune of disease. Treatment: Avoid milk. [Milk] give flesh in liquid form. albuminous vegetable. fruits. keep body clean. brandy frequenty. Proteids are stood better than fats & sugars.. give inactions of Cod liver oil daily. or Cocoa Butter. Lanoline. occasional doses of Castor oil small doses. 10 to 15 drops 2 or 3x a day. Calomel occasionly. Phosphate of Soda with Calomel. for Liver, Intestional irrigation; 2 to 3 gts of warm sterile water. also normal salt solution. Beto Napthol Bismuth. 5 grs. Podophylin 1 gr. alcohol 1 dram. 3 to 5 drops Morning & evening. Tr nux Vomica Nov.20.'06. Causes Head retraction. 1.Tetany 2. Tetanus. 3. Otitis Media. 4. Naso Pharyngeal Obsctruction. 5. Cerebral Anemia due to exhaustion. (false hydrocephalus). 6. Meningitis due to Pneumococcus. 7. Cerebral form of Pneumonia & Typhoid. Bulging fontinelles prove Meningitis. T.B. Meningitis is Ant. Head straight facial signs. Tumor causes pressure congestion & Choked disc. T.B. Meningitis Opthal. Tubercles on Choroid. [illustration] Seven Bronchial glands. Chronic Whooping Cough from enlarged glands press on Recur. Laryngeal Nerve Cyanosis from Pressure on L. Inominate Vein. Large Veins over Clav. Auscultation fluid vein Retraction Murmur. Percussion Dull over glands. Treatment: Syr. Io. of Iron. Signs of Enlarged Thymus: Dullness over Sternum. Nov.21.'06. Acute Milk Infection: Chlorea Infantum produced by intoxins of milk & milk foods. Summer Disease very uncommon in Breast fed. emaciation great. sunken fontinelles If last for couple of days there is hypostatic congestion, capillary congestion of Mucous Membrane. stools liquid entire mucous membrane of Colon is congested. Multiple ulcers may occur. Symptoms. Mild Diarrhea. Chacteristic onset, sudden. vomiting & purging naseau continuous cyanosis. collapse. Cold calmy sweat. continuous evacuation green then gradually colorless. consisting serum, desquamated Epithelium odor mysty. acid. suaring Bacteria. unquenchable thirst. (Child often dies of Coma which comes on very much like opium poisioning therefore be careful about giving opium) May inform for 1 hr or so then symptoms return increased. Prognosis when you continue to use milk will surely die. Stop milk. feed only steralyzed water in small frequent doses with little Brandy or Whisky. Wash out stomach & intestines 1% salt solution warm. No time for Cathartics. After Lavage of stomach give 3 to 5 grs Calomel. Hypodermoclysis is good in extreme cases. Vomiting checks 1/100 gr. of Morphia combined with Atropia 1/800 subgalate of Bismuth 5-10 gr. After child is almost well temperature may return use hydrotherapy not medicines. If child is too cold give warm bath. Nov.27.'06. Types of Pneumonia. Vomiting at onset. Prostration in Lobar Pneum Clements. Easy. Rapid. shallow breathing. [illustration] Double breath sounds transmitted from trachea this solid media. Loud on acct of compensation. Fluid does not convey sound because long is colapsed. Def of Pleursy & Pneumonia is absence of tactile vocal Phrenitus. Dif of Colapsed & Consolidated is Bronchial Breathing on consolidated lung. Pulmonary abcess gives friction sound is present not in Empyemia. Needle moves when in lung then withdraw. Nov.28.'06. Atkinson. Ilio Colitis. Dysentery Patches of Ulceration. Acute & Chronic. occurs sometimes as an epidemic. always mostly dependent on a Bacteria. Diphtheritic Dysentery are patches of gray Pseudo Membrane on healthy membrane. Peals off & leaves a bleeding surface which usually ulcerates. greater extension here than in other parts. Bacteria conveyed by drinking water Sudden chilling often causes the attack. prevails in Hot weather usually late hot days of September. Some affection of Liver are also present. Symptoms 1 form diarrhea. discharges a smell frequent consisting of mucous & at time jelly appearance stained at times by blood. odor absent. Tinesmus present. Vesicle tinesmus. Urine scanty & highly colored. Most children have elevation of temperature. some distention of abdomen with tenderness. Patient rapidly loses strength. Face becomes pinched, tongue is dry & coated by brownish fur. tips red. May be hemorrhages. Shreads in chronic cases appear. Stool assume various forms. Sigh of Respiration. Pupil dilated. May be convulsions. Treatment. Diminish amt. & more frequent. Albuminates are good. Keep warm. hot stupes. give boiled water. & plenty of it. Castor oil. Irrigation. large injections. use no force. 1 qt. may be used. Pulv. Epicac gr. ss. Sug - of Milk is very good. Pute Mass Hydrag. gr. iii Pulv. aeromatic gr. xi Sacra alba. gr. xv mft Pute no x Sig. one every 2 hrs. Emulsion of starch. & Deodorized Tr. of Opii: Cocain 1 gr. Ex of Ergot aquas 12 gr. aristol gr. 5. Cocoa Butter qs. Mass. Make 12 suppsitories 8 size fitting child 1 every hr. give some form of alcohol for weakness Tokay Urine. sweet. Egg Nogg. hot fomentations. Dec.4.'06 Clements. Adenitis: [illustration] Post. Cervical Ext jug Pharynx larynx etc. [illegible] lower part of Pharynx. Communicate with Bronch & Axilliary Supraclav. Post Cerv. Gl. Enlarg. 1. Exzema or Lice Pre auricular... Otitis Externas. Sup Cerv, at angle if jaw. {connect with other sets above. {Earache due to Otitis media. Sup Cerv. Angle of Hyoid shore Diphtheria. Angle of jaw to lobule of Ear Above. Parotid below cervical In front or behind stems Mastoid at level of Hyoid. is T.B. Lymphatism. 1. Acute simple. 2. Chronic simple. 3. T.B. A. Anatomical nature. B. Physical characters. C. Degree of sensitiveness. D. Discrete or fused. E. Skin involved. F. Onset. g. Constitutional. Acute Simple (1). Infants up to 3 yrs. discard T.B. under three Bronch & Mes. mostly. Syr of Io of Iron. Icthysl for T.B. Whooping Cough. Nervous terminations in Bronchial Mucosa is attacked by Infectious cause. causes cough. Begins with running nose. fever. cough at night. Clements. Dec.11.'06. Vomits later then whoops. Lymphocytosis in whooping cough Diphtheria: 1. Nasal {after affects guard 6 wks. 2. Tonsillar { 3. Pharyngeal { 4.. Laryngeal (Croup). Dangerous at time only no after affects on account of glandular arrangement. 2.. Membrane on tonsil & past. wall. Follicular Tonsilitis May be small necrosis. Glands at angle of jaw indicate severity. Patch may be any color. Don't depend on detachability. Goes to bed wakes up with sore throat. any form of Patch Temperature 100 is Diphtheria may be higher. Paralysis: May occur during attack or during convalescence. Uvula. Heart during attack. Nasal voice During Convalescence {Soft Palate. fluids by nose. Ophthal. Externa or Interna. Multiple Neuritis. peripheral - This recovery is good. Neck drop. Respiration affected Intercostal Cough - Non Explosive Stomach Pit bulges during Expiration - Diaphragmatic paralysis. Pulse irregular. Vagus paralyzed. Mulford's Antitoxin for late stage of Paralysis. large doses. over Buttox (Comby of France) 500 units for 3 wks. Dec.20.'06. Marasmus. An extreme form of Malnutrition not depending so far as known upon a constitutional for Atk. Organic diseases. caused probably by malnutrition & assimilation. 1. Primary & Secondary. 1. Primary is applied to cases where profound & persistent [babies] malnutrition in infants fed on properly modified milk These babies so far as known have no underlying disease constitutional so far as known. 2. Wasting usually found from improper feeding or in course of Const. Disease or Chronic indigestion or resulting from acute enteric disease not gotten well is known as Secondary. These are more hopeful of cure 1&2 Clinically alike. History may differenciate. symptoms: Loss of adipose tissue. wght. strength skin loose & flabby. cheeks, sunken, fontinelles ant. depressed. Cold extremities. purperic appearance on skin. eccymosis on abdomen & leg. subnormal temperature. Mouth & tongue dry & red. Appears about 2 or 3 mo. Both fed infants. Blood concentration. Anemia. Atelectiasis frequent Starvation similar T.B. dullness in front. Syphilis occurs early. Treatment: Wet nurse. Keep body warm. Internal stimulation. Alcohol. Modified cows milk fur. 1/2 %. Sug 6% prot 1% .75% whey Proteids .25% Cascernoan Proteids. Lime water 5% Sadium Citrate 1 qv to oz food. a.c.cotton.text. Jan.8.'07. Acute Bronchitis [illustration] Capilliary " Bronchi - Pneumonia. Lobar Pneumonia. Young baby Br. Pneu. is rare. under 1 yr. larger some air enters & Br. Pneu. present. Acute Bronchitis fever regular 101-02. Acute Bronch. Onset. Tempt. Age. Local Phys. Dyspnoea & Prostration Grad. Mod. & sustained Any Bilateral Absent. Cap. Br. Grad. High Remit. Under 1 yr. Harsh breathing or suppressed. No crepitations extreme Br Pneu. Grad. High Remit. Any age. Bilateral & Unilat. Basal Crepitations. Fairly severe. Treatment: Acute Bronchitis. Calomel Cathartic. Comp. Tr. Benzoin teaspoonful to pint of Hot water & use steam Liq Ammon. Acetas Sodii Bicarb. Epicac wine. Syr. Toluol. ꝶ Tr. Camphor. Co. Syr. Epicac. Syr. Tolulana. ꝶ Guaicol Carb. Syr Picis Liquidi. {young Baby. Syr. Tolutana. Vapor Cresoline lamp. Jan.10.'07. Lobar Pneumonia: missed. Broncho - Pneumonia. Lobular. Capilliary Br. Pneu. An inflam. of walls of Terminal Bronchi & Alveoli adjacent, Primary & Secondary. Primary usually under 2 yrs. May occur at any age but is most common under 5. Younger child worse Prog. Secondary are more numerous. & dangerous. Measles. Whooping Cough. Diphthesia. Bronchitis. Acute Iliocolitis. Scarlet fevr. Variola. Path Inflam of walls of smal. Bronchi. walls thick & infiltrated. extends to surrounding Alveoli. Scattered areas of dullness are Bilateral. Bronchial lymph nodes are enlarged. Areas of atelectiasis areas between Scapulae as a rule. No distinctive stage. Develops by irregular invasions of successive portions of lungs Resolves also irregularly. Inflamatory product is cellular Products may develop into Con.tis & form a chronic Pneumon. Results of Disease: Emphysema. usually from Pertosis T.B. gangrene. Symptoms vary: often observed in primary dis Whooping cough. Rapid Resp Fever rises. Whoop eases & comes back when Pneumonia is well. Cyanosis some. increase [Deb??] Temp. may be high. More involvement faster Respiration. Phy. signs like Bronchitis except dullness. small moist Rales. Early auscultory sounds are high in anillar. Treatment: Muriate of Ammonia is stimulative expectorant. Strychnine. Digitalis & Ki. Nitroglycerine. Stry. Digataline for heart failure. Atropine for Cyanosis 1/1000. 68-70°. Milk shift position. Hot bath for stimulation of Resp. Comp syr. Hypophosphites in Convalescence. Cod liver oil water & kidneys. Jan.17.'07. Catarrhal Laryngitis - False Croup. reduces lumen, also spasm. awake in spasmodic condition. well during day. usually extended from above. Tem 101-03 during attack. Eating too much before going to bed no temp purely neurosis. Pseudo Croup. Memb. may not always be due to Klebo Loeffler B. Chloroform disappears Nervous form. Give Epicac in small doses for spasm. Open bowels. Sulphate of Hg. emmetic. 1 Drop under 2 yr. Tr. [Epicac] aconite root.. Cresoline . Vapors. Bronchitis fever. cough. dryness. pain. Bronchial Nodes are often affected. 100-02°. Sibilant Rales between Shoulder blades mostly. Moist rales when secretions returns. Bronchi Pneu. Localized dullness. Dyspnoea Symptoms are aggravated. keep warm. aconite - Muriate of Ammonia. Jan.22.'07. Cong. Syphilis. 1st stage from birth 2nd stage 3rd wk. to 1 yr. Latent Period. 3rd stage. Begin of 2nd [denta?] 1 Mother may give birth at 6 mo. 2 " " " " " 9 " dead. 3 " " " " " " " signs of Syph. 4." " " " " healthy for 3 mo. Baby safe after 3 mo. 1st stage {1st is snuffles, Rash {Macule. Papule Past. Psorian {Pemphligus. Rupia. Mild Cases. {Others sever. Rash comes on Palms & soles. {Sheding of skin Mucous Memb. sensitive on mouth. Mucous Patche or Ulcers. stretching to angles of Mouth Rhagade Condylomata of anus. Enlargement is Diaphysis in Syph. Richits " " Ephysis " Pseudo Syphilitic Paralysis of New Born Age differenciates from Paralysis of Scuig Richits Ulcer around Nail " " Frontal Bones may Project No Hair no Eyebrows, Bone, skin, Eyes - Plastic irites. 32rd Stage. Bones - Chronic Periostitis, Tibia Mid third sabre shalpe tibia Richits lower third. Saddle back nose Hutchington teeth [illustration] Syphititic Keratilis. gray peculiar cornea. Deaf. Acute Rash does not reappear. Phagedina in skin of 2 stage. Mucous Memb. gumata no pain. Nervous. Infantilism Salication. Diarrhoea is mark to go by. Pulv. Hg Cum Craeta. gr. T 3 or 4x a day. Ung Hygrg. size of bid pea 15 gr. stop when skin clears. Jan.24.'07. Exanthemata diseases which have skin eruptions. Scarlet fever: Mostly over 6 months. acute infectious Dis. Char by short incub. rapid. [efflor?????] fever. crimson eruption. sore throat Ossquamation in decline. 4-6 days incubation. Prodromic not more than 1 or 2 days. Eruption appears in 36 hrs. after illness begins. fades about 6th. day. Desq. begins 1 day after. Period of quanrntine 40 days from beginning. Scarlet fever is serious. occurs in epidemics usually. During school sessions. Complications Angina. severe sore throat thin. greenish yellow he, layer. extensive. contains streptococci. Endocarditis. Otitis Media is quite common. Nephritis common. Alb & Casts. Red disappears on pressure. Puncta Temp 101-03. Higher temp. more dangerous. May begin with vomiting or Convulsions. Eruption first on Neck, wrist, buttox. Tongue light white coat. becomes strawberry. Crimson eruption fever. Treatment: Isolate. Ventilate room. nail curtion of Carbolic Acid over door. Tr. of Acomto for fever. 1 drop ever 1/4 hr for 1 hr then [illegible] Carbolized Vasaline over body. lowes temp prevents escape & cold baths for fever. Spray H2O2 for throat. [cross out] Paracentesis for Ear trouble. 1[?] of Acetate Duf of Dig alone for Rd. Comp jalap for effusion - Acetate of iron Hot baths. Dig poultice over loin. Hydrocephaloid: Diarrhoea, Head retracted & fontenelles sunken. Drainage on Brain Pseudo Meningitis. often Celled T.B. Meningitis. Treatment is to stimulate. Saline injection etc. Jan.31.'07. Atk. Measles: Char. by Naso Bronch. Catarrh. eruption fever incubation & period of onset. more infectious than scarlet fever. occurs epidemically once in every two years. May attack adults. does not recur as a rule. Prog. very unreliable. first attack in community is severer. Incubation 10-14 days uncertain may be 20 days. begins with coriza. watery eyes. cough - thick watery 3-5 days then temp rises. eruption begins usually on face. [Coplicks] spots in mouth bluish white elevations on red base. Remittent fever is peculiar. Scarlet fever is scaly pink. scales are larger. Measles is Bran. Complications: Broncho - Pneumonia. Otitis Media. Ulceration of Coma. Meningitis. T.B. quite Common. comes on later. Treatment: Decoction of flax seed tea 1/4 whiskey sweeten & flavor with lemon juice, drink all wanted. ꝶ Syr. Epicac. Sweet spt. Niter. Paragon. Syr. Squells. Feb..7.'07. Rubella. - german Measles -. shotty feel. Post cervical glands are enlarged. Feb.28.'07. Infantile Paralysis. Symptoms: sudden Vomit. temp 101-03. after 3 ro 4 days. paralysis sets in. Muscle of lower limbs. then upper. improvement in 4 wks begins. Muscles early fail to respond to faradic current but increase with galvanic. Pseudo Hypertrophic Paralysis. [also] all muscles paralyzed except Gastrocnemius. Previous History. Mar.5.'07. Milk Modification: (1) Sodium ([Crossed Out]) Citrate Calcium salts. Sod. Citrate aquous Sol. gr. 64. aq. Dis. ℥ VIII. 1/3 skim milk & water. 1/2 1 teaspoonful of Sod. Citrate to ounce. 2/3 ꝶ Milk ℥ ii Water ℥ IV Sod. Cit. Sol. ʒ [IV] VI one feed. [Cow's] Cow's. Woman's. Reaction acid acid Proteids 3 2-1. Contains more lact Alb. Casein to lact. alb. 3-1 (5-1.) Fat. same Sug. 4% 7% Bact. suarming sterile. (1) Pasteurizing. 155° Boiling prevents T.B. typhoid. Cholera. Scarlet. Causes - Scurvy. ꝶ fat 3.50 Sugar 6.50 Proteid 1.25. alkali .5 fatty Diarrhoea. Sugar causes acid erodes anus. Proteids " Cobe. Sol at first 4% when stands becomes 7% then 10% [illustration] 3.50 take ℥ viii of uper 1/3 milk. 6.50 take 2 tablespoon of milk Sug in solution. 1.25 ℥ ss of bottom 1/3 [illegible] .5 2 gr Sod Bicarb & ounce of milk. add to 20 ℥ boiling water. Mar.12.'07. Difficulty of feeding baby at breast - % a gaining weight-constant colic. b loss wt; no colic B baby on bottle Mothers milk too much proteid she must take more exercise large amts of watter test again at end of meet baby gaining wt. Loosing wt mother does not opposite may have to remove child in either case but last is usually most urgent. Modification of mills always begin law as 3 Mo begin with 1 Mo. M 20 ℥ mixture ꝶ Fat 3.00 = 6 ℥ (10% cream) Sugar 6.00 = 2 1/2 measures [teaspoons] Proteid .75 - Alkali 5. 2 tablespoons of lime water 13 ounces of boiled water. 4-7-10% are the usefull proportions. Make whey by coagulating with [illegible] Mar.14.'07. 3% fat to begin continue for 1 month go up to 4% too low fat cause Rickits. 6 times in Proportion amt of water first few years. Tuberculosis women should not nurse. Suffering serious complications during labor. Choreic or epileptic. Serious chronic disease. & Delicate. Women secreting poor milk & deficient amt. first month 10 times a day once at night. 2 hrs apart. 4 to 8 th. wk. 8 nursings a day. 2 to 4 th mo. 7 times a day not at night. 4-10 mo. 6 times. 10-12-5 a day. In adequate nursing. Temperature more or less 101-02. especially from 2 to 4 days. child is uncomfortable. loses in weight. after 3 days gain 48 a wh. or more. dry hard stools tugs at breast. Papoid? to make agreeable. Red boiled Sugar Beets for mother's milk. Mar.19.'07. Acute Diarrhoes. 1. Mechanical Food. Chill. 2. Infectious form. A. Ectogenous Toxic & cholera infantum. B. Endogeneous. Coli Communis. Pyocoyaneous Proteus. Strepto cocci. 3. Dysentery. Coli Communis. Strepto cocci. amoeba. Chronic. A. Lienteric. B. Mucous disease. Observe condition of skin: inelastic bad prognosis. due to oedema due to renal inadequacy. Treats cut out milk. support patient. Chlorea Infactum & sever ileccolitis only use opium. Blood & Mucous signify dysentary. Wash bowel for ilcocolitis. stool of lienteric Diarrhoea. large indigested. treatment. Diet. Arsenic - arsenicalis. large, oily matter. odor bad. - Mucous Disease. food digested. Mucous thrown off which increases. Calomel. & Bismuth alkali. ꝶ Sod. Bicarb Spts am. ar. Inf. gentianae. Mar.21.'07. Early proteids 1/2 - 1 %. 2 mo. 1 1/2 % 4-5 mo. 2% Don't use whole milk till one year. Too low Proteids cause anaemia. Fats 3 times proteids normal 1-3 mo. " 2 " " " 3-9 ". " = " " 9-14 " Milk of 10 fat most often used. % of fat is always 1/2 no of oz. used in 10% Mixt. Removing upper 1/5 = 12%. Skimming = 16%. Cream: subtract proteid % from fat % multiply remainder by total amt. per day divide quotient by 12. Whole milk multiply amt. of mixture by Proteid % ÷ by 4. this gives total amt of milk & scream - the cream = whole milk. Amt. of sugar multiply difference between sugars & proteids. April.4.'07. Infantile Therapeutics. Dont give Nauseunt dose. Highly seasoned soon disliked by child. Small bitter doses better. Change of air & environment good. Study Alkaloids. Triturates. Calomel. 1/2 % Arsenious Acid for Chorea, tonic etc. [F??leis] 1-2 drops. Atropin 1/400 - 1/200 gr. Dovers Pu. 1/10 gr. Bromides frequent small doses. arseniated copper. 1/300 gr good in diarrhoea. Lavage of Stomach. Purgation. irrigation. Phenacetin. good antipyretic 1 gr. every 2 hrs. 5 gr. 2 gr. Alcohol good stimulant. well stood. Flax seed lemonade with alcohol for measles to bring eruption. Brandy 1-8 = 1 yr. of age. 1/2 oz in 24 hrs. of Brandy 4 yr. double. Tonics: Cod liver oil. not when tongue is coated - 10-20 drops pure. [Peptoman?inate] of Iron. Scropulos use Syr. 20 gram. give in milk. Blauds Mass or Pill sol & absorbable. Paragoric 1 mo. 1 minim. 3 mo. 2 min. 1 yr. 5-10 min. 5 yr. 30-40. Dovers 1 mo 1/20 gr. 3 mo 1/10 1 y 1/4 to 1/2.? 5 yr. 2-3 grs. Morphine (1/1000 1 mo) 3 mo. 1/500 (1 yr 1/200) (5-1/30) Codein 1/200 3 mo. 1 y 1/60 5 yr 1/10-1/5. Dont repeat dose of opium till first passes away. Chloral for anodyne 1 mo 1 gr. 1 y 3-5 grs. every 2 hrs. good in Convulsions give by rectum. Oct.8.06 Ear: wilde specula 1. External: Auricle Ex Auditory Canal Middle: Ant. Mem. Tym. Int by ant wall of vestibule Inner Ear. [illustration] Between Fibrous & Mucous Memb. are Ossicles. Promentory between oval & round window. Skin. Fibrous. Mucous. {Tym. Mem. Oct.15.'06. [illustration] Memb Flaxido {Epithelial {Mucous Memb. Vibartum color Half dry oyster shell. Fibrous layer {Radiating fiver. {Circulating " in Pephery. Triangular light spot. Four segments of Drum Membrane. {sup ant & post {Inf. " " Lines Bisecting each other in center. Oct.17.'06. Corda Tympanic. Nerve Plexus on Memb. [illustration] Vestibule Cochles & sevicercular. {Labrynth. Promentory between Oral & Round window. Wound window covered wit fibrous Memb. safely Valve of Labrynth [illustration] Membranous Laby within Barny Laby. Between Memb & y is a fluid cald perilymph Within Memb Laby is Endolymph. Nerve endings suspended in Endolymph. Cordae Tympani. Scola Cochilaris. 2,000 Cordae Arches. Music & Noise.? Cochlea interpret musical tones. Gaynos Physics. Oct.2.'06. Eustachian 1 1/2 to 1 3/4 in. lat wal of Nasal Pharynx to Tympanic Cavity. Isthmus near entrance to Tym Cav. Isthmus Tube. At point where bony & Cart. tube join Inner 1/4 is Bony outer 3/4 Cartilaginous. Cart is in Scroll form 3/4 Boundary. Mucosa in Ruggi. 72 sq in. Oct.29.'06. Max. Antrum connection to Middle Meatus. Another entrance is thro 1 Molar. Tooth. or go thro' Alveolar process. Semilunaris Hyatus connects all these sinuses. Nov.5'06. [illustration] Faucel Tonsel. Plica of Tonsil mostly affected in Peritonsila abcess. Ventricle Morgani. Ventricler Band Vocal Cord Glotis. Nov.14.'06. 1.. Pain. 2.. Deafriess. 3.. Discharge. 4.. Teermites. 5.. Vertigo. Pain caused by Pluging of Cerumen. " " Reflexly from lower end of Eustachian tube. " " by involvement of Cordae Tympani. " " by extreme exposure to cold. " " by mechanical irritation. " " " slap causing pressure on Drum. 2.. Deafness: 2 varieties {of conducting opparatus. {of Perceiving " . Conduct Apparatus Ossicles, oval window. Perceiving " are Nerve endings of Auditory N. Impaired hearing may be caused by Rheumatism. Syphalis. long continued chronic Catarrh. Inflam. of small joints of Malleus, Incus & stapes. 3. Discharge indicates perforation of Drum Membrane except in moist [Ethyma]. furuncluosis. Purulent Discharges come from Tympanic Cavity. Corisa Patient should not blow nose. 4. Tenitus is ringing of ear. [duct]. Mechanical by mechanical irritation. Vaescular Venous stase; arterial tension. Arteric Sclerosis. Nervous. Tennitus may occur in gravid uterus. Kidney trouble. Corisa. fever. Medicines. is continuous. intermittant or pulsating Vertigo. Equilibrium centers are in Semicircular Canal. Unilateral is local symptom in ear. Bilateral is general by pressure of some of the Nerve endings. Dec..3.'06. Otitis Media 1. Acute Non Suppurative Catarrhal. 2. Chronic " " " 3. Acute suppurative or Purulent. 4. Chronic " " . 6 to 8 wks. divides acute from chronic. 90% is secondary to Nose affection. No. 1 (Earache) Air supply cut off by closure of Eustachian tube. Tym. Memb. first reddened then bulges from excess of Mucous Dec.5.'06. Catarrhal becomes suppurative when Pathogenic organisms enter. Pain, impaired hearing. Pressure on stapes causes pressure of Perilymph & thus vertigo. 1.. Not yet bulging. 2.. bulging or 3. bursted. Don't use syringe or inflation where there is a fluid in Mid. Ear. Post nasal Syringe antiseptic alkaline solution. (Dobels Tablet.) Bicarb & Biborate. Soda glycerine. Carbolic Acid. 10 to 15 grs. Borax Bicarb soda teaspoonful gly. & Carbolic 2 ℥ water. Drastic Purge. Mg Citrate. Aspirin. Dec.10.'06. Acute suppurative. Otitis Media: Make Pathological. Examination by Microscope. 1. Staphlo Pyo. Aureus. 2.. Pyogenes Albus. 3.. Streptococcus. 3. first in Primary. Friedlanders rather severe. Suppurative more destructive. Don't use water but pack with dry sterile gauze. Never inflate in Acute Inflam. of Middle ear. lasts from 2 to 4 wks. Boracic acid Powder ovoid too much. Spray on tympanum aristol. Dec.13.'06. 1. sequel destruction of soft parts. striped Mucous Membrane. [illustration][illustration] 105° water add Lysol 1/2 to 1% in gal. water use every few hrs. 1/2 gal. every 2 hrs. low pressure. Cold counter irritated. Wilde incision. Leeches. Comp. Tr. of Io. good counter irritant. use swab for painting over Mastoid Process Cessation of profuse flow is dangerous goes other way. 2. sequel aural Poly pus has source only in middle ear. Dec.17.'06. Suppuration in attic is serious & chronic. Post per. is in conjunction with Incus. Ant " " " " " Malleus. High " " " " " Shrapnels. Memb. Memb almost destroyed Sup. is inattic adities & Masb. Granulations not much formed with Pin hole. Pez. Never use Cocain on mucous Memb over 10% Never spray Cocain Adrenalin chloride [du???les] toxic affects of Cocain. 1 to 1000 brushed over after 1 to 10% Cocain alternate a few times. Adrenalin blanches surfaces prevents absorption. Jan.10.'07. Outcome of suppurative Otitis Media. Syringe may be used in certain cases where you cannot reach with mop. Continued flow of Pus the focus is in Mastoid antrum Chronic form may not trouble much but Acute Acerbations are severe. 1. Acute. 2. Chronic 3. Acute Exacerbation. Suppuration of Mastoid may occur primarily. Temperature not reliable as to extent of Process. R. Angle between Temporal line & line of Post [and. Canal] most. antrum is place of Election. Scluvartzes. Simple Mastoid operation. Classic Radical. Jan.17.'07. Nose - Extensive Mucous surface - 36 -72 sq. in. Rhinitis {Hypertrophic. A. {Atrophic. B. Sense of Ol faction is in upper section. Mid. & Upper Resp. function " " lower. A. is Prolif. of soft tissue of Mucous & Erectile tissue. Develops slowly. Section Epi multiplied. Erectile tis. inc. Fibrin elements present, Bone Hypertrophied Nasal turgescence. turg is temporary. [He???t??] Plem. Electricity shrinks turgescence. Atrophic cause obscure. may follow above. Jan.21.'07. Hay fever. Rhinitis produced on nerve endings of action of Pollen. of Ragweed. Milkweed. Golden Rod. Rose Cold. Neurotic Rhinitis. 1. Path Cond. of Mucosa. 2 A Pollen. 3. Neurotic. Antitoxin of Dunbar. Pollentine. Jan.24.'07. Valerianate of zinc good in these nervous conditions 2 or 3 gr 3x a day pill form. Adrenalin Chloride 1-3000. Spray. Dont use cocain as a spray. Ad. Cl. Blanches & constricts Mucosa. Keep Nasal opening open to prevent Asthma. Sedative spray. ꝶ Mentholi. gr. IV oily spray. Camphor. grs ii Ol. Gaultheri gtts ii Liq Petrolatum ℥ IV. Devilbis Atomizer. both water & Oil. Keep P. out of Dust & bright sunlight. Feb.4.'07. Follicular Tonsilitis. Parenchymatous - Diphtheria fever not so high. usually begin unilateral. Exudate limited to tonsil in tonsilitis. Cheesy white Exudate in Tonsilitis. Cheesy product of Bacillus in tonsilitis. can [illegible] away. Bleeds in Tonsilitis is deeper. grip Tonsilitis is a cross. Tonsilitis is shorter duration. acute & Secondary to exanthema. Mar.4.07. Nasal catarrh. deflected septum irritated & cong of compensated side. Vase Motor disturbance increasing secretions. Chronic Rhinitis: 1. Simple. 2. Hypertrophic. 3. Atrophic. 4. Specific. 1. Constant exposure to irritation. sl. Path. change. 2. Secondary to frequent irritation frequent colds of head. Turgescence is inc. Bld. Supply in Mucous Memb. Mar.11.'07. Trichloracetic acid for hypertrophy. Chronic acid. on silver prope. Cocainize first. Pressure Mucous Memb. Maxilliary Antrum to Mid turbinal bone.          Chemistry. Vol 1. Oct.23.'06. Hydrogen. Sym. H. At wght. 1.008 Mol. wght. 2.016 1 Lit. .0899gm 1 gm. occupy 11.16 Liters Standard Cond. Occurence disc 1776 Cavendash. 2.. At. 2 pts in 10.ooo. 3.. Near Volcanoes 4.. Near fumaroles 5.. Comb with water & some or organic comp. Pupar. 1. acidulated H2O + Electricity. 2.. Decomposing H2O by certain metal as Sodium R. in cold. Na2 + 2H2O -> 2NaOH + H2 3.. By mineral acids on metals as Zn. Zn + H2SO4 = ZnSO4 + H2. Physical Prop. 1. Colorless. odorless. tasteless gas. 2.. 14 1/2 x lighter than air. 3.. 1 L wghs. .0899 g. 4.. can be liquefied. 5. can be ignited by finely divided Platinum. Chem. Properties: 1. Very inert body 2.. H & Cl gas. for HCl in light in dark do not combine. 3.. It is combustible gives higher Heat than any known Sub. 4. does not support combustion. 5.. Comb. with 1/2 vol of O form H2O. Always in same proportions. Law of Definite Por. 6.. Reduce at High temperatures. Ferrum Reductum of Pharmacy. 7.. Nascent H is in ionic state active body. 8.. It acts somewhat as a metal. may call acids salt of H.. Used 1. to fill Baloons. 2.. is a reducing agent. 3.. Drumnonds light or blow pipe light. Oxygen Sym. O. At wght 16 Mol ght 32. liter wghs. 1.43 grms. 16 gm. occupies 11.16 L. at St. Cond. Occurrence Disc by Priestly. 1774 & by Sheele in Sweeden. 2 Occurs in Air. in Organic Comp. some inorganic & most widely distributed of substance. Prep. 1.. by heating Red Oxide of Hg or HgO. 2..HgO + heated -> Hg2O + O. Heat Hg2O -> Hg + C 2. Heat MnO2 to Redness -> 3MnO2 = Mn2O4 + O2. MnO2 + KClO3 -> MnO2 not changed. 2KClO3 = 2KCl + 3O2 Phy. prop. 1. Odorless etc. Sp.g. 1.1056 3. Disolves in water 3%. 4.. Can be liquified 1 l. wg 1.43. Chem. Prop. (1). forms oxide of all elements except Fl & Br. Helium. Argon. etc. 2.. Very active chemically. 3. Most elements combine directly with O. at comp low temp. Combustion. is rapid Oxidation of a body with production of light & heat. Oxidation is slow combustion with evolution of Heat but no light A body is combustable when it will [cross out] unite with O. to form light & heat. Carbon Comp as a rule are combustable. Ignition point is temperature to which a body must be heated before it will unite with O. & burn. (Bunsen Burner & Candle.) Candle flame & lamp flame. Inner zone Middle & Outer Outer zone is oxidizing flame. Inner zone. consists of gases being formed middle zone is reducing flame. Oct.29.'06 Brown. 1. Name of Drug group. 2. Source. 3. Chemistry {Class {Formula. {Incompatabilities {Tests. {How made. 4.. Pharmacy Dosage U.S.P.. 5.. Physiologic Action. 6.. Therapeutic Action. 7. Toxicologic Action & Antedotes. Oct.27.'06. Uses of Oxygen 1. Oxidation. 2. Disinfectant. 3.. Blow pipe analysis. 4.. Chem. Comp. 5. Bleeching. 6. Active Principle in H2O2 & O3 Ozone Preparation: Electric sparks passed this a Scimen's ozone tube containing oxygen. 2. In air after Electric storms. found 3. Near frictional electric machines 4.. K2MnO8 + 3H2SO4 = K2SO4 + 2MnSO4 + 3H2O + O2 + O3 5.. Ozone in Atmosphere 1Pt. 700000 Allotropism. Allotropic forms of O. = O=O [illustration]. Properties: Those of Oxygen intensified. Test: Starch + KI = Blue Color. Ozone breaks up KI. Water & Hydrogen Peroxide. Water exists in Solid. liquid. Vapor. Solid below & up to 32° & O°. Between 0 & 100 L. above 100 Vapor. Prep. 1. H & O in a tube + Electricity 2. Burning H in Air or Oxygen. 3. Neutralization of Acid & Base. NaOH + HCl = NaCl + H2O. 4. In reduction of Metalic Oxide. Physical Prop. Liquid. no taste. bluish color. Boiling pr. 100°C. 3. water expands in freezing. 4. little pure water in nature. Chem Prop. Many metals + water = Hydroxide. with SO2 & CO2 get acids. Dissociates Salts into ions. taken up by dehydrating agents P2O5, CaCl.H2SO4. Natural water are never pure. {Potable. {Mineral. {Saline. Potable: spring, well, river & lake water. Char of good water: clear, colorles, odorless, must not be too cold. agreeable taste. free from organic matter. 7. Must not have to much hardness. due to power to decompose coap. due to acid carb & sulph. of Ca & Mg. Hardness 1. temp. or 2. Permanent. 1 due to Carb. 2 perm due to sulph. To get rid of Hardnes 1. Temp 1. Boiling CaH2(CO3)2 -> CaCO3 + H2O + CO2 2. By adding lime to water. Perma. Hardness. K2CO3 + Na2CO3 Coidences of Organic Matter: 1. Nitrates & Nitrites. 2. Free Am. 3.. Albuminoid Am. 4. Total Oxy consuming power. Oct.30.'06. The point to all percipitations is to render a soluable compound less soluable. Test for nitrates & nitrites in water 1. De Phenol Amine in strong H2SO4 equal volumes of H2SO4 & water + 1(a few drops) gives a deep blue. Nitrites alone 2. Carry out same way as no 1. except use Meta Diarmine gives yellow to brown. 3. water + little H2SO4 + K Permang which produce purplish color after 15 min Color disappears if organic is present 1. Purifying water 1 filtration. 2. Sedementation Natural. 3. Sed. by Chem Means. 4. Boiling. Mineral water 7. Carbonated. 2. Sulphurated. 3. Alkaline NaK. 4.. Saline 5.. Chalyheati or iron. 6. Acid cont. H2SO4 or HNO3 7.. Thermal. Official forms Aqua Dist Medicated waters 18 of their Hydrogen Peroxide. H2O2 occurence: 1. Traces in water. 2.. Traces in snow water. 3.. air Prep. BaO2 + H2SO4 -> BaSO4 + H2O2. 2.BaO2 + HCO3 -> BaCO3 + H2O2 3.. BaO2 + 2HFl -> BaFl + H2O2 Commercial Prep. Ordinary H2O2 = 3% solution of glycerine 5-25% Use. Bleaching by direct oxidation. 2.. action lead of Oil painting 3.. Disinfectant. 4.. Tests for Blood & Pus. Prep. 1. [illegible] Phosphorus in confined space Ph + O = P2O5 + N. 2. Pass air over metalic copper or iron heated to redness. 3. Liquid air N. given off pure 4.. By Heating [am] (NH4)NO2 -. 4H2O + N2. Properties: Phy & Chem. Colorless etc. 2. Incombustable does not support Combustion. 3 not poisonous. 4. Inert Chem. 5.. Unstable compound. 6.. By Elec. Current N & H will unite to form NH3 also N + O -> N2O (Lq.). Comp. N + H -> NH3: Source: 1. Decomposed animal matter 2.. Comercially Prep. from Coal. which contains 2% N. By product in formation of Illuminating Gas. [illustration] Impure NH4OH from gass works. treated with HCl -> NH4Cl + H2O. Sal Ammoniac = +[Ca2O] 2NH4Cl + CaO -> ^ NH3 -. in water = com. U.S.P. Aqua Fortior Am 28% by wght. Aqua Am. Delutun 10% by wg Prop: Pungent. Colorless. gass cannot be breathed 2. Not combustable in air but will burn with dif. in O. does not support Comb. 3.. lighter than air. Cura be liquified. 4. Very sol in water. 5.. Sometimes called Volatile Alkali. Tests: 1. odor. 2.. fume with HCl. 3.. Litmus test. Uses: 1. Salts of Am are used as fertilizers. 2.. Therap salts are expectorants. 3. Manufacture of Ice. Liq. Am. N2O 5 known Oxides of Nitrogen N2O (Lq.) Nitrous Oxide or Nitrogen Monoxide. Disc. by Priestly 1776 first used as an Anesthetic by [David] Davy. Prep.1.. Heating Am Nitrate in retort NH4NO3 to 210°-250° -> N2O + 2H2O. for Anesthetic purposes should be run this Sodium Hydroxide. Prop. 1. Sweetish colorless gas soluable in water & alcohol. Support combustion 3. For Anesthesia liquid from tubes glass cylinders. Stages of Anesthesia: [illegible] Vaudun. 2. Anesthesia 3. Danger Asphyxia. Acts as Excluding air 2.. Affects central Nervous Sys Excreted: Does not decompose in Blood. Merely dissolved in blood. thrown off by lungs as Nitrous Oxide. Other Oxides 2. N2O2 Nitric oxide 3. N2O3 N Trioxide 4. N2O4 Nit. tetraoxide 5. N2O5. N. PentO. Nov.13.'06. Nitrogen Acids. 1. H2O + N2O -> 2HNO hyponitrous acid AgNO Ag NO. 2. H2O + N2O3 -> 2HNO2 has not been isolated - nitrites well formed. 3. H2O + N2O5 -> 2HNO3 has been isolated. Nitric acid. Prep. 1. A. 2NaNO3 + H2SO4 -> NaHSO4 + Na2SO4 + HNO3. B. NaHSO4 + NaNO3 -> Na2SO4 + HNO3 Properties 1. Colorless. heavy. fuming liquid. 2. Sp grav. 1.52. 3. Exposed to air turns yellow. due to Production of N2O4. 4. Strong Oxidyzing agent. Tests: 1. few drops H2SO4 + Iordigo + HNO3 -> decolorizes. 2. Copper turnings + HNO3 -> greenish blue liquid red fumes. Physiological affect: 1. small doses is stomachic 2. large doses is corrosive & Vio. poision tissues become yellow at first. Antidote: 1.. Milk lime. 2.. Sodii Bicarb. Atmosphere: 1. Mixture of gases. 2. one liter weighs 1.293 gm. 3.. 14.44 times heavier than H. 4. Consists of 20.61 O. 77.95 N. by Volume..23 + O by wght. .73 + N. by weight. Argon, Helium, Xenon. 1% watery vapor. CO2 4 pts in 10.000 NH3 Traces of H2O2 over cities. Traces of H2SO4. Liquified Air. Air first put under pressure 2. Surrounded by cooling mixtures. Properties: bluish liquid. 2. sp. gr. .9. 3. boils at -191°C.(a) Nitrogen pass off more rapidly (b) leaves 50% Mix of O. Disinfection of atmosphere 1.. heat 2. gases. Ozon. Ox. Cl. Br. SO2 etc. 3. Solids. HgCl2 Chloride of zinc. Al & K permang. Carbolic acid. 4. Liquids: (soluable solids) Deordorize -> Destroy [?ensive] odors. 1. Dry earth 2. line. charcoal. ashes. 2. Liquid. Lead Chloride. ZnCl2 (Burnestle Fl.). K. & Na Permang mixed (Condys fluid). 3. Gases. Ozone. formaldehyde. Chlorate Sulphur. 1. Occurence. Volcanic regions, 2. In clay. 3. As sulphate. gypsum etc. 4. Sulphur waters. 2H2S + O2 -> 2H2O + S2. Prep. 1. from Native Sulphur. found in clay by distilation. 2. dist. by opparatus. 1. By roasting iron [parasites] 3 FeS2 -> Fe3S4 + S2. 2. first flowers of Sulphur [illustration] 3. Roll sulphur or Brimstone. In B. heat fast. Physical Properties: 1. Ordinary sulphur yellow solid. 2. Boils at 148° Melts at 115°. 3. Non conductor. 4. Insoluable. 5. best solv. CS2 Allotropic forms. 4.1. Native Sulphur in Octahedral Cupals. 2. Melt at high tem then cool get monoclinic crystals. (Dimorphous) 3. Heat to Boiling point & plunge into cold water becomes putty like. 4. Amorphous powder. Official forms of S. Sulphur sublimatun 2. Sulph. Latum = flowers of S. digested in NH4OH then washed. 3 S. percipitatum prep as follows. 3Ca(OH)2 + 6S2 -> (2CaS5 + (CaS2O3 + H2O). + HCl -> 3CaCl2 + 3H2O + 6S2 4. Unguentum Sulph. 10% Sulph in Bengooted Lard. H + S - H2S or Hydrogen Sulphide or Sulphuretled H. H2S2 Hydrogen persulphide not important. Occurrence: 1. In Volcanic gases 2. in mineral springs. 3 result of decomposition of organic matter. Preparation; Treat FeS or ferrus sulphide with an acid = FeS + H2SO4 -> FeSO4 + H2S. properties: 1. Colorless, transparent gas, 2. odor of Rotten Eggs. 3. heavier than air 4. Can be liquified. 5. Poisionous when inhaled. Chem. Prop. Burns with blue flame 1. H2S + 3O2 -> 2H2O + 2SO2 2. Decomposed by Halogens. 3.. [Pot] KOH + H2S -> KSH + H2O. Uses. used principally in chem lab. as analytical agen. Phy. Prop: 1.. Narcotic poison 2.. Acts as a reducing agent on blood preventing Oxy hauns globin from taking up oxygen. 3.. By stomach does no harm. 4. popular remidy for gout. Rheu. etc. 5.. Poisoning may be acute or chronic generally acute. Treatment in acute Oxygen gas. pure air. stimulation by brandy. some give Cl. water. Sulphur & Oxygen & Sulphurdioxide Prep. 1. Copper + H2SO4 -> CuSO4 + SO2 + H2O. 2. Burning S. in oxygen or in air. 3. H2SO4 + C + heat -> 2H2O + 2SO2 + CO2 Phy. Prop. 1. Gas suffocating 2.. soluable in water making Sulphuran acid SO2 + H2O -> H2SO3. Chem. Prop. 1.. Non Combustable 2.. does not support combustion. 3.. Nascent H. reduces it to H2S + H2O. 4.. Valuable reducing agent taking up O. to form H2SO4 Uses. 1. Disinfectant. 3lbd. sulphur. burned for 1000 cuft. of space. 2. Deodorizing By Distilling Nordhausens Sulphuric acid H2S2O7. 2.. Passing SO2 gas thro cyl. containing finely divided Platinum Sulphuric acid. H2SO4 Prep. 1.. By Platinum method. (oil of vitrol) 2.. A. FeS2 or S2 {roasted in O. B.. 2 NaNO3 + H2SO4 -> NaSO4 + HNO3 {Gives SO2 c. 2HNO3 + SO2 -> 2SO2OH NO2 nitrosil Sulphuric Acid. d.. jet of stream -> 2SO2 OH NO2 + NO2 -> 2H2SO4 + N2O3 Prop. 1.. Heavy oily liquid. 2. takes up water forms Ortho Sulphuric acid & heat. 3.. Pecular action on unsized paper produces parchment pater 4.. Sphg [?83] 5.. forms 2 series of salts normal sulphate & acids sulphates: med. effects 1. Dilute is conic & astringent. 2. Large doses is corrosive poision. Antidote Lime water. wag. Sod. Bicarb. Official Prep 1. strong H2SO4 or oil of vitrol. 2. Dilute 10%. 3.. Acromatic this is alc sol. Tr. of ginger & Cinamon 13.8 [illegible] Nov.26.'06. Test. BaCl. General Properties of Halogens. 1. Electro negative.Fl. Io least. 2. Pungent Odor. 3. Disinfectant. 4. Bleeching agents. 5. Form Binary compounds with most elements. 6. Lower members set free the higher 7.. Comp. with Hydrogen have marked acid properties. 8. Have but little affinity for O. all form Oxides except Fl. 9.. Valence 1. Fourine at . w. 19 Val. 1. sp.g. 1.3 occurrence in fluorspar (.CaCl2.) 2. Cryolite Na al flouride Prep: By decomposing Pure HFl. in Platinum tube with El. Current. Prop. 1. Pungent gas. 2. decomposes water gives HFl. H + Fl. Prep. CaFl. + H2SO4 -> CaSO4 + 2HFl. Prop. a transparent liquid 2. fumes giving off Pungent odor. corrodes skin 4.. Ability to etch glass by removing its silicon. Fl. formes no oxides. Vl. at wgt. 35.5 Sp. g. 2.47 Val. 1. -2 -5 -7. generally in form of Clorides of sodium. Prep. in (a) 2H2SO4 + MnO2 + 2NaCl. -> Na2SO4 + MnSO4 + 2H2O + Cl2. (B) 4HCl + MnO2 -> MnCl2 + 2H2O + Cl2 2. By decomposing clorinated Lime. 3.. Manufacture of NaOH by Elect. of NaCl. Phys. Prop. 1. greenish yellow gas. pungent odor. 2. 2 1/2 times heavier than air. 3. can be liquefied. 4 Poisionous to Mucous Memb. Chem Prop. 1. has strong affinities for H & metals. 2.. all metals are tarnished by Clorine. 3.. Burns in atmosphere of H gives HCl. 4. Allotropic forms a Clorine prep in dark is not active. B. Cl in light is very active. 5 Bleeches because it has a strong affinity for H. Takes H. from water . & set free Noscent Ox. & this O. oxidized the colored to colorless comp. Most important comp is HCl occurrence in Nature 1. Volcanic regions, in Stomach of Mammals. Prep. 1. H2SO4 + 2NaCl -> Na2SO4 + 2HCl. By direct union of H & Cl. a. in tube in light. B. Tube with El. current. 3. As By product in LeBlancs method for production of Na2CO3 Phy. Prop. 1.. Colorless Transparent gas 2. Pungent Penetrating odor. 3. strong acid. 2. forms salts called chlorides. 3. when HCl is dry it has no acid properties. Official prep. acidum Hydroledum sp. 1.15. 31.9 d. acid. acidiom HgCl. Dil. 10%. Test: 1. MnO2 + 2HCl = Clorine 2Silver NO3 = white PP of AgCl. 3.. Hg2(NO3)2 + 2HCl -> Hg2CL2 + 2HNO3 + am OH. = Black Pepcpefutal. Aqua Regia: 180 CC HNO3 + 820 CC of HCl -> yellowish liquid. Nitro HCl acid. Bromine. Br. at. 80. Spg. 2.99 Val. 1. Occurence never free 2. salts of alkali metals & alkali earths. 3. Ashes of Sea weed. 4. Saline spring Prep. from sea water by evaporating & crystalying which leave, Bromide Bromide & Cl gas sets free Br. 2 most of it today comes from mineral springs instassfurt. Phy prop. 1. Heavy dark red. mobile liquid 2. gives off at ordinary temp. gives off pritant fumes. 3. Sol. in water. Readily soluable in ether & alc. & CS2 Chem Prop. similar to Cl only weaker. HBr. Prep 1. Phosporus Br5 + 4H2O -> H3PO4 + 5HBr . 2.. KBr + H2SO4 -> K2SO4 + 2HBr. Prop. It is a gas colorless 2. can be liquified. 3.. Sol in water. 4. forms salts caled Bromides. Weaker acid than HCl. ides ides [Nov]Dec.4.'06. Iodine Occurrence: Seaweed. 2. springs with Clorides & [B??sides] standing sea water. Mostly from Seaweed. Prep. 1. Seaweed dried in sun 2. Burned in shallow excavation at a low temperature as not to volatilize Io. 3.. Ash called Kelp. it is then leeched in water. 4.. Then evaporated in open pans which allows some other salts to crystalize out. 5. Mother liquor called Io lye - which is left in pan - is mixed with 1/8 vol of H2SO4 & stands 24 hrs. H2SO4 breaks up carb. & hyposulphides & sulphides. Na Io remains & unites 2NaIo + 2H2SO4 + MnO2 -> Na2SO4 + MNO2 + 2H2O + Io2. Phy. Prop. 1. Blueish black crystaline solid 2.. heated gives off violet vapors. 3.. only sl. sol in water. 4. sol. in alc. & K.I. Med. uses: 1. Counter irritant. 2. Alterative internally. 3. Eliminated by KI. & Saliva not by skin. official Prep. 1. TR. Io. alc sol. 70 gms Io 50 gm K.I. to 1000 CC alcohol. Colorless Tr of Io is made by adding Am Hydrate to ordinary Tr. comb. with Io & forms NH4I. 2. Lugo's sol. (5gms. Io gms K.I. H2O q.s. 100 gms.) Unguentrim Iodii 4% Io rubbed with KI & H2O & Mixed with Lard. H.I. 1. Colorless gas. 2. Breaks up easy giving free Io. Prep. Io2 + H2S -. 2HI + S Tests for Iodine. 1. Starch test. 2. Carbon Bisulphide dissolve Io giving Blue color. 3. Silver Nitrate -. yellow P.P. KI: Crystaline sol. salt. Prep. Metalic 3Io2 + 6KOH -> 5KI + KIO3 + [?1] Evap. to dryness then heated the KIO3 breaks -> KI + 3O. Antidotes: Starch flower, milk, white of Egg. Phosphorus. Occurrence: 1. Disc. by BrND 1669. In Urine. 2. Redisc. by Galin 1769. in Bones. 3. Most common mineral is Ca3(PO4)2 Most P comes from Bone. Prep: I ash of Bones treated with H2SO4 Ca3(PO4)2 + 2H2SO4 -> CaH4(PO4)2 + 2CaSO4 dis in water leaves CaSO4 undissolved. II This Sol of noI + Charcoal + Sand is evaporated to dryness then heated CaH4(PO4)2 -> Ca(PO3)2 Ca.mutt Ph. + water. 2Ca(PO3)2 + 2SiO2 + 10 C -> 2CaSiO3 + 10 O + P4 Phosphorus carried under water & condensed. Allotropic forms 1. Yellow or waxy Phosphorous. 2. Red Phosphorous. 3. metalic or Crystaline. Properties of Yell. Ph. Translucent wax like solid. 2. Sphg g. 1.82. 3. By light becomes covered with W. Powder. (P2O5) 4. luminous in dard. 5. Exposed to moist air gives odor of Ozone. 6 Insol in water. Sol in alc. best solvent is Carbon Bisulphide. Red Ph. (amorphous) Reddish brown amorphous powder sph gr. 2.14. Insol in Carbon Bisulph. does not show Phosphorescence. 5. not poisionous to workmen. 6. Heated does not melt but subllimes. 7. formed by heating ordinary Ph in an atmosphere of H or CO2 for 36 hrs. to a temp. of 260°C. Chem. Prop of Yell. Phosphorous: 1. Easily oxidized. 60° Burns yellow flame. B2O5. 3.. May be burned under water by throwing jet of O. on it. 4. For reason in 3. must be under water. 5.. Differs from Red Ph. which. is not easily Oxidized. 6.. Unites readily will all Halogens. 7.. forms Comp. with all elements except C. & N. Physiological Action. 1. by handling causes burns 2. Over doses cause sever poisonous symptoms. 3.. after poisoning. weak pulse cold extremities. 3.. Burning in stomach. 4. garlicky breath. 5. dilated Pupils. 6. Collapse. 7. Average time of life is 3 to 4 days. 7. amt. 1/8 to 1/5 gr. may be poisonous. Antidotes: 1. no real chem. antidote.. CuSO4 as an Emetic & gives metalic coating to Ph. rendering it more harmless. KMnO4 H2O2. 2. Emetics. Stomach pump. 3.. Mucilaginous ducts. Never give fats. 4. Ozonized turpentine. 5.. Supportive. Chronic Poisoning: Workers in Ph. match factories. 1. fatigue. anemia. necrosis of jaw. fatty liver. & Kd. swollen gums. Inflam. Mucous lining of Mouth. Analysis of Stomach Contents. 1. Dilute Contents with water. 2. acidulate with weak acid (Tartaric). 3. Distil this on Sand bath. connected with liebigs condenses. & Naso in AgNO3 this is done in dark - Phosphorescence. Black P.P. of Ag. Phosphate. Old match S + P. safety m. KClO3 + MnO2 + S. Compounds of Phosphorous. Phosphor + H. PH3 -> Phosphine. Prep:. 1. 3NaOH + 4 Ph. -> 3 NaH2PO2 + PH3. Properties: 1. Gaseous. takes fire spontaneously in air. 2. Collected under water. 3. Sparingly sol in water. 4.. In organic Comp. containing Ph. Decomposing under water give us impure Phosphine. this comes to surface & burns. forming Ignis faters oil bill of the wisp: P & Halogens combines with all. P + O -> P4O Phos Monoxide P2O3 Phos trioxide. P2O4 Ph tetra. P2O5 Ph. Pentoxide. Acids of Phosphorus. Hypo phosphorus acid. H3PO2 Prep: BaH2(PO2)2 + H2SO4 -> BaSO4 + H3PO2 Ca(H2[(]PO2)2 = Calcium Hypophosphite. NaH2PO2. Phosphorous Acid. H3PO3 Prep: [Ph} PCl3 + H2O -> 3HCl + H3PO3. Salts are called phosphites. H3PO4 Phosphoric Acid. Prep: P2O5 + H2O -> 2HPO3 + 2H2O -> 2H3PO4 Ortho " also 2. Boiling P + HNO3 + H2O -> H3PO4 + ... Salts of Phosphoric Acid. 3 series. Normal salt. Na3PO4 Acid salt. 3. Double salt. Mg. NH4 PO4 triple Phosphates Properties of Phosphoric Acid: Colorless. nonfuming. strong acid. 2. 85% absolute acid. 3.. So. in water. 4. Sphg. 1.707 Chem. Prop. Heat 2H3PO4 loses H2O -> H4P2O7 + H2O Pyrophosphoric A. Heat 2H3PO4 -> 2HPO3 + 2H2O Glacial Phosphoric acid. or Meta Phosphoric acid. Arsenic: At w. 75 - Mol. w. 300. occurrence 1. As2S3 orpuneus 2. Realger As2S2 3.. Cobaltite. CoAs.S. 4.. Mispickell FeAs.S Prep: 1. Heating Mispickell in clay cylinders & condensing. gives AS2O3 2.. Heating AS2O3 + Charcoal & distilling off. 3. Distill from FeS2As2 Fe (Arsenical Pyrites = As2 + 2FeS Properties of Metalic Arenic. 1. Brittle steel gray Metalic lustre. 2. Exists as amorphous - non lustreless [crossed out] 3. At higher temp. yellow form. Chem Prop: 1. Insol in water. 2. Sublimes. 3. Vapor has yellow color. garlic odor. 4. Heated Burns with blue flame. -> As2O3. 5. Combines directly with most elements. 6. Combines with H. only when H is nascent. 7. HNO3 H2SO4 dissolve it without forming salts 8. NaOH + As -> Arsenite Use of Arsenic: 1. Used in fire works - Pyrotechny. 2. fly paper. 3. Rough on rats. 4. Shot making. 5. Used extensively in medicine. Page. 425.  28 Therapeutics - Prof. Friedman. 145 Physical Diagnosis - Prof. Summa. 200 Medicine - Prof. Crandall. 280 Medicine - " Summa. 340 Chest Diseases " Lemen. 240 Surgical Pathology " Lutz. 100 Clinical Chemistry. 300 Parasitetology. Johnson. 365 Obstetrics - Prof. Ehrenfest. 160 Physiology - Prof. Lyon. Skin Duncan. 60 Quiz Work Friedman. 380 Gynecology. - Laidley. Dorsett. 400 Eye. - - - Barck. 420 Fractures & Dislocations - Mr. Candless - 313. Embryology. Wilson. 430 Nervous Diseases. Schwab, Graves, Chaddock. 450 Children's Diseases. Atkinson & Clemens. 475 Ear. Nose. & Throat. Goldstein. 420. Ry Surgery. Fair brother. 109 G.U. Lewis. 315 Surgery. Geiger & Nicholson. 57. Electro Therapeutics. 490. 425. Chemistry. Dr. Neilson. 372 & 392 Obstetrics. Dr. Hypes. 160. Skin - Dr. Duncan. 118 Dietetics - Dr. Neilson.   56 to 100 March. {Cerebro Spinal fever.} {Lobar Pneumonia.} {Diphtheria Eng.}  October 22nd, 1906. Ulcer of Stomach. Recurring hemorrhages-perforating ulcer of stomach and duodenum frequently met with-origin-location-persons usually affected- hemorrhages-stenosis and perforation most frequent complications. Symptoms. Fixed pain-circumscribed area of tenderness-vomiting soon after eating-hyperacidity of stomach contents. When patient vomits blood-(symptoms of cardinoma absent) diagnosis almost positive. Surgical Treatment. Location of Ulcer. Arrest of hemorrhage-excision of ulcer-suturing of perforation- method of proceedure when ulcer occupies posterior wll-when ulcer can not be found. Cicatricial Stenosis. Remote sequel-location at cardiac orifice-pyloric orifice- development slow process. Diagnosis. When at cardiac orifice-at pyloric orifice-regurgitation solid food-presence of stricture and exact position determined by use of eosphegeal bougie. Obstruction-retention of food-dilation of stomach-diagnosis based on history of case-use of siphon stomach tube and inflation of organ. Radiograph. History reveals evidence of indigestion for years, incident to presence of unhealed ulcer-more recently caused by obstruction-results-treatment. [crossed out] Duties of Med. Ob. minute surroundings finger marks etc. keep Diary. Memorandum. Preserve History. Death by violence: Exact time. attitude. Position & Cond. of Body. Dress. all surroundings. Photograph. Vomited Matter. Expression of face etc. marks of violence. progress of dissolution. P.M. Preserve Stomach Examine contents. Observe Contents of L. Intestines. Cond. of Urine pipe. throat. L. & Ht. genital organs. Remove Bladder. Examine for disease. Adrenals. ugt. 10 gm. Cortex & medulla Intermediary zone belongs to cortex. Cortex - Colums of Cells. containing glistening granules of lipoid character. medulla - contains numerous nerves. & multipolar ganglion cells. & nests of cells stained brown with chromic acid - are called chromaffin cells. Arteries - from Diaphragm - Aorta & Renal - Branches anastamose & form a network sub capsular & pierce thro cortex & form Cap. network in the medulla. Accessory Chromaffin cells & tissue are found. on Carotid Artery in Gang. of Sympathetic trunks & Solar Plexus. Superior Meseateric & Hylus of Kidney & along course of Sympathetic nerves. Total amt. Extra medullary Tissue is equal to Med. Part. Cortical substance can be found in hylus of Kd. & in Kd & in Internal genitalia Phylogenesis. There are two independent systems - The Chromaffin or adrenalin system is of Ectodermal origin & is part of sympathetic Cortical system - interrenal system - develops from ventral part of mesoderm Chemical knowledge with regard to Pathological conditions of the ad. glands has, unfortunately, not yet [given] been joined to the facts established by Physiological research with such happy completeness as to give that reward which all workers ardently desire, the power to control & check disease. Cortex 90 of gland. small in encephalic Secretion of adrenalin by glands is controlled by [Schleuchric] Splanchnic sym. nerves. & the Secretion is a stim. to all plain muscle supplied by sym system & these muscles are maintained in a certain tone by ad. The cortex is not controlled by nor related to the nerves. Have to do with supplying the secretion which influence the growth & reproductive power of the animal. super renal cortex & sexual glands are laid out in Wolffian Duct & have origin in that place of Celomic epithelium from which the sexual glds. originate. This early separation of the two systems becomes nil as the development of The gland occurs & both systems give way to a nearly common function. Addison's Disease 1855- Develops in 3 & 4 decades quite insidiously with adynamia & apathy. Constipation - pigmenting of skin & mucous membrane - Pts. succomb under increasing cachexia - at times with stormy terminal manifestations. Autopsy shows disease of both adrenals usually caseous. T.B.C. Peracute cases of Haemorrhages & death within a few days with stormy cerebral symptoms & Intestional chronic cases may show remissions. Path. Anatomy. Congenital malformations with other malformations may exist. Hypoplasia of chromaffin tissue is sometimes associated with status Lymph. & great Parenchymal valves of Thymus. This condition makes susceptible subjects.  Path. Anatomy Haemorrhage & thrombosis are found of Suprarenal Veins. with resulting destruction or suppuration also atrophy & sclerosis - causes shrinking & coalesence of adjacent tissue. Micro Reduction of Parenchyma flattening & necrosis of cells. Thickening of Vessels in sclerosis gumma have been found. T.B.C. usually Bilaterally. 17% of 49 cases Primary & 48% associated with Pulmonary & other foci. Tumors. may destroy supracenals. Hyperneph. may show addison's disease. Healthy adv. have been found in Addison's & Destroyed adrenals found without addison's disease. showing the existance of compensatory tissue of same function. also the result of deficient secretion depends upon the secretion value of outside tissue. Destruction of the entire chromaffin system has been noted in some addison cases. while cortex was less involved. Destruction begins in chromaffin & secondarily affects Cortex. Recent work show both systems affected.  atrophy of Heart & Sexual glands usually present. The Suprarenal becomes affected in severe infections diseases & intoxications. Diphtheria toxins has an espcecial affinity may show haemorrhages in animals after Diph. toxins. An Insuf. of suprarenals is an important cause of Cardiac Insufficiency. Pathological Physiology Brown - Sequard's thesis that Extirpation of both glands caused death has been disputed Beidel showed that death was not due to sympt. nerve plexus shock as the operation ended fatally after transplant. ads under skin. After Extirpation - after latent period animals showed increasing opathy dynamia. paresis & emaciation Weight & Temp decreased as did Sugar content of Bld. Injection of Phloredzen. Produced no glycosuria. glycogen rapidly disappeared from liver & muscles. & there existed a higher sensitivity for poisons. Bld. seemed toxic Death in convulsions. We know not yet which symptoms of addison's are due to cortex lack or lack of Medullary Sub.  Chromaffin tissue active principle is Adrenalin Action: Powerful Increasor of Bld. Pressure. thro. narrowing of Peripheral Vessels. slows then accelerates pulse. slows by Reflex excitation of Vagus center - so called by activities of adrenalin - also by activities are shallowing of Resp. & the excitability of Striated muscles. Relaxes stomach & Intestines contracting agent on three sphincters. Mydriasis occurs under circumstances. Diuresis by Dil. of Vessels of Kd. Salivation & secretion of tears may occur. Produces Hyperglycaemia & glycosuria. by mobilization of glycogen & by secondarily increased Carbohydrate formation in liver. Resp. quotient temporarily inc. Produces neutrophilic Hyper Sencocytosis. Above are accessory actions. apart form above action is on the purely sympath. nerve ending so cal'd Musculs. neural function. It is therefore purely sympath. Harmone. Adrenalin is continuously supplied to Vena Cava. The Suprarenalin Vein contains 1/2 part per. million of adrenaline per C.C. In 24 hrs 4.3 mg. are given to Bld.  Twas thot that the activity of Chromaffin tissue & the excitability of Myoneural function was regulated by centers in the medulla since puncture glycosuria is brot about dissemination of ad. from Chrom. system. Puncture of Dog without Thyroid had no effect also there was no effect in dog with adrenals removed after Puncture the ad. Medulla took less chrome stain & contained less adrenalin. Cutting of sphlanchnic nerves prevents this and also glycosuria is prevented. Path of Adrenalin in stream: [Portal Vein] Inf. Vera Cava. Lungs & systemic Cir. most is used in Muscles & Intestines - Increased amt. produces Hypermia of Vital organs Liver Brain Heart & Kidneys. Especially favorable conditions seem to exist in the liver for the action of adrenalin on Metabolism. The assumption is that Adrenalin maintains the normal excitability of the Sympathetic nerves & by means of a graduation of the secretion it is concerned in the regulation of Bld. Pressure & the distribution of Bld. It maintains the tonus of all organs supplied by sympath. It maintains the sugar content of Bld. & influences Muscular power by sugar regulation & influences neutrophilic leucocytes  Function of Cortex. Contains an oydase. & Cholin. Cholin acts as a toning agent on the autonomous nerves. & is found in other organs. Whether this is an antagonistic regulator against the chromaffin system is questionable. It is assumed the the cortex possesses a detoxicating function. as animals seem poisonous when adrenals are removed. This may be due to disturbance of regulator function thereby lessens resistance. Influences are noted on sexual development. from cortex function. Add. Disease depends on an acute or chronic more or less complete loss of function of the suprarenal apparatus. Perhaps from youth there is a weakness. There is usually found pathology in the ad. system yet there may be an affection of the nervous mechanism regulating the ad. apparatus. If one gland is diseased there is a reflex affecton of the other side as anemia sometimes results of  The symptoms depending on lack of function of Chrom. System, are: low Bld Pressure. low Bld sugar content. High tolerence of grape sugar Adynamia. Mononucleosis or status Lymphaticus. Tuberculosis associated. Symptoms depending on lack of Cortex symptoms are Vomiting. Diarrhoea. Psychical dist. Convulsions. Delirium Cornea Iron Free pigmentations are difficult to interpret. Pigment found in Basedows where there is inc. ad. Differential Diaq. Pigmentations are very frequent especially in mucous Memb. where T.B. Otch. affections. Pregnancy Use of arenic & Chronic Ht. dixeose there are no pigmentations on Mucous Membranes also Bronz. Diabetes Pit not on M. Memb. Scleroderma. Pellegra. Leucaernia. Basedow's disease. Carcinoma  Hypoglycaemia - mono[le] nucleosis with Hypereosiniphlulia are important in addison's. Extrodinary slowing of tense pulse - violent intestional colic occurring in attacks, failure of Intestional peristalsis and localized intestinal distension. Prognosis. Always dubious. Luetic cases get better. Removal of one T.B. Supra Renal. gland. led to a cure. Treatment: Adrenalin should not be continued Excitement Tremor & insomnia may occur. Wash Stomach. with Sodium Cl. Vegetable diet. avoid alc. & HCl acid. medication Acoid severe exertion. Large amts. Sugar should be given. Use of Adrenalin in Therapeutics. In stopping Haem. In collapse in Infectious diseases. In obstructed Esophagus by mouth. In Obs. contracts uterus. In Phosphorous Poisoning Osteo Malacia.  Symptoms due to Failure of Function of Suprarenalin Cortex. Symptoms of Addison's of Intoxication in acute & Terminal cases are supposed to be due to lack of Cortex. Aplasia of Supra renals. the Aplasia of Cortex is the more important. At Birth there is aplasia of Cortex with Suprarenals well developed. In Adenomata & Hyperplasia of Cortex there occurs in youth abnormal growth of the organism & premature development of secondary sexual characters. & the genitalia In adults are unusual Harriness. In opposite conditions there is belief in existance of Cortical Insufficiency In case of Hypophysial dystrophy in later life with marked retrogression of Harriness on face & Trunk. both Suprarenals were sclerosed The retrogression of secondary sexual characters may set is as result of failure of sexual glands especially in Men. In women the mere loss of sexual function is not followed by losing Hair etc. This occurs first in cases where there is sclerosis of multiple glands. In multiple glandular sclerosis there is found marked sclerosis of Cortex of Suprarenals.  In Euchnoidism in addition to Hypoplasia of sexual glands there is a Hypoplasia of Suprarenal Cortex. From the Cortex there proceeds a furthering influence on the genital sphere & especially the Hairiness. Hyperfunction of Supra renal Apparatus. Tumors usually produce hyperfunction. Cocaine An aesthetic use for Tooth Extraction in healthy man produced sudden death. Pm. showed double suprarenal Tumor rich in Adrenalin death due to Adrenalin poisoning In Tumor of Sympath. in 2 yr. old there was found arterio sclerosis similar to that produced by adrenalin. Hence it seems that Tumors can produce Hyperfunction.  Pituitary Body. Marie in 1888 - wrote of acromegaly & Pituitary tumors which stimulated modern investigation. Body consists of 3 parts 1. Pars Anterior or Pars glanduleus. 2. Pars Intermedia 3. Pars Posterior or Pars nervosa. 1 is derived from Ectodermic wall of Buccal Imagination 3 is down growth of ThalamenCephalon. Anterior Portion - glandular - made up of network of of Epithelial threads & columns interlined with their walled Bld Vessels. Intermediary Portion is fine granular cells almost devoid of Bld Vessels. this layer contains some colloid but no Iodine. The Pars. Nervosa - Post - is composed of neuroglia of primitave type & contains granules & masses of Hyaline substance derived from Pars Intermediary & contains Pigment cells & granules. Physiology. Injected Extract raises Bld Pressure more lasting than ad. This extract action comes from Post Lobe. Stim. of gland produces some effect. Heart rate is slowed. Second & third doses lower Pressure. Pressor effect of Pituitrin is not due to stim of adrenalin system. but due to direct action on Heart Muscle.  There is peripheral vagus stimulation & slowing of Resp. There is extreme sensitiveness of Uterus to Pituitrin Bladder is stimulated to contract. Restores Intestinal Peristalsis.   Methods of Exam. Nervous System: 1. Mentality 2. Reflexes. 3. Sensation. - Muscle strength. 4. Pupils Dec.'088. Disturbance of Intell: Imbecility B.T. Paralytic Dement. Mult. Sel. Haem. & Softening. Tremor: Mult. Sel. - intention tremor. Paralysis. Agetans Senile. Goitre. Exop. Toxic - Pb. Hg. Morph. Alc. Physiologic - over exertion. Ataxia: Locomotor Ataxia. Freidrich's " . Cortical " ([B.T.]) Neuritis Alc. Mult. Sel. Pain: (a) Parenchymatous (B) Neuralgic. (a) Irritation at terminal points. (B) " " Trunks. Neuralgic: Localized, more severe, fatigued, remissions. Tabes, joint Rheumatism, Syphalis. Diabetes. True Neuralgia. Parenchymatous: Organic Visceral disease. Headaches of Meningitis. Intracranial pressure. Toxic febrile Dyspeptics. Anaemic Headaches, Migraine, Neursthenia. are not localized. Coordination: Affected by sensation - ataxia -. Reflexes: Spinal. Cerebral. Complex. Spinal Cerebro Spinal. {Sahli Spinal: Tendon; Joint; Periosteal. Cerebral: Cutaneous; Abd; Cremasterics; Eye; Plantar etc. liberated by special sensation. latent time longer. not so constant. Dim. on Paralyzed side. Complex. Sneezing; Vomit, Urinating; def; swallowing. Cerebro-Spinal. Cortex discharges lower arc. May be daming effect. May be new formed reflexes. Lesions retained abd. & Crem. good sign. Permits discharge affect - not complete injury. Reflexes Increased: by irritation of lower reflex arc. By destruction of inhibition. Irritation of Inhibitors causes weakening. Tabes. Peripheral neuritis. Inhibitory fibers are in lateral columns.  Dec.08 Stomach Indication for Operation: 1. Uncontrollable diffuse Haem. (30% ulcers die in Haem attack) 2. Rapid loss weight. (no other cause). 3. Dilated atonic Cond. 4. Obstruction - Benign or otherwise. Post gastro - Enterostomy. A. Ang. of Trite. B. Inerse Peri. expose stomach C. Replace all but parts used. D. Resect for Malig. E. Always loosen adhesions. app. etc. gB. Benign Obs: 1. Sacinae - yellow Cotton Bales. grow only in HCl. Dont wash first. Large & Small - are digg. 2. Vomit large amt. 3. Dilation. Lactic acid B. Lugol neg. Abd. Paralytic. (Poor Intrauterine development) 1. Long. 2. Arch acute. 3. Misplaced organs. 4. St. Vert. 5. Colon V. shape 6. atony. Constipation. 7. Fl. R. Rid. 8. Fl. 10 Rib. Amb. Hernia: May be small Cause severe st. trouble. Cramps.